H. R. 2 
One Hundred Fourteenth Congress 
of the 
United States of America 
AT THE FIRST SESSION 
Begun and held at the City of Washington on Tuesday, 
the sixth day of January, two thousand and fifteen 
An Act 
To amend title XVIII of the Social Security Act to repeal the Medicare sustainable 
growth rate and strengthen Medicare access by improving physician payments 
and making other improvements, to reauthorize the Children’s Health Insurance 
Program, and for other purposes. 
Be it enacted by the Senate and House of Representatives 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 ‘‘Medicare 
Access and CHIP Reauthorization Act of 2015’’. 
(b) TABLE OF CONTENTS.—The table of contents of this Act 
is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—SGR REPEAL AND MEDICARE PROVIDER PAYMENT 
MODERNIZATION 
Sec. 101. Repealing the sustainable growth rate (SGR) and improving Medicare 
payment for physicians’ services. 
Sec. 102. Priorities and funding for measure development. 
Sec. 103. Encouraging care management for individuals with chronic care needs. 
Sec. 104. Empowering beneficiary choices through continued access to information 
on physicians’ services. 
Sec. 105. Expanding availability of Medicare data. 
Sec. 106. Reducing administrative burden and other provisions. 
TITLE II—MEDICARE AND OTHER HEALTH EXTENDERS 
Subtitle A—Medicare Extenders 
Sec. 201. Extension of work GPCI floor. 
Sec. 202. Extension of therapy cap exceptions process. 
Sec. 203. Extension of ambulance add-ons. 
Sec. 204. Extension of increased inpatient hospital payment adjustment for certain 
low-volume hospitals. 
Sec. 205. Extension of the Medicare-dependent hospital (MDH) program. 
Sec. 206. Extension for specialized Medicare Advantage plans for special needs in-
dividuals. 
Sec. 207. Extension of funding for quality measure endorsement, input, and selec-
tion. 
Sec. 208. Extension of funding outreach and assistance for low-income programs. 
Sec. 209. Extension and transition of reasonable cost reimbursement contracts. 
Sec. 210. Extension of home health rural add-on. 
Subtitle B—Other Health Extenders 
Sec. 211. Permanent extension of the qualifying individual (QI) program. 
Sec. 212. Permanent extension of transitional medical assistance (TMA). 
Sec. 213. Extension of special diabetes program for type I diabetes and for Indians. 
Sec. 214. Extension of abstinence education. 
Sec. 215. Extension of personal responsibility education program (PREP). 
Sec. 216. Extension of funding for family-to-family health information centers. 
Sec. 217. Extension of health workforce demonstration project for low-income indi-
viduals.
H. R. 2—2 
Sec. 218. Extension of maternal, infant, and early childhood home visiting pro-
grams. 
Sec. 219. Tennessee DSH allotment for fiscal years 2015 through 2025. 
Sec. 220. Delay in effective date for Medicaid amendments relating to beneficiary 
liability settlements. 
Sec. 221. Extension of funding for community health centers, the National Health 
Service Corps, and teaching health centers. 
TITLE III—CHIP 
Sec. 301. 2-year extension of the Children’s Health Insurance Program. 
Sec. 302. Extension of express lane eligibility. 
Sec. 303. Extension of outreach and enrollment program. 
Sec. 304. Extension of certain programs and demonstration projects. 
Sec. 305. Report of Inspector General of HHS on use of express lane option under 
Medicaid and CHIP. 
TITLE IV—OFFSETS 
Subtitle A—Medicare Beneficiary Reforms 
Sec. 401. Limitation on certain medigap policies for newly eligible Medicare bene-
ficiaries. 
Sec. 402. Income-related premium adjustment for parts B and D. 
Subtitle B—Other Offsets 
Sec. 411. Medicare payment updates for post-acute providers. 
Sec. 412. Delay of reduction to Medicaid DSH allotments. 
Sec. 413. Levy on delinquent providers. 
Sec. 414. Adjustments to inpatient hospital payment rates. 
TITLE V—MISCELLANEOUS 
Subtitle A—Protecting the Integrity of Medicare 
Sec. 501. Prohibition of inclusion of Social Security account numbers on Medicare 
cards. 
Sec. 502. Preventing wrongful Medicare payments for items and services furnished 
to incarcerated individuals, individuals not lawfully present, and de-
ceased individuals. 
Sec. 503. Consideration of measures regarding Medicare beneficiary smart cards. 
Sec. 504. Modifying Medicare durable medical equipment face-to-face encounter 
documentation requirement. 
Sec. 505. Reducing improper Medicare payments. 
Sec. 506. Improving senior Medicare patrol and fraud reporting rewards. 
Sec. 507. Requiring valid prescriber National Provider Identifiers on pharmacy 
claims. 
Sec. 508. Option to receive Medicare Summary Notice electronically. 
Sec. 509. Renewal of MAC contracts. 
Sec. 510. Study on pathway for incentives to States for State participation in med-
icaid data match program. 
Sec. 511. Guidance on application of Common Rule to clinical data registries. 
Sec. 512. Eliminating certain civil money penalties; gainsharing study and report. 
Sec. 513. Modification of Medicare home health surety bond condition of participa-
tion requirement. 
Sec. 514. Oversight of Medicare coverage of manual manipulation of the spine to 
correct subluxation. 
Sec. 515. National expansion of prior authorization model for repetitive scheduled 
non-emergent ambulance transport. 
Sec. 516. Repealing duplicative Medicare secondary payor provision. 
Sec. 517. Plan for expanding data in annual CERT report. 
Sec. 518. Removing funds for Medicare Improvement Fund added by IMPACT Act 
of 2014. 
Sec. 519. Rule of construction. 
Subtitle B—Other Provisions 
Sec. 521. Extension of two-midnight PAMA rules on certain medical review activi-
ties. 
Sec. 522. Requiring bid surety bonds and State licensure for entities submitting 
bids under the Medicare DMEPOS competitive acquisition program. 
Sec. 523. Payment for global surgical packages. 
Sec. 524. Extension of Secure Rural Schools and Community Self-Determination 
Act of 2000. 
Sec. 525. Exclusion from PAYGO scorecards.
H. R. 2—3 
TITLE I—SGR REPEAL AND MEDICARE 
PROVIDER PAYMENT MODERNIZATION 
SEC. 101. REPEALING THE SUSTAINABLE GROWTH RATE (SGR) AND 
IMPROVING MEDICARE PAYMENT FOR PHYSICIANS’ SERV-
ICES. 
(a) STABILIZING FEE UPDATES.— 
(1) REPEAL OF SGR PAYMENT METHODOLOGY.—Section 1848 
of the Social Security Act (42 U.S.C. 1395w–4) is amended— 
(A) in subsection (d)— 
(i) in paragraph (1)(A)— 
(I) by inserting ‘‘and ending with 2025’’ after 
‘‘beginning with 2001’’; and 
(II) by inserting ‘‘or a subsequent paragraph’’ 
after ‘‘paragraph (4)’’; and 
(ii) in paragraph (4)— 
(I) in the heading, by inserting ‘‘AND ENDING 
WITH 2014’’ after ‘‘YEARS BEGINNING WITH 2001’’; and 
(II) in subparagraph (A), by inserting ‘‘and 
ending with 2014’’ after ‘‘a year beginning with 
2001’’; and 
(B) in subsection (f)— 
(i) in paragraph (1)(B), by inserting ‘‘through 2014’’ 
after ‘‘of each succeeding year’’; and 
(ii) in paragraph (2), in the matter preceding 
subparagraph (A), by inserting ‘‘and ending with 2014’’ 
after ‘‘beginning with 2000’’. 
(2) UPDATE OF RATES FOR 2015 AND SUBSEQUENT YEARS.— 
Subsection (d) of section 1848 of the Social Security Act (42 
U.S.C. 1395w–4) is amended— 
(A) in paragraph (1)(A), by adding at the end the 
following: ‘‘There shall be two separate conversion factors 
for each year beginning with 2026, one for items and serv-
ices furnished by a qualifying APM participant (as defined 
in section 1833(z)(2)) (referred to in this subsection as 
the ‘qualifying APM conversion factor’) and the other for 
other items and services (referred to in this subsection 
as the ‘nonqualifying APM conversion factor’), equal to 
the respective conversion factor for the previous year (or, 
in the case of 2026, equal to the single conversion factor 
for 2025) multiplied by the update established under para-
graph (20) for such respective conversion factor for such 
year.’’; 
(B) in paragraph (1)(D), by inserting ‘‘(or, beginning 
with 2026, applicable conversion factor)’’ after ‘‘single 
conversion factor’’; and 
(C) by striking paragraph (16) and inserting the fol-
lowing new paragraphs: 
‘‘(16) UPDATE FOR JANUARY THROUGH JUNE OF 2015.—Sub-
ject to paragraphs (7)(B), (8)(B), (9)(B), (10)(B), (11)(B), (12)(B), 
(13)(B), (14)(B), and (15)(B), in lieu of the update to the single 
conversion factor established in paragraph (1)(C) that would 
otherwise apply for 2015 for the period beginning on January 
1, 2015, and ending on June 30, 2015, the update to the 
single conversion factor shall be 0.0 percent.
H. R. 2—4 
‘‘(17) UPDATE FOR JULY THROUGH DECEMBER OF 2015.—The 
update to the single conversion factor established in paragraph 
(1)(C) for the period beginning on July 1, 2015, and ending 
on December 31, 2015, shall be 0.5 percent. 
‘‘(18) UPDATE FOR 2016 THROUGH 2019.—The update to the 
single conversion factor established in paragraph (1)(C) for 
2016 and each subsequent year through 2019 shall be 0.5 
percent. 
‘‘(19) UPDATE FOR 2020 THROUGH 2025.—The update to the 
single conversion factor established in paragraph (1)(C) for 
2020 and each subsequent year through 2025 shall be 0.0 
percent. 
‘‘(20) UPDATE FOR 2026 AND SUBSEQUENT YEARS.—For 2026 
and each subsequent year, the update to the qualifying APM 
conversion factor established under paragraph (1)(A) is 0.75 
percent, and the update to the nonqualifying APM conversion 
factor established under such paragraph is 0.25 percent.’’. 
(3) MEDPAC REPORTS.— 
(A) INITIAL REPORT.—Not later than July 1, 2017, the 
Medicare Payment Advisory Commission shall submit to 
Congress a report on the relationship between— 
(i) physician and other health professional utiliza-
tion and expenditures (and the rate of increase of 
such utilization and expenditures) of items and services 
for which payment is made under section 1848 of the 
Social Security Act (42 U.S.C. 1395w–4); and 
(ii) total utilization and expenditures (and the rate 
of increase of such utilization and expenditures) under 
parts A, B, and D of title XVIII of such Act. 
Such report shall include a methodology to describe such 
relationship and the impact of changes in such physician 
and other health professional practice and service ordering 
patterns on total utilization and expenditures under parts 
A, B, and D of such title. 
(B) FINAL REPORT.—Not later than July 1, 2021, the 
Medicare Payment Advisory Commission shall submit to 
Congress a report on the relationship described in subpara-
graph (A), including the results determined from applying 
the methodology included in the report submitted under 
such subparagraph. 
(C) REPORT ON UPDATE TO PHYSICIANS’ SERVICES UNDER 
MEDICARE.—Not later than July 1, 2019, the Medicare Pay-
ment Advisory Commission shall submit to Congress a 
report on— 
(i) the payment update for professional services 
applied under the Medicare program under title XVIII 
of the Social Security Act for the period of years 2015 
through 2019; 
(ii) the effect of such update on the efficiency, 
economy, and quality of care provided under such pro-
gram; 
(iii) the effect of such update on ensuring a suffi-
cient number of providers to maintain access to care 
by Medicare beneficiaries; and 
(iv) recommendations for any future payment 
updates for professional services under such program
H. R. 2—5 
to ensure adequate access to care is maintained for 
Medicare beneficiaries. 
(b) CONSOLIDATION OF CERTAIN CURRENT LAW PERFORMANCE 
PROGRAMS WITH NEW MERIT-BASED INCENTIVE PAYMENT SYSTEM.— 
(1) EHR MEANINGFUL USE INCENTIVE PROGRAM.— 
(A) SUNSETTING SEPARATE MEANINGFUL USE PAYMENT 
ADJUSTMENTS.—Section 1848(a)(7)(A) of the Social Security 
Act (42 U.S.C. 1395w–4(a)(7)(A)) is amended— 
(i) in clause (i), by striking ‘‘2015 or any subse-
quent payment year’’ and inserting ‘‘each of 2015 
through 2018’’; 
(ii) in clause (ii)(III), by striking ‘‘each subsequent 
year’’ and inserting ‘‘2018’’; and 
(iii) in clause (iii)— 
(I) in the heading, by striking ‘‘AND SUBSE-
QUENT YEARS’’; 
(II) by striking ‘‘and each subsequent year’’; 
and 
(III) by striking ‘‘, but in no case shall the 
applicable percent be less than 95 percent’’. 
(B) CONTINUATION
OF
MEANINGFUL
USE
DETERMINA-
TIONS FOR MIPS.—Section 1848(o)(2) of the Social Security 
Act (42 U.S.C. 1395w–4(o)(2)) is amended— 
(i) in subparagraph (A), in the matter preceding 
clause (i)— 
(I) by striking ‘‘For purposes of paragraph (1), 
an’’ and inserting ‘‘An’’; and 
(II) by inserting ‘‘, or pursuant to subpara-
graph (D) for purposes of subsection (q), for a 
performance period under such subsection for a 
year’’ after ‘‘under such subsection for a year’’; 
and 
(ii) by adding at the end the following new 
subparagraph: 
‘‘(D) CONTINUED APPLICATION FOR PURPOSES OF MIPS.— 
With respect to 2019 and each subsequent payment year, 
the Secretary shall, for purposes of subsection (q) and 
in accordance with paragraph (1)(F) of such subsection, 
determine whether an eligible professional who is a MIPS 
eligible professional (as defined in subsection (q)(1)(C)) for 
such year is a meaningful EHR user under this paragraph 
for the performance period under subsection (q) for such 
year.’’. 
(2) QUALITY REPORTING.— 
(A) SUNSETTING SEPARATE QUALITY REPORTING INCEN-
TIVES.—Section 1848(a)(8)(A) of the Social Security Act (42 
U.S.C. 1395w–4(a)(8)(A)) is amended— 
(i) in clause (i), by striking ‘‘2015 or any subse-
quent year’’ and inserting ‘‘each of 2015 through 2018’’; 
and 
(ii) in clause (ii)(II), by striking ‘‘and each subse-
quent year’’ and inserting ‘‘, 2017, and 2018’’. 
(B) CONTINUATION OF QUALITY MEASURES AND PROC-
ESSES FOR MIPS.—Section 1848 of the Social Security Act 
(42 U.S.C. 1395w–4) is amended— 
(i) in subsection (k), by adding at the end the 
following new paragraph:
H. R. 2—6 
‘‘(9) CONTINUED APPLICATION FOR PURPOSES OF MIPS AND 
FOR CERTAIN PROFESSIONALS VOLUNTEERING TO REPORT.—The 
Secretary shall, in accordance with subsection (q)(1)(F), carry 
out the provisions of this subsection— 
‘‘(A) for purposes of subsection (q); and 
‘‘(B) for eligible professionals who are not MIPS eligible 
professionals (as defined in subsection (q)(1)(C)) for the 
year involved.’’; and 
(ii) in subsection (m)— 
(I) by redesignating paragraph (7) added by 
section 10327(a) of Public Law 111–148 as para-
graph (8); and 
(II) by adding at the end the following new 
paragraph: 
‘‘(9) CONTINUED APPLICATION FOR PURPOSES OF MIPS AND 
FOR CERTAIN PROFESSIONALS VOLUNTEERING TO REPORT.—The 
Secretary shall, in accordance with subsection (q)(1)(F), carry 
out the processes under this subsection— 
‘‘(A) for purposes of subsection (q); and 
‘‘(B) for eligible professionals who are not MIPS eligible 
professionals (as defined in subsection (q)(1)(C)) for the 
year involved.’’. 
(3) VALUE-BASED PAYMENTS.— 
(A) SUNSETTING SEPARATE VALUE-BASED PAYMENTS.— 
Clause (iii) of section 1848(p)(4)(B) of the Social Security 
Act (42 U.S.C. 1395w–4(p)(4)(B)) is amended to read as 
follows: 
‘‘(iii) APPLICATION.—The Secretary shall apply the 
payment modifier established under this subsection 
for items and services furnished on or after January 
1, 2015, with respect to specific physicians and groups 
of physicians the Secretary determines appropriate, 
and for services furnished on or after January 1, 2017, 
with respect to all physicians and groups of physicians. 
Such payment modifier shall not be applied for items 
and services furnished on or after January 1, 2019.’’. 
(B) CONTINUATION OF VALUE-BASED PAYMENT MODIFIER 
MEASURES FOR MIPS.—Section 1848(p) of the Social Security 
Act (42 U.S.C. 1395w–4(p)) is amended— 
(i) in paragraph (2), by adding at the end the 
following new subparagraph: 
‘‘(C) CONTINUED APPLICATION FOR PURPOSES OF MIPS.— 
The Secretary shall, in accordance with subsection (q)(1)(F), 
carry out subparagraph (B) for purposes of subsection (q).’’; 
and 
(ii) in paragraph (3), by adding at the end the 
following: ‘‘With respect to 2019 and each subsequent 
year, the Secretary shall, in accordance with subsection 
(q)(1)(F), carry out this paragraph for purposes of sub-
section (q).’’. 
(c) MERIT-BASED INCENTIVE PAYMENT SYSTEM.— 
(1) IN GENERAL.—Section 1848 of the Social Security Act 
(42 U.S.C. 1395w–4) is amended by adding at the end the 
following new subsection: 
‘‘(q) MERIT-BASED INCENTIVE PAYMENT SYSTEM.— 
‘‘(1) ESTABLISHMENT.—
H. R. 2—7 
‘‘(A) IN GENERAL.—Subject to the succeeding provisions 
of this subsection, the Secretary shall establish an eligible 
professional Merit-based Incentive Payment System (in this 
subsection referred to as the ‘MIPS’) under which the Sec-
retary shall— 
‘‘(i) develop a methodology for assessing the total 
performance 
of 
each 
MIPS 
eligible 
professional 
according to performance standards under paragraph 
(3) for a performance period (as established under para-
graph (4)) for a year; 
‘‘(ii) using such methodology, provide for a com-
posite performance score in accordance with paragraph 
(5) for each such professional for each performance 
period; and 
‘‘(iii) use such composite performance score of the 
MIPS eligible professional for a performance period 
for a year to determine and apply a MIPS adjustment 
factor (and, as applicable, an additional MIPS adjust-
ment factor) under paragraph (6) to the professional 
for the year. 
Notwithstanding subparagraph (C)(ii), under the MIPS, the 
Secretary shall permit any eligible professional (as defined 
in subsection (k)(3)(B)) to report on applicable measures 
and activities described in paragraph (2)(B). 
‘‘(B) PROGRAM
IMPLEMENTATION.—The MIPS shall 
apply to payments for items and services furnished on 
or after January 1, 2019. 
‘‘(C) MIPS ELIGIBLE PROFESSIONAL DEFINED.— 
‘‘(i) IN GENERAL.—For purposes of this subsection, 
subject to clauses (ii) and (iv), the term ‘MIPS eligible 
professional’ means— 
‘‘(I) for the first and second years for which 
the MIPS applies to payments (and for the 
performance period for such first and second year), 
a physician (as defined in section 1861(r)), a physi-
cian assistant, nurse practitioner, and clinical 
nurse specialist (as such terms are defined in sec-
tion 1861(aa)(5)), a certified registered nurse anes-
thetist (as defined in section 1861(bb)(2)), and a 
group that includes such professionals; and 
‘‘(II) for the third year for which the MIPS 
applies to payments (and for the performance 
period for such third year) and for each succeeding 
year (and for the performance period for each such 
year), the professionals described in subclause (I), 
such other eligible professionals (as defined in sub-
section (k)(3)(B)) as specified by the Secretary, and 
a group that includes such professionals. 
‘‘(ii) EXCLUSIONS.—For purposes of clause (i), the 
term ‘MIPS eligible professional’ does not include, with 
respect to a year, an eligible professional (as defined 
in subsection (k)(3)(B)) who— 
‘‘(I) is a qualifying APM participant (as defined 
in section 1833(z)(2)); 
‘‘(II) subject to clause (vii), is a partial quali-
fying APM participant (as defined in clause (iii))
H. R. 2—8 
for the most recent period for which data are avail-
able and who, for the performance period with 
respect to such year, does not report on applicable 
measures and activities described in paragraph 
(2)(B) that are required to be reported by such 
a professional under the MIPS; or 
‘‘(III) for the performance period with respect 
to such year, does not exceed the low-volume 
threshold measurement selected under clause (iv). 
‘‘(iii) PARTIAL QUALIFYING APM PARTICIPANT.—For 
purposes of this subparagraph, the term ‘partial quali-
fying APM participant’ means, with respect to a year, 
an eligible professional for whom the Secretary deter-
mines the minimum payment percentage (or percent-
ages), as applicable, described in paragraph (2) of sec-
tion 1833(z) for such year have not been satisfied, 
but who would be considered a qualifying APM partici-
pant (as defined in such paragraph) for such year 
if— 
‘‘(I) with respect to 2019 and 2020, the ref-
erence in subparagraph (A) of such paragraph to 
25 percent was instead a reference to 20 percent; 
‘‘(II) with respect to 2021 and 2022— 
‘‘(aa) the reference in subparagraph (B)(i) 
of such paragraph to 50 percent was instead 
a reference to 40 percent; and 
‘‘(bb) the references in subparagraph 
(B)(ii) of such paragraph to 50 percent and 
25 percent of such paragraph were instead 
references to 40 percent and 20 percent, 
respectively; and 
‘‘(III) with respect to 2023 and subsequent 
years— 
‘‘(aa) the reference in subparagraph (C)(i) 
of such paragraph to 75 percent was instead 
a reference to 50 percent; and 
‘‘(bb) the references in subparagraph 
(C)(ii) of such paragraph to 75 percent and 
25 percent of such paragraph were instead 
references to 50 percent and 20 percent, 
respectively. 
‘‘(iv) 
SELECTION
OF
LOW-VOLUME
THRESHOLD 
MEASUREMENT.—The Secretary shall select a low- 
volume threshold to apply for purposes of clause 
(ii)(III), which may include one or more or a combina-
tion of the following: 
‘‘(I) The minimum number (as determined by 
the Secretary) of individuals enrolled under this 
part who are treated by the eligible professional 
for the performance period involved. 
‘‘(II) The minimum number (as determined by 
the Secretary) of items and services furnished to 
individuals enrolled under this part by such profes-
sional for such performance period. 
‘‘(III) The minimum amount (as determined 
by the Secretary) of allowed charges billed by such
H. R. 2—9 
professional under this part for such performance 
period. 
‘‘(v) TREATMENT
OF
NEW
MEDICARE
ENROLLED 
ELIGIBLE PROFESSIONALS.—In the case of a professional 
who first becomes a Medicare enrolled eligible profes-
sional during the performance period for a year (and 
had not previously submitted claims under this title 
such as a person, an entity, or a part of a physician 
group or under a different billing number or tax identi-
fier), such professional shall not be treated under this 
subsection as a MIPS eligible professional until the 
subsequent year and performance period for such sub-
sequent year. 
‘‘(vi) CLARIFICATION.—In the case of items and 
services furnished during a year by an individual who 
is not a MIPS eligible professional (including pursuant 
to clauses (ii) and (v)) with respect to a year, in no 
case shall a MIPS adjustment factor (or additional 
MIPS adjustment factor) under paragraph (6) apply 
to such individual for such year. 
‘‘(vii) PARTIAL QUALIFYING APM PARTICIPANT CLARI-
FICATIONS.— 
‘‘(I) TREATMENT
AS
MIPS
ELIGIBLE
PROFES-
SIONAL.—In the case of an eligible professional 
who is a partial qualifying APM participant, with 
respect to a year, and who, for the performance 
period for such year, reports on applicable meas-
ures and activities described in paragraph (2)(B) 
that are required to be reported by such a profes-
sional under the MIPS, such eligible professional 
is considered to be a MIPS eligible professional 
with respect to such year. 
‘‘(II) NOT
ELIGIBLE
FOR
QUALIFYING
APM 
PARTICIPANT
PAYMENTS.—In no case shall an 
eligible professional who is a partial qualifying 
APM participant, with respect to a year, be consid-
ered a qualifying APM participant (as defined in 
paragraph (2) of section 1833(z)) for such year 
or be eligible for the additional payment under 
paragraph (1) of such section for such year. 
‘‘(D) APPLICATION TO GROUP PRACTICES.— 
‘‘(i) IN GENERAL.—Under the MIPS: 
‘‘(I) QUALITY
PERFORMANCE
CATEGORY.—The 
Secretary shall establish and apply a process that 
includes features of the provisions of subsection 
(m)(3)(C) for MIPS eligible professionals in a group 
practice with respect to assessing performance of 
such group with respect to the performance cat-
egory described in clause (i) of paragraph (2)(A). 
