H. R. 1892—93 
‘‘(A) the individual may contribute such property or 
an amount equal to the sum of— 
‘‘(i) the amount of money so returned by the Sec-
retary, and 
‘‘(ii) interest paid under subsection (c) on such 
amount of money, 
into such eligible retirement plan if such contribution is 
permitted by the plan, or into an individual retirement 
plan (other than an endowment contract) to which a roll-
over contribution of a distribution from such eligible retire-
ment plan is permitted, but only if such contribution is 
made not later than the due date (not including extensions) 
for filing the return of tax for the taxable year in which 
such property or amount of money is returned, and 
‘‘(B) the Secretary shall, at the time such property 
or amount of money is returned, notify such individual 
that a contribution described in subparagraph (A) may 
be made. 
‘‘(2) TREATMENT AS ROLLOVER.—The distribution on account 
of the levy and any contribution under paragraph (1) with 
respect to the return of such distribution shall be treated for 
purposes of this title as if such distribution and contribution 
were described in section 402(c), 402A(c)(3), 403(a)(4), 403(b)(8), 
408(d)(3), 408A(d)(3), or 457(e)(16), whichever is applicable; 
except that— 
‘‘(A) the contribution shall be treated as having been 
made for the taxable year in which the distribution on 
account of the levy occurred, and the interest paid under 
subsection (c) shall be treated as earnings within the plan 
after the contribution and shall not be included in gross 
income, and 
‘‘(B) such contribution shall not be taken into account 
under section 408(d)(3)(B). 
‘‘(3) REFUND, ETC., OF INCOME TAX ON LEVY.— 
‘‘(A) IN GENERAL.—If any amount is includible in gross 
income for a taxable year by reason of a distribution on 
account of a levy referred to in paragraph (1) and any 
portion of such amount is treated as a rollover contribution 
under paragraph (2), any tax imposed by chapter 1 on 
such portion shall not be assessed, and if assessed shall 
be abated, and if collected shall be credited or refunded 
as an overpayment made on the due date for filing the 
return of tax for such taxable year. 
‘‘(B) EXCEPTION.—Subparagraph (A) shall not apply 
to a rollover contribution under this subsection which is 
made from an eligible retirement plan which is not a Roth 
IRA or a designated Roth account (within the meaning 
of section 402A) to a Roth IRA or a designated Roth account 
under an eligible retirement plan. 
‘‘(4) INTEREST.—Notwithstanding subsection (d), interest 
shall be allowed under subsection (c) in a case in which the 
Secretary makes a determination described in subsection 
(d)(2)(A) with respect to a levy upon an individual retirement 
plan. 
‘‘(5) TREATMENT OF INHERITED ACCOUNTS.—For purposes 
of paragraph (1)(A), section 408(d)(3)(C) shall be disregarded 
in determining whether an individual retirement plan is a
H. R. 1892—94 
plan to which a rollover contribution of a distribution from 
the plan levied upon is permitted.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to amounts paid under subsections (b), (c), and (d)(2)(A) 
of section 6343 of the Internal Revenue Code of 1986 in taxable 
years beginning after December 31, 2017. 
SEC. 41105. MODIFICATION OF USER FEE REQUIREMENTS FOR 
INSTALLMENT AGREEMENTS. 
(a) IN GENERAL.—Section 6159 is amended by redesignating 
subsection (f) as subsection (g) and by inserting after subsection 
(e) the following new subsection: 
‘‘(f) INSTALLMENT AGREEMENT FEES.— 
‘‘(1) LIMITATION ON FEE AMOUNT.—The amount of any fee 
imposed on an installment agreement under this section may 
not exceed the amount of such fee as in effect on the date 
of the enactment of this subsection. 
‘‘(2) WAIVER OR REIMBURSEMENT.—In the case of any tax-
payer with an adjusted gross income, as determined for the 
most recent year for which such information is available, which 
does not exceed 250 percent of the applicable poverty level 
(as determined by the Secretary)— 
‘‘(A) if the taxpayer has agreed to make payments 
under the installment agreement by electronic payment 
through a debit instrument, no fee shall be imposed on 
an installment agreement under this section, and 
‘‘(B) if the taxpayer is unable to make payments under 
the installment agreement by electronic payment through 
a debit instrument, the Secretary shall, upon completion 
of the installment agreement, pay the taxpayer an amount 
equal to any such fees imposed.’’. 
(b) EFFECTIVE DATE.—The amendments made by this section 
shall apply to agreements entered into on or after the date which 
is 60 days after the date of the enactment of this Act. 
SEC. 41106. FORM 1040SR FOR SENIORS. 
(a) IN GENERAL.—The Secretary of the Treasury (or the Sec-
retary’s delegate) shall make available a form, to be known as 
‘‘Form 1040SR’’, for use by individuals to file the return of tax 
imposed by chapter 1 of the Internal Revenue Code of 1986. Such 
form shall be as similar as practicable to Form 1040EZ, except 
that— 
(1) the form shall be available only to individuals who 
have attained age 65 as of the close of the taxable year, 
(2) the form may be used even if income for the taxable 
year includes— 
(A) social security benefits (as defined in section 86(d) 
of the Internal Revenue Code of 1986), 
(B) distributions from qualified retirement plans (as 
defined in section 4974(c) of such Code), annuities or other 
such deferred payment arrangements, 
(C) interest and dividends, or 
(D) capital gains and losses taken into account in deter-
mining adjusted net capital gain (as defined in section 
1(h)(3) of such Code), and 
(3) the form shall be available without regard to the amount 
of any item of taxable income or the total amount of taxable 
income for the taxable year.
H. R. 1892—95 
(b) EFFECTIVE DATE.—The form required by subsection (a) shall 
be made available for taxable years beginning after the date of 
the enactment of this Act. 
SEC. 41107. ATTORNEYS FEES RELATING TO AWARDS TO WHISTLE-
BLOWERS. 
(a) IN GENERAL.—Paragraph (21) of section 62(a) is amended 
to read as follows: 
‘‘(21) ATTORNEYS’ FEES RELATING TO AWARDS TO WHISTLE-
BLOWERS.— 
‘‘(A) IN GENERAL.—Any deduction allowable under this 
chapter for attorney fees and court costs paid by, or on 
behalf of, the taxpayer in connection with any award 
under— 
‘‘(i) section 7623(b), or 
‘‘(ii) in the case of taxable years beginning after 
December 31, 2017, any action brought under— 
‘‘(I) section 21F of the Securities Exchange 
Act of 1934 (15 U.S.C. 78u–6), 
‘‘(II) a State false claims act, including a State 
false claims act with qui tam provisions, or 
‘‘(III) section 23 of the Commodity Exchange 
Act (7 U.S.C. 26). 
‘‘(B) MAY NOT EXCEED AWARD.—Subparagraph (A) shall 
not apply to any deduction in excess of the amount includ-
ible in the taxpayer’s gross income for the taxable year 
on account of such award.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after December 31, 2017. 
SEC. 41108. CLARIFICATION OF WHISTLEBLOWER AWARDS. 
(a) DEFINITION OF PROCEEDS.— 
(1) IN GENERAL.—Section 7623 is amended by adding at 
the end the following new subsection: 
‘‘(c) PROCEEDS.—For purposes of this section, the term ‘proceeds’ 
includes— 
‘‘(1) penalties, interest, additions to tax, and additional 
amounts provided under the internal revenue laws, and 
‘‘(2) any proceeds arising from laws for which the Internal 
Revenue Service is authorized to administer, enforce, or inves-
tigate, including— 
‘‘(A) criminal fines and civil forfeitures, and 
‘‘(B) violations of reporting requirements.’’. 
(2) CONFORMING AMENDMENTS.—Paragraphs (1) and (2)(A) 
of section 7623(b) are each amended by striking ‘‘collected pro-
ceeds (including penalties, interest, additions to tax, and addi-
tional amounts) resulting from the action’’ and inserting ‘‘pro-
ceeds collected as a result of the action’’. 
(b) AMOUNT OF PROCEEDS DETERMINED WITHOUT REGARD TO 
AVAILABILITY.—Paragraphs (1) and (2)(A) of section 7623(b) are 
each amended by inserting ‘‘(determined without regard to whether 
such proceeds are available to the Secretary)’’ after ‘‘in response 
to such action’’. 
(c) DISPUTED AMOUNT THRESHOLD.—Section 7623(b)(5)(B) is 
amended by striking ‘‘tax, penalties, interest, additions to tax, and 
additional amounts’’ and inserting ‘‘proceeds’’. 
(d) EFFECTIVE DATE.—The amendments made by this section 
shall apply to information provided before, on, or after the date
H. R. 1892—96 
of the enactment of this Act with respect to which a final determina-
tion for an award has not been made before such date of enactment. 
SEC. 41109. CLARIFICATION REGARDING EXCISE TAX BASED ON 
INVESTMENT INCOME OF PRIVATE COLLEGES AND 
UNIVERSITIES. 
(a) IN GENERAL.—Subsection (b)(1) of section 4968, as added 
by section 13701(a) of Public Law 115–97, is amended— 
(1) by inserting ‘‘tuition-paying’’ after ‘‘500’’ in subpara-
graph (A), and 
(2) by inserting ‘‘tuition-paying’’ after ‘‘50 percent of the’’ 
in subparagraph (B). 
(b) EFFECTIVE DATE.—The amendments made by this section 
shall apply to taxable years beginning after December 31, 2017. 
SEC. 41110. EXCEPTION FROM PRIVATE FOUNDATION EXCESS BUSI-
NESS HOLDING TAX FOR INDEPENDENTLY-OPERATED 
PHILANTHROPIC BUSINESS HOLDINGS. 
(a) IN GENERAL.—Section 4943 is amended by adding at the 
end the following new subsection: 
‘‘(g) EXCEPTION FOR CERTAIN HOLDINGS LIMITED TO INDEPEND-
ENTLY-OPERATED PHILANTHROPIC BUSINESS.— 
‘‘(1) IN
GENERAL.—Subsection (a) shall not apply with 
respect to the holdings of a private foundation in any business 
enterprise which meets the requirements of paragraphs (2), 
(3), and (4) for the taxable year. 
‘‘(2) OWNERSHIP.—The requirements of this paragraph are 
met if— 
‘‘(A) 100 percent of the voting stock in the business 
enterprise is held by the private foundation at all times 
during the taxable year, and 
‘‘(B) all the private foundation’s ownership interests 
in the business enterprise were acquired by means other 
than by purchase. 
‘‘(3) ALL PROFITS TO CHARITY.— 
‘‘(A) IN GENERAL.—The requirements of this paragraph 
are met if the business enterprise, not later than 120 
days after the close of the taxable year, distributes an 
amount equal to its net operating income for such taxable 
year to the private foundation. 
‘‘(B) NET
OPERATING
INCOME.—For purposes of this 
paragraph, the net operating income of any business enter-
prise for any taxable year is an amount equal to the gross 
income of the business enterprise for the taxable year, 
reduced by the sum of— 
‘‘(i) the deductions allowed by chapter 1 for the 
taxable year which are directly connected with the 
production of such income, 
‘‘(ii) the tax imposed by chapter 1 on the business 
enterprise for the taxable year, and 
‘‘(iii) an amount for a reasonable reserve for 
working capital and other business needs of the busi-
ness enterprise. 
‘‘(4) INDEPENDENT OPERATION.—The requirements of this 
paragraph are met if, at all times during the taxable year— 
‘‘(A) no substantial contributor (as defined in section 
4958(c)(3)(C)) to the private foundation or family member
H. R. 1892—97 
(as determined under section 4958(f)(4)) of such a contrib-
utor is a director, officer, trustee, manager, employee, or 
contractor of the business enterprise (or an individual 
having powers or responsibilities similar to any of the 
foregoing), 
‘‘(B) at least a majority of the board of directors of 
the private foundation are persons who are not— 
‘‘(i) directors or officers of the business enterprise, 
or 
‘‘(ii) family members (as so determined) of a 
substantial contributor (as so defined) to the private 
foundation, and 
‘‘(C) there is no loan outstanding from the business 
enterprise to a substantial contributor (as so defined) to 
the private foundation or to any family member of such 
a contributor (as so determined). 
‘‘(5) CERTAIN DEEMED PRIVATE FOUNDATIONS EXCLUDED.— 
This subsection shall not apply to— 
‘‘(A) any fund or organization treated as a private 
foundation for purposes of this section by reason of sub-
section (e) or (f), 
‘‘(B) any trust described in section 4947(a)(1) (relating 
to charitable trusts), and 
‘‘(C) any trust described in section 4947(a)(2) (relating 
to split-interest trusts).’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after December 31, 2017. 
SEC. 41111. RULE OF CONSTRUCTION FOR CRAFT BEVERAGE MOD-
ERNIZATION AND TAX REFORM. 
(a) IN GENERAL.—Subpart A of part IX of subtitle C of title 
I of Public Law 115–97 is amended by adding at the end the 
following new section: 
‘‘SEC. 13809. RULE OF CONSTRUCTION. 
‘‘Nothing in this subpart, the amendments made by this sub-
part, or any regulation promulgated under this subpart or the 
amendments made by this subpart, shall be construed to preempt, 
supersede, or otherwise limit or restrict any State, local, or tribal 
law that prohibits or regulates the production or sale of distilled 
spirits, wine, or malt beverages.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall take effect as if included in Public Law 115–97. 
SEC. 41112. SIMPLIFICATION OF RULES REGARDING RECORDS, STATE-
MENTS, AND RETURNS. 
(a) IN GENERAL.—Subsection (a) of section 5555 is amended 
by adding at the end the following: ‘‘For calendar quarters beginning 
after the date of the enactment of this sentence, and before January 
1, 2020, the Secretary shall permit a person to employ a unified 
system for any records, statements, and returns required to be 
kept, rendered, or made under this section for any beer produced 
in the brewery for which the tax imposed by section 5051 has 
been determined, including any beer which has been removed for 
consumption on the premises of the brewery.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to calendar quarters beginning after the date of the 
enactment of this Act.
H. R. 1892—98 
SEC. 41113. MODIFICATION OF RULES GOVERNING HARDSHIP DIS-
TRIBUTIONS. 
(a) IN GENERAL.—Not later than 1 year after the date of the 
enactment of this Act, the Secretary of the Treasury shall modify 
Treasury Regulation section 1.401(k)–1(d)(3)(iv)(E) to— 
(1) delete the 6-month prohibition on contributions imposed 
by paragraph (2) thereof, and 
(2) make any other modifications necessary to carry out 
the purposes of section 401(k)(2)(B)(i)(IV) of the Internal Rev-
enue Code of 1986. 
(b) EFFECTIVE DATE.—The revised regulations under this sec-
tion shall apply to plan years beginning after December 31, 2018. 
SEC. 41114. MODIFICATION OF RULES RELATING TO HARDSHIP WITH-
DRAWALS FROM CASH OR DEFERRED ARRANGEMENTS. 
(a) IN GENERAL.—Section 401(k) is amended by adding at the 
end the following: 
‘‘(14) SPECIAL
RULES
RELATING
TO
HARDSHIP
WITH-
DRAWALS.—For purposes of paragraph (2)(B)(i)(IV)— 
‘‘(A) AMOUNTS WHICH MAY BE WITHDRAWN.—The fol-
lowing amounts may be distributed upon hardship of the 
employee: 
‘‘(i) Contributions to a profit-sharing or stock bonus 
plan to which section 402(e)(3) applies. 
‘‘(ii) Qualified nonelective contributions (as defined 
in subsection (m)(4)(C)). 
‘‘(iii) Qualified matching contributions described 
in paragraph (3)(D)(ii)(I). 
‘‘(iv) Earnings on any contributions described in 
clause (i), (ii), or (iii). 
‘‘(B) NO REQUIREMENT TO TAKE AVAILABLE LOAN.—A 
distribution shall not be treated as failing to be made 
upon the hardship of an employee solely because the 
employee does not take any available loan under the plan.’’. 
(b) CONFORMING AMENDMENT.—Section 401(k)(2)(B)(i)(IV) is 
amended to read as follows: 
‘‘(IV) subject to the provisions of paragraph 
(14), upon hardship of the employee, or’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall apply to plan years beginning after December 31, 2018. 
SEC. 41115. OPPORTUNITY ZONES RULE FOR PUERTO RICO. 
(a) IN GENERAL.—Subsection (b) of section 1400Z–1 is amended 
by adding at the end the following new paragraph: 
‘‘(3) SPECIAL
RULE
FOR
PUERTO
RICO.—Each population 
census tract in Puerto Rico that is a low- income community 
shall be deemed to be certified and designated as a qualified 
opportunity zone, effective on the date of the enactment of 
Public Law 115–97.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1400Z–1(d)(1) 
is 
amended by inserting ‘‘and subsection (b)(3)’’ after ‘‘paragraph (2)’’. 
SEC. 41116. TAX HOME OF CERTAIN CITIZENS OR RESIDENTS OF THE 
UNITED STATES LIVING ABROAD. 
(a) IN GENERAL.—Paragraph (3) of section 911(d) is amended 
by inserting before the period at the end of the second sentence 
the following: ‘‘, unless such individual is serving in an area des-
ignated by the President of the United States by Executive order
H. R. 1892—99 
as a combat zone for purposes of section 112 in support of the 
Armed Forces of the United States’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after December 31, 2017. 
SEC. 41117. TREATMENT OF FOREIGN PERSONS FOR RETURNS 
RELATING TO PAYMENTS MADE IN SETTLEMENT OF PAY-
MENT CARD AND THIRD PARTY NETWORK TRANS-
ACTIONS. 
(a) IN GENERAL.—Section 6050W(d)(1)(B) is amended by adding 
at the end the following: ‘‘Notwithstanding the preceding sentence, 
a person with only a foreign address shall not be treated as a 
participating payee with respect to any payment settlement entity 
solely because such person receives payments from such payment 
settlement entity in dollars.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to returns for calendar years beginning after December 
31, 2017. 
SEC. 41118. REPEAL OF SHIFT IN TIME OF PAYMENT OF CORPORATE 
ESTIMATED TAXES. 
The Trade Preferences Extension Act of 2015 is amended by 
striking section 803 (relating to time for payment of corporate 
estimated taxes). 
SEC. 41119. ENHANCEMENT OF CARBON DIOXIDE SEQUESTRATION 
CREDIT. 
(a) IN GENERAL.—Section 45Q is amended to read as follows: 
‘‘SEC. 45Q. CREDIT FOR CARBON OXIDE SEQUESTRATION. 
‘‘(a) GENERAL RULE.—For purposes of section 38, the carbon 
oxide sequestration credit for any taxable year is an amount equal 
to the sum of— 
‘‘(1) $20 per metric ton of qualified carbon oxide which 
is— 
‘‘(A) captured by the taxpayer using carbon capture 
equipment which is originally placed in service at a quali-
fied facility before the date of the enactment of the Bipar-
tisan Budget Act of 2018, and 
‘‘(B) disposed of by the taxpayer in secure geological 
storage and not used by the taxpayer as described in para-
graph (2)(B), 
‘‘(2) $10 per metric ton of qualified carbon oxide which 
is— 
‘‘(A) captured by the taxpayer using carbon capture 
equipment which is originally placed in service at a quali-
fied facility before the date of the enactment of the Bipar-
tisan Budget Act of 2018, and 
‘‘(B)(i) used by the taxpayer as a tertiary injectant 
in a qualified enhanced oil or natural gas recovery project 
and disposed of by the taxpayer in secure geological storage, 
or 
‘‘(ii) utilized by the taxpayer in a manner described 
in subsection (f)(5), 
‘‘(3) the applicable dollar amount (as determined under 
subsection (b)(1)) per metric ton of qualified carbon oxide which 
is—
H. R. 1892—100 
‘‘(A) captured by the taxpayer using carbon capture 
equipment which is originally placed in service at a quali-
fied facility on or after the date of the enactment of the 
Bipartisan Budget Act of 2018, during the 12-year period 
beginning on the date the equipment was originally placed 
in service, and 
‘‘(B) disposed of by the taxpayer in secure geological 
storage and not used by the taxpayer as described in para-
graph (4)(B), and 
‘‘(4) the applicable dollar amount (as determined under 
subsection (b)(1)) per metric ton of qualified carbon oxide which 
is— 
‘‘(A) captured by the taxpayer using carbon capture 
equipment which is originally placed in service at a quali-
fied facility on or after the date of the enactment of the 
Bipartisan Budget Act of 2018, during the 12-year period 
beginning on the date the equipment was originally placed 
in service, and 
‘‘(B)(i) used by the taxpayer as a tertiary injectant 
in a qualified enhanced oil or natural gas recovery project 
and disposed of by the taxpayer in secure geological storage, 
or 
‘‘(ii) utilized by the taxpayer in a manner described 
in subsection (f)(5). 
