I 
114TH CONGRESS 
2D SESSION 
H. R. 5273 
To amend title XVIII of the Social Security Act to provide for regulatory 
relief under the Medicare program for certain providers of services and 
suppliers and increased transparency in hospital coding and enrollment 
data, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 18, 2016 
Mr. TIBERI (for himself and Mr. MCDERMOTT) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for regulatory relief under the Medicare program for 
certain providers of services and suppliers and increased 
transparency in hospital coding and enrollment data, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Helping Hospitals Improve Patient Care Act of 2016’’. 
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(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—PROVISIONS RELATING TO MEDICARE PART A 
Sec. 101. Development of Medicare study for HCPCS version of MS–DRG 
codes for similar hospital services. 
Sec. 102. Establishing beneficiary equity in the Medicare hospital readmission 
program. 
Sec. 103. Five-year extension of the rural community hospital demonstration 
program. 
Sec. 104. Regulatory relief for LTCHs. 
Sec. 105. Savings from IPPS MACRA pay-for through not applying docu-
mentation and coding adjustments. 
TITLE II—PROVISIONS RELATING TO MEDICARE PART B 
Sec. 201. Continuing Medicare payment under HOPD prospective payment sys-
tem for services furnished by off-campus outpatient depart-
ments of providers under development. 
Sec. 202. Treatment of cancer hospitals in off-campus outpatient department of 
a provider policy. 
Sec. 203. Treatment of eligible professionals in ambulatory surgical centers for 
meaningful use and MIPS. 
TITLE III—OTHER MEDICARE PROVISIONS 
Sec. 301. Delay in authority to terminate contracts for Medicare Advantage 
plans failing to achieve minimum quality ratings. 
Sec. 302. Requirement for enrollment data reporting for Medicare. 
Sec. 303. Updating the Welcome to Medicare package. 
TITLE I—PROVISIONS RELATING 
TO MEDICARE PART A 
SEC. 101. DEVELOPMENT OF MEDICARE STUDY FOR HCPCS 
VERSION OF MS–DRG CODES FOR SIMILAR 
HOSPITAL SERVICES. 
Section 1886 of the Social Security Act (42 U.S.C. 
1395ww) is amended by adding at the end the following 
new subsection: 
‘‘(t) RELATING
SIMILAR
INPATIENT
AND
OUT-
PATIENT HOSPITAL SERVICES.— 
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‘‘(1) DEVELOPMENT
OF
HCPCS
VERSION
OF 
MS–DRG CODES.— 
‘‘(A) IN GENERAL.—Not later than Janu-
ary 1, 2018, the Secretary shall develop 
HCPCS versions for MS–DRGs that is similar 
to the ICD–10–PCS for such MS–DRGs such 
that, to the extent possible, the MS–DRG as-
signment shall be similar for a claim coded with 
the HCPCS version as an identical claim coded 
with a ICD–10–PCS code. 
‘‘(B) COVERAGE OF SURGICAL MS–DRGS.— 
In carrying out subparagraph (A), the Sec-
retary shall develop HCPCS versions of MS– 
DRG codes for not fewer than 10 surgical MS– 
DRGs. 
‘‘(C) PUBLICATION
AND
DISSEMINATION 
OF THE HCPCS VERSIONS OF MS–DRGS.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall develop a HCPCS MS–DRG defini-
tions manual and software that is similar 
to the definitions manual and software for 
ICD–10–PCS codes for such MS–DRGs. 
The Secretary shall post the HCPCS MS– 
DRG definitions manual and software on 
the Internet website of the Centers for 
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Medicare 
& 
Medicaid 
Services. 
The 
HCPCS MS–DRG definitions manual and 
software shall be in the public domain and 
available for use and redistribution without 
charge. 
‘‘(ii) USE
OF
PREVIOUS
ANALYSIS 
DONE
BY
MEDPAC.—In developing the 
HCPCS MS–DRG definitions manual and 
software under clause (i), the Secretary 
shall consult with the Medicare Payment 
Advisory Commission and shall consider 
the analysis done by such Commission in 
translating outpatient surgical claims into 
inpatient surgical MS–DRGs in preparing 
chapter 7 (relating to hospital short-stay 
policy issues) of its ‘Medicare and the 
Health Care Delivery System’ report sub-
mitted to Congress in June 2015. 
