order to provide access to longitudinal informa-
tion for such providers to facilitate coordinated 
care and improved Medicare beneficiary out-
comes; and 
‘‘(C) in accordance with subsections (b)(1) 
and (c)(2), modify PAC assessment instruments 
(as defined in paragraph (2)(B)) applicable to 
post-acute care providers to— 
‘‘(i) provide for the submission of 
standardized 
patient 
assessment 
data 
under this title with respect to such pro-
viders; and 
‘‘(ii) enable comparison of such as-
sessment data across all such providers to 
whom such data are applicable. 
‘‘(2) DEFINITIONS.—For purposes of this sec-
tion: 
‘‘(A) 
POST-ACUTE
CARE
(PAC)
PRO-
VIDER.—The terms ‘post-acute care provider’ 
and ‘PAC provider’ mean— 
‘‘(i) a home health agency; 
‘‘(ii) a skilled nursing facility; 
‘‘(iii) an inpatient rehabilitation facil-
ity; and 
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‘‘(iv) a long-term care hospital (other 
than a hospital classified under section 
1886(d)(1)(B)(iv)(II)). 
‘‘(B) PAC ASSESSMENT
INSTRUMENT.— 
The 
term 
‘PAC 
assessment 
instrument’ 
means— 
‘‘(i) in the case of home health agen-
cies, the instrument used for purposes of 
reporting and assessment with respect to 
the Outcome and Assessment Information 
Set (OASIS), as described in sections 
484.55 and 484.250 of title 42, the Code 
of Federal Regulations, or any successor 
regulation, or any other instrument used 
with respect to home health agencies for 
such purposes; 
‘‘(ii) in the case of skilled nursing fa-
cilities, the resident’s assessment under 
section 1819(b)(3); 
‘‘(iii) in the case of inpatient rehabili-
tation facilities, any Medicare beneficiary 
assessment instrument established by the 
Secretary for purposes of section 1886(j); 
and 
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‘‘(iv) in the case of long-term care 
hospitals, the Medicare beneficiary assess-
ment instrument used with respect to such 
hospitals for the collection of data elements 
necessary to calculate quality measures as 
described in the August 18, 2011, Federal 
Register (76 Fed. Reg. 51754–51755), in-
cluding 
for 
purposes 
of 
section 
1886(m)(5)(C), or any other instrument 
used with respect to such hospitals for 
such purposes. 
‘‘(C) 
APPLICABLE
REPORTING
PROVI-
SION.—The term ‘applicable reporting provi-
sion’ means— 
‘‘(i) for home health agencies, section 
1895(b)(3)(B)(v); 
‘‘(ii) for skilled nursing facilities, sec-
tion 1888(e)(6); 
‘‘(iii) for inpatient rehabilitation facili-
ties, section 1886(j)(7); and 
‘‘(iv) for long-term care hospitals, sec-
tion 1886(m)(5). 
‘‘(D) PAC PAYMENT SYSTEM.—The term 
‘PAC payment system’ means— 
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‘‘(i) with respect to a home health 
agency, the prospective payment system 
under section 1895; 
‘‘(ii) with respect to a skilled nursing 
facility, the prospective payment system 
under section 1888(e); 
‘‘(iii) with respect to an inpatient re-
habilitation facility, the prospective pay-
ment system under section 1886(j); and 
‘‘(iv) with respect to a long-term care 
hospital, the prospective payment system 
under section 1886(m). 