‘‘(b) APPLICABLE DOLLAR AMOUNT; ADDITIONAL EQUIPMENT; 
ELECTION.— 
‘‘(1) APPLICABLE DOLLAR AMOUNT.— 
‘‘(A) IN GENERAL.—The applicable dollar amount shall 
be an amount equal to— 
‘‘(i) for any taxable year beginning in a calendar 
year after 2016 and before 2027— 
‘‘(I) for purposes of paragraph (3) of subsection 
(a), the dollar amount established by linear inter-
polation between $22.66 and $50 for each calendar 
year during such period, and 
‘‘(II) for purposes of paragraph (4) of such sub-
section, the dollar amount established by linear 
interpolation between $12.83 and $35 for each cal-
endar year during such period, and 
‘‘(ii) for any taxable year beginning in a calendar 
year after 2026— 
‘‘(I) for purposes of paragraph (3) of subsection 
(a), an amount equal to the product of $50 and 
the inflation adjustment factor for such calendar 
year determined under section 43(b)(3)(B) for such 
calendar year, determined by substituting ‘2025’ 
for ‘1990’, and 
‘‘(II) for purposes of paragraph (4) of such sub-
section, an amount equal to the product of $35 
and the inflation adjustment factor for such cal-
endar year determined under section 43(b)(3)(B) 
for such calendar year, determined by substituting 
‘2025’ for ‘1990’. 
‘‘(B) ROUNDING.—The applicable dollar amount deter-
mined under subparagraph (A) shall be rounded to the 
nearest cent.
H. R. 1892—101 
‘‘(2) INSTALLATION OF ADDITIONAL CARBON CAPTURE EQUIP-
MENT ON EXISTING QUALIFIED FACILITY.—In the case of a quali-
fied facility placed in service before the date of the enactment 
of the Bipartisan Budget Act of 2018, for which additional 
carbon capture equipment is placed in service on or after the 
date of the enactment of such Act, the amount of qualified 
carbon oxide which is captured by the taxpayer shall be equal 
to— 
‘‘(A) for purposes of paragraphs (1)(A) and (2)(A) of 
subsection (a), the lesser of— 
‘‘(i) the total amount of qualified carbon oxide cap-
tured at such facility for the taxable year, or 
‘‘(ii) the total amount of the carbon dioxide capture 
capacity of the carbon capture equipment in service 
at such facility on the day before the date of the 
enactment of the Bipartisan Budget Act of 2018, and 
‘‘(B) for purposes of paragraphs (3)(A) and (4)(A) of 
such subsection, an amount (not less than zero) equal to 
the excess of— 
‘‘(i) the amount described in clause (i) of subpara-
graph (A), over 
‘‘(ii) the amount described in clause (ii) of such 
subparagraph. 
‘‘(3) ELECTION.—For purposes of determining the carbon 
oxide sequestration credit under this section, a taxpayer may 
elect to have the dollar amounts applicable under paragraph 
(1) or (2) of subsection (a) apply in lieu of the dollar amounts 
applicable under paragraph (3) or (4) of such subsection for 
each metric ton of qualified carbon oxide which is captured 
by the taxpayer using carbon capture equipment which is origi-
nally placed in service at a qualified facility on or after the 
date of the enactment of the Bipartisan Budget Act of 2018. 
‘‘(c) QUALIFIED CARBON OXIDE.—For purposes of this section— 
‘‘(1) IN
GENERAL.—The term ‘qualified carbon oxide’ 
means— 
‘‘(A) any carbon dioxide which— 
‘‘(i) is captured from an industrial source by carbon 
capture equipment which is originally placed in service 
before the date of the enactment of the Bipartisan 
Budget Act of 2018, 
‘‘(ii) 
would 
otherwise 
be 
released 
into 
the 
atmosphere as industrial emission of greenhouse gas 
or lead to such release, and 
‘‘(iii) is measured at the source of capture and 
verified at the point of disposal, injection, or utilization, 
‘‘(B) any carbon dioxide or other carbon oxide which— 
‘‘(i) is captured from an industrial source by carbon 
capture equipment which is originally placed in service 
on or after the date of the enactment of the Bipartisan 
Budget Act of 2018, 
‘‘(ii) 
would 
otherwise 
be 
released 
into 
the 
atmosphere as industrial emission of greenhouse gas 
or lead to such release, and 
‘‘(iii) is measured at the source of capture and 
verified at the point of disposal, injection, or utilization, 
or
H. R. 1892—102 
‘‘(C) in the case of a direct air capture facility, any 
carbon dioxide which— 
‘‘(i) is captured directly from the ambient air, and 
‘‘(ii) is measured at the source of capture and 
verified at the point of disposal, injection, or utilization. 
‘‘(2) RECYCLED CARBON OXIDE.—The term ‘qualified carbon 
oxide’ includes the initial deposit of captured carbon oxide 
used as a tertiary injectant. Such term does not include carbon 
oxide that is recaptured, recycled, and re-injected as part of 
the enhanced oil and natural gas recovery process. 
‘‘(d) QUALIFIED FACILITY.—For purposes of this section, the 
term ‘qualified facility’ means any industrial facility or direct air 
capture facility— 
‘‘(1) the construction of which begins before January 1, 
2024, and— 
‘‘(A) construction of carbon capture equipment begins 
before such date, or 
‘‘(B) the original planning and design for such facility 
includes installation of carbon capture equipment, and 
‘‘(2) which captures— 
‘‘(A) in the case of a facility which emits not more 
than 500,000 metric tons of carbon oxide into the 
atmosphere during the taxable year, not less than 25,000 
metric tons of qualified carbon oxide during the taxable 
year which is utilized in a manner described in subsection 
(f)(5), 
‘‘(B) in the case of an electricity generating facility 
which is not described in subparagraph (A), not less than 
500,000 metric tons of qualified carbon oxide during the 
taxable year, or 
‘‘(C) in the case of a direct air capture facility or 
any facility not described in subparagraph (A) or (B), not 
less than 100,000 metric tons of qualified carbon oxide 
during the taxable year. 
‘‘(e) DEFINITIONS.—For purposes of this section— 
‘‘(1) DIRECT AIR CAPTURE FACILITY.— 
‘‘(A) IN GENERAL.—Subject to subparagraph (B), the 
term ‘direct air capture facility’ means any facility which 
uses carbon capture equipment to capture carbon dioxide 
directly from the ambient air. 
‘‘(B) EXCEPTION.—The term ‘direct air capture facility’ 
shall not include any facility which captures carbon 
dioxide— 
‘‘(i) which is deliberately released from naturally 
occurring subsurface springs, or 
‘‘(ii) using natural photosynthesis. 
‘‘(2) QUALIFIED ENHANCED OIL OR NATURAL GAS RECOVERY 
PROJECT.—The term ‘qualified enhanced oil or natural gas 
recovery project’ has the meaning given the term ‘qualified 
enhanced oil recovery project’ by section 43(c)(2), by substituting 
‘crude oil or natural gas’ for ‘crude oil’ in subparagraph (A)(i) 
thereof. 
‘‘(3) TERTIARY INJECTANT.—The term ‘tertiary injectant’ has 
the same meaning as when used within section 193(b)(1). 
‘‘(f) SPECIAL RULES.— 
‘‘(1) ONLY QUALIFIED CARBON OXIDE CAPTURED AND DIS-
POSED OF OR USED WITHIN THE UNITED STATES TAKEN INTO
H. R. 1892—103 
ACCOUNT.—The credit under this section shall apply only with 
respect to qualified carbon oxide the capture and disposal, 
use, or utilization of which is within— 
‘‘(A) the United States (within the meaning of section 
638(1)), or 
‘‘(B) a possession of the United States (within the 
meaning of section 638(2)). 
‘‘(2) SECURE GEOLOGICAL STORAGE.—The Secretary, in con-
sultation with the Administrator of the Environmental Protec-
tion Agency, the Secretary of Energy, and the Secretary of 
the Interior, shall establish regulations for determining ade-
quate security measures for the geological storage of qualified 
carbon oxide under subsection (a) such that the qualified carbon 
oxide does not escape into the atmosphere. Such term shall 
include storage at deep saline formations, oil and gas reservoirs, 
and unminable coal seams under such conditions as the Sec-
retary may determine under such regulations. 
‘‘(3) CREDIT ATTRIBUTABLE TO TAXPAYER.— 
‘‘(A) IN GENERAL.—Except as provided in subparagraph 
(B) or in any regulations prescribed by the Secretary, any 
credit under this section shall be attributable to— 
‘‘(i) in the case of qualified carbon oxide captured 
using carbon capture equipment which is originally 
placed in service at a qualified facility before the date 
of the enactment of the Bipartisan Budget Act of 2018, 
the person that captures and physically or contrac-
tually ensures the disposal, utilization, or use as a 
tertiary injectant of such qualified carbon oxide, and 
‘‘(ii) in the case of qualified carbon oxide captured 
using carbon capture equipment which is originally 
placed in service at a qualified facility on or after 
the date of the enactment of the Bipartisan Budget 
Act of 2018, the person that owns the carbon capture 
equipment and physically or contractually ensures the 
capture and disposal, utilization, or use as a tertiary 
injectant of such qualified carbon oxide. 
‘‘(B) ELECTION.—If the person described in subpara-
graph (A) makes an election under this subparagraph in 
such time and manner as the Secretary may prescribe 
by regulations, the credit under this section— 
‘‘(i) shall be allowable to the person that disposes 
of the qualified carbon oxide, utilizes the qualified 
carbon oxide, or uses the qualified carbon oxide as 
a tertiary injectant, and 
‘‘(ii) shall not be allowable to the person described 
in subparagraph (A). 
‘‘(4) RECAPTURE.—The Secretary shall, by regulations, pro-
vide for recapturing the benefit of any credit allowable under 
subsection (a) with respect to any qualified carbon oxide which 
ceases to be captured, disposed of, or used as a tertiary injectant 
in a manner consistent with the requirements of this section. 
‘‘(5) UTILIZATION OF QUALIFIED CARBON OXIDE.— 
‘‘(A) IN GENERAL.—For purposes of this section, utiliza-
tion of qualified carbon oxide means— 
‘‘(i) the fixation of such qualified carbon oxide 
through photosynthesis or chemosynthesis, such as 
through the growing of algae or bacteria,
H. R. 1892—104 
‘‘(ii) the chemical conversion of such qualified 
carbon oxide to a material or chemical compound in 
which such qualified carbon oxide is securely stored, 
or 
‘‘(iii) the use of such qualified carbon oxide for 
any other purpose for which a commercial market 
exists (with the exception of use as a tertiary injectant 
in a qualified enhanced oil or natural gas recovery 
project), as determined by the Secretary. 
‘‘(B) MEASUREMENT.— 
‘‘(i) IN GENERAL.—For purposes of determining the 
amount of qualified carbon oxide utilized by the tax-
payer under paragraph (2)(B)(ii) or (4)(B)(ii) of sub-
section (a), such amount shall be equal to the metric 
tons of qualified carbon oxide which the taxpayer dem-
onstrates, based upon an analysis of lifecycle green-
house gas emissions and subject to such requirements 
as the Secretary, in consultation with the Secretary 
of Energy and the Administrator of the Environmental 
Protection Agency, determines appropriate, were— 
‘‘(I) captured and permanently isolated from 
the atmosphere, or 
‘‘(II) displaced from being emitted into the 
atmosphere, 
through use of a process described in subparagraph 
(A). 
‘‘(ii) LIFECYCLE GREENHOUSE GAS EMISSIONS.—For 
purposes of clause (i), the term ‘lifecycle greenhouse 
gas emissions’ has the same meaning given such term 
under subparagraph (H) of section 211(o)(1) of the 
Clean Air Act (42 U.S.C. 7545(o)(1)), as in effect on 
the date of the enactment of the Bipartisan Budget 
Act of 2018, except that ‘product’ shall be substituted 
for ‘fuel’ each place it appears in such subparagraph. 
‘‘(6) ELECTION FOR APPLICABLE FACILITIES.— 
‘‘(A) IN GENERAL.—For purposes of this section, in the 
case of an applicable facility, for any taxable year in which 
such facility captures not less than 500,000 metric tons 
of qualified carbon oxide during the taxable year, the per-
son described in paragraph (3)(A)(ii) may elect to have 
such facility, and any carbon capture equipment placed 
in service at such facility, deemed as having been placed 
in service on the date of the enactment of the Bipartisan 
Budget Act of 2018. 
‘‘(B) APPLICABLE FACILITY.—For purposes of this para-
graph, the term ‘applicable facility’ means a qualified 
facility— 
‘‘(i) which was placed in service before the date 
of the enactment of the Bipartisan Budget Act of 2018, 
and 
‘‘(ii) for which no taxpayer claimed a credit under 
this section in regards to such facility for any taxable 
year ending before the date of the enactment of such 
Act. 
‘‘(7) INFLATION ADJUSTMENT.—In the case of any taxable 
year beginning in a calendar year after 2009, there shall be 
substituted for each dollar amount contained in paragraphs
H. R. 1892—105 
(1) and (2) of subsection (a) an amount equal to the product 
of— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the inflation adjustment factor for such calendar 
year determined under section 43(b)(3)(B) for such calendar 
year, determined by substituting ‘2008’ for ‘1990’. 
‘‘(g) APPLICATION OF SECTION FOR CERTAIN CARBON CAPTURE 
EQUIPMENT.—In the case of any carbon capture equipment placed 
in service before the date of the enactment of the Bipartisan Budget 
Act of 2018, the credit under this section shall apply with respect 
to qualified carbon oxide captured using such equipment before 
the end of the calendar year in which the Secretary, in consultation 
with the Administrator of the Environmental Protection Agency, 
certifies that, during the period beginning after October 3, 2008, 
a total of 75,000,000 metric tons of qualified carbon oxide have 
been taken into account in accordance with— 
‘‘(1) subsection (a) of this section, as in effect on the day 
before the date of the enactment of the Bipartisan Budget 
Act of 2018, and 
‘‘(2) paragraphs (1) and (2) of subsection (a) of this section. 
‘‘(h) REGULATIONS.—The Secretary may prescribe such regula-
tions and other guidance as may be necessary or appropriate to 
carry out this section, including regulations or other guidance to— 
‘‘(1) ensure proper allocation under subsection (a) for quali-
fied carbon oxide captured by a taxpayer during the taxable 
year ending after the date of the enactment of the Bipartisan 
Budget Act of 2018, and 
‘‘(2) determine whether a facility satisfies the requirements 
under subsection (d)(1) during such taxable year.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after December 31, 2017. 
DIVISION E—HEALTH AND HUMAN 
SERVICES EXTENDERS 
SEC. 50100. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This division may be cited as the ‘‘Advancing 
Chronic Care, Extenders, and Social Services (ACCESS) Act’’ 
(b) TABLE OF CONTENTS.—The table of contents for this division 
is as follows: 
DIVISION E—HEALTH AND HUMAN SERVICES EXTENDERS 
Sec. 50100. Short title; table of contents. 
TITLE I—CHIP 
Sec. 50101. Funding extension of the Children’s Health Insurance Program through 
fiscal year 2027. 
Sec. 50102. Extension of pediatric quality measures program. 
Sec. 50103. Extension of outreach and enrollment program. 
TITLE II—MEDICARE EXTENDERS 
Sec. 50201. Extension of work GPCI floor. 
Sec. 50202. Repeal of Medicare payment cap for therapy services; limitation to en-
sure appropriate therapy. 
Sec. 50203. Medicare ambulance services. 
Sec. 50204. Extension of increased inpatient hospital payment adjustment for cer-
tain low-volume hospitals. 
Sec. 50205. Extension of the Medicare-dependent hospital (MDH) program. 
Sec. 50206. Extension of funding for quality measure endorsement, input, and se-
lection; reporting requirements.
H. R. 1892—106 
Sec. 50207. Extension of funding outreach and assistance for low-income programs; 
State health insurance assistance program reporting requirements. 
Sec. 50208. Extension of home health rural add-on. 
TITLE III—CREATING HIGH-QUALITY RESULTS AND OUTCOMES 
NECESSARY TO IMPROVE CHRONIC (CHRONIC) CARE 
Subtitle A—Receiving High Quality Care in the Home 
Sec. 50301. Extending the Independence at Home Demonstration Program. 
Sec. 50302. Expanding access to home dialysis therapy. 
Subtitle B—Advancing Team-Based Care 
Sec. 50311. Providing continued access to Medicare Advantage special needs plans 
for vulnerable populations. 
Subtitle C—Expanding Innovation and Technology 
Sec. 50321. Adapting benefits to meet the needs of chronically ill Medicare Advan-
tage enrollees. 
Sec. 50322. Expanding supplemental benefits to meet the needs of chronically ill 
Medicare Advantage enrollees. 
Sec. 50323. Increasing convenience for Medicare Advantage enrollees through tele-
health. 
Sec. 50324. Providing accountable care organizations the ability to expand the use 
of telehealth. 
Sec. 50325. Expanding the use of telehealth for individuals with stroke. 
Subtitle D—Identifying the Chronically Ill Population 
Sec. 50331. Providing flexibility for beneficiaries to be part of an accountable care 
organization. 
Subtitle E—Empowering Individuals and Caregivers in Care Delivery 
Sec. 50341. Eliminating barriers to care coordination under accountable care orga-
nizations. 
Sec. 50342. GAO study and report on longitudinal comprehensive care planning 
services under Medicare part B. 
Subtitle F—Other Policies to Improve Care for the Chronically Ill 
Sec. 50351. GAO study and report on improving medication synchronization. 
Sec. 50352. GAO study and report on impact of obesity drugs on patient health and 
spending. 
Sec. 50353. HHS study and report on long-term risk factors for chronic conditions 
among Medicare beneficiaries. 
Sec. 50354. Providing prescription drug plans with parts A and B claims data to 
promote the appropriate use of medications and improve health out-
comes. 
TITLE IV—PART B IMPROVEMENT ACT AND OTHER PART B 
ENHANCEMENTS 
Subtitle A—Medicare Part B Improvement Act 
Sec. 50401. Home infusion therapy services temporary transitional payment. 
Sec. 50402. Orthotist’s and prosthetist’s clinical notes as part of the patient’s med-
ical record. 
Sec. 50403. Independent accreditation for dialysis facilities and assurance of high 
quality surveys. 
Sec. 50404. Modernizing the application of the Stark rule under Medicare. 
Subtitle B—Additional Medicare Provisions 
Sec. 50411. Making permanent the removal of the rental cap for durable medical 
equipment under Medicare with respect to speech generating devices. 
Sec. 50412. Increased civil and criminal penalties and increased sentences for Fed-
eral health care program fraud and abuse. 
Sec. 50413. Reducing the volume of future EHR-related significant hardship re-
quests. 
Sec. 50414. Strengthening rules in case of competition for diabetic testing strips. 
TITLE V—OTHER HEALTH EXTENDERS 
Sec. 50501. Extension for family-to-family health information centers. 