‘‘(D) DEFINITION
AND
REFERENCE.—In 
this paragraph: 
‘‘(i) HCPCS.—The term ‘HCPCS’ 
means, with respect to hospital items and 
services, the code under the Healthcare 
Common 
Procedure 
Coding 
System 
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(HCPCS) (or a successor code) for such 
items and services. 
‘‘(ii) ICD–10–PCS.—The term ‘ICD– 
10–PCS’ means the International Classi-
fication of Diseases, 10th Revision, Proce-
dure Coding System, and includes a subse-
quent revision of such International Classi-
fication of Diseases, Procedure Coding 
System.’’. 
SEC. 102. ESTABLISHING BENEFICIARY EQUITY IN THE 
MEDICARE 
HOSPITAL 
READMISSION 
PRO-
GRAM. 
(a) TRANSITIONAL ADJUSTMENT FOR DUAL ELIGI-
BLE POPULATION.—Section 1886(q)(3) of the Social Se-
curity Act (42 U.S.C. 1395ww(q)(3)) is amended— 
(1) in subparagraph (A), by inserting ‘‘subject 
to subparagraph (D),’’ after ‘‘purposes of paragraph 
(1),’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) TRANSITIONAL
ADJUSTMENT
FOR 
DUAL ELIGIBLES.— 
‘‘(i) IN GENERAL.—In determining a 
hospital’s adjustment factor under this 
paragraph for purposes of making pay-
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ments for discharges occurring during and 
after fiscal year 2019, and before the ap-
plication of clause (i) of subparagraph (E), 
the Secretary shall assign hospitals to 
groups (as defined by the Secretary under 
clause (ii)) and apply the applicable provi-
sions of this subsection using a method-
ology in a manner that allows for separate 
comparison of hospitals within each such 
group, as determined by the Secretary. 
‘‘(ii) DEFINING
GROUPS.—For pur-
poses of this subparagraph, the Secretary 
shall define groups of hospitals based on 
their overall proportion of inpatients who 
are full-benefit dual eligible individuals (as 
defined in section 1935(c)(6)). In defining 
groups, the Secretary shall consult the 
Medicare Payment Advisory Commission 
and may consider the analysis done by 
such Commission in preparing the portion 
of its report submitted to Congress in June 
2013 relating to readmissions. 
‘‘(iii) MINIMIZING
REPORTING
BUR-
DEN ON HOSPITALS.—In carrying out this 
subparagraph, the Secretary shall not im-
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pose any additional reporting requirements 
on hospitals. 
‘‘(iv) 
BUDGET
NEUTRAL
DESIGN 
METHODOLOGY.—The Secretary shall de-
sign the methodology to implement this 
subparagraph so that the estimated total 
amount of reductions in payments under 
this subsection equals the estimated total 
amount of reductions in payments that 
would otherwise occur under this sub-
section if this subparagraph did not 
apply.’’. 
(b) SUBSEQUENT ADJUSTMENTS BASED
ON IM-
PACT REPORTS.—Section 1886(q)(3) of the Social Secu-
rity Act (42 U.S.C. 1395ww(q)(3)), as amended by sub-
section (a), is further amended by adding at the end the 
following new subparagraph: 
‘‘(E) CHANGES IN RISK ADJUSTMENT.— 
‘‘(i) 
CONSIDERATION
OF
REC-
OMMENDATIONS
IN
IMPACT
REPORTS.— 
The Secretary may take into account the 
studies conducted and the recommenda-
tions made by the Secretary under section 
2(d)(1) of the IMPACT Act of 2014 (Pub-
lic Law 113–185; 42 U.S.C. 1395lll note) 
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with respect to the application under this 
subsection of risk adjustment methodolo-
gies. Nothing in this clause shall be con-
strued as precluding consideration of the 
use of groupings of hospitals.’’. 
(c) MEDPAC STUDY ON READMISSIONS PROGRAM.— 
The Medicare Payment Advisory Commission shall con-
duct a study to review overall hospital readmissions de-
scribed in section 1886(q)(5)(E) of the Social Security Act 
(42 U.S.C. 1395ww(q)(5)(E)) and whether such readmis-
sions are related to any changes in outpatient and emer-
gency services furnished. The Commission shall submit to 
Congress a report on such study in its report to Congress 
in June 2017. 
