(A) 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)). 
(B) The terms ‘‘supplier’’ and ‘‘provider of 
services’’ have the meanings given such terms 
in subsections (d) and (u), respectively, of sec-
tion 1861 of the Social Security Act (42 U.S.C. 
1395x). 
(b) ACCESS TO MEDICARE DATA TO PROVIDERS OF 
SERVICES
AND SUPPLIERS TO FACILITATE DEVELOP-
MENT
OF ALTERNATIVE PAYMENT MODELS
AND
TO 
QUALIFIED CLINICAL DATA REGISTRIES TO FACILITATE 
QUALITY
IMPROVEMENT.—Consistent with applicable 
laws and regulations with respect to privacy and other rel-
evant matters, the Secretary shall provide Medicare claims 
data for non-public use (in a form and manner determined 
to be appropriate) to— 
(1) qualified entities, that may share with pro-
viders of services and suppliers that are registered or 
authorized users or subscribers, in order to facilitate 
the development of new models of care (including de-
velopment of Alternate Payment Models under sec-
tion 1848A of the Social Security Act, models for 
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small group specialty practices, and care coordina-
tion models); and 
(2) qualified clinical data registries under sec-
tion 1848(m)(3)(E) of the Social Security Act (42 
U.S.C. 1395w–4(m)(3)(E)) for purposes of linking 
such data with clinical outcomes data and per-
forming analysis and research to support quality im-
provement. 
SEC. 4. ENCOURAGING CARE COORDINATION AND MED-
ICAL HOMES. 
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 COORDINATION AND 
MEDICAL HOMES.— 
‘‘(A) IN GENERAL.—In order to promote 
the coordination of care by an applicable physi-
cian (as defined in subparagraph (B)) for indi-
viduals with complex chronic care needs who 
are furnished items and services by multiple 
physicians and other suppliers and providers of 
services, the Secretary shall— 
‘‘(i) develop one or more HCPCS 
codes for complex chronic care manage-
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ment services for individuals with complex 
chronic care needs; and 
‘‘(ii) for such services furnished on or 
after January 1, 2015, by an applicable 
physician, make payment (as the Secretary 
determines to be appropriate) under the 
fee schedule under this section using such 
HCPCS codes. 
‘‘(B) APPLICABLE PHYSICIAN DEFINED.— 
For purposes of this paragraph, the term ‘ap-
plicable physician’ means a physician (as de-
fined in section 1861(r)(1)) who— 
‘‘(i) is certified as a medical home (by 
achieving an accreditation status of level 3 
by the National Committee for Quality As-
surance); 
‘‘(ii) is recognized as a patient-cen-
tered specialty practice by the National 
Committee for Quality Assurance; 
‘‘(iii) has received equivalent certifi-
cation (as determined by the Secretary); or 
‘‘(iv) meets such other comparable 
qualifications as the Secretary determines 
to be appropriate. 
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‘‘(C) BUDGET NEUTRALITY.—The budget 
neutrality 
provision 
under 
subsection 
(c)(2)(B)(ii)(II) shall apply in establishing the 
payment under subparagraph (A)(ii). 
‘‘(D) SINGLE APPLICABLE PHYSICIAN PAY-
MENT.—In carrying out this paragraph, the 
Secretary shall only make payment to a single 
applicable physician for complex chronic care 
management services furnished to an indi-
vidual.’’. 
SEC. 5. MISCELLANEOUS. 
(a) SOLICITATIONS, RECOMMENDATIONS, AND RE-
PORTS.— 
(1) SOLICITATION FOR RECOMMENDATIONS ON 
EPISODES
OF
CARE
DEFINITION.—The Adminis-
trator of the Centers for Medicare & Medicaid Serv-
ices shall request eligible professional organizations 
(as defined in section 1848(k)(3) of the Social Secu-
rity Act (42 U.S.C. 1395w–4(k)(3))) and other rel-
evant stakeholders to submit recommendations for 
defining non-acute related episodes of care for pur-
poses of applying such definition under subsections 
(k) and (q) of section 1848 of the Social Security 
Act (42 U.S.C. 1395w–4) and section 1848A of such 
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Act, as added by subsections (b) and (c) of section 
2. 
(2) SOLICITATION FOR RECOMMENDATIONS ON 
PROVIDER FEE SCHEDULE PAYMENT BUNDLES.— 
(A) IN GENERAL.—The Administrator of 
the Centers for Medicare & Medicaid Services 
shall solicit from eligible professional organiza-
tions (as defined in section 1848(k)(3) of the 
Social Security Act (42 U.S.C. 1395w–4(k)(3))) 
recommendations for payment bundles for 
chronic conditions and expensive, high-volume 
services for which payment is made under title 
XVIII of such Act. 
(B) REPORT
TO
CONGRESS.—Not later 
than 24 months after the date of the enactment 
of this Act, the Administrator shall submit to 
Congress a report proposals for such payment 
bundles. 
