774 
section 603 of the Bipartisan Budget Act of 2015 (Public 
Law 114–74). 
SEC. 16003. TREATMENT OF ELIGIBLE PROFESSIONALS IN 
AMBULATORY 
SURGICAL 
CENTERS 
FOR 
MEANINGFUL USE AND MIPS. 
Section 1848(a)(7)(D) of the Social Security Act (42 
U.S.C. 1395w–4(a)(7)(D)) is amended— 
(1) by striking ‘‘HOSPITAL-BASED ELIGIBLE PRO-
FESSIONALS’’ and all that follows through ‘‘No pay-
ment’’ and inserting the following: ‘‘HOSPITAL-BASED 
AND
AMBULATORY
SURGICAL
CENTER-BASED
ELIGI-
BLE PROFESSIONALS.— 
‘‘(i) HOSPITAL-BASED.—No payment’’; 
and 
(2) by adding at the end the following new 
clauses: 
‘‘(ii) AMBULATORY SURGICAL CENTER- 
BASED.—Subject to clause (iv), no payment 
adjustment may be made under subpara-
graph (A) for 2017 and 2018 in the case of 
an eligible professional with respect to 
whom substantially all of the covered profes-
sional services furnished by such profes-
sional are furnished in an ambulatory sur-
gical center.
775 
‘‘(iii) 
DETERMINATION.—The 
deter-
mination of whether an eligible professional 
is an eligible professional described in 
clause (ii) may be made on the basis of— 
‘‘(I) the site of service (as defined 
by the Secretary); or 
‘‘(II) an attestation submitted by 
the eligible professional. 
Determinations made under subclauses (I) 
and (II) shall be made without regard to 
any employment or billing arrangement be-
tween the eligible professional and any other 
supplier or provider of services. 
‘‘(iv) SUNSET.—Clause (ii) shall no 
longer apply as of the first year that begins 
more than 3 years after the date on which 
the Secretary determines, through notice 
and comment rulemaking, that certified 
EHR technology applicable to the ambula-
tory surgical center setting is available.’’. 
SEC. 16004. CONTINUING ACCESS TO HOSPITALS ACT OF 
2016. 
(a) EXTENSION OF ENFORCEMENT INSTRUCTION ON 
SUPERVISION REQUIREMENTS FOR OUTPATIENT THERA-
PEUTIC SERVICES IN CRITICAL ACCESS AND SMALL RURAL
776 
HOSPITALS THROUGH 2016.—Section 1 of Public Law 
113–198, as amended by section 1 of Public Law 114–112, 
is amended— 
(1) in the heading, by striking ‘‘2014 AND 2015’’ 
and inserting ‘‘2016’’; and 
(2) by striking ‘‘and 2015’’ and inserting ‘‘, 
2015, and 2016’’. 
(b) REPORT.—Not later than 1 year after the date of 
the enactment of this Act, the Medicare Payment Advisory 
Commission (established under section 1805 of the Social 
Security Act (42 U.S.C. 1395b–6)) shall submit to Congress 
a report analyzing the effect of the extension of the enforce-
ment instruction under section 1 of Public Law 113–198, 
as amended by section 1 of Public Law 114–112 and sub-
section (a) of this section, on the access to health care by 
Medicare beneficiaries, on the economic impact and the im-
pact upon hospital staffing needs, and on the quality of 
health care furnished to such beneficiaries.
777 
SEC. 16005. DELAY OF IMPLEMENTATION OF MEDICARE FEE 
SCHEDULE ADJUSTMENTS FOR WHEELCHAIR 
ACCESSORIES AND SEATING SYSTEMS WHEN 
USED IN CONJUNCTION WITH COMPLEX RE-
HABILITATION TECHNOLOGY (CRT) WHEEL-
CHAIRS. 
Section 2(a) of the Patient Access and Medicare Pro-
tection Act (42 U.S.C. 1305 note) is amended by striking 
‘‘January 1, 2017’’ and inserting ‘‘July 1, 2017’’. 
SEC. 16006. ALLOWING PHYSICAL THERAPISTS TO UTILIZE 
LOCUM 
TENENS 
ARRANGEMENTS 
UNDER 
MEDICARE. 
(a) IN
GENERAL.—The first sentence of section 
1842(b)(6) of the Social Security Act (42 U.S.C. 
1395u(b)(6)), as amended by section 5012, is further 
amended— 
(1) by striking ‘‘and’’ before ‘‘(I)’’; and 
(2) by inserting before the period at the end the 
following: ‘‘, and (J) in the case of outpatient phys-
ical therapy services furnished by physical therapists 
in a health professional shortage area (as defined in 
section 332(a)(1)(A) of the Public Health Service 
Act), a medically underserved area (as designated 
pursuant to section 330(b)(3)(A) of such Act), or a 
rural area (as defined in section 1886(d)(2)(D)), sub-
paragraph (D) of this sentence shall apply to such
778 
services and therapists in the same manner as such 
subparagraph applies to physicians’ services fur-
nished by physicians’’. 
(b) EFFECTIVE DATE; IMPLEMENTATION.— 
(1) EFFECTIVE DATE.—The amendments made 
by subsection (a) shall apply to services furnished be-
ginning not later than six months after the date of the 
enactment of this Act. 
(2) IMPLEMENTATION.—The Secretary of Health 
and Human Services may implement subparagraph 
(J) of section 1842(b)(6) of the Social Security Act 
(42 U.S.C. 1395u(b)(6)), as added by subsection 
(a)(2), by program instruction or otherwise. 
SEC. 16007. EXTENSION OF THE TRANSITION TO NEW PAY-
MENT RATES FOR DURABLE MEDICAL EQUIP-
MENT UNDER THE MEDICARE PROGRAM. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall extend the transition period de-
scribed in clause (i) of section 414.210(g)(9) of title 42, Code 
of Federal Regulations, from June 30, 2016, to December 
31, 2016 (with the full implementation described in clause 
(ii) of such section applying to items and services furnished 
with dates of service on or after January 1, 2017). 
(b) STUDY AND REPORT.— 
(1) STUDY.—
779 
(A) IN GENERAL.—The Secretary of Health 
and Human Services shall conduct a study that 
examines the impact of applicable payment ad-
justments upon— 
(i) the number of suppliers of durable 
medical equipment that, on a date that is 
not before January 1, 2016, and not later 
than December 31, 2016, ceased to conduct 
business as such suppliers; and 
(ii) the availability of durable medical 
equipment, during the period beginning on 
January 1, 2016, and ending on December 
31, 2016, to individuals entitled to benefits 
under part A of title XVIII of the Social Se-
curity Act (42 U.S.C. 1395 et seq.) or en-
rolled under part B of such title. 