(d) ADDRESSING ISSUE OF CERTAIN PATIENTS.— 
Subparagraph (E) of section 1886(q)(3) of the Social Se-
curity Act (42 U.S.C. 1395ww(q)(3)), as added by sub-
section (b), is further amended by adding at the end the 
following new clause: 
‘‘(ii) CONSIDERATION OF EXCLUSION 
OF PATIENT CASES BASED ON V OR OTHER 
APPROPRIATE
CODES.—In promulgating 
regulations to carry out this subsection 
with respect to discharges occurring after 
fiscal year 2018, the Secretary may con-
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sider the use of V or other ICD-related 
codes for removal of a readmission. The 
Secretary may consider modifying meas-
ures under this subsection to incorporate V 
or other ICD-related codes at the same 
time as other changes are being made 
under this subparagraph.’’. 
(e) REMOVAL
OF CERTAIN READMISSIONS.—Sub-
paragraph (E) of section 1886(q)(3) of the Social Security 
Act (42 U.S.C. 1395ww(q)(3)), as added by subsection (b) 
and amended by subsection (d), is further amended by 
adding at the end the following new clause: 
‘‘(iii) REMOVAL
OF
CERTAIN
RE-
ADMISSIONS.—In promulgating regulations 
to carry out this subsection, with respect 
to discharges occurring after fiscal year 
2018, the Secretary may consider removal 
as a readmission of an admission that is 
classified within one or more of the fol-
lowing: transplants, end-stage renal dis-
ease, burns, trauma, psychosis, or sub-
stance abuse. The Secretary may consider 
modifying measures under this subsection 
to remove readmissions at the same time 
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as other changes are being made under 
this subparagraph.’’. 
SEC. 103. FIVE-YEAR EXTENSION OF THE RURAL COMMU-
NITY HOSPITAL DEMONSTRATION PROGRAM. 
(a) EXTENSION.—Section 410A of the Medicare Pre-
scription Drug, Improvement, and Modernization Act of 
2003 (Public Law 108–173; 42 U.S.C. 1395ww note), as 
amended by sections 3123 and 10313 of the Patient Pro-
tection and Affordable Care Act (Public Law 111–148), 
is amended— 
(1) in subsection (a)(5), by striking ‘‘5-year ex-
tension period’’ and inserting ‘‘10-year extension pe-
riod’’; and 
(2) in subsection (g)— 
(A) in the subsection heading, by striking 
‘‘FIVE-YEAR’’ and inserting ‘‘TEN-YEAR’’; 
(B) in paragraph (1), by striking ‘‘addi-
tional 5-year’’ and inserting ‘‘additional 10- 
year’’; 
(C) by striking ‘‘5-year extension period’’ 
and inserting ‘‘10-year extension period’’ each 
place it appears; 
(D) in paragraph (4)(B)— 
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(i) in the matter preceding clause (i), 
by inserting ‘‘each 5-year period in’’ after 
‘‘hospital during’’; and 
(ii) in clause (i), by inserting ‘‘each 
applicable 5-year period in’’ after ‘‘the first 
day of’’; and 
(E) by adding at the end the following new 
paragraphs: 
‘‘(5) OTHER
HOSPITALS
IN
DEMONSTRATION 
PROGRAM.—During the second 5 years of the 10- 
year extension period, the Secretary shall apply the 
provisions of paragraph (4) to rural community hos-
pitals that are not described in paragraph (4) but 
are participating in the demonstration program 
under this section as of December 30, 2014, in a 
similar manner as such provisions apply to rural 
community hospitals described in paragraph (4). 
‘‘(6) EXPANSION OF DEMONSTRATION PROGRAM 
TO RURAL AREAS IN ANY STATE.— 
‘‘(A) IN GENERAL.—The Secretary shall, 
notwithstanding subsection (a)(2) or paragraph 
(2) of this subsection, not later than 120 days 
after the date of the enactment of this para-
graph, issue a solicitation for applications to se-
lect up to the maximum number of additional 
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rural community hospitals located in any State 
to participate in the demonstration program 
under this section for the second 5 years of the 
10-year extension period without exceeding the 
limitation under paragraph (3) of this sub-
section. 
