ance threshold for purposes of determining 
MIPS adjustment factors under subpara-
graph (A) and a threshold for purposes of 
determining additional MIPS adjustment 
factors under subparagraph (C). Each 
such performance threshold shall— 
‘‘(I) be based on a period prior to 
such performance periods; and 
‘‘(II) take into account— 
‘‘(aa) data available with re-
spect to performance on meas-
ures and activities that may be 
used under the performance cat-
egories 
under 
subparagraph 
(2)(B); and 
‘‘(bb) other factors deter-
mined appropriate by the Sec-
retary. 
‘‘(E) APPLICATION OF MIPS ADJUSTMENT 
FACTORS.—In the case of items and services 
furnished by a MIPS eligible professional dur-
ing a year (beginning with 2019), the amount 
otherwise paid under this part with respect to 
such items and services and MIPS eligible pro-
fessional for such year, shall be multiplied by—
‘‘(i) 1, plus 
‘‘(ii) the sum of— 
‘‘(I) the MIPS adjustment factor 
determined under subparagraph (A) 
divided by 100, and 
‘‘(II) as applicable, the additional 
MIPS adjustment factor determined 
under subparagraph (C) divided by 
100. 
‘‘(F) AGGREGATE
APPLICATION
OF
MIPS 
ADJUSTMENT FACTORS.— 
‘‘(i) APPLICATION OF SCALING FAC-
TOR.— 
‘‘(I) IN GENERAL.—With respect 
to positive MIPS adjustment factors 
under subparagraph (A)(ii)(I) for eli-
gible professionals whose composite 
performance score is above the per-
formance threshold under subpara-
graph (D)(i) for such year, subject to 
subclause (II), the Secretary shall in-
crease or decrease such adjustment 
factors by a scaling factor in order to 
ensure that the budget neutrality re-
quirement of clause (ii) is met.
‘‘(II) SCALING FACTOR LIMIT.— 
In no case may the scaling factor ap-
plied under this clause exceed 3.0. 
‘‘(ii) BUDGET NEUTRALITY REQUIRE-
MENT.— 
‘‘(I) IN
GENERAL.—Subject to 
clause (iii), the Secretary shall ensure 
that the estimated amount described 
in subclause (II) for a year is equal to 
the estimated amount described in 
subclause (III) for such year. 
‘‘(II) AGGREGATE INCREASES.— 
The amount described in this sub-
clause is the estimated increase in the 
aggregate allowed charges resulting 
from the application of positive MIPS 
adjustment factors under subpara-
graph (A) (after application of the 
scaling factor described in clause (i)) 
to MIPS eligible professionals whose 
composite performance score for a 
year is above the performance thresh-
old under subparagraph (D)(i) for 
such year.
‘‘(III) 
AGGREGATE
DE-
CREASES.—The amount described in 
this subclause is the estimated de-
crease 
in 
the 
aggregate 
allowed 
charges resulting from the application 
of negative MIPS adjustment factors 
under subparagraph (A) to MIPS eli-
gible professionals whose composite 
performance score for a year is below 
the performance threshold under sub-
paragraph (D)(i) for such year. 
‘‘(iii) EXCEPTIONS.— 
‘‘(I) In the case that all MIPS el-
igible professionals receive composite 
performance scores for a year that are 
below 
the 
performance 
threshold 
under subparagraph (D)(i) for such 
year, the negative MIPS adjustment 
factors under subparagraph (A) shall 
apply with respect to such MIPS eligi-
ble professionals and the budget neu-
trality requirement of clause (ii) and 
the 
additional 
adjustment 
factors 
under clause (iv) shall not apply for 
such year.
‘‘(II) In the case that, with re-
spect to a year, the application of 
clause (i) results in a scaling factor 
equal to the maximum scaling factor 
specified in clause (i)(II), such scaling 
factor shall apply and the budget neu-
trality requirement of clause (ii) shall 
not apply for such year. 