(B) DEFINITIONS.—For purposes of this 
subsection, the following definitions apply: 
(i) 
SUPPLIER; 
DURABLE
MEDICAL 
EQUIPMENT.—The terms ‘‘supplier’’ and 
‘‘durable medical equipment’’ have the 
meanings given such terms by section 1861 
of the Social Security Act (42 U.S.C. 
1395x).
780 
(ii) APPLICABLE
PAYMENT
ADJUST-
MENT.—The term ‘‘applicable payment ad-
justment’’ means a payment adjustment de-
scribed in section 414.210(g) of title 42, 
Code of Federal Regulations, that is phased 
in by paragraph (9)(i) of such section. For 
purposes of the preceding sentence, a pay-
ment adjustment that is phased in pursuant 
to the extension under subsection (a) shall 
be considered a payment adjustment that is 
phased in by such paragraph (9)(i). 
(2) REPORT.—The Secretary of Health and 
Human Services shall, not later than January 12, 
2017, submit to the Committees on Ways and Means 
and on Energy and Commerce of the House of Rep-
resentatives, and to the Committee on Finance of the 
Senate, a report on the findings of the study con-
ducted under paragraph (1). 
SEC. 16008. REQUIREMENTS IN DETERMINING ADJUST-
MENTS USING INFORMATION FROM COMPETI-
TIVE BIDDING PROGRAMS. 
(a) IN GENERAL.—Section 1834(a)(1)(G) of the Social 
Security Act (42 U.S.C. 1395m(a)(1)(G)) is amended by 
adding at the end the following new sentence: ‘‘In the case 
of items and services furnished on or after January 1, 2019,
781 
in making any adjustments under clause (ii) or (iii) of sub-
paragraph (F), under subsection (h)(1)(H)(ii), or under 
section 1842(s)(3)(B), the Secretary shall— 
‘‘(i) solicit and take into account stake-
holder input; and 
‘‘(ii) take into account the highest 
amount bid by a winning supplier in a 
competitive acquisition area and a com-
parison of each of the following with respect 
to non-competitive acquisition areas and 
competitive acquisition areas: 
‘‘(I) The average travel distance 
and cost associated with furnishing 
items and services in the area. 
‘‘(II) The average volume of items 
and services furnished by suppliers in 
the area. 
‘‘(III) The number of suppliers in 
the area.’’. 
(b) 
CONFORMING
AMENDMENTS.—(1) 
Section 
1834(h)(1)(H)(ii) of the Social Security Act (42 U.S.C. 
1395m(h)(1)(H)(ii)) is amended by striking ‘‘the Sec-
retary’’ and inserting ‘‘subject to subsection (a)(1)(G), the 
Secretary’’.
782 
(2) Section 1842(s)(3)(B) of the Social Security Act 
(42 U.S.C. 1395m(s)(3)(B)) is amended by striking ‘‘the 
Secretary’’ and inserting ‘‘subject to section 1834(a)(1)(G), 
the Secretary’’. 
TITLE XVII—OTHER MEDICARE 
PROVISIONS 
SEC. 17001. DELAY IN AUTHORITY TO TERMINATE CON-
TRACTS FOR MEDICARE ADVANTAGE PLANS 
FAILING TO ACHIEVE MINIMUM QUALITY RAT-
INGS. 
(a) FINDINGS.—Consistent with the studies provided 
under the IMPACT Act of 2014 (Public Law 113–185), it 
is the intent of Congress— 
(1) to continue to study and request input on the 
effects of socioeconomic status and dual-eligible popu-
lations on the Medicare Advantage STARS rating 
system before reforming such system with the input of 
stakeholders; and 
(2) pending the results of such studies and input, 
to provide for a temporary delay in authority of the 
Centers for Medicare & Medicaid Services (CMS) to 
terminate Medicare Advantage plan contracts solely 
on the basis of performance of plans under the 
STARS rating system.
783 
(b) DELAY IN MA CONTRACT TERMINATION AUTHOR-
ITY FOR PLANS FAILING TO ACHIEVE MINIMUM QUALITY 
RATINGS.—Section 1857(h) of the Social Security Act (42 
U.S.C. 1395w–27(h)) is amended by adding at the end the 
following new paragraph: 
‘‘(3) DELAY
IN
CONTRACT
TERMINATION
AU-
THORITY FOR PLANS FAILING TO ACHIEVE MINIMUM 
QUALITY RATING.—During the period beginning on 
the date of the enactment of this paragraph and 
through the end of plan year 2018, the Secretary may 
not terminate a contract under this section with re-
spect to the offering of an MA plan by a Medicare Ad-
vantage organization solely because the MA plan has 
failed to achieve a minimum quality rating under the 
5-star rating system under section 1853(o)(4).’’. 
SEC. 17002. REQUIREMENT FOR ENROLLMENT DATA RE-
PORTING FOR MEDICARE. 
Section 1874 of the Social Security Act (42 U.S.C. 
1395kk) is amended by adding at the end the following new 
subsection: 
‘‘(g) REQUIREMENT FOR ENROLLMENT DATA REPORT-
ING.— 
‘‘(1) IN GENERAL.—Each year (beginning with 
2016), the Secretary shall submit to the Committees 
on Ways and Means and Energy and Commerce of
784 
the House of Representatives and the Committee on 
Finance of the Senate a report on Medicare enroll-
ment data (and, in the case of part A, on data on in-
dividuals receiving benefits under such part) as of a 
date in such year specified by the Secretary. Such 
data shall be presented— 
‘‘(A) by Congressional district and State; 
and 
‘‘(B) in a manner that provides for such 
data based on— 
‘‘(i) fee-for-service enrollment (as de-
fined in paragraph (2)); 
‘‘(ii) enrollment under part C (includ-
ing separate for aggregate enrollment in 
MA–PD plans and aggregate enrollment in 
MA plans that are not MA–PD plans); and 
‘‘(iii) enrollment under part D. 
‘‘(2) 
FEE-FOR-SERVICE
ENROLLMENT
DE-
FINED.—For purpose of paragraph (1)(B)(i), the term 
‘fee-for-service enrollment’ means aggregate enrollment 
(including receipt of benefits other than through en-
rollment) under— 
‘‘(A) part A only; 
‘‘(B) part B only; and 
‘‘(C) both part A and part B.’’.