‘‘(B) PRIORITY.—In determining which 
rural community hospitals that submitted an 
application pursuant to the solicitation under 
subparagraph (A) to select for participation in 
the demonstration program, the Secretary— 
‘‘(i) shall give priority to rural com-
munity hospitals located in one of the 20 
States with the lowest population densities 
(as determined by the Secretary using the 
2015 Statistical Abstract of the United 
States); and 
‘‘(ii) may consider— 
‘‘(I) closures of hospitals located 
in rural areas in the State in which 
the rural community hospital is lo-
cated during the 5-year period imme-
diately preceding the date of the en-
actment of this paragraph; and 
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‘‘(II) the population density of 
the State in which the rural commu-
nity hospital is located.’’. 
(b) CHANGE IN TIMING FOR REPORT.—Subsection 
(e) of such section 410A is amended— 
(1) by striking ‘‘Not later than 6 months after 
the completion of the demonstration program under 
this section’’ and inserting ‘‘Not later than August 
1, 2018’’; and 
(2) by striking ‘‘such program’’ and inserting 
‘‘the demonstration program under this section’’. 
SEC. 104. REGULATORY RELIEF FOR LTCHS. 
(a) TECHNICAL CHANGE TO THE MEDICARE LONG- 
TERM CARE HOSPITAL MORATORIUM EXCEPTION.— 
(1) IN
GENERAL.—Section 114(d)(7) of the 
Medicare, Medicaid, and SCHIP Extension Act of 
2007 (42 U.S.C. 1395ww note), as amended by sec-
tions 3106(b) and 10312(b) of Public Law 111–148, 
section 1206(b)(2) of the Pathway for SGR Reform 
Act of 2013 (division B of Public Law 113–67), and 
section 112 of the Protecting Access to Medicare Act 
of 2014, is amended by striking ‘‘The moratorium 
under paragraph (1)(A)’’ and inserting ‘‘Any mora-
torium under paragraph (1)’’. 
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(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall take effect as if included in 
the enactment of section 112 of the Protecting Ac-
cess to Medicare Act of 2014. 
(b) MODIFICATION TO MEDICARE LONG-TERM CARE 
HOSPITAL HIGH COST OUTLIER PAYMENTS.—Section 
1886(m) of the Social Security Act (42 U.S.C. 
1395ww(m)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(7) TREATMENT OF HIGH COST OUTLIER PAY-
MENTS.— 
‘‘(A) ADJUSTMENT
TO
THE
STANDARD 
FEDERAL
PAYMENT
RATE
FOR
ESTIMATED 
HIGH
COST
OUTLIER
PAYMENTS.—Under the 
system described in paragraph (1), for fiscal 
years beginning on or after October 1, 2017, 
the Secretary shall reduce the standard Federal 
payment rate as if the estimated aggregate 
amount of high cost outlier payments for stand-
ard Federal payment rate discharges for each 
such fiscal year would be equal to 8 percent of 
estimated aggregate payments for standard 
Federal payment rate discharges for each such 
fiscal year. 
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‘‘(B) LIMITATION ON HIGH COST OUTLIER 
PAYMENT
AMOUNTS.—Notwithstanding 
sub-
paragraph (A), the Secretary shall set the fixed 
loss amount for high cost outlier payments such 
that the estimated aggregate amount of high 
cost outlier payments made for standard Fed-
eral payment rate discharges for fiscal years be-
ginning on or after October 1, 2017, shall be 
equal to 99.6875 percent of 8 percent of esti-
mated aggregate payments for standard Fed-
eral payment rate discharges for each such fis-
cal year. 
‘‘(C) WAIVER OF BUDGET NEUTRALITY.— 
Any reduction in payments resulting from the 
application of subparagraph (B) shall not be 
taken into account in applying any budget neu-
trality provision under such system. 
‘‘(D) NO EFFECT ON SITE NEUTRAL HIGH 
COST
OUTLIER
PAYMENT
RATE.—This para-
graph shall not apply with respect to the com-
putation of the applicable site neutral payment 
rate under paragraph (6).’’. 
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SEC. 105. SAVINGS FROM IPPS MACRA PAY-FOR THROUGH 
NOT APPLYING DOCUMENTATION AND COD-
ING ADJUSTMENTS. 
Section 7(b)(1)(B)(iii) of the TMA, Abstinence Edu-
cation, and QI Programs Extension Act of 2007 (Public 
Law 110–90), as amended by section 631(b) of the Amer-
ican Taxpayer Relief Act of 2012 (Public Law 122–240) 
and section 414(1)(B)(iii) of the Medicare Access and 
CHIP Reauthorization Act of 2015 (Public Law 114–10), 
is amended by striking ‘‘0.5 percentage points’’ and insert-
ing ‘‘0.4590 percentage points’’. 
