HR 4994 RDS 
paragraph (1) not less frequently than on a quar-
terly basis. Notwithstanding the previous sentence, 
with respect to measures described in such para-
graph that are reported on an annual basis, the Sec-
retary may provide such feedback reports on an an-
nual basis. 
‘‘(g) PUBLIC REPORTING OF PAC PROVIDER PER-
FORMANCE.— 
‘‘(1) IN GENERAL.—Subject to the succeeding 
paragraphs of this subsection, the Secretary shall 
provide for public reporting of PAC provider per-
formance on quality measures under subsection 
(c)(1) and the resource use and other measures 
under subsection (d)(1), including by establishing 
procedures for making available to the public infor-
mation regarding the performance of individual PAC 
providers with respect to such measures. 
‘‘(2) OPPORTUNITY
TO
REVIEW.—The proce-
dures under paragraph (1) shall ensure, including 
through a process consistent with the process ap-
plied under section 1886(b)(3)(B)(viii)(VII) for simi-
lar purposes, that a PAC provider has the oppor-
tunity to review and submit corrections to the data 
and information that is to be made public with re-
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spect to the provider prior to such data being made 
public. 
‘‘(3) TIMING.—Such procedures shall provide 
that the data and information described in para-
graph (1), with respect to a measure and PAC pro-
vider, is made publicly available beginning not later 
than two years after the specified application date 
applicable to such a measure and provider. 
‘‘(4) COORDINATION
WITH
EXISTING
PRO-
GRAMS.—Such procedures shall provide that data 
and information described in paragraph (1) with re-
spect to quality measures and resource use and 
other measures under subsections (c)(1) and (d)(1) 
shall be made publicly available consistent with the 
following provisions: 
‘‘(A) In the case of home health agencies, 
section 1895(b)(3)(B)(v)(III). 
‘‘(B) In the case of skilled nursing facili-
ties, sections 1819(i) and 1919(i). 
‘‘(C) In the case of inpatient rehabilitation 
facilities, section 1886(j)(7)(E). 
‘‘(D) In the case of long-term care hos-
pitals, section 1886(m)(5)(E). 
‘‘(h) REMOVING, SUSPENDING, OR ADDING MEAS-
URES.— 
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‘‘(1) IN GENERAL.—The Secretary may remove, 
suspend, or add a quality measure or resource use 
or other measure described in subsection (c)(1) or 
(d)(1), so long as, subject to paragraph (2), the Sec-
retary publishes in the Federal Register (with a no-
tice and comment period) a justification for such re-
moval, suspension, or addition. 
‘‘(2) EXCEPTION.—In the case of such a quality 
measure or resource use or other measure for which 
there is a reason to believe that the continued collec-
tion of such measure raises potential safety concerns 
or would cause other unintended consequences, the 
Secretary may promptly suspend or remove such 
measure and satisfy paragraph (1) by publishing in 
the Federal Register a justification for such suspen-
sion or removal in the next rulemaking cycle fol-
lowing such suspension or removal. 
‘‘(i) USE
OF STANDARDIZED ASSESSMENT DATA, 
QUALITY MEASURES, AND RESOURCE USE AND OTHER 
MEASURES TO INFORM DISCHARGE PLANNING AND IN-
CORPORATE PATIENT PREFERENCE.— 
‘‘(1) IN GENERAL.—Not later than January 1, 
2016, and periodically thereafter (but not less fre-
quently than once every 5 years), the Secretary shall 
promulgate regulations to modify conditions of par-
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ticipation and subsequent interpretive guidance ap-
plicable to PAC providers, hospitals, and critical ac-
cess hospitals. Such regulations and interpretive 
guidance shall require such providers to take into 
account quality, resource use, and other measures 
under the applicable reporting provisions (which, as 
available, shall include measures specified under sub-
sections (c) and (d), and other relevant measures) in 
the discharge planning process. Specifically, such 
regulations and interpretive guidance shall address 
the settings to which a patient may be discharged in 
order to assist subsection (d) hospitals, critical ac-
cess 
hospitals, 
hospitals 
described 
in 
section 
1886(d)(1)(B)(v), PAC providers, patients, and fam-
ilies of such patients with discharge planning from 
inpatient settings, including such hospitals, and 
from PAC provider settings. In addition, such regu-
lations and interpretive guidance shall include proce-
dures to address— 
‘‘(A) treatment preferences of patients; 
and 
‘‘(B) goals of care of patients. 
‘‘(2) DISCHARGE PLANNING.—All requirements 
applied pursuant to paragraph (1) shall be used to 
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help inform and mandate the discharge planning 
process. 
‘‘(3) CLARIFICATION.—Such regulations shall 
not require an individual to be provided post-acute 
care by a specific type of PAC provider in order for 
such care to be eligible for payment under this title. 