785 
SEC. 17003. UPDATING THE WELCOME TO MEDICARE PACK-
AGE. 
(a) IN GENERAL.—Not later than 12 months after the 
last day of the period for the request of information de-
scribed in subsection (b), the Secretary of Health and 
Human Services shall, taking into consideration informa-
tion collected pursuant to subsection (b), update the infor-
mation included in the Welcome to Medicare package to in-
clude information, presented in a clear and simple manner, 
about options for receiving benefits under the Medicare pro-
gram under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.), including through the original medi-
care fee-for-service program under parts A and B of such 
title (42 U.S.C. 1395c et seq., 42 U.S.C. 1395j et seq.), Medi-
care Advantage plans under part C of such title (42 U.S.C. 
1395w–21 et seq.), and prescription drug plans under part 
D of such title (42 U.S.C. 1395w–101 et seq.)). The Sec-
retary shall make subsequent updates to the information in-
cluded in the Welcome to Medicare package as appropriate. 
(b) REQUEST FOR INFORMATION.—Not later than 6 
months after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall request infor-
mation, including recommendations, from stakeholders (in-
cluding patient advocates, issuers, and employers) on infor-
mation included in the Welcome to Medicare package, in-
786 
cluding pertinent data and information regarding enroll-
ment and coverage for Medicare eligible individuals. 
SEC. 17004. NO PAYMENT FOR ITEMS AND SERVICES FUR-
NISHED BY NEWLY ENROLLED PROVIDERS OR 
SUPPLIERS WITHIN A TEMPORARY MORATO-
RIUM AREA. 
(a) MEDICARE.—Section 1866(j)(7) of the Social Secu-
rity Act (42 U.S.C. 1395cc(j)(7)) is amended— 
(1) in the paragraph heading, by inserting ‘‘; 
NONPAYMENT’’ before the period; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) NONPAYMENT.— 
‘‘(i) IN GENERAL.—No payment may 
be made under this title or under a pro-
gram described in subparagraph (A) with 
respect to an item or service described in 
clause (ii) furnished on or after October 1, 
2017. 
‘‘(ii) ITEM OR SERVICE DESCRIBED.— 
An item or service described in this clause 
is an item or service furnished— 
‘‘(I) within a geographic area 
with respect to which a temporary
787 
moratorium imposed under subpara-
graph (A) is in effect; and 
‘‘(II) by a provider of services or 
supplier that meets the requirements of 
clause (iii). 
‘‘(iii) REQUIREMENTS.—For purposes 
of clause (ii), the requirements of this clause 
are that a provider of services or supplier— 
‘‘(I) enrolls under this title on or 
after the effective date of such tem-
porary moratorium; and 
‘‘(II) is within a category of pro-
viders of services and suppliers (as de-
scribed in subparagraph (A)) subject to 
such temporary moratorium. 
‘‘(iv) PROHIBITION ON CHARGES FOR 
SPECIFIED ITEMS OR SERVICES.—In no case 
shall a provider of services or supplier de-
scribed in clause (ii)(II) charge an indi-
vidual or other person for an item or service 
described in clause (ii) furnished on or after 
October 1, 2017, to an individual entitled to 
benefits under part A or enrolled under part 
B or an individual under a program speci-
fied in subparagraph (A).’’.
788 
(b) CONFORMING AMENDMENTS.— 
(1) MEDICAID.— 
(A) IN GENERAL.—Section 1903(i)(2) of the 
Social Security Act (42 U.S.C. 1396b(i)(2)), as 
amended by section 5005(a)(4), is further 
amended— 
(i) in subparagraph (C), by striking 
‘‘or’’ at the end; and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(E) with respect to any amount expended 
for such an item or service furnished during cal-
endar quarters beginning on or after October 1, 
2017, subject to section 1902(kk)(4)(A)(ii)(II), 
within a geographic area that is subject to a 
moratorium imposed under section 1866(j)(7) by 
a provider or supplier that meets the require-
ments specified in subparagraph (C)(iii) of such 
section, during the period of such moratorium; 
or’’. 
(B) EXCEPTION
WITH
RESPECT
TO
AC-
CESS.—Section 1902(kk)(4)(A)(ii) of the Social 
Security Act (42 U.S.C. 1396a(kk)(4)(A)(ii)) is 
amended to read as follows: 
‘‘(ii) EXCEPTIONS.—
789 
‘‘(I) COMPLIANCE WITH MORATO-
RIUM.—A State shall not be required 
to comply with a temporary morato-
rium described in clause (i) if the 
State determines that the imposition of 
such temporary moratorium would ad-
versely impact beneficiaries’ access to 
medical assistance. 
‘‘(II) FFP AVAILABLE.—Notwith-
standing section 1903(i)(2)(E), pay-
ment may be made to a State under 
this title with respect to amounts ex-
pended for items and services described 
in such section if the Secretary, in con-
sultation with the State agency admin-
istering the State plan under this title 
(or a waiver of the plan), determines 
that denying payment to the State 
pursuant to such section would ad-
versely impact beneficiaries’ access to 
medical assistance. ’’. 
(C) STATE PLAN REQUIREMENT WITH RE-
SPECT TO LIMITATION ON CHARGES TO BENE-
FICIARIES.—Section 1902(kk)(4)(A) of the Social 
Security Act (42 U.S.C. 1396a(kk)(4)(A)) is
790 
amended by adding at the end the following new 
clause: 
‘‘(iii) LIMITATION
ON
CHARGES
TO 
BENEFICIARIES.—With 
respect 
to 
any 
amount expended for items or services fur-
nished during calendar quarters beginning 
on or after October 1, 2017, the State pro-
hibits, during the period of a temporary 
moratorium described in clause (i), a pro-
vider meeting the requirements specified in 
subparagraph (C)(iii) of section 1866(j)(7) 
from charging an individual or other per-
son eligible to receive medical assistance 
under the State plan under this title (or a 
waiver of the plan) for an item or service 
described in section 1903(i)(2)(E) furnished 
to such an individual.’’. 
(2) CORRECTING
AMENDMENTS
TO
RELATED 
PROVISIONS.— 
(A) SECTION 1866(J).—Section 1866(j) of the 
Social Security Act (42 U.S.C. 1395cc(j)) is 
amended— 
(i) in paragraph (1)(A)— 
(I) by striking ‘‘paragraph (4)’’ 
and inserting ‘‘paragraph (5)’’;
791 
(II) by striking ‘‘moratoria in ac-
cordance with paragraph (5)’’ and in-
serting ‘‘moratoria in accordance with 
paragraph (7)’’; and 
(III) by striking ‘‘paragraph (6)’’ 
and inserting ‘‘paragraph (9)’’; and 
(ii) by redesignating the second para-
graph (8) (redesignated by section 1304(1) 
of Public Law 111–152) as paragraph (9). 
