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† HR 1892 EAS2 
(iii) in clause (iii)— 
(I) in the heading, by striking ‘‘2’’ 
and inserting ‘‘5’’; and 
(II) in the first sentence, by strik-
ing ‘‘two years’’ and inserting ‘‘five 
years’’; and 
(iv) by adding at the end the following 
new clause: 
‘‘(iv) ADDITIONAL SPECIAL RULE FOR 
THIRD, FOURTH
AND
FIFTH
YEARS
OF 
MIPS.—For purposes of determining MIPS 
adjustment factors under subparagraph (A), 
in addition to the requirements specified in 
clause (iii), the Secretary shall increase the 
performance threshold with respect to each 
of the third, fourth, and fifth years to which 
the MIPS applies to ensure a gradual and 
incremental transition to the performance 
threshold described in clause (i) (as esti-
mated by the Secretary) with respect to the 
sixth year to which the MIPS applies.’’; 
(E) in paragraph (6)(E)— 
(i) by striking ‘‘In the case of items 
and services’’ and inserting ‘‘In the case of
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† HR 1892 EAS2 
covered professional services (as defined in 
subsection (k)(3)(A))’’; and 
(ii) by striking ‘‘under this part with 
respect to such items and services’’ and in-
serting ‘‘under this part with respect to 
such covered professional services’’; and 
(F) in paragraph (7), in the first sentence, 
by striking ‘‘items and services’’ and inserting 
‘‘covered professional services (as defined in sub-
section (k)(3)(A))’’; 
(2) in subsection (r)(2), by adding at the end the 
following new subparagraph: 
‘‘(I) INFORMATION.—The Secretary shall, 
not later than December 31st of each year (begin-
ning with 2018), post on the Internet website of 
the Centers for Medicare & Medicaid Services in-
formation on resource use measures in use under 
subsection (q), resource use measures under de-
velopment and the time-frame for such develop-
ment, potential future resource use measure top-
ics, a description of stakeholder engagement, and 
the percent of expenditures under part A and 
this part that are covered by resource use meas-
ures.’’; and
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† HR 1892 EAS2 
(3) in subsection (s)(5)(B), by striking ‘‘section 
1833(z)(2)(C)’’ and inserting ‘‘section 1833(z)(3)(D)’’. 
(b) PHYSICIAN-FOCUSED PAYMENT MODEL TECHNICAL 
ADVISORY COMMITTEE PROVISION OF INITIAL PROPOSAL 
FEEDBACK.—Section 1868(c)(2)(C) of the Social Security 
Act (42 U.S.C. 1395ee(c)(2)(C)) is amended to read as fol-
lows: 
‘‘(C) COMMITTEE REVIEW OF MODELS SUB-
MITTED.—The Committee, on a periodic basis— 
‘‘(i) shall review models submitted 
under subparagraph (B); 
‘‘(ii) may provide individuals and 
stakeholder entities who submitted such 
models with— 
‘‘(I) initial feedback on such mod-
els regarding the extent to which such 
models meet the criteria described in 
subparagraph (A); and 
‘‘(II) an explanation of the basis 
for the feedback provided under sub-
clause (I); and 
‘‘(iii) shall prepare comments and rec-
ommendations regarding whether such mod-
els meet the criteria described in subpara-
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† HR 1892 EAS2 
graph (A) and submit such comments and 
recommendations to the Secretary.’’. 
SEC. 51004. EXPANDED ACCESS TO MEDICARE INTENSIVE 
CARDIAC REHABILITATION PROGRAMS. 
Section 1861(eee)(4)(B) of the Social Security Act (42 
U.S.C. 1395x(eee)(4)(B)) is amended— 
(1) in clause (v), by striking ‘‘or’’ at the end; 
(2) in clause (vi), by striking the period at the 
end and inserting a semicolon; and 
(3) by adding at the end the following new 
clauses: 
‘‘(vii) stable, chronic heart failure (defined 
as patients with left ventricular ejection fraction 
of 35 percent or less and New York Heart Asso-
ciation (NYHA) class II to IV symptoms despite 
being on optimal heart failure therapy for at 
least 6 weeks); or 
‘‘(viii) any additional condition for which 
the Secretary has determined that a cardiac re-
habilitation program shall be covered, unless the 
Secretary determines, using the same process 
used to determine that the condition is covered 
for a cardiac rehabilitation program, that such 
coverage is not supported by the clinical evi-
dence.’’.