(3) REPORTS ON MODIFIED PFS SYSTEM AND 
PAYMENT SYSTEM ALTERNATIVES.— 
(A) BIANNUAL PROGRESS REPORTS.—Not 
later than January 15, 2016, and annually 
thereafter, the Secretary of Health and Human 
Services shall submit to Congress and post on 
the public Internet website of the Centers for 
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Medicare & Medicaid Services a biannual 
progress report— 
(i) on the implementation of para-
graph (9) of section 1848(k) of the Social 
Security Act (42 U.S.C. 1395w–4(k)), as 
added by section 2(b)(2), and the quality 
update incentive program under subsection 
(q) of section 1848 of the Social Security 
Act (42 U.S.C. 1395w–4), as added by sec-
tion 2(b)(3); 
(ii) that includes an evaluation of 
such paragraph and such quality update 
incentive program and recommendations 
with respect to such program and appro-
priate update mechanisms; and 
(iii) on the actions taken to promote 
and fulfill the identification of eligible 
APMs under section 1848A of the Social 
Security Act, as added by section 2(c), for 
application under such section 1848A. 
(B) GAO AND MEDPAC REPORTS.— 
(i) GAO REPORT ON INITIAL STAGES 
OF
PROGRAM.—The Comptroller General 
of the United States shall submit to Con-
gress a report analyzing the extent to 
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which the system under section 1848(k)(9) 
of the Social Security Act (42 U.S.C. 
1395w–4(k)(9)) and such quality update 
incentive program under section 1848(q) of 
the Social Security Act, as added by sec-
tion 2(b), as of such date, is successfully 
satisfying performance objectives, including 
with respect to— 
(I) the process for developing and 
selecting 
measures 
and 
activities 
under subsection (k)(9) of section 
1848 of such Act (42 U.S.C. 1395w– 
4); 
(II) the process for assessing per-
formance against such measures and 
activities under subsection (q) of such 
section; and 
(III) the adequacy of the meas-
ures and activities so selected. 
(ii) 
EVALUATION
BY
GAO
AND 
MEDPAC ON IMPLEMENTATION OF QUALITY 
UPDATE INCENTIVE PROGRAM.— 
(I) GAO.—The Comptroller Gen-
eral of the United States shall evalu-
ate the initial phase of the quality up-
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date incentive program under sub-
section (q) of section 1848 of the So-
cial Security Act (42 U.S.C. 1395w– 
4) and shall submit to Congress, not 
later than 2019, a report with rec-
ommendations for improving such 
quality update incentive program. 
(II) MEDPAC.—In the course of 
its March Report to Congress on 
Medicare payment policy, MedPAC 
shall analyze the initial phase of such 
quality update incentive program and 
make recommendations, as appro-
priate, for improving such quality up-
date incentive program. 
(iii) MEDPAC REPORT ON PAYMENT 
SYSTEM ALTERNATIVES.— 
(I) IN GENERAL.—Not later than 
June 15, 2016, the Medicare Payment 
Advisory Commission shall submit to 
Congress a report that analyzes mul-
tiple options for alternative payment 
models in lieu of section 1848 of the 
Social 
Security 
Act 
(42 
U.S.C. 
1395w–4). In analyzing such models, 
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the Medicare Payment Advisory Com-
mission shall examine at least the fol-
lowing models: 
(aa) Accountable care orga-
nization payment models. 
(bb) Primary care medical 
home payment models. 
(cc) Bundled or episodic 
payments for certain conditions 
and services. 
(dd) Gainsharing arrange-
ments 
(II) ITEMS TO BE INCLUDED.— 
Such report shall include information 
on how each recommended new pay-
ment model will achieve maximum 
flexibility to reward high-quality, effi-
cient care. 
(C) TRACKING
EXPENDITURE
GROWTH 
AND
ACCESS.—Beginning in 2015, the Chief 
Actuary of the Centers for Medicare & Medicaid 
Services shall track expenditure growth and 
beneficiary access to physicians’ services under 
section 1848 of the Social Security Act (42 
U.S.C. 1395w–4) and shall post on the public 
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Internet website of the Centers for Medicare & 
Medicaid Services annual reports on such top-
ics. 
(b) RELATIVE VALUES UNDER THE MEDICARE PHY-
SICIAN FEE SCHEDULE.— 
(1) ELIGIBLE PHYSICIANS REPORTING SYSTEM 
TO IMPROVE ACCURACY OF RELATIVE VALUES.—Sec-
tion 1848(c) of the Social Security Act (42 U.S.C. 
1395w–4(c)) is amended by adding at the end the 
following new paragraph: 
‘‘(8) PHYSICIAN
REPORTING
SYSTEM
TO
IM-
PROVE ACCURACY OF RELATIVE VALUES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
implement a system for the periodic reporting 
by physicians of data on the accuracy of relative 
values under this subsection, such as data relat-
ing to service volume and time. Such data shall 
be submitted in a form and manner specified by 
the Secretary and shall, as appropriate, incor-
porate data from existing sources of data, pa-
tient scheduling systems, cost accounting sys-
tems, and other similar systems. 