Sec. 50502. Extension for sexual risk avoidance education.
H. R. 1892—107 
Sec. 50503. Extension for personal responsibility education. 
TITLE VI—CHILD AND FAMILY SERVICES AND SUPPORTS EXTENDERS 
Subtitle A—Continuing the Maternal, Infant, and Early Childhood Home Visiting 
Program 
Sec. 50601. Continuing evidence-based home visiting program. 
Sec. 50602. Continuing to demonstrate results to help families. 
Sec. 50603. Reviewing statewide needs to target resources. 
Sec. 50604. Improving the likelihood of success in high-risk communities. 
Sec. 50605. Option to fund evidence-based home visiting on a pay for outcome 
basis. 
Sec. 50606. Data exchange standards for improved interoperability. 
Sec. 50607. Allocation of funds. 
Subtitle B—Extension of Health Professions Workforce Demonstration Projects 
Sec. 50611. Extension of health workforce demonstration projects for low-income in-
dividuals. 
TITLE VII—FAMILY FIRST PREVENTION SERVICES ACT 
Subtitle A—Investing in Prevention and Supporting Families 
Sec. 50701. Short title. 
Sec. 50702. Purpose. 
PART I—PREVENTION ACTIVITIES UNDER TITLE IV–E 
Sec. 50711. Foster care prevention services and programs. 
Sec. 50712. Foster care maintenance payments for children with parents in a li-
censed residential family-based treatment facility for substance abuse. 
Sec. 50713. Title IV–E payments for evidence-based kinship navigator programs. 
PART II—ENHANCED SUPPORT UNDER TITLE IV–B 
Sec. 50721. Elimination of time limit for family reunification services while in fos-
ter care and permitting time-limited family reunification services when 
a child returns home from foster care. 
Sec. 50722. Reducing bureaucracy and unnecessary delays when placing children in 
homes across State lines. 
Sec. 50723. Enhancements to grants to improve well-being of families affected by 
substance abuse. 
PART III—MISCELLANEOUS 
Sec. 50731. Reviewing and improving licensing standards for placement in a rel-
ative foster family home. 
Sec. 50732. Development of a statewide plan to prevent child abuse and neglect fa-
talities. 
Sec. 50733. Modernizing the title and purpose of title IV–E. 
Sec. 50734. Effective dates. 
PART IV—ENSURING THE NECESSITY OF A PLACEMENT THAT IS NOT IN A FOSTER 
FAMILY HOME 
Sec. 50741. Limitation on Federal financial participation for placements that are 
not in foster family homes. 
Sec. 50742. Assessment and documentation of the need for placement in a qualified 
residential treatment program. 
Sec. 50743. Protocols to prevent inappropriate diagnoses. 
Sec. 50744. Additional data and reports regarding children placed in a setting that 
is not a foster family home. 
Sec. 50745. Criminal records checks and checks of child abuse and neglect reg-
istries for adults working in child-care institutions and other group care 
settings. 
Sec. 50746. Effective dates; application to waivers. 
PART V—CONTINUING SUPPORT FOR CHILD AND FAMILY SERVICES 
Sec. 50751. Supporting and retaining foster families for children. 
Sec. 50752. Extension of child and family services programs. 
Sec. 50753. Improvements to the John H. Chafee foster care independence program 
and related provisions. 
PART VI—CONTINUING INCENTIVES TO STATES TO PROMOTE ADOPTION AND LEGAL 
GUARDIANSHIP 
Sec. 50761. Reauthorizing adoption and legal guardianship incentive programs.
H. R. 1892—108 
PART VII—TECHNICAL CORRECTIONS 
Sec. 50771. Technical corrections to data exchange standards to improve program 
coordination. 
Sec. 50772. Technical corrections to State requirement to address the develop-
mental needs of young children. 
PART VIII—ENSURING STATES REINVEST SAVINGS RESULTING FROM INCREASE IN 
ADOPTION ASSISTANCE 
Sec. 50781. Delay of adoption assistance phase-in. 
Sec. 50782. GAO study and report on State reinvestment of savings resulting from 
increase in adoption assistance. 
TITLE VIII—SUPPORTING SOCIAL IMPACT PARTNERSHIPS TO PAY FOR 
RESULTS 
Sec. 50801. Short title. 
Sec. 50802. Social impact partnerships to pay for results. 
TITLE IX—PUBLIC HEALTH PROGRAMS 
Sec. 50901. Extension for community health centers, the National Health Service 
Corps, and teaching health centers that operate GME programs. 
Sec. 50902. Extension for special diabetes programs. 
TITLE X—MISCELLANEOUS HEALTH CARE POLICIES 
Sec. 51001. Home health payment reform. 
Sec. 51002. Information to satisfy documentation of Medicare eligibility for home 
health services. 
Sec. 51003. Technical amendments to Public Law 114–10. 
Sec. 51004. Expanded access to Medicare intensive cardiac rehabilitation programs. 
Sec. 51005. Extension of blended site neutral payment rate for certain long-term 
care hospital discharges; temporary adjustment to site neutral payment 
rates. 
Sec. 51006. Recognition of attending physician assistants as attending physicians 
to serve hospice patients. 
Sec. 51007. Extension of enforcement instruction on supervision requirements for 
outpatient therapeutic services in critical access and small rural hos-
pitals through 2017. 
Sec. 51008. Allowing physician assistants, nurse practitioners, and clinical nurse 
specialists to supervise cardiac, intensive cardiac, and pulmonary reha-
bilitation programs. 
Sec. 51009. Transitional payment rules for certain radiation therapy services under 
the physician fee schedule. 
TITLE XI—PROTECTING SENIORS’ ACCESS TO MEDICARE ACT 
Sec. 52001. Repeal of the Independent Payment Advisory Board. 
TITLE XII—OFFSETS 
Sec. 53101. Modifying reductions in Medicaid DSH allotments. 
Sec. 53102. Third party liability in Medicaid and CHIP. 
Sec. 53103. Treatment of lottery winnings and other lump-sum income for purposes 
of income eligibility under Medicaid. 
Sec. 53104. Rebate obligation with respect to line extension drugs. 
Sec. 53105. Medicaid Improvement Fund. 
Sec. 53106. Physician fee schedule update. 
Sec. 53107. Payment for outpatient physical therapy services and outpatient occu-
pational therapy services furnished by a therapy assistant. 
Sec. 53108. Reduction for non-emergency ESRD ambulance transports. 
Sec. 53109. Hospital transfer policy for early discharges to hospice care. 
Sec. 53110. Medicare payment update for home health services. 
Sec. 53111. Medicare payment update for skilled nursing facilities. 
Sec. 53112. Preventing the artificial inflation of star ratings after the consolidation 
of Medicare Advantage plans offered by the same organization. 
Sec. 53113. Sunsetting exclusion of biosimilars from Medicare part D coverage gap 
discount program. 
Sec. 53114. Adjustments to Medicare part B and part D premium subsidies for 
higher income individuals. 
Sec. 53115. Medicare Improvement Fund. 
Sec. 53116. Closing the Donut Hole for Seniors. 
Sec. 53117. Modernizing child support enforcement fees. 
Sec. 53118. Increasing efficiency of prison data reporting. 
Sec. 53119. Prevention and Public Health Fund.
H. R. 1892—109 
TITLE I—CHIP 
SEC. 50101. FUNDING EXTENSION OF THE CHILDREN’S HEALTH INSUR-
ANCE PROGRAM THROUGH FISCAL YEAR 2027. 
(a) IN GENERAL.—Section 2104(a) of the Social Security Act 
(42 U.S.C. 1397dd(a)), as amended by section 3002(a) of the 
HEALTHY KIDS Act (division C of Public Law 115–120), is 
amended— 
(1) in paragraph (25), by striking ‘‘; and’’ and inserting 
a semicolon; 
(2) in paragraph (26), by striking the period at the end 
and inserting a semicolon; and 
(3) by adding at the end the following new paragraphs: 
‘‘(27) for each of fiscal years 2024 through 2026, such 
sums as are necessary to fund allotments to States under 
subsections (c) and (m); and 
‘‘(28) for fiscal year 2027, for purposes of making two semi- 
annual allotments— 
‘‘(A) $7,650,000,000 for the period beginning on October 
1, 2026, and ending on March 31, 2027; and 
‘‘(B) $7,650,000,000 for the period beginning on April 
1, 2027, and ending on September 30, 2027.’’. 
(b) ALLOTMENTS.— 
(1) IN GENERAL.—Section 2104(m) of the Social Security 
Act (42 U.S.C. 1397dd(m)), as amended by section 3002(b) of 
the HEALTHY KIDS Act (division C of Public Law 115–120), 
is amended— 
(A) in paragraph (2)(B)— 
(i) in the matter preceding clause (i), by striking 
‘‘(25)’’ and inserting ‘‘(27)’’; 
(ii) in clause (i), by striking ‘‘and 2023’’ and 
inserting ‘‘, 2023, and 2027’’; and 
(iii) in clause (ii)(I), by striking ‘‘(or, in the case 
of fiscal year 2018, under paragraph (4))’’ and inserting 
‘‘(or, in the case of fiscal year 2018 or 2024, under 
paragraph (4) or (10), respectively)’’; 
(B) in paragraph (5)— 
(i) by striking ‘‘or (10)’’ and inserting ‘‘(10), or 
(11)’’; and 
(ii) by striking ‘‘or 2023,’’ and inserting ‘‘2023, or 
2027,’’; 
(C) in paragraph (7)— 
(i) in subparagraph (A), by striking ‘‘2023’’ and 
inserting ‘‘2027,’’; and 
(ii) in the matter following subparagraph (B), by 
striking ‘‘or fiscal year 2022’’ and inserting ‘‘fiscal year 
2022, fiscal year 2024, or fiscal year 2026’’; 
(D) in paragraph (9)— 
(i) by striking ‘‘or (10)’’ and inserting ‘‘(10), or 
(11)’’; and 
(ii) by striking ‘‘or 2023,’’ and inserting ‘‘2023, or 
2027,’’; and 
(E) by adding at the end the following: 
‘‘(11) FOR FISCAL YEAR 2027.— 
‘‘(A) FIRST HALF.—Subject to paragraphs (5) and (7), 
from the amount made available under subparagraph (A)
H. R. 1892—110 
of paragraph (28) of subsection (a) for the semi-annual 
period described in such subparagraph, increased by the 
amount of the appropriation for such period under section 
50101(b)(2) of the Advancing Chronic Care, Extenders, and 
Social Services Act, 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 subparagraph (C). 
‘‘(B) SECOND HALF.—Subject to paragraphs (5) and (7), 
from the amount made available under subparagraph (B) 
of paragraph (28) of subsection (a) for the semi-annual 
period described in such subparagraph, 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 2026 (including payments made to the State 
under subsection (n) for fiscal year 2026 as well as amounts 
redistributed to the State in fiscal year 2026), multiplied 
by the allotment increase factor under paragraph (6) for 
fiscal year 2027. 
‘‘(D) FIRST HALF RATIO.—The first half ratio described 
in this subparagraph is the ratio of— 
‘‘(i) the sum of— 
‘‘(I) the amount made available under sub-
section (a)(28)(A); and 
‘‘(II) the amount of the appropriation for such 
period under section 50101(b)(2) of the Advancing 
Chronic Care, Extenders, and Social Services Act; 
to 
‘‘(ii) the sum of— 
‘‘(I) the amount described in clause (i); and 
‘‘(II) the amount made available under sub-
section (a)(28)(B).’’. 
(2) ONE-TIME APPROPRIATION FOR FISCAL YEAR 2027.—There 
is appropriated to the Secretary of Health and Human Services, 
out of any money in the Treasury not otherwise appropriated, 
such sums as are necessary to fund allotments to States under 
subsections (c) and (m) of section 2104 of the Social Security 
Act (42 U.S.C. 1397dd) for fiscal year 2027, taking into account 
the full year amounts calculated for States under paragraph 
(11)(C) of subsection (m) of such section (as added by paragraph 
(1)) and the amounts appropriated under subparagraphs (A) 
and (B) of subsection (a)(28) of such section (as added by 
subsection (a)). Such amount shall accompany the allotment
H. R. 1892—111 
made for the period beginning on October 1, 2026, and ending 
on March 31, 2027, under paragraph (28)(A) of section 2104(a) 
of such Act (42 U.S.C. 1397dd(a)), to remain available until 
expended. Such amount shall be used to provide allotments 
to States under paragraph (11) of section 2104(m) of such 
Act for the first 6 months of fiscal year 2027 in the same 
manner as allotments are provided under subsection (a)(28)(A) 
of such section 2104 and subject to the same terms and condi-
tions as apply to the allotments provided from such subsection 
(a)(28)(A). 
(c) EXTENSION
OF
THE
CHILD
ENROLLMENT
CONTINGENCY 
FUND.—Section 2104(n) of the Social Security Act (42 U.S.C. 
1397dd(n)), as amended by section 3002(c) of the HEALTHY KIDS 
Act (division C of Public Law 115–120), is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A)(ii)— 
(i) by striking ‘‘and 2018 through 2022’’ and 
inserting ‘‘2018 through 2022, and 2024 through 2026’’; 
and 
(ii) by striking ‘‘and 2023’’ and inserting ‘‘2023, 
and 2027’’; and 
(B) in subparagraph (B)— 
(i) by striking ‘‘and 2018 through 2022’’ and 
inserting ‘‘2018 through 2022, and 2024 through 2026’’; 
and 
(ii) by striking ‘‘and 2023’’ and inserting ‘‘2023, 
and 2027’’; and 
(2) in paragraph (3)(A), in the matter preceding clause 
(i)— 
(A) by striking ‘‘or in any of fiscal years 2018 through 
2022’’ and inserting ‘‘fiscal years 2018 through 2022, or 
fiscal years 2024 through 2026’’; and 
(B) by striking ‘‘or 2023’’ and inserting ‘‘2023, or 2027’’. 
(d) EXTENSION
OF
QUALIFYING
STATES
OPTION.—Section 
2105(g)(4) of the Social Security Act (42 U.S.C. 1397ee(g)(4)), as 
amended by section 3002(d) of the HEALTHY KIDS Act (division 
C of Public Law 115–120), is amended— 
(1) in the paragraph heading, by striking ‘‘THROUGH 2023’’ 
and inserting ‘‘THROUGH 2027’’; and 
(2) in subparagraph (A), by striking ‘‘2023’’ and inserting 
‘‘2027’’. 
(e) EXTENSION OF EXPRESS LANE ELIGIBILITY OPTION.—Section 
1902(e)(13)(I) of the Social Security Act (42 U.S.C. 1396a(e)(13)(I)), 
as amended by section 3002(e) of the HEALTHY KIDS Act (division 
C of Public Law 115–120), is amended by striking ‘‘2023’’ and 
inserting ‘‘2027’’. 
(f) ASSURANCE OF ELIGIBILITY STANDARD FOR CHILDREN AND 
FAMILIES.— 
(1) IN GENERAL.—Section 2105(d)(3) of the Social Security 
Act (42 U.S.C. 1397ee(d)(3)), as amended by section 3002(f)(1) 
of the HEALTHY KIDS Act (division C of Public Law 115– 
120), is amended— 
(A) in the paragraph heading, by striking ‘‘THROUGH 
SEPTEMBER 30, 2023’’ and inserting ‘‘THROUGH SEPTEMBER 
30, 2027’’; and
H. R. 1892—112 
(B) in subparagraph (A), in the matter preceding clause 
(i), by striking ‘‘2023’’ each place it appears and inserting 
‘‘2027’’. 
(2) CONFORMING AMENDMENTS.—Section 1902(gg)(2) of the 
Social Security Act (42 U.S.C. 1396a(gg)(2)), as amended by 
section 3002(f)(2) of the HEALTHY KIDS Act (division C of 
Public Law 115–120), is amended— 
(A) in the paragraph heading, by striking ‘‘THROUGH 
SEPTEMBER 30, 2023’’ and inserting ‘‘THROUGH SEPTEMBER 
30, 2027’’; and 
(B) by striking ‘‘2023,’’ each place it appears and 
inserting ‘‘2027’’. 
SEC. 50102. EXTENSION OF PEDIATRIC QUALITY MEASURES PROGRAM. 
(a) IN GENERAL.—Section 1139A(i)(1) of the Social Security 
Act (42 U.S.C. 1320b–9a(i)(1)), as amended by section 3003(b) of 
the HEALTHY KIDS Act (division C of Public Law 115–120), is 
amended— 
(1) in subparagraph (B), by striking ‘‘; and’’ and inserting 
a semicolon; 
(2) in subparagraph (C), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new subparagraph: 
‘‘(D) for the period of fiscal years 2024 through 2027, 
$60,000,000 for the purpose of carrying out this section 
(other than subsections (e), (f), and (g)).’’. 
(b) MAKING REPORTING MANDATORY.—Section 1139A of the 
Social Security Act (42 U.S.C. 1320b–9a) is amended— 
(1) in subsection (a)— 
(A) in the heading for paragraph (4), by inserting ‘‘AND 
MANDATORY REPORTING’’ after ‘‘REPORTING’’; 
(B) in paragraph (4)— 
(i) by striking ‘‘Not later than’’ and inserting the 
following: 
‘‘(A) VOLUNTARY REPORTING.—Not later than’’; and 
(ii) by adding at the end the following: 
‘‘(B) MANDATORY
REPORTING.—Beginning with the 
annual State report on fiscal year 2024 required under 
subsection (c)(1), the Secretary shall require States to use 
the initial core measurement set and any updates or 
changes to that set to report information regarding the 
quality of pediatric health care under titles XIX and XXI 
using the standardized format for reporting information 
and procedures developed under subparagraph (A).’’; and 
(C) in paragraph (6)(B), by inserting ‘‘and, beginning 
with the report required on January 1, 2025, and for each 
annual report thereafter, the status of mandatory reporting 
by States under titles XIX and XXI, utilizing the initial 
core quality measurement set and any updates or changes 
to that set’’ before the semicolon; and 
(2) in subsection (c)(1)(A), by inserting ‘‘and, beginning 
with the annual report on fiscal year 2024, all of the core 
measures described in subsection (a) and any updates or 
changes to those measures’’ before the semicolon.
H. R. 1892—113 
SEC. 50103. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM. 
(a) IN GENERAL.—Section 2113 of the Social Security Act (42 
U.S.C. 1397mm), as amended by section 3004(a) of the HEALTHY 
KIDS Act (division C of Public Law 115–120), is amended— 
(1) in subsection (a)(1), by striking ‘‘2023’’ and inserting 
‘‘2027’’; and 
(2) in subsection (g)— 
(A) by striking ‘‘and $120,000,000’’ and inserting ‘‘, 
$120,000,000’’; and 
(B) by inserting ‘‘, and $48,000,000 for the period of 
fiscal years 2024 through 2027’’ after ‘‘2023’’. 
(b) ADDITIONAL RESERVED FUNDS.—Section 2113(a) of the Social 
Security Act (42 U.S.C. 1397mm(a)) is amended— 
(1) in paragraph (1), by striking ‘‘paragraph (2)’’ and 
inserting ‘‘paragraphs (2) and (3)’’; and 
(2) by adding at the end the following new paragraph: 
‘‘(3) TEN PERCENT SET ASIDE FOR EVALUATING AND PRO-
VIDING TECHNICAL ASSISTANCE TO GRANTEES.—For the period 
of fiscal years 2024 through 2027, an amount equal to 10 
percent of such amounts shall be used by the Secretary for 
the purpose of evaluating and providing technical assistance 
to eligible entities awarded grants under this section.’’. 