‘‘(iv) ADDITIONAL
INCENTIVE
PAY-
MENT ADJUSTMENTS.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), in specifying the MIPS 
additional adjustment factors under 
subparagraph (C) for each applicable 
MIPS eligible professional for a year, 
the Secretary shall ensure that the es-
timated aggregate increase in pay-
ments under this part resulting from 
the application of such additional ad-
justment factors for MIPS eligible 
professionals in a year shall be equal 
(as estimated by the Secretary) to 
$500,000,000 for each year beginning 
with 2019 and ending with 2024.
‘‘(II) 
LIMITATION
ON
ADDI-
TIONAL INCENTIVE PAYMENT ADJUST-
MENTS.—The MIPS additional ad-
justment factor under subparagraph 
(C) for a year for an applicable MIPS 
eligible professional whose composite 
performance score is above the addi-
tional performance threshold under 
subparagraph (D)(ii) for such year 
shall not exceed 10 percent. The ap-
plication of the previous sentence may 
result in an aggregate amount of ad-
ditional incentive payments that are 
less than the amount specified in sub-
clause (I). 
‘‘(7) ANNOUNCEMENT OF RESULT OF ADJUST-
MENTS.—Under the MIPS, the Secretary shall, not 
later than 30 days prior to January 1 of the year 
involved, make available to MIPS eligible profes-
sionals the MIPS adjustment factor (and, as appli-
cable, the additional MIPS adjustment factor) under 
paragraph (6) applicable to the eligible professional 
for items and services furnished by the professional 
for such year. The Secretary may include such infor-
mation in the confidential feedback under paragraph 
(12). 
‘‘(8) NO EFFECT IN SUBSEQUENT YEARS.—The 
MIPS adjustment factors and additional MIPS ad-
justment factors under paragraph (6) shall apply 
only with respect to the year involved, and the Sec-
retary shall not take into account such adjustment 
factors in making payments to a MIPS eligible pro-
fessional under this part in a subsequent year. 
‘‘(9) PUBLIC REPORTING.— 
‘‘(A) IN GENERAL.—The Secretary shall, 
in an easily understandable format, make avail-
able on the Physician Compare Internet website 
of the Centers for Medicare & Medicaid Serv-
ices the following: 
‘‘(i) Information regarding the per-
formance of MIPS eligible professionals 
under the MIPS, which— 
‘‘(I) shall include the composite 
score for each such MIPS eligible pro-
fessional and the performance of each 
such MIPS eligible professional with 
respect to each performance category; 
and
‘‘(II) may include the perform-
ance of each such MIPS eligible pro-
fessional with respect to each measure 
or activity specified in paragraph 
(2)(B). 
‘‘(ii) The names of eligible profes-
sionals in eligible alternative payment mod-
els (as defined in section 1833(z)(3)(D)) 
and, to the extent feasible, the names of 
such eligible alternative payment models 
and performance of such models. 
‘‘(B) 
DISCLOSURE.—The 
information 
made available under this paragraph shall indi-
cate, where appropriate, that publicized infor-
mation may not be representative of the eligible 
professional’s entire patient population, the va-
riety of services furnished by the eligible profes-
sional, or the health conditions of individuals 
treated. 
‘‘(C) OPPORTUNITY TO REVIEW AND SUB-
MIT
CORRECTIONS.—The Secretary shall pro-
vide for an opportunity for a professional de-
scribed in subparagraph (A) to review, and sub-
mit corrections for, the information to be made 
public with respect to the professional under
such subparagraph prior to such information 
being made public. 
‘‘(D) 
AGGREGATE
INFORMATION.—The 
Secretary shall periodically post on the Physi-
cian Compare Internet website aggregate infor-
mation on the MIPS, including the range of 
composite scores for all MIPS eligible profes-
sionals and the range of the performance of all 
MIPS eligible professionals with respect to each 
performance category. 
‘‘(10) CONSULTATION.—The Secretary shall 
consult with stakeholders in carrying out the MIPS, 
including for the identification of measures and ac-
tivities under paragraph (2)(B) and the methodolo-
gies developed under paragraphs (5)(A) and (6) and 
regarding the use of qualified clinical data registries. 
Such consultation shall include the use of a request 
for information or other mechanisms determined ap-
propriate. 