TITLE 
II—PROVISIONS 
RELAT-
ING TO MEDICARE PART B 
SEC. 201. CONTINUING MEDICARE PAYMENT UNDER HOPD 
PROSPECTIVE PAYMENT SYSTEM FOR SERV-
ICES 
FURNISHED 
BY 
OFF-CAMPUS 
OUT-
PATIENT 
DEPARTMENTS 
OF 
PROVIDERS 
UNDER DEVELOPMENT. 
(a) IN GENERAL.—Section 1833(t)(21) of the Social 
Security Act (42 U.S.C. 1395l(t)(21)) is amended— 
(1) in subparagraph (B)— 
(A) in clause (i), by striking ‘‘clause (ii)’’ 
and inserting ‘‘the subsequent provisions of this 
subparagraph’’; and 
(B) by adding at the end the following new 
clauses: 
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‘‘(iii) 
DEEMED
TREATMENT
FOR 
2017.—For purposes of applying clause (ii) 
with respect to applicable items and serv-
ices furnished during 2017, a department 
of a provider (as so defined) not described 
in such clause is deemed to be billing 
under this subsection with respect to cov-
ered OPD services furnished prior to No-
vember 2, 2015, if the Secretary received 
from the provider prior to December 2, 
2015, an attestation (pursuant to section 
413.65(b)(3) of title 42 of the Code of 
Federal Regulations) that such department 
was a department of a provider (as so de-
fined). 
‘‘(iv) ALTERNATIVE
EXCEPTION
BE-
GINNING
WITH
2018.—For purposes of 
paragraph (1)(B)(v) and this paragraph 
with respect to applicable items and serv-
ices furnished during 2018 or a subsequent 
year, the term ‘off-campus outpatient de-
partment of a provider’ also shall not in-
clude a department of a provider (as so de-
fined) that is not described in clause (ii) 
if— 
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‘‘(I) the Secretary receives from 
the provider an attestation (pursuant 
to such section 413.65(b)(3)) before 
July 1, 2016, that such department 
met the requirements of a department 
of a provider specified in section 
413.65 of title 42 of the Code of Fed-
eral Regulations; 
‘‘(II) the provider includes such 
department as part of the provider on 
its enrollment form in accordance with 
the enrollment process under section 
1866(j); and 
‘‘(III) before July 1, 2016, the 
department met the mid-build require-
ment of clause (v) and the Secretary 
receives from the chief executive offi-
cer or chief operating officer of the 
provider a written certification that 
the department met such requirement. 
‘‘(v) MID-BUILD
REQUIREMENT
DE-
SCRIBED.—The mid-build requirement of 
this clause is, with respect to a department 
of a provider, that before November 2, 
2015, the provider had a binding written 
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agreement with an outside unrelated party 
for the actual construction of such depart-
ment. 
‘‘(vi) AUDIT.—Not later than Decem-
ber 31, 2018, the Secretary shall audit the 
compliance with requirements of clause (iv) 
with respect to a department of a provider 
for which an attestation is submitted under 
such clause. If the Secretary finds as a re-
sult of an audit under this clause that the 
applicable requirements were not met with 
respect to such department, the depart-
ment shall not be excluded from the term 
‘off-campus outpatient department of a 
provider’ under the respective clause. 
‘‘(vii) IMPLEMENTATION.—For pur-
poses of implementing clauses (iii) through 
(vii): 
‘‘(I) Notwithstanding any other 
provision of law, the Secretary may 
implement such clauses by program 
instruction or otherwise. 
‘‘(II) Subchapter I of chapter 35 
of title 44, United States Code, shall 
not apply. 
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‘‘(III) For purposes of carrying 
out this subparagraph with respect to 
clauses (iii) and (iv) (and clause (vii) 
insofar as it relates to such clauses), 
the Secretary shall provide for the 
transfer 
from 
the 
Supplementary 
Medical Insurance Trust Fund under 
section 1841, of $10,000,000 to the 
Centers for Medicare & Medicaid 
Services Program Management Ac-
count to remain available until De-
cember 31, 2018.’’; and 
(2) in subparagraph (E), by adding at the end 
the following new clause: 
‘‘(iv) The determination of an audit 
under subparagraph (B)(vii).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall be effective as if included in the enact-
ment of section 603 of the Bipartisan Budget Act of 2015 
(Public Law 114–74). 