(c) USE OF RESERVED FUNDS FOR NATIONAL ENROLLMENT AND 
RETENTION STRATEGIES.—Section 2113(h) of the Social Security Act 
(42 U.S.C. 1397mm(h)) is amended— 
(1) in paragraph (5), by striking ‘‘; and’’ and inserting 
a semicolon; 
(2) by redesignating paragraph (6) as paragraph (7); and 
(3) by inserting after paragraph (5) the following new para-
graph: 
‘‘(6) the development of materials and toolkits and the 
provision of technical assistance to States regarding enrollment 
and retention strategies for eligible children under this title 
and title XIX; and’’. 
TITLE II—MEDICARE EXTENDERS 
SEC. 50201. 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 ‘‘January 1, 2018’’ and 
inserting ‘‘January 1, 2020’’. 
SEC. 50202. REPEAL OF MEDICARE PAYMENT CAP FOR THERAPY SERV-
ICES; LIMITATION TO ENSURE APPROPRIATE THERAPY. 
Section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)) 
is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘Subject to paragraphs (4) and (5)’’ 
and inserting ‘‘(A) Subject to paragraphs (4) and (5)’’; 
(B) in the subparagraph (A), as inserted and designated 
by subparagraph (A) of this paragraph, by adding at the 
end the following new sentence: ‘‘The preceding sentence 
shall not apply to expenses incurred with respect to services 
furnished after December 31, 2017.’’; and 
(C) by adding at the end the following new subpara-
graph:
H. R. 1892—114 
‘‘(B) With respect to services furnished during 2018 or a subse-
quent year, in the case of physical therapy services of the type 
described in section 1861(p), speech-language pathology services 
of the type described in such section through the application of 
section 1861(ll)(2), and physical therapy services and speech-lan-
guage pathology services of such type which are furnished by a 
physician or as incident to physicians’ services, with respect to 
expenses incurred in any calendar year, any amount that is more 
than the amount specified in paragraph (2) for the year shall 
not be considered as incurred expenses for purposes of subsections 
(a) and (b) unless the applicable requirements of paragraph (7) 
are met.’’; 
(2) in paragraph (3)— 
(A) by striking ‘‘Subject to paragraphs (4) and (5)’’ 
and inserting ‘‘(A) Subject to paragraphs (4) and (5)’’; 
(B) in the subparagraph (A), as inserted and designated 
by subparagraph (A) of this paragraph, by adding at the 
end the following new sentence: ‘‘The preceding sentence 
shall not apply to expenses incurred with respect to services 
furnished after December 31, 2017.’’; and 
(C) by adding at the end the following new subpara-
graph:. 
‘‘(B) With respect to services furnished during 2018 or a subse-
quent year, in the case of occupational therapy services (of the 
type that are described in section 1861(p) through the operation 
of section 1861(g) and of such type which are furnished by a 
physician or as incident to physicians’ services), with respect to 
expenses incurred in any calendar year, any amount that is more 
than the amount specified in paragraph (2) for the year shall 
not be considered as incurred expenses for purposes of subsections 
(a) and (b) unless the applicable requirements of paragraph (7) 
are met.’’; 
(3) in paragraph (5)— 
(A) by redesignating subparagraph (D) as paragraph 
(8) and moving such paragraph to immediately follow para-
graph (7), as added by paragraph (4) of this section; and 
(B) in subparagraph (E)(iv), by inserting ‘‘, except as 
such process is applied under paragraph (7)(B)’’ before the 
period at the end; and 
(4) by adding at the end the following new paragraph: 
‘‘(7) For purposes of paragraphs (1)(B) and (3)(B), with respect 
to services described in such paragraphs, the requirements 
described in this paragraph are as follows: 
‘‘(A) INCLUSION OF APPROPRIATE MODIFIER.—The claim for 
such services contains an appropriate modifier (such as the 
KX modifier described in paragraph (5)(B)) indicating that such 
services are medically necessary as justified by appropriate 
documentation in the medical record involved. 
‘‘(B) TARGETED
MEDICAL
REVIEW
FOR
CERTAIN
SERVICES 
ABOVE THRESHOLD.— 
‘‘(i) IN
GENERAL.—In the case where expenses that 
would be incurred for such services would exceed the 
threshold described in clause (ii) for the year, such services 
shall be subject to the process for medical review imple-
mented under paragraph (5)(E). 
‘‘(ii) THRESHOLD.—The threshold under this clause 
for—
H. R. 1892—115 
‘‘(I) a year before 2028, is $3,000; 
‘‘(II) 2028, is the amount specified in subclause 
(I) increased by the percentage increase in the MEI 
(as defined in section 1842(i)(3)) for 2028; and 
‘‘(III) a subsequent year, is the amount specified 
in this clause for the preceding year increased by the 
percentage increase in the MEI (as defined in section 
1842(i)(3)) for such subsequent year; 
except that if an increase under subclause (II) or (III) 
for a year is not a multiple of $10, it shall be rounded 
to the nearest multiple of $10. 
‘‘(iii) APPLICATION.—The threshold under clause (ii) 
shall be applied separately— 
‘‘(I) for physical therapy services and speech-lan-
guage pathology services; and 
‘‘(II) for occupational therapy services. 
‘‘(iv) FUNDING.—For purposes of carrying out this 
subparagraph, the Secretary shall provide for the transfer, 
from the Federal Supplementary Medical Insurance Trust 
Fund under section 1841 to the Centers for Medicare & 
Medicaid Services Program Management Account, of 
$5,000,000 for each fiscal year beginning with fiscal year 
2018, to remain available until expended. Such funds may 
not be used by a contractor under section 1893(h) for med-
ical reviews under this subparagraph.’’. 
SEC. 50203. MEDICARE AMBULANCE SERVICES. 
(a) EXTENSION OF CERTAIN GROUND AMBULANCE ADD-ON PAY-
MENTS.— 
(1) GROUND
AMBULANCE.—Section 1834(l)(13)(A) of the 
Social Security Act (42 U.S.C. 1395m(l)(13)(A)) is amended 
by striking ‘‘2018’’ and inserting ‘‘2023’’ each place it appears. 
(2) SUPER RURAL 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 ‘‘2018’’ and inserting ‘‘2023’’. 
(b) REQUIRING GROUND AMBULANCE PROVIDERS OF SERVICES 
AND SUPPLIERS TO SUBMIT COST AND OTHER INFORMATION.—Section 
1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) is amended 
by adding at the end the following new paragraph: 
‘‘(17) SUBMISSION OF COST AND OTHER INFORMATION.— 
‘‘(A) DEVELOPMENT OF DATA COLLECTION SYSTEM.—The 
Secretary shall develop a data collection system (which 
may include use of a cost survey) to collect cost, revenue, 
utilization, and other information determined appropriate 
by the Secretary with respect to providers of services (in 
this paragraph referred to as ‘providers’) and suppliers 
of ground ambulance services. Such system shall be 
designed to collect information— 
‘‘(i) needed to evaluate the extent to which reported 
costs relate to payment rates under this subsection; 
‘‘(ii) on the utilization of capital equipment and 
ambulance capacity, including information consistent 
with the type of information described in section 
1121(a); and 
‘‘(iii) on different types of ground ambulance serv-
ices furnished in different geographic locations,
H. R. 1892—116 
including rural areas and low population density areas 
described in paragraph (12). 
‘‘(B) SPECIFICATION OF DATA COLLECTION SYSTEM.— 
‘‘(i) IN GENERAL.—The Secretary shall— 
‘‘(I) not later than December 31, 2019, specify 
the data collection system under subparagraph (A); 
and 
‘‘(II) identify the providers and suppliers of 
ground ambulance services that would be required 
to submit information under such data collection 
system, 
including 
the 
representative 
sample 
described in clause (ii). 
‘‘(ii) 
DETERMINATION
OF
REPRESENTATIVE 
SAMPLE.— 
‘‘(I) IN
GENERAL.—Not later than December 
31, 2019, with respect to the data collection for 
the first year under such system, and for each 
subsequent year through 2024, the Secretary shall 
determine a representative sample to submit 
information under the data collection system. 
‘‘(II) REQUIREMENTS.—The sample under sub-
clause (I) shall be representative of the different 
types of providers and suppliers of ground ambu-
lance services (such as those providers and sup-
pliers that are part of an emergency service or 
part of a government organization) and the 
geographic locations in which ground ambulance 
services are furnished (such as urban, rural, and 
low population density areas). 
‘‘(III) LIMITATION.—The Secretary shall not 
include an individual provider or supplier of 
ground ambulance services in the sample under 
subclause (I) in 2 consecutive years, to the extent 
practicable. 
‘‘(C) REPORTING OF COST INFORMATION.—For each year, 
a provider or supplier of ground ambulance services identi-
fied by the Secretary under subparagraph (B)(i)(II) as being 
required to submit information under the data collection 
system with respect to a period for the year shall submit 
to the Secretary information specified under the system. 
Such information shall be submitted in a form and manner, 
and at a time, specified by the Secretary for purposes 
of this subparagraph. 
‘‘(D) PAYMENT REDUCTION FOR FAILURE TO REPORT.— 
‘‘(i) IN GENERAL.—Beginning January 1, 2022, sub-
ject to clause (ii), a 10 percent reduction to payments 
under this subsection shall be made for the applicable 
period (as defined in clause (ii)) to a provider or sup-
plier of ground ambulance services that— 
‘‘(I) is required to submit information under 
the data collection system with respect to a period 
under subparagraph (C); and 
‘‘(II) does not sufficiently submit such informa-
tion, as determined by the Secretary. 
‘‘(ii) APPLICABLE PERIOD DEFINED.—For purposes 
of clause (i), the term ‘applicable period’ means, with 
respect to a provider or supplier of ground ambulance
H. R. 1892—117 
services, a year specified by the Secretary not more 
than 2 years after the end of the period with respect 
to which the Secretary has made a determination 
under clause (i)(II) that the provider or supplier of 
ground ambulance services failed to sufficiently submit 
information under the data collection system. 
‘‘(iii) HARDSHIP
EXEMPTION.—The Secretary may 
exempt a provider or supplier from the payment reduc-
tion under clause (i) with respect to an applicable 
period in the event of significant hardship, such as 
a natural disaster, bankruptcy, or other similar situa-
tion that the Secretary determines interfered with the 
ability of the provider or supplier of ground ambulance 
services to submit such information in a timely manner 
for the specified period. 
‘‘(iv) INFORMAL
REVIEW.—The Secretary shall 
establish a process under which a provider or supplier 
of ground ambulance services may seek an informal 
review of a determination that the provider or supplier 
is subject to the payment reduction under clause (i). 
‘‘(E) ONGOING DATA COLLECTION.— 
‘‘(i) REVISION OF DATA COLLECTION SYSTEM.—The 
Secretary may, as the Secretary determines appro-
priate and, if available, taking into consideration the 
report (or reports) under subparagraph (F), revise the 
data collection system under subparagraph (A). 
‘‘(ii) SUBSEQUENT DATA COLLECTION.—In order to 
continue to evaluate the extent to which reported costs 
relate to payment rates under this subsection and for 
other purposes the Secretary deems appropriate, the 
Secretary shall require providers and suppliers of 
ground ambulance services to submit information for 
years after 2024 as the Secretary determines appro-
priate, but in no case less often than once every 3 
years. 
‘‘(F) GROUND
AMBULANCE
DATA
COLLECTION
SYSTEM 
STUDY.— 
‘‘(i) IN GENERAL.—Not later than March 15, 2023, 
and as determined necessary by the Medicare Payment 
Advisory Commission thereafter, such Commission 
shall assess, and submit to Congress a report on, 
information submitted by providers and suppliers of 
ground ambulance services through the data collection 
system under subparagraph (A), the adequacy of pay-
ments for ground ambulance services under this sub-
section, and geographic variations in the cost of fur-
nishing such services. 
‘‘(ii) CONTENTS.—A report under clause (i) shall 
contain the following: 
‘‘(I) An analysis of information submitted 
through the data collection system. 
‘‘(II) An analysis of any burden on providers 
and suppliers of ground ambulance services associ-
ated with the data collection system. 
‘‘(III) A recommendation as to whether 
information should continue to be submitted 
through such data collection system or if such
H. R. 1892—118 
system should be revised under subparagraph 
(E)(i). 
‘‘(IV) Other information determined appro-
priate by the Commission. 
‘‘(G) PUBLIC AVAILABILITY.—The Secretary shall post 
information on the results of the data collection under 
this paragraph on the Internet website of the Centers 
for Medicare & Medicaid Services, as determined appro-
priate by the Secretary. 
‘‘(H) IMPLEMENTATION.—The Secretary shall implement 
this paragraph through notice and comment rulemaking. 
‘‘(I) ADMINISTRATION.—Chapter 35 of title 44, United 
States Code, shall not apply to the collection of information 
required under this subsection. 
‘‘(J) LIMITATIONS
ON
REVIEW.—There shall be no 
administrative or judicial review under section 1869, sec-
tion 1878, or otherwise of the data collection system or 
identification of respondents under this paragraph. 
‘‘(K) FUNDING FOR IMPLEMENTATION.—For purposes of 
carrying out subparagraph (A), 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 fiscal year 2018. Amounts trans-
ferred under this subparagraph shall remain available until 
expended.’’. 
SEC. 50204. EXTENSION OF INCREASED INPATIENT HOSPITAL PAY-
MENT ADJUSTMENT FOR CERTAIN LOW-VOLUME HOS-
PITALS. 
(a) IN GENERAL.—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 ‘‘fiscal year 2018’’ and inserting ‘‘fiscal year 
2023’’; 
(2) in subparagraph (C)— 
(A) in clause (i)— 
(i) by striking ‘‘through 2017’’ the first place it 
appears and inserting ‘‘through 2022’’; and 
(ii) by striking ‘‘ and has less than 800 discharges’’ 
and all that follows through the period at the end 
and inserting the following ‘‘and has— 
‘‘(I) with respect to each of fiscal years 2005 
through 2010, less than 800 discharges during the 
fiscal year; 
‘‘(II) with respect to each of fiscal years 2011 
through 2018, less than 1,600 discharges of 
individuals entitled to, or enrolled for, benefits 
under part A during the fiscal year or portion 
of fiscal year; 
‘‘(III) with respect to each of fiscal years 2019 
through 2022, less than 3,800 discharges during 
the fiscal year; and 
‘‘(IV) with respect to fiscal year 2023 and each 
subsequent fiscal year, less than 800 discharges 
during the fiscal year.’’; and 
(B) in clause (ii)—
H. R. 1892—119 
(i) by striking ‘‘subparagraph (B)’’ and inserting 
‘‘subparagraphs (B) and (D)’’; and 
(ii) by inserting ‘‘(except as provided in clause (i)(II) 
and subparagraph (D)(i))’’ after ‘‘regardless’’; and 
(3) in subparagraph (D)— 
(A) by striking ‘‘through 2017’’ and inserting ‘‘through 
2022’’; 
(B) by striking ‘‘hospitals with 200 or fewer’’ and 
inserting the following: ‘‘hospitals— 
‘‘(i) with respect to each of fiscal years 2011 
through 2018, with 200 or fewer’’; 
(C) by striking the period at the end and inserting 
‘‘or portion of fiscal year; and’’; and 
(D) by adding at the end the following new clause: 
‘‘(ii) with respect to each of fiscal years 2019 
through 2022, with 500 or fewer discharges in the 
fiscal year to 0 percent for low-volume hospitals with 
greater than 3,800 discharges in the fiscal year.’’. 
(b) MEDPAC REPORT ON EXTENSION OF INCREASED INPATIENT 
HOSPITAL PAYMENT ADJUSTMENT FOR CERTAIN LOW-VOLUME HOS-
PITALS.— 
(1) IN GENERAL.—Not later than March 15, 2022, the Medi-
care Payment Advisory Commission shall submit to Congress 
a report on the extension of the increased inpatient hospital 
payment adjustment for certain low-volume hospitals under 
section 1886(d)(12) of the Social Security Act (42 U.S.C. 
1395ww(d)(12)) under the provisions of, and amendments made 
by, this section. 
(2) CONTENTS.—The report under paragraph (1) shall 
include an evaluation of the effects of such extension on the 
following: 
(A) Beneficiary utilization of inpatient hospital services 
under title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.). 
(B) The financial status of hospitals with a low volume 
of Medicare or total inpatient admissions. 
(C) Program spending under such title XVIII. 
(D) Other matters relevant to evaluating the effects 
of such extension. 
SEC. 50205. 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— 
(1) in clause (i), by striking ‘‘October 1, 2017’’ and inserting 
‘‘October 1, 2022’’; 
(2) in clause (ii)(II), by striking ‘‘October 1, 2017’’ and 
inserting ‘‘October 1, 2022’’; and 
(3) in clause (iv), by striking subclause (I) and inserting 
the following new subclause: 
‘‘(I) that is located in— 
‘‘(aa) a rural area; or 
‘‘(bb) a State with no rural area (as defined in para-
graph (2)(D)) and satisfies any of the criteria in subclause 
(I), (II), or (III) of paragraph (8)(E)(ii),’’; and 
(4) by inserting after subclause (IV) the following new 
flush sentences:
H. R. 1892—120 
‘‘Subclause (I)(bb) shall apply for purposes of payment under clause 
(ii) only for discharges of a hospital occurring on or after the 
effective date of a determination of medicare-dependent small rural 
hospital status made by the Secretary with respect to the hospital 
after the date of the enactment of this sentence. For purposes 
of applying subclause (II) of paragraph (8)(E)(ii) under subclause 
(I)(bb), such subclause (II) shall be applied by inserting ‘as of 
January 1, 2018,’ after ‘such State’ each place it appears.’’. 
(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 
‘‘October 1, 2017’’ and inserting ‘‘October 1, 2022’’; and 
(B) in clause (iv), by striking ‘‘through fiscal year 2017’’ 
and inserting ‘‘through fiscal year 2022’’. 
(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 fiscal year 2017’’ and inserting ‘‘through fiscal year 
2022’’. 
(c) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the United States 
(in this subsection referred to as the ‘‘Comptroller General’’) 
shall conduct a study on the medicare-dependent, small rural 
hospital program under section 1886(d) of the Social Security 
Act (42 U.S.C. 1395x(d)). Such study shall include an analysis 
of the following: 
(A) The payor mix of medicare-dependent, small rural 
hospitals (as defined in paragraph (5)(G)(iv) of such section 
1886(d)), how such mix will trend in future years (based 
on current trends and projections), and whether or not 
the requirement under subclause (IV) of such paragraph 
should be revised. 
(B) The characteristics of medicare-dependent, small 
rural hospitals that meet the requirement of such subclause 
(IV) through the application of paragraph (a)(iii)(A) or 
(a)(iii)(B) of section 412.108 of title 42, Code of Federal 
Regulations, including Medicare inpatient and outpatient 
utilization, payor mix, and financial status (including Medi-
care and total margins), and whether or not Medicare 
payments for such hospitals should be revised. 
(C) Such other items related to medicare-dependent, 
small rural hospitals as the Comptroller General deter-
mines appropriate. 
(2) REPORT.—Not later than 2 years after the date of the 
enactment of this Act, the Comptroller General shall submit 
to Congress a report containing the results of the study con-
ducted under paragraph (1), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
SEC. 
50206. 
EXTENSION 
OF 
FUNDING 
FOR 
QUALITY 
MEASURE 
ENDORSEMENT, INPUT, AND SELECTION; REPORTING 
REQUIREMENTS. 
(a) EXTENSION OF FUNDING.—Section 1890(d)(2) of the Social 
Security Act (42 U.S.C. 1395aaa(d)(2)) is amended—
H. R. 1892—121 
(1) in the first sentence— 
(A) by striking ‘‘2014 and’’ and inserting ‘‘2014,’’; and 
(B) by inserting the following before the period: ‘‘, 
and $7,500,000 for each of fiscal years 2018 and 2019’’; 
and 
(2) by adding at the end the following new sentence: 
‘‘Amounts transferred for each of fiscal years 2018 and 2019 
shall be in addition to any unobligated funds transferred for 
a preceding fiscal year that are available under the preceding 
sentence.’’ 