‘‘(II) OTHER PERFORMANCE CATEGORIES.—The 
Secretary may establish and apply a process that 
includes features of the provisions of subsection 
(m)(3)(C) for MIPS eligible professionals in a group 
practice with respect to assessing the performance 
of such group with respect to the performance 
categories described in clauses (ii) through (iv) of 
such paragraph.
H. R. 2—10 
‘‘(ii) ENSURING
COMPREHENSIVENESS
OF
GROUP 
PRACTICE ASSESSMENT.—The process established under 
clause (i) shall to the extent practicable reflect the 
range of items and services furnished by the MIPS 
eligible professionals in the group practice involved. 
‘‘(E) USE OF REGISTRIES.—Under the MIPS, the Sec-
retary shall encourage the use of qualified clinical data 
registries pursuant to subsection (m)(3)(E) in carrying out 
this subsection. 
‘‘(F) APPLICATION OF CERTAIN PROVISIONS.—In applying 
a provision of subsection (k), (m), (o), or (p) for purposes 
of this subsection, the Secretary shall— 
‘‘(i) adjust the application of such provision to 
ensure the provision is consistent with the provisions 
of this subsection; and 
‘‘(ii) not apply such provision to the extent that 
the provision is duplicative with a provision of this 
subsection. 
‘‘(G) ACCOUNTING FOR RISK FACTORS.— 
‘‘(i) RISK FACTORS.—Taking into account the rel-
evant studies conducted and recommendations made 
in reports under section 2(d) of the Improving Medicare 
Post-Acute Care Transformation Act of 2014, and, as 
appropriate, other information, including information 
collected before completion of such studies and rec-
ommendations, the Secretary, on an ongoing basis, 
shall, as the Secretary determines appropriate and 
based on an individual’s health status and other risk 
factors— 
‘‘(I) assess appropriate adjustments to quality 
measures, resource use measures, and other meas-
ures used under the MIPS; and 
‘‘(II) assess and implement appropriate adjust-
ments to payment adjustments, composite perform-
ance scores, scores for performance categories, or 
scores for measures or activities under the MIPS. 
‘‘(2) MEASURES AND ACTIVITIES UNDER PERFORMANCE CAT-
EGORIES.— 
‘‘(A) PERFORMANCE CATEGORIES.—Under the MIPS, the 
Secretary shall use the following performance categories 
(each of which is referred to in this subsection as a perform-
ance category) in determining the composite performance 
score under paragraph (5): 
‘‘(i) Quality. 
‘‘(ii) Resource use. 
‘‘(iii) Clinical practice improvement activities. 
‘‘(iv) Meaningful use of certified EHR technology. 
‘‘(B) MEASURES AND ACTIVITIES SPECIFIED FOR EACH 
CATEGORY.—For purposes of paragraph (3)(A) and subject 
to subparagraph (C), measures and activities specified for 
a performance period (as established under paragraph (4)) 
for a year are as follows: 
‘‘(i) 
QUALITY.—For 
the 
performance 
category 
described in subparagraph (A)(i), the quality measures 
included in the final measures list published under 
subparagraph (D)(i) for such year and the list of quality 
measures described in subparagraph (D)(vi) used by
H. R. 2—11 
qualified clinical data registries under subsection 
(m)(3)(E). 
‘‘(ii) RESOURCE USE.—For the performance category 
described in subparagraph (A)(ii), the measurement 
of resource use for such period under subsection (p)(3), 
using the methodology under subsection (r) as appro-
priate, and, as feasible and applicable, accounting for 
the cost of drugs under part D. 
‘‘(iii) CLINICAL
PRACTICE
IMPROVEMENT
ACTIVI-
TIES.—For the performance category described in 
subparagraph (A)(iii), clinical practice improvement 
activities (as defined in subparagraph (C)(v)(III)) under 
subcategories specified by the Secretary for such 
period, which shall include at least the following: 
‘‘(I) The subcategory of expanded practice 
access, such as same day appointments for urgent 
needs and after hours access to clinician advice. 
‘‘(II) The subcategory of population manage-
ment, such as monitoring health conditions of 
individuals to provide timely health care interven-
tions or participation in a qualified clinical data 
registry. 
‘‘(III) The subcategory of care coordination, 
such as timely communication of test results, 
timely exchange of clinical information to patients 
and other providers, and use of remote monitoring 
or telehealth. 
‘‘(IV) The subcategory of beneficiary engage-
ment, such as the establishment of care plans for 
individuals with complex care needs, beneficiary 
self-management assessment and training, and 
using shared decision-making mechanisms. 
‘‘(V) The subcategory of patient safety and 
practice assessment, such as through use of clinical 
or surgical checklists and practice assessments 
related to maintaining certification. 
‘‘(VI) The subcategory of participation in an 
alternative payment model (as defined in section 
1833(z)(3)(C)). 
In establishing activities under this clause, the Sec-
retary shall give consideration to the circumstances 
of small practices (consisting of 15 or fewer profes-
sionals) and practices located in rural areas and in 
health professional shortage areas (as designated 
under section 332(a)(1)(A) of the Public Health Service 
Act). 
‘‘(iv) MEANINGFUL EHR USE.—For the performance 
category described in subparagraph (A)(iv), the require-
ments established for such period under subsection 
(o)(2) for determining whether an eligible professional 
is a meaningful EHR user. 
‘‘(C) ADDITIONAL PROVISIONS.— 
‘‘(i) EMPHASIZING OUTCOME MEASURES UNDER THE 
QUALITY
PERFORMANCE
CATEGORY.—In 
applying 
subparagraph (B)(i), the Secretary shall, as feasible, 
emphasize the application of outcome measures.
H. R. 2—12 
‘‘(ii) APPLICATION
OF
ADDITIONAL
SYSTEM
MEAS-
URES.—The Secretary may use measures used for a 
payment system other than for physicians, such as 
measures for inpatient hospitals, for purposes of the 
performance categories described in clauses (i) and (ii) 
of subparagraph (A). For purposes of the previous sen-
tence, the Secretary may not use measures for hospital 
outpatient departments, except in the case of items 
and services furnished by emergency physicians, radi-
ologists, and anesthesiologists. 
‘‘(iii) GLOBAL AND POPULATION-BASED MEASURES.— 
The Secretary may use global measures, such as global 
outcome measures, and population-based measures for 
purposes of the performance category described in 
subparagraph (A)(i). 
‘‘(iv) APPLICATION OF MEASURES AND ACTIVITIES TO 
NON-PATIENT-FACING PROFESSIONALS.—In carrying out 
this paragraph, with respect to measures and activities 
specified in subparagraph (B) for performance cat-
egories described in subparagraph (A), the Secretary— 
‘‘(I) shall give consideration to the cir-
cumstances of professional types (or subcategories 
of those types determined by practice characteris-
tics) who typically furnish services that do not 
involve face-to-face interaction with a patient; and 
‘‘(II) may, to the extent feasible and appro-
priate, take into account such circumstances and 
apply under this subsection with respect to MIPS 
eligible professionals of such professional types or 
subcategories, alternative measures or activities 
that fulfill the goals of the applicable performance 
category. 
In carrying out the previous sentence, the Secretary 
shall consult with professionals of such professional 
types or subcategories. 
‘‘(v) CLINICAL
PRACTICE
IMPROVEMENT
ACTIVI-
TIES.— 
‘‘(I) REQUEST FOR INFORMATION.—In initially 
applying subparagraph (B)(iii), the Secretary shall 
use a request for information to solicit rec-
ommendations from stakeholders to identify activi-
ties described in such subparagraph and specifying 
criteria for such activities. 
‘‘(II) CONTRACT AUTHORITY FOR CLINICAL PRAC-
TICE IMPROVEMENT ACTIVITIES PERFORMANCE CAT-
EGORY.—In applying subparagraph (B)(iii), the 
Secretary may contract with entities to assist the 
Secretary in— 
‘‘(aa) identifying activities described in 
subparagraph (B)(iii); 
‘‘(bb) specifying criteria for such activities; 
and 
‘‘(cc) determining whether a MIPS eligible 
professional meets such criteria. 
‘‘(III) CLINICAL PRACTICE IMPROVEMENT ACTIVI-
TIES
DEFINED.—For purposes of this subsection, 
the term ‘clinical practice improvement activity’
H. R. 2—13 
means an activity that relevant eligible profes-
sional organizations and other relevant stake-
holders identify as improving clinical practice or 
care delivery and that the Secretary determines, 
when effectively executed, is likely to result in 
improved outcomes. 
‘‘(D) ANNUAL LIST OF QUALITY MEASURES AVAILABLE 
FOR MIPS ASSESSMENT.— 
‘‘(i) IN GENERAL.—Under the MIPS, the Secretary, 
through notice and comment rulemaking and subject 
to the succeeding clauses of this subparagraph, shall, 
with respect to the performance period for a year, 
establish an annual final list of quality measures from 
which MIPS eligible professionals may choose for pur-
poses of assessment under this subsection for such 
performance period. Pursuant to the previous sentence, 
the Secretary shall— 
‘‘(I) not later than November 1 of the year 
prior to the first day of the first performance period 
under the MIPS, establish and publish in the Fed-
eral Register a final list of quality measures; and 
‘‘(II) not later than November 1 of the year 
prior to the first day of each subsequent perform-
ance period, update the final list of quality meas-
ures from the previous year (and publish such 
updated final list in the Federal Register), by— 
‘‘(aa) removing from such list, as appro-
priate, quality measures, which may include 
the removal of measures that are no longer 
meaningful (such as measures that are topped 
out); 
‘‘(bb) adding to such list, as appropriate, 
new quality measures; and 
‘‘(cc) determining whether or not quality 
measures on such list that have undergone 
substantive changes should be included in the 
updated list. 
‘‘(ii) CALL FOR QUALITY MEASURES.— 
‘‘(I) 
IN
GENERAL.—Eligible 
professional 
organizations and other relevant stakeholders 
shall be requested to identify and submit quality 
measures to be considered for selection under this 
subparagraph in the annual list of quality meas-
ures published under clause (i) and to identify 
and submit updates to the measures on such list. 
For purposes of the previous sentence, measures 
may be submitted regardless of whether such 
measures were previously published in a proposed 
rule or endorsed by an entity with a contract under 
section 1890(a). 
‘‘(II) ELIGIBLE
PROFESSIONAL
ORGANIZATION 
DEFINED.—In this subparagraph, the term ‘eligible 
professional organization’ means a professional 
organization as defined by nationally recognized 
specialty boards of certification or equivalent cer-
tification boards.
H. R. 2—14 
‘‘(iii) REQUIREMENTS.—In selecting quality meas-
ures for inclusion in the annual final list under clause 
(i), the Secretary shall— 
‘‘(I) provide that, to the extent practicable, all 
quality domains (as defined in subsection (s)(1)(B)) 
are addressed by such measures; and 
‘‘(II) ensure that such selection is consistent 
with the process for selection of measures under 
subsections (k), (m), and (p)(2). 
‘‘(iv) PEER
REVIEW.—Before including a new 
measure in the final list of measures published under 
clause (i) for a year, the Secretary shall submit for 
publication in applicable specialty-appropriate, peer- 
reviewed journals such measure and the method for 
developing and selecting such measure, including clin-
ical and other data supporting such measure. 
‘‘(v) MEASURES FOR INCLUSION.—The final list of 
quality measures published under clause (i) shall 
include, as applicable, measures under subsections (k), 
(m), and (p)(2), including quality measures from 
among— 
‘‘(I) measures endorsed by a consensus-based 
entity; 
‘‘(II) measures developed under subsection (s); 
and 
‘‘(III) measures submitted under clause (ii)(I). 
Any measure selected for inclusion in such list that 
is not endorsed by a consensus-based entity shall have 
a focus that is evidence-based. 
‘‘(vi) EXCEPTION FOR QUALIFIED CLINICAL DATA REG-
ISTRY MEASURES.—Measures used by a qualified clin-
ical data registry under subsection (m)(3)(E) shall not 
be subject to the requirements under clauses (i), (iv), 
and (v). The Secretary shall publish the list of meas-
ures used by such qualified clinical data registries 
on the Internet website of the Centers for Medicare 
& Medicaid Services. 
‘‘(vii) EXCEPTION
FOR
EXISTING
QUALITY
MEAS-
URES.—Any quality measure specified by the Secretary 
under subsection (k) or (m), including under subsection 
(m)(3)(E), and any measure of quality of care estab-
lished under subsection (p)(2) for the reporting period 
or performance period under the respective subsection 
beginning before the first performance period under 
the MIPS— 
‘‘(I) shall not be subject to the requirements 
under clause (i) (except under items (aa) and (cc) 
of subclause (II) of such clause) or to the require-
ment under clause (iv); and 
‘‘(II) shall be included in the final list of quality 
measures published under clause (i) unless 
removed under clause (i)(II)(aa). 
‘‘(viii) CONSULTATION
WITH
RELEVANT
ELIGIBLE 
PROFESSIONAL
ORGANIZATIONS
AND
OTHER
RELEVANT 
STAKEHOLDERS.—Relevant 
eligible 
professional 
organizations 
and 
other 
relevant 
stakeholders,
H. R. 2—15 
including State and national medical societies, shall 
be consulted in carrying out this subparagraph. 
‘‘(ix) OPTIONAL APPLICATION.—The process under 
section 1890A is not required to apply to the selection 
of measures under this subparagraph. 
‘‘(3) PERFORMANCE STANDARDS.— 
‘‘(A) ESTABLISHMENT.—Under the MIPS, the Secretary 
shall establish performance standards with respect to 
measures and activities specified under paragraph (2)(B) 
for a performance period (as established under paragraph 
(4)) for a year. 
‘‘(B) CONSIDERATIONS IN ESTABLISHING STANDARDS.— 
In establishing such performance standards with respect 
to measures and activities specified under paragraph (2)(B), 
the Secretary shall consider the following: 
‘‘(i) Historical performance standards. 
‘‘(ii) Improvement. 
‘‘(iii) The opportunity for continued improvement. 
‘‘(4) PERFORMANCE PERIOD.—The Secretary shall establish 
a performance period (or periods) for a year (beginning with 
2019). Such performance period (or periods) shall begin and 
end prior to the beginning of such year and be as close as 
possible to such year. In this subsection, such performance 
period (or periods) for a year shall be referred to as the perform-
ance period for the year. 
‘‘(5) COMPOSITE PERFORMANCE SCORE.— 
‘‘(A) IN GENERAL.—Subject to the succeeding provisions 
of this paragraph and taking into account, as available 
and applicable, paragraph (1)(G), the Secretary shall 
develop a methodology for assessing the total performance 
of each MIPS eligible professional according to performance 
standards under paragraph (3) with respect to applicable 
measures and activities specified in paragraph (2)(B) with 
respect to each performance category applicable to such 
professional for a performance period (as established under 
paragraph (4)) for a year. Using such methodology, the 
Secretary shall provide for a composite assessment (using 
a scoring scale of 0 to 100) for each such professional 
for the performance period for such year. In this subsection 
such a composite assessment for such a professional with 
respect to a performance period shall be referred to as 
the ‘composite performance score’ for such professional for 
such performance period. 
‘‘(B) INCENTIVE TO REPORT; ENCOURAGING USE OF CER-
TIFIED
EHR
TECHNOLOGY
FOR
REPORTING
QUALITY
MEAS-
URES.— 
‘‘(i) INCENTIVE TO REPORT.—Under the methodology 
established under subparagraph (A), the Secretary 
shall provide that in the case of a MIPS eligible profes-
sional who fails to report on an applicable measure 
or activity that is required to be reported by the profes-
sional, the professional shall be treated as achieving 
the lowest potential score applicable to such measure 
or activity. 
‘‘(ii) ENCOURAGING USE OF CERTIFIED EHR TECH-
NOLOGY AND QUALIFIED CLINICAL DATA REGISTRIES FOR
H. R. 2—16 
REPORTING
QUALITY
MEASURES.—Under the method-
ology established under subparagraph (A), the Sec-
retary shall— 
‘‘(I) encourage MIPS eligible professionals to 
report on applicable measures with respect to the 
performance category described in paragraph 
(2)(A)(i) through the use of certified EHR tech-
nology and qualified clinical data registries; and 
‘‘(II) with respect to a performance period, with 
respect to a year, for which a MIPS eligible profes-
sional reports such measures through the use of 
such EHR technology, treat such professional as 
satisfying the clinical quality measures reporting 
requirement described in subsection (o)(2)(A)(iii) 
for such year. 
‘‘(C) CLINICAL
PRACTICE
IMPROVEMENT
ACTIVITIES 
PERFORMANCE SCORE.— 
‘‘(i) RULE
FOR
CERTIFICATION.—A MIPS eligible 
professional who is in a practice that is certified as 
a patient-centered medical home or comparable spe-
cialty practice, as determined by the Secretary, with 
respect to a performance period shall be given the 
highest potential score for the performance category 
described in paragraph (2)(A)(iii) for such period. 
‘‘(ii) APM PARTICIPATION.—Participation by a MIPS 
eligible professional in an alternative payment model 
(as defined in section 1833(z)(3)(C)) with respect to 
a performance period shall earn such eligible profes-
sional a minimum score of one-half of the highest 
potential score for the performance category described 
in paragraph (2)(A)(iii) for such performance period. 
‘‘(iii) SUBCATEGORIES.—A MIPS eligible profes-
sional shall not be required to perform activities in 
each subcategory under paragraph (2)(B)(iii) or partici-
pate in an alternative payment model in order to 
achieve the highest potential score for the performance 
category described in paragraph (2)(A)(iii). 
‘‘(D) ACHIEVEMENT AND IMPROVEMENT.— 
‘‘(i) TAKING INTO ACCOUNT IMPROVEMENT.—Begin-
ning with the second year to which the MIPS applies, 
in addition to the achievement of a MIPS eligible 
professional, if data sufficient to measure improvement 
is available, the methodology developed under subpara-
graph (A)— 
‘‘(I) in the case of the performance score for 
the performance category described in clauses (i) 
and (ii) of paragraph (2)(A), shall take into account 
the improvement of the professional; and 
‘‘(II) in the case of performance scores for other 
performance categories, may take into account the 
improvement of the professional. 
‘‘(ii) ASSIGNING
HIGHER
WEIGHT
FOR
ACHIEVE-
MENT.—Subject to clause (i), under the methodology 
developed under subparagraph (A), the Secretary may 
assign a higher scoring weight under subparagraph 
(F) with respect to the achievement of a MIPS eligible 
professional than with respect to any improvement
H. R. 2—17 
of such professional applied under clause (i) with 
respect to a measure, activity, or category described 
in paragraph (2). 
‘‘(E) WEIGHTS FOR THE PERFORMANCE CATEGORIES.— 
‘‘(i) IN GENERAL.—Under the methodology devel-
oped under subparagraph (A), subject to subparagraph 
(F)(i) and clause (ii), the composite performance score 
shall be determined as follows: 
‘‘(I) QUALITY.— 
‘‘(aa) IN GENERAL.—Subject to item (bb), 
thirty percent of such score shall be based 
on performance with respect to the category 
described in clause (i) of paragraph (2)(A). In 
applying the previous sentence, the Secretary 
shall, as feasible, encourage the application 
of outcome measures within such category. 
‘‘(bb) FIRST 2 YEARS.—For the first and 
second years for which the MIPS applies to 
payments, the percentage applicable under 
item (aa) shall be increased in a manner such 
that the total percentage points of the increase 
under this item for the respective year equals 
the total number of percentage points by which 
the 
percentage 
applied 
under 
subclause 
(II)(bb) for the respective year is less than 
30 percent. 
‘‘(II) RESOURCE USE.— 
‘‘(aa) IN GENERAL.—Subject to item (bb), 
thirty percent of such score shall be based 
on performance with respect to the category 
described in clause (ii) of paragraph (2)(A). 
‘‘(bb) FIRST 2 YEARS.—For the first year 
for which the MIPS applies to payments, not 
more than 10 percent of such score shall be 
based on performance with respect to the cat-
egory described in clause (ii) of paragraph 
(2)(A). For the second year for which the MIPS 
applies to payments, not more than 15 percent 
of such score shall be based on performance 
with respect to the category described in 
clause (ii) of paragraph (2)(A). 
‘‘(III) CLINICAL PRACTICE IMPROVEMENT ACTIVI-
TIES.—Fifteen percent of such score shall be based 
on performance with respect to the category 
described in clause (iii) of paragraph (2)(A). 
‘‘(IV) MEANINGFUL
USE
OF
CERTIFIED
EHR 
TECHNOLOGY.—Twenty-five percent of such score 
shall be based on performance with respect to the 
category described in clause (iv) of paragraph 
(2)(A). 
‘‘(ii) AUTHORITY TO ADJUST PERCENTAGES IN CASE 
OF HIGH EHR MEANINGFUL USE ADOPTION.—In any year 
in which the Secretary estimates that the proportion 
of eligible professionals (as defined in subsection (o)(5)) 
who are meaningful EHR users (as determined under 
subsection (o)(2)) is 75 percent or greater, the Secretary 
may reduce the percent applicable under clause (i)(IV),
H. R. 2—18 
but not below 15 percent. If the Secretary makes such 
reduction for a year, subject to subclauses (I)(bb) and 
(II)(bb) of clause (i), the percentages applicable under 
one or more of subclauses (I), (II), and (III) of clause 
(i) for such year shall be increased in a manner such 
that the total percentage points of the increase under 
this clause for such year equals the total number of 
percentage points reduced under the preceding sen-
tence for such year. 
‘‘(F) CERTAIN
FLEXIBILITY
FOR
WEIGHTING
PERFORM-
ANCE CATEGORIES, MEASURES, AND ACTIVITIES.—Under the 
methodology under subparagraph (A), if there are not suffi-
cient measures and activities (described in paragraph 
(2)(B)) applicable and available to each type of eligible 
professional involved, the Secretary shall assign different 
scoring weights (including a weight of 0)— 
‘‘(i) which may vary from the scoring weights speci-
fied in subparagraph (E), for each performance category 
based on the extent to which the category is applicable 
to the type of eligible professional involved; and 
‘‘(ii) for each measure and activity specified under 
paragraph (2)(B) with respect to each such category 
based on the extent to which the measure or activity 
is applicable and available to the type of eligible profes-
sional involved. 
‘‘(G) RESOURCE USE.—Analysis of the performance cat-
egory described in paragraph (2)(A)(ii) shall include results 
from the methodology described in subsection (r)(5), as 
appropriate. 
‘‘(H) INCLUSION OF QUALITY MEASURE DATA FROM OTHER 
PAYERS.—In applying subsections (k), (m), and (p) with 
respect to measures described in paragraph (2)(B)(i), anal-
ysis of the performance category described in paragraph 
(2)(A)(i) may include data submitted by MIPS eligible 
professionals with respect to items and services furnished 
to individuals who are not individuals entitled to benefits 
under part A or enrolled under part B. 
‘‘(I) USE OF VOLUNTARY VIRTUAL GROUPS FOR CERTAIN 
ASSESSMENT PURPOSES.— 
‘‘(i) IN
GENERAL.—In the case of MIPS eligible 
professionals electing to be a virtual group under clause 
(ii) with respect to a performance period for a year, 
for purposes of applying the methodology under 
subparagraph (A) with respect to the performance cat-
egories described in clauses (i) and (ii) of paragraph 
(2)(A)— 
‘‘(I) the assessment of performance provided 
under such methodology with respect to such 
performance categories that is to be applied to 
each such professional in such group for such 
performance period shall be with respect to the 
combined performance of all such professionals in 
such group for such period; and 
‘‘(II) with respect to the composite performance 
score provided under this paragraph for such 
performance period for each such MIPS eligible 
professional in such virtual group, the components
H. R. 2—19 
of the composite performance score that assess 
performance with respect to such performance cat-
egories shall be based on the assessment of the 
combined performance under subclause (I) for such 
performance categories and performance period. 
‘‘(ii) ELECTION
OF
PRACTICES
TO
BE
A
VIRTUAL 
GROUP.—The Secretary shall, in accordance with the 
requirements under clause (iii), establish and have 
in place a process to allow an individual MIPS eligible 
professional or a group practice consisting of not more 
than 10 MIPS eligible professionals to elect, with 
respect to a performance period for a year to be a 
virtual group under this subparagraph with at least 
one other such individual MIPS eligible professional 
or group practice. Such a virtual group may be based 
on appropriate classifications of providers, such as by 
geographic areas or by provider specialties defined by 
nationally recognized specialty boards of certification 
or equivalent certification boards. 
‘‘(iii) REQUIREMENTS.—The requirements for the 
process under clause (ii) shall— 
‘‘(I) provide that an election under such clause, 
with respect to a performance period, shall be 
made before the beginning of such performance 
period and may not be changed during such 
performance period; 
‘‘(II) provide that an individual MIPS eligible 
professional and a group practice described in 
clause (ii) may elect to be in no more than one 
virtual group for a performance period and that, 
in the case of such a group practice that elects 
to be in such virtual group for such performance 
period, such election applies to all MIPS eligible 
professionals in such group practice; 
‘‘(III) provide that a virtual group be a com-
bination of tax identification numbers; 
‘‘(IV) provide for formal written agreements 
among MIPS eligible professionals electing to be 
a virtual group under this subparagraph; and 
‘‘(V) include such other requirements as the 
Secretary determines appropriate. 
