H. R. 34—293 
of the enactment of this clause, from the chief 
executive officer or chief operating officer of the 
provider a written certification that the depart-
ment met such requirement. 
‘‘(v) MID-BUILD
REQUIREMENT
DESCRIBED.—The 
mid-build requirement of this clause is, with respect 
to a department of a provider, that before November 
2, 2015, the provider had a binding written agreement 
with an outside unrelated party for the actual construc-
tion of such department. 
‘‘(vii) AUDIT.—Not later than December 31, 2018, 
the Secretary shall audit the compliance with require-
ments of clause (iv) with respect to each department 
of a provider to which such clause applies. If the Sec-
retary finds as a result of an audit under this clause 
that the applicable requirements were not met with 
respect to such department, the department shall not 
be excluded from the term ‘off-campus outpatient 
department of a provider’ under such clause. 
‘‘(viii) IMPLEMENTATION.—For purposes of imple-
menting clauses (iii) through (vii): 
‘‘(I) Notwithstanding any other provision of 
law, the Secretary may implement such clauses 
by program instruction or otherwise. 
‘‘(II) Subchapter I of chapter 35 of title 44, 
United States Code, shall not apply. 
‘‘(III) For purposes of carrying out this 
subparagraph with respect to clauses (iii) and (iv) 
(and clause (vii) insofar as it relates to clause 
(iv)), $10,000,000 shall be available from the Fed-
eral Supplementary Medical Insurance Trust Fund 
under section 1841, to remain available until 
December 31, 2018.’’; and 
(2) in subparagraph (E), by adding at the end the following 
new clause: 
‘‘(iv) The determination of an audit under subpara-
graph (B)(vii).’’. 
(b) EFFECTIVE DATE.—The amendments made by this section 
shall be effective as if included in the enactment of section 603 
of the Bipartisan Budget Act of 2015 (Public Law 114–74). 
SEC. 16002. TREATMENT OF CANCER HOSPITALS IN OFF-CAMPUS OUT-
PATIENT DEPARTMENT OF A PROVIDER POLICY. 
(a) IN GENERAL.—Section 1833(t)(21)(B) of the Social Security 
Act (42 U.S.C. 1395l(t)(21)(B)), as amended by section 16001(a), 
is amended— 
(1) by inserting after clause (v) the following new clause: 
‘‘(vi) EXCLUSION FOR CERTAIN CANCER HOSPITALS.— 
For purposes of paragraph (1)(B)(v) and this paragraph 
with respect to applicable items and services furnished 
during 2017 or a subsequent year, the term ‘off-campus 
outpatient department of a provider’ also shall not 
include a department of a provider (as so defined) 
that is not described in clause (ii) if the provider is 
a hospital described in section 1886(d)(1)(B)(v) and— 
‘‘(I) in the case of a department that met the 
requirements of section 413.65 of title 42 of the
H. R. 34—294 
Code of Federal Regulations after November 1, 
2015, and before the date of the enactment of 
this clause, the Secretary receives from the pro-
vider an attestation that such department met 
such requirements not later than 60 days after 
such date of enactment; or 
‘‘(II) in the case of a department that meets 
such requirements after such date of enactment, 
the Secretary receives from the provider an 
attestation that such department meets such 
requirements not later than 60 days after the date 
such requirements are first met with respect to 
such department.’’; 
(2) in clause (vii), by inserting after the first sentence 
the following: ‘‘Not later than 2 years after the date the Sec-
retary receives an attestation under clause (vi) relating to 
compliance of a department of a provider with requirements 
referred to in such clause, the Secretary shall audit the compli-
ance with such requirements with respect to the department.’’; 
and 
(3) in clause (viii)(III), by adding at the end the following: 
‘‘For purposes of carrying out this subparagraph with respect 
to clause (vi) (and clause (vii) insofar as it relates to such 
clause), $2,000,000 shall be available from the Federal Supple-
mentary Medical Insurance Trust Fund under section 1841, 
to remain available until expended.’’. 