‘‘(E) SPECIFIED APPLICATION DATE.—The 
term ‘specified application date’ means the fol-
lowing: 
‘‘(i) QUALITY
MEASURES.—In the 
case of quality measures under subsection 
(c)(1)— 
‘‘(I) with respect to the domain 
described in subsection (c)(1)(A) (re-
lating to functional status, cognitive 
function, and changes in function and 
cognitive function)— 
‘‘(aa) for PAC providers de-
scribed in clauses (ii) and (iii) of 
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paragraph (2)(A), October 1, 
2016; 
‘‘(bb) for PAC providers de-
scribed in clause (iv) of such 
paragraph, October 1, 2018; and 
‘‘(cc) for PAC providers de-
scribed in clause (i) of such para-
graph, January 1, 2019; 
‘‘(II) with respect to the domain 
described in subsection (c)(1)(B) (re-
lating to skin integrity and changes in 
skin integrity)— 
‘‘(aa) for PAC providers de-
scribed in clauses (ii), (iii), and 
(iv) of paragraph (2)(A), October 
1, 2016; and 
‘‘(bb) for PAC providers de-
scribed in clause (i) of such para-
graph, January 1, 2017; 
‘‘(III) with respect to the domain 
described in subsection (c)(1)(C) (re-
lating to medication reconciliation)— 
‘‘(aa) for PAC providers de-
scribed in clause (i) of such para-
graph, January 1, 2017; and 
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‘‘(bb) for PAC providers de-
scribed in clauses (ii), (iii), and 
(iv) of such paragraph, October 
1, 2018; 
‘‘(IV) with respect to the domain 
described in subsection (c)(1)(D) (re-
lating to incidence of major falls)— 
‘‘(aa) for PAC providers de-
scribed in clauses (ii), (iii), and 
(iv) of paragraph (2)(A), October 
1, 2016; and 
‘‘(bb) for PAC providers de-
scribed in clause (i) of such para-
graph, January 1, 2019; and 
‘‘(V) with respect to the domain 
described in subsection (c)(1)(E) (re-
lating to accurately communicating 
the existence of and providing for the 
transfer of health information and 
care preferences)— 
‘‘(aa) for PAC providers de-
scribed in clauses (ii), (iii), and 
(iv) of paragraph (2)(A), October 
1, 2018; and 
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‘‘(bb) for PAC providers de-
scribed in clause (i) of such para-
graph, January 1, 2019. 
‘‘(ii) RESOURCE
USE
AND
OTHER 
MEASURES.—In the case of resource use 
and other measures under subsection 
(d)(1)— 
‘‘(I) for PAC providers described 
in clauses (ii), (iii), and (iv) of para-
graph (2)(A), October 1, 2016; and 
‘‘(II) for PAC providers de-
scribed in clause (i) of such para-
graph, January 1, 2017. 
‘‘(F) MEDICARE BENEFICIARY.—The term 
‘Medicare beneficiary’ means an individual enti-
tled to benefits under part A or, as appropriate, 
enrolled for benefits under part B. 
‘‘(b) STANDARDIZED PATIENT ASSESSMENT DATA.— 
‘‘(1) REQUIREMENT FOR REPORTING ASSESS-
MENT DATA.— 
‘‘(A) IN
GENERAL.—Beginning not later 
than October 1, 2018, for PAC providers de-
scribed in clauses (ii), (iii), and (iv) of sub-
section (a)(2)(A) and January 1, 2019, for 
PAC providers described in clause (i) of such 
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subsection, the Secretary shall require PAC 
providers to submit to the Secretary, under the 
applicable reporting provisions and through the 
use of PAC assessment instruments, the stand-
ardized patient assessment data described in 
subparagraph (B). The Secretary shall require 
such data be submitted with respect to admis-
sion and discharge of an individual (and may be 
submitted more frequently as the Secretary 
deems appropriate). 
‘‘(B) STANDARDIZED
PATIENT
ASSESS-
MENT DATA DESCRIBED.—For purposes of sub-
paragraph (A), the standardized patient assess-
ment data described in this subparagraph is 
data required for at least the quality measures 
described in subsection (c)(1) and that is with 
respect to the following categories: 
‘‘(i) Functional status, such as mobil-
ity, self care, and history of major falls— 
‘‘(I) in the period immediately 
prior to the reason for acute hos-
pitalization; or 
‘‘(II) in the case of no antecedent 
acute hospitalization, in the period 
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prior to the use of post-acute care 
services. 
‘‘(ii) Cognitive function, such as abil-
ity to express ideas and to understand, and 
mental status, such as depression and de-
mentia. 
‘‘(iii) Special services, treatments, and 
interventions, such as need for ventilator 
use, dialysis, chemotherapy, central line 
placement, and total parenteral nutrition. 
‘‘(iv) Medical conditions and co- 
morbidities, such as diabetes, congestive 
heart failure, and pressure ulcers. 
‘‘(v) Impairments, such as inconti-
nence and an impaired ability to hear, see, 
or swallow. 
‘‘(vi) Other categories deemed nec-
essary and appropriate by the Secretary. 