‘‘(6) MIPS PAYMENTS.— 
‘‘(A) MIPS ADJUSTMENT FACTOR.—Taking into account 
paragraph (1)(G), the Secretary shall specify a MIPS adjust-
ment factor for each MIPS eligible professional for a year. 
Such MIPS adjustment factor for a MIPS eligible profes-
sional for a year shall be in the form of a percent and 
shall be determined— 
‘‘(i) by comparing the composite performance score 
of the eligible professional for such year to the perform-
ance threshold established under subparagraph (D)(i) 
for such year; 
‘‘(ii) in a manner such that the adjustment factors 
specified under this subparagraph for a year result 
in 
differential 
payments 
under 
this 
paragraph 
reflecting that—
H. R. 2—20 
‘‘(I) MIPS eligible professionals with composite 
performance scores for such year at or above such 
performance threshold for such year receive zero 
or positive payment adjustment factors for such 
year in accordance with clause (iii), with such 
professionals having higher composite performance 
scores receiving higher adjustment factors; and 
‘‘(II) MIPS eligible professionals with com-
posite performance scores for such year below such 
performance threshold for such year receive nega-
tive payment adjustment factors for such year in 
accordance with clause (iv), with such professionals 
having 
lower 
composite 
performance 
scores 
receiving lower adjustment factors; 
‘‘(iii) in a manner such that MIPS eligible profes-
sionals with composite scores described in clause (ii)(I) 
for such year, subject to clauses (i) and (ii) of subpara-
graph (F), receive a zero or positive adjustment factor 
on a linear sliding scale such that an adjustment factor 
of 0 percent is assigned for a score at the performance 
threshold and an adjustment factor of the applicable 
percent specified in subparagraph (B) is assigned for 
a score of 100; and 
‘‘(iv) in a manner such that— 
‘‘(I) subject to subclause (II), MIPS eligible 
professionals with composite performance scores 
described in clause (ii)(II) for such year receive 
a negative payment adjustment factor on a linear 
sliding scale such that an adjustment factor of 
0 percent is assigned for a score at the performance 
threshold and an adjustment factor of the negative 
of the applicable percent specified in subparagraph 
(B) is assigned for a score of 0; and 
‘‘(II) MIPS eligible professionals with com-
posite performance scores that are equal to or 
greater than 0, but not greater than 1⁄4 of the 
performance threshold specified under subpara-
graph (D)(i) for such year, receive a negative pay-
ment adjustment factor that is equal to the nega-
tive of the applicable percent specified in subpara-
graph (B) for such year. 
‘‘(B) APPLICABLE PERCENT DEFINED.—For purposes of 
this paragraph, the term ‘applicable percent’ means— 
‘‘(i) for 2019, 4 percent; 
‘‘(ii) for 2020, 5 percent; 
‘‘(iii) for 2021, 7 percent; and 
‘‘(iv) for 2022 and subsequent years, 9 percent. 
‘‘(C) ADDITIONAL MIPS ADJUSTMENT FACTORS FOR EXCEP-
TIONAL PERFORMANCE.—For 2019 and each subsequent year 
through 2024, in the case of a MIPS eligible professional 
with a composite performance score for a year at or above 
the additional performance threshold under subparagraph 
(D)(ii) for such year, in addition to the MIPS adjustment 
factor under subparagraph (A) for the eligible professional 
for such year, subject to subparagraph (F)(iv), the Secretary 
shall specify an additional positive MIPS adjustment factor 
for such professional and year. Such additional MIPS
H. R. 2—21 
adjustment factors shall be in the form of a percent and 
determined by the Secretary in a manner such that profes-
sionals having higher composite performance scores above 
the additional performance threshold receive higher addi-
tional MIPS adjustment factors. 
‘‘(D) ESTABLISHMENT OF PERFORMANCE THRESHOLDS.— 
‘‘(i) PERFORMANCE THRESHOLD.—For each year of 
the MIPS, the Secretary shall compute a performance 
threshold with respect to which the composite perform-
ance score of MIPS eligible professionals shall be com-
pared for purposes of determining adjustment factors 
under subparagraph (A) that are positive, negative, 
and zero. Such performance threshold for a year shall 
be the mean or median (as selected by the Secretary) 
of the composite performance scores for all MIPS 
eligible professionals with respect to a prior period 
specified by the Secretary. The Secretary may reassess 
the selection of the mean or median under the previous 
sentence every 3 years. 
‘‘(ii) ADDITIONAL
PERFORMANCE
THRESHOLD
FOR 
EXCEPTIONAL
PERFORMANCE.—In 
addition 
to 
the 
performance threshold under clause (i), for each year 
of the MIPS, the Secretary shall compute an additional 
performance threshold for purposes of determining the 
additional MIPS adjustment factors under subpara-
graph (C). For each such year, the Secretary shall 
apply either of the following methods for computing 
such additional performance threshold for such a year: 
‘‘(I) The threshold shall be the score that is 
equal to the 25th percentile of the range of possible 
composite performance scores above the perform-
ance threshold determined under clause (i). 
‘‘(II) The threshold shall be the score that 
is equal to the 25th percentile of the actual com-
posite performance scores for MIPS eligible profes-
sionals with composite performance scores at or 
above the performance threshold with respect to 
the prior period described in clause (i). 
‘‘(iii) SPECIAL
RULE
FOR
INITIAL
YEARS.—With 
respect to each of the first two years to which the 
MIPS applies, the Secretary shall, prior to the perform-
ance period for such years, establish a performance 
threshold for purposes of determining MIPS adjust-
ment factors under subparagraph (A) and a threshold 
for purposes of determining additional MIPS adjust-
ment factors under subparagraph (C). Each such 
performance threshold shall— 
‘‘(I) be based on a period prior to such perform-
ance periods; and 
‘‘(II) take into account— 
‘‘(aa) data available with respect to 
performance on measures and activities that 
may be used under the performance categories 
under subparagraph (2)(B); and 
‘‘(bb) other factors determined appropriate 
by the Secretary.
H. R. 2—22 
‘‘(E) APPLICATION OF MIPS ADJUSTMENT FACTORS.—In 
the case of items and services furnished by a MIPS eligible 
professional during a year (beginning with 2019), the 
amount otherwise paid under this part with respect to 
such items and services and MIPS eligible professional 
for such year, shall be multiplied by— 
‘‘(i) 1, plus 
‘‘(ii) the sum of— 
‘‘(I) the MIPS adjustment factor determined 
under subparagraph (A) divided by 100, and 
‘‘(II) as applicable, the additional MIPS adjust-
ment factor determined under subparagraph (C) 
divided by 100. 
‘‘(F) AGGREGATE APPLICATION OF MIPS ADJUSTMENT FAC-
TORS.— 
‘‘(i) APPLICATION OF SCALING FACTOR.— 
‘‘(I) IN
GENERAL.—With respect to positive 
MIPS adjustment factors under subparagraph 
(A)(ii)(I) for eligible professionals whose composite 
performance score is above the performance 
threshold under subparagraph (D)(i) for such year, 
subject to subclause (II), the Secretary shall 
increase or decrease such adjustment factors by 
a scaling factor in order to ensure that the budget 
neutrality requirement of clause (ii) is met. 
‘‘(II) SCALING FACTOR LIMIT.—In no case may 
the scaling factor applied under this clause exceed 
3.0. 
‘‘(ii) BUDGET NEUTRALITY REQUIREMENT.— 
‘‘(I) IN GENERAL.—Subject to clause (iii), the 
Secretary shall ensure that the estimated amount 
described in subclause (II) for a year is equal to 
the estimated amount described in subclause (III) 
for such year. 
‘‘(II) AGGREGATE
INCREASES.—The amount 
described in this subclause is the estimated 
increase in the aggregate allowed charges resulting 
from the application of positive MIPS adjustment 
factors under subparagraph (A) (after application 
of the scaling factor described in clause (i)) to 
MIPS 
eligible 
professionals 
whose 
composite 
performance score for a year is above the perform-
ance threshold under subparagraph (D)(i) for such 
year. 
‘‘(III) AGGREGATE
DECREASES.—The amount 
described in this subclause is the estimated 
decrease 
in 
the 
aggregate 
allowed 
charges 
resulting from the application of negative MIPS 
adjustment factors under subparagraph (A) to 
MIPS 
eligible 
professionals 
whose 
composite 
performance score for a year is below the perform-
ance threshold under subparagraph (D)(i) for such 
year. 
‘‘(iii) EXCEPTIONS.— 
‘‘(I) In the case that all MIPS eligible profes-
sionals receive composite performance scores for 
a year that are below the performance threshold
H. R. 2—23 
under subparagraph (D)(i) for such year, the nega-
tive MIPS adjustment factors under subparagraph 
(A) shall apply with respect to such MIPS eligible 
professionals and the budget neutrality require-
ment of clause (ii) and the additional adjustment 
factors under clause (iv) shall not apply for such 
year. 
‘‘(II) In the case that, with respect to a year, 
the application of clause (i) results in a scaling 
factor equal to the maximum scaling factor speci-
fied in clause (i)(II), such scaling factor shall apply 
and the budget neutrality requirement of clause 
(ii) shall not apply for such year. 
‘‘(iv) ADDITIONAL
INCENTIVE
PAYMENT
ADJUST-
MENTS.— 
‘‘(I) IN
GENERAL.—Subject to subclause (II), 
in specifying the MIPS additional adjustment fac-
tors under subparagraph (C) for each applicable 
MIPS eligible professional for a year, the Secretary 
shall ensure that the estimated aggregate increase 
in payments under this part resulting from the 
application of such additional adjustment factors 
for MIPS eligible professionals in a year shall be 
equal 
(as 
estimated 
by 
the 
Secretary) 
to 
$500,000,000 for each year beginning with 2019 
and ending with 2024. 
‘‘(II) LIMITATION
ON
ADDITIONAL
INCENTIVE 
PAYMENT
ADJUSTMENTS.—The MIPS additional 
adjustment factor under subparagraph (C) for a 
year for an applicable MIPS eligible professional 
whose composite performance score is above the 
additional performance threshold under subpara-
graph (D)(ii) for such year shall not exceed 10 
percent. The application of the previous sentence 
may result in an aggregate amount of additional 
incentive payments that are less than the amount 
specified in subclause (I). 
‘‘(7) ANNOUNCEMENT OF RESULT OF ADJUSTMENTS.—Under 
the MIPS, the Secretary shall, not later than 30 days prior 
to January 1 of the year involved, make available to MIPS 
eligible professionals the MIPS adjustment factor (and, as 
applicable, the additional MIPS adjustment factor) under para-
graph (6) applicable to the eligible professional for items and 
services furnished by the professional for such year. The Sec-
retary may include such information in the confidential feed-
back under paragraph (12). 
‘‘(8) NO EFFECT IN SUBSEQUENT YEARS.—The MIPS adjust-
ment factors and additional MIPS adjustment factors under 
paragraph (6) shall apply only with respect to the year involved, 
and the Secretary shall not take into account such adjustment 
factors in making payments to a MIPS eligible professional 
under this part in a subsequent year. 
‘‘(9) PUBLIC REPORTING.— 
‘‘(A) IN GENERAL.—The Secretary shall, in an easily 
understandable format, make available on the Physician 
Compare Internet website of the Centers for Medicare & 
Medicaid Services the following:
H. R. 2—24 
‘‘(i) Information regarding the performance of 
MIPS eligible professionals under the MIPS, which— 
‘‘(I) shall include the composite score for each 
such MIPS eligible professional and the perform-
ance of each such MIPS eligible professional with 
respect to each performance category; and 
‘‘(II) may include the performance of each such 
MIPS eligible professional with respect to each 
measure or activity specified in paragraph (2)(B). 
‘‘(ii) The names of eligible professionals in eligible 
alternative payment models (as defined in section 
1833(z)(3)(D)) and, to the extent feasible, the names 
of such eligible alternative payment models and 
performance of such models. 
‘‘(B) DISCLOSURE.—The information made available 
under this paragraph shall indicate, where appropriate, 
that publicized information may not be representative of 
the eligible professional’s entire patient population, the 
variety of services furnished by the eligible professional, 
or the health conditions of individuals treated. 
‘‘(C) OPPORTUNITY
TO
REVIEW
AND
SUBMIT
CORREC-
TIONS.—The Secretary shall provide for an opportunity for 
a professional described in subparagraph (A) to review, 
and submit corrections for, the information to be made 
public with respect to the professional under such subpara-
graph prior to such information being made public. 
‘‘(D) AGGREGATE
INFORMATION.—The Secretary shall 
periodically post on the Physician Compare Internet 
website aggregate information on the MIPS, including the 
range of composite scores for all MIPS eligible professionals 
and the range of the performance of all MIPS eligible 
professionals with respect to each performance category. 
‘‘(10) CONSULTATION.—The Secretary shall consult with 
stakeholders in carrying out the MIPS, including for the identi-
fication of measures and activities under paragraph (2)(B) and 
the methodologies developed under paragraphs (5)(A) and (6) 
and regarding the use of qualified clinical data registries. Such 
consultation shall include the use of a request for information 
or other mechanisms determined appropriate. 
‘‘(11) TECHNICAL
ASSISTANCE
TO
SMALL
PRACTICES
AND 
PRACTICES IN HEALTH PROFESSIONAL SHORTAGE AREAS.— 
‘‘(A) IN GENERAL.—The Secretary shall enter into con-
tracts or agreements with appropriate entities (such as 
quality improvement organizations, regional extension cen-
ters (as described in section 3012(c) of the Public Health 
Service Act), or regional health collaboratives) to offer guid-
ance and assistance to MIPS eligible professionals in prac-
tices of 15 or fewer professionals (with priority given to 
such practices located in rural areas, health professional 
shortage areas (as designated under in section 332(a)(1)(A) 
of such Act), and medically underserved areas, and prac-
tices with low composite scores) with respect to— 
‘‘(i) the performance categories described in clauses 
(i) through (iv) of paragraph (2)(A); or 
‘‘(ii) how to transition to the implementation of 
and participation in an alternative payment model as 
described in section 1833(z)(3)(C).
H. R. 2—25 
‘‘(B) FUNDING FOR TECHNICAL ASSISTANCE.—For pur-
poses of implementing subparagraph (A), the Secretary 
shall provide for the transfer from the Federal Supple-
mentary Medical Insurance Trust Fund established under 
section 1841 to the Centers for Medicare & Medicaid Serv-
ices Program Management Account of $20,000,000 for each 
of fiscal years 2016 through 2020. Amounts transferred 
under this subparagraph for a fiscal year shall be available 
until expended. 
‘‘(12) FEEDBACK AND INFORMATION TO IMPROVE PERFORM-
ANCE.— 
‘‘(A) PERFORMANCE FEEDBACK.— 
‘‘(i) IN GENERAL.—Beginning July 1, 2017, the Sec-
retary— 
‘‘(I) shall make available timely (such as quar-
terly) confidential feedback to MIPS eligible profes-
sionals on the performance of such professionals 
with respect to the performance categories under 
clauses (i) and (ii) of paragraph (2)(A); and 
‘‘(II) may make available confidential feedback 
to such professionals on the performance of such 
professionals with respect to the performance cat-
egories under clauses (iii) and (iv) of such para-
graph. 
‘‘(ii) MECHANISMS.—The Secretary may use one or 
more mechanisms to make feedback available under 
clause (i), which may include use of a web-based portal 
or other mechanisms determined appropriate by the 
Secretary. With respect to the performance category 
described in paragraph (2)(A)(i), feedback under this 
subparagraph shall, to the extent an eligible profes-
sional chooses to participate in a data registry for 
purposes of this subsection (including registries under 
subsections (k) and (m)), be provided based on perform-
ance on quality measures reported through the use 
of such registries. With respect to any other perform-
ance category described in paragraph (2)(A), the Sec-
retary shall encourage provision of feedback through 
qualified clinical data registries as described in sub-
section (m)(3)(E)). 
‘‘(iii) USE
OF
DATA.—For purposes of clause (i), 
the Secretary may use data, with respect to a MIPS 
eligible professional, from periods prior to the current 
performance period and may use rolling periods in 
order to make illustrative calculations about the 
performance of such professional. 
‘‘(iv) DISCLOSURE
EXEMPTION.—Feedback made 
available under this subparagraph shall be exempt 
from disclosure under section 552 of title 5, United 
States Code. 
‘‘(v) RECEIPT OF INFORMATION.—The Secretary may 
use the mechanisms established under clause (ii) to 
receive 
information 
from 
professionals, 
such 
as 
information with respect to this subsection. 
‘‘(B) ADDITIONAL INFORMATION.—
H. R. 2—26 
‘‘(i) IN GENERAL.—Beginning July 1, 2018, the Sec-
retary shall make available to MIPS eligible profes-
sionals information, with respect to individuals who 
are patients of such MIPS eligible professionals, about 
items and services for which payment is made under 
this title that are furnished to such individuals by 
other suppliers and providers of services, which may 
include information described in clause (ii). Such 
information may be made available under the previous 
sentence to such MIPS eligible professionals by mecha-
nisms determined appropriate by the Secretary, which 
may include use of a web-based portal. Such informa-
tion may be made available in accordance with the 
same or similar terms as data are made available 
to accountable care organizations participating in the 
shared savings program under section 1899. 
‘‘(ii) TYPE OF INFORMATION.—For purposes of clause 
(i), the information described in this clause, is the 
following: 
‘‘(I) With respect to selected items and services 
(as determined appropriate by the Secretary) for 
which payment is made under this title and that 
are furnished to individuals, who are patients of 
a MIPS eligible professional, by another supplier 
or provider of services during the most recent 
period for which data are available (such as the 
most recent three-month period), such as the name 
of such providers furnishing such items and serv-
ices to such patients during such period, the types 
of such items and services so furnished, and the 
dates such items and services were so furnished. 
‘‘(II) Historical data, such as averages and 
other measures of the distribution if appropriate, 
of the total, and components of, allowed charges 
(and other figures as determined appropriate by 
the Secretary). 
‘‘(13) REVIEW.— 
‘‘(A) TARGETED REVIEW.—The Secretary shall establish 
a process under which a MIPS eligible professional may 
seek an informal review of the calculation of the MIPS 
adjustment factor (or factors) applicable to such eligible 
professional under this subsection for a year. The results 
of a review conducted pursuant to the previous sentence 
shall not be taken into account for purposes of paragraph 
(6) with respect to a year (other than with respect to 
the calculation of such eligible professional’s MIPS adjust-
ment factor for such year or additional MIPS adjustment 
factor for such year) after the factors determined in 
subparagraph (A) and subparagraph (C) of such paragraph 
have been determined for such year. 
‘‘(B) LIMITATION.—Except as provided for in subpara-
graph (A), there shall be no administrative or judicial 
review under section 1869, section 1878, or otherwise of 
the following: 
‘‘(i) The methodology used to determine the amount 
of the MIPS adjustment factor under paragraph (6)(A) 
and the amount of the additional MIPS adjustment
H. R. 2—27 
factor under paragraph (6)(C) and the determination 
of such amounts. 
‘‘(ii) The establishment of the performance stand-
ards under paragraph (3) and the performance period 
under paragraph (4). 
‘‘(iii) The identification of measures and activities 
specified under paragraph (2)(B) and information made 
public or posted on the Physician Compare Internet 
website of the Centers for Medicare & Medicaid Serv-
ices under paragraph (9). 
‘‘(iv) The methodology developed under paragraph 
(5) that is used to calculate performance scores and 
the calculation of such scores, including the weighting 
of measures and activities under such methodology.’’. 
(2) GAO REPORTS.— 
(A) EVALUATION OF ELIGIBLE PROFESSIONAL MIPS.—Not 
later than October 1, 2021, the Comptroller General of 
the United States shall submit to Congress a report evalu-
ating the eligible professional Merit-based Incentive Pay-
ment System under subsection (q) of section 1848 of the 
Social Security Act (42 U.S.C. 1395w–4), as added by para-
graph (1). Such report shall— 
(i) examine the distribution of the composite 
performance scores and MIPS adjustment factors (and 
additional MIPS adjustment factors) for MIPS eligible 
professionals (as defined in subsection (q)(1)(c) of such 
section) under such program, and patterns relating 
to such scores and adjustment factors, including based 
on type of provider, practice size, geographic location, 
and patient mix; 
(ii) provide recommendations for improving such 
program; 
(iii) evaluate the impact of technical assistance 
funding under section 1848(q)(11) of the Social Security 
Act, as added by paragraph (1), on the ability of profes-
sionals to improve within such program or successfully 
transition to an alternative payment model (as defined 
in section 1833(z)(3) of the Social Security Act, as 
added by subsection (e)), with priority for such evalua-
tion given to practices located in rural areas, health 
professional shortage areas (as designated in section 
332(a)(1)(A) of the Public Health Service Act), and 
medically underserved areas; and 
(iv) provide recommendations for optimizing the 
use of such technical assistance funds. 
(B) STUDY TO EXAMINE ALIGNMENT OF QUALITY MEAS-
URES USED IN PUBLIC AND PRIVATE PROGRAMS.— 
(i) IN GENERAL.—Not later than 18 months after 
the date of the enactment of this Act, the Comptroller 
General of the United States shall submit to Congress 
a report that— 
(I) compares the similarities and differences 
in the use of quality measures under the original 
Medicare fee-for-service program under parts A 
and B of title XVIII of the Social Security Act, 
the Medicare Advantage program under part C 
of such title, selected State Medicaid programs
H. R. 2—28 
under title XIX of such Act, and private payer 
arrangements; and 
(II) makes recommendations on how to reduce 
the administrative burden involved in applying 
such quality measures. 
(ii) REQUIREMENTS.—The report under clause (i) 
shall— 
(I) consider those measures applicable to 
individuals entitled to, or enrolled for, benefits 
under such part A, or enrolled under such part 
B and individuals under the age of 65; and 
(II) focus on those measures that comprise 
the most significant component of the quality 
performance category of the eligible professional 
MIPS incentive program under subsection (q) of 
section 1848 of the Social Security Act (42 U.S.C. 
1395w–4), as added by paragraph (1). 
(C) STUDY ON ROLE OF INDEPENDENT RISK MANAGERS.— 
Not later than January 1, 2017, the Comptroller General 
of the United States shall submit to Congress a report 
examining whether entities that pool financial risk for 
physician practices, such as independent risk managers, 
can play a role in supporting physician practices, particu-
larly small physician practices, in assuming financial risk 
for the treatment of patients. Such report shall examine 
barriers that small physician practices currently face in 
assuming financial risk for treating patients, the types 
of risk management entities that could assist physician 
practices in participating in two-sided risk payment models, 
and how such entities could assist with risk management 
and with quality improvement activities. Such report shall 
also include an analysis of any existing legal barriers to 
such arrangements. 
(D) STUDY TO EXAMINE RURAL AND HEALTH PROFES-
SIONAL SHORTAGE AREA ALTERNATIVE PAYMENT MODELS.— 
Not later than October 1, 2021, the Comptroller General 
of the United States shall submit to Congress a report 
that examines the transition of professionals in rural areas, 
health professional shortage areas (as designated in section 
332(a)(1)(A) of the Public Health Service Act), or medically 
underserved areas to an alternative payment model (as 
defined in section 1833(z)(3) of the Social Security Act, 
as added by subsection (e)). Such report shall make rec-
ommendations for removing administrative barriers to 
practices, including small practices consisting of 15 or fewer 
professionals, in rural areas, health professional shortage 
areas, and medically underserved areas to participation 
in such models. 
(3) FUNDING FOR IMPLEMENTATION.—For purposes of imple-
menting the provisions of and the amendments made by this 
section, the Secretary of Health and Human Services shall 
provide for the transfer of $80,000,000 from the Supplementary 
Medical Insurance Trust Fund established under section 1841 
of the Social Security Act (42 U.S.C. 1395t) to the Centers 
for Medicare & Medicaid Program Management Account for 
each of the fiscal years 2015 through 2019. Amounts transferred 
under this paragraph shall be available until expended.
H. R. 2—29 
(d) IMPROVING QUALITY REPORTING FOR COMPOSITE SCORES.— 
(1) CHANGES FOR GROUP REPORTING OPTION.— 
(A) IN GENERAL.—Section 1848(m)(3)(C)(ii) of the Social 
Security Act (42 U.S.C. 1395w–4(m)(3)(C)(ii)) is amended 
by inserting ‘‘and, for 2016 and subsequent years, may 
provide’’ after ‘‘shall provide’’. 
(B) CLARIFICATION OF QUALIFIED CLINICAL DATA REG-
ISTRY
REPORTING
TO
GROUP
PRACTICES.—Section 
1848(m)(3)(D) of the Social Security Act (42 U.S.C. 1395w– 
4(m)(3)(D)) is amended by inserting ‘‘and, for 2016 and 
subsequent years, subparagraph (A) or (C)’’ after ‘‘subpara-
graph (A)’’. 
(2) CHANGES FOR MULTIPLE REPORTING PERIODS AND ALTER-
NATIVE
CRITERIA
FOR
SATISFACTORY
REPORTING.—Section 
1848(m)(5)(F) of the Social Security Act (42 U.S.C. 1395w– 
4(m)(5)(F)) is amended— 
(A) by striking ‘‘and subsequent years’’ and inserting 
‘‘through reporting periods occurring in 2015’’; and 
(B) by inserting ‘‘and, for reporting periods occurring 
in 2016 and subsequent years, the Secretary may establish’’ 
after ‘‘shall establish’’. 