(b) ANNUAL REPORT BY SECRETARY TO CONGRESS.—Section 1890 
of the Social Security Act (42 U.S.C. 1395aaa) is amended by 
adding at the end the following new subsection: 
‘‘(e) ANNUAL REPORT
BY SECRETARY
TO CONGRESS.—By not 
later than March 1 of each year (beginning with 2019), the Secretary 
shall submit to Congress a report containing the following: 
‘‘(1) A comprehensive plan that identifies the quality 
measurement needs of programs and initiatives of the Secretary 
and provides a strategy for using the entity with a contract 
under subsection (a) and any other entity the Secretary has 
contracted with or may contract with to perform work associ-
ated with section 1890A to help meet those needs, specifically 
with respect to the programs under this title and title XIX. 
In years after the first plan under this paragraph is submitted, 
the requirements of this paragraph may be met by providing 
an update to the plan. 
‘‘(2) The amount of funding provided under subsection (d) 
for purposes of carrying out this section and section 1890A 
that has been obligated by the Secretary, the amount of funding 
provided that has been expended, and the amount of funding 
provided that remains unobligated. 
‘‘(3) With respect to the activities described under this 
section or section 1890A, a description of how the funds 
described in paragraph (2) have been obligated or expended, 
including how much of that funding has been obligated or 
expended for work performed by the Secretary, the entity with 
a contract under subsection (a), and any other entity the Sec-
retary has contracted with to perform work. 
‘‘(4) A description of the activities for which the funds 
described in paragraph (2) were used, including task orders 
and activities assigned to the entity with a contract under 
subsection (a), activities performed by the Secretary, and task 
orders and activities assigned to any other entity the Secretary 
has contracted with to perform work related to carrying out 
section 1890A. 
‘‘(5) The amount of funding described in paragraph (2) 
that has been obligated or expended for each of the activities 
described in paragraph (4). 
‘‘(6) Estimates for, and descriptions of, obligations and 
expenditures that the Secretary anticipates will be needed in 
the succeeding two year period to carry out each of the quality 
measurement activities required under this section and section 
1890A, including any obligations that will require funds to 
be expended in a future year.’’. 
(c) REVISIONS
TO ANNUAL REPORT FROM CONSENSUS-BASED 
ENTITY TO CONGRESS AND THE SECRETARY.—
H. R. 1892—122 
(1) IN GENERAL.—Section 1890(b)(5)(A) of the Social Secu-
rity Act (42 U.S.C. 1395aaa(b)(5)(A)) is amended— 
(A) by redesignating clauses (i) through (vi) as sub-
clauses (I) through (VI), respectively, and moving the mar-
gins accordingly; 
(B) in the matter preceding subclause (I), as redesig-
nated by subparagraph (A), by striking ‘‘containing a 
description of—’’ and inserting ‘‘containing the following: 
‘‘(i) A description of—’’; and 
(C) by adding at the end the following new clauses: 
‘‘(ii) An itemization of financial information for 
the fiscal year ending September 30 of the preceding 
year, including— 
‘‘(I) annual revenues of the entity (including 
any government funding, private sector contribu-
tions, grants, membership revenues, and invest-
ment revenue); 
‘‘(II) annual expenses of the entity (including 
grants paid, benefits paid, salaries or other com-
pensation, fundraising expenses, and overhead 
costs); and 
‘‘(III) a breakdown of the amount awarded per 
contracted task order and the specific projects 
funded in each task order assigned to the entity. 
‘‘(iii) Any updates or modifications of internal poli-
cies and procedures of the entity as they relate to 
the duties of the entity under this section, including— 
‘‘(I) specifically identifying any modifications 
to the disclosure of interests and conflicts of 
interests for committees, work groups, task forces, 
and advisory panels of the entity; and 
‘‘(II) information on external stakeholder 
participation in the duties of the entity under this 
section (including complete rosters for all commit-
tees, work groups, task forces, and advisory panels 
funded through government contracts, descriptions 
of relevant interests and any conflicts of interest 
for members of all committees, work groups, task 
forces, and advisory panels, and the total percent-
age by health care sector of all convened commit-
tees, work groups, task forces, and advisory 
panels.’’. 
(2) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply to reports submitted for years beginning 
with 2019. 
(d) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the United States 
shall conduct a study on health care quality measurement 
efforts funded under sections 1890 and 1890A of the Social 
Security Act (42 U.S.C. 1395aaa; 1395aaa–1). Such study shall 
include an examination of the following: 
(A) The extent to which the Secretary of Health and 
Human Services (in this subsection referred to as the ‘‘Sec-
retary’’) has set and prioritized objectives to be achieved 
for each of the quality measurement activities required 
under such sections 1890 and 1890A.
H. R. 1892—123 
(B) The efforts that the Secretary has undertaken to 
meet quality measurement objectives associated with such 
sections 1890 and 1890A, including division of responsibil-
ities for those efforts within the Department of Health 
and Human Services and through contracts with a con-
sensus-based entity under subsection (a) of such section 
1890 (in this subsection referred to as the ‘‘consensus- 
based entity’’) and other entities, and the extent of any 
overlap among the work performed by the Secretary, the 
consensus-based entity, the Measure Applications Partner-
ship (MAP) convened by such entity to provide input to 
the Secretary on the selection of quality and efficiency 
measures, and any other entities the Secretary has con-
tracted with to perform work related to carrying out such 
sections 1890 and 1890A. 
(C) The total amount of funding provided to the Sec-
retary for purposes of carrying out such sections 1890 
and 1890A, the amount of such funding that has been 
obligated or expended by the Secretary, and the amount 
of such funding that remains unobligated. 
(D) How the funds described in subparagraph (C) have 
been allocated, including how much of the funding has 
been allocated for work performed by the Secretary, the 
consensus-based entity, and any other entity the Secretary 
has contracted with to perform work related to carrying 
out such sections 1890 and 1890A, respectively, and 
descriptions of such work. 
(E) The extent to which the Secretary has developed 
a comprehensive and long-term plan to ensure that it can 
achieve quality measurement objectives related to carrying 
out such sections 1890 and 1890A in a timely manner 
and with efficient use of available resources, including the 
roles of the consensus-based entity, the Measure Applica-
tions Partnership (MAP), and any other entity the Sec-
retary has contracted with to perform work related to such 
sections 1890 and 1890A in helping the Secretary achieve 
those objectives. 
(2) REPORT.—Not later than 18 months after the date of 
enactment of this Act, the Comptroller General of the United 
States shall submit to Congress a report containing the results 
of the study conducted under paragraph (1), together with 
recommendations for such legislation and administrative action 
as the Comptroller General determines appropriate. 
SEC. 50207. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR 
LOW-INCOME PROGRAMS; STATE HEALTH INSURANCE 
ASSISTANCE PROGRAM REPORTING REQUIREMENTS. 
(a) FUNDING EXTENSIONS.— 
(1) ADDITIONAL
FUNDING
FOR
STATE
HEALTH
INSURANCE 
PROGRAMS.—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), sec-
tion 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), section 110 of the Protecting 
Access to Medicare Act of 2014 (Public Law 113–93), and section
H. R. 1892—124 
208 of the Medicare Access and CHIP Reauthorization Act 
of 2015 (Public Law 114–10) is amended— 
(A) in clause (vi), by striking ‘‘and’’ at the end; 
(B) in clause (vii), by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by adding at the end the following new clauses: 
‘‘(viii) for fiscal year 2018, of $13,000,000; and 
‘‘(ix) for fiscal year 2019, of $13,000,000.’’. 
(2) ADDITIONAL FUNDING FOR AREA AGENCIES ON AGING.— 
Subsection (b)(1)(B) of such section 119, as so amended, is 
amended— 
(A) in clause (vi), by striking ‘‘and’’ at the end; 
(B) in clause (vii), by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the following new 
clauses: 
‘‘(viii) for fiscal year 2018, of $7,500,000; and 
‘‘(ix) for fiscal year 2019, of $7,500,000.’’. 
(3) ADDITIONAL
FUNDING
FOR
AGING
AND
DISABILITY 
RESOURCE CENTERS.—Subsection (c)(1)(B) of such section 119, 
as so amended, is amended— 
(A) in clause (vi), by striking ‘‘and’’ at the end; 
(B) in clause (vii), by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the following new 
clauses: 
‘‘(viii) for fiscal year 2018, of $5,000,000; and 
‘‘(ix) for fiscal year 2019, of $5,000,000.’’. 
(4) ADDITIONAL FUNDING FOR CONTRACT WITH THE NATIONAL 
CENTER
FOR
BENEFITS
AND
OUTREACH
ENROLLMENT.—Sub-
section (d)(2) of such section 119, as so amended, is amended— 
(A) in clause (vi), by striking ‘‘and’’ at the end; 
(B) in clause (vii), by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the following new 
clauses: 
‘‘(viii) for fiscal year 2018, of $12,000,000; and 
‘‘(ix) for fiscal year 2019, of $12,000,000.’’. 
(b) STATE HEALTH INSURANCE ASSISTANCE PROGRAM REPORTING 
REQUIREMENTS.—Beginning not later than April 1, 2019, and 
biennially thereafter, the Agency for Community Living shall elec-
tronically post on its website the following information, with respect 
to grants to States for State health insurance assistance programs, 
(such information to be presented by State and by entity receiving 
funds from the State to carry out such a program funded by such 
grant): 
(1) The amount of Federal funding provided to each such 
State for such program for the period involved and the amount 
of Federal funding provided by each such State for such pro-
gram to each such entity for the period involved. 
(2) Information as the Secretary may specify, with respect 
to such programs carried out through such grants, consistent 
with the terms and conditions for receipt of such grants. 
SEC. 50208. EXTENSION OF HOME HEALTH RURAL ADD-ON. 
(a) EXTENSION.—
H. R. 1892—125 
(1) IN GENERAL.—Section 421 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), section 3131(c) of 
the Patient Protection and Affordable Care Act (Public Law 
111–148; 124 Stat. 428), and section 210 of the Medicare Access 
and CHIP Reauthorization Act of 2015 (Public Law 114–10; 
129 Stat. 151) is amended— 
(A) in subsection (a), by striking ‘‘January 1, 2018’’ 
and inserting ‘‘January 1, 2019’’ each place it appears; 
(B) by redesignating subsections (b) and (c) as sub-
sections (c) and (d), respectively; 
(C) in each of subsections (c) and (d), as so redesig-
nated, by striking ‘‘subsection (a)’’ and inserting ‘‘subsection 
(a) or (b)’’; and 
(D) by inserting after subsection (a) the following new 
subsection: 
‘‘(b) SUBSEQUENT TEMPORARY INCREASE.— 
‘‘(1) IN GENERAL.—The Secretary shall increase the pay-
ment amount otherwise made under such section 1895 for 
home health services furnished in a county (or equivalent area) 
in a rural area (as defined in such section 1886(d)(2)(D)) that, 
as determined by the Secretary— 
‘‘(A) is in the highest quartile of all counties (or equiva-
lent areas) based on the number of Medicare home health 
episodes furnished per 100 individuals who are 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 (but not enrolled in a plan under 
part C of such title)— 
‘‘(i) in the case of episodes and visits ending during 
2019, by 1.5 percent; and 
‘‘(ii) in the case of episodes and visits ending during 
2020, by 0.5 percent; 
‘‘(B) has a population density of 6 individuals or fewer 
per square mile of land area and is not described in 
subparagraph (A)— 
‘‘(i) in the case of episodes and visits ending during 
2019, by 4 percent; 
‘‘(ii) in the case of episodes and visits ending during 
2020, by 3 percent; 
‘‘(iii) in the case of episodes and visits ending 
during 2021, by 2 percent; and 
‘‘(iv) in the case of episodes and visits ending 
during 2022, by 1 percent; and 
‘‘(C) is not described in either subparagraph (A) or 
(B)— 
‘‘(i) in the case of episodes and visits ending during 
2019, by 3 percent; 
‘‘(ii) in the case of episodes and visits ending during 
2020, by 2 percent; and 
‘‘(iii) in the case of episodes and visits ending 
during 2021, by 1 percent. 
‘‘(2) RULES FOR DETERMINATIONS.—
H. R. 1892—126 
‘‘(A) NO SWITCHING.—For purposes of this subsection, 
the determination by the Secretary as to which subpara-
graph of paragraph (1) applies to a county (or equivalent 
area) shall be made a single time and shall apply for 
the duration of the period to which this subsection applies. 
‘‘(B) UTILIZATION.—In determining which counties (or 
equivalent areas) are in the highest quartile under para-
graph (1)(A), the following rules shall apply: 
‘‘(i) The Secretary shall use data from 2015. 
‘‘(ii) The Secretary shall exclude data from the 
territories (and the territories shall not be described 
in such paragraph). 
‘‘(iii) The Secretary may exclude data from counties 
(or equivalent areas) in rural areas with a low volume 
of home health episodes (and if data is so excluded 
with respect to a county (or equivalent area), such 
county (or equivalent area) shall not be described in 
such paragraph). 
‘‘(C) POPULATION DENSITY.—In determining population 
density under paragraph (1)(B), the Secretary shall use 
data from the 2010 decennial Census. 
‘‘(3) LIMITATIONS ON REVIEW.—There shall be no adminis-
trative or judicial review under section 1869, section 1878, 
or otherwise of determinations under paragraph (1).’’. 
(2) REQUIREMENT
TO
SUBMIT
COUNTY
DATA
ON
CLAIM 
FORM.—Section 1895(c) of the Social Security Act (42 U.S.C. 
1395fff(c)) is amended— 
(A) in paragraph (1), by striking ‘‘and’’ at the end; 
(B) in paragraph (2), by striking the period at the 
end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new paragraph: 
‘‘(3) in the case of home health services furnished on or 
after January 1, 2019, the claim contains the code for the 
county (or equivalent area) in which the home health service 
was furnished.’’. 
(b) HHS OIG ANALYSIS.—Not later than January 1, 2023, the 
Inspector General of the Department of Health and Human Services 
shall submit to Congress— 
(1) an analysis of the home health claims and utilization 
of home health services by county (or equivalent area) under 
the Medicare program; and 
(2) recommendations the Inspector General determines 
appropriate based on such analysis.
H. R. 1892—127 
TITLE 
III—CREATING 
HIGH-QUALITY 
RESULTS 
AND 
OUTCOMES 
NEC-
ESSARY 
TO 
IMPROVE 
CHRONIC 
(CHRONIC) CARE 
Subtitle A—Receiving High Quality Care in 
the Home 
SEC. 50301. EXTENDING THE INDEPENDENCE AT HOME DEMONSTRA-
TION PROGRAM. 
(a) IN GENERAL.—Section 1866E of the Social Security Act 
(42 U.S.C. 1395cc–5) is amended— 
(1) in subsection (e)— 
(A) in paragraph (1)— 
(i) by striking ‘‘An agreement’’ and inserting 
‘‘Agreements’’; and 
(ii) by striking ‘‘5-year’’ and inserting ‘‘7-year’’; and 
(B) in paragraph (5)— 
(i) by striking ‘‘10,000’’ and inserting ‘‘15,000’’; and 
(ii) by adding at the end the following new sen-
tence: ‘‘An applicable beneficiary that participates in 
the demonstration program by reason of the increase 
from 10,000 to 15,000 in the preceding sentence pursu-
ant 
to 
the 
amendment 
made 
by 
section 
50301(a)(1)(B)(i) of the Advancing Chronic Care, 
Extenders, and Social Services Act shall be considered 
in the spending target estimates under paragraph (1) 
of subsection (c) and the incentive payment calculations 
under paragraph (2) of such subsection for the sixth 
and seventh years of such program.’’; 
(2) in subsection (g), in the first sentence, by inserting 
‘‘, including, to the extent practicable, with respect to the use 
of electronic health information systems, as described in sub-
section (b)(1)(A)(vi)’’ after ‘‘under the demonstration program’’; 
and 
(3) in subsection (i)(1)(A), by striking ‘‘will not receive an 
incentive payment for the second of 2’’ and inserting ‘‘did not 
achieve savings for the third of 3’’. 
(b) EFFECTIVE DATE.—The amendment made by subsection 
(a)(3) shall take effect as if included in the enactment of Public 
Law 111–148. 
SEC. 50302. EXPANDING ACCESS TO HOME DIALYSIS THERAPY. 
(a) IN GENERAL.—Section 1881(b)(3) of the Social Security Act 
(42 U.S.C. 1395rr(b)(3)) is amended— 
(1) by redesignating subparagraphs (A) and (B) as clauses 
(i) and (ii), respectively; 
(2) in clause (ii), as redesignated by paragraph (1), by 
striking ‘‘on a comprehensive’’ and insert ‘‘subject to subpara-
graph (B), on a comprehensive’’; 
(3) by striking ‘‘With respect to’’ and inserting ‘‘(A) With 
respect to’’; and 
(4) by adding at the end the following new subparagraph:
H. R. 1892—128 
‘‘(B)(i) For purposes of subparagraph (A)(ii), subject to clause 
(ii), an individual determined to have end stage renal disease 
receiving home dialysis may choose to receive monthly end stage 
renal disease-related clinical assessments furnished on or after 
January 1, 2019, via telehealth. 
‘‘(ii) Clause (i) shall apply to an individual only if the individual 
receives a face-to-face clinical assessment, without the use of tele-
health— 
‘‘(I) in the case of the initial 3 months of home dialysis 
of such individual, at least monthly; and 
‘‘(II) after such initial 3 months, at least once every 3 
consecutive months.’’. 
(b) ORIGINATING SITE REQUIREMENTS.— 
(1) IN GENERAL.—Section 1834(m) of the Social Security 
Act (42 U.S.C. 1395m(m)) is amended— 
(A) in paragraph (4)(C)(ii), by adding at the end the 
following new subclauses: 
‘‘(IX) A renal dialysis facility, but only for pur-
poses of section 1881(b)(3)(B). 
‘‘(X) The home of an individual, but only for 
purposes of section 1881(b)(3)(B).’’; and 
(B) by adding at the end the following new paragraph: 
‘‘(5) TREATMENT OF HOME DIALYSIS MONTHLY ESRD-RELATED 
VISIT.—The geographic requirements described in paragraph 
(4)(C)(i) shall not apply with respect to telehealth services 
furnished on or after January 1, 2019, for purposes of section 
1881(b)(3)(B), at an originating site described in subclause (VI), 
(IX), or (X) of paragraph (4)(C)(ii).’’. 
(2) NO FACILITY FEE IF ORIGINATING SITE FOR HOME DIALYSIS 
THERAPY
IS
THE
HOME.—Section 1834(m)(2)(B) of the Social 
Security (42 U.S.C. 1395m(m)(2)(B)) is amended— 
(A) by redesignating clauses (i) and (ii) as subclauses 
(I) and (II), and indenting appropriately; 
(B) in subclause (II), as redesignated by subparagraph 
(A), by striking ‘‘clause (i) or this clause’’ and inserting 
‘‘subclause (I) or this subclause’’; 
(C) by striking ‘‘SITE.—With respect to’’ and inserting 
‘‘SITE.— 
‘‘(i) IN
GENERAL.—Subject to clause (ii), with 
respect to’’; and 
(D) by adding at the end the following new clause: 
‘‘(ii) NO
FACILITY
FEE
IF
ORIGINATING
SITE
FOR 
HOME DIALYSIS THERAPY IS THE HOME.—No facility fee 
shall be paid under this subparagraph to an originating 
site described in paragraph (4)(C)(ii)(X).’’. 
(c) CLARIFICATION REGARDING TELEHEALTH PROVIDED TO BENE-
FICIARIES.—Section 1128A(i)(6) of the Social Security Act (42 U.S.C. 