‘‘(2) ALIGNMENT
OF
CLAIMS
DATA
WITH 
STANDARDIZED
PATIENT
ASSESSMENT
DATA.—To 
the extent practicable, not later than October 1, 
2018, for PAC providers described in clauses (ii), 
(iii), and (iv) of subsection (a)(2)(A), and January 
1, 2019, for PAC providers described in clause (i) of 
such subsection, the Secretary shall match claims 
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data with assessment data pursuant to this section 
for purposes of assessing prior service use and con-
current service use, such as antecedent hospital or 
PAC provider use, and may use such matched data 
for such other uses as the Secretary determines ap-
propriate. 
‘‘(3) REPLACEMENT
OF
CERTAIN
EXISTING 
DATA ELEMENTS.—In the case of patient assessment 
data being used with respect to a PAC assessment 
instrument that duplicates or overlaps with stand-
ardized patient assessment data within a category 
described in paragraph (1), the Secretary shall, as 
soon as practicable, revise or replace such existing 
data with the standardized data. 
‘‘(4) CLARIFICATION.—Standardized patient as-
sessment data submitted pursuant to this subsection 
shall not be used to require individuals to be pro-
vided post-acute care by a specific type of PAC pro-
vider in order for such care to be eligible for pay-
ment under this title. 
‘‘(c) QUALITY MEASURES.— 
‘‘(1) REQUIREMENT FOR REPORTING QUALITY 
MEASURES.—Not later than the specified application 
date, as applicable to measures and PAC providers, 
the Secretary shall specify quality measures on 
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which PAC providers are required under the applica-
ble reporting provisions to submit standardized pa-
tient assessment data described in subsection (b)(1) 
and other necessary data specified by the Secretary. 
Such measures shall be with respect to at least the 
following domains: 
‘‘(A) Functional status, cognitive function, 
and changes in function and cognitive function. 
‘‘(B) Skin integrity and changes in skin in-
tegrity. 
‘‘(C) Medication reconciliation. 
‘‘(D) Incidence of major falls. 
‘‘(E) Accurately communicating the exist-
ence of and providing for the transfer of health 
information and care preferences of an indi-
vidual to the individual, family caregiver of the 
individual, and providers of services furnishing 
items and services to the individual, when the 
individual transitions— 
‘‘(i) from a hospital or critical access 
hospital to another applicable setting, in-
cluding a PAC provider or the home of the 
individual; or 
‘‘(ii) from a PAC provider to another 
applicable setting, including a different 
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PAC provider, a hospital, a critical access 
hospital, or the home of the individual. 
‘‘(2) REPORTING
THROUGH
PAC
ASSESSMENT 
INSTRUMENTS.— 
‘‘(A) IN
GENERAL.—To the extent pos-
sible, the Secretary shall require such reporting 
by a PAC provider of quality measures under 
paragraph (1) through the use of a PAC assess-
ment instrument and shall modify such PAC 
assessment instrument as necessary to enable 
the use of such instrument with respect to such 
quality measures. 
‘‘(B) LIMITATION.—The Secretary may 
not make significant modifications to a PAC as-
sessment instrument more than once per cal-
endar year or fiscal year, as applicable, unless 
the Secretary publishes in the Federal Register 
a justification for such significant modification. 
‘‘(3) ADJUSTMENTS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
consider applying adjustments to the quality 
measures under this subsection taking into con-
sideration the studies under section 2(d) of the 
IMPACT Act of 2014. 
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‘‘(B) RISK
ADJUSTMENT.—Such quality 
measures shall be risk adjusted, as determined 
appropriate by the Secretary. 
‘‘(d) RESOURCE USE AND OTHER MEASURES.— 
‘‘(1) REQUIREMENT FOR RESOURCE USE AND 
OTHER MEASURES.—Not later than the specified ap-
plication date, as applicable to measures and PAC 
providers, the Secretary shall specify resource use 
and other measures on which PAC providers are re-
quired under the applicable reporting provisions to 
submit any necessary data specified by the Sec-
retary, which may include standardized assessment 
data in addition to claims data. Such measures shall 
be with respect to at least the following domains: 
‘‘(A) Resource use measures, including 
total estimated Medicare spending per bene-
ficiary. 
‘‘(B) Discharge to community. 
‘‘(C) Measures to reflect all-condition risk- 
adjusted potentially preventable hospital read-
mission rates. 