(3) PHYSICIAN FEEDBACK PROGRAM REPORTS SUCCEEDED BY 
REPORTS UNDER MIPS.—Section 1848(n) of the Social Security 
Act (42 U.S.C. 1395w–4(n)) is amended by adding at the end 
the following new paragraph: 
‘‘(11) REPORTS ENDING WITH 2017.—Reports under the Pro-
gram shall not be provided after December 31, 2017. See sub-
section (q)(12) for reports under the eligible professionals Merit- 
based Incentive Payment System.’’. 
(4) COORDINATION WITH SATISFYING MEANINGFUL EHR USE 
CLINICAL QUALITY MEASURE REPORTING REQUIREMENT.—Section 
1848(o)(2)(A)(iii) of the Social Security Act (42 U.S.C. 1395w– 
4(o)(2)(A)(iii)) is amended by inserting ‘‘and subsection 
(q)(5)(B)(ii)(II)’’ after ‘‘Subject to subparagraph (B)(ii)’’. 
(e) PROMOTING ALTERNATIVE PAYMENT MODELS.— 
(1) INCREASING TRANSPARENCY OF PHYSICIAN-FOCUSED PAY-
MENT MODELS.—Section 1868 of the Social Security Act (42 
U.S.C. 1395ee) is amended by adding at the end the following 
new subsection: 
‘‘(c) PHYSICIAN-FOCUSED PAYMENT MODELS.— 
‘‘(1) TECHNICAL ADVISORY COMMITTEE.— 
‘‘(A) ESTABLISHMENT.—There is established an ad hoc 
committee to be known as the ‘Physician-Focused Payment 
Model Technical Advisory Committee’ (referred to in this 
subsection as the ‘Committee’). 
‘‘(B) MEMBERSHIP.— 
‘‘(i) NUMBER AND APPOINTMENT.—The Committee 
shall be composed of 11 members appointed by the 
Comptroller General of the United States. 
‘‘(ii) QUALIFICATIONS.—The membership of the 
Committee shall include individuals with national rec-
ognition for their expertise in physician-focused pay-
ment models and related delivery of care. No more 
than 5 members of the Committee shall be providers 
of services or suppliers, or representatives of providers 
of services or suppliers.
H. R. 2—30 
‘‘(iii) PROHIBITION
ON
FEDERAL
EMPLOYMENT.—A 
member of the Committee shall not be an employee 
of the Federal Government. 
‘‘(iv) ETHICS DISCLOSURE.—The Comptroller Gen-
eral shall establish a system for public disclosure by 
members of the Committee of financial and other 
potential conflicts of interest relating to such members. 
Members of the Committee shall be treated as 
employees of Congress for purposes of applying title 
I of the Ethics in Government Act of 1978 (Public 
Law 95–521). 
‘‘(v) DATE OF INITIAL APPOINTMENTS.—The initial 
appointments of members of the Committee shall be 
made by not later than 180 days after the date of 
enactment of this subsection. 
‘‘(C) TERM; VACANCIES.— 
‘‘(i) TERM.—The terms of members of the Com-
mittee shall be for 3 years except that the Comptroller 
General shall designate staggered terms for the mem-
bers first appointed. 
‘‘(ii) VACANCIES.—Any member appointed to fill a 
vacancy occurring before the expiration of the term 
for which the member’s predecessor was appointed 
shall be appointed only for the remainder of that term. 
A member may serve after the expiration of that mem-
ber’s term until a successor has taken office. A vacancy 
in the Committee shall be filled in the manner in 
which the original appointment was made. 
‘‘(D) DUTIES.—The Committee shall meet, as needed, 
to provide comments and recommendations to the Sec-
retary, as described in paragraph (2)(C), on physician- 
focused payment models. 
‘‘(E) COMPENSATION OF MEMBERS.— 
‘‘(i) IN
GENERAL.—Except as provided in clause 
(ii), a member of the Committee shall serve without 
compensation. 
‘‘(ii) TRAVEL EXPENSES.—A member of the Com-
mittee shall be allowed travel expenses, including per 
diem in lieu of subsistence, at rates authorized for 
an employee of an agency under subchapter I of chapter 
57 of title 5, United States Code, while away from 
the home or regular place of business of the member 
in the performance of the duties of the Committee. 
‘‘(F) OPERATIONAL AND TECHNICAL SUPPORT.— 
‘‘(i) IN
GENERAL.—The Assistant Secretary for 
Planning and Evaluation shall provide technical and 
operational support for the Committee, which may be 
by use of a contractor. The Office of the Actuary of 
the Centers for Medicare & Medicaid Services shall 
provide to the Committee actuarial assistance as 
needed. 
‘‘(ii) FUNDING.—The Secretary shall provide for the 
transfer, from the Federal Supplementary Medical 
Insurance Trust Fund under section 1841, such 
amounts as are necessary to carry out this paragraph 
(not to exceed $5,000,000) for fiscal year 2015 and 
each subsequent fiscal year. Any amounts transferred
H. R. 2—31 
under the preceding sentence for a fiscal year shall 
remain available until expended. 
‘‘(G) APPLICATION.—Section 14 of the Federal Advisory 
Committee Act (5 U.S.C. App.) shall not apply to the Com-
mittee. 
‘‘(2) CRITERIA AND PROCESS FOR SUBMISSION AND REVIEW 
OF PHYSICIAN-FOCUSED PAYMENT MODELS.— 
‘‘(A) CRITERIA FOR ASSESSING PHYSICIAN-FOCUSED PAY-
MENT MODELS.— 
‘‘(i) RULEMAKING.—Not later than November 1, 
2016, the Secretary shall, through notice and comment 
rulemaking, following a request for information, estab-
lish criteria for physician-focused payment models, 
including models for specialist physicians, that could 
be used by the Committee for making comments and 
recommendations pursuant to paragraph (1)(D). 
‘‘(ii) MEDPAC SUBMISSION OF COMMENTS.—During 
the comment period for the proposed rule described 
in clause (i), the Medicare Payment Advisory Commis-
sion may submit comments to the Secretary on the 
proposed criteria under such clause. 
‘‘(iii) UPDATING.—The Secretary may update the 
criteria established under this subparagraph through 
rulemaking. 
‘‘(B) STAKEHOLDER SUBMISSION OF PHYSICIAN-FOCUSED 
PAYMENT MODELS.—On an ongoing basis, individuals and 
stakeholder entities may submit to the Committee pro-
posals for physician-focused payment models that such 
individuals and entities believe meet the criteria described 
in subparagraph (A). 
‘‘(C) COMMITTEE REVIEW OF MODELS SUBMITTED.—The 
Committee shall, on a periodic basis, review models sub-
mitted under subparagraph (B), prepare comments and 
recommendations regarding whether such models meet the 
criteria described in subparagraph (A), and submit such 
comments and recommendations to the Secretary. 
‘‘(D) SECRETARY REVIEW AND RESPONSE.—The Secretary 
shall review the comments and recommendations submitted 
by the Committee under subparagraph (C) and post a 
detailed response to such comments and recommendations 
on the Internet website of the Centers for Medicare & 
Medicaid Services. 
‘‘(3) RULE OF CONSTRUCTION.—Nothing in this subsection 
shall be construed to impact the development or testing of 
models under this title or titles XI, XIX, or XXI.’’. 
(2) INCENTIVE PAYMENTS FOR PARTICIPATION IN ELIGIBLE 
ALTERNATIVE
PAYMENT
MODELS.—Section 1833 of the Social 
Security Act (42 U.S.C. 1395l) is amended by adding at the 
end the following new subsection: 
‘‘(z) INCENTIVE PAYMENTS
FOR PARTICIPATION
IN ELIGIBLE 
ALTERNATIVE PAYMENT MODELS.— 
‘‘(1) PAYMENT INCENTIVE.— 
‘‘(A) IN GENERAL.—In the case of covered professional 
services furnished by an eligible professional during a year 
that is in the period beginning with 2019 and ending with 
2024 and for which the professional is a qualifying APM 
participant with respect to such year, in addition to the
H. R. 2—32 
amount of payment that would otherwise be made for such 
covered professional services under this part for such year, 
there also shall be paid to such professional an amount 
equal to 5 percent of the estimated aggregate payment 
amounts for such covered professional services under this 
part for the preceding year. For purposes of the previous 
sentence, the payment amount for the preceding year may 
be an estimation for the full preceding year based on a 
period of such preceding year that is less than the full 
year. The Secretary shall establish policies to implement 
this subparagraph in cases in which payment for covered 
professional services furnished by a qualifying APM partici-
pant in an alternative payment model— 
‘‘(i) is made to an eligible alternative payment 
entity rather than directly to the qualifying APM 
participant; or 
‘‘(ii) is made on a basis other than a fee-for-service 
basis (such as payment on a capitated basis). 
‘‘(B) FORM OF PAYMENT.—Payments under this sub-
section shall be made in a lump sum, on an annual basis, 
as soon as practicable. 
‘‘(C) TREATMENT
OF
PAYMENT
INCENTIVE.—Payments 
under this subsection shall not be taken into account for 
purposes of determining actual expenditures under an 
alternative payment model and for purposes of determining 
or rebasing any benchmarks used under the alternative 
payment model. 
‘‘(D) COORDINATION.—The amount of the additional 
payment under this subsection or subsection (m) shall be 
determined without regard to any additional payment 
under subsection (m) and this subsection, respectively. The 
amount of the additional payment under this subsection 
or subsection (x) shall be determined without regard to 
any additional payment under subsection (x) and this sub-
section, respectively. The amount of the additional payment 
under this subsection or subsection (y) shall be determined 
without regard to any additional payment under subsection 
(y) and this subsection, respectively. 
‘‘(2) QUALIFYING APM PARTICIPANT.—For purposes of this 
subsection, the term ‘qualifying APM participant’ means the 
following: 
‘‘(A) 2019 AND 2020.—With respect to 2019 and 2020, 
an eligible professional for whom the Secretary determines 
that at least 25 percent of payments under this part for 
covered professional services furnished by such professional 
during the most recent period for which data are available 
(which may be less than a year) were attributable to such 
services furnished under this part through an eligible alter-
native payment entity. 
‘‘(B) 2021 AND 2022.—With respect to 2021 and 2022, 
an eligible professional described in either of the following 
clauses: 
‘‘(i) MEDICARE PAYMENT THRESHOLD OPTION.—An 
eligible professional for whom the Secretary determines 
that at least 50 percent of payments under this part 
for covered professional services furnished by such 
professional during the most recent period for which
H. R. 2—33 
data are available (which may be less than a year) 
were attributable to such services furnished under this 
part through an eligible alternative payment entity. 
‘‘(ii) COMBINATION ALL-PAYER AND MEDICARE PAY-
MENT THRESHOLD OPTION.—An eligible professional— 
‘‘(I) for whom the Secretary determines, with 
respect to items and services furnished by such 
professional during the most recent period for 
which data are available (which may be less than 
a year), that at least 50 percent of the sum of— 
‘‘(aa) payments described in clause (i); and 
‘‘(bb) all other payments, regardless of 
payer (other than payments made by the Sec-
retary of Defense or the Secretary of Veterans 
Affairs and other than payments made under 
title XIX in a State in which no medical home 
or alternative payment model is available 
under the State program under that title), 
meet the requirement described in clause (iii)(I) 
with respect to payments described in item (aa) 
and meet the requirement described in clause 
(iii)(II) with respect to payments described in item 
(bb); 
‘‘(II) for whom the Secretary determines at 
least 25 percent of payments under this part for 
covered professional services furnished by such 
professional during the most recent period for 
which data are available (which may be less than 
a year) were attributable to such services furnished 
under this part through an eligible alternative pay-
ment entity; and 
‘‘(III) who provides to the Secretary such 
information as is necessary for the Secretary to 
make a determination under subclause (I), with 
respect to such professional. 
‘‘(iii) 
REQUIREMENT.—For 
purposes 
of 
clause 
(ii)(I)— 
‘‘(I) the requirement described in this sub-
clause, with respect to payments described in item 
(aa) of such clause, is that such payments are 
made to an eligible alternative payment entity; 
and 
‘‘(II) the requirement described in this sub-
clause, with respect to payments described in item 
(bb) of such clause, is that such payments are 
made under arrangements in which— 
‘‘(aa) quality measures comparable to 
measures under the performance category 
described in section 1848(q)(2)(B)(i) apply; 
‘‘(bb) certified EHR technology is used; 
and 
‘‘(cc) the eligible professional participates 
in an entity that— 
‘‘(AA) bears more than nominal finan-
cial risk if actual aggregate expenditures 
exceeds expected aggregate expenditures; 
or
H. R. 2—34 
‘‘(BB) with respect to beneficiaries 
under title XIX, is a medical home that 
meets criteria comparable to medical 
homes expanded under section 1115A(c). 
‘‘(C) BEGINNING IN 2023.—With respect to 2023 and 
each subsequent year, an eligible professional described 
in either of the following clauses: 
‘‘(i) MEDICARE PAYMENT THRESHOLD OPTION.—An 
eligible professional for whom the Secretary determines 
that at least 75 percent of payments under this part 
for covered professional services furnished by such 
professional during the most recent period for which 
data are available (which may be less than a year) 
were attributable to such services furnished under this 
part through an eligible alternative payment entity. 
‘‘(ii) COMBINATION ALL-PAYER AND MEDICARE PAY-
MENT THRESHOLD OPTION.—An eligible professional— 
‘‘(I) for whom the Secretary determines, with 
respect to items and services furnished by such 
professional during the most recent period for 
which data are available (which may be less than 
a year), that at least 75 percent of the sum of— 
‘‘(aa) payments described in clause (i); and 
‘‘(bb) all other payments, regardless of 
payer (other than payments made by the Sec-
retary of Defense or the Secretary of Veterans 
Affairs and other than payments made under 
title XIX in a State in which no medical home 
or alternative payment model is available 
under the State program under that title), 
meet the requirement described in clause (iii)(I) 
with respect to payments described in item (aa) 
and meet the requirement described in clause 
(iii)(II) with respect to payments described in item 
(bb); 
‘‘(II) for whom the Secretary determines at 
least 25 percent of payments under this part for 
covered professional services furnished by such 
professional during the most recent period for 
which data are available (which may be less than 
a year) were attributable to such services furnished 
under this part through an eligible alternative pay-
ment entity; and 
‘‘(III) who provides to the Secretary such 
information as is necessary for the Secretary to 
make a determination under subclause (I), with 
respect to such professional. 
‘‘(iii) 
REQUIREMENT.—For 
purposes 
of 
clause 
(ii)(I)— 
‘‘(I) the requirement described in this sub-
clause, with respect to payments described in item 
(aa) of such clause, is that such payments are 
made to an eligible alternative payment entity; 
and 
‘‘(II) the requirement described in this sub-
clause, with respect to payments described in item
H. R. 2—35 
(bb) of such clause, is that such payments are 
made under arrangements in which— 
‘‘(aa) quality measures comparable to 
measures under the performance category 
described in section 1848(q)(2)(B)(i) apply; 
‘‘(bb) certified EHR technology is used; 
and 
‘‘(cc) the eligible professional participates 
in an entity that— 
‘‘(AA) bears more than nominal finan-
cial risk if actual aggregate expenditures 
exceeds expected aggregate expenditures; 
or 
‘‘(BB) with respect to beneficiaries 
under title XIX, is a medical home that 
meets criteria comparable to medical 
homes expanded under section 1115A(c). 
‘‘(D) USE OF PATIENT APPROACH.—The Secretary may 
base the determination of whether an eligible professional 
is a qualifying APM participant under this subsection and 
the determination of whether an eligible professional is 
a partial qualifying APM participant under section 
1848(q)(1)(C)(iii) by using counts of patients in lieu of using 
payments and using the same or similar percentage criteria 
(as specified in this subsection and such section, respec-
tively), as the Secretary determines appropriate. 
‘‘(3) ADDITIONAL DEFINITIONS.—In this subsection: 
‘‘(A) COVERED PROFESSIONAL SERVICES.—The term ‘cov-
ered professional services’ has the meaning given that term 
in section 1848(k)(3)(A). 
‘‘(B) 
ELIGIBLE
PROFESSIONAL.—The 
term 
‘eligible 
professional’ has the meaning given that term in section 
1848(k)(3)(B) and includes a group that includes such 
professionals. 
‘‘(C) ALTERNATIVE PAYMENT MODEL (APM).—The term 
‘alternative payment model’ means, other than for purposes 
of subparagraphs (B)(ii)(I)(bb) and (C)(ii)(I)(bb) of para-
graph (2), any of the following: 
‘‘(i) A model under section 1115A (other than a 
health care innovation award). 
‘‘(ii) The shared savings program under section 
1899. 
‘‘(iii) A demonstration under section 1866C. 
‘‘(iv) A demonstration required by Federal law. 
‘‘(D) ELIGIBLE
ALTERNATIVE
PAYMENT
ENTITY.—The 
term ‘eligible alternative payment entity’ means, with 
respect to a year, an entity that— 
‘‘(i) participates in an alternative payment model 
that— 
‘‘(I) requires participants in such model to use 
certified EHR technology (as defined in subsection 
(o)(4)); and 
‘‘(II) provides for payment for covered profes-
sional services based on quality measures com-
parable to measures under the performance cat-
egory described in section 1848(q)(2)(B)(i); and
H. R. 2—36 
‘‘(ii)(I) bears financial risk for monetary losses 
under such alternative payment model that are in 
excess of a nominal amount; or 
‘‘(II) is a medical home expanded under section 
1115A(c). 
‘‘(4) LIMITATION.—There shall be no administrative or 
judicial review under section 1869, 1878, or otherwise, of the 
following: 
‘‘(A) The determination that an eligible professional 
is a qualifying APM participant under paragraph (2) and 
the determination that an entity is an eligible alternative 
payment entity under paragraph (3)(D). 
‘‘(B) The determination of the amount of the 5 percent 
payment incentive under paragraph (1)(A), including any 
estimation as part of such determination.’’. 
(3) COORDINATION
CONFORMING
AMENDMENTS.—Section 
1833 of the Social Security Act (42 U.S.C. 1395l) is further 
amended— 
(A) in subsection (x)(3), by adding at the end the fol-
lowing new sentence: ‘‘The amount of the additional pay-
ment for a service under this subsection and subsection 
(z) shall be determined without regard to any additional 
payment for the service under subsection (z) and this sub-
section, respectively.’’; and 
(B) in subsection (y)(3), by adding at the end the fol-
lowing new sentence: ‘‘The amount of the additional pay-
ment for a service under this subsection and subsection 
(z) shall be determined without regard to any additional 
payment for the service under subsection (z) and this sub-
section, respectively.’’. 
(4) ENCOURAGING DEVELOPMENT AND TESTING OF CERTAIN 
MODELS.—Section 1115A(b)(2) of the Social Security Act (42 
U.S.C. 1315a(b)(2)) is amended— 
(A) in subparagraph (B), by adding at the end the 
following new clauses: 
‘‘(xxi) Focusing primarily on physicians’ services 
(as defined in section 1848(j)(3)) furnished by physi-
cians who are not primary care practitioners. 
‘‘(xxii) Focusing on practices of 15 or fewer profes-
sionals. 
‘‘(xxiii) Focusing on risk-based models for small 
physician practices which may involve two-sided risk 
and prospective patient assignment, and which 
examine risk-adjusted decreases in mortality rates, 
hospital readmissions rates, and other relevant and 
appropriate clinical measures. 
‘‘(xxiv) Focusing primarily on title XIX, working 
in conjunction with the Center for Medicaid and CHIP 
Services.’’; and 
(B) in subparagraph (C)(viii), by striking ‘‘other public 
sector or private sector payers’’ and inserting ‘‘other public 
sector payers, private sector payers, or statewide payment 
models’’. 
(5) CONSTRUCTION
REGARDING
TELEHEALTH
SERVICES.— 
Nothing in the provisions of, or amendments made by, this 
title shall be construed as precluding an alternative payment 
model or a qualifying APM participant (as those terms are
H. R. 2—37 
defined in section 1833(z) of the Social Security Act, as added 
by paragraph (1)) from furnishing a telehealth service for which 
payment is not made under section 1834(m) of the Social Secu-
rity Act (42 U.S.C. 1395m(m)). 
(6) INTEGRATING MEDICARE ADVANTAGE ALTERNATIVE PAY-
MENT
MODELS.—Not later than July 1, 2016, the Secretary 
of Health and Human Services shall submit to Congress a 
study that examines the feasibility of integrating alternative 
payment models in the Medicare Advantage payment system. 
The study shall include the feasibility of including a value- 
based modifier and whether such modifier should be budget 
neutral. 
(7) STUDY AND REPORT ON FRAUD RELATED TO ALTERNATIVE 
PAYMENT MODELS UNDER THE MEDICARE PROGRAM.— 
(A) STUDY.—The Secretary of Health and Human Serv-
ices, in consultation with the Inspector General of the 
Department of Health and Human Services, shall conduct 
a study that— 
(i) examines the applicability of the Federal fraud 
prevention laws to items and services furnished under 
title XVIII of the Social Security Act for which payment 
is made under an alternative payment model (as 
defined in section 1833(z)(3)(C) of such Act (42 U.S.C. 
1395l(z)(3)(C))); 
(ii) identifies aspects of such alternative payment 
models that are vulnerable to fraudulent activity; and 
(iii) examines the implications of waivers to such 
laws granted in support of such alternative payment 
models, including under any potential expansion of 
such models. 
(B) REPORT.—Not later than 2 years after the date 
of the enactment of this Act, the Secretary shall submit 
to Congress a report containing the results of the study 
conducted under subparagraph (A). Such report shall 
include recommendations for actions to be taken to reduce 
the vulnerability of such alternative payment models to 
fraudulent activity. Such report also shall include, as appro-
priate, recommendations of the Inspector General for 
changes in Federal fraud prevention laws to reduce such 
vulnerability. 
(f) COLLABORATING WITH THE PHYSICIAN, PRACTITIONER, AND 
OTHER STAKEHOLDER COMMUNITIES TO IMPROVE RESOURCE USE 
MEASUREMENT.—Section 1848 of the Social Security Act (42 U.S.C. 
1395w–4), as amended by subsection (c), is further amended by 
adding at the end the following new subsection: 
‘‘(r) COLLABORATING WITH THE PHYSICIAN, PRACTITIONER, AND 
OTHER STAKEHOLDER COMMUNITIES TO IMPROVE RESOURCE USE 
MEASUREMENT.— 
‘‘(1) IN GENERAL.—In order to involve the physician, practi-
tioner, and other stakeholder communities in enhancing the 
infrastructure for resource use measurement, including for pur-
poses of the Merit-based Incentive Payment System under sub-
section (q) and alternative payment models under section 
1833(z), the Secretary shall undertake the steps described in 
the succeeding provisions of this subsection. 
‘‘(2) DEVELOPMENT OF CARE EPISODE AND PATIENT CONDI-
TION GROUPS AND CLASSIFICATION CODES.—
H. R. 2—38 
‘‘(A) IN GENERAL.—In order to classify similar patients 
into care episode groups and patient condition groups, the 
Secretary shall undertake the steps described in the suc-
ceeding provisions of this paragraph. 
‘‘(B) PUBLIC
AVAILABILITY
OF
EXISTING
EFFORTS
TO 
DESIGN AN EPISODE GROUPER.—Not later than 180 days 
after the date of the enactment of this subsection, the 
Secretary shall post on the Internet website of the Centers 
for Medicare & Medicaid Services a list of the episode 
groups developed pursuant to subsection (n)(9)(A) and 
related descriptive information. 
‘‘(C) STAKEHOLDER INPUT.—The Secretary shall accept, 
through the date that is 120 days after the day the Sec-
retary posts the list pursuant to subparagraph (B), sugges-
tions from physician specialty societies, applicable practi-
tioner organizations, and other stakeholders for episode 
groups in addition to those posted pursuant to such 
subparagraph, and specific clinical criteria and patient 
characteristics to classify patients into— 
‘‘(i) care episode groups; and 
‘‘(ii) patient condition groups. 
‘‘(D) DEVELOPMENT
OF
PROPOSED
CLASSIFICATION 
CODES.— 
‘‘(i) IN GENERAL.—Taking into account the informa-
tion described in subparagraph (B) and the information 
received under subparagraph (C), the Secretary shall— 
‘‘(I) establish care episode groups and patient 
condition groups, which account for a target of 
an estimated 1⁄2 of expenditures under parts A 
and B (with such target increasing over time as 
appropriate); and 
‘‘(II) assign codes to such groups. 
‘‘(ii) CARE EPISODE GROUPS.—In establishing the 
care episode groups under clause (i), the Secretary 
shall take into account— 
‘‘(I) the patient’s clinical problems at the time 
items and services are furnished during an episode 
of care, such as the clinical conditions or diagnoses, 
whether or not inpatient hospitalization occurs, 
and the principal procedures or services furnished; 
and 
‘‘(II) other factors determined appropriate by 
the Secretary. 