‘‘(11) TECHNICAL ASSISTANCE TO SMALL PRAC-
TICES AND PRACTICES IN HEALTH PROFESSIONAL 
SHORTAGE AREAS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
enter into contracts or agreements with appro-
priate entities (such as quality improvement or-
ganizations, regional extension centers (as de-
scribed in section 3012(c) of the Public Health 
Service Act), or regional health collaboratives) 
to offer guidance and assistance to MIPS eligi-
ble professionals in practices of 15 or fewer pro-
fessionals (with priority given to such practices 
located in rural areas, health professional short-
age areas (as designated under in section 
332(a)(1)(A) of such Act), and medically under-
served areas, and practices with low composite 
scores) with respect to— 
‘‘(i) the performance categories de-
scribed in clauses (i) through (iv) of para-
graph (2)(A); or 
‘‘(ii) how to transition to the imple-
mentation of and participation in an alter-
native payment model as described in sec-
tion 1833(z)(3)(C). 
‘‘(B) FUNDING
FOR
TECHNICAL
ASSIST-
ANCE.—For purposes of implementing subpara-
graph (A), the Secretary shall provide for the 
transfer from the Federal Supplementary Med-
ical Insurance Trust Fund established under 
section 1841 to the Centers for Medicare & 
Medicaid Services Program Management Ac-
count of $20,000,000 for each of fiscal years 
2016 through 2020. Amounts transferred under 
this subparagraph for a fiscal year shall be 
available until expended. 
‘‘(12) FEEDBACK
AND
INFORMATION
TO
IM-
PROVE PERFORMANCE.— 
‘‘(A) PERFORMANCE FEEDBACK.— 
‘‘(i) IN GENERAL.—Beginning July 1, 
2017, the Secretary— 
‘‘(I) shall make available timely 
(such as quarterly) confidential feed-
back to MIPS eligible professionals on 
the performance of such professionals 
with respect to the performance cat-
egories under clauses (i) and (ii) of 
paragraph (2)(A); and 
‘‘(II) may make available con-
fidential feedback to such profes-
sionals on the performance of such 
professionals with respect to the per-
formance categories under clauses (iii) 
and (iv) of such paragraph. 
‘‘(ii) MECHANISMS.—The Secretary 
may use one or more mechanisms to make 
feedback available under clause (i), which
may include use of a web-based portal or 
other mechanisms determined appropriate 
by the Secretary. With respect to the per-
formance category described in paragraph 
(2)(A)(i), feedback under this subpara-
graph shall, to the extent an eligible pro-
fessional chooses to participate in a data 
registry for purposes of this subsection (in-
cluding registries under subsections (k) 
and (m)), be provided based on perform-
ance on quality measures reported through 
the use of such registries. With respect to 
any other performance category described 
in paragraph (2)(A), the Secretary shall 
encourage provision of feedback through 
qualified clinical data registries as de-
scribed in subsection (m)(3)(E)). 
‘‘(iii) USE OF DATA.—For purposes of 
clause (i), the Secretary may use data, 
with respect to a MIPS eligible profes-
sional, from periods prior to the current 
performance period and may use rolling 
periods in order to make illustrative cal-
culations about the performance of such 
professional.
‘‘(iv) 
DISCLOSURE
EXEMPTION.— 
Feedback made available under this sub-
paragraph shall be exempt from disclosure 
under section 552 of title 5, United States 
Code. 
‘‘(v) RECEIPT
OF
INFORMATION.— 
The Secretary may use the mechanisms es-
tablished under clause (ii) to receive infor-
mation from professionals, such as infor-
mation with respect to this subsection. 
‘‘(B) ADDITIONAL INFORMATION.— 
‘‘(i) IN GENERAL.—Beginning July 1, 
2018, the Secretary shall make available to 
MIPS eligible professionals information, 
with respect to individuals who are pa-
tients of such MIPS eligible professionals, 
about items and services for which pay-
ment is made under this title that are fur-
nished to such individuals by other sup-
pliers and providers of services, which may 
include information described in clause (ii). 
Such information may be made available 
under the previous sentence to such MIPS 
eligible professionals by mechanisms deter-
mined appropriate by the Secretary, which
may include use of a web-based portal. 