‘‘(2) 
ALIGNING
METHODOLOGY
ADJUST-
MENTS.— 
‘‘(A) LENGTH OF EPISODE.—With respect 
to the length of an episode, the Secretary shall, 
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to the extent the Secretary determines appro-
priate, align resource use and other measures 
specified under this subsection with respect to 
the domain described in paragraph (1)(A) with 
the methodology used for purposes of section 
1886(o)(2)(B)(ii). 
‘‘(B) GEOGRAPHIC
AND
OTHER
ADJUST-
MENTS.—The Secretary shall standardize meas-
ures with respect to the domain described in 
paragraph (1)(A) for geographic payment rate 
differences and payment differentials (and other 
adjustments, as applicable) consistent with the 
methodology published in the Federal Register 
on August 18, 2011 (76 Fed. Reg. 51624 
through 51626), or any subsequent modifica-
tions made to the methodology. 
‘‘(C) MEDICARE
SPENDING
PER
BENE-
FICIARY.—The Secretary shall adjust, as appro-
priate, measures with respect to the domain de-
scribed in paragraph (1)(A) for the factors ap-
plied under section 1886(o)(2)(B)(ii). 
‘‘(3) ADJUSTMENTS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
consider applying adjustments to the resource 
use and other measures specified under this 
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subsection with respect to the domain described 
in paragraph (1)(A), taking into consideration 
the studies under section 2(d) of the IMPACT 
Act of 2014. 
‘‘(B) RISK ADJUSTMENT.—Such resource 
use and other measures shall be risk adjusted, 
as determined appropriate by the Secretary. 
‘‘(e) MEASUREMENT IMPLEMENTATION PHASES; SE-
LECTION OF QUALITY MEASURES AND RESOURCE USE 
AND OTHER MEASURES.— 
‘‘(1) 
MEASUREMENT
IMPLEMENTATION 
PHASES.—In the case of quality measures specified 
under subsection (c)(1) and resource use and other 
measures specified under subsection (d)(1), the pro-
visions of this section shall be implemented in ac-
cordance with the following phases: 
‘‘(A) INITIAL IMPLEMENTATION PHASE.— 
The initial implementation phase, with respect 
to such a measure, shall, in accordance with 
subsections (c) and (d), as applicable, consist 
of— 
‘‘(i) measure specification, including 
informing the public of the measure’s nu-
merator, denominator, exclusions, and any 
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other aspects the Secretary determines 
necessary; 
‘‘(ii) data collection, including, in the 
case of quality measures, requiring PAC 
providers to report data elements needed 
to calculate such a measure; and 
‘‘(iii) data analysis, including, in the 
case of resource use and other measures, 
the use of claims data to calculate such a 
measure. 
‘‘(B) SECOND IMPLEMENTATION PHASE.— 
The second implementation phase, with respect 
to such a measure, shall consist of the provision 
of feedback reports to PAC providers, in ac-
cordance with subsection (f). 
‘‘(C) THIRD
IMPLEMENTATION
PHASE.— 
The third implementation phase, with respect to 
such a measure, shall consist of public reporting 
of PAC providers’ performance on such meas-
ure in accordance with subsection (g). 
‘‘(2) CONSENSUS-BASED ENTITY.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), each measure specified by the Sec-
retary under this section shall be endorsed by 
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the entity with a contract under section 
1890(a). 
‘‘(B) EXCEPTION.—In the case of a speci-
fied area or medical topic determined appro-
priate by the Secretary for which a feasible and 
practical measure has not been endorsed by the 
entity with a contract under section 1890(a), 
the Secretary may specify a measure that is not 
so endorsed as long as due consideration is 
given to measures that have been endorsed or 
adopted by a consensus organization identified 
by the Secretary. 
‘‘(3) TREATMENT
OF
APPLICATION
OF
PRE- 
RULEMAKING
PROCESS
(MEASURE
APPLICATIONS 
PARTNERSHIP PROCESS).— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the provisions of section 1890A shall 
apply in the case of a quality measure specified 
under subsection (c) or a resource use or other 
measure specified under subsection (d). 