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† HR 1892 EAS2 
SEC. 51005. EXTENSION OF BLENDED SITE NEUTRAL PAY-
MENT RATE FOR CERTAIN LONG-TERM CARE 
HOSPITAL 
DISCHARGES; 
TEMPORARY 
AD-
JUSTMENT 
TO 
SITE 
NEUTRAL 
PAYMENT 
RATES. 
(a) EXTENSION.—Section 1886(m)(6)(B)(i) of the So-
cial Security Act (42 U.S.C. 1395ww(m)(6)(B)(i)) is 
amended— 
(1) in subclause (I), by striking ‘‘fiscal year 
2016 or fiscal year 2017’’ and inserting ‘‘fiscal years 
2016 through 2019’’; and 
(2) in subclause (II), by striking ‘‘2018’’ and in-
serting ‘‘2020’’. 
(b) TEMPORARY ADJUSTMENT TO SITE NEUTRAL PAY-
MENT RATES.—Section 1886(m)(6)(B) of the Social Secu-
rity Act (42 U.S.C. 1395ww(m)(6)(B)) is amended— 
(1) in clause (ii), in the matter preceding sub-
clause (I), by striking ‘‘In this paragraph’’ and in-
serting ‘‘Subject to clause (iv), in this paragraph’’; 
and 
(2) by adding at the end the following new 
clause: 
‘‘(iv) ADJUSTMENT.—For each of fiscal 
years 2018 through 2026, the amount that 
would otherwise apply under clause (ii)(I) 
for the year (determined without regard to
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† HR 1892 EAS2 
this clause) shall be reduced by 4.6 per-
cent.’’. 
SEC. 51006. RECOGNITION OF ATTENDING PHYSICIAN AS-
SISTANTS AS ATTENDING PHYSICIANS TO 
SERVE HOSPICE PATIENTS. 
(a) RECOGNITION OF ATTENDING PHYSICIAN ASSIST-
ANTS AS ATTENDING PHYSICIANS TO SERVE HOSPICE PA-
TIENTS.— 
(1) IN GENERAL.—Section 1861(dd)(3)(B) of the 
Social Security Act (42 U.S.C. 1395x(dd)(3)(B)) is 
amended— 
(A) by striking ‘‘or nurse’’ and inserting ‘‘, 
the nurse’’; and 
(B) by inserting ‘‘, or the physician assist-
ant (as defined in such subsection)’’ after ‘‘sub-
section (aa)(5))’’. 
(2) CLARIFICATION OF HOSPICE ROLE OF PHYSI-
CIAN ASSISTANTS.—Section 1814(a)(7)(A)(i)(I) of the 
Social Security Act (42 U.S.C. 1395f(a)(7)(A)(i)(I)) 
is amended by inserting ‘‘or a physician assistant’’ 
after ‘‘a nurse practitioner’’. 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall apply to items and services furnished on or 
after January 1, 2019.
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† HR 1892 EAS2 
clinical nurse specialist (as those terms are de-
fined in subsection (aa)(5))’’ before the period at 
the end; 
(2) in paragraph (2)— 
(A) in subparagraph (A)(iii), by striking 
the period at the end and inserting a semicolon; 
and 
(B) in subparagraph (B), by striking ‘‘a 
physician’’ and inserting ‘‘a physician (as de-
fined in subsection (r)(1)) or a physician assist-
ant, nurse practitioner, or clinical nurse spe-
cialist (as those terms are defined in subsection 
(aa)(5))’’; and 
(3) in paragraph (4)(A), in the matter preceding 
clause (i)— 
(A) by striking ‘‘physician-supervised’’; and 
(B) by inserting ‘‘under the supervision of 
a physician (as defined in subsection (r)(1)) or 
a physician assistant, nurse practitioner, or 
clinical nurse specialist (as those terms are de-
fined in subsection (aa)(5))’’ after ‘‘paragraph 
(3)’’. 
(b) PULMONARY REHABILITATION PROGRAMS.—Sec-
tion 1861(fff)(1) of the Social Security Act (42 U.S.C. 
1395x(fff)(1)) is amended—
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† HR 1892 EAS2 
(1) by striking ‘‘physician-supervised’’; and 
(2) by inserting ‘‘under the supervision of a phy-
sician (as defined in subsection (r)(1)) or a physician 
assistant, nurse practitioner, or clinical nurse spe-
cialist (as those terms are defined in subsection 
(aa)(5))’’ before the period at the end. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to items and services furnished on or 
after January 1, 2024. 