‘‘(j) STAKEHOLDER INPUT.—Before the initial rule-
making process to implement this section, the Secretary 
shall allow for stakeholder input, such as through town 
halls, open door forums, and mail-box submissions. 
‘‘(k) FUNDING.—For purposes of carrying out this 
section, the Secretary shall provide for the transfer to the 
Centers for Medicare & Medicaid Services Program Man-
agement Account, from the Federal Hospital Insurance 
Trust Fund under section 1817 and the Federal Supple-
mentary Medical Insurance Trust Fund under section 
1841, in such proportion as the Secretary determines ap-
propriate, of $130,000,000. Fifty percent of such amount 
shall be available on the date of the enactment of this sec-
tion and fifty percent of such amount shall be equally pro-
portioned for each of fiscal years 2015 through 2019. 
Such sums shall remain available until expended. 
‘‘(l) LIMITATION.—There shall be no administrative 
or judicial review under sections 1869 and 1878 or other-
wise of the specification of standardized patient assess-
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ment data required, the determination of measures, and 
the systems to report such standardized data under this 
section. 
‘‘(m) NON-APPLICATION
OF PAPERWORK REDUC-
TION ACT.—Chapter 35 of title 44, United States Code 
(commonly referred to as the ‘Paperwork Reduction Act 
of 1995’) shall not apply to this section and the sections 
referenced in subsection (a)(2)(B) that require modifica-
tion in order to achieve the standardization of patient as-
sessment data.’’. 
(b) STUDIES OF ALTERNATIVE PAC PAYMENT MOD-
ELS.— 
(1) MEDPAC.—Using data from the Post- 
Acute Payment Reform Demonstration authorized 
under section 5008 of the Deficit Reduction Act of 
2005 (Public Law 109–171) or other data, as avail-
able, not later than June 30, 2016, the Medicare 
Payment Advisory Commission shall submit to Con-
gress a report that evaluates and recommends fea-
tures of PAC payment systems (as defined in section 
1899B(a)(2)(D) of the Social Security Act, as added 
by subsection (a)) that establish, or a unified post- 
acute care payment system under title XVIII of the 
Social Security Act that establishes, payment rates 
according to characteristics of individuals (such as 
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cognitive ability, functional status, and impairments) 
instead of according to the post-acute care setting 
where the Medicare beneficiary involved is treated. 
To the extent feasible, such report shall consider the 
impacts of moving from PAC payment systems (as 
defined in subsection (a)(2)(D) of such section 
1899B) in existence as of the date of the enactment 
of this Act to new post-acute care payment systems 
under title XVIII of the Social Security Act. 
(2) RECOMMENDATIONS FOR PAC PROSPECTIVE 
PAYMENT.— 
(A) REPORT
BY
SECRETARY.—Not later 
than 2 years after the date by which the Sec-
retary of Health and Human Services has col-
lected 2 years of data on quality measures 
under subsection (c) of section 1899B, as added 
by subsection (a), the Secretary shall, in con-
sultation with the Medicare Payment Advisory 
Commission and appropriate stakeholders, sub-
mit to Congress a report, including— 
(i) recommendations and a technical 
prototype, on a post-acute care prospective 
payment system under title XVIII of the 
Social Security Act that would— 
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(I) in lieu of the rates that would 
otherwise apply under PAC payment 
systems (as defined in subsection 
(a)(2)(D) of such section 1899B), 
base payments under such title, with 
respect to items and services fur-
nished to an individual by a PAC pro-
vider 
(as 
defined 
in 
subsection 
(a)(2)(A) of such section), according 
to individual characteristics (such as 
cognitive ability, functional status, 
and impairments) of such individual 
instead of the post-acute care setting 
in which the individual is furnished 
such items and services; 
(II) account for the clinical ap-
propriateness of items and services so 
furnished and Medicare beneficiary 
outcomes; 
(III) be designed to incorporate 
(or otherwise account for) standard-
ized patient assessment data under 
section 1899B; and 
(IV) further clinical integration, 
such as by motivating greater coordi-
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nation around a single condition or 
procedure to integrate hospital sys-
tems with PAC providers (as so de-
fined). 