‘‘(B) EXCEPTIONS.— 
‘‘(i) EXPEDITED
PROCEDURES.—For 
purposes of satisfying subparagraph (A), 
the Secretary may use expedited proce-
dures, such as ad-hoc reviews, as nec-
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essary, in the case of a quality measure 
specified under subsection (c) or a resource 
use or other measure specified in sub-
section (d) required with respect to data 
submissions under the applicable reporting 
provisions before one year after the speci-
fied application date applicable to such a 
measure and provider involved. 
‘‘(ii) 
OPTION
TO
WAIVE
PROVI-
SIONS.—The Secretary may waive the ap-
plication of the provisions of section 1890A 
in the case of a quality measure or re-
source use or other measure described in 
clause (i), if the application of such provi-
sions (including through the use of an ex-
pedited procedure described in such clause) 
would result in the inability of the Sec-
retary to satisfy any deadline specified in 
this section with respect to such measure. 
‘‘(f) FEEDBACK REPORTS TO PAC PROVIDERS.— 
‘‘(1) IN GENERAL.—Beginning one year after 
the specified application date, as applicable to PAC 
providers and quality measures and resource use and 
other measures under this section, the Secretary, in-
cluding through a process consistent with the proc-
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ess applied under section 1886(b)(3)(B)(viii)(VII) 
for similar purposes, shall provide confidential feed-
back reports to such PAC providers on the perform-
ance of such providers with respect to such measures 
required under the applicable provisions. 
‘‘(2) FREQUENCY.—To the extent feasible, the 
Secretary shall provide feedback reports described in 
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 annual 
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. 
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‘‘(2) OPPORTUNITY
TO
REVIEW.—The proce-
dures under paragraph (1) shall ensure that a PAC 
provider has the opportunity to review and submit 
corrections to the data and information that is to be 
made public with respect 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). 
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‘‘(D) In the case of long-term care hos-
pitals, section 1886(m)(5)(E). 
‘‘(h) REMOVING, SUSPENDING, OR ADDING MEAS-
URES.— 
‘‘(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 con-
cerns, the Secretary may promptly suspend or re-
move such measure and satisfy paragraph (1) by 
publishing in the Federal Register a justification for 
such suspension or removal in the next rulemaking 
cycle following 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 MEDICARE BENEFICIARY PREFERENCE.— 
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‘‘(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-
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 such PAC providers, patients, and 
families of such patients with discharge planning 
from inpatient settings, including subsection (d) hos-
pitals, critical access hospitals, and hospitals de-
scribed in section 1886(d)(1)(B)(v), and from PAC 
provider settings. In addition, such regulations and 
interpretive guidance shall include procedures to ad-
dress— 
‘‘(A) treatment preferences of patients; 
and 
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‘‘(B) goals of care of patients. 
‘‘(2) DISCHARGE PLANNING.—All requirements 
applied pursuant to paragraph (1) shall be used to 
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. 
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‘‘(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-
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- 
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acute care payment system under title XVIII of the 
Social Security Act that establishes, payment rates 
according to characteristics of individuals (such as 
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 payments 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 
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payment system under title XVIII of the 
Social Security Act that would— 
(I) in lieu of the rates that would 
otherwise apply under PAC payments 
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 
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(IV) further clinical integration, 
such as by motivating greater coordi-
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 
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(v) a review of the value of subsection 
(d) 
hospitals 
(as 
defined 
in 
section 
1886(d)(1)(B) of the Social Security Act 
(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)) colleting and re-
porting 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 
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that would satisfy the criteria described in sub-
paragraph (A). 
(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 
(IV)(cc), 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 
subclause: 
‘‘(IV) 
SUBMISSION
OF
ADDI-
TIONAL DATA.— 
‘‘(aa) 
IN
GENERAL.—For 
the year beginning on the speci-
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fied application date (as defined 
in subsection (a)(2)(E) of section 
1899B), as applicable with re-
spect to home health agencies 
and quality measures under sub-
section (c)(1) of such section and 
measures under subsection (d)(1) 
of such section, and each subse-
quent year, each home health 
agency shall submit to the Sec-
retary data on such quality meas-
ures and any necessary data 
specified by the Secretary under 
such subsection (d)(1). 
‘‘(bb) STANDARDIZED
PA-
TIENT ASSESSMENT DATA.—For 
2019 and each subsequent year, 
in addition to such data de-
scribed in item (aa), each home 
health agency shall submit to the 
Secretary standardized patient 
assessment data required under 
subsection 
(b)(1) 
of 
section 
1899B. 