SEC. 51009. TRANSITIONAL PAYMENT RULES FOR CERTAIN 
RADIATION THERAPY SERVICES UNDER THE 
PHYSICIAN FEE SCHEDULE. 
Section 1848 of the Social Security Act (42 U.S.C. 
1395w–4) is amended— 
(1) in subsection (b)(11), by striking ‘‘2017 and 
2018’’ and inserting ‘‘2017, 2018, and 2019’’; and 
(2) in subsection (c)(2)(K)(iv), by striking ‘‘2017 
and 2018’’ and inserting ‘‘2017, 2018, and 2019’’. 
TITLE 
XI—PROTECTING 
SEN-
IORS’ ACCESS TO MEDICARE 
ACT 
SEC. 52001. REPEAL OF THE INDEPENDENT PAYMENT ADVI-
SORY BOARD. 
(a) REPEAL.—Section 1899A of the Social Security 
Act (42 U.S.C. 1395kkk) is repealed.
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† HR 1892 EAS2 
(b) CONFORMING AMENDMENTS.— 
(1) LOBBYING
COOLING-OFF
PERIOD.—Para-
graph (3) of section 207(c) of title 18, United States 
Code, is repealed. 
(2) GAO STUDY AND REPORT.—Section 3403(b) 
of the Patient Protection and Affordable Care Act (42 
U.S.C. 1395kkk–1) is repealed. 
(3) MEDPAC REVIEW AND COMMENT.—Section 
1805(b) of the Social Security Act (42 U.S.C. 1395b– 
6(b)) is amended— 
(A) by striking paragraph (4); 
(B) 
by 
redesignating 
paragraphs 
(5) 
through (8) as paragraphs (4) through (7), re-
spectively; and 
(C) by redesignating the paragraph (9) that 
was redesignated by section 3403(c)(1) of the Pa-
tient Protection and Affordable Care Act (Public 
Law 111–148) as paragraph (8). 
(4) NAME CHANGE.—Section 10320(b) of the Pa-
tient Protection and Affordable Care Act (Public Law 
111–148) is repealed. 
(5) RULE OF CONSTRUCTION.—Section 10320(c) 
of the Patient Protection and Affordable Care Act 
(Public Law 111–148) is repealed.
599 
† HR 1892 EAS2 
TITLE XII—OFFSETS 
SEC. 53101. MODIFYING REDUCTIONS IN MEDICAID DSH AL-
LOTMENTS. 
Section 1923(f)(7)(A) of the Social Security Act (42 
U.S.C. 1396r–4(f)(7)(A)) is amended— 
(1) in clause (i), in the matter preceding sub-
clause (I), by striking ‘‘2018’’ and inserting ‘‘2020’’; 
and 
(2) in clause (ii), by striking subclauses (I) 
through (VIII) and inserting the following: 
‘‘(I) $4,000,000,000 for fiscal year 
2020; and 
‘‘(II) $8,000,000,000 for each of 
fiscal years 2021 through 2025.’’. 
SEC. 53102. THIRD PARTY LIABILITY IN MEDICAID AND 
CHIP. 
(a) MODIFICATION OF THIRD PARTY LIABILITY RULES 
RELATED TO SPECIAL TREATMENT OF CERTAIN TYPES OF 
CARE AND PAYMENTS.— 
(1) IN GENERAL.—Section 1902(a)(25)(E) of the 
Social Security Act (42 U.S.C. 1396a(a)(25)(E)) is 
amended, in the matter preceding clause (i), by strik-
ing ‘‘prenatal or’’.
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† HR 1892 EAS2 
(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall take effect on the date of enact-
ment of this Act. 
(b) DELAY IN EFFECTIVE DATE AND REPEAL OF CER-
TAIN BIPARTISAN BUDGET ACT OF 2013 AMENDMENTS.— 
(1) REPEAL.—Effective as of September 30, 
2017, subsection (b) of section 202 of the Bipartisan 
Budget Act of 2013 (Public Law 113–67; 127 Stat. 
1177; 42 U.S.C. 1396a note) (including any amend-
ments made by such subsection) is repealed and the 
provisions amended by such subsection shall be ap-
plied and administered as if such amendments had 
never been enacted. 
(2) DELAY IN EFFECTIVE DATE.—Subsection (c) 
of section 202 of the Bipartisan Budget Act of 2013 
(Public Law 113–67; 127 Stat. 1177; 42 U.S.C. 
1396a note) is amended to read as follows: 
‘‘(c) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect on October 1, 2019.’’. 