‘‘(iii) PATIENT CONDITION GROUPS.—In establishing 
the patient condition groups under clause (i), the Sec-
retary shall take into account— 
‘‘(I) the patient’s clinical history at the time 
of a medical visit, such as the patient’s combination 
of chronic conditions, current health status, and 
recent significant history (such as hospitalization 
and major surgery during a previous period, such 
as 3 months); and 
‘‘(II) other factors determined appropriate by 
the Secretary, such as eligibility status under this 
title (including eligibility under section 226(a), 
226(b), or 226A, and dual eligibility under this 
title and title XIX).
H. R. 2—39 
‘‘(E) DRAFT
CARE
EPISODE
AND
PATIENT
CONDITION 
GROUPS AND CLASSIFICATION CODES.—Not later than 270 
days after the end of the comment period described in 
subparagraph (C), the Secretary shall post on the Internet 
website of the Centers for Medicare & Medicaid Services 
a draft list of the care episode and patient condition codes 
established under subparagraph (D) (and the criteria and 
characteristics assigned to such code). 
‘‘(F) SOLICITATION OF INPUT.—The Secretary shall seek, 
through the date that is 120 days after the Secretary 
posts the list pursuant to subparagraph (E), comments 
from physician specialty societies, applicable practitioner 
organizations, and other stakeholders, including represent-
atives of individuals entitled to benefits under part A or 
enrolled under this part, regarding the care episode and 
patient condition groups (and codes) posted under subpara-
graph (E). In seeking such comments, the Secretary shall 
use one or more mechanisms (other than notice and com-
ment rulemaking) that may include use of open door 
forums, town hall meetings, or other appropriate mecha-
nisms. 
‘‘(G) OPERATIONAL LIST OF CARE EPISODE AND PATIENT 
CONDITION GROUPS AND CODES.—Not later than 270 days 
after the end of the comment period described in subpara-
graph (F), taking into account the comments received under 
such subparagraph, the Secretary shall post on the Internet 
website of the Centers for Medicare & Medicaid Services 
an operational list of care episode and patient condition 
codes (and the criteria and characteristics assigned to such 
code). 
‘‘(H) 
SUBSEQUENT
REVISIONS.—Not 
later 
than 
November 1 of each year (beginning with 2018), the Sec-
retary shall, through rulemaking, make revisions to the 
operational lists of care episode and patient condition codes 
as the Secretary determines may be appropriate. Such 
revisions may be based on experience, new information 
developed pursuant to subsection (n)(9)(A), and input from 
the physician specialty societies, applicable practitioner 
organizations, and other stakeholders, including represent-
atives of individuals entitled to benefits under part A or 
enrolled under this part. 
‘‘(3) ATTRIBUTION OF PATIENTS TO PHYSICIANS OR PRACTI-
TIONERS.— 
‘‘(A) IN GENERAL.—In order to facilitate the attribution 
of patients and episodes (in whole or in part) to one or 
more physicians or applicable practitioners furnishing 
items and services, the Secretary shall undertake the steps 
described in the succeeding provisions of this paragraph. 
‘‘(B) DEVELOPMENT
OF
PATIENT
RELATIONSHIP
CAT-
EGORIES AND CODES.—The Secretary shall develop patient 
relationship categories and codes that define and distin-
guish the relationship and responsibility of a physician 
or applicable practitioner with a patient at the time of 
furnishing an item or service. Such patient relationship 
categories shall include different relationships of the physi-
cian or applicable practitioner to the patient (and the codes
H. R. 2—40 
may reflect combinations of such categories), such as a 
physician or applicable practitioner who— 
‘‘(i) considers themself to have the primary respon-
sibility for the general and ongoing care for the patient 
over extended periods of time; 
‘‘(ii) considers themself to be the lead physician 
or practitioner and who furnishes items and services 
and coordinates care furnished by other physicians 
or practitioners for the patient during an acute episode; 
‘‘(iii) furnishes items and services to the patient 
on a continuing basis during an acute episode of care, 
but in a supportive rather than a lead role; 
‘‘(iv) furnishes items and services to the patient 
on an occasional basis, usually at the request of 
another physician or practitioner; or 
‘‘(v) furnishes items and services only as ordered 
by another physician or practitioner. 
‘‘(C) DRAFT LIST OF PATIENT RELATIONSHIP CATEGORIES 
AND CODES.—Not later than one year after the date of 
the enactment of this subsection, the Secretary shall post 
on the Internet website of the Centers for Medicare & 
Medicaid Services a draft list of the patient relationship 
categories and codes developed under subparagraph (B). 
‘‘(D) STAKEHOLDER INPUT.—The Secretary shall seek, 
through the date that is 120 days after the Secretary 
posts the list pursuant to subparagraph (C), comments 
from physician specialty societies, applicable practitioner 
organizations, and other stakeholders, including represent-
atives of individuals entitled to benefits under part A or 
enrolled under this part, regarding the patient relationship 
categories and codes posted under subparagraph (C). In 
seeking such comments, the Secretary shall use one or 
more mechanisms (other than notice and comment rule-
making) that may include open door forums, town hall 
meetings, web-based forums, or other appropriate mecha-
nisms. 
‘‘(E) OPERATIONAL LIST OF PATIENT RELATIONSHIP CAT-
EGORIES AND CODES.—Not later than 240 days after the 
end of the comment period described in subparagraph (D), 
taking into account the comments received under such 
subparagraph, the Secretary shall post on the Internet 
website of the Centers for Medicare & Medicaid Services 
an operational list of patient relationship categories and 
codes. 
‘‘(F) 
SUBSEQUENT
REVISIONS.—Not 
later 
than 
November 1 of each year (beginning with 2018), the Sec-
retary shall, through rulemaking, make revisions to the 
operational list of patient relationship categories and codes 
as the Secretary determines appropriate. Such revisions 
may be based on experience, new information developed 
pursuant to subsection (n)(9)(A), and input from the physi-
cian specialty societies, applicable practitioner organiza-
tions, and other stakeholders, including representatives of 
individuals entitled to benefits under part A or enrolled 
under this part.
H. R. 2—41 
‘‘(4) REPORTING
OF
INFORMATION
FOR
RESOURCE
USE 
MEASUREMENT.—Claims submitted for items and services fur-
nished by a physician or applicable practitioner on or after 
January 1, 2018, shall, as determined appropriate by the Sec-
retary, include— 
‘‘(A) applicable codes established under paragraphs (2) 
and (3); and 
‘‘(B) the national provider identifier of the ordering 
physician or applicable practitioner (if different from the 
billing physician or applicable practitioner). 
‘‘(5) METHODOLOGY FOR RESOURCE USE ANALYSIS.— 
‘‘(A) IN GENERAL.—In order to evaluate the resources 
used to treat patients (with respect to care episode and 
patient condition groups), the Secretary shall, as the Sec-
retary determines appropriate— 
‘‘(i) use the patient relationship codes reported on 
claims pursuant to paragraph (4) to attribute patients 
(in whole or in part) to one or more physicians and 
applicable practitioners; 
‘‘(ii) use the care episode and patient condition 
codes reported on claims pursuant to paragraph (4) 
as a basis to compare similar patients and care epi-
sodes and patient condition groups; and 
‘‘(iii) conduct an analysis of resource use (with 
respect to care episodes and patient condition groups 
of such patients). 
‘‘(B) ANALYSIS OF PATIENTS OF PHYSICIANS AND PRACTI-
TIONERS.—In conducting the analysis described in subpara-
graph (A)(iii) with respect to patients attributed to physi-
cians and applicable practitioners, the Secretary shall, as 
feasible— 
‘‘(i) use the claims data experience of such patients 
by patient condition codes during a common period, 
such as 12 months; and 
‘‘(ii) use the claims data experience of such patients 
by care episode codes— 
‘‘(I) in the case of episodes without a hos-
pitalization, during periods of time (such as the 
number of days) determined appropriate by the 
Secretary; and 
‘‘(II) in the case of episodes with a hospitaliza-
tion, during periods of time (such as the number 
of days) before, during, and after the hospitaliza-
tion. 
‘‘(C) MEASUREMENT OF RESOURCE USE.—In measuring 
such resource use, the Secretary— 
‘‘(i) shall use per patient total allowed charges 
for all services under part A and this part (and, if 
the Secretary determines appropriate, part D) for the 
analysis of patient resource use, by care episode codes 
and by patient condition codes; and 
‘‘(ii) may, as determined appropriate, use other 
measures of allowed charges (such as subtotals for 
categories of items and services) and measures of utili-
zation of items and services (such as frequency of spe-
cific items and services and the ratio of specific items 
and services among attributed patients or episodes).
H. R. 2—42 
‘‘(D) STAKEHOLDER INPUT.—The Secretary shall seek 
comments from the physician specialty societies, applicable 
practitioner 
organizations, 
and 
other 
stakeholders, 
including representatives of individuals entitled to benefits 
under part A or enrolled under this part, regarding the 
resource use methodology established pursuant to this 
paragraph. In seeking comments the Secretary shall use 
one or more mechanisms (other than notice and comment 
rulemaking) that may include open door forums, town hall 
meetings, web-based forums, or other appropriate mecha-
nisms. 
‘‘(6) IMPLEMENTATION.—To the extent that the Secretary 
contracts with an entity to carry out any part of the provisions 
of this subsection, the Secretary may not contract with an 
entity or an entity with a subcontract if the entity or subcon-
tracting entity currently makes recommendations to the Sec-
retary on relative values for services under the fee schedule 
for physicians’ services under this section. 
‘‘(7) LIMITATION.—There shall be no administrative or 
judicial review under section 1869, section 1878, or otherwise 
of— 
‘‘(A) care episode and patient condition groups and 
codes established under paragraph (2); 
‘‘(B) patient relationship categories and codes estab-
lished under paragraph (3); and 
‘‘(C) measurement of, and analyses of resource use 
with respect to, care episode and patient condition codes 
and patient relationship codes pursuant to paragraph (5). 
‘‘(8) ADMINISTRATION.—Chapter 35 of title 44, United States 
Code, shall not apply to this section. 
‘‘(9) DEFINITIONS.—In this subsection: 
‘‘(A) PHYSICIAN.—The term ‘physician’ has the meaning 
given such term in section 1861(r)(1). 
‘‘(B) APPLICABLE PRACTITIONER.—The term ‘applicable 
practitioner’ means— 
‘‘(i) a physician assistant, nurse practitioner, and 
clinical nurse specialist (as such terms are defined 
in section 1861(aa)(5)), and a certified registered nurse 
anesthetist (as defined in section 1861(bb)(2)); and 
‘‘(ii) beginning January 1, 2019, such other eligible 
professionals (as defined in subsection (k)(3)(B)) as 
specified by the Secretary. 
‘‘(10) CLARIFICATION.—The provisions of sections 1890(b)(7) 
and 1890A shall not apply to this subsection.’’. 
SEC. 102. PRIORITIES AND FUNDING FOR MEASURE DEVELOPMENT. 
Section 1848 of the Social Security Act (42 U.S.C. 1395w– 
4), as amended by subsections (c) and (f) of section 101, is further 
amended by inserting at the end the following new subsection: 
‘‘(s) PRIORITIES AND FUNDING FOR MEASURE DEVELOPMENT.— 
‘‘(1) PLAN IDENTIFYING MEASURE DEVELOPMENT PRIORITIES 
AND TIMELINES.— 
‘‘(A) DRAFT MEASURE DEVELOPMENT PLAN.—Not later 
than January 1, 2016, the Secretary shall develop, and 
post on the Internet website of the Centers for Medicare 
& Medicaid Services, a draft plan for the development 
of quality measures for application under the applicable
H. R. 2—43 
provisions (as defined in paragraph (5)). Under such plan 
the Secretary shall— 
‘‘(i) address how measures used by private payers 
and integrated delivery systems could be incorporated 
under title XVIII; 
‘‘(ii) describe how coordination, to the extent pos-
sible, will occur across organizations developing such 
measures; and 
‘‘(iii) take into account how clinical best practices 
and clinical practice guidelines should be used in the 
development of quality measures. 
‘‘(B) QUALITY
DOMAINS.—For purposes of this sub-
section, the term ‘quality domains’ means at least the fol-
lowing domains: 
‘‘(i) Clinical care. 
‘‘(ii) Safety. 
‘‘(iii) Care coordination. 
‘‘(iv) Patient and caregiver experience. 
‘‘(v) Population health and prevention. 
‘‘(C) CONSIDERATION.—In developing the draft plan 
under this paragraph, the Secretary shall consider— 
‘‘(i) gap analyses conducted by the entity with a 
contract under section 1890(a) or other contractors or 
entities; 
‘‘(ii) whether measures are applicable across health 
care settings; 
‘‘(iii) clinical practice improvement activities sub-
mitted under subsection (q)(2)(C)(iv) for identifying 
possible areas for future measure development and 
identifying existing gaps with respect to such meas-
ures; and 
‘‘(iv) the quality domains applied under this sub-
section. 
‘‘(D) PRIORITIES.—In developing the draft plan under 
this paragraph, the Secretary shall give priority to the 
following types of measures: 
‘‘(i) Outcome measures, including patient reported 
outcome and functional status measures. 
‘‘(ii) Patient experience measures. 
‘‘(iii) Care coordination measures. 
‘‘(iv) Measures of appropriate use of services, 
including measures of over use. 
‘‘(E) STAKEHOLDER INPUT.—The Secretary shall accept 
through March 1, 2016, comments on the draft plan posted 
under paragraph (1)(A) from the public, including health 
care providers, payers, consumers, and other stakeholders. 
‘‘(F) FINAL MEASURE DEVELOPMENT PLAN.—Not later 
than May 1, 2016, taking into account the comments 
received under this subparagraph, the Secretary shall 
finalize the plan and post on the Internet website of the 
Centers for Medicare & Medicaid Services an operational 
plan for the development of quality measures for use under 
the applicable provisions. Such plan shall be updated as 
appropriate. 
‘‘(2) CONTRACTS AND OTHER ARRANGEMENTS FOR QUALITY 
MEASURE DEVELOPMENT.—
H. R. 2—44 
‘‘(A) IN GENERAL.—The Secretary shall enter into con-
tracts or other arrangements with entities for the purpose 
of developing, improving, updating, or expanding in accord-
ance with the plan under paragraph (1) quality measures 
for application under the applicable provisions. Such enti-
ties shall include organizations with quality measure 
development expertise. 
‘‘(B) PRIORITIZATION.— 
‘‘(i) IN
GENERAL.—In entering into contracts or 
other arrangements under subparagraph (A), the Sec-
retary shall give priority to the development of the 
types of measures described in paragraph (1)(D). 
‘‘(ii) CONSIDERATION.—In selecting measures for 
development under this subsection, the Secretary shall 
consider— 
‘‘(I) whether such measures would be electroni-
cally specified; and 
‘‘(II) clinical practice guidelines to the extent 
that such guidelines exist. 
‘‘(3) ANNUAL REPORT BY THE SECRETARY.— 
‘‘(A) IN GENERAL.—Not later than May 1, 2017, and 
annually thereafter, the Secretary shall post on the Inter-
net website of the Centers for Medicare & Medicaid Serv-
ices a report on the progress made in developing quality 
measures for application under the applicable provisions. 
‘‘(B) REQUIREMENTS.—Each report submitted pursuant 
to subparagraph (A) shall include the following: 
‘‘(i) A description of the Secretary’s efforts to imple-
ment this paragraph. 
‘‘(ii) With respect to the measures developed during 
the previous year— 
‘‘(I) a description of the total number of quality 
measures developed and the types of such meas-
ures, such as an outcome or patient experience 
measure; 
‘‘(II) the name of each measure developed; 
‘‘(III) the name of the developer and steward 
of each measure; 
‘‘(IV) with respect to each type of measure, 
an estimate of the total amount expended under 
this title to develop all measures of such type; 
and 
‘‘(V) whether the measure would be electroni-
cally specified. 
‘‘(iii) With respect to measures in development at 
the time of the report— 
‘‘(I) the information described in clause (ii), 
if available; and 
‘‘(II) a timeline for completion of the develop-
ment of such measures. 
‘‘(iv) A description of any updates to the plan under 
paragraph (1) (including newly identified gaps and the 
status of previously identified gaps) and the inventory 
of measures applicable under the applicable provisions. 
‘‘(v) Other information the Secretary determines 
to be appropriate.
H. R. 2—45 
‘‘(4) STAKEHOLDER INPUT.—With respect to paragraph (1), 
the Secretary shall seek stakeholder input with respect to— 
‘‘(A) the identification of gaps where no quality meas-
ures exist, particularly with respect to the types of meas-
ures described in paragraph (1)(D); 
‘‘(B) prioritizing quality measure development to 
address such gaps; and 
‘‘(C) other areas related to quality measure develop-
ment determined appropriate by the Secretary. 
‘‘(5) DEFINITION OF APPLICABLE PROVISIONS.—In this sub-
section, the term ‘applicable provisions’ means the following 
provisions: 
‘‘(A) Subsection (q)(2)(B)(i). 
‘‘(B) Section 1833(z)(2)(C). 
‘‘(6) FUNDING.—For purposes of carrying out this sub-
section, the Secretary shall provide for the transfer, from the 
Federal Supplementary Medical Insurance Trust Fund under 
section 1841, of $15,000,000 to the Centers for Medicare & 
Medicaid Services Program Management Account for each of 
fiscal years 2015 through 2019. Amounts transferred under 
this paragraph shall remain available through the end of fiscal 
year 2022. 
‘‘(7) ADMINISTRATION.—Chapter 35 of title 44, United States 
Code, shall not apply to the collection of information for the 
development of quality measures.’’. 
SEC. 103. ENCOURAGING CARE MANAGEMENT FOR INDIVIDUALS WITH 
CHRONIC CARE NEEDS. 
(a) IN GENERAL.—Section 1848(b) of the Social Security Act 
(42 U.S.C. 1395w–4(b)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(8) ENCOURAGING
CARE
MANAGEMENT
FOR
INDIVIDUALS 
WITH CHRONIC CARE NEEDS.— 
‘‘(A) IN GENERAL.—In order to encourage the manage-
ment of care for individuals with chronic care needs the 
Secretary shall, subject to subparagraph (B), make payment 
(as the Secretary determines to be appropriate) under this 
section for chronic care management services furnished 
on or after January 1, 2015, by a physician (as defined 
in section 1861(r)(1)), physician assistant or nurse practi-
tioner (as defined in section 1861(aa)(5)(A)), clinical nurse 
specialist (as defined in section 1861(aa)(5)(B)), or certified 
nurse midwife (as defined in section 1861(gg)(2)). 
‘‘(B) POLICIES RELATING TO PAYMENT.—In carrying out 
this paragraph, with respect to chronic care management 
services, the Secretary shall— 
‘‘(i) make payment to only one applicable provider 
for such services furnished to an individual during 
a period; 
‘‘(ii) not make payment under subparagraph (A) 
if such payment would be duplicative of payment that 
is otherwise made under this title for such services; 
and 
‘‘(iii) not require that an annual wellness visit 
(as defined in section 1861(hhh)) or an initial preven-
tive physical examination (as defined in section
H. R. 2—46 
1861(ww)) be furnished as a condition of payment for 
such management services.’’. 
(b) EDUCATION AND OUTREACH.— 
(1) CAMPAIGN.— 
(A) IN GENERAL.—The Secretary of Health and Human 
Services (in this subsection referred to as the ‘‘Secretary’’) 
shall conduct an education and outreach campaign to 
inform professionals who furnish items and services under 
part B of title XVIII of the Social Security Act and individ-
uals enrolled under such part of the benefits of chronic 
care management services described in section 1848(b)(8) 
of the Social Security Act, as added by subsection (a), 
and encourage such individuals with chronic care needs 
to receive such services. 
(B) REQUIREMENTS.—Such campaign shall— 
(i) be directed by the Office of Rural Health Policy 
of the Department of Health and Human Services and 
the Office of Minority Health of the Centers for Medi-
care & Medicaid Services; and 
(ii) focus on encouraging participation by under-
served rural populations and racial and ethnic minority 
populations. 
(2) REPORT.—Not later than December 31, 2017, the Sec-
retary shall submit to Congress a report on the use of chronic 
care management services described in such section 1848(b)(8) 
by individuals living in rural areas and by racial and ethnic 
minority populations. Such report shall— 
(A) identify barriers to receiving chronic care manage-
ment services; and 
(B) make recommendations for increasing the appro-
priate use of chronic care management services. 
SEC. 104. EMPOWERING BENEFICIARY CHOICES THROUGH CONTINUED 
ACCESS TO INFORMATION ON PHYSICIANS’ SERVICES. 
(a) IN GENERAL.—On an annual basis (beginning with 2015), 
the Secretary shall make publicly available, in an easily under-
standable format, information with respect to physicians and, as 
appropriate, other eligible professionals on items and services fur-
nished to Medicare beneficiaries under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.). 
(b) TYPE AND MANNER OF INFORMATION.—The information made 
available under this section shall be similar to the type of informa-
tion in the Medicare Provider Utilization and Payment Data: Physi-
cian and Other Supplier Public Use File released by the Secretary 
with respect to 2012 and shall be made available in a manner 
similar to the manner in which the information in such file is 
made available. 
(c) REQUIREMENTS.—The information made available under this 
section shall include, at a minimum, the following: 
(1) Information on the number of services furnished by 
the physician or other eligible professional under part B of 
title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.), 
which may include information on the most frequent services 
furnished or groupings of services. 
(2) Information on submitted charges and payments for 
services under such part.
H. R. 2—47 
(3) A unique identifier for the physician or other eligible 
professional that is available to the public, such as a national 
provider identifier. 
(d) SEARCHABILITY.—The information made available under this 
section shall be searchable by at least the following: 
(1) The specialty or type of the physician or other eligible 
professional. 
(2) Characteristics of the services furnished, such as volume 
or groupings of services. 
(3) The location of the physician or other eligible profes-
sional. 
(e) INTEGRATION
ON PHYSICIAN COMPARE.—Beginning with 
2016, the Secretary shall integrate the information made available 
under this section on Physician Compare. 
(f) DEFINITIONS.—In this section: 
(1) ELIGIBLE PROFESSIONAL; PHYSICIAN; SECRETARY.—The 
terms ‘‘eligible professional’’, ‘‘physician’’, and ‘‘Secretary’’ have 
the meaning given such terms in section 10331(i) of Public 
Law 111–148. 
(2) PHYSICIAN COMPARE.—The term ‘‘Physician Compare’’ 
means the Physician Compare Internet website of the Centers 
for Medicare & Medicaid Services (or a successor website). 
SEC. 105. EXPANDING AVAILABILITY OF MEDICARE DATA. 
(a) EXPANDING USES OF MEDICARE DATA BY QUALIFIED ENTI-
TIES.— 
(1) ADDITIONAL ANALYSES.— 
(A) IN GENERAL.—Subject to subparagraph (B), to the 
extent consistent with applicable information, privacy, 
security, and disclosure laws (including paragraph (3)), not-
withstanding paragraph (4)(B) of section 1874(e) of the 
Social Security Act (42 U.S.C. 1395kk(e)) and the second 
sentence of paragraph (4)(D) of such section, beginning 
July 1, 2016, a qualified entity may use the combined 
data described in paragraph (4)(B)(iii) of such section 
received by such entity under such section, and information 
derived from the evaluation described in such paragraph 
(4)(D), to conduct additional non-public analyses (as deter-
mined appropriate by the Secretary) and provide or sell 
such analyses to authorized users for non-public use 
(including for the purposes of assisting providers of services 
and suppliers to develop and participate in quality and 
patient care improvement activities, including developing 
new models of care). 
(B) LIMITATIONS WITH RESPECT TO ANALYSES.— 
(i) EMPLOYERS.—Any analyses provided or sold 
under subparagraph (A) to an employer described in 
paragraph (9)(A)(iii) may only be used by such 
employer for purposes of providing health insurance 
to employees and retirees of the employer. 
(ii) HEALTH
INSURANCE
ISSUERS.—A qualified 
entity may not provide or sell an analysis to a health 
insurance issuer described in paragraph (9)(A)(iv) 
unless the issuer is providing the qualified entity with 
data under section 1874(e)(4)(B)(iii) of the Social Secu-
rity Act (42 U.S.C. 1395kk(e)(4)(B)(iii)). 
(2) ACCESS TO CERTAIN DATA.—
H. R. 2—48 
(A) ACCESS.—To the extent consistent with applicable 
information, 
privacy, 
security, 
and 
disclosure 
laws 
(including paragraph (3)), notwithstanding paragraph 
(4)(B) of section 1874(e) of the Social Security Act (42 
U.S.C. 1395kk(e)) and the second sentence of paragraph 
(4)(D) of such section, beginning July 1, 2016, a qualified 
entity may— 
(i) provide or sell the combined data described 
in paragraph (4)(B)(iii) of such section to authorized 
users described in clauses (i), (ii), and (v) of paragraph 
(9)(A) for non-public use, including for the purposes 
described in subparagraph (B); or 
(ii) subject to subparagraph (C), provide Medicare 
claims data to authorized users described in clauses 
(i), (ii), and (v), of paragraph (9)(A) for non-public use, 
including for the purposes described in subparagraph 
(B). 