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‘‘(cc) NON-DUPLICATION.— 
To the extent such standardized 
data under subsection (b)(1) of 
such section 1899B, data on 
quality measures required under 
subsection (c)(1) of such section, 
or necessary data required under 
subsection (d)(1) of such section 
are duplicative of any other data 
required to be reported under 
this subclause, the submission of 
such standardized data, data on 
such quality measures, or nec-
essary data, respectively, shall be 
required under this subclause in 
lieu of the submission of such 
other data. 
‘‘(dd) 
SUBMISSION.—Such 
data shall be submitted in the 
form and manner, and at the 
time, specified by the Secretary 
for purposes of subclause (II).’’. 
(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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(A) in subparagraph (A)(i), by striking 
‘‘subparagraph (C)’’ and inserting ‘‘subpara-
graphs (C) and (F)’’; 
(B) in subparagraph (C), by striking ‘‘For 
fiscal year’’ and inserting ‘‘Subject to subpara-
graph (F)(iii), for fiscal year’’; 
(C) in subparagraph (E), by inserting 
‘‘and subparagraph (F)(i)’’ after ‘‘subpara-
graph (C)’’; and 
(D) by adding at the end the following new 
subparagraph: 
‘‘(F) SUBMISSION OF ADDITIONAL DATA.— 
‘‘(i) IN GENERAL.—For the fiscal year 
beginning on the specified application date 
(as defined in subsection (a)(2)(E) of sec-
tion 1899B), as applicable with respect to 
inpatient rehabilitation facilities and qual-
ity measures under subsection (c)(1) of 
such section and measures under sub-
section (d)(1) of such section, and each 
subsequent fiscal year, in addition to such 
data on the quality measures described in 
subparagraph (C), each rehabilitation facil-
ity shall submit to the Secretary data on 
the quality measures under such subsection 
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(c)(1) and any necessary data specified by 
the Secretary under such subsection (d)(1). 
‘‘(ii) STANDARDIZED
PATIENT
AS-
SESSMENT
DATA.—For fiscal year 2019 
and each subsequent fiscal year, in addi-
tion to such data described in clause (i), 
each rehabilitation facility shall submit to 
the Secretary standardized patient assess-
ment data required under subsection (b)(1) 
of section 1899B. 
‘‘(iii) NON-DUPLICATION.—To the ex-
tent such standardized data under sub-
section (b)(1) of such section 1899B, data 
on quality measures required under sub-
section (c)(1) of such section, or necessary 
data required under subsection (d)(1) of 
such section are duplicative of any other 
data required to be reported under this 
subparagraph, the submission of such 
standardized data, data on such quality 
measures, or necessary data, respectively, 
shall be required under this subparagraph 
in lieu of the submission of such other 
data. 
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‘‘(iv) SUBMISSION.—Such data shall 
be submitted in the form and manner, and 
at the time, specified by the Secretary for 
purposes of subparagraph (C).’’. 
(3) LONG-TERM
CARE
HOSPITALS.—Section 
1886(m)(5) of the Social Security Act (42 U.S.C. 
1395ww(m)(5)) is amended— 
(A) in subparagraph (A)(i), by striking 
‘‘subparagraph (C)’’ and inserting ‘‘subpara-
graphs (C) and (F)’’; 
(B) in subparagraph (C), by striking ‘‘For 
rate year’’ and inserting ‘‘Subject to subpara-
graph (F)(iii), for rate year’’; 
(C) in subparagraph (E), by inserting 
‘‘and subparagraph (F)(i)’’ after ‘‘subpara-
graph (C)’’; and 
(D) by adding at the end the following new 
subparagraph: 
‘‘(F) SUBMISSION OF ADDITIONAL DATA.— 
‘‘(i) IN GENERAL.—For the rate year 
beginning on the specified application date 
(as defined in subsection (a)(2)(E) of sec-
tion 1899B), as applicable with respect to 
long-term care hospitals and quality meas-
ures under subsection (c)(1) of such sec-
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tion and measures under subsection (d)(1) 
of such section, and each subsequent rate 
year, in addition to the data on the quality 
measures described in subparagraph (C), 
each long-term care hospital (other than a 
hospital 
classified 
under 
subsection 
(b)(3)(B)(iv)(II)) shall submit to the Sec-
retary data on the quality measures under 
such subsection (c)(1) and any necessary 
data specified by the Secretary under such 
subsection (d)(1). 