(3) EFFECTIVE DATE; TREATMENT.—The repeal 
and amendment made by this subsection shall take ef-
fect as if enacted on September 30, 2017, and shall 
apply with respect to any open claims, including 
claims pending, generated, or filed, after such date. 
The amendments made by subsections (a) and (b) of
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† HR 1892 EAS2 
section 202 of the Bipartisan Budget Act of 2013 
(Public Law 113–67; 127 Stat. 1177; 42 U.S.C. 
1396a note) that took effect on October 1, 2017, are 
null and void and section 1902(a)(25) of the Social 
Security Act (42 U.S.C. 1396a(a)(25)) shall be ap-
plied and administered as if such amendments had 
not taken effect on such date. 
(c) GAO STUDY AND REPORT.—Not later than 18 
months after the date of enactment of this Act, the Comp-
troller General of the United States shall submit a report 
to the Committee on Energy and Commerce of the House 
of Representatives and the Committee on Finance of the 
Senate on the impacts of the amendments made by sub-
sections (a)(1) and (b)(2), including— 
(1) the impact, or potential effect, of such 
amendments on access to prenatal and preventive pe-
diatric care (including early and periodic screening, 
diagnostic, and treatment services) covered under 
State plans under such title (or waivers of such 
plans); 
(2) the impact, or potential effect, of such 
amendments on access to services covered under such 
plans or waivers for individuals on whose behalf child 
support enforcement is being carried out by a State 
agency under part D of title IV of such Act; and
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† HR 1892 EAS2 
(3) the impact, or potential effect, on providers 
of services under such plans or waivers of delays in 
payment or related issues that result from such 
amendments. 
(d) APPLICATION TO CHIP.— 
(1) IN GENERAL.—Section 2107(e)(1) of the So-
cial Security Act (42 U.S.C. 1397gg(e)(1)) is amend-
ed— 
(A) by redesignating subparagraphs (B) 
through (R) as subparagraphs (C) through (S), 
respectively; and 
(B) by inserting after subparagraph (A) the 
following new subparagraph: 
‘‘(B) Section 1902(a)(25) (relating to third 
party liability).’’. 
(2) 
MANDATORY
REPORTING.—Section 
1902(a)(25)(I)(i) of the Social Security Act (42 
U.S.C. 1396a(a)(25)(I)(i)) is amended— 
(A) by striking ‘‘medical assistance under 
the State plan’’ and inserting ‘‘medical assist-
ance under a State plan (or under a waiver of 
the plan)’’; 
(B) by striking ‘‘(and, at State option, 
child’’ and inserting ‘‘and child’’; and
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† HR 1892 EAS2 
(C) by striking ‘‘title XXI)’’ and inserting 
‘‘title XXI’’. 
SEC. 53103. TREATMENT OF LOTTERY WINNINGS AND 
OTHER LUMP-SUM INCOME FOR PURPOSES 
OF INCOME ELIGIBILITY UNDER MEDICAID. 
(a) IN GENERAL.—Section 1902 of the Social Security 
Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)(17), by striking ‘‘(e)(14), 
(e)(14)’’ and inserting ‘‘(e)(14), (e)(15)’’; and 
(2) in subsection (e)(14), by adding at the end 
the following new subparagraph: 
‘‘(K) TREATMENT
OF
CERTAIN
LOTTERY 
WINNINGS AND INCOME RECEIVED AS A LUMP 
SUM.— 
‘‘(i) IN GENERAL.—In the case of an 
individual who is the recipient of qualified 
lottery winnings (pursuant to lotteries oc-
curring on or after January 1, 2018) or 
qualified lump sum income (received on or 
after such date) and whose eligibility for 
medical assistance is determined based on 
the application of modified adjusted gross 
income under subparagraph (A), a State 
shall, in determining such eligibility, in-
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† HR 1892 EAS2 
clude such winnings or income (as applica-
ble) as income received— 
‘‘(I) in the month in which such 
winnings or income (as applicable) is 
received 
if 
the 
amount 
of 
such 
winnings or income is less than 
$80,000; 
‘‘(II) over a period of 2 months if 
the amount of such winnings or income 
(as applicable) is greater than or equal 
to $80,000 but less than $90,000; 
‘‘(III) over a period of 3 months 
if the amount of such winnings or in-
come (as applicable) is greater than or 
equal 
to 
$90,000 
but 
less 
than 
$100,000; and 
‘‘(IV) over a period of 3 months 
plus 1 additional month for each incre-
ment of $10,000 of such winnings or 
income (as applicable) received, not to 
exceed a period of 120 months (for 
winnings or income of $1,260,000 or 
more), if the amount of such winnings 
or income is greater than or equal to 
$100,000.