1320a–7a(i)(6)) is amended— 
(1) in subparagraph (H), by striking ‘‘or’’ at the end; 
(2) in subparagraph (I), by striking the period at the end 
and inserting ‘‘; or’’; and 
(3) by adding at the end the following new subparagraph: 
‘‘(J) the provision of telehealth technologies (as defined 
by the Secretary) on or after January 1, 2019, by a provider 
of services or a renal dialysis facility (as such terms are 
defined for purposes of title XVIII) to an individual with 
end stage renal disease who is receiving home dialysis
H. R. 1892—129 
for which payment is being made under part B of such 
title, if— 
‘‘(i) the telehealth technologies are not offered as 
part of any advertisement or solicitation; 
‘‘(ii) the telehealth technologies are provided for 
the purpose of furnishing telehealth services related 
to the individual’s end stage renal disease; and 
‘‘(iii) the provision of the telehealth technologies 
meets any other requirements set forth in regulations 
promulgated by the Secretary.’’. 
(d) CONFORMING AMENDMENT.—Section 1881(b)(1) of the Social 
Security Act (42 U.S.C. 1395rr(b)(1)) is amended by striking ‘‘para-
graph (3)(A)’’ and inserting ‘‘paragraph (3)(A)(i)’’. 
Subtitle B—Advancing Team-Based Care 
SEC. 50311. PROVIDING CONTINUED ACCESS TO MEDICARE ADVAN-
TAGE SPECIAL NEEDS PLANS FOR VULNERABLE POPU-
LATIONS. 
(a) EXTENSION.—Section 1859(f)(1) of the Social Security Act 
(42 U.S.C. 1395w–28(f)(1)) is amended by striking ‘‘and for periods 
before January 1, 2019’’. 
(b) INCREASED INTEGRATION OF DUAL SNPS.— 
(1) IN
GENERAL.—Section 1859(f) of the Social Security 
Act (42 U.S.C. 1395w–28(f)) is amended— 
(A) in paragraph (3), by adding at the end the following 
new subparagraph: 
‘‘(F) The plan meets the requirements applicable under 
paragraph (8).’’; and 
(B) by adding at the end the following new paragraph: 
‘‘(8) INCREASED INTEGRATION OF DUAL SNPS.— 
‘‘(A) DESIGNATED
CONTACT.—The Secretary, acting 
through the Federal Coordinated Health Care Office estab-
lished under section 2602 of Public Law 111–148, shall 
serve as a dedicated point of contact for States to address 
misalignments that arise with the integration of specialized 
MA plans for special needs individuals described in sub-
section (b)(6)(B)(ii) under this paragraph and, consistent 
with such role, shall establish— 
‘‘(i) a uniform process for disseminating to State 
Medicaid 
agencies 
information 
under 
this 
title 
impacting contracts between such agencies and such 
plans under this subsection; and 
‘‘(ii) basic resources for States interested in 
exploring such plans as a platform for integration, 
such as a model contract or other tools to achieve 
those goals. 
‘‘(B) UNIFIED GRIEVANCES AND APPEALS PROCESS.— 
‘‘(i) IN GENERAL.—Not later than April 1, 2020, 
the Secretary shall establish procedures, to the extent 
feasible as determined by the Secretary, unifying griev-
ances and appeals procedures under sections 1852(f), 
1852(g), 1902(a)(3), 1902(a)(5), and 1932(b)(4) for items 
and services provided by specialized MA plans for spe-
cial 
needs 
individuals 
described 
in 
subsection 
(b)(6)(B)(ii) under this title and title XIX. With respect
H. R. 1892—130 
to items and services described in the preceding sen-
tence, procedures established under this clause shall 
apply in place of otherwise applicable grievances and 
appeals procedures. The Secretary shall solicit com-
ment in developing such procedures from States, plans, 
beneficiaries and their representatives, and other rel-
evant stakeholders. 
‘‘(ii) PROCEDURES.—The procedures established 
under clause (i) shall be included in the plan contract 
under paragraph (3)(D) and shall— 
‘‘(I) adopt the provisions for the enrollee that 
are most protective for the enrollee and, to the 
extent feasible as determined by the Secretary, 
are compatible with unified timeframes and 
consolidated access to external review under an 
integrated process; 
‘‘(II) take into account differences in State 
plans under title XIX to the extent necessary; 
‘‘(III) be easily navigable by an enrollee; and 
‘‘(IV) include the elements described in clause 
(iii), as applicable. 
‘‘(iii) ELEMENTS DESCRIBED.—Both unified appeals 
and unified grievance procedures shall include, as 
applicable, the following elements described in this 
clause: 
‘‘(I) Single written notification of all applicable 
grievances and appeal rights under this title and 
title XIX. For purposes of this subparagraph, the 
Secretary may waive the requirements under sec-
tion 1852(g)(1)(B) when the specialized MA plan 
covers items or services under this part or under 
title XIX. 
‘‘(II) Single pathways for resolution of any 
grievance or appeal related to a particular item 
or service provided by specialized MA plans for 
special needs individuals described in subsection 
(b)(6)(B)(ii) under this title and title XIX. 
‘‘(III) Notices written in plain language and 
available in a language and format that is acces-
sible to the enrollee, including in non-English lan-
guages that are prevalent in the service area of 
the specialized MA plan. 
‘‘(IV) Unified timeframes for grievances and 
appeals processes, such as an individual’s filing 
of a grievance or appeal, a plan’s acknowledgment 
and resolution of a grievance or appeal, and 
notification of decisions with respect to a grievance 
or appeal. 
‘‘(V) Requirements for how the plan must 
process, track, and resolve grievances and appeals, 
to ensure beneficiaries are notified on a timely 
basis of decisions that are made throughout the 
grievance or appeals process and are able to easily 
determine the status of a grievance or appeal. 
‘‘(iv) 
CONTINUATION
OF
BENEFITS
PENDING 
APPEAL.—The unified procedures under clause (i) shall, 
with respect to all benefits under parts A and B and
H. R. 1892—131 
title XIX subject to appeal under such procedures, 
incorporate provisions under current law and imple-
menting regulations that provide continuation of bene-
fits pending appeal under this title and title XIX. 
‘‘(C) REQUIREMENT
FOR
UNIFIED
GRIEVANCES
AND 
APPEALS.—For 2021 and subsequent years, the contract 
of a specialized MA plan for special needs individuals 
described in subsection (b)(6)(B)(ii) with a State Medicaid 
agency under paragraph (3)(D) shall require the use of 
unified grievances and appeals procedures as described 
in subparagraph (B). 
‘‘(D) REQUIREMENTS FOR INTEGRATION.— 
‘‘(i) IN GENERAL.—For 2021 and subsequent years, 
a specialized MA plan for special needs individuals 
described in subsection (b)(6)(B)(ii) shall meet one or 
more of the following requirements, to the extent per-
mitted under State law, for integration of benefits 
under this title and title XIX: 
‘‘(I) The specialized MA plan must meet the 
requirements of contracting with the State Med-
icaid agency described in paragraph (3)(D) in addi-
tion to coordinating long-term services and sup-
ports or behavioral health services, or both, by 
meeting an additional minimum set of require-
ments determined by the Secretary through the 
Federal Coordinated Health Care Office estab-
lished under section 2602 of the Patient Protection 
and Affordable Care Act based on input from stake-
holders, such as notifying the State in a timely 
manner of hospitalizations, emergency room visits, 
and hospital or nursing home discharges of 
enrollees, assigning one primary care provider for 
each enrollee, or sharing data that would benefit 
the coordination of items and services under this 
title and the State plan under title XIX. Such 
minimum set of requirements must be included 
in the contract of the specialized MA plan with 
the State Medicaid agency under such paragraph. 
‘‘(II) The specialized MA plan must meet the 
requirements of a fully integrated plan described 
in section 1853(a)(1)(B)(iv)(II) (other than the 
requirement that the plan have similar average 
levels of frailty, as determined by the Secretary, 
as the PACE program), or enter into a capitated 
contract with the State Medicaid agency to provide 
long-term services and supports or behavioral 
health services, or both. 
‘‘(III) In the case of a specialized MA plan 
that is offered by a parent organization that is 
also the parent organization of a Medicaid man-
aged care organization providing long term serv-
ices and supports or behavioral services under a 
contract 
under 
section 
1903(m), 
the 
parent 
organization must assume clinical and financial 
responsibility for benefits provided under this title 
and title XIX with respect to any individual who
H. R. 1892—132 
is enrolled in both the specialized MA plan and 
the Medicaid managed care organization. 
‘‘(ii) SUSPENSION OF ENROLLMENT FOR FAILURE TO 
MEET REQUIREMENTS DURING INITIAL PERIOD.—During 
the period of plan years 2021 through 2025, if the 
Secretary determines that a specialized MA plan for 
special needs individuals described in subsection 
(b)(6)(B)(ii) has failed to comply with clause (i), the 
Secretary may provide for the application against the 
Medicare Advantage organization offering the plan of 
the remedy described in section 1857(g)(2)(B) in the 
same manner as the Secretary may apply such remedy, 
and in accordance with the same procedures as would 
apply, in the case of an MA organization determined 
by the Secretary to have engaged in conduct described 
in section 1857(g)(1). If the Secretary applies such 
remedy to a Medicare Advantage organization under 
the preceding sentence, the organization shall submit 
to the Secretary (at a time, and in a form and manner, 
specified by the Secretary) information describing how 
the plan will come into compliance with clause (i). 
‘‘(E) STUDY AND REPORT TO CONGRESS.— 
‘‘(i) IN GENERAL.—Not later than March 15, 2022, 
and, subject to clause (iii), biennially thereafter 
through 
2032, 
the 
Medicare 
Payment 
Advisory 
Commission established under section 1805, in con-
sultation with the Medicaid and CHIP Payment and 
Access Commission established under section 1900, 
shall conduct (and submit to the Secretary and the 
Committees on Ways and Means and Energy and Com-
merce of the House of Representatives and the Com-
mittee on Finance of the Senate a report on) a study 
to determine how specialized MA plans for special 
needs individuals described in subsection (b)(6)(B)(ii) 
perform among each other based on data from 
Healthcare Effectiveness Data and Information Set 
(HEDIS) quality measures, reported on the plan level, 
as required under section 1852(e)(3) (or such other 
measures or data sources that are available and appro-
priate, such as encounter data and Consumer Assess-
ment of Healthcare Providers and Systems data, as 
specified by such Commissions as enabling an accurate 
evaluation under this subparagraph). Such study shall 
include, as feasible, the following comparison groups 
of specialized MA plans for special needs individuals 
described in subsection (b)(6)(B)(ii): 
‘‘(I) A comparison group of such plans that 
are described in subparagraph (D)(i)(I). 
‘‘(II) A comparison group of such plans that 
are described in subparagraph (D)(i)(II). 
‘‘(III) A comparison group of such plans oper-
ating within the Financial Alignment Initiative 
demonstration for the period for which such plan 
is so operating and the demonstration is in effect, 
and, in the case that an integration option that 
is not with respect to specialized MA plans for
H. R. 1892—133 
special needs individuals is established after the 
conclusion of the demonstration involved. 
‘‘(IV) A comparison group of such plans that 
are described in subparagraph (D)(i)(III). 
‘‘(V) A comparison group of MA plans, as fea-
sible, not described in a previous subclause of this 
clause, with respect to the performance of such 
plans for enrollees who are special needs individ-
uals described in subsection (b)(6)(B)(ii). 
‘‘(ii) ADDITIONAL REPORTS.—Beginning with 2033 
and every five years thereafter, the Medicare Payment 
Advisory Commission, in consultation with the Med-
icaid and CHIP Payment and Access Commission, shall 
conduct a study described in clause (i).’’. 
(2) CONFORMING AMENDMENT TO RESPONSIBILITIES OF FED-
ERAL COORDINATED HEALTH CARE OFFICE.—Section 2602(d) of 
Public Law 111–148 (42 U.S.C. 1315b(d)) is amended by adding 
at the end the following new paragraphs: 
‘‘(6) To act as a designated contact for States under sub-
section (f)(8)(A) of section 1859 of the Social Security Act (42 
U.S.C. 1395w–28) with respect to the integration of specialized 
MA plans for special needs individuals described in subsection 
(b)(6)(B)(ii) of such section. 
‘‘(7) To be responsible, subject to the final approval of 
the Secretary, for developing regulations and guidance related 
to the implementation of a unified grievance and appeals 
process as described in subparagraphs (B) and (C) of section 
1859(f)(8) of the Social Security Act (42 U.S.C. 1395w–28(f)(8)). 
‘‘(8) To be responsible, subject to the final approval of 
the Secretary, for developing regulations and guidance related 
to the integration or alignment of policy and oversight under 
the Medicare program under title XVIII of such Act and the 
Medicaid program under title XIX of such Act regarding special-
ized MA plans for special needs individuals described in sub-
section (b)(6)(B)(ii) of such section 1859.’’. 
(c) IMPROVEMENTS TO SEVERE OR DISABLING CHRONIC CONDI-
TION SNPS.— 
(1) CARE MANAGEMENT REQUIREMENTS.—Section 1859(f)(5) 
of the Social Security Act (42 U.S.C. 1395w–28(f)(5)) is 
amended— 
(A) by striking ‘‘ALL
SNPS.—The requirements’’ and 
inserting ‘‘ALL SNPS.— 
‘‘(A) IN GENERAL.—Subject to subparagraph (B), the 
requirements’’; 
(B) by redesignating subparagraphs (A) and (B) as 
clauses (i) and (ii), respectively, and indenting appro-
priately; and 
(C) in clause (ii), as redesignated by subparagraph 
(B), by redesignating clauses (i) through (iii) as subclauses 
(I) through (III), respectively, and indenting appropriately; 
and 
(D) by adding at the end the following new subpara-
graph: 
‘‘(B) IMPROVEMENTS TO CARE MANAGEMENT REQUIRE-
MENTS
FOR
SEVERE
OR
DISABLING
CHRONIC
CONDITION 
SNPS.—For 2020 and subsequent years, in the case of a 
specialized MA plan for special needs individuals described
H. R. 1892—134 
in subsection (b)(6)(B)(iii), the requirements described in 
this paragraph include the following: 
‘‘(i) The interdisciplinary team under subpara-
graph (A)(ii)(III) includes a team of providers with 
demonstrated expertise, including training in an 
applicable specialty, in treating individuals similar to 
the targeted population of the plan. 
‘‘(ii) Requirements developed by the Secretary to 
provide 
face-to-face 
encounters 
with 
individuals 
enrolled in the plan not less frequently than on an 
annual basis. 
‘‘(iii) As part of the model of care under clause 
(i) of subparagraph (A), the results of the initial assess-
ment and annual reassessment under clause (ii)(I) of 
such subparagraph of each individual enrolled in the 
plan are addressed in the individual’s individualized 
care plan under clause (ii)(II) of such subparagraph. 
‘‘(iv) As part of the annual evaluation and approval 
of such model of care, the Secretary shall take into 
account whether the plan fulfilled the previous year’s 
goals (as required under the model of care). 
‘‘(v) The Secretary shall establish a minimum 
benchmark for each element of the model of care of 
a plan. The Secretary shall only approve a plan’s model 
of care under this paragraph if each element of the 
model of care meets the minimum benchmark 
applicable under the preceding sentence.’’. 
(2) REVISIONS TO THE DEFINITION OF A SEVERE OR DISABLING 
CHRONIC CONDITIONS SPECIALIZED NEEDS INDIVIDUAL.— 
(A) IN GENERAL.—Section 1859(b)(6)(B)(iii) of the Social 
Security 
Act 
(42 
U.S.C. 
1395w–28(b)(6)(B)(iii)) 
is 
amended— 
(i) by striking ‘‘who have’’ and inserting ‘‘who— 
‘‘(I) before January 1, 2022, have’’; 
(ii) in subclause (I), as added by clause (i), by 
striking the period at the end and inserting ‘‘; and’’; 
and 
(iii) by adding at the end the following new sub-
clause: 
‘‘(II) on or after January 1, 2022, have one 
or more comorbid and medically complex chronic 
conditions that is life threatening or significantly 
limits overall health or function, have a high risk 
of hospitalization or other adverse health out-
comes, and require intensive care coordination and 
that is listed under subsection (f)(9)(A).’’. 
(B) PANEL OF CLINICAL ADVISORS.—Section 1859(f) of 
the Social Security Act (42 U.S.C. 1395w–28(f)), as 
amended by subsection (b), is amended by adding at the 
end the following new paragraph: 
‘‘(9) LIST OF CONDITIONS FOR CLARIFICATION OF THE DEFINI-
TION OF A SEVERE OR DISABLING CHRONIC CONDITIONS SPECIAL-
IZED NEEDS INDIVIDUAL.— 
‘‘(A) IN GENERAL.—Not later than December 31, 2020, 
and every 5 years thereafter, subject to subparagraphs 
(B) and (C), the Secretary shall convene a panel of clinical
H. R. 1892—135 
advisors to establish and update a list of conditions that 
meet each of the following criteria: 
‘‘(i) Conditions that meet the definition of a severe 
or 
disabling 
chronic 
condition 
under 
subsection 
(b)(6)(B)(iii) on or after January 1, 2022. 
‘‘(ii) Conditions that require prescription drugs, 
providers, and models of care that are unique to the 
specific population of enrollees in a specialized MA 
plan for special needs individuals described in such 
subsection on or after such date and— 
‘‘(I) as a result of access to, and enrollment 
in, such a specialized MA plan for special needs 
individuals, individuals with such condition would 
have a reasonable expectation of slowing or halting 
the progression of the disease, improving health 
outcomes and decreasing overall costs for individ-
uals diagnosed with such condition compared to 
available options of care other than through such 
a specialized MA plan for special needs individuals; 
or 
‘‘(II) have a low prevalence in the general 
population of beneficiaries under this title or a 
disproportionally high per-beneficiary cost under 
this title. 
‘‘(B) INCLUSION OF CERTAIN CONDITIONS.—The condi-
tions listed under subparagraph (A) shall include HIV/ 
AIDS, end stage renal disease, and chronic and disabling 
mental illness. 
‘‘(C) REQUIREMENT.—In establishing and updating the 
list under subparagraph (A), the panel shall take into 
account the availability of varied benefits, cost-sharing, 
and supplemental benefits under the model described in 
paragraph (2) of section 1859(h), including the expansion 
under paragraph (1) of such section.’’. 
(d) QUALITY MEASUREMENT
AT
THE PLAN LEVEL
FOR SNPS 
AND DETERMINATION OF FEASABILITY OF QUALITY MEASUREMENT 
AT THE PLAN LEVEL FOR ALL MA PLANS.—Section 1853(o) of the 
Social Security Act (42 U.S.C. 1395w–23(o)) is amended by adding 
at the end the following new paragraphs: 
‘‘(6) QUALITY MEASUREMENT AT THE PLAN LEVEL FOR SNPS.— 
‘‘(A) IN GENERAL.—Subject to subparagraph (B), the 
Secretary may require reporting of data under section 
1852(e) for, and apply under this subsection, quality meas-
ures at the plan level for specialized MA plans for special 
needs individuals instead of at the contract level. 
‘‘(B) 
CONSIDERATIONS.—Prior 
to 
applying 
quality 
measurement at the plan level under this paragraph, the 
Secretary shall— 
‘‘(i) take into consideration the minimum number 
of enrollees in a specialized MA plan for special needs 
individuals in order to determine if a statistically 
significant or valid measurement of quality at the plan 
level is possible under this paragraph; 
‘‘(ii) take into consideration the impact of such 
application on plans that serve a disproportionate 
number of individuals dually eligible for benefits under 
this title and under title XIX;
H. R. 1892—136 
‘‘(iii) if quality measures are reported at the plan 
level, ensure that MA plans are not required to provide 
duplicative information; and 
‘‘(iv) ensure that such reporting does not interfere 
with the collection of encounter data submitted by 
MA organizations or the administration of any changes 
to the program under this part as a result of the 
collection of such data. 