(B) SECTION 1902(KK).—Section 1902(kk) of 
such Act (42 U.S.C. 1396a(kk)) is amended— 
(i) in paragraph (1), by striking ‘‘sec-
tion 1886(j)(2)’’ and inserting ‘‘section 
1866(j)(2)’’; 
(ii) in paragraph (2), by striking ‘‘sec-
tion 1886(j)(3)’’ and inserting ‘‘section 
1866(j)(3)’’; 
(iii) in paragraph (3), by striking 
‘‘section 1886(j)(4)’’ and inserting ‘‘section 
1866(j)(5)’’; and 
(iv) in paragraph (4)(A), by striking 
‘‘section 1886(j)(6)’’ and inserting ‘‘section 
1866(j)(7)’’.
792 
SEC. 17005. PRESERVATION OF MEDICARE BENEFICIARY 
CHOICE UNDER MEDICARE ADVANTAGE. 
Section 1851(e)(2) of the Social Security Act (42 
U.S.C. 1395w–21(e)(2)) is amended— 
(1) in subparagraph (C)— 
(A) in the heading, by inserting ‘‘FROM 2011 
THROUGH 2018’’ after ‘‘45-DAY PERIOD’’; and 
(B) by inserting ‘‘and ending with 2018’’ 
after ‘‘beginning with 2011’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(G) CONTINUOUS OPEN ENROLLMENT AND 
DISENROLLMENT FOR FIRST 3 MONTHS IN 2016 
AND SUBSEQUENT YEARS.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii) and subparagraph (D)— 
‘‘(I) in the case of an MA eligible 
individual who is enrolled in an MA 
plan, at any time during the first 3 
months of a year (beginning with 
2019); or 
‘‘(II) in the case of an individual 
who first becomes an MA eligible indi-
vidual during a year (beginning with 
2019) and enrolls in an MA plan, dur-
ing the first 3 months during such
793 
year in which the individual is an MA 
eligible individual; 
such MA eligible individual may change the 
election under subsection (a)(1). 
‘‘(ii) LIMITATION
OF
ONE
CHANGE 
DURING OPEN ENROLLMENT PERIOD EACH 
YEAR.—An individual may change the elec-
tion pursuant to clause (i) only once during 
the applicable 3-month period described in 
such clause in each year. The limitation 
under this clause shall not apply to changes 
in elections effected during an annual, co-
ordinated election period under paragraph 
(3) or during a special enrollment period 
under paragraph (4). 
‘‘(iii) LIMITED APPLICATION TO PART 
D.—Clauses (i) and (ii) of this subpara-
graph shall only apply with respect to 
changes in enrollment in a prescription 
drug plan under part D in the case of an 
individual who, previous to such change in 
enrollment, is enrolled in a Medicare Ad-
vantage plan. 
‘‘(iv) LIMITATIONS ON MARKETING.— 
Pursuant to subsection (j), no unsolicited
794 
marketing or marketing materials may be 
sent to an individual described in clause (i) 
during the continuous open enrollment and 
disenrollment period established for the in-
dividual under such clause, notwithstanding 
marketing guidelines established by the Cen-
ters for Medicare & Medicaid Services.’’. 
SEC. 17006. ALLOWING END-STAGE RENAL DISEASE BENE-
FICIARIES TO CHOOSE A MEDICARE ADVAN-
TAGE PLAN. 
(a) REMOVING PROHIBITION.— 
(1) IN GENERAL.—Section 1851(a)(3) of the So-
cial Security Act (42 U.S.C. 1395w–21(a)(3)) is 
amended— 
(A) by striking subparagraph (B); and 
(B) by striking ‘‘ELIGIBLE
INDIVIDUAL’’ 
and all that follows through ‘‘In this title, subject 
to subparagraph (B),’’ and inserting ‘‘ELIGIBLE 
INDIVIDUAL.—In this title,’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1852(b)(1) of the Social Secu-
rity Act (42 U.S.C. 1395w–22(b)(1)) is amend-
ed— 
(i) by striking subparagraph (B); and
795 
(ii) by striking ‘‘BENEFICIARIES’’ and 
all 
that 
follows 
through 
‘‘A 
Medicare+Choice organization’’ and insert-
ing ‘‘BENEFICIARIES.—A Medicare Advan-
tage organization’’. 
(B) Section 1859(b)(6) of the Social Secu-
rity Act (42 U.S.C. 1395w–28(b)(6)) is amended, 
in the last sentence, by striking ‘‘may waive’’ 
and all that follows through ‘‘subparagraph 
and’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to plan 
years beginning on or after January 1, 2021. 
(b) EXCLUDING COSTS
FOR KIDNEY ACQUISITIONS 
FROM MA BENCHMARK.—Section 1853 of the Social Secu-
rity Act (42 U.S.C. 1395w–23) is amended— 
(1) in subsection (k)— 
(A) in paragraph (1)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘paragraphs (2) and 
(4)’’ and inserting ‘‘paragraphs (2), (4), 
and (5)’’; and 
(ii) in subparagraph (B)(i), by strik-
ing ‘‘paragraphs (2) and (4)’’ and inserting 
‘‘paragraphs (2), (4), and (5)’’; and
796 
(B) by adding at the end the following new 
paragraph: 
‘‘(5) EXCLUSION OF COSTS FOR KIDNEY ACQUISI-
TIONS FROM CAPITATION RATES.—After determining 
the applicable amount for an area for a year under 
paragraph (1) (beginning with 2021), the Secretary 
shall adjust such applicable amount to exclude from 
such applicable amount the Secretary’s estimate of the 
standardized costs for payments for organ acquisi-
tions for kidney transplants covered under this title 
(including expenses covered under section 1881(d)) in 
the area for the year.’’; and 
(2) in subsection (n)(2)— 
(A) in subparagraph (A)(i), by inserting 
‘‘and, for 2021 and subsequent years, the exclu-
sion of payments for organ acquisitions for kid-
ney transplants from the capitation rate as de-
scribed in subsection (k)(5)’’ before the semicolon 
at the end; 
(B) in subparagraph (E), in the matter 
preceding clause (i), by striking ‘‘subparagraph 
(F)’’ and inserting ‘‘subparagraphs (F) and 
(G)’’; and 
(C) by adding at the end the following new 
subparagraph:
797 
‘‘(G) APPLICATION
OF
KIDNEY
ACQUISI-
TIONS ADJUSTMENT.—The base payment amount 
specified in subparagraph (E) for a year (begin-
ning with 2021) shall be adjusted in the same 
manner under paragraph (5) of subsection (k) as 
the applicable amount is adjusted under such 
subsection.’’. 