(B) PURPOSES DESCRIBED.—The purposes described in 
this subparagraph are assisting providers of services and 
suppliers in developing and participating in quality and 
patient care improvement activities, including developing 
new models of care. 
(C) MEDICARE CLAIMS DATA MUST BE PROVIDED AT NO 
COST.—A qualified entity may not charge a fee for providing 
the data under subparagraph (A)(ii). 
(3) PROTECTION OF INFORMATION.— 
(A) IN GENERAL.—Except as provided in subparagraph 
(B), an analysis or data that is provided or sold under 
paragraph (1) or (2) shall not contain information that 
individually identifies a patient. 
(B) INFORMATION ON PATIENTS OF THE PROVIDER OF 
SERVICES
OR
SUPPLIER.—To the extent consistent with 
applicable information, privacy, security, and disclosure 
laws, an analysis or data that is provided or sold to a 
provider of services or supplier under paragraph (1) or 
(2) may contain information that individually identifies 
a patient of such provider or supplier, including with 
respect to items and services furnished to the patient by 
other providers of services or suppliers. 
(C) PROHIBITION ON USING ANALYSES OR DATA FOR MAR-
KETING PURPOSES.—An authorized user shall not use an 
analysis or data provided or sold under paragraph (1) or 
(2) for marketing purposes. 
(4) DATA
USE
AGREEMENT.—A qualified entity and an 
authorized user described in clauses (i), (ii), and (v) of para-
graph (9)(A) shall enter into an agreement regarding the use 
of any data that the qualified entity is providing or selling 
to the authorized user under paragraph (2). Such agreement 
shall describe the requirements for privacy and security of 
the data and, as determined appropriate by the Secretary, 
any prohibitions on using such data to link to other individually 
identifiable sources of information. If the authorized user is 
not a covered entity under the rules promulgated pursuant 
to the Health Insurance Portability and Accountability Act 
of 1996, the agreement shall identify the relevant regulations, 
as determined by the Secretary, that the user shall comply
H. R. 2—49 
with as if it were acting in the capacity of such a covered 
entity. 
(5) NO REDISCLOSURE OF ANALYSES OR DATA.— 
(A) IN GENERAL.—Except as provided in subparagraph 
(B), an authorized user that is provided or sold an analysis 
or data under paragraph (1) or (2) shall not redisclose 
or make public such analysis or data or any analysis using 
such data. 
(B) PERMITTED REDISCLOSURE.—A provider of services 
or supplier that is provided or sold an analysis or data 
under paragraph (1) or (2) may, as determined by the 
Secretary, redisclose such analysis or data for the purposes 
of performance improvement and care coordination activi-
ties but shall not make public such analysis or data or 
any analysis using such data. 
(6) OPPORTUNITY FOR PROVIDERS OF SERVICES AND SUP-
PLIERS TO REVIEW.—Prior to a qualified entity providing or 
selling an analysis to an authorized user under paragraph 
(1), to the extent that such analysis would individually identify 
a provider of services or supplier who is not being provided 
or sold such analysis, such qualified entity shall provide such 
provider or supplier with the opportunity to appeal and correct 
errors in the manner described in section 1874(e)(4)(C)(ii) of 
the Social Security Act (42 U.S.C. 1395kk(e)(4)(C)(ii)). 
(7) ASSESSMENT FOR A BREACH.— 
(A) IN GENERAL.—In the case of a breach of a data 
use agreement under this section or section 1874(e) of 
the Social Security Act (42 U.S.C. 1395kk(e)), the Secretary 
shall impose an assessment on the qualified entity both 
in the case of— 
(i) an agreement between the Secretary and a 
qualified entity; and 
(ii) an agreement between a qualified entity and 
an authorized user. 
(B) ASSESSMENT.—The assessment under subpara-
graph (A) shall be an amount up to $100 for each individual 
entitled to, or enrolled for, benefits under part A of title 
XVIII of the Social Security Act or enrolled for benefits 
under part B of such title— 
(i) in the case of an agreement described in 
subparagraph (A)(i), for whom the Secretary provided 
data on to the qualified entity under paragraph (2); 
and 
(ii) in the case of an agreement described in 
subparagraph (A)(ii), for whom the qualified entity pro-
vided data on to the authorized user under paragraph 
(2). 
(C) DEPOSIT OF AMOUNTS COLLECTED.—Any amounts 
collected pursuant to this paragraph shall be deposited 
in Federal Supplementary Medical Insurance Trust Fund 
under section 1841 of the Social Security Act (42 U.S.C. 
1395t). 
(8) ANNUAL REPORTS.—Any qualified entity that provides 
or sells an analysis or data under paragraph (1) or (2) shall 
annually submit to the Secretary a report that includes— 
(A) a summary of the analyses provided or sold, 
including the number of such analyses, the number of
H. R. 2—50 
purchasers of such analyses, and the total amount of fees 
received for such analyses; 
(B) a description of the topics and purposes of such 
analyses; 
(C) information on the entities who received the data 
under paragraph (2), the uses of the data, and the total 
amount of fees received for providing, selling, or sharing 
the data; and 
(D) other information determined appropriate by the 
Secretary. 
(9) DEFINITIONS.—In this subsection and subsection (b): 
(A) AUTHORIZED
USER.—The term ‘‘authorized user’’ 
means the following: 
(i) A provider of services. 
(ii) A supplier. 
(iii) An employer (as defined in section 3(5) of 
the Employee Retirement Insurance Security Act of 
1974). 
(iv) A health insurance issuer (as defined in section 
2791 of the Public Health Service Act). 
(v) A medical society or hospital association. 
(vi) Any entity not described in clauses (i) through 
(v) that is approved by the Secretary (other than an 
employer or health insurance issuer not described in 
clauses (iii) and (iv), respectively, as determined by 
the Secretary). 
(B) PROVIDER
OF
SERVICES.—The term ‘‘provider of 
services’’ has the meaning given such term in section 
1861(u) of the Social Security Act (42 U.S.C. 1395x(u)). 
(C) QUALIFIED ENTITY.—The term ‘‘qualified entity’’ has 
the meaning given such term in section 1874(e)(2) of the 
Social Security Act (42 U.S.C. 1395kk(e)). 
(D) SECRETARY.—The term ‘‘Secretary’’ means the Sec-
retary of Health and Human Services. 
(E) SUPPLIER.—The term ‘‘supplier’’ has the meaning 
given such term in section 1861(d) of the Social Security 
Act (42 U.S.C. 1395x(d)). 
(b) ACCESS TO MEDICARE DATA BY QUALIFIED CLINICAL DATA 
REGISTRIES TO FACILITATE QUALITY IMPROVEMENT.— 
(1) ACCESS.— 
(A) IN
GENERAL.—To the extent consistent with 
applicable information, privacy, security, and disclosure 
laws, beginning July 1, 2016, the Secretary shall, at the 
request of a qualified clinical data registry under section 
1848(m)(3)(E) of the Social Security Act (42 U.S.C. 1395w– 
4(m)(3)(E)), provide the data described in subparagraph 
(B) (in a form and manner determined to be appropriate) 
to such qualified clinical data registry for purposes of 
linking such data with clinical outcomes data and per-
forming risk-adjusted, scientifically valid analyses and 
research to support quality improvement or patient safety, 
provided that any public reporting of such analyses or 
research that identifies a provider of services or supplier 
shall only be conducted with the opportunity of such pro-
vider or supplier to appeal and correct errors in the manner 
described in subsection (a)(6).
H. R. 2—51 
(B) DATA
DESCRIBED.—The data described in this 
subparagraph is— 
(i) claims data under the Medicare program under 
title XVIII of the Social Security Act; and 
(ii) if the Secretary determines appropriate, claims 
data under the Medicaid program under title XIX of 
such Act and the State Children’s Health Insurance 
Program under title XXI of such Act. 
(2) FEE.—Data described in paragraph (1)(B) shall be pro-
vided to a qualified clinical data registry under paragraph 
(1) at a fee equal to the cost of providing such data. Any 
fee collected pursuant to the preceding sentence shall be depos-
ited in the Centers for Medicare & Medicaid Services Program 
Management Account. 
(c) EXPANSION OF DATA AVAILABLE TO QUALIFIED ENTITIES.— 
Section 1874(e) of the Social Security Act (42 U.S.C. 1395kk(e)) 
is amended— 
(1) in the subsection heading, by striking ‘‘MEDICARE’’; and 
(2) in paragraph (3)— 
(A) by inserting after the first sentence the following 
new sentence: ‘‘Beginning July 1, 2016, if the Secretary 
determines appropriate, the data described in this para-
graph may also include standardized extracts (as deter-
mined by the Secretary) of claims data under titles XIX 
and XXI for assistance provided under such titles for one 
or more specified geographic areas and time periods 
requested by a qualified entity.’’; and 
(B) in the last sentence, by inserting ‘‘or under titles 
XIX or XXI’’ before the period at the end. 
(d) REVISION OF PLACEMENT OF FEES.—Section 1874(e)(4)(A) 
of the Social Security Act (42 U.S.C. 1395kk(e)(4)(A)) is amended, 
in the second sentence— 
(1) by inserting ‘‘, for periods prior to July 1, 2016,’’ after 
‘‘deposited’’; and 
(2) by inserting the following before the period at the 
end: ‘‘, and, beginning July 1, 2016, into the Centers for Medi-
care & Medicaid Services Program Management Account’’. 
SEC. 106. REDUCING ADMINISTRATIVE BURDEN AND OTHER PROVI-
SIONS. 
(a) MEDICARE PHYSICIAN AND PRACTITIONER OPT-OUT TO PRI-
VATE CONTRACT.— 
(1) INDEFINITE, CONTINUING AUTOMATIC EXTENSION OF OPT 
OUT ELECTION.— 
(A) IN GENERAL.—Section 1802(b)(3) of the Social Secu-
rity Act (42 U.S.C. 1395a(b)(3)) is amended— 
(i) in subparagraph (B)(ii), by striking ‘‘during the 
2-year period beginning on the date the affidavit is 
signed’’ and inserting ‘‘during the applicable 2-year 
period (as defined in subparagraph (D))’’; 
(ii) in subparagraph (C), by striking ‘‘during the 
2-year period described in subparagraph (B)(ii)’’ and 
inserting ‘‘during the applicable 2-year period’’; and 
(iii) by adding at the end the following new 
subparagraph: 
‘‘(D) APPLICABLE 2-YEAR PERIODS FOR EFFECTIVENESS 
OF AFFIDAVITS.—In this subsection, the term ‘applicable
H. R. 2—52 
2-year period’ means, with respect to an affidavit of a 
physician or practitioner under subparagraph (B), the 2- 
year period beginning on the date the affidavit is signed 
and includes each subsequent 2-year period unless the 
physician or practitioner involved provides notice to the 
Secretary (in a form and manner specified by the Sec-
retary), not later than 30 days before the end of the pre-
vious 2-year period, that the physician or practitioner does 
not want to extend the application of the affidavit for 
such subsequent 2-year period.’’. 
(B) EFFECTIVE
DATE.—The amendments made by 
subparagraph (A) shall apply to affidavits entered into 
on or after the date that is 60 days after the date of 
the enactment of this Act. 
(2) PUBLIC
AVAILABILITY
OF
INFORMATION
ON
OPT-OUT 
PHYSICIANS AND PRACTITIONERS.—Section 1802(b) of the Social 
Security Act (42 U.S.C. 1395a(b)) is amended— 
(A) in paragraph (5), by adding at the end the following 
new subparagraph: 
‘‘(D) OPT-OUT PHYSICIAN OR PRACTITIONER.—The term ‘opt- 
out physician or practitioner’ means a physician or practitioner 
who has in effect an affidavit under paragraph (3)(B).’’; 
(B) by redesignating paragraph (5) as paragraph (6); 
and 
(C) by inserting after paragraph (4) the following new 
paragraph: 
‘‘(5) POSTING OF INFORMATION ON OPT-OUT PHYSICIANS AND 
PRACTITIONERS.— 
‘‘(A) IN GENERAL.—Beginning not later than February 
1, 2016, the Secretary shall make publicly available 
through an appropriate publicly accessible website of the 
Department of Health and Human Services information 
on the number and characteristics of opt-out physicians 
and practitioners and shall update such information on 
such website not less often than annually. 
‘‘(B) INFORMATION TO BE INCLUDED.—The information 
to be made available under subparagraph (A) shall include 
at least the following with respect to opt-out physicians 
and practitioners: 
‘‘(i) Their number. 
‘‘(ii) Their physician or professional specialty or 
other designation. 
‘‘(iii) Their geographic distribution. 
‘‘(iv) The timing of their becoming opt-out physi-
cians and practitioners, relative, to the extent feasible, 
to when they first enrolled in the program under this 
title and with respect to applicable 2-year periods. 
‘‘(v) The proportion of such physicians and practi-
tioners who billed for emergency or urgent care serv-
ices.’’. 
(b) PROMOTING
INTEROPERABILITY
OF
ELECTRONIC
HEALTH 
RECORD SYSTEMS.— 
(1) RECOMMENDATIONS
FOR
ACHIEVING
WIDESPREAD
EHR 
INTEROPERABILITY.— 
(A) OBJECTIVE.—As a consequence of a significant Fed-
eral investment in the implementation of health informa-
tion technology through the Medicare and Medicaid EHR
H. R. 2—53 
incentive programs, Congress declares it a national objec-
tive to achieve widespread exchange of health information 
through interoperable certified EHR technology nationwide 
by December 31, 2018. 
(B) DEFINITIONS.—In this paragraph: 
(i) WIDESPREAD
INTEROPERABILITY.—The term 
‘‘widespread interoperability’’ means interoperability 
between certified EHR technology systems employed 
by meaningful EHR users under the Medicare and 
Medicaid EHR incentive programs and other clinicians 
and health care providers on a nationwide basis. 
(ii) 
INTEROPERABILITY.—The 
term 
‘‘interoper-
ability’’ means the ability of two or more health 
information systems or components to exchange clinical 
and other information and to use the information that 
has been exchanged using common standards as to 
provide access to longitudinal information for health 
care providers in order to facilitate coordinated care 
and improved patient outcomes. 
(C) ESTABLISHMENT OF METRICS.—Not later than July 
1, 2016, and in consultation with stakeholders, the Sec-
retary shall establish metrics to be used to determine if 
and to the extent that the objective described in subpara-
graph (A) has been achieved. 
(D) RECOMMENDATIONS IF OBJECTIVE NOT ACHIEVED.— 
If the Secretary of Health and Human Services determines 
that the objective described in subparagraph (A) has not 
been achieved by December 31, 2018, then the Secretary 
shall submit to Congress a report, by not later than 
December 31, 2019, that identifies barriers to such objective 
and recommends actions that the Federal Government can 
take to achieve such objective. Such recommended actions 
may include recommendations— 
(i) to adjust payments for not being meaningful 
EHR users under the Medicare EHR incentive pro-
grams; and 
(ii) for criteria for decertifying certified EHR tech-
nology products. 
(2) PREVENTING BLOCKING THE SHARING OF INFORMATION.— 
(A) FOR MEANINGFUL USE EHR PROFESSIONALS.—Section 
1848(o)(2)(A)(ii) of the Social Security Act (42 U.S.C. 
1395w–4(o)(2)(A)(ii)) is amended by inserting before the 
period at the end the following: ‘‘, and the professional 
demonstrates (through a process specified by the Secretary, 
such as the use of an attestation) that the professional 
has not knowingly and willfully taken action (such as to 
disable functionality) to limit or restrict the compatibility 
or interoperability of the certified EHR technology’’. 
(B) FOR
MEANINGFUL
USE
EHR
HOSPITALS.—Section 
1886(n)(3)(A)(ii) of the Social Security Act (42 U.S.C. 
1395ww(n)(3)(A)(ii)) is amended by inserting before the 
period at the end the following: ‘‘, and the hospital dem-
onstrates (through a process specified by the Secretary, 
such as the use of an attestation) that the hospital has 
not knowingly and willfully taken action (such as to disable 
functionality) to limit or restrict the compatibility or inter-
operability of the certified EHR technology’’.
H. R. 2—54 
(C) EFFECTIVE DATE.—The amendments made by this 
subsection shall apply to meaningful EHR users as of the 
date that is one year after the date of the enactment 
of this Act. 
(3) STUDY AND REPORT ON THE FEASIBILITY OF ESTABLISHING 
A MECHANISM TO COMPARE CERTIFIED EHR TECHNOLOGY PROD-
UCTS.— 
(A) STUDY.—The Secretary shall conduct a study to 
examine the feasibility of establishing one or more mecha-
nisms to assist providers in comparing and selecting cer-
tified EHR technology products. Such mechanisms may 
include— 
(i) a website with aggregated results of surveys 
of meaningful EHR users on the functionality of cer-
tified EHR technology products to enable such users 
to directly compare the functionality and other features 
of such products; and 
(ii) information from vendors of certified products 
that is made publicly available in a standardized for-
mat. 
The aggregated results of the surveys described in clause 
(i) may be made available through contracts with physi-
cians, hospitals, or other organizations that maintain such 
comparative information described in such clause. 
(B) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the Secretary shall submit 
to Congress a report on mechanisms that would assist 
providers in comparing and selecting certified EHR tech-
nology products. The report shall include information on 
the benefits of, and resources needed to develop and main-
tain, such mechanisms. 
(4) DEFINITIONS.—In this subsection: 
(A) The term ‘‘certified EHR technology’’ has the 
meaning given such term in section 1848(o)(4) of the Social 
Security Act (42 U.S.C. 1395w–4(o)(4)). 
(B) The term ‘‘meaningful EHR user’’ has the meaning 
given such term under the Medicare EHR incentive pro-
grams. 
(C) The term ‘‘Medicare and Medicaid EHR incentive 
programs’’ means— 
(i) in the case of the Medicare program under 
title XVIII of the Social Security Act, the incentive 
programs under section 1814(l)(3), section 1848(o), sub-
sections (l) and (m) of section 1853, and section 1886(n) 
of the Social Security Act (42 U.S.C. 1395f(l)(3), 1395w– 
4(o), 1395w–23, 1395ww(n)); and 
(ii) in the case of the Medicaid program under 
title XIX of such Act, the incentive program under 
subsections (a)(3)(F) and (t) of section 1903 of such 
Act (42 U.S.C. 1396b). 
(D) The term ‘‘Secretary’’ means the Secretary of 
Health and Human Services. 
(c) GAO STUDIES AND REPORTS ON THE USE OF TELEHEALTH 
UNDER FEDERAL PROGRAMS AND ON REMOTE PATIENT MONITORING 
SERVICES.—
H. R. 2—55 
(1) STUDY
ON
TELEHEALTH
SERVICES.—The Comptroller 
General of the United States shall conduct a study on the 
following: 
(A) How the definition of telehealth across various 
Federal programs and Federal efforts can inform the use 
of telehealth in the Medicare program under title XVIII 
of the Social Security Act (42 U.S.C. 1395 et seq.). 
(B) Issues that can facilitate or inhibit the use of 
telehealth under the Medicare program under such title, 
including oversight and professional licensure, changing 
technology, privacy and security, infrastructure require-
ments, and varying needs across urban and rural areas. 
(C) Potential implications of greater use of telehealth 
with respect to payment and delivery system trans-
formations under the Medicare program under such title 
XVIII and the Medicaid program under title XIX of such 
Act (42 U.S.C. 1396 et seq.). 
(D) How the Centers for Medicare & Medicaid Services 
monitors payments made under the Medicare program 
under such title XVIII to providers for telehealth services. 
(2) STUDY ON REMOTE PATIENT MONITORING SERVICES.— 
(A) IN
GENERAL.—The Comptroller General of the 
United States shall conduct a study— 
(i) of the dissemination of remote patient moni-
toring technology in the private health insurance 
market; 
(ii) of the financial incentives in the private health 
insurance market relating to adoption of such tech-
nology; 
(iii) of the barriers to adoption of such services 
under the Medicare program under title XVIII of the 
Social Security Act; 
(iv) that evaluates the patients, conditions, and 
clinical circumstances that could most benefit from 
remote patient monitoring services; and 
(v) that evaluates the challenges related to estab-
lishing appropriate valuation for remote patient moni-
toring services under the Medicare physician fee 
schedule under section 1848 of the Social Security Act 
(42 U.S.C. 1395w–4) in order to accurately reflect the 
resources involved in furnishing such services. 
(B) DEFINITIONS.—For purposes of this paragraph: 
(i) REMOTE PATIENT MONITORING SERVICES.—The 
term ‘‘remote patient monitoring services’’ means serv-
ices furnished through remote patient monitoring tech-
nology. 
(ii) REMOTE PATIENT MONITORING TECHNOLOGY.— 
The term ‘‘remote patient monitoring technology’’ 
means a coordinated system that uses one or more 
home-based or mobile monitoring devices that auto-
matically transmit vital sign data or information on 
activities of daily living and may include responses 
to assessment questions collected on the devices wire-
lessly or through a telecommunications connection to 
a server that complies with the Federal regulations 
(concerning the privacy of individually identifiable 
health information) promulgated under section 264(c)
H. R. 2—56 
of the Health Insurance Portability and Accountability 
Act of 1996, as part of an established plan of care 
for that patient that includes the review and 
interpretation of that data by a health care profes-
sional. 
(3) REPORTS.—Not later than 24 months after the date 
of the enactment of this Act, the Comptroller General shall 
submit to Congress— 
(A) a report containing the results of the study con-
ducted under paragraph (1); and 
(B) a report containing the results of the study con-
ducted under paragraph (2). 
A report required under this paragraph shall be submitted 
together with recommendations for such legislation and 
administrative action as the Comptroller General determines 
appropriate. The Comptroller General may submit one report 
containing the results described in subparagraphs (A) and (B) 
and the recommendations described in the previous sentence. 
(d) RULE OF CONSTRUCTION REGARDING HEALTH CARE PRO-
VIDERS.— 
(1) IN GENERAL.—Subject to paragraph (3), the develop-
ment, recognition, or implementation of any guideline or other 
standard under any Federal health care provision shall not 
be construed to establish the standard of care or duty of care 
owed by a health care provider to a patient in any medical 
malpractice or medical product liability action or claim. 
(2) DEFINITIONS.—For purposes of this subsection: 
(A) FEDERAL HEALTH CARE PROVISION.—The term ‘‘Fed-
eral health care provision’’ means any provision of the 
Patient Protection and Affordable Care Act (Public Law 
111–148), title I or subtitle B of title II of the Health 
Care and Education Reconciliation Act of 2010 (Public Law 
111–152), or title XVIII or XIX of the Social Security Act 
(42 U.S.C. 1395 et seq., 42 U.S.C. 1396 et seq.). 
(B) HEALTH CARE PROVIDER.—The term ‘‘health care 
provider’’ means any individual, group practice, corporation 
of health care professionals, or hospital— 
(i) licensed, registered, or certified under Federal 
or State laws or regulations to provide health care 
services; or 
(ii) required to be so licensed, registered, or cer-
tified but that is exempted by other statute or regula-
tion. 
(C) MEDICAL
MALPRACTICE
OR
MEDICAL
PRODUCT 
LIABILITY
ACTION
OR
CLAIM.—The term ‘‘medical mal-
practice or medical product liability action or claim’’ means 
a medical malpractice action or claim (as defined in section 
431(7) of the Health Care Quality Improvement Act of 
1986 (42 U.S.C. 11151(7))) and includes a liability action 
or claim relating to a health care provider’s prescription 
or provision of a drug, device, or biological product (as 
such terms are defined in section 201 of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 321) or section 351 
of the Public Health Service Act (42 U.S.C. 262)). 
(D) STATE.—The term ‘‘State’’ includes the District of 
Columbia, Puerto Rico, and any other commonwealth, 
possession, or territory of the United States.
H. R. 2—57 
(3) NO
PREEMPTION.—Nothing in paragraph (1) or any 
provision of the Patient Protection and Affordable Care Act 
(Public Law 111–148), title I or subtitle B of title II of the 
Health Care and Education Reconciliation Act of 2010 (Public 
Law 111–152), or title XVIII or XIX of the Social Security 
Act (42 U.S.C. 1395 et seq., 42 U.S.C. 1396 et seq.) shall 
be construed to preempt any State or common law governing 
medical professional or medical product liability actions or 
claims. 
TITLE II—MEDICARE AND OTHER 
HEALTH EXTENDERS 
Subtitle A—Medicare Extenders 
SEC. 201. EXTENSION OF WORK GPCI FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 
1395w–4(e)(1)(E)) is amended by striking ‘‘April 1, 2015’’ and 
inserting ‘‘January 1, 2018’’. 
SEC. 202. EXTENSION OF THERAPY CAP EXCEPTIONS PROCESS. 
(a) IN GENERAL.—Section 1833(g) of the Social Security Act 
(42 U.S.C. 1395l(g)) is amended— 
(1) in paragraph (5)(A), in the first sentence, by striking 
‘‘March 31, 2015’’ and inserting ‘‘December 31, 2017’’; and 
(2) in paragraph (6)(A)— 
(A) by striking ‘‘March 31, 2015’’ and inserting 
‘‘December 31, 2017’’; and 
(B) by striking ‘‘2012, 2013, 2014, or the first three 
months of 2015’’ and inserting ‘‘2012 through 2017’’. 