‘‘(ii) STANDARDIZED
PATIENT
AS-
SESSMENT DATA.—For rate year 2019 and 
each subsequent rate year, in addition to 
such data described in clause (i), each 
long-term care hospital (other than a hos-
pital 
classified 
under 
subsection 
(b)(3)(B)(iv)(II)) shall submit to the Sec-
retary standardized patient assessment 
data required under subsection (b)(1) of 
section 1899B. 
‘‘(iii) NON-DUPLICATION.—To the ex-
tent such standardized data under sub-
section (b)(1) of such section 1899B, data 
on quality measures required under sub-
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section (c)(1) of such section, or necessary 
data required under subsection (d)(1) of 
such section are duplicative of any other 
data required to be reported under this 
subparagraph, the submission of such 
standardized data, data on such quality 
measures, or necessary data, respectively, 
shall be required under this subparagraph 
in lieu of the submission of such other 
data. 
‘‘(iv) SUBMISSION.—Such data shall 
be submitted in the form and manner, and 
at the time, specified by the Secretary for 
purposes of subparagraph (C).’’. 
(4) SKILLED NURSING FACILITIES.— 
(A) IN GENERAL.—Paragraph (6) of sec-
tion 1888(e) of the Social Security Act is 
amended to read as follows: 
‘‘(6) REPORTING OF ASSESSMENT AND QUALITY 
DATA.— 
‘‘(A) REDUCTION IN UPDATE FOR FAILURE 
TO REPORT.— 
‘‘(i) IN
GENERAL.—For fiscal years 
beginning on or after the specified applica-
tion 
date 
(as 
defined 
in 
subsection 
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(a)(2)(E) of section 1899B), as applicable 
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, in the 
case of a skilled nursing facility that does 
not submit, in accordance with subpara-
graph (B) with respect to such a fiscal 
year, data on the quality measures speci-
fied under such subsection (c)(1), any nec-
essary data specified by the Secretary 
under such subsection (d)(1), and (for fis-
cal years beginning on or after October 1, 
2018) standardized patient assessment 
data specified under subsection (b)(1) of 
such section, after determining the per-
centage 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), 
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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.— 
‘‘(i) IN GENERAL.—A skilled nursing 
facility, or a facility described in paragraph 
(7)(B), shall submit to the Secretary, in a 
manner and within the timeframes pre-
scribed by the Secretary— 
‘‘(I) 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-
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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-
ardized patient assessment data re-
quired under subsection (b)(1) of sec-
tion 1899B. 
To the extent such standardized data 
under subsection (b)(1) of such section, 
data on quality measures required under 
subsection (c)(1) of such section, or nec-
essary data required under subsection 
(d)(1) of such section are duplicative of 
any other data required to be reported 
under this subparagraph, the submission of 
such standardized data, data on such qual-
ity measures, or necessary data, respec-
tively, shall be required under this sub-
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paragraph in lieu of the submission of such 
other data. 
‘‘(ii) USE
OF
STANDARD
INSTRU-
MENT.—For purposes of meeting the re-
quirement under clause (i), a skilled nurs-
ing facility, or a facility described in para-
graph (7)(B), may submit the resident as-
sessment data required under section 
1819(b)(3), using the standard instrument 
designated by the State under section 
1819(e)(5).’’. 
(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).’’. 
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(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.— 
(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 
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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, 
the Secretary shall submit to Congress a 
report on the study conducted under clause 
(i). 
(B) STUDY USING OTHER DATA.— 
(i) STUDY.—The Secretary shall con-
duct a study that examines the impact of 
risk factors, such as those described in sec-
tion 1848(p)(3) of the Social Security Act 
(42 U.S.C. 1395w–4(p)(3)), race, health 
literacy, limited English proficiency (LEP), 
and Medicare beneficiary activation, on 
quality measures and resource use and 
other measures under the Medicare pro-
gram (such as to recognize that less 
healthy individuals may require more in-
tensive interventions). In conducting such 
study the Secretary may use existing Fed-
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eral data and collect such additional data 
as may be necessary to complete the study. 