(c) FFS COVERAGE OF KIDNEY ACQUISITIONS.— 
(1) IN
GENERAL.—Section 1852(a)(1)(B)(i) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395w– 
22(a)(1)(B)(i)) is amended by inserting ‘‘or coverage 
for organ acquisitions for kidney transplants, includ-
ing as covered under section 1881(d)’’ after ‘‘hospice 
care’’. 
(2) CONFORMING AMENDMENT.—Section 1851(i) 
of the Social Security Act (42 U.S.C. 1395w–21(i)) is 
amended by adding at the end the following new 
paragraph: 
‘‘(3) FFS PAYMENT FOR EXPENSES FOR KIDNEY 
ACQUISITIONS.—Paragraphs (1) and (2) shall not 
apply with respect to expenses for organ acquisitions 
for 
kidney 
transplants 
described 
in 
section 
1852(a)(1)(B)(i).’’.
798 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to plan 
years beginning on or after January 1, 2021. 
(d) EVALUATION OF QUALITY.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this subsection referred to as the 
‘‘Secretary’’) shall conduct an evaluation of whether 
the 5-star rating system based on the data collected 
under section 1852(e) of the Social Security Act (42 
U.S.C. 1395w–22(e)) should include a quality meas-
ure specifically related to care for enrollees in Medi-
care Advantage plans under part C of title XVIII of 
such Act determined to have end-stage renal disease. 
(2) PUBLIC AVAILABILITY.—Not later than April 
1, 2020, the Secretary shall post on the Internet 
website of the Centers for Medicare & Medicaid Serv-
ices the results of the evaluation under paragraph (1). 
(e) REPORT.—Not later than December 31, 2023, the 
Secretary of Health and Human Services (in this subsection 
referred to as the ‘‘Secretary’’) shall submit to Congress a 
report on the impact of the provisions of, and amendments 
made by, this section with respect to the following: 
(1) Spending under—
799 
(A) the original Medicare fee-for-service pro-
gram under parts A and B of title XVIII of the 
Social Security Act; and 
(B) the Medicare Advantage program under 
part C of such title. 
(2) The number of enrollees determined to have 
end-stage renal disease— 
(A) in the original Medicare fee-for-service 
program; and 
(B) in the Medicare Advantage program. 
(3) The sufficiency of the amount of data under 
the original Medicare fee-for-service program for indi-
viduals determined to have end-stage renal disease for 
purposes of determining payment rates for end-stage 
renal disease under the Medicare Advantage program. 
(f) IMPROVEMENTS
TO RISK ADJUSTMENT UNDER 
MEDICARE ADVANTAGE.— 
(1) IN GENERAL.—Section 1853(a)(1) of the So-
cial Security Act (42 U.S.C. 1395w–23(a)(1)) is 
amended— 
(A) in subparagraph (C)(i), by striking 
‘‘The Secretary’’ and inserting ‘‘Subject to sub-
paragraph (I), the Secretary’’; and 
(B) by adding at the end the following new 
subparagraph:
800 
‘‘(I) IMPROVEMENTS TO RISK ADJUSTMENT 
FOR 2019 AND SUBSEQUENT YEARS.— 
‘‘(i) IN GENERAL.—In order to deter-
mine the appropriate adjustment for health 
status under subparagraph (C)(i), the fol-
lowing shall apply: 
‘‘(I) TAKING INTO ACCOUNT TOTAL 
NUMBER
OF
DISEASES
OR
CONDI-
TIONS.—The Secretary shall take into 
account the total number of diseases or 
conditions of an individual enrolled in 
an MA plan. The Secretary shall make 
an additional adjustment under such 
subparagraph as the number of dis-
eases or conditions of an individual in-
creases. 
‘‘(II) USING AT LEAST 2 YEARS OF 
DIAGNOSTIC
DATA.—The 
Secretary 
may use at least 2 years of diagnosis 
data. 
‘‘(III) PROVIDING SEPARATE AD-
JUSTMENTS FOR DUAL ELIGIBLE INDI-
VIDUALS.—With respect to individuals 
who are dually eligible for benefits 
under this title and title XIX, the Sec-
801 
retary shall make separate adjustments 
for each of the following: 
‘‘(aa) Full-benefit dual eligi-
ble individuals (as defined in sec-
tion 1935(c)(6)). 
‘‘(bb) Such individuals not 
described in item (aa). 
‘‘(IV) EVALUATION
OF
MENTAL 
HEALTH
AND
SUBSTANCE
USE
DIS-
ORDERS.—The Secretary shall evaluate 
the impact of including additional di-
agnosis codes related to mental health 
and substance use disorders in the risk 
adjustment model. 
‘‘(V) EVALUATION
OF
CHRONIC 
KIDNEY DISEASE.—The Secretary shall 
evaluate the impact of including the se-
verity of chronic kidney disease in the 
risk adjustment model. 
‘‘(VI) EVALUATION
OF
PAYMENT 
RATES
FOR
END-STAGE
RENAL
DIS-
EASE.—The Secretary shall evaluate 
whether other factors (in addition to 
those described in subparagraph (H)) 
should be taken into consideration
802 
when computing payment rates under 
such subparagraph. 
‘‘(ii) PHASED-IN
IMPLEMENTATION.— 
The Secretary shall phase-in any changes to 
risk adjustment payment amounts under 
subparagraph (C)(i) under this subpara-
graph over a 3-year period, beginning with 
2019, with such changes being fully imple-
mented for 2022 and subsequent years. 
‘‘(iii) OPPORTUNITY FOR REVIEW AND 
PUBLIC
COMMENT.—The Secretary shall 
provide an opportunity for review of the 
proposed changes to such risk adjustment 
payment amounts under this subparagraph 
and a public comment period of not less 
than 60 days before implementing such 
changes.’’. 
(2) STUDIES AND REPORTS.— 
(A) REPORTS ON THE RISK ADJUSTMENT 
SYSTEM.— 
(i) MEDPAC
EVALUATION
AND
RE-
PORT.— 
(I) EVALUATION.—The Medicare 
Payment Advisory Commission shall 
conduct an evaluation of the impact of
803 
the provisions of, and amendments 
made by, this section on risk scores for 
enrollees in Medicare Advantage plans 
under part C of title XVIII of the So-
cial Security Act and payments to 
Medicare Advantage plans under such 
part, including the impact of such pro-
visions and amendments on the overall 
accuracy of risk scores under the Medi-
care Advantage program. 