(ii) recommendations on which Medi-
care fee-for-service regulations for post- 
acute care payment systems under title 
XVIII of the Social Security Act should be 
altered (such as the skilled nursing facility 
3-day stay and inpatient rehabilitation fa-
cility 60 percent rule); 
(iii) an analysis of the impact of the 
recommended payment system described in 
clause (i) on Medicare beneficiary cost- 
sharing, access to care, and choice of set-
ting; 
(iv) a projection of any potential re-
duction in expenditures under title XVIII 
of the Social Security Act that may be at-
tributable to the application of the rec-
ommended payment system described in 
clause (i); and 
(v) a review of the value of subsection 
(d) 
hospitals 
(as 
defined 
in 
section 
1886(d)(1)(B) of the Social Security Act 
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(42 U.S.C. 1395ww(d)(1)(B)), hospitals 
described in section 1886(d)(1)(B)(v) of 
such Act (42 U.S.C. 1395ww(d)(1)(B)(v)), 
and critical access hospitals described in 
section 1820(c)(2)(B) of such Act (42 
U.S.C. 1395i–4(c)(2)(B)) collecting and 
reporting to the Secretary standardized pa-
tient assessment data with respect to inpa-
tient hospital services furnished by such a 
hospital or critical access hospital to indi-
viduals who are entitled to benefits under 
part A of title XVIII of such Act or, as ap-
propriate, enrolled for benefits under part 
B of such title. 
(B) REPORT BY MEDPAC.—Not later than 
the first June 30th following the date on which 
the report is required under subparagraph (A), 
the Medicare Payment Advisory Commission 
shall submit to Congress a report, including 
recommendations and a technical prototype, on 
a post-acute care prospective payment system 
under title XVIII of the Social Security Act 
that would satisfy the criteria described in sub-
paragraph (A). 
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(3) MEDICARE
BENEFICIARY
DEFINED.—For 
purposes of this subsection, the term ‘‘Medicare ben-
eficiary’’ has the meaning given such term in section 
1899B(a)(2) of the Social Security Act, as added by 
subsection (a). 
(c) PAYMENT CONSEQUENCES UNDER THE APPLICA-
BLE REPORTING PROVISIONS.— 
(1) 
HOME
HEALTH
AGENCIES.—Section 
1895(b)(3)(B)(v) of the Social Security Act (42 
U.S.C. 1395fff(b)(3)(B)(v)) is amended— 
(A) in subclause (I), by striking ‘‘subclause 
(II)’’ and inserting ‘‘subclauses (II) and (IV)’’; 
(B) in subclause (II), by striking ‘‘For 
2007’’ and inserting ‘‘Subject to subclause (V), 
for 2007’’; 
(C) in subclause (III), by inserting ‘‘and 
subclause (IV)(aa)’’ after ‘‘subclause (II)’’; and 
(D) by adding at the end the following new 
subclauses: 
‘‘(IV) 
SUBMISSION
OF
ADDI-
TIONAL DATA.— 
‘‘(aa) 
IN
GENERAL.—For 
the year beginning on the speci-
fied application date (as defined 
in subsection (a)(2)(E) of section 
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‘‘(cc) 
SUBMISSION.—Data 
shall be submitted under items 
(aa) and (bb) in the form and 
manner, and at the time, speci-
fied by the Secretary for pur-
poses of this clause. 
‘‘(V) NON-DUPLICATION.—To the 
extent data submitted under subclause 
(IV) duplicates other data required to 
be submitted under subclause (II), the 
submission of such data under sub-
clause (IV) shall be in lieu of the sub-
mission of such data under subclause 
(II). The previous sentence shall not 
apply insofar as the Secretary deter-
mines it is necessary to avoid a delay 
in the implementation of section 
1899B, taking into account the dif-
ferent 
specified 
application 
dates 
under subsection (a)(2)(E) of such 
section.’’. 
(2) INPATIENT REHABILITATION FACILITIES.— 
Section 1886(j)(7) of the Social Security Act (42 
U.S.C. 1395ww(j)(7)) is amended— 
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‘‘(G) NON-DUPLICATION.—To the extent 
data submitted under subparagraph (F) dupli-
cates other data required to be submitted under 
subparagraph (C), the submission of such data 
under subparagraph (F) shall be in lieu of the 
submission of such data under subparagraph 
(C). The previous sentence shall not apply inso-
far as the Secretary determines it is necessary 
to avoid a delay in the implementation of sec-
tion 1899B, taking into account the different 
specified application dates under subsection 
(a)(2)(E) of such section.’’. 
(4) SKILLED NURSING FACILITIES.— 
(A) IN GENERAL.—Paragraph (6) of sec-
tion 1888(e) of the Social Security Act (42 
U.S.C. 1395yy(e)) is amended to read as fol-
lows: 
‘‘(6) REPORTING OF ASSESSMENT AND QUALITY 
DATA.— 
‘‘(A) REDUCTION IN UPDATE FOR FAILURE 
TO REPORT.— 
‘‘(i) IN
GENERAL.—For fiscal years 
beginning with fiscal year 2018, in the 
case of a skilled nursing facility that does 
not submit data, as applicable, in accord-
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ance with subclauses (II) and (III) of sub-
paragraph (B)(i) with respect to such a 
fiscal year, after determining the percent-
age described in paragraph (5)(B)(i), and 
after application of paragraph (5)(B)(ii), 
the Secretary shall reduce such percentage 
for payment rates during such fiscal year 
by 2 percentage points. 