Such information may be made available in 
accordance with the same or similar terms 
as data are made available to accountable 
care organizations participating in the 
shared savings program under section 
1899. 
‘‘(ii) TYPE
OF
INFORMATION.—For 
purposes of clause (i), the information de-
scribed in this clause, is the following: 
‘‘(I) With respect to selected 
items and services (as determined ap-
propriate by the Secretary) for which 
payment is made under this title and 
that are furnished to individuals, who 
are patients of a MIPS eligible profes-
sional, by another supplier or provider 
of services during the most recent pe-
riod for which data are available (such 
as the most recent three-month pe-
riod), such as the name of such pro-
viders furnishing such items and serv-
ices to such patients during such pe-
riod, the types of such items and serv-
ices so furnished, and the dates such 
items and services were so furnished. 
‘‘(II) Historical data, such as 
averages and other measures of the 
distribution if appropriate, of the 
total, and components of, allowed 
charges (and other figures as deter-
mined appropriate by the Secretary). 
‘‘(13) REVIEW.— 
‘‘(A) TARGETED REVIEW.—The Secretary 
shall establish a process under which a MIPS 
eligible professional may seek an informal re-
view of the calculation of the MIPS adjustment 
factor (or factors) applicable to such eligible 
professional under this subsection for a year. 
The results of a review conducted pursuant to 
the previous sentence shall not be taken into ac-
count for purposes of paragraph (6) with re-
spect to a year (other than with respect to the 
calculation of such eligible professional’s MIPS 
adjustment factor for such year or additional 
MIPS adjustment factor for such year) after 
the factors determined in subparagraph (A) and 
subparagraph (C) of such paragraph have been 
determined for such year.
(iii) evaluate the impact of technical 
assistance 
funding 
under 
section 
1848(q)(11) of the Social Security Act, as 
added by paragraph (1), on the ability of 
professionals to improve within such pro-
gram or successfully transition to an alter-
native payment model (as defined in sec-
tion 1833(z)(3) of the Social Security Act, 
as added by subsection (e)), with priority 
for such evaluation given to practices lo-
cated in rural areas, health professional 
shortage areas (as designated in section 
332(a)(1)(A) of the Public Health Service 
Act), and medically underserved areas; and 
(iv) provide recommendations for opti-
mizing the use of such technical assistance 
funds. 
(B) STUDY TO EXAMINE ALIGNMENT OF 
QUALITY MEASURES USED IN PUBLIC AND PRI-
VATE PROGRAMS.— 
(i) IN GENERAL.—Not later than 18 
months after the date of the enactment of 
this Act, the Comptroller General of the 
United States shall submit to Congress a 
report that—
(I) compares the similarities and 
differences in the use of quality meas-
ures under the original Medicare fee- 
for-service program under parts A and 
B of title XVIII of the Social Security 
Act, the Medicare Advantage program 
under part C of such title, selected 
State Medicaid programs under title 
XIX of such Act, and private payer 
arrangements; and 
(II) makes recommendations on 
how to reduce the administrative bur-
den involved in applying such quality 
measures. 
(ii) 
REQUIREMENTS.—The 
report 
under clause (i) shall— 
(I) consider those measures ap-
plicable to individuals entitled to, or 
enrolled for, benefits under such part 
A, or enrolled under such part B and 
individuals under the age of 65; and 
(II) focus on those measures that 
comprise the most significant compo-
nent of the quality performance cat-
egory of the eligible professional
MIPS incentive program under sub-
section (q) of section 1848 of the So-
cial Security Act (42 U.S.C. 1395w– 
4), as added by paragraph (1). 
(C) STUDY
ON
ROLE
OF
INDEPENDENT 
RISK MANAGERS.—Not later than January 1, 
2017, the Comptroller General of the United 
States shall submit to Congress a report exam-
ining whether entities that pool financial risk 
for physician practices, such as independent 
risk managers, can play a role in supporting 
physician practices, particularly small physician 
practices, in assuming financial risk for the 
treatment of patients. Such report shall exam-
ine barriers that small physician practices cur-
rently face in assuming financial risk for treat-
ing patients, the types of risk management enti-
ties that could assist physician practices in par-
ticipating in two-sided risk payment models, 
and how such entities could assist with risk 
management and with quality improvement ac-
tivities. Such report shall also include an anal-
ysis of any existing legal barriers to such ar-
rangements.