(b) TARGETED
REVIEWS
UNDER
MANUAL
MEDICAL
REVIEW 
PROCESS FOR OUTPATIENT THERAPY SERVICES.— 
(1) IN GENERAL.—Section 1833(g)(5) of the Social Security 
Act (42 U.S.C. 1395l(g)(5)) is amended— 
(A) in subparagraph (C)(i), by inserting ‘‘, subject to 
subparagraph (E),’’ after ‘‘manual medical review process 
that’’; and 
(B) by adding at the end the following new subpara-
graph: 
‘‘(E)(i) In place of the manual medical review process under 
subparagraph (C)(i), the Secretary shall implement a process for 
medical review under this subparagraph under which the Secretary 
shall identify and conduct medical review for services described 
in subparagraph (C)(i) furnished by a provider of services or supplier 
(in this subparagraph referred to as a ‘therapy provider’) using 
such factors as the Secretary determines to be appropriate. 
‘‘(ii) Such factors may include the following: 
‘‘(I) The therapy provider has had a high claims denial 
percentage for therapy services under this part or is less compli-
ant with applicable requirements under this title. 
‘‘(II) The therapy provider has a pattern of billing for 
therapy services under this part that is aberrant compared 
to peers or otherwise has questionable billing practices for 
such services, such as billing medically unlikely units of services 
in a day.
H. R. 2—58 
‘‘(III) The therapy provider is newly enrolled under this 
title or has not previously furnished therapy services under 
this part. 
‘‘(IV) The services are furnished to treat a type of medical 
condition. 
‘‘(V) The therapy provider is part of group that includes 
another therapy provider identified using the factors deter-
mined under this subparagraph. 
‘‘(iii) For purposes of carrying out this subparagraph, the Sec-
retary shall provide for the transfer, from the Federal Supple-
mentary Medical Insurance Trust Fund under section 1841, of 
$5,000,000 to the Centers for Medicare & Medicaid Services Pro-
gram Management Account for fiscal years 2015 and 2016, to 
remain available until expended. Such funds may not be used 
by a contractor under section 1893(h) for medical reviews under 
this subparagraph. 
‘‘(iv) The targeted review process under this subparagraph shall 
not apply to services for which expenses are incurred beyond the 
period for which the exceptions process under subparagraph (A) 
is implemented.’’. 
(2) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply with respect to requests described in section 
1833(g)(5)(C)(i) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395l(g)(5)(C)(i)) with respect to which the Secretary of Health 
and Human Services has not conducted medical review under 
such section by a date (not later than 90 days after the date 
of the enactment of this Act) specified by the Secretary. 
SEC. 203. EXTENSION OF AMBULANCE ADD-ONS. 
(a) GROUND AMBULANCE.—Section 1834(l)(13)(A) of the Social 
Security Act (42 U.S.C. 1395m(l)(13)(A)) is amended by striking 
‘‘April 1, 2015’’ and inserting ‘‘January 1, 2018’’ each place it 
appears. 
(b) SUPER RURAL GROUND AMBULANCE.—Section 1834(l)(12)(A) 
of the Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended, 
in the first sentence, by striking ‘‘April 1, 2015’’ and inserting 
‘‘January 1, 2018’’. 
SEC. 204. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT 
ADJUSTMENT FOR CERTAIN LOW-VOLUME HOSPITALS. 
Section 1886(d)(12) of the Social Security Act (42 U.S.C. 
1395ww(d)(12)) is amended— 
(1) in subparagraph (B), in the matter preceding clause 
(i), by striking ‘‘in fiscal year 2015 (beginning on April 1, 
2015), fiscal year 2016, and subsequent fiscal years’’ and 
inserting ‘‘in fiscal year 2018 and subsequent fiscal years’’; 
(2) in subparagraph (C)(i), by striking ‘‘fiscal years 2011 
through 2014 and fiscal year 2015 (before April 1, 2015),’’ 
and inserting ‘‘fiscal years 2011 through 2017,’’ each place 
it appears; and 
(3) in subparagraph (D), by striking ‘‘fiscal years 2011 
through 2014 and fiscal year 2015 (before April 1, 2015),’’ 
and inserting ‘‘fiscal years 2011 through 2017,’’. 
SEC. 205. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL (MDH) 
PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the Social Security 
Act (42 U.S.C. 1395ww(d)(5)(G)) is amended—
H. R. 2—59 
(1) in clause (i), by striking ‘‘April 1, 2015’’ and inserting 
‘‘October 1, 2017’’; and 
(2) in clause (ii)(II), by striking ‘‘April 1, 2015’’ and inserting 
‘‘October 1, 2017’’. 
(b) CONFORMING AMENDMENTS.— 
(1) EXTENSION OF TARGET AMOUNT.—Section 1886(b)(3)(D) 
of the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is 
amended— 
(A) in the matter preceding clause (i), by striking ‘‘April 
1, 2015’’ and inserting ‘‘October 1, 2017’’; and 
(B) in clause (iv), by striking ‘‘through fiscal year 2014 
and the portion of fiscal year 2015 before April 1, 2015’’ 
and inserting ‘‘through fiscal year 2017’’. 
(2) PERMITTING HOSPITALS TO DECLINE RECLASSIFICATION.— 
Section 13501(e)(2) of the Omnibus Budget Reconciliation Act 
of 1993 (42 U.S.C. 1395ww note) is amended by striking 
‘‘through the first 2 quarters of fiscal year 2015’’ and inserting 
‘‘through fiscal year 2017’’. 
SEC. 206. EXTENSION FOR SPECIALIZED MEDICARE ADVANTAGE 
PLANS FOR SPECIAL NEEDS INDIVIDUALS. 
Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w– 
28(f)(1)) is amended by striking ‘‘2017’’ and inserting ‘‘2019’’. 
SEC. 207. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSE-
MENT, INPUT, AND SELECTION. 
Section 1890(d)(2) of the Social Security Act (42 U.S.C. 
1395aaa(d)(2)) is amended by striking ‘‘and $15,000,000 for the 
first 6 months of fiscal year 2015’’ and inserting ‘‘and $30,000,000 
for each of fiscal years 2015 through 2017’’. 
SEC. 208. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR 
LOW-INCOME PROGRAMS. 
(a) ADDITIONAL FUNDING FOR STATE HEALTH INSURANCE PRO-
GRAMS.—Subsection (a)(1)(B) of section 119 of the Medicare 
Improvements for Patients and Providers Act of 2008 (42 U.S.C. 
1395b–3 note), as amended by section 3306 of the Patient Protection 
and Affordable Care Act (Public Law 111–148), section 610 of the 
American Taxpayer Relief Act of 2012 (Public Law 112–240), section 
1110 of the Pathway for SGR Reform Act of 2013 (Public Law 
113–67), and section 110 of the Protecting Access to Medicare 
Act of 2014 (Public Law 113–93), is amended— 
(1) in clause (iv), by striking ‘‘and’’ at the end; 
(2) by striking clause (v); and 
(3) by adding at the end the following new clauses: 
‘‘(v) for fiscal year 2015, of $7,500,000; 
‘‘(vi) for fiscal year 2016, of $13,000,000; and 
‘‘(vii) for fiscal year 2017, of $13,000,000.’’. 
(b) ADDITIONAL FUNDING
FOR AREA AGENCIES
ON AGING.— 
Subsection (b)(1)(B) of such section 119, as so amended, is 
amended— 
(1) in clause (iv), by striking ‘‘and’’ at the end; 
(2) by striking clause (v); and 
(3) by inserting after clause (iv) the following new clauses: 
‘‘(v) for fiscal year 2015, of $7,500,000; 
‘‘(vi) for fiscal year 2016, of $7,500,000; and 
‘‘(vii) for fiscal year 2017, of $7,500,000.’’.
H. R. 2—60 
(c) ADDITIONAL FUNDING FOR AGING AND DISABILITY RESOURCE 
CENTERS.—Subsection (c)(1)(B) of such section 119, as so amended, 
is amended— 
(1) in clause (iv), by striking ‘‘and’’ at the end; 
(2) by striking clause (v); and 
(3) by inserting after clause (iv) the following new clauses: 
‘‘(v) for fiscal year 2015, of $5,000,000; 
‘‘(vi) for fiscal year 2016, of $5,000,000; and 
‘‘(vii) for fiscal year 2017, of $5,000,000.’’. 
(d) ADDITIONAL FUNDING FOR CONTRACT WITH THE NATIONAL 
CENTER FOR BENEFITS AND OUTREACH ENROLLMENT.—Subsection 
(d)(2) of such section 119, as so amended, is amended— 
(1) in clause (iv), by striking ‘‘and’’ at the end; 
(2) by striking clause (v); and 
(3) by inserting after clause (iv) the following new clauses: 
‘‘(v) for fiscal year 2015, of $5,000,000; 
‘‘(vi) for fiscal year 2016, of $12,000,000; and 
‘‘(vii) for fiscal year 2017, of $12,000,000.’’. 
SEC. 209. EXTENSION AND TRANSITION OF REASONABLE COST 
REIMBURSEMENT CONTRACTS. 
(a) ONE-YEAR TRANSITION
AND NOTICE REGARDING TRANSI-
TION.—Section 1876(h)(5)(C) of the Social Security Act (42 U.S.C. 
1395mm(h)(5)(C)) is amended— 
(1) in clause (ii), in the matter preceding subclause (I), 
by striking ‘‘For any’’ and inserting ‘‘Subject to clause (iv), 
for any’’; 
(2) in clause (iii)(I), by inserting ‘‘cost plan service’’ after 
‘‘With respect to any portion of the’’; 
(3) in clause (iii)(II), by inserting ‘‘cost plan service’’ after 
‘‘With respect to any other portion of such’’; and 
(4) by adding at the end the following new clauses: 
‘‘(iv) In the case of an eligible organization that is offering 
a reasonable cost reimbursement contract that may no longer be 
extended or renewed because of the application of clause (ii), or 
where such contract has been extended or renewed but the eligible 
organization has informed the Secretary in writing not later than 
a date determined appropriate by the Secretary that such organiza-
tion voluntarily plans not to seek renewal of the reasonable cost 
reimbursement contract, the following shall apply: 
‘‘(I) Notwithstanding such clause, such contract may be 
extended or renewed for the two years subsequent to 2016. 
The final year in which such contract is extended or renewed 
is referred to in this subsection as the ‘last reasonable cost 
reimbursement contract year for the contract’. 
‘‘(II) The organization may not enroll a new enrollee under 
such contract during the last reasonable cost reimbursement 
contract year for the contract (but may continue to enroll new 
enrollees through the end of the year immediately preceding 
such year) unless such enrollee is any of the following: 
‘‘(aa) An individual who chooses enrollment in the 
reasonable cost contract during the annual election period 
with respect to such last year. 
‘‘(bb) An individual whose spouse, at the time of the 
individual’s enrollment is an enrollee under the reasonable 
cost reimbursement contract.
H. R. 2—61 
‘‘(cc) An individual who is covered under an employer 
group health plan that offers coverage through the reason-
able cost reimbursement contract. 
‘‘(dd) An individual who becomes entitled to benefits 
under part A, or enrolled under part B, and was enrolled 
in a plan offered by the eligible organization immediately 
prior to the individual’s enrollment under the reasonable 
cost reimbursement contract. 
‘‘(III) Not later than a date determined appropriate by 
the Secretary prior to the beginning of the last reasonable 
cost reimbursement contract year for the contract, the organiza-
tion shall provide notice to the Secretary as to whether the 
organization will apply to have the contract converted over, 
in whole or in part, and offered as a Medicare Advantage 
plan under part C for the year following the last reasonable 
cost reimbursement contract year for the contract. 
‘‘(IV) If the organization provides the notice described in 
subclause (III) that the contract will be converted, in whole 
or in part, the organization shall, not later than a date deter-
mined appropriate by the Secretary, provide the Secretary with 
such information as the Secretary determines appropriate in 
order to carry out section 1851(c)(4) and to carry out section 
1854(a)(5), including subparagraph (C)(ii) of such section. 
‘‘(V) In the case that the organization enrolls a new enrollee 
under such contract during the last reasonable cost reimburse-
ment contract year for the contract, the organization shall 
provide the individual with a notification that such year is 
the last year for such contract. 
‘‘(v) If an eligible organization that is offering a reasonable 
cost reimbursement contract that is extended or renewed pursuant 
to clause (iv) provides the notice described in clause (iv)(III) that 
the contract will be converted, in whole or in part, the following 
shall apply: 
‘‘(I) The deemed enrollment under section 1851(c)(4). 
‘‘(II) The special rule for quality increase under section 
1853(o)(4)(C). 
‘‘(III) During the last reasonable cost reimbursement con-
tract year for the contract and the year immediately preceding 
such year, the eligible organization, or the corporate parent 
organization of the eligible organization, shall be permitted 
to offer an MA plan in the area that such contract is being 
offered and enroll Medicare Advantage eligible individuals in 
such MA plan and such cost plan.’’. 
(b) DEEMED ENROLLMENT FROM REASONABLE COST REIMBURSE-
MENT CONTRACTS CONVERTED TO MEDICARE ADVANTAGE PLANS.— 
(1) IN
GENERAL.—Section 1851(c) of the Social Security 
Act (42 U.S.C. 1395w–21(c)) is amended— 
(A) in paragraph (1), by striking ‘‘Such elections’’ and 
inserting ‘‘Subject to paragraph (4), such elections’’; and 
(B) by adding at the end the following: 
‘‘(4) DEEMED
ENROLLMENT
RELATING
TO
CONVERTED 
REASONABLE COST REIMBURSEMENT CONTRACTS.— 
‘‘(A) IN
GENERAL.—On the first day of the annual, 
coordinated election period under subsection (e)(3) for plan 
years beginning on or after January 1, 2017, an MA eligible 
individual described in clause (i) or (ii) of subparagraph 
(B) is deemed, unless the individual elects otherwise, to
H. R. 2—62 
have elected to receive benefits under this title through 
an applicable MA plan (and shall be enrolled in such plan) 
beginning with such plan year, if— 
‘‘(i) the individual is enrolled in a reasonable cost 
reimbursement contract under section 1876(h) in the 
previous plan year; 
‘‘(ii) such reasonable cost reimbursement contract 
was extended or renewed for the last reasonable cost 
reimbursement contract year of the contract (as 
described in subclause (I) of section 1876(h)(5)(C)(iv)) 
pursuant to such section; 
‘‘(iii) the eligible organization that is offering such 
reasonable cost reimbursement contract provided the 
notice described in subclause (III) of such section that 
the contract was to be converted; 
‘‘(iv) the applicable MA plan— 
‘‘(I) is the plan that was converted from the 
reasonable cost reimbursement contract described 
in clause (iii); 
‘‘(II) is offered by the same entity (or an 
organization affiliated with such entity that has 
a common ownership interest of control) that 
entered into such contract; and 
‘‘(III) is offered in the service area where the 
individual resides; 
‘‘(v) in the case of reasonable cost reimbursement 
contracts that provide coverage under parts A and 
B (and, to the extent the Secretary determines it to 
be feasible, contracts that provide only part B cov-
erage), the difference between the estimated individual 
costs (as determined applicable by the Secretary) for 
the applicable MA plan and such costs for the prede-
cessor cost plan does not exceed a threshold established 
by the Secretary; and 
‘‘(vi) the applicable MA plan— 
‘‘(I) 
provides 
coverage 
for 
enrollees 
transitioning from the converted reasonable cost 
reimbursement contract to such plan to maintain 
current providers of services and suppliers and 
course of treatment at the time of enrollment for 
a period of at least 90 days after enrollment; and 
‘‘(II) during such period, pays such providers 
of services and suppliers for items and services 
furnished to the enrollee an amount that is not 
less than the amount of payment applicable for 
such items and services under the original Medi-
care fee-for-service program under parts A and 
B. 
‘‘(B) MA ELIGIBLE INDIVIDUALS DESCRIBED.— 
‘‘(i) WITHOUT PRESCRIPTION DRUG COVERAGE.—An 
MA eligible individual described in this clause, with 
respect to a plan year, is an MA eligible individual 
who is enrolled in a reasonable cost reimbursement 
contract under section 1876(h) in the previous plan 
year and who is not, for such previous plan year, 
enrolled in a prescription drug plan under part D, 
including coverage under section 1860D–22.
H. R. 2—63 
‘‘(ii) WITH PRESCRIPTION DRUG COVERAGE.—An MA 
eligible individual described in this clause, with respect 
to a plan year, is an MA eligible individual who is 
enrolled in a reasonable cost reimbursement contract 
under section 1876(h) in the previous plan year and 
who, for such previous plan year, is enrolled in a 
prescription drug plan under part D— 
‘‘(I) through such contract; or 
‘‘(II) through a prescription drug plan, if the 
sponsor of such plan is the same entity (or an 
organization affiliated with such entity) that 
entered into such contract. 
‘‘(C) APPLICABLE MA PLAN DEFINED.—In this paragraph, 
the term ‘applicable MA plan’ means, in the case of an 
individual described in— 
‘‘(i) subparagraph (B)(i), an MA plan that is not 
an MA–PD plan; and 
‘‘(ii) subparagraph (B)(ii), an MA–PD plan. 
‘‘(D) IDENTIFICATION
AND
NOTIFICATION
OF
DEEMED 
INDIVIDUALS.—Not later than 45 days before the first day 
of the annual, coordinated election period under subsection 
(e)(3) for plan years beginning on or after January 1, 2017, 
the Secretary shall identify and notify the individuals who 
will be subject to deemed elections under subparagraph 
(A) on the first day of such period.’’. 
(2) BENEFICIARY OPTION TO DISCONTINUE OR CHANGE MA 
PLAN OR MA–PD PLAN AFTER DEEMED ENROLLMENT.— 
(A) IN GENERAL.—Section 1851(e)(2) of the Social Secu-
rity Act (42 U.S.C. 1395w–21(e)(4)) is amended by adding 
at the end the following: 
‘‘(F) SPECIAL
PERIOD
FOR
CERTAIN
DEEMED
ELEC-
TIONS.— 
‘‘(i) IN GENERAL.—At any time during the period 
beginning after the last day of the annual, coordinated 
election period under paragraph (3) in which an indi-
vidual is deemed to have elected to enroll in an MA 
plan or MA–PD plan under subsection (c)(4) and ending 
on the last day of February of the first plan year 
for which the individual is enrolled in such plan, such 
individual may change the election under subsection 
(a)(1) (including changing the MA plan or MA–PD plan 
in which the individual is enrolled). 
‘‘(ii) LIMITATION OF ONE CHANGE.—An individual 
may exercise the right under clause (i) only once during 
the applicable period described in such clause. The 
limitation under this clause shall not apply to changes 
in elections effected during an annual, coordinated elec-
tion period under paragraph (3) or during a special 
enrollment period under paragraph (4).’’. 
(B) CONFORMING AMENDMENTS.— 
(i) PLAN REQUIREMENT FOR OPEN ENROLLMENT.— 
Section 1851(e)(6)(A) of the Social Security Act (42 
U.S.C. 1395w–21(e)(6)(A)) is amended by striking 
‘‘paragraph (1),’’ and inserting ‘‘paragraph (1), during 
the period described in paragraph (2)(F),’’. 
(ii) PART D.—Section 1860D–1(b)(1)(B) of such Act 
(42 U.S.C. 1395w–101(b)(1)(B)) is amended—
H. R. 2—64 
(I) in clause (ii), by adding ‘‘and paragraph 
(4)’’ after ‘‘paragraph (3)(A)’’; and 
(II) in clause (iii) by striking ‘‘and (E)’’ and 
inserting ‘‘(E), and (F)’’. 
(3) TREATMENT OF ESRD FOR DEEMED ENROLLMENT.—Sec-
tion 1851(a)(3)(B) of the Social Security Act (42 U.S.C. 1395w– 
21(a)(3)(B)) is amended by adding at the end the following 
flush sentence: ‘‘An individual who develops end-stage renal 
disease while enrolled in a reasonable cost reimbursement con-
tract under section 1876(h) shall be treated as an MA eligible 
individual for purposes of applying the deemed enrollment 
under subsection (c)(4).’’. 
(c) INFORMATION REQUIREMENTS.—Section 1851(d)(2)(B) of the 
Social Security Act (42 U.S.C. 1395w–21(d)(2)(B)) is amended— 
(1) in the heading, by striking ‘‘NOTIFICATION TO NEWLY 
ELIGIBLE
MEDICARE
ADVANTAGE
ELIGIBLE
INDIVIDUALS’’ and 
inserting the following: ‘‘NOTIFICATIONS REQUIRED.— 
‘‘(i) NOTIFICATION TO NEWLY ELIGIBLE MEDICARE 
ADVANTAGE ELIGIBLE INDIVIDUALS.—’’; and 
(2) by adding at the end the following new clause: 
‘‘(ii) NOTIFICATION RELATED TO CERTAIN DEEMED 
ELECTIONS.—The Secretary shall require a Medicare 
Advantage organization that is offering a Medicare 
Advantage plan that has been converted from a reason-
able cost reimbursement contract pursuant to section 
1876(h)(5)(C)(iv) to mail, not later than 30 days prior 
to the first day of the annual, coordinated election 
period under subsection (e)(3) of a year, to any indi-
vidual enrolled under such contract and identified by 
the Secretary under subsection (c)(4)(D) for such year— 
‘‘(I) a notification that such individual will, 
on such day, be deemed to have made an election 
with respect to such plan to receive benefits under 
this title through an MA plan or MA–PD plan 
(and shall be enrolled in such plan) for the next 
plan year under subsection (c)(4)(A), but that the 
individual may make a different election during 
the annual, coordinated election period for such 
year; 
‘‘(II) the information described in subpara-
graph (A); 
‘‘(III) a description of the differences between 
such MA plan or MA–PD plan and the reasonable 
cost reimbursement contract in which the indi-
vidual was most recently enrolled with respect 
to benefits covered under such plans, including 
cost-sharing, premiums, drug coverage, and pro-
vider networks; 
‘‘(IV) information about the special period for 
elections under subsection (e)(2)(F); and 
‘‘(V) other information the Secretary may 
specify.’’. 
(d) TREATMENT OF TRANSITION PLAN FOR QUALITY RATING FOR 
PAYMENT PURPOSES.—Section 1853(o)(4) of the Social Security Act 
(42 U.S.C. 1395w–23(o)(4)) is amended by adding at the end the 
following new subparagraph:
H. R. 2—65 
‘‘(C) SPECIAL RULE FOR FIRST 3 PLAN YEARS FOR PLANS 
THAT
WERE
CONVERTED
FROM
A
REASONABLE
COST 
REIMBURSEMENT
CONTRACT.—For purposes of applying 
paragraph (1) and section 1854(b)(1)(C) for the first 3 plan 
years under this part in the case of an MA plan to which 
deemed enrollment applies under section 1851(c)(4)— 
‘‘(i) such plan shall not be treated as a new MA 
plan (as defined in paragraph (3)(A)(iii)(II)); and 
‘‘(ii) in determining the star rating of the plan 
under subparagraph (A), to the extent that Medicare 
Advantage data for such plan is not available for a 
measure used to determine such star rating, the Sec-
retary shall use data from the period in which such 
plan was a reasonable cost reimbursement contract.’’. 
SEC. 210. EXTENSION OF HOME HEALTH RURAL ADD-ON. 
Section 421(a) of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (Public Law 108–173; 117 Stat. 
2283; 42 U.S.C. 1395fff note), as amended by section 5201(b) of 
the Deficit Reduction Act of 2005 (Public Law 109–171; 120 Stat. 
46) and by section 3131(c) of the Patient Protection and Affordable 
Care Act (Public Law 111–148; 124 Stat. 428), is amended by 
striking ‘‘January 1, 2016’’ and inserting ‘‘January 1, 2018’’ each 
place it appears. 
Subtitle B—Other Health Extenders 
SEC. 211. PERMANENT EXTENSION OF THE QUALIFYING INDIVIDUAL 
(QI) PROGRAM. 
(a) PERMANENT EXTENSION.—Section 1902(a)(10)(E)(iv) of the 
Social Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by 
striking ‘‘(but only for premiums payable with respect to months 
during the period beginning with January 1998, and ending with 
March 2015)’’. 
(b) ALLOCATIONS.—Section 1933(g) of the Social Security Act 
(42 U.S.C. 1396u–3(g)) is amended— 
(1) in paragraph (2)— 
(A) by striking subparagraphs (A) through (H); 
(B) in subparagraph (V), by striking ‘‘and’’ at the end; 
(C) in subparagraph (W), by striking the period at 
the end and inserting a semicolon; 
(D) by redesignating subparagraphs (I) through (W) 
as subparagraphs (A) through (O), respectively; and 
(E) by adding at the end the following new subpara-
graphs: 
‘‘(P) for the period that begins on April 1, 2015, and 
ends on December 31, 2015, the total allocation amount 
is $535,000,000; and 
‘‘(Q) for 2016 and, subject to paragraph (4), for each 
subsequent 
year, 
the 
total 
allocation 
amount 
is 
$980,000,000.’’; 
(2) in paragraph (3), by striking ‘‘(P), (R), (T), or (V)’’ 
and inserting ‘‘or (P)’’; and 
(3) by adding at the end the following new paragraph: 
‘‘(4) ADJUSTMENT
TO
ALLOCATIONS.—The Secretary may 
increase the allocation amount under paragraph (2)(Q) for a
H. R. 2—66 
year (beginning with 2017) up to an amount that does not 
exceed the product of the following: 
‘‘(A) MAXIMUM
ALLOCATION
AMOUNT
FOR
PREVIOUS 
YEAR.—In the case of 2017, the allocation amount for 2016, 
or in the case of a subsequent year, the maximum allocation 
amount allowed under this paragraph for the previous 
year. 