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SEC. 202. TREATMENT OF CANCER HOSPITALS IN OFF-CAM-
PUS OUTPATIENT DEPARTMENT OF A PRO-
VIDER POLICY. 
(a) IN GENERAL.—Section 1833(t)(21)(B) of the So-
cial Security Act (42 U.S.C. 1395l(t)(21)(B)), as amended 
by section 201(a), is amended— 
(1) by inserting after clause (v) the following 
new clause: 
‘‘(vi) EXCLUSION FOR CERTAIN CAN-
CER
HOSPITALS.—For purposes of para-
graph (1)(B)(v) and this paragraph with 
respect to applicable items and services 
furnished during 2017 or a subsequent 
year, the term ‘off-campus outpatient de-
partment of a provider’ also shall not in-
clude a department of a provider (as so de-
fined) that is not described in clause (ii) if 
the provider is a hospital described in sec-
tion 1886(d)(1)(B)(v) and— 
‘‘(I) in the case of a department 
that met the requirements of section 
413.65 of title 42 of the Code of Fed-
eral Regulations after November 1, 
2015, and before the date of the en-
actment of this clause, the Secretary 
receives from the provider an attesta-
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tion that such department met such 
requirements not later than 60 days 
after such date of enactment; or 
‘‘(II) in the case of a department 
that meets such requirements after 
such date of enactment, the Secretary 
receives from the provider an attesta-
tion that such department meets such 
requirements not later than 60 days 
after the date such requirements are 
first met with respect to such depart-
ment.’’; 
(2) in clause (vii), by inserting after the first 
sentence the following: ‘‘Not later than 2 years after 
the date the Secretary receives an attestation under 
clause (vi) relating to compliance of a department of 
a provider with requirements referred to in such 
clause, the Secretary shall audit the compliance with 
such requirements with respect to the department.’’; 
and 
(3) in clause (viii)(III), by adding at the end 
the following: ‘‘For purposes of carrying out this 
subparagraph with respect to clause (vi) (and clause 
(vii) insofar as it relates to such clause), the Sec-
retary shall provide for the transfer from the Sup-
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plementary Medical Insurance Trust Fund under 
section 1841, of $2,000,000 to the Centers for Medi-
care & Medicaid Services Program Management Ac-
count to remain available until expended.’’ 
(b) OFFSETTING SAVINGS.—Section 1833(t)(18) of 
the Social Security Act (42 U.S.C. 1395l(t)(18)) is 
amended— 
(1) in subparagraph (B), by inserting ‘‘, subject 
to subparagraph (C),’’ after ‘‘shall’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) TARGET PCR ADJUSTMENT.—In ap-
plying section 419.43(i) of title 42 of the Code 
of Federal Regulations to implement the appro-
priate adjustment under this paragraph for 
services furnished on or after January 1, 2018, 
the Secretary shall use a target PCR that is 1.0 
percentage points less than the target PCR that 
would otherwise apply. In addition to the per-
centage point reduction under the previous sen-
tence, the Secretary may consider making an 
additional percentage point reduction to such 
target PCR that takes into account payment 
rates for applicable items and services described 
in paragraph (21)(C) other than for services 
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furnished by hospitals described in section 
1886(d)(1)(B)(v). In making any budget neu-
trality adjustments under this subsection for 
2018 or a subsequent year, the Secretary shall 
not take into account the reduced expenditures 
that result from the application of this subpara-
graph.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall be effective as if included in the enact-
ment of section 603 of the Bipartisan Budget Act of 2015 
(Public Law 114–74). 
SEC. 203. TREATMENT OF ELIGIBLE PROFESSIONALS IN 
AMBULATORY 
SURGICAL 
CENTERS 
FOR 
MEANINGFUL USE AND MIPS. 