(II) REPORT.—Not later than 
July 1, 2020, the Medicare Payment 
Advisory Commission shall submit to 
Congress a report on the evaluation 
under subclause (I), together with rec-
ommendations for such legislation and 
administrative action as the Commis-
sion determines appropriate. 
(ii) 
REPORTS
BY
SECRETARY
OF 
HEALTH AND HUMAN SERVICES.—Not later 
than December 31, 2018, and every 3 years 
thereafter, the Secretary of Health and 
Human Services shall submit to Congress a 
report on the risk adjustment model and the 
ESRD risk adjustment model under the
804 
Medicare Advantage program under part C 
of title XVIII of the Social Security Act, in-
cluding any revisions to either such model 
since the previous report. Such report shall 
include information on how such revisions 
impact the predictive ratios under either 
such model for groups of enrollees in Medi-
care Advantage plans, including very high 
and very low cost enrollees, and groups de-
fined by the number of chronic conditions of 
enrollees. 
(B) STUDY AND REPORT ON FUNCTIONAL 
STATUS.— 
(i) STUDY.—The Comptroller General 
of the United States (in this subparagraph 
referred to as the ‘‘Comptroller General’’) 
shall conduct a study on how to most accu-
rately measure the functional status of en-
rollees in Medicare Advantage plans and 
whether the use of such functional status 
would improve the accuracy of risk adjust-
ment payments under the Medicare Advan-
tage program under part C of title XVIII of 
the Social Security Act. Such study shall 
include an analysis of the challenges in col-
805 
lecting and reporting functional status in-
formation for Medicare Advantage plans 
under such part, providers of services and 
suppliers under the Medicare program, and 
the Centers for Medicare & Medicaid Serv-
ices. 
(ii) REPORT.—Not later than June 30, 
2018, the Comptroller General shall submit 
to Congress a report containing the results 
of the study under clause (i), together with 
recommendations for such legislation and 
administrative action as the Comptroller 
General determines appropriate. 
SEC. 17007. IMPROVEMENTS TO THE ASSIGNMENT OF BENE-
FICIARIES UNDER THE MEDICARE SHARED 
SAVINGS PROGRAM. 
Section 1899(c) of the Social Security Act (42 U.S.C. 
1395jjj(c)) is amended— 
(1) by striking ‘‘utilization of primary’’ and in-
serting ‘‘utilization of— 
‘‘(1) in the case of performance years beginning 
on or after April 1, 2012, primary’’; 
(2) in paragraph (1), as added by paragraph (1) 
of this section, by striking the period at the end and 
inserting ‘‘; and’’;
806 
(3) by adding at the end the following new para-
graph: 
‘‘(2) in the case of performance years beginning 
on or after January 1, 2019, services provided under 
this title by a Federally qualified health center or 
rural health clinic (as those terms are defined in sec-
tion 1861(aa)), as may be determined by the Sec-
retary.’’. 
TITLE XVIII—OTHER 
PROVISIONS 
SEC. 18001. EXCEPTION FROM GROUP HEALTH PLAN RE-
QUIREMENTS FOR QUALIFIED SMALL EM-
PLOYER HEALTH REIMBURSEMENT ARRANGE-
MENTS. 
(a) AMENDMENTS TO THE INTERNAL REVENUE CODE 
OF 1986 AND THE PATIENT PROTECTION AND AFFORDABLE 
CARE ACT.— 
(1) IN GENERAL.—Section 9831 of the Internal 
Revenue Code of 1986 is amended by adding at the 
end the following new subsection: 
‘‘(d) EXCEPTION FOR QUALIFIED SMALL EMPLOYER 
HEALTH REIMBURSEMENT ARRANGEMENTS.— 
‘‘(1) IN GENERAL.—For purposes of this title (ex-
cept as provided in section 4980I(f)(4) and notwith-
standing any other provision of this title), the term
807 
‘group health plan’ shall not include any qualified 
small employer health reimbursement arrangement. 
‘‘(2) QUALIFIED SMALL EMPLOYER HEALTH RE-
IMBURSEMENT ARRANGEMENT.—For purposes of this 
subsection— 
‘‘(A) IN
GENERAL.—The term ‘qualified 
small employer health reimbursement arrange-
ment’ means an arrangement which— 
‘‘(i) is described in subparagraph (B), 
and 
‘‘(ii) is provided on the same terms to 
all eligible employees of the eligible em-
ployer. 
‘‘(B) ARRANGEMENT
DESCRIBED.—An ar-
rangement is described in this subparagraph if— 
‘‘(i) such arrangement is funded solely 
by an eligible employer and no salary re-
duction contributions may be made under 
such arrangement, 
‘‘(ii) such arrangement provides, after 
the employee provides proof of coverage, for 
the payment of, or reimbursement of, an eli-
gible employee for expenses for medical care 
(as defined in section 213(d)) incurred by 
the eligible employee or the eligible employ-
808 
ee’s family members (as determined under 
the terms of the arrangement), and 
‘‘(iii) the amount of payments and re-
imbursements described in clause (ii) for 
any year do not exceed $4,950 ($10,000 in 
the case of an arrangement that also pro-
vides for payments or reimbursements for 
family members of the employee). 
‘‘(C) CERTAIN VARIATION PERMITTED.—For 
purposes of subparagraph (A)(ii), an arrange-
ment shall not fail to be treated as provided on 
the same terms to each eligible employee merely 
because the employee’s permitted benefit under 
such arrangement varies in accordance with the 
variation in the price of an insurance policy in 
the relevant individual health insurance market 
based on— 
‘‘(i) the age of the eligible employee 
(and, in the case of an arrangement which 
covers medical expenses of the eligible em-
ployee’s family members, the age of such 
family members), or 
‘‘(ii) the number of family members of 
the eligible employee the medical expenses of 
which are covered under such arrangement.
809 
The variation permitted under the preceding sen-
tence shall be determined by reference to the 
same insurance policy with respect to all eligible 
employees. 
‘‘(D) RULES RELATING TO MAXIMUM DOL-
LAR LIMITATION.— 
‘‘(i) AMOUNT
PRORATED
IN
CERTAIN 
CASES.—In the case of an individual who is 
not covered by an arrangement for the en-
tire year, the limitation under subpara-
graph (B)(iii) for such year shall be an 
amount which bears the same ratio to the 
amount which would (but for this clause) be 
in effect for such individual for such year 
under subparagraph (B)(iii) as the number 
of months for which such individual is cov-
ered by the arrangement for such year bears 
to 12. 