‘‘(C) APPLICATION.—If the Secretary applies quality 
measurement at the plan level under this paragraph— 
‘‘(i) such quality measurement may include Medi-
care Health Outcomes Survey (HOS), Healthcare 
Effectiveness Data and Information Set (HEDIS), Con-
sumer Assessment of Healthcare Providers and Sys-
tems (CAHPS) measures and quality measures under 
part D; and 
‘‘(ii) the Secretary shall consider applying adminis-
trative actions, such as remedies described in section 
1857(g)(2), at the plan level. 
‘‘(7) DETERMINATION OF FEASIBILITY OF QUALITY MEASURE-
MENT AT THE PLAN LEVEL FOR ALL MA PLANS.— 
‘‘(A) DETERMINATION OF FEASIBILITY.—The Secretary 
shall determine the feasibility of requiring reporting of 
data under section 1852(e) for, and applying under this 
subsection, quality measures at the plan level for all MA 
plans under this part. 
‘‘(B) CONSIDERATION
OF
CHANGE.—After making a 
determination under subparagraph (A), the Secretary shall 
consider requiring such reporting and applying such quality 
measures at the plan level as described in such subpara-
graph’’. 
(e) GAO STUDY
AND REPORT
ON STATE-LEVEL INTEGRATION 
BETWEEN DUAL SNPS AND MEDICAID.— 
(1) STUDY.—The Comptroller General of the United States 
(in this subsection referred to as the ‘‘Comptroller General’’) 
shall conduct a study on State-level integration between special-
ized MA plans for special needs individuals described in sub-
section (b)(6) (B)(ii) of section 1859 of the Social Security Act 
(42 U.S.C. 1395w–28) and the Medicaid program under title 
XIX of such Act (42 U.S.C. 1396 et seq.). Such study shall 
include an analysis of the following: 
(A) The characteristics of States in which the State 
agency responsible for administering the State plan under 
such title XIX has a contract with such a specialized MA 
plan and that delivers long-term services and supports 
under the State plan under such title XIX through a man-
aged care program, including the requirements under such 
State plan with respect to long-term services and supports. 
(B) The types of such specialized MA plans, which 
may include the following: 
(i) A plan described in section 1853(a)(1)(B)(iv)(II) 
of such Act (42 U.S.C. 1395w–23(a)(1)(B)(iv)(II)). 
(ii) A plan that meets the requirements described 
in subsection (f)(3)(D) of such section 1859. 
(iii) A plan described in clause (ii) that also meets 
additional requirements established by the State.
H. R. 1892—137 
(C) The characteristics of individuals enrolled in such 
specialized MA plans. 
(D) As practicable, the following with respect to State 
programs for the delivery of long-term services and sup-
ports under such title XIX through a managed care pro-
gram: 
(i) Which populations of individuals are eligible 
to receive such services and supports. 
(ii) Whether all such services and supports are 
provided on a capitated basis or if any of such services 
and supports are carved out and provided through 
fee-for service. 
(E) As practicable, how the availability and variation 
of integration arrangements of such specialized MA plans 
offered in States affects spending, service delivery options, 
access to community-based care, and utilization of care. 
(F) The efforts of State Medicaid programs to transition 
dually-eligible beneficiaries receiving long-term services 
and supports (LTSS) from institutional settings to home 
and community-based settings and related financial 
impacts of such transitions. 
(G) Barriers and opportunities for making further 
progress on dual integration, as well as recommendations 
for legislation or administrative action to expedite or refine 
pathways toward fully integrated care. 
(2) REPORT.—Not later than 2 years after the date of the 
enactment of this Act, the Comptroller General shall submit 
to Congress a report containing the results of the study con-
ducted under paragraph (1), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
Subtitle C—Expanding Innovation and 
Technology 
SEC. 50321. ADAPTING BENEFITS TO MEET THE NEEDS OF CHRON-
ICALLY ILL MEDICARE ADVANTAGE ENROLLEES. 
Section 1859 of the Social Security Act (42 U.S.C. 1395w– 
28) is amended by adding at the end the following new subsection: 
‘‘(h) NATIONAL TESTING OF MEDICARE ADVANTAGE VALUE-BASED 
INSURANCE DESIGN MODEL.— 
‘‘(1) IN GENERAL.—In implementing the Medicare Advan-
tage Value-Based Insurance Design model that is being tested 
under section 1115A(b), the Secretary shall revise the testing 
of the model under such section to cover, effective not later 
than January 1, 2020, all States. 
‘‘(2) TERMINATION
AND
MODIFICATION
PROVISION
NOT 
APPLICABLE UNTIL JANUARY 1, 2022.—The provisions of section 
1115A(b)(3)(B) shall apply to the Medicare Advantage Value- 
Based Insurance Design model, including such model as revised 
under paragraph (1), beginning January 1, 2022, but shall 
not apply to such model, as so revised, prior to such date. 
‘‘(3) FUNDING.—The Secretary shall allocate funds made 
available under section 1115A(f)(1) to design, implement, and 
evaluate the Medicare Advantage Value-Based Insurance 
Design model, as revised under paragraph (1).’’.
H. R. 1892—138 
SEC. 50322. EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE 
NEEDS OF CHRONICALLY ILL MEDICARE ADVANTAGE 
ENROLLEES. 
(a) IN GENERAL.—Section 1852(a)(3) of the Social Security Act 
(42 U.S.C. 1395w–22(a)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘Each’’ and inserting 
‘‘Subject to subparagraph (D), each’’; and 
(2) by adding at the end the following new subparagraph: 
‘‘(D) EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE 
NEEDS OF CHRONICALLY ILL ENROLLEES.— 
‘‘(i) IN GENERAL.—For plan year 2020 and subse-
quent plan years, in addition to any supplemental 
health care benefits otherwise provided under this 
paragraph, an MA plan, including a specialized MA 
plan for special needs individuals (as defined in section 
1859(b)(6)), 
may 
provide 
supplemental 
benefits 
described in clause (ii) to a chronically ill enrollee 
(as defined in clause (iii)). 
‘‘(ii) SUPPLEMENTAL BENEFITS DESCRIBED.— 
‘‘(I) 
IN
GENERAL.—Supplemental 
benefits 
described in this clause are supplemental benefits 
that, with respect to a chronically ill enrollee, have 
a 
reasonable 
expectation 
of 
improving 
or 
maintaining the health or overall function of the 
chronically ill enrollee and may not be limited 
to being primarily health related benefits. 
‘‘(II) 
AUTHORITY
TO
WAIVE
UNIFORMITY 
REQUIREMENTS.—The Secretary may, only with 
respect to supplemental benefits provided to a 
chronically ill enrollee under this subparagraph, 
waive the uniformity requirements under this part, 
as determined appropriate by the Secretary. 
‘‘(iii) CHRONICALLY ILL ENROLLEE DEFINED.—In this 
subparagraph, the term ‘chronically ill enrollee’ means 
an enrollee in an MA plan that the Secretary deter-
mines— 
‘‘(I) has one or more comorbid and medically 
complex chronic conditions that is life threatening 
or significantly limits the overall health or function 
of the enrollee; 
‘‘(II) has a high risk of hospitalization or other 
adverse health outcomes; and 
‘‘(III) requires intensive care coordination.’’. 
(b) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the United States 
(in this subsection referred to as the ‘‘Comptroller General’’) 
shall conduct a study on supplemental benefits provided to 
enrollees in Medicare Advantage plans under part C of title 
XVIII of the Social Security Act, including specialized MA plans 
for special needs individuals (as defined in section 1859(b)(6) 
of such Act (42 U.S.C. 1395w–28(b)(6))). To the extend data 
are available, such study shall include an analysis of the fol-
lowing: 
(A) The type of supplemental benefits provided to such 
enrollees, the total number of enrollees receiving each
H. R. 1892—139 
supplemental benefit, and whether the supplemental ben-
efit is covered by the standard benchmark cost of the 
benefit or with an additional premium. 
(B) The frequency in which supplemental benefits are 
utilized by such enrollees. 
(C) The impact supplemental benefits have on— 
(i) indicators of the quality of care received by 
such enrollees, including overall health and function 
of the enrollees; 
(ii) the utilization of items and services for which 
benefits are available under the original Medicare fee- 
for-service program option under parts A and B of 
such title XVIII by such enrollees; and 
(iii) the amount of the bids submitted by Medicare 
Advantage Organizations for Medicare Advantage 
plans under such part C. 
(2) CONSULTATION.—In conducting the study under para-
graph (1), the Comptroller General shall, as necessary, consult 
with the Centers for Medicare & Medicaid Services and Medi-
care Advantage organizations offering Medicare Advantage 
plans. 
(3) REPORT.—Not later than 5 years after the date of the 
enactment of this Act, the Comptroller General shall submit 
to Congress a report containing the results of the study con-
ducted under paragraph (1), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
SEC. 50323. INCREASING CONVENIENCE FOR MEDICARE ADVANTAGE 
ENROLLEES THROUGH TELEHEALTH. 
(a) IN GENERAL.—Section 1852 of the Social Security Act (42 
U.S.C. 1395w–22) is amended— 
(1) in subsection (a)(1)(B)(i), by inserting ‘‘, subject to sub-
section (m),’’ after ‘‘means’’; and 
(2) by adding at the end the following new subsection: 
‘‘(m) PROVISION OF ADDITIONAL TELEHEALTH BENEFITS.— 
‘‘(1) MA PLAN OPTION.—For plan year 2020 and subsequent 
plan years, subject to the requirements of paragraph (3), an 
MA plan may provide additional telehealth benefits (as defined 
in paragraph (2)) to individuals enrolled under this part. 
‘‘(2) ADDITIONAL TELEHEALTH BENEFITS DEFINED.— 
‘‘(A) IN GENERAL.—For purposes of this subsection and 
section 1854: 
‘‘(i) DEFINITION.—The term ‘additional telehealth 
benefits’ means services— 
‘‘(I) for which benefits are available under part 
B, including services for which payment is not 
made under section 1834(m) due to the conditions 
for payment under such section; and 
‘‘(II) that are identified for such year as clini-
cally appropriate to furnish using electronic 
information and telecommunications technology 
when a physician (as defined in section 1861(r)) 
or practitioner (described in section 1842(b)(18)(C)) 
providing the service is not at the same location 
as the plan enrollee.
H. R. 1892—140 
‘‘(ii) EXCLUSION OF CAPITAL AND INFRASTRUCTURE 
COSTS AND INVESTMENTS.—The term ‘additional tele-
health benefits’ does not include capital and infrastruc-
ture costs and investments relating to such benefits. 
‘‘(B) PUBLIC COMMENT.—Not later than November 30, 
2018, the Secretary shall solicit comments on— 
‘‘(i) what types of items and services (including 
those provided through supplemental health care bene-
fits, such as remote patient monitoring, secure mes-
saging, store and forward technologies, and other non- 
face-to-face communication) should be considered to 
be additional telehealth benefits; and 
‘‘(ii) the requirements for the provision or fur-
nishing of such benefits (such as training and coordina-
tion requirements). 
‘‘(3) REQUIREMENTS
FOR
ADDITIONAL
TELEHEALTH
BENE-
FITS.—The Secretary shall specify requirements for the provi-
sion or furnishing of additional telehealth benefits, including 
with respect to the following: 
‘‘(A) Physician or practitioner qualifications (other than 
licensure) and other requirements such as specific training. 
‘‘(B) Factors necessary for the coordination of such 
benefits with other items and services including those fur-
nished in-person. 
‘‘(C) Such other areas as determined by the Secretary. 
‘‘(4) ENROLLEE CHOICE.—If an MA plan provides a service 
as an additional telehealth benefit (as defined in paragraph 
(2))— 
‘‘(A) the MA plan shall also provide access to such 
benefit through an in-person visit (and not only as an 
additional telehealth benefit); and 
‘‘(B) an individual enrollee shall have discretion as 
to whether to receive such service through the in-person 
visit or as an additional telehealth benefit. 
‘‘(5) TREATMENT
UNDER
MA.—For purposes of this sub-
section and section 1854, if a plan provides additional telehealth 
benefits, such additional telehealth benefits shall be treated 
as if they were benefits under the original Medicare fee-for- 
service program option. 
‘‘(6) CONSTRUCTION.—Nothing in this subsection shall be 
construed as affecting the requirement under subsection (a)(1) 
that MA plans provide enrollees with items and services (other 
than hospice care) for which benefits are available under parts 
A and B, including benefits available under section 1834(m).’’. 
(b) CLARIFICATION REGARDING INCLUSION IN BID AMOUNT.— 
Section 1854(a)(6)(A)(ii)(I) of the Social Security Act (42 U.S.C. 
1395w–24(a)(6)(A)(ii)(I)) is amended by inserting ‘‘, including, for 
plan year 2020 and subsequent plan years, the provision of addi-
tional telehealth benefits as described in section 1852(m)’’ before 
the semicolon at the end. 
SEC. 50324. PROVIDING ACCOUNTABLE CARE ORGANIZATIONS THE 
ABILITY TO EXPAND THE USE OF TELEHEALTH. 
(a) IN GENERAL.—Section 1899 of the Social Security Act (42 
U.S.C. 1395jjj) is amended by adding at the end the following 
new subsection:
H. R. 1892—141 
‘‘(l) PROVIDING ACOS THE ABILITY TO EXPAND THE USE OF 
TELEHEALTH SERVICES.— 
‘‘(1) IN GENERAL.—In the case of telehealth services for 
which payment would otherwise be made under this title fur-
nished on or after January 1, 2020, for purposes of this sub-
section only, the following shall apply with respect to such 
services furnished by a physician or practitioner participating 
in an applicable ACO (as defined in paragraph (2)) to a Medi-
care fee-for-service beneficiary assigned to the applicable ACO: 
‘‘(A) INCLUSION OF HOME AS ORIGINATING SITE.—Subject 
to paragraph (3), the home of a beneficiary shall be treated 
as an originating site described in section 1834(m)(4)(C)(ii). 
‘‘(B) NO APPLICATION OF GEOGRAPHIC LIMITATION.—The 
geographic limitation under section 1834(m)(4)(C)(i) shall 
not apply with respect to an originating site described 
in section 1834(m)(4)(C)(ii) (including the home of a bene-
ficiary under subparagraph (A)), subject to State licensing 
requirements. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) APPLICABLE
ACO.—The term ‘applicable ACO’ 
means an ACO participating in a model tested or expanded 
under section 1115A or under this section— 
‘‘(i) that operates under a two-sided model— 
‘‘(I) described in section 425.600(a) of title 42, 
Code of Federal Regulations; or 
‘‘(II) tested or expanded under section 1115A; 
and 
‘‘(ii) for which Medicare fee-for-service beneficiaries 
are assigned to the ACO using a prospective assign-
ment method, as determined appropriate by the Sec-
retary. 
‘‘(B) HOME.—The term ‘home’ means, with respect to 
a Medicare fee-for-service beneficiary, the place of residence 
used as the home of the beneficiary. 
‘‘(3) TELEHEALTH
SERVICES
RECEIVED
IN
THE
HOME.—In 
the case of telehealth services described in paragraph (1) where 
the home of a Medicare fee-for-service beneficiary is the origi-
nating site, the following shall apply: 
‘‘(A) NO FACILITY FEE.—There shall be no facility fee 
paid to the originating site under section 1834(m)(2)(B). 
‘‘(B) EXCLUSION OF CERTAIN SERVICES.—No payment 
may be made for such services that are inappropriate to 
furnish in the home setting such as services that are typi-
cally furnished in inpatient settings such as a hospital.’’. 
(b) STUDY AND REPORT.— 
(1) STUDY.— 
(A) IN GENERAL.—The Secretary of Health and Human 
Services (in this subsection referred to as the ‘‘Secretary’’) 
shall conduct a study on the implementation of section 
1899(l) of the Social Security Act, as added by subsection 
(a). Such study shall include an analysis of the utilization 
of, and expenditures for, telehealth services under such 
section. 
(B) COLLECTION OF DATA.—The Secretary may collect 
such data as the Secretary determines necessary to carry 
out the study under this paragraph.
H. R. 1892—142 
(2) REPORT.—Not later than January 1, 2026, the Secretary 
shall submit to Congress a report containing the results of 
the study conducted under paragraph (1), together with rec-
ommendations for such legislation and administrative action 
as the Secretary determines appropriate. 
SEC. 50325. EXPANDING THE USE OF TELEHEALTH FOR INDIVIDUALS 
WITH STROKE. 
Section 1834(m) of the Social Security Act (42 U.S.C. 
1395m(m)), as amended by section 50302(b)(1), is amended— 
(1) in paragraph (4)(C)(i), in the matter preceding subclause 
(I), by striking ‘‘The term’’ and inserting ‘‘Except as provided 
in paragraph (6), the term’’; and 
(2) by adding at the end the following new paragraph: 
‘‘(6) TREATMENT OF STROKE TELEHEALTH SERVICES.— 
‘‘(A) NON-APPLICATION OF ORIGINATING SITE REQUIRE-
MENTS.—The requirements described in paragraph (4)(C) 
shall not apply with respect to telehealth services furnished 
on or after January 1, 2019, for purposes of diagnosis, 
evaluation, or treatment of symptoms of an acute stroke, 
as determined by the Secretary. 
‘‘(B) INCLUSION
OF
CERTAIN
SITES.—With respect to 
telehealth services described in subparagraph (A), the term 
‘originating site’ shall include any hospital (as defined in 
section 1861(e)) or critical access hospital (as defined in 
section 1861(mm)(1)), any mobile stroke unit (as defined 
by the Secretary), or any other site determined appropriate 
by the Secretary, at which the eligible telehealth individual 
is located at the time the service is furnished via a tele-
communications system. 
‘‘(C) NO
ORIGINATING
SITE
FACILITY
FEE
FOR
NEW 
SITES.—No facility fee shall be paid under paragraph (2)(B) 
to an originating site with respect to a telehealth service 
described in subparagraph (A) if the originating site does 
not otherwise meet the requirements for an originating 
site under paragraph (4)(C).’’. 
Subtitle D—Identifying the Chronically Ill 
Population 
SEC. 50331. PROVIDING FLEXIBILITY FOR BENEFICIARIES TO BE PART 
OF AN ACCOUNTABLE CARE ORGANIZATION. 
Section 1899(c) of the Social Security Act (42 U.S.C. 1395jjj(c)) 
is amended— 
(1) by redesignating paragraphs (1) and (2) as subpara-
graphs (A) and (B), respectively, and indenting appropriately; 
(2) by striking ‘‘ACOS.—The Secretary’’ and inserting 
‘‘ACOS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), the Secretary’’; 
and 
(3) by adding at the end the following new paragraph: 
‘‘(2) PROVIDING FLEXIBILITY.— 
‘‘(A) CHOICE OF PROSPECTIVE ASSIGNMENT.—For each 
agreement period (effective for agreements entered into 
or renewed on or after January 1, 2020), in the case where 
an ACO established under the program is in a Track that
H. R. 1892—143 
provides for the retrospective assignment of Medicare fee- 
for-service beneficiaries to the ACO, the Secretary shall 
permit the ACO to choose to have Medicare fee-for-service 
beneficiaries assigned prospectively, rather than retrospec-
tively, to the ACO for an agreement period. 
‘‘(B) ASSIGNMENT BASED ON VOLUNTARY IDENTIFICATION 
BY MEDICARE FEE-FOR-SERVICE BENEFICIARIES.— 
‘‘(i) IN GENERAL.—For performance year 2018 and 
each subsequent performance year, if a system is avail-
able for electronic designation, the Secretary shall 
permit a Medicare fee-for-service beneficiary to volun-
tarily identify an ACO professional as the primary 
care provider of the beneficiary for purposes of 
assigning such beneficiary to an ACO, as determined 
by the Secretary. 