(D) STUDY
TO
EXAMINE
RURAL
AND 
HEALTH
PROFESSIONAL
SHORTAGE
AREA
AL-
TERNATIVE PAYMENT MODELS.—Not later than 
October 1, 2021, the Comptroller General of 
the United States shall submit to Congress a 
report that examines the transition of profes-
sionals in rural areas, health professional short-
age 
areas 
(as 
designated 
in 
section 
332(a)(1)(A) of the Public Health Service Act), 
or medically underserved areas to an alternative 
payment 
model 
(as 
defined 
in 
section 
1833(z)(3) of the Social Security Act, as added 
by subsection (e)). Such report shall make rec-
ommendations for removing administrative bar-
riers to practices, including small practices con-
sisting of 15 or fewer professionals, in rural 
areas, health professional shortage areas, and 
medically underserved areas to participation in 
such models. 
(3) FUNDING
FOR
IMPLEMENTATION.—For 
purposes of implementing the provisions of and the 
amendments made by this section, the Secretary of 
Health and Human Services shall provide for the 
transfer of $80,000,000 from the Supplementary 
Medical Insurance Trust Fund established under
section 1841 of the Social Security Act (42 U.S.C. 
1395t) to the Centers for Medicare & Medicaid Pro-
gram Management Account for each of the fiscal 
years 2015 through 2019. Amounts transferred 
under this paragraph shall be available until ex-
pended. 
(d) IMPROVING QUALITY REPORTING
FOR COM-
POSITE SCORES.— 
(1) CHANGES
FOR
GROUP
REPORTING
OP-
TION.— 
(A) 
IN
GENERAL.—Section 
1848(m)(3)(C)(ii) of the Social Security Act 
(42 U.S.C. 1395w–4(m)(3)(C)(ii)) is amended 
by inserting ‘‘and, for 2016 and subsequent 
years, may provide’’ after ‘‘shall provide’’. 
(B) CLARIFICATION OF QUALIFIED CLIN-
ICAL
DATA
REGISTRY
REPORTING
TO
GROUP 
PRACTICES.—Section 1848(m)(3)(D) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1395w– 
4(m)(3)(D)) is amended by inserting ‘‘and, for 
2016 and subsequent years, subparagraph (A) 
or (C)’’ after ‘‘subparagraph (A)’’. 
(2) CHANGES FOR MULTIPLE REPORTING PERI-
ODS
AND
ALTERNATIVE
CRITERIA
FOR
SATISFAC-
TORY
REPORTING.—Section 1848(m)(5)(F) of the
Social Security Act (42 U.S.C. 1395w–4(m)(5)(F)) 
is amended— 
(A) by striking ‘‘and subsequent years’’ 
and inserting ‘‘through reporting periods occur-
ring in 2015’’; and 
(B) by inserting ‘‘and, for reporting peri-
ods occurring in 2016 and subsequent years, 
the Secretary may establish’’ after ‘‘shall estab-
lish’’. 
(3) PHYSICIAN FEEDBACK PROGRAM REPORTS 
SUCCEEDED
BY
REPORTS
UNDER
MIPS.—Section 
1848(n) of the Social Security Act (42 U.S.C. 
1395w–4(n)) is amended by adding at the end the 
following new paragraph: 
‘‘(11) REPORTS ENDING WITH 2017.—Reports 
under the Program shall not be provided after De-
cember 31, 2017. See subsection (q)(12) for reports 
under the eligible professionals Merit-based Incentive 
Payment System.’’. 
(4) COORDINATION WITH SATISFYING MEANING-
FUL EHR USE CLINICAL QUALITY MEASURE REPORT-
ING
REQUIREMENT.—Section 1848(o)(2)(A)(iii) of 
the Social Security Act (42 U.S.C. 1395w– 
4(o)(2)(A)(iii)) is amended by inserting ‘‘and sub-