(b) OFFSETTING SAVINGS.—Section 1833(t)(18) of the Social 
Security Act (42 U.S.C. 1395l(t)(18)) is amended— 
(1) in subparagraph (B), by inserting ‘‘, subject to subpara-
graph (C),’’ after ‘‘shall’’; and 
(2) by adding at the end the following new subparagraph: 
‘‘(C) TARGET
PCR
ADJUSTMENT.—In applying section 
419.43(i) of title 42 of the Code of Federal Regulations 
to implement the appropriate adjustment under this para-
graph for services furnished on or after January 1, 2018, 
the Secretary shall use a target PCR that is 1.0 percentage 
points less than the target PCR that would otherwise apply. 
In addition to the percentage point reduction under the 
previous sentence, the Secretary may consider making an 
additional percentage point reduction to such target PCR 
that takes into account payment rates for applicable items 
and services described in paragraph (21)(C) other than 
for services furnished by hospitals described in section 
1886(d)(1)(B)(v). In making any budget neutrality adjust-
ments under this subsection for 2018 or a subsequent year, 
the Secretary shall not take into account the reduced 
expenditures that result from the application of this 
subparagraph.’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall be effective as if included in the enactment of section 603 
of the Bipartisan Budget Act of 2015 (Public Law 114–74). 
SEC. 16003. TREATMENT OF ELIGIBLE PROFESSIONALS IN AMBULA-
TORY SURGICAL CENTERS FOR MEANINGFUL USE AND 
MIPS. 
Section 1848(a)(7)(D) of the Social Security Act (42 U.S.C. 
1395w–4(a)(7)(D)) is amended—
H. R. 34—295 
(1) by striking ‘‘HOSPITAL-BASED ELIGIBLE PROFESSIONALS’’ 
and all that follows through ‘‘No payment’’ and inserting the 
following: ‘‘HOSPITAL-BASED AND AMBULATORY SURGICAL CENTER- 
BASED ELIGIBLE PROFESSIONALS.— 
‘‘(i) HOSPITAL-BASED.—No payment’’; and 
(2) by adding at the end the following new clauses: 
‘‘(ii) AMBULATORY SURGICAL CENTER-BASED.—Sub-
ject to clause (iv), no payment adjustment may be 
made under subparagraph (A) for 2017 and 2018 in 
the case of an eligible professional with respect to 
whom substantially all of the covered professional serv-
ices furnished by such professional are furnished in 
an ambulatory surgical center. 
‘‘(iii) 
DETERMINATION.—The 
determination 
of 
whether an eligible professional is an eligible profes-
sional described in clause (ii) may be made on the 
basis of— 
‘‘(I) the site of service (as defined by the Sec-
retary); or 
‘‘(II) an attestation submitted by the eligible 
professional. 
Determinations made under subclauses (I) and (II) 
shall be made without regard to any employment or 
billing arrangement between the eligible professional 
and any other supplier or provider of services. 
‘‘(iv) SUNSET.—Clause (ii) shall no longer apply 
as of the first year that begins more than 3 years 
after the date on which the Secretary determines, 
through notice and comment rulemaking, that certified 
EHR technology applicable to the ambulatory surgical 
center setting is available.’’. 
SEC. 16004. CONTINUING ACCESS TO HOSPITALS ACT OF 2016. 
(a) EXTENSION OF ENFORCEMENT INSTRUCTION ON SUPERVISION 
REQUIREMENTS FOR OUTPATIENT THERAPEUTIC SERVICES IN CRIT-
ICAL ACCESS AND SMALL RURAL HOSPITALS THROUGH 2016.—Section 
1 of Public Law 113–198, as amended by section 1 of Public Law 
114–112, is amended— 
(1) in the heading, by striking ‘‘2014 AND 2015’’ and inserting 
‘‘2016’’; and 
(2) by striking ‘‘and 2015’’ and inserting ‘‘, 2015, and 2016’’. 