‘‘(ii) INFLATION ADJUSTMENT.—In the 
case of any year beginning after 2016, each 
of the dollar amounts in subparagraph 
(B)(iii) shall be increased by an amount 
equal to— 
‘‘(I) such dollar amount, multi-
plied by
810 
‘‘(II) the cost-of-living adjustment 
determined under section 1(f)(3) for 
the calendar year in which the taxable 
year begins, determined by substituting 
‘calendar year 2015’ for ‘calendar year 
1992’ in subparagraph (B) thereof. 
If any dollar amount increased under the 
preceding sentence is not a multiple of $50, 
such dollar amount shall be rounded to the 
next lowest multiple of $50. 
‘‘(3) OTHER DEFINITIONS.—For purposes of this 
subsection— 
‘‘(A) ELIGIBLE EMPLOYEE.—The term ‘eli-
gible employee’ means any employee of an eligi-
ble employer, except that the terms of the ar-
rangement may exclude from consideration em-
ployees described in any clause of section 
105(h)(3)(B) (applied by substituting ‘90 days’ 
for ‘3 years’ in clause (i) thereof). 
‘‘(B) ELIGIBLE EMPLOYER.—The term ‘eli-
gible employer’ means an employer that— 
‘‘(i) is not an applicable large em-
ployer as defined in section 4980H(c)(2), 
and
811 
‘‘(ii) does not offer a group health plan 
to any of its employees. 
‘‘(C) PERMITTED BENEFIT.—The term ‘per-
mitted benefit’ means, with respect to any eligi-
ble employee, the maximum dollar amount of 
payments and reimbursements which may be 
made under the terms of the qualified small em-
ployer health reimbursement arrangement for the 
year with respect to such employee. 
‘‘(4) NOTICE.— 
‘‘(A) IN GENERAL.—An employer funding a 
qualified small employer health reimbursement 
arrangement for any year shall, not later than 
90 days before the beginning of such year (or, in 
the case of an employee who is not eligible to 
participate in the arrangement as of the begin-
ning of such year, the date on which such em-
ployee is first so eligible), provide a written no-
tice to each eligible employee which includes the 
information described in subparagraph (B). 
‘‘(B) CONTENTS OF NOTICE.—The notice re-
quired under subparagraph (A) shall include 
each of the following:
812 
‘‘(i) A statement of the amount which 
would be such eligible employee’s permitted 
benefit under the arrangement for the year. 
‘‘(ii) A statement that the eligible em-
ployee should provide the information de-
scribed in clause (i) to any health insurance 
exchange to which the employee applies for 
advance payment of the premium assistance 
tax credit. 
‘‘(iii) A statement that if the employee 
is not covered under minimum essential 
coverage for any month the employee may 
be subject to tax under section 5000A for 
such month and reimbursements under the 
arrangement may be includible in gross in-
come.’’. 
(2) LIMITATION ON EXCLUSION FROM GROSS IN-
COME.—Section 106 of such Code is amended by add-
ing at the end the following: 
‘‘(g) QUALIFIED SMALL EMPLOYER HEALTH REIM-
BURSEMENT ARRANGEMENT.—For purposes of this section 
and section 105, payments or reimbursements from a quali-
fied small employer health reimbursement arrangement (as 
defined in section 9831(d)) of an individual for medical 
care (as defined in section 213(d)) shall not be treated as
813 
paid or reimbursed under employer-provided coverage for 
medical expenses under an accident or health plan if for 
the month in which such medical care is provided the indi-
vidual does not have minimum essential coverage (within 
the meaning of section 5000A(f)).’’. 
(3) COORDINATION
WITH
HEALTH
INSURANCE 
PREMIUM CREDIT.—Section 36B(c) of such Code is 
amended by adding at the end the following new 
paragraph: 
‘‘(4) SPECIAL RULES FOR QUALIFIED SMALL EM-
PLOYER HEALTH REIMBURSEMENT ARRANGEMENTS.— 
‘‘(A) IN
GENERAL.—The term ‘coverage 
month’ shall not include any month with respect 
to an employee (or any spouse or dependent of 
such employee) if for such month the employee is 
provided a qualified small employer health reim-
bursement arrangement which constitutes afford-
able coverage. 
‘‘(B) DENIAL OF DOUBLE BENEFIT.—In the 
case of any employee who is provided a qualified 
small employer health reimbursement arrange-
ment for any coverage month (determined with-
out regard to subparagraph (A)), the credit oth-
erwise allowable under subsection (a) to the tax-
payer for such month shall be reduced (but not
814 
below zero) by the amount described in subpara-
graph (C)(i)(II) for such month. 
‘‘(C) AFFORDABLE
COVERAGE.—For pur-
poses of subparagraph (A), a qualified small em-
ployer health reimbursement arrangement shall 
be treated as constituting affordable coverage for 
a month if— 
‘‘(i) the excess of— 
‘‘(I) the amount that would be 
paid by the employee as the premium 
for such month for self-only coverage 
under the second lowest cost silver plan 
offered in the relevant individual 
health insurance market, over 
‘‘(II) 1⁄12 of the employee’s per-
mitted benefit (as defined in section 
9831(d)(3)(C)) under such arrange-
ment, does not exceed— 
‘‘(ii) 1⁄12 of 9.5 percent of the employ-
ee’s household income. 
‘‘(D) QUALIFIED SMALL EMPLOYER HEALTH 
REIMBURSEMENT ARRANGEMENT.—For purposes 
of this paragraph, the term ‘qualified small em-
ployer health reimbursement arrangement’ has
815 
the meaning given such term by section 
9831(d)(2). 
‘‘(E) COVERAGE
FOR
LESS
THAN
ENTIRE 
YEAR.—In the case of an employee who is pro-
vided a qualified small employer health reim-
bursement arrangement for less than an entire 
year, subparagraph (C)(i)(II) shall be applied by 
substituting ‘the number of months during the 
year for which such arrangement was provided’ 
for ‘12’. 
‘‘(F) INDEXING.—In the case of plan years 
beginning in any calendar year after 2014, the 
Secretary shall adjust the 9.5 percent amount 
under subparagraph (C)(ii) in the same manner 
as the percentages are adjusted under subsection 
(b)(3)(A)(ii).’’. 