(a) IN GENERAL.—Section 1848(a)(7)(D) of the So-
cial Security Act (42 U.S.C. 1395w–4(a)(7)(D)) is amend-
ed— 
(1) by striking ‘‘HOSPITAL-BASED
ELIGIBLE 
PROFESSIONALS’’ and all that follows through ‘‘No 
payment’’ and inserting the following: ‘‘HOSPITAL- 
BASED AND AMBULATORY SURGICAL CENTER-BASED 
ELIGIBLE PROFESSIONALS.— 
‘‘(i) 
HOSPITAL-BASED.—No 
pay-
ment’’; and 
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(2) by adding at the end the following new 
clauses: 
‘‘(ii) AMBULATORY
SURGICAL
CEN-
TER-BASED.—Subject to clause (iv), no 
payment adjustment may be made under 
subparagraph (A) for 2017 and 2018 in 
the case of an eligible professional with re-
spect to whom substantially all of the cov-
ered professional services furnished by 
such professional are furnished in an am-
bulatory surgical center. 
‘‘(iii) DETERMINATION.—The deter-
mination of whether an eligible profes-
sional is an eligible professional described 
in clause (ii) may be made on the basis 
of— 
‘‘(I) the site of service (as de-
fined 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. 
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‘‘(iv) SUNSET.—Clause (ii) shall no 
longer apply as of the first year that be-
gins more than 3 years after the date on 
which the Secretary determines, through 
notice and comment rulemaking, that cer-
tified EHR technology applicable to the 
ambulatory surgical center setting is avail-
able.’’. 
(b) CONTINUED APPLICATION OF CERTAIN PROVI-
SIONS UNDER MIPS.—Section 1848(o)(2)(D) of the So-
cial Security Act (42 U.S.C. 1395w–4(o)(2)(D)) is amend-
ed by adding at the end the following new sentence: ‘‘The 
provisions of subparagraphs (B) and (D) of subsection 
(a)(7), including the application of clause (iv) of such sub-
paragraph (D), shall apply to assessments of MIPS eligi-
ble professionals under subsection (q) with respect to the 
performance category described in subsection (q)(2)(A)(iv) 
in a manner similar to the manner in which such provi-
sions apply with respect to payment adjustments made 
under subsection (a)(7)(A).’’. 
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TITLE III—OTHER MEDICARE 
PROVISIONS 
SEC. 301. DELAY IN AUTHORITY TO TERMINATE CON-
TRACTS FOR MEDICARE ADVANTAGE PLANS 
FAILING TO ACHIEVE MINIMUM QUALITY 
RATINGS. 
(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 
populations on the Medicare Advantage STARS rat-
ing 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 con-
tracts solely on the basis of performance of plans 
under the STARS rating system. 
(b) DELAY IN MA CONTRACT TERMINATION AU-
THORITY FOR PLANS FAILING TO ACHIEVE MINIMUM 
QUALITY RATINGS.—Section 1857(h) of the Social Secu-
rity Act (42 U.S.C. 1395w–27(h)) is amended by adding 
at the end the following new paragraph: 
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‘‘(3) DELAY IN CONTRACT TERMINATION AU-
THORITY FOR PLANS FAILING TO ACHIEVE MINIMUM 
QUALITY RATING.—During the period beginning on 
the date of enactment of this paragraph and through 
the end of plan year 2018, the Secretary may not 
terminate a contract under this section with respect 
to the offering of an MA plan by a Medicare Advan-
tage 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. 302. REQUIREMENT FOR ENROLLMENT DATA REPORT-
ING 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 RE-
PORTING.— 
‘‘(1) IN GENERAL.—Each year (beginning with 
2016), the Secretary shall submit to the Committees 
on Ways and Means and Energy and Commerce of 
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 
individuals receiving benefits under such part) as of 
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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 en-
rollment (including receipt of benefits other than 
through enrollment) under— 
‘‘(A) part A only; 
‘‘(B) part B only; and 
‘‘(C) both part A and part B.’’. 
SEC. 303. 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 
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described 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 
include information, presented in a clear and simple man-
ner, about options for receiving benefits under the Medi-
care program under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.), including through the original 
medicare 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.), Medicare 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 Secretary shall make subsequent updates to the infor-
mation included in the Welcome to Medicare package as 
appropriate. 
(b) REQUEST FOR INFORMATION.—Not later than six 
months after the date of the enactment of this Act, the 
Secretary of Health and Human Services shall request in-
formation, including recommendations, from stakeholders 
(including patient advocates, issuers, and employers) on 
information included in the Welcome to Medicare package, 
including pertinent data and information regarding enroll-
ment and coverage for Medicare eligible individuals. 
Æ 
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