‘‘(B) IDENTIFICATION OF REPORTING CO-
HORT.—Not later than January 1, 2015, the 
Secretary shall establish a mechanism for physi-
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cians to participate under the reporting system 
under this paragraph, all of whom shall collec-
tively be referred to under this paragraph as 
the ‘reporting group’. The reporting group shall 
include physicians across settings that collec-
tively represent a range of specialties and prac-
titioner types, furnish a range of physicians’ 
services, and serve a range of patient popu-
lations. 
‘‘(C) INCENTIVE TO REPORT.—Under the 
system under this paragraph, the Secretary 
may provide for such payments under this part 
to physicians included in the reporting group as 
the Secretary determines appropriate to com-
pensate such physicians for reporting data 
under the system. Such payments shall be pro-
vided in such form and manner as specified by 
the Secretary. In carrying out this subpara-
graph, reporting by such a physician under this 
paragraph shall not be treated as the furnishing 
of physicians’ services for purposes of applying 
this section. 
‘‘(D) FUNDING.—To carry out this para-
graph (other than with respect to payments 
made under subparagraph (C)), in addition to 
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funds otherwise appropriated, the Secretary 
shall provide for the transfer from the Federal 
Supplementary Medical Insurance Trust Fund 
under section 1841 of $1,000,000 to the Cen-
ters for Medicare & Medicaid Services Program 
Management Account for each fiscal year begin-
ning with fiscal year 2014. Amounts trans-
ferred under this subparagraph for a fiscal year 
shall be available until expended.’’. 
(2) RELATIVE
VALUE
ADJUSTMENTS
FOR 
MISVALUED PHYSICIANS’ SERVICES.— 
(A) IN GENERAL.—Section 1848(c)(2) of 
the Social Security Act (42 U.S.C. 1395w– 
4(c)(2)) is amended by adding at the end the 
following new subparagraph: 
‘‘(M) ADJUSTMENTS FOR MISVALUED PHY-
SICIANS’ SERVICES.—With respect to fee sched-
ules established for 2016, 2017, and 2018, the 
Secretary shall— 
‘‘(i) identify, based on the data re-
ported under paragraph (8) and other rel-
evant data, misvalued services for which 
adjustments to the relative values estab-
lished under this paragraph would result in 
a net reduction in expenditures under the 
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fee schedule under this section, with re-
spect to such year, of not more than 1 per-
cent of the projected amount of expendi-
tures under such fee schedule for such 
year; and 
‘‘(ii) make such adjustments for each 
such year so as to result in such a net re-
duction for such year.’’. 
(B) 
BUDGET
NEUTRALITY.—Section 
1848(c)(2)(B)(v) of the Social Security Act (42 
U.S.C. 1395w–4(c)(2)(B)(v)) is amended by 
adding at the end the following new subclause: 
‘‘(VIII) 
REDUCTIONS
FOR 
MISVALUED PHYSICIANS’ SERVICES.— 
Reduced expenditures attributable to 
subparagraph (M).’’. 
(c) RULE OF CONSTRUCTION REGARDING HEALTH 
CARE PROVIDER STANDARDS OF CARE.— 
(1) IN GENERAL.—The development, recogni-
tion, 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. 
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(2) DEFINITIONS.—For purposes of this sub-
section: 
(A) The term ‘‘Federal health care provi-
sion’’ means any provision of the Patient Pro-
tection and Affordable Care Act (Public Law 
111–148), title I and subtitle B of title III of 
the Health Care and Education Reconciliation 
Act of 2010 (Public Law 111–152), and titles 
XVIII and XIX of the Social Security Act. 
(B) The term ‘‘health care provider’’ 
means any individual or entity— 
(i) licensed, registered, or certified 
under Federal or State laws or regulations 
to provide health care services; or 
(ii) required to be so licensed, reg-
istered, or certified but that is exempted 
by other statute or regulation. 
(C) The term ‘‘medical malpractice or 
medical liability action or claim’’ means a med-
ical malpractice action or claim (as defined in 
section 431(7) of the Health Care Quality Im-
provement 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 provi-
sion of a drug, device, or biological product (as 
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such terms are defined in section 201 of the 
Federal Food, Drug, and Cosmetic Act or sec-
tion 351 of the Public Health Service Act). 
(D) The term ‘‘State’’ includes the District 
of Columbia, Puerto Rico, and any other com-
monwealth, possession, or territory of the 
United States. 
(3) NO PREEMPTION.—No provision of the Pa-
tient Protection and Affordable Care Act (Public 
Law 111–148), title I or subtitle B of title III of the 
Health Care and Education Reconciliation Act of 
2010 (Public Law 111–152), or title XVIII or XIX 
of the Social Security Act shall be construed to pre-
empt any State or common law governing medical 
professional or medical product liability actions or 
claims. 
Æ 
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