(b) REPORT.—Not later than 1 year after the date of the enact-
ment of this Act, the Medicare Payment Advisory Commission 
(established under section 1805 of the Social Security Act (42 U.S.C. 
1395b–6)) shall submit to Congress a report analyzing the effect 
of the extension of the enforcement instruction under section 1 
of Public Law 113–198, as amended by section 1 of Public Law 
114–112 and subsection (a) of this section, on the access to health 
care by Medicare beneficiaries, on the economic impact and the 
impact upon hospital staffing needs, and on the quality of health 
care furnished to such beneficiaries.
H. R. 34—296 
SEC. 
16005. 
DELAY 
OF 
IMPLEMENTATION 
OF 
MEDICARE 
FEE 
SCHEDULE ADJUSTMENTS FOR WHEELCHAIR ACCES-
SORIES 
AND 
SEATING 
SYSTEMS 
WHEN 
USED 
IN 
CONJUNCTION WITH COMPLEX REHABILITATION TECH-
NOLOGY (CRT) WHEELCHAIRS. 
Section 2(a) of the Patient Access and Medicare Protection 
Act (42 U.S.C. 1305 note) is amended by striking ‘‘January 1, 
2017’’ and inserting ‘‘July 1, 2017’’. 
SEC. 16006. ALLOWING PHYSICAL THERAPISTS TO UTILIZE LOCUM 
TENENS ARRANGEMENTS UNDER MEDICARE. 
(a) IN GENERAL.—The first sentence of section 1842(b)(6) of 
the Social Security Act (42 U.S.C. 1395u(b)(6)), as amended by 
section 5012, is further amended— 
(1) by striking ‘‘and’’ before ‘‘(I)’’; and 
(2) by inserting before the period at the end the following: 
‘‘, and (J) in the case of outpatient physical therapy services 
furnished by physical therapists in a health professional short-
age area (as defined in section 332(a)(1)(A) of the Public Health 
Service Act), a medically underserved area (as designated 
pursuant to section 330(b)(3)(A) of such Act), or a rural area 
(as defined in section 1886(d)(2)(D)), subparagraph (D) of this 
sentence shall apply to such services and therapists in the 
same manner as such subparagraph applies to physicians’ serv-
ices furnished by physicians’’. 
(b) EFFECTIVE DATE; IMPLEMENTATION.— 
(1) EFFECTIVE DATE.—The amendments made by subsection 
(a) shall apply to services furnished beginning not later than 
six months after the date of the enactment of this Act. 
(2) IMPLEMENTATION.—The Secretary of Health and Human 
Services may implement subparagraph (J) of section 1842(b)(6) 
of the Social Security Act (42 U.S.C. 1395u(b)(6)), as added 
by subsection (a)(2), by program instruction or otherwise. 
SEC. 16007. EXTENSION OF THE TRANSITION TO NEW PAYMENT RATES 
FOR DURABLE MEDICAL EQUIPMENT UNDER THE MEDI-
CARE PROGRAM. 
(a) IN GENERAL.—The Secretary of Health and Human Services 
shall extend the transition period described in clause (i) of section 
414.210(g)(9) of title 42, Code of Federal Regulations, from June 
30, 2016, to December 31, 2016 (with the full implementation 
described in clause (ii) of such section applying to items and services 
furnished with dates of service on or after January 1, 2017). 
(b) STUDY AND REPORT.— 
(1) STUDY.— 
(A) IN GENERAL.—The Secretary of Health and Human 
Services shall conduct a study that examines the impact 
of applicable payment adjustments upon— 
(i) the number of suppliers of durable medical 
equipment that, on a date that is not before January 
1, 2016, and not later than December 31, 2016, ceased 
to conduct business as such suppliers; and 
(ii) the availability of durable medical equipment, 
during the period beginning on January 1, 2016, and 
ending on December 31, 2016, to individuals entitled 
to benefits under part A of title XVIII of the Social