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† HR 1892 EAS2 
‘‘(ii) COUNTING
IN
EQUAL
INSTALL-
MENTS.—For purposes of subclauses (II), 
(III), and (IV) of clause (i), winnings or 
income to which such subclause applies 
shall be counted in equal monthly install-
ments over the period of months specified 
under such subclause. 
‘‘(iii) HARDSHIP EXEMPTION.—An in-
dividual whose income, by application of 
clause (i), exceeds the applicable eligibility 
threshold established by the State, shall con-
tinue to be eligible for medical assistance to 
the extent that the State determines, under 
procedures established by the State (in ac-
cordance with standards specified by the 
Secretary), that the denial of eligibility of 
the individual would cause an undue med-
ical or financial hardship as determined on 
the basis of criteria established by the Sec-
retary. 
‘‘(iv) NOTIFICATIONS AND ASSISTANCE 
REQUIRED
IN
CASE
OF
LOSS
OF
ELIGI-
BILITY.—A State shall, with respect to an 
individual who loses eligibility for medical
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† HR 1892 EAS2 
assistance under the State plan (or a waiv-
er of such plan) by reason of clause (i)— 
‘‘(I) before the date on which the 
individual loses such eligibility, inform 
the individual— 
‘‘(aa) of the individual’s op-
portunity to enroll in a qualified 
health plan offered through an 
Exchange established under title I 
of the Patient Protection and Af-
fordable Care Act during the spe-
cial enrollment period specified in 
section 9801(f)(3) of the Internal 
Revenue Code of 1986 (relating to 
loss of Medicaid or CHIP cov-
erage); and 
‘‘(bb) of the date on which 
the individual would no longer be 
considered ineligible by reason of 
clause (i) to receive medical as-
sistance under the State plan or 
under any waiver of such plan 
and be eligible to reapply to re-
ceive such medical assistance; and
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† HR 1892 EAS2 
‘‘(II) provide technical assistance 
to the individual seeking to enroll in 
such a qualified health plan. 
‘‘(v) QUALIFIED
LOTTERY
WINNINGS 
DEFINED.—In this subparagraph, the term 
‘qualified lottery winnings’ means winnings 
from a sweepstakes, lottery, or pool de-
scribed in paragraph (3) of section 4402 of 
the Internal Revenue Code of 1986 or a lot-
tery operated by a multistate or multijuris-
dictional 
lottery 
association, 
including 
amounts awarded as a lump sum payment. 
‘‘(vi) QUALIFIED
LUMP
SUM
INCOME 
DEFINED.—In this subparagraph, the term 
‘qualified lump sum income’ means income 
that is received as a lump sum from mone-
tary winnings from gambling (as defined by 
the Secretary and including gambling ac-
tivities described in section 1955(b)(4) of 
title 18, United States Code).’’. 
(b) RULES OF CONSTRUCTION.— 
(1) INTERCEPTION OF LOTTERY WINNINGS AL-
LOWED.—Nothing in the amendment made by sub-
section (a)(2) shall be construed as preventing a State 
from intercepting the State lottery winnings awarded
608 
† HR 1892 EAS2 
to an individual in the State to recover amounts paid 
by the State under the State Medicaid plan under 
title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) for medical assistance furnished to the indi-
vidual. 
(2) APPLICABILITY LIMITED TO ELIGIBILITY OF 
RECIPIENT OF LOTTERY WINNINGS OR LUMP SUM IN-
COME.—Nothing in the amendment made by sub-
section (a)(2) shall be construed, with respect to a de-
termination of household income for purposes of a de-
termination of eligibility for medical assistance under 
the State plan under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.) (or a waiver of such 
plan) made by applying modified adjusted gross in-
come under subparagraph (A) of section 1902(e)(14) 
of such Act (42 U.S.C. 1396a(e)(14)), as limiting the 
eligibility for such medical assistance of any indi-
vidual that is a member of the household other than 
the individual who received qualified lottery winnings 
or qualified lump-sum income (as defined in subpara-
graph (K) of such section 1902(e)(14), as added by 
subsection (a)(2) of this section).
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† HR 1892 EAS2 
SEC. 53104. REBATE OBLIGATION WITH RESPECT TO LINE 
EXTENSION DRUGS. 