(4) APPLICATION OF EXCISE TAX ON HIGH COST 
EMPLOYER-SPONSORED HEALTH COVERAGE.— 
(A) IN
GENERAL.—Section 4980I(f)(4) of 
such Code is amended by adding at the end the 
following: ‘‘Section 9831(d)(1) shall not apply 
for purposes of this section.’’. 
(B) DETERMINATION
OF
COST
OF
COV-
ERAGE.—Section 4980I(d)(2) of such Code is 
amended by redesignating subparagraph (D) as
816 
subparagraph (E) and by inserting after sub-
paragraph (C) the following new subparagraph: 
‘‘(D) QUALIFIED SMALL EMPLOYER HEALTH 
REIMBURSEMENT ARRANGEMENTS.—In the case 
of applicable employer-sponsored coverage con-
sisting of coverage under any qualified small em-
ployer health reimbursement arrangement (as de-
fined in section 9831(d)(2)), the cost of coverage 
shall be equal to the amount described in section 
6051(a)(15).’’. 
(5) ENFORCEMENT OF NOTICE REQUIREMENT.— 
Section 6652 of such Code is amended by adding at 
the end the following new subsection: 
‘‘(o) FAILURE TO PROVIDE NOTICES WITH RESPECT 
TO QUALIFIED SMALL EMPLOYER HEALTH REIMBURSE-
MENT ARRANGEMENTS.—In the case of each failure to pro-
vide a written notice as required by section 9831(d)(4), un-
less it is shown that such failure is due to reasonable cause 
and not willful neglect, there shall be paid, on notice and 
demand of the Secretary and in the same manner as tax, 
by the person failing to provide such written notice, an 
amount equal to $50 per employee per incident of failure 
to provide such notice, but the total amount imposed on 
such person for all such failures during any calendar year 
shall not exceed $2,500.’’.
817 
(6) REPORTING.— 
(A) W–2 REPORTING.—Section 6051(a) of 
such Code is amended by striking ‘‘and’’ at the 
end of paragraph (13), by striking the period at 
the end of paragraph (14) and inserting ‘‘, and’’, 
and by inserting after paragraph (14) the fol-
lowing new paragraph: 
‘‘(15) the total amount of permitted benefit (as 
defined in section 9831(d)(3)(C)) for the year under 
a qualified small employer health reimbursement ar-
rangement (as defined in section 9831(d)(2)) with re-
spect to the employee.’’. 
(B) INFORMATION REQUIRED TO BE PRO-
VIDED
BY
EXCHANGE
SUBSIDY
APPLICANTS.— 
Section 1411(b)(3) of the Patient Protection and 
Affordable Care Act is amended by redesignating 
subparagraph (B) as subparagraph (C) and by 
inserting after subparagraph (A) the following 
new subparagraph: 
‘‘(B) CERTAIN INDIVIDUAL HEALTH INSUR-
ANCE POLICIES OBTAINED THROUGH SMALL EM-
PLOYERS.—The amount of the enrollee’s per-
mitted 
benefit 
(as 
defined 
in 
section 
9831(d)(3)(C) of the Internal Revenue Code of 
1986) under a qualified small employer health
818 
reimbursement arrangement (as defined in sec-
tion 9831(d)(2) of such Code).’’. 
(7) EFFECTIVE DATES.— 
(A) IN GENERAL.—Except as otherwise pro-
vided in this paragraph, the amendments made 
by this subsection shall apply to years beginning 
after December 31, 2016. 
(B) TRANSITION RELIEF.—The relief under 
Treasury Notice 2015–17 shall be treated as ap-
plying to any plan year beginning on or before 
December 31, 2016. 
(C) COORDINATION WITH HEALTH INSUR-
ANCE PREMIUM CREDIT.—The amendments made 
by paragraph (3) shall apply to taxable years be-
ginning after December 31, 2016. 
(D) EMPLOYEE NOTICE.— 
(i) IN
GENERAL.—The amendments 
made by paragraph (5) shall apply to no-
tices with respect to years beginning after 
December 31, 2016. 
(ii) TRANSITION
RELIEF.—For pur-
poses of section 6652(o) of the Internal Rev-
enue Code of 1986 (as added by this Act), 
a person shall not be treated as failing to 
provide a written notice as required by sec-
819 
tion 9831(d)(4) of such Code if such notice 
is so provided not later than 90 days after 
the date of the enactment of this Act. 
(E) W–2 REPORTING.—The amendments 
made by paragraph (6)(A) shall apply to cal-
endar years beginning after December 31, 2016. 
(F) INFORMATION PROVIDED BY EXCHANGE 
SUBSIDY APPLICANTS.— 
(i) IN
GENERAL.—The amendments 
made by paragraph (6)(B) shall apply to 
applications for enrollment made after De-
cember 31, 2016. 
(ii) VERIFICATION.—Verification under 
section 1411 of the Patient Protection and 
Affordable Care Act of information provided 
under section 1411(b)(3)(B) of such Act 
shall apply with respect to months begin-
ning after October 2016. 
(iii) TRANSITIONAL
RELIEF.—In the 
case of an application for enrollment under 
section 1411(b) of the Patient Protection 
and Affordable Care Act made before April 
1, 
2017, 
the 
requirement 
of 
section 
1411(b)(3)(B) of such Act shall be treated as 
met if the information described therein is
820 
provided not later than 30 days after the 
date on which the applicant receives the no-
tice described in section 9831(d)(4) of the 
Internal Revenue Code of 1986. 
(8) SUBSTANTIATION REQUIREMENTS.—The Sec-
retary of the Treasury (or his designee) may issue 
substantiation requirements as necessary to carry out 
this subsection. 
(b) AMENDMENTS TO THE EMPLOYEE RETIREMENT 
INCOME SECURITY ACT OF 1974.— 
(1) IN GENERAL.—Section 733(a)(1) of the Em-
ployee Retirement Income Security Act of 1974 (29 
U.S.C. 1191b(a)(1)) is amended by adding at the end 
the following: ‘‘Such term shall not include any quali-
fied small employer health reimbursement arrange-
ment (as defined in section 9831(d)(2) of the Internal 
Revenue Code of 1986).’’. 
(2) EXCEPTION FROM CONTINUATION COVERAGE 
REQUIREMENTS, ETC.—Section 607(1) of such Act (29 
U.S.C. 1167(1)) is amended by adding at the end the 
following: ‘‘Such term shall not include any qualified 
small employer health reimbursement arrangement 
(as defined in section 9831(d)(2) of the Internal Rev-
enue Code of 1986).’’.