(ii) REPORT.—Not later than 5 years 
after the date of the enactment of this Act, 
the Secretary shall submit to Congress a 
report on the study conducted under clause 
(i). 
(C) EXAMINATION
OF
DATA
IN
CON-
DUCTING STUDIES.—In conducting the studies 
under subparagraphs (A) and (B), the Sec-
retary shall examine what non-Medicare data 
sets, such as data from the American Commu-
nity Survey (ACS), can be useful in conducting 
the types of studies under such paragraphs and 
how such data sets that are identified as useful 
can be coordinated with Medicare administra-
tive data in order to improve the overall data 
set available to do such studies and for the ad-
ministration of the Medicare program. 
(D) RECOMMENDATIONS TO ACCOUNT FOR 
INFORMATION
IN
PAYMENT
ADJUSTMENT 
MECHANISMS.—If the studies conducted under 
subparagraphs (A) and (B) find a relationship 
between the factors examined in the studies and 
quality measures and resource use and other 
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measures, then the Secretary shall also provide 
recommendations for how the Centers for Medi-
care & Medicaid Services should— 
(i) obtain access to the necessary data 
(if such data is not already being collected) 
on such factors, including recommenda-
tions on how to address barriers to the 
Centers in accessing such data; and 
(ii) account for such factors— 
(I) in quality measures, resource 
use measures, and other measures 
under subsections (c) and (d) of sec-
tion 1899B of the Social Security Act, 
as added by subsection (a), and under 
other applicable provisions of title 
XVIII of such Act (42 U.S.C. 1395 et 
seq.); and 
(II) in determining payment ad-
justments based on such measures in 
other applicable provisions of such 
title. 
(E) FUNDING.—There are hereby appro-
priated to the Secretary from the Federal Hos-
pital Insurance Trust Fund under section 1817 
of the Social Security Act (42 U.S.C. 1395i) 
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and the Federal Supplementary Medical Insur-
ance Trust Fund under section 1841 of such 
Act (42 U.S.C. 1395t) (in proportions deter-
mined appropriate by the Secretary) to carry 
out this paragraph $6,000,000, to remain avail-
able until expended. 
(2) CMS ACTIVITIES.— 
(A) IN
GENERAL.—Taking into account 
the 
relevant 
studies 
conducted 
and 
rec-
ommendations made in reports under para-
graph (1) and, as appropriate, other informa-
tion, including information collected before com-
pletion of such studies and recommendations, 
the Secretary, on an ongoing basis, shall, as the 
Secretary determines appropriate and based on 
an individual’s health status and other fac-
tors— 
(i) assess appropriate adjustments to 
quality measures, resource use measures, 
and other measures under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et 
seq.) (including measures specified in sub-
sections (c) and (d) of section 1899B of 
such Act, as added by subsection (a)); and 
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(ii) assess and implement appropriate 
adjustments to payments under such title. 
(B) ACCESSING
DATA.—The Secretary 
shall collect or otherwise obtain access to the 
data necessary to carry out this paragraph 
through existing and new data sources. 
(C) PERIODIC ANALYSES.—The Secretary 
shall carry out periodic analyses, at least every 
3 years, based on the factors referred to in sub-
paragraph (A) so as to monitor changes in pos-
sible relationships. 
(D) FUNDING.—There are hereby appro-
priated to the Secretary from the Federal Hos-
pital Insurance Trust Fund under section 1817 
of the Social Security Act (42 U.S.C. 1395i) 
and the Federal Supplementary Medical Insur-
ance Trust Fund under section 1841 of such 
Act (42 U.S.C. 1395t) (in proportions deter-
mined appropriate by the Secretary) to carry 
out this paragraph $10,000,000, to remain 
available until expended. 
(3) STRATEGIC
PLAN
FOR
ACCESSING
RACE 
AND ETHNICITY DATA.—Not later than 18 months 
after the date of the enactment of this Act, the Sec-
retary shall develop and report to Congress on a 
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strategic plan for collecting or otherwise accessing 
data on race and ethnicity for purposes of specifying 
quality measures and resource use and other meas-
ures under subsections (c) and (d) of section 1899B 
of the Social Security Act, as added by subsection 
(a), and, as the Secretary determines appropriate, 
other similar provision of, including payment adjust-
ments under, title XVIII of such Act (42 U.S.C. 
1395 et seq.). 
Æ 
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