(a) IN GENERAL.—Section 1927(c)(2)(C) of the Social 
Security Act (42 U.S.C. 1396r–8(c)(2)(C)) is amended by 
striking ‘‘(C) TREATMENT OF NEW FORMULATIONS.—In the 
case’’ and all that follows through the period at the end 
of the first sentence and inserting the following: 
‘‘(C) 
TREATMENT
OF
NEW
FORMULA-
TIONS.— 
‘‘(i) IN GENERAL.—In the case of a 
drug that is a line extension of a single 
source drug or an innovator multiple source 
drug that is an oral solid dosage form, the 
rebate obligation for a rebate period with 
respect to such drug under this subsection 
shall be the greater of the amount described 
in clause (ii) for such drug or the amount 
described in clause (iii) for such drug. 
‘‘(ii) AMOUNT
1.—For purposes of 
clause (i), the amount described in this 
clause with respect to a drug described in 
clause (i) and rebate period is the amount 
computed under paragraph (1) for such 
drug, increased by the amount computed 
under subparagraph (A) and, as applicable,
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† HR 1892 EAS2 
subparagraph (B) for such drug and rebate 
period. 
‘‘(iii) AMOUNT
2.—For purposes of 
clause (i), the amount described in this 
clause with respect to a drug described in 
clause (i) and rebate period is the amount 
computed under paragraph (1) for such 
drug, increased by the product of— 
‘‘(I) the average manufacturer 
price for the rebate period of the line 
extension of a single source drug or an 
innovator multiple source drug that is 
an oral solid dosage form; 
‘‘(II) the highest additional rebate 
(calculated as a percentage of average 
manufacturer price) under this para-
graph for the rebate period for any 
strength of the original single source 
drug or innovator multiple source 
drug; and 
‘‘(III) the total number of units of 
each dosage form and strength of the 
line extension product paid for under 
the State plan in the rebate period (as 
reported by the State).’’.
611 
† HR 1892 EAS2 
(b) EFFECTIVE DATE.—The amendments made sub-
section (a) shall apply with respect to rebate periods begin-
ning on or after October 1, 2018. 
SEC. 53105. MEDICAID IMPROVEMENT FUND. 
Section 1941(b) of the Social Security Act (42 U.S.C. 
1396w–1(b)) is amended— 
(1) in paragraph (1), by striking ‘‘$5,000,000’’ 
and inserting ‘‘$0’’; and 
(2) 
in 
paragraph 
(3)(A), 
by 
striking 
‘‘$980,000,000’’ and inserting ‘‘$0’’. 
SEC. 53106. PHYSICIAN FEE SCHEDULE UPDATE. 
Section 1848(d)(18) of the Social Security Act (42 
U.S.C. 1395w–4(d)(18)) is amended by striking ‘‘para-
graph (1)(C)’’ and all that follows and inserting the fol-
lowing: ‘‘paragraph (1)(C)— 
‘‘(A) for 2016 and each subsequent year 
through 2018 shall be 0.5 percent; and 
‘‘(B) for 2019 shall be 0.25 percent.’’. 
SEC. 53107. PAYMENT FOR OUTPATIENT PHYSICAL THER-
APY SERVICES AND OUTPATIENT OCCUPA-
TIONAL THERAPY SERVICES FURNISHED BY A 
THERAPY ASSISTANT. 
Section 1834 of the Social Security Act (42 U.S.C. 
1395m) is amended by adding at the end the following new 
subsection:
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† HR 1892 EAS2 
‘‘(v) PAYMENT FOR OUTPATIENT PHYSICAL THERAPY 
SERVICES
AND
OUTPATIENT
OCCUPATIONAL
THERAPY 
SERVICES FURNISHED BY A THERAPY ASSISTANT.— 
‘‘(1) IN GENERAL.—In the case of an outpatient 
physical therapy service or outpatient occupational 
therapy service furnished on or after January 1, 
2022, for which payment is made under section 1848 
or subsection (k), that is furnished in whole or in 
part by a therapy assistant (as defined by the Sec-
retary), the amount of payment for such service shall 
be an amount equal to 85 percent of the amount of 
payment otherwise applicable for the service under 
this part. Nothing in the preceding sentence shall be 
construed to change applicable requirements with re-
spect to such services. 
‘‘(2) USE OF MODIFIER.— 
‘‘(A) ESTABLISHMENT.—Not later than 
January 1, 2019, the Secretary shall establish a 
modifier to indicate (in a form and manner 
specified by the Secretary), in the case of an out-
patient physical therapy service or outpatient 
occupational therapy service furnished in whole 
or in part by a therapy assistant (as so defined), 
that the service was furnished by a therapy as-
sistant.