‘‘(B) INCREASE IN PART B PREMIUM.—The monthly pre-
mium rate determined under section 1839 for the year 
divided by the monthly premium rate determined under 
such section for the previous year. 
‘‘(C) INCREASE IN PART B ENROLLMENT.—The average 
number of individuals (as estimated by the Chief Actuary 
of the Centers for Medicare & Medicaid Services in Sep-
tember of the previous year) to be enrolled under part 
B of title XVIII for months in the year divided by the 
average number of such individuals (as so estimated) under 
this subparagraph with respect to enrollments in months 
in the previous year.’’. 
SEC. 212. PERMANENT EXTENSION OF TRANSITIONAL MEDICAL 
ASSISTANCE (TMA). 
(a) IN GENERAL.—Section 1925 of the Social Security Act (42 
U.S.C. 1396r–6) is amended— 
(1) by striking subsection (f); and 
(2) by redesignating subsection (g) as subsection (f). 
(b) CONFORMING AMENDMENT.—Section 1902(e)(1) of the Social 
Security Act (42 U.S.C. 1396a(e)(1)) is amended to read as follows: 
‘‘(1) Beginning April 1, 1990, for provisions relating to the 
extension of eligibility for medical assistance for certain families 
who have received aid pursuant to a State plan approved under 
part A of title IV and have earned income, see section 1925.’’. 
SEC. 213. EXTENSION OF SPECIAL DIABETES PROGRAM FOR TYPE I 
DIABETES AND FOR INDIANS. 
(a) SPECIAL DIABETES PROGRAMS FOR TYPE I DIABETES.—Sec-
tion 330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c– 
2(b)(2)(C)) is amended by striking ‘‘2015’’ and inserting ‘‘2017’’. 
(b) SPECIAL
DIABETES
PROGRAMS
FOR
INDIANS.—Section 
330C(c)(2)(C) of the Public Health Service Act (42 U.S.C. 254c– 
3(c)(2)(C)) is amended by striking ‘‘2015’’ and inserting ‘‘2017’’. 
SEC. 214. EXTENSION OF ABSTINENCE EDUCATION. 
(a) IN GENERAL.—Section 510 of the Social Security Act (42 
U.S.C. 710) is amended— 
(1) in subsection (a), striking ‘‘2015’’ and inserting ‘‘2017’’; 
and 
(2) in subsection (d), by inserting ‘‘and an additional 
$75,000,000 for each of fiscal years 2016 and 2017’’ after ‘‘2015’’. 
(b) BUDGET SCORING.—Notwithstanding section 257(b)(2) of the 
Balanced Budget and Emergency Deficit Control Act of 1985, the 
baseline shall be calculated assuming that no grant shall be made 
under section 510 of the Social Security Act (42 U.S.C. 710) after 
fiscal year 2017. 
(c) REALLOCATION
OF
UNUSED
FUNDING.—The remaining 
unobligated balances of the amount appropriated for fiscal years 
2016 and 2017 by section 510(d) of the Social Security Act (42 
U.S.C. 710(d)) for which no application has been received by the
H. R. 2—67 
Funding Opportunity Announcement deadline, shall be made avail-
able to States that require the implementation of each element 
described in subparagraphs (A) through (H) of the definition of 
abstinence education in section 510(b)(2). The remaining unobli-
gated balances shall be reallocated to such States that submit 
a valid application consistent with the original formula for this 
funding. 
SEC. 215. EXTENSION OF PERSONAL RESPONSIBILITY EDUCATION 
PROGRAM (PREP). 
Section 513 of the Social Security Act (42 U.S.C. 713) is 
amended— 
(1) in paragraphs (1)(A) and (4)(A) of subsection (a), by 
striking ‘‘2015’’ and inserting ‘‘2017’’ each place it appears; 
(2) in subsection (a)(4)(B)(i), by striking ‘‘, 2013, 2014, 
and 2015’’ and inserting ‘‘through 2017’’; and 
(3) in subsection (f), by striking ‘‘2015’’ and inserting ‘‘2017’’. 
SEC. 216. EXTENSION OF FUNDING FOR FAMILY-TO-FAMILY HEALTH 
INFORMATION CENTERS. 
Section 501(c)(1)(A) of the Social Security Act (42 U.S.C. 
701(c)(1)(A)) is amended— 
(1) by striking clause (vi); and 
(2) by adding after clause (v) the following new clause: 
‘‘(vi) $5,000,000 for each of fiscal years 2015 through 2017.’’. 
SEC. 217. EXTENSION OF HEALTH WORKFORCE DEMONSTRATION 
PROJECT FOR LOW-INCOME INDIVIDUALS. 
Section 2008(c)(1) of the Social Security Act (42 U.S.C. 
1397g(c)(1)) is amended by striking ‘‘2015’’ and inserting ‘‘2017’’. 
SEC. 218. EXTENSION OF MATERNAL, INFANT, AND EARLY CHILDHOOD 
HOME VISITING PROGRAMS. 
Section 511(j)(1) of the Social Security Act (42 U.S.C. 711(j)) 
is amended— 
(1) by striking ‘‘and’’ at the end of subparagraph (E); 
(2) in subparagraph (F)— 
(A) by striking ‘‘for the period beginning on October 
1, 2014, and ending on March 31, 2015’’ and inserting 
‘‘for fiscal year 2015’’; 
(B) by striking ‘‘an amount equal to the amount pro-
vided in subparagraph (E)’’ and inserting ‘‘$400,000,000’’; 
and 
(C) by striking the period at the end and inserting 
a semicolon; and 
(3) by adding at the end the following new subparagraphs: 
‘‘(G) for fiscal year 2016, $400,000,000; and 
‘‘(H) for fiscal year 2017, $400,000,000.’’. 
SEC. 219. TENNESSEE DSH ALLOTMENT FOR FISCAL YEARS 2015 
THROUGH 2025. 
Section 1923(f)(6)(A) of the Social Security Act (42 U.S.C. 
1396r–4(f)(6)(A)) is amended by adding at the end the following: 
‘‘(vi) ALLOTMENT FOR FISCAL YEARS 2015 THROUGH 
2025.—Notwithstanding any other provision of this sub-
section, any other provision of law, or the terms of 
the TennCare Demonstration Project in effect for the 
State, the DSH allotment for Tennessee for fiscal year
H. R. 2—68 
2015, and for each fiscal year thereafter through fiscal 
year 2025, shall be $53,100,000 for each such fiscal 
year.’’. 
SEC. 220. DELAY IN EFFECTIVE DATE FOR MEDICAID AMENDMENTS 
RELATING TO BENEFICIARY LIABILITY SETTLEMENTS. 
Section 202(c) of the Bipartisan Budget Act of 2013 (division 
A of Public Law 113–67; 42 U.S.C. 1396a note), as amended by 
section 211 of the Protecting Access to Medicare Act of 2014 (Public 
Law 113–93; 128 Stat. 1047) is amended by striking ‘‘October 1, 
2016’’ and inserting ‘‘October 1, 2017’’. 
SEC. 221. EXTENSION OF FUNDING FOR COMMUNITY HEALTH CEN-
TERS, THE NATIONAL HEALTH SERVICE CORPS, AND 
TEACHING HEALTH CENTERS. 
(a) FUNDING
FOR COMMUNITY HEALTH CENTERS
AND
THE 
NATIONAL HEALTH SERVICE CORPS.— 
(1) COMMUNITY HEALTH CENTERS.—Section 10503(b)(1)(E) 
of the Patient Protection and Affordable Care Act (42 U.S.C. 
254b–2(b)(1)(E)) is amended by striking ‘‘for fiscal year 2015’’ 
and inserting ‘‘for each of fiscal years 2015 through 2017’’. 
(2) 
NATIONAL
HEALTH
SERVICE
CORPS.—Section 
10503(b)(2)(E) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 254b–2(b)(2)(E)) is amended by striking ‘‘for 
fiscal year 2015’’ and inserting ‘‘for each of fiscal years 2015 
through 2017’’. 
(b) EXTENSION OF TEACHING HEALTH CENTERS PROGRAM.—Sec-
tion 340H(g) of the Public Health Service Act (42 U.S.C. 256h(g)) 
is amended by inserting ‘‘and $60,000,000 for each of fiscal years 
2016 and 2017’’ before the period at the end. 
(c) APPLICATION.—Amounts appropriated pursuant to this sec-
tion for fiscal year 2016 and fiscal year 2017 are subject to the 
requirements contained in Public Law 113–235 for funds for pro-
grams authorized under sections 330 through 340 of the Public 
Health Service Act (42 U.S.C. 254b–256). 
TITLE III—CHIP 
SEC. 301. 2-YEAR EXTENSION OF THE CHILDREN’S HEALTH INSURANCE 
PROGRAM. 
(a) FUNDING.—Section 2104(a) of the Social Security Act (42 
U.S.C. 1397dd(a)) is amended— 
(1) in paragraph (17), by striking ‘‘and’’ at the end; 
(2) in paragraph (18)(B), by striking the period at the 
end and inserting a semicolon; and 
(3) by adding at the end the following new paragraphs: 
‘‘(19) for fiscal year 2016, $19,300,000,000; and 
‘‘(20) for fiscal year 2017, for purposes of making 2 semi- 
annual allotments— 
‘‘(A) $2,850,000,000 for the period beginning on October 
1, 2016, and ending on March 31, 2017; and 
‘‘(B) $2,850,000,000 for the period beginning on April 
1, 2017, and ending on September 30, 2017.’’. 
(b) ALLOTMENTS.— 
(1) IN GENERAL.—Section 2104(m) of the Social Security 
Act (42 U.S.C. 1397dd(m)) is amended—
H. R. 2—69 
(A) in the subsection heading, by striking ‘‘THROUGH 
2015’’ and inserting ‘‘AND THEREAFTER’’; 
(B) in paragraph (2)— 
(i) in the paragraph heading, by striking ‘‘2014’’ 
and inserting ‘‘2016’’; and 
(ii) by striking subparagraph (B) and inserting 
the following new subparagraph: 
‘‘(B) FISCAL YEAR 2013 AND EACH SUCCEEDING FISCAL 
YEAR.—Subject to paragraphs (5) and (7), from the amount 
made available under paragraphs (16) through (19) of sub-
section (a) for fiscal year 2013 and each succeeding fiscal 
year, respectively, the Secretary shall compute a State 
allotment for each State (including the District of Columbia 
and each commonwealth and territory) for each such fiscal 
year as follows: 
‘‘(i) REBASING IN FISCAL YEAR 2013 AND EACH SUC-
CEEDING ODD-NUMBERED FISCAL YEAR.—For fiscal year 
2013 and each succeeding odd-numbered fiscal year 
(other than fiscal years 2015 and 2017), the allotment 
of the State is equal to the Federal payments to the 
State that are attributable to (and countable toward) 
the total amount of allotments available under this 
section to the State in the preceding fiscal year 
(including payments made to the State under sub-
section (n) for such preceding fiscal year as well as 
amounts redistributed to the State in such preceding 
fiscal year), multiplied by the allotment increase factor 
under paragraph (6) for such odd-numbered fiscal year. 
‘‘(ii) GROWTH FACTOR UPDATE FOR FISCAL YEAR 2014 
AND EACH SUCCEEDING EVEN-NUMBERED FISCAL YEAR.— 
Except as provided in clauses (iii) and (iv), for fiscal 
year 2014 and each succeeding even-numbered fiscal 
year, the allotment of the State is equal to the sum 
of— 
‘‘(I) the amount of the State allotment under 
clause (i) for the preceding fiscal year; and 
‘‘(II) the amount of any payments made to 
the State under subsection (n) for such preceding 
fiscal year, 
multiplied by the allotment increase factor under para-
graph (6) for such even-numbered fiscal year. 
‘‘(iii) SPECIAL RULE FOR 2016.—For fiscal year 2016, 
the allotment of the State is equal to the Federal 
payments to the State that are attributable to (and 
countable toward) the total amount of allotments avail-
able under this section to the State in the preceding 
fiscal year (including payments made to the State 
under subsection (n) for such preceding fiscal year 
as well as amounts redistributed to the State in such 
preceding fiscal year), but determined as if the last 
two sentences of section 2105(b) were in effect in such 
preceding fiscal year and then multiplying the result 
by the allotment increase factor under paragraph (6) 
for fiscal year 2016. 
‘‘(iv) REDUCTION
IN
2018.—For fiscal year 2018, 
with respect to the allotment of the State for fiscal 
year 2017, any amounts of such allotment that remain
H. R. 2—70 
available for expenditure by the State in fiscal year 
2018 shall be reduced by one-third.’’; 
(C) in paragraph (4), by inserting ‘‘or 2017’’ after 
‘‘2015’’; 
(D) in paragraph (6)— 
(i) in subparagraph (A), by striking ‘‘2015’’ and 
inserting ‘‘2017’’; and 
(ii) in the second sentence, by striking ‘‘or fiscal 
year 2014’’ and inserting ‘‘fiscal year 2014, or fiscal 
year 2016’’; 
(E) in paragraph (8)— 
(i) in the paragraph heading, by striking ‘‘FISCAL 
YEAR 2015’’ and inserting ‘‘FISCAL YEARS 2015 AND 2017’’; 
and 
(ii) by inserting ‘‘or fiscal year 2017’’ after ‘‘2015’’; 
(F) by redesignating paragraphs (4) through (8) as 
paragraphs (5) through (9), respectively; and 
(G) by inserting after paragraph (3) the following new 
paragraph: 
‘‘(4) FOR FISCAL YEAR 2017.— 
‘‘(A) FIRST HALF.—Subject to paragraphs (5) and (7), 
from the amount made available under subparagraph (A) 
of paragraph (20) of subsection (a) for the semi-annual 
period described in such paragraph, increased by the 
amount of the appropriation for such period under section 
301(b)(3) of the Medicare Access and CHIP Reauthorization 
Act of 2015, the Secretary shall compute a State allotment 
for each State (including the District of Columbia and 
each commonwealth and territory) for such semi-annual 
period in an amount equal to the first half ratio (described 
in subparagraph (D)) of the amount described in subpara-
graph (C). 
‘‘(B) SECOND HALF.—Subject to paragraphs (5) and (7), 
from the amount made available under subparagraph (B) 
of paragraph (20) of subsection (a) for the semi-annual 
period described in such paragraph, the Secretary shall 
compute a State allotment for each State (including the 
District of Columbia and each commonwealth and territory) 
for such semi-annual period in an amount equal to the 
amount made available under such subparagraph, multi-
plied by the ratio of— 
‘‘(i) the amount of the allotment to such State 
under subparagraph (A); to 
‘‘(ii) the total of the amount of all of the allotments 
made available under such subparagraph. 
‘‘(C) FULL YEAR AMOUNT BASED ON REBASED AMOUNT.— 
The amount described in this subparagraph for a State 
is equal to the Federal payments to the State that are 
attributable to (and countable towards) the total amount 
of allotments available under this section to the State 
in fiscal year 2016 (including payments made to the State 
under subsection (n) for fiscal year 2016 as well as amounts 
redistributed to the State in fiscal year 2016), multiplied 
by the allotment increase factor under paragraph (6) for 
fiscal year 2017. 
‘‘(D) FIRST HALF RATIO.—The first half ratio described 
in this subparagraph is the ratio of—
H. R. 2—71 
‘‘(i) the sum of— 
‘‘(I) the amount made available under sub-
section (a)(20)(A); and 
‘‘(II) the amount of the appropriation for such 
period under section 301(b)(3) of the Medicare 
Access and CHIP Reauthorization Act of 2015; to 
‘‘(ii) the sum of the— 
‘‘(I) amount described in clause (i); and 
‘‘(II) the amount made available under sub-
section (a)(20)(B).’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 2104(c)(1) of the Social Security Act (42 
U.S.C. 1397dd(c)(1)) is amended by striking ‘‘(m)(4)’’ and 
inserting ‘‘(m)(5)’’. 
(B) Section 2104(m) of such Act (42 U.S.C. 1397dd(m)), 
as amended by paragraph (1), is further amended— 
(i) in paragraph (1)— 
(I) by striking ‘‘paragraph (4)’’ each place it 
appears in subparagraphs (A) and (B) and 
inserting ‘‘paragraph (5)’’; and 
(II) by striking ‘‘the allotment increase factor 
determined under paragraph (5)’’ each place it 
appears and inserting ‘‘the allotment increase 
factor determined under paragraph (6)’’; 
(ii) in paragraph (2)(A), by striking ‘‘the allotment 
increase factor under paragraph (5)’’ and inserting ‘‘the 
allotment increase factor under paragraph (6)’’; 
(iii) in paragraph (3)— 
(I) by striking ‘‘paragraphs (4) and (6)’’ and 
inserting ‘‘paragraphs (5) and (7)’’ each place it 
appears; and 
(II) by striking ‘‘the allotment increase factor 
under paragraph (5)’’ and inserting ‘‘the allotment 
increase factor under paragraph (6)’’; 
(iv) in paragraph (5) (as redesignated by paragraph 
(1)(F)), by striking ‘‘paragraph (1), (2), or (3)’’ and 
inserting ‘‘paragraph (1), (2), (3), or (4)’’; 
(v) in paragraph (7) (as redesignated by paragraph 
(1)(F)), by striking ‘‘subject to paragraph (4)’’ and 
inserting ‘‘subject to paragraph (5)’’; and 
(vi) in paragraph (9), (as redesignated by para-
graph (1)(F)), by striking ‘‘paragraph (3)’’ and inserting 
‘‘paragraph (3) or (4)’’. 
(C) Section 2104(n)(3)(B)(ii) of such Act (42 U.S.C. 
1397dd(n)(3)(B)(ii)) is amended by striking ‘‘subsection 
(m)(5)(B)’’ and inserting ‘‘subsection (m)(6)(B)’’. 
(D) Section 2111(b)(2)(B)(i) of such Act (42 U.S.C. 
1397kk(b)(2)(B)(i)) 
is 
amended 
by 
striking 
‘‘section 
2104(m)(4)’’ and inserting ‘‘section 2104(m)(5)’’. 
(3) ONE-TIME APPROPRIATION FOR FISCAL YEAR 2017.—There 
is appropriated to the Secretary of Health and Human Services, 
out of any money in the Treasury not otherwise appropriated, 
$14,700,000,000 to accompany the allotment made for the 
period beginning on October 1, 2016, and ending on March 
31, 2017, under paragraph (20)(A) of section 2104(a) of the 
Social Security Act (42 U.S.C. 1397dd(a)) (as added by sub-
section (a)(1)), to remain available until expended. Such amount
H. R. 2—72 
shall be used to provide allotments to States under paragraph 
(4) of section 2104(m) of such Act (42 U.S.C. 1397dd(m)) (as 
amended by paragraph(1)(G)) for the first 6 months of fiscal 
year 2017 in the same manner as allotments are provided 
under subsection (a)(20)(A) of such section 2104 and subject 
to the same terms and conditions as apply to the allotments 
provided from such subsection (a)(20)(A). 
(c) EXTENSION
OF
QUALIFYING
STATES
OPTION.—Section 
2105(g)(4) of the Social Security Act (42 U.S.C. 1397ee(g)(4)) is 
amended— 
(1) in the paragraph heading, by striking ‘‘2015’’ and 
inserting ‘‘2017’’; and 
(2) in subparagraph (A), by striking ‘‘2015’’ and inserting 
‘‘2017’’. 
(d) EXTENSION
OF
THE
CHILD
ENROLLMENT
CONTINGENCY 
FUND.— 
(1) IN GENERAL.—Section 2104(n) of the Social Security 
Act (42 U.S.C. 1397dd(n)) is amended— 
(A) in paragraph (2)— 
(i) in subparagraph (A)(ii)— 
(I) by striking ‘‘2010 through 2014’’ and 
inserting ‘‘2010, 2011, 2012, 2013, 2014, and 2016’’; 
and 
(II) by inserting ‘‘and fiscal year 2017’’ after 
‘‘2015’’; and 
(ii) in subparagraph (B)— 
(I) by striking ‘‘2010 through 2014’’ and 
inserting ‘‘2010, 2011, 2012, 2013, 2014, and 2016’’; 
and 
(II) by inserting ‘‘and fiscal year 2017’’ after 
‘‘2015’’; and 
(B) in paragraph (3)(A), in the matter preceding clause 
(i), by striking ‘‘fiscal year 2009, fiscal year 2010, fiscal 
year 2011, fiscal year 2012, fiscal year 2013, fiscal year 
2014, or a semi-annual allotment period for fiscal year 
2015’’ and inserting ‘‘any of fiscal years 2009 through 2014, 
fiscal year 2016, or a semi-annual allotment period for 
fiscal year 2015 or 2017’’. 
SEC. 302. EXTENSION OF EXPRESS LANE ELIGIBILITY. 
Section 1902(e)(13)(I) of the Social Security Act (42 U.S.C. 
1396a(e)(13)(I)) is amended by striking ‘‘2015’’ and inserting ‘‘2017’’. 
SEC. 303. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM. 
Section 2113 of the Social Security Act (42 U.S.C. 1397mm) 
is amended— 
(1) in subsection (a)(1), by striking ‘‘2015’’ and inserting 
‘‘2017’’; and 
(2) in subsection (g), by inserting ‘‘and $40,000,000 for 
the period of fiscal years 2016 and 2017’’ after ‘‘2015’’. 
SEC. 304. EXTENSION OF CERTAIN PROGRAMS AND DEMONSTRATION 
PROJECTS. 
(a) CHILDHOOD OBESITY DEMONSTRATION PROJECT.—Section 
1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b–9a(e)(8)) 
is amended by inserting ‘‘, and $10,000,000 for the period of fiscal 
years 2016 and 2017’’ after ‘‘2014’’.
H. R. 2—73 
(b) PEDIATRIC QUALITY MEASURES PROGRAM.—Section 1139A(i) 
of the Social Security Act (42 U.S.C. 1320b–9a(i)) is amended in 
the first sentence by inserting before the period at the end the 
following: ‘‘, and there is appropriated for the period of fiscal years 
2016 and 2017, $20,000,000 for the purpose of carrying out this 
section (other than subsections (e), (f), and (g))’’. 
SEC. 305. REPORT OF INSPECTOR GENERAL OF HHS ON USE OF 
EXPRESS LANE OPTION UNDER MEDICAID AND CHIP. 
Not later than 18 months after the date of the enactment 
of this Act, the Inspector General of the Department of Health 
and Human Services shall submit to the Committee on Energy 
and Commerce of the House of Representatives and the Committee 
on Finance of the Senate a report that— 
(1) provides data on the number of individuals enrolled 
in the Medicaid program under title XIX of the Social Security 
Act (referred to in this section as ‘‘Medicaid’’) and the Children’s 
Health Insurance Program under title XXI of such Act (referred 
to in this section as ‘‘CHIP’’) through the use of the Express 
Lane option under section 1902(e)(13) of the Social Security 
Act (42 U.S.C. 1396a(e)(13)); 
(2) assesses the extent to which individuals so enrolled 
meet the eligibility requirements under Medicaid or CHIP (as 
applicable); and 
(3) provides data on Federal and State expenditures under 
Medicaid 
and 
CHIP 
for 
individuals 
so 
enrolled 
and 
disaggregates such data between expenditures made for individ-
uals who meet the eligibility requirements under Medicaid 
or CHIP (as applicable) and expenditures made for individuals 
who do not meet such requirements. 
TITLE IV—OFFSETS 
Subtitle A—Medicare Beneficiary Reforms 
SEC. 401. LIMITATION ON CERTAIN MEDIGAP POLICIES FOR NEWLY 
ELIGIBLE MEDICARE BENEFICIARIES. 
Section 1882 of the Social Security Act (42 U.S.C. 1395ss) 
is amended by adding at the end the following new subsection: 
‘‘(z) LIMITATION ON CERTAIN MEDIGAP POLICIES FOR NEWLY 
ELIGIBLE MEDICARE BENEFICIARIES.— 
‘‘(1) IN GENERAL.—Notwithstanding any other provision of 
this section, on or after January 1, 2020, a medicare supple-
mental policy that provides coverage of the part B deductible, 
including any such policy (or rider to such a policy) issued 
under a waiver granted under subsection (p)(6), may not be 
sold or issued to a newly eligible Medicare beneficiary. 
‘‘(2) NEWLY
ELIGIBLE
MEDICARE
BENEFICIARY
DEFINED.— 
In this subsection, the term ‘newly eligible Medicare beneficiary’ 
means an individual who is neither of the following: 
‘‘(A) An individual who has attained age 65 before 
January 1, 2020. 
‘‘(B) An individual who was entitled to benefits under 
part A pursuant to section 226(b) or 226A, or deemed 
to be eligible for benefits under section 226(a), before 
January 1, 2020.