‘‘(ii) SPECIAL RULE.—The application 
of this subparagraph may result in the per-
centage described in paragraph (5)(B)(i), 
after application of paragraph (5)(B)(ii), 
being less than 0.0 for a fiscal year, and 
may result in payment rates under this 
subsection for a fiscal year being less than 
such payment rates for the preceding fiscal 
year. 
‘‘(iii) 
NONCUMULATIVE
APPLICA-
TION.—Any reduction under clause (i) 
shall apply only with respect to the fiscal 
year involved and the Secretary shall not 
take into account such reduction in com-
puting the payment amount under this 
subsection for a subsequent fiscal year. 
‘‘(B) ASSESSMENT AND MEASURE DATA.— 
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‘‘(i) IN GENERAL.—A skilled nursing 
facility, or a facility (other than a critical 
access hospital) described in paragraph 
(7)(B), shall submit to the Secretary, in a 
manner and within the timeframes pre-
scribed by the Secretary— 
‘‘(I) subject to clause (iii), the 
resident assessment data necessary to 
develop and implement the rates 
under this subsection; 
‘‘(II) for fiscal years beginning 
on or after the specified application 
date 
(as 
defined 
in 
subsection 
(a)(2)(E) of section 1899B), as appli-
cable with respect to skilled nursing 
facilities and quality measures under 
subsection (c)(1) of such section and 
measures under subsection (d)(1) of 
such section, data on such quality 
measures under such subsection (c)(1) 
and any necessary data specified by 
the Secretary under such subsection 
(d)(1); and 
‘‘(III) for fiscal years beginning 
on or after October 1, 2018, stand-
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ardized patient assessment data re-
quired under subsection (b)(1) of sec-
tion 1899B. 
‘‘(ii) USE
OF
STANDARD
INSTRU-
MENT.—For purposes of meeting the re-
quirement under clause (i), a skilled nurs-
ing facility, or a facility (other than a crit-
ical access hospital) described in paragraph 
(7)(B), may submit the resident assess-
ment 
data 
required 
under 
section 
1819(b)(3), using the standard instrument 
designated by the State under section 
1819(e)(5). 
‘‘(iii) NON-DUPLICATION.—To the ex-
tent data submitted under subclause (II) 
or (III) of clause (i) duplicates other data 
required to be submitted under clause 
(i)(I), the submission of such data under 
such a subclause shall be in lieu of the 
submission of such data under clause 
(i)(I). The previous sentence shall not 
apply insofar as the Secretary determines 
it is necessary to avoid a delay in the im-
plementation of section 1899B, taking into 
account the different specified application 
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dates under subsection (a)(2)(E) of such 
section.’’. 
(B) FUNDING FOR NURSING HOME COM-
PARE WEBSITE.—Section 1819(i) of the Social 
Security Act (42 U.S.C. 1395i–3(i)) is amended 
by adding at the end the following new para-
graph: 
‘‘(3) FUNDING.—The Secretary shall transfer 
to the Centers for Medicare & Medicaid Services 
Program Management Account, from the Federal 
Hospital Insurance Trust Fund under section 1817 
a one-time allocation of $11,000,000. The amount 
shall be available on the date of the enactment of 
this paragraph. Such sums shall remain available 
until expended. Such sums shall be used to imple-
ment section 1128I(g).’’. 
(d) IMPROVING PAYMENT ACCURACY UNDER THE 
PAC PAYMENT SYSTEMS AND OTHER MEDICARE PAY-
MENT SYSTEMS.— 
(1) STUDIES AND REPORTS OF EFFECT OF CER-
TAIN
INFORMATION
ON
QUALITY
AND
RESOURCE 
USE.— 
(A) STUDY
USING
EXISTING
MEDICARE 
DATA.— 
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(i) STUDY.—The Secretary of Health 
and Human Services (in this subsection re-
ferred to as the ‘‘Secretary’’) shall conduct 
a study that examines the effect of individ-
uals’ socioeconomic status on quality meas-
ures and resource use and other measures 
for individuals under the Medicare pro-
gram under title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.) (such as 
to recognize that less healthy individuals 
may require more intensive interventions). 
The study shall use information collected 
on such individuals in carrying out such 
program, such as urban and rural location, 
eligibility for Medicaid under title XIX of 
such Act (42 U.S.C. 1396 et seq.) (recog-
nizing and accounting for varying Medicaid 
eligibility across States), and eligibility for 
benefits under the supplemental security 
income (SSI) program. The Secretary shall 
carry out this paragraph acting through 
the Assistant Secretary for Planning and 
Evaluation. 
(ii) REPORT.—Not later than 2 years 
after the date of the enactment of this Act, 
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