‘‘(ii) NOTIFICATION PROCESS.—The Secretary shall 
establish a process under which a Medicare fee-for- 
service beneficiary is— 
‘‘(I) notified of their ability to make an identi-
fication described in clause (i); and 
‘‘(II) informed of the process by which they 
may make and change such identification. 
‘‘(iii) SUPERSEDING CLAIMS-BASED ASSIGNMENT.—A 
voluntary identification by a Medicare fee-for-service 
beneficiary under this subparagraph shall supersede 
any claims-based assignment otherwise determined by 
the Secretary.’’. 
Subtitle E—Empowering Individuals and 
Caregivers in Care Delivery 
SEC. 50341. ELIMINATING BARRIERS TO CARE COORDINATION UNDER 
ACCOUNTABLE CARE ORGANIZATIONS. 
(a) IN GENERAL.—Section 1899 of the Social Security Act (42 
U.S.C. 1395jjj), as amended by section 50324(a), is amended— 
(1) in subsection (b)(2), by adding at the end the following 
new subparagraph: 
‘‘(I) An ACO that seeks to operate an ACO Beneficiary 
Incentive Program pursuant to subsection (m) shall apply 
to the Secretary at such time, in such manner, and with 
such information as the Secretary may require.’’; 
(2) by adding at the end the following new subsection: 
‘‘(m) AUTHORITY TO PROVIDE INCENTIVE PAYMENTS TO BENE-
FICIARIES WITH RESPECT TO QUALIFYING PRIMARY CARE SERVICES.— 
‘‘(1) PROGRAM.— 
‘‘(A) IN GENERAL.—In order to encourage Medicare fee- 
for-service beneficiaries to obtain medically necessary pri-
mary care services, an ACO participating under this section 
under a payment model described in clause (i) or (ii) of 
paragraph (2)(B) may apply to establish an ACO Bene-
ficiary Incentive Program to provide incentive payments 
to such beneficiaries who are furnished qualifying services 
in accordance with this subsection. The Secretary shall 
permit such an ACO to establish such a program at the 
Secretary’s discretion and subject to such requirements,
H. R. 1892—144 
including program integrity requirements, as the Secretary 
determines necessary. 
‘‘(B) IMPLEMENTATION.—The Secretary shall implement 
this subsection on a date determined appropriate by the 
Secretary. Such date shall be no earlier than January 
1, 2019, and no later than January 1, 2020. 
‘‘(2) CONDUCT OF PROGRAM.— 
‘‘(A) DURATION.—Subject to subparagraph (H), an ACO 
Beneficiary Incentive Program established under this sub-
section shall be conducted for such period (of not less 
than 1 year) as the Secretary may approve. 
‘‘(B) SCOPE.—An ACO Beneficiary Incentive Program 
established under this subsection shall provide incentive 
payments to all of the following Medicare fee-for-service 
beneficiaries who are furnished qualifying services by the 
ACO: 
‘‘(i) With respect to the Track 2 and Track 3 pay-
ment models described in section 425.600(a) of title 
42, Code of Federal Regulations (or in any successor 
regulation), Medicare fee-for-service beneficiaries who 
are 
preliminarily 
prospectively 
or 
prospectively 
assigned (or otherwise assigned, as determined by the 
Secretary) to the ACO. 
‘‘(ii) With respect to any future payment models 
involving two-sided risk, Medicare fee-for-service bene-
ficiaries who are assigned to the ACO, as determined 
by the Secretary. 
‘‘(C) QUALIFYING SERVICE.—For purposes of this sub-
section, a qualifying service is a primary care service, as 
defined in section 425.20 of title 42, Code of Federal Regula-
tions (or in any successor regulation), with respect to which 
coinsurance applies under part B, furnished through an 
ACO by— 
‘‘(i) an ACO professional described in subsection 
(h)(1)(A) who has a primary care specialty designation 
included in the definition of primary care physician 
under section 425.20 of title 42, Code of Federal Regu-
lations (or any successor regulation); 
‘‘(ii) an ACO professional described in subsection 
(h)(1)(B); or 
‘‘(iii) a Federally qualified health center or rural 
health clinic (as such terms are defined in section 
1861(aa)). 
‘‘(D) INCENTIVE
PAYMENTS.—An incentive payment 
made by an ACO pursuant to an ACO Beneficiary Incentive 
Program established under this subsection shall be— 
‘‘(i) in an amount up to $20, with such maximum 
amount updated annually by the percentage increase 
in the consumer price index for all urban consumers 
(United States city average) for the 12-month period 
ending with June of the previous year; 
‘‘(ii) in the same amount for each Medicare fee- 
for-service beneficiary described in clause (i) or (ii) 
of subparagraph (B) without regard to enrollment of 
such a beneficiary in a medicare supplemental policy 
(described in section 1882(g)(1)), in a State Medicaid 
plan under title XIX or a waiver of such a plan, or
H. R. 1892—145 
in any other health insurance policy or health benefit 
plan; 
‘‘(iii) made for each qualifying service furnished 
to such a beneficiary described in clause (i) or (ii) 
of subparagraph (B) during a period specified by the 
Secretary; and 
‘‘(iv) made no later than 30 days after a qualifying 
service is furnished to such a beneficiary described 
in clause (i) or (ii) of subparagraph (B). 
‘‘(E) NO SEPARATE PAYMENTS FROM THE SECRETARY.— 
The Secretary shall not make any separate payment to 
an ACO for the costs, including incentive payments, of 
carrying out an ACO Beneficiary Incentive Program estab-
lished under this subsection. Nothing in this subparagraph 
shall be construed as prohibiting an ACO from using shared 
savings received under this section to carry out an ACO 
Beneficiary Incentive Program. 
‘‘(F) NO
APPLICATION
TO
SHARED
SAVINGS
CALCULA-
TION.—Incentive payments made by an ACO under this 
subsection shall be disregarded for purposes of calculating 
benchmarks, estimated average per capita Medicare 
expenditures, and shared savings under this section. 
‘‘(G) REPORTING REQUIREMENTS.—An ACO conducting 
an ACO Beneficiary Incentive Program under this sub-
section shall, at such times and in such format as the 
Secretary may require, report to the Secretary such 
information and retain such documentation as the Sec-
retary may require, including the amount and frequency 
of incentive payments made and the number of Medicare 
fee-for-service beneficiaries receiving such payments. 
‘‘(H) TERMINATION.—The Secretary may terminate an 
ACO Beneficiary Incentive Program established under this 
subsection at any time for reasons determined appropriate 
by the Secretary. 
‘‘(3) EXCLUSION
OF
INCENTIVE
PAYMENTS.—Any payment 
made under an ACO Beneficiary Incentive Program established 
under this subsection shall not be considered income or 
resources or otherwise taken into account for purposes of— 
‘‘(A) determining eligibility for benefits or assistance 
(or the amount or extent of benefits or assistance) under 
any Federal program or under any State or local program 
financed in whole or in part with Federal funds; or 
‘‘(B) any Federal or State laws relating to taxation.’’; 
(3) in subsection (e), by inserting ‘‘, including an ACO 
Beneficiary Incentive Program under subsections (b)(2)(I) and 
(m)’’ after ‘‘the program’’; and 
(4) in subsection (g)(6), by inserting ‘‘or of an ACO Bene-
ficiary Incentive Program under subsections (b)(2)(I) and (m)’’ 
after ‘‘under subsection (d)(4)’’. 
(b) AMENDMENT
TO SECTION 1128B.—Section 1128B(b)(3) of 
the Social Security Act (42 U.S.C. 1320a–7b(b)(3)) is amended— 
(1) by striking ‘‘and’’ at the end of subparagraph (I); 
(2) by striking the period at the end of subparagraph (J) 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following new subparagraph:
H. R. 1892—146 
‘‘(K) an incentive payment made to a Medicare fee- 
for-service beneficiary by an ACO under an ACO Bene-
ficiary Incentive Program established under subsection (m) 
of section 1899, if the payment is made in accordance 
with the requirements of such subsection and meets such 
other conditions as the Secretary may establish.’’. 
(c) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary of Health and Human 
Services (in this subsection referred to as the ‘‘Secretary’’) shall 
conduct an evaluation of the ACO Beneficiary Incentive Pro-
gram established under subsections (b)(2)(I) and (m) of section 
1899 of the Social Security Act (42 U.S.C. 1395jjj), as added 
by subsection (a). The evaluation shall include an analysis 
of the impact of the implementation of the Program on expendi-
tures and beneficiary health outcomes under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.). 
(2) REPORT.—Not later than October 1, 2023, the Secretary 
shall submit to Congress a report containing the results of 
the evaluation under paragraph (1), together with recommenda-
tions for such legislation and administrative action as the Sec-
retary determines appropriate. 
SEC. 50342. GAO STUDY AND REPORT ON LONGITUDINAL COMPREHEN-
SIVE CARE PLANNING SERVICES UNDER MEDICARE 
PART B. 
(a) STUDY.—The Comptroller General shall conduct a study 
on the establishment under part B of the Medicare program under 
title XVIII of the Social Security Act of a payment code for a 
visit for longitudinal comprehensive care planning services. Such 
study shall include an analysis of the following to the extent such 
information is available: 
(1) The frequency with which services similar to longitu-
dinal comprehensive care planning services are furnished to 
Medicare beneficiaries, which providers of services and sup-
pliers are furnishing those services, whether Medicare 
reimbursement is being received for those services, and, if 
so, through which codes those services are being reimbursed. 
(2) Whether, and the extent to which, longitudinal com-
prehensive care planning services would overlap, and could 
therefore result in duplicative payment, with services covered 
under the hospice benefit as well as the chronic care manage-
ment code, evaluation and management codes, or other codes 
that already exist under part B of the Medicare program. 
(3) Any barriers to hospitals, skilled nursing facilities, hos-
pice programs, home health agencies, and other applicable pro-
viders working with a Medicare beneficiary to engage in the 
care planning process and complete the necessary documenta-
tion to support the treatment and care plan of the beneficiary 
and provide such documentation to other providers and the 
beneficiary or the beneficiary’s representative. 
(4) Any barriers to providers, other than the provider fur-
nishing longitudinal comprehensive care planning services, 
accessing the care plan and associated documentation for use 
related to the care of the Medicare beneficiary. 
(5) Potential options for ensuring that applicable providers 
are notified of a patient’s existing longitudinal care plan and 
that applicable providers consider that plan in making their
H. R. 1892—147 
treatment decisions, and what the challenges might be in imple-
menting such options. 
(6) Stakeholder’s views on the need for the development 
of quality metrics with respect to longitudinal comprehensive 
care planning services, such as measures related to— 
(A) the process of eliciting input from the Medicare 
beneficiary or from a legally authorized representative and 
documenting in the medical record the patient-directed care 
plan; 
(B) the effectiveness and patient-centeredness of the 
care plan in organizing delivery of services consistent with 
the plan; 
(C) the availability of the care plan and associated 
documentation to other providers that care for the bene-
ficiary; and 
(D) the extent to which the beneficiary received services 
and support that is free from discrimination based on 
advanced age, disability status, or advanced illness. 
(7) Stakeholder’s views on how such quality metrics would 
provide information on— 
(A) the goals, values, and preferences of the beneficiary; 
(B) the documentation of the care plan; 
(C) services furnished to the beneficiary; and 
(D) outcomes of treatment. 
(8) Stakeholder’s views on— 
(A) the type of training and education needed for 
applicable providers, individuals, and caregivers in order 
to facilitate longitudinal comprehensive care planning serv-
ices; 
(B) the types of providers of services and suppliers 
that should be included in the interdisciplinary team of 
an applicable provider; and 
(C) the characteristics of Medicare beneficiaries that 
would be most appropriate to receive longitudinal com-
prehensive care planning services, such as individuals with 
advanced disease and individuals who need assistance with 
multiple activities of daily living. 
(9) Stakeholder’s views on the frequency with which 
longitudinal comprehensive care planning services should be 
furnished. 
(b) REPORT.—Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to 
Congress a report containing the results of the study conducted 
under subsection (a), together with recommendations for such legis-
lation and administrative action as the Comptroller General deter-
mines appropriate. 
(c) DEFINITIONS.—In this section: 
(1) APPLICABLE PROVIDER.—The term ‘‘applicable provider’’ 
means a hospice program (as defined in subsection (dd)(2) of 
section 1861 of the Social Security Act (42 U.S.C. 1395ww)) 
or other provider of services (as defined in subsection (u) of 
such section) or supplier (as defined in subsection (d) of such 
section) that— 
(A) furnishes longitudinal comprehensive care planning 
services through an interdisciplinary team; and 
(B) meets such other requirements as the Secretary 
may determine to be appropriate.
H. R. 1892—148 
(2) COMPTROLLER GENERAL.—The term ‘‘Comptroller Gen-
eral’’ means the Comptroller General of the United States. 
(3) INTERDISCIPLINARY TEAM.—The term ‘‘interdisciplinary 
team’’ means a group that— 
(A) includes the personnel described in subsection 
(dd)(2)(B)(i) of such section 1861; 
(B) may include a chaplain, minister, or other clergy; 
and 
(C) may include other direct care personnel. 
(4) LONGITUDINAL COMPREHENSIVE CARE PLANNING SERV-
ICES.—The term ‘‘longitudinal comprehensive care planning 
services’’ means a voluntary shared decisionmaking process 
that is furnished by an applicable provider through an inter-
disciplinary team and includes a conversation with Medicare 
beneficiaries who have received a diagnosis of a serious or 
life-threatening illness. The purpose of such services is to dis-
cuss a longitudinal care plan that addresses the progression 
of the disease, treatment options, the goals, values, and pref-
erences of the beneficiary, and the availability of other resources 
and social supports that may reduce the beneficiary’s health 
risks and promote self-management and shared decision-
making. 
(5) SECRETARY.—The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
Subtitle F—Other Policies to Improve Care 
for the Chronically Ill 
SEC. 50351. GAO STUDY AND REPORT ON IMPROVING MEDICATION 
SYNCHRONIZATION. 
(a) STUDY.—The Comptroller General of the United States (in 
this section referred to as the ‘‘Comptroller General’’) shall conduct 
a study on the extent to which Medicare prescription drug plans 
(MA–PD plans and stand alone prescription drug plans) under 
part D of title XVIII of the Social Security Act and private payors 
use programs that synchronize pharmacy dispensing so that individ-
uals may receive multiple prescriptions on the same day to facilitate 
comprehensive counseling and promote medication adherence. The 
study shall include a analysis of the following: 
(1) The extent to which pharmacies have adopted such 
programs. 
(2) The common characteristics of such programs, including 
how pharmacies structure counseling sessions under such pro-
grams and the types of payment and other arrangements that 
Medicare prescription drug plans and private payors employ 
under such programs to support the efforts of pharmacies. 
(3) How such programs compare for Medicare prescription 
drug plans and private payors. 
(4) What is known about how such programs affect patient 
medication adherence and overall patient health outcomes, 
including if adherence and outcomes vary by patient subpopula-
tions, such as disease state and socioeconomic status. 
(5) What is known about overall patient satisfaction with 
such programs and satisfaction with such programs, including 
within patient subpopulations, such as disease state and socio-
economic status.
H. R. 1892—149 
(6) The extent to which laws and regulations of the Medi-
care program support such programs. 
(7) Barriers to the use of medication synchronization pro-
grams by Medicare prescription drug plans. 
(b) REPORT.—Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to 
Congress a report containing the results of the study under sub-
section (a), together with recommendations for such legislation and 
administrative action as the Comptroller General determines appro-
priate. 
SEC. 50352. GAO STUDY AND REPORT ON IMPACT OF OBESITY DRUGS 
ON PATIENT HEALTH AND SPENDING. 
(a) STUDY.—The Comptroller General of the United States (in 
this section referred to as the ‘‘Comptroller General’’) shall, to 
the extent data are available, conduct a study on the use of prescrip-
tion drugs to manage the weight of obese patients and the impact 
of coverage of such drugs on patient health and on health care 
spending. Such study shall examine the use and impact of these 
obesity drugs in the non-Medicare population and for Medicare 
beneficiaries who have such drugs covered through an MA–PD 
plan (as defined in section 1860D–1(a)(3)(C) of the Social Security 
Act (42 U.S.C. 1395w–101(a)(3)(C))) as a supplemental health care 
benefit. The study shall include an analysis of the following: 
(1) The prevalence of obesity in the Medicare and non- 
Medicare population. 
(2) The utilization of obesity drugs. 
(3) The distribution of Body Mass Index by individuals 
taking obesity drugs, to the extent practicable. 
(4) What is known about the use of obesity drugs in 
conjunction with the receipt of other items or services, such 
as behavioral counseling, and how these compare to items 
and services received by obese individuals who do not take 
obesity drugs. 
(5) Physician considerations and attitudes related to pre-
scribing obesity drugs. 
(6) The extent to which coverage policies cease or limit 
coverage for individuals who fail to receive clinical benefit. 
(7) What is known about the extent to which individuals 
who take obesity drugs adhere to the prescribed regimen. 
(8) What is known about the extent to which individuals 
who take obesity drugs maintain weight loss over time. 
(9) What is known about the subsequent impact such drugs 
have on medical services that are directly related to obesity, 
including with respect to subpopulations determined based on 
the extent of obesity. 
(10) What is known about the spending associated with 
the care of individuals who take obesity drugs, compared to 
the spending associated with the care of individuals who do 
not take such drugs. 
(b) REPORT.—Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to 
Congress a report containing the results of the study under sub-
section (a), together with recommendations for such legislation and 
administrative action as the Comptroller General determines appro-
priate.
H. R. 1892—150 
SEC. 50353. HHS STUDY AND REPORT ON LONG-TERM RISK FACTORS 
FOR CHRONIC CONDITIONS AMONG MEDICARE BENE-
FICIARIES. 
(a) STUDY.—The Secretary of Health and Human Services (in 
this section referred to as the ‘‘Secretary’’) shall conduct a study 
on long-term cost drivers to the Medicare program, including obe-
sity, tobacco use, mental health conditions, and other factors that 
may contribute to the deterioration of health conditions among 
individuals with chronic conditions in the Medicare population. 
The study shall include an analysis of any barriers to collecting 
and analyzing such information and how to remove any such bar-
riers (including through legislation and administrative actions). 
(b) REPORT.—Not later than 18 months after the date of the 
enactment of this Act, the Secretary shall submit to Congress 
a report containing the results of the study under subsection (a), 
together with recommendations for such legislation and administra-
tive action as the Secretary determines appropriate. The Secretary 
shall also post such report on the Internet website of the Depart-
ment of Health and Human Services. 
SEC. 50354. PROVIDING PRESCRIPTION DRUG PLANS WITH PARTS A 
AND B CLAIMS DATA TO PROMOTE THE APPROPRIATE 
USE OF MEDICATIONS AND IMPROVE HEALTH OUT-
COMES. 
Section 1860D–4(c) of the Social Security Act (42 U.S.C. 1395w– 
104(c)) is amended by adding at the end the following new para-
graph: 
‘‘(6) PROVIDING PRESCRIPTION DRUG PLANS WITH PARTS A 
AND
B
CLAIMS
DATA
TO
PROMOTE
THE
APPROPRIATE
USE
OF 
MEDICATIONS AND IMPROVE HEALTH OUTCOMES.— 
‘‘(A) PROCESS.—Subject to subparagraph (B), the Sec-
retary shall establish a process under which a PDP sponsor 
of a prescription drug plan may submit a request for the 
Secretary to provide the sponsor, on a periodic basis and 
in an electronic format, beginning in plan year 2020, data 
described in subparagraph (D) with respect to enrollees 
in such plan. Such data shall be provided without regard 
to whether such enrollees are described in clause (ii) of 
paragraph (2)(A). 
‘‘(B) PURPOSES.—A PDP sponsor may use the data 
provided to the sponsor pursuant to subparagraph (A) for 
any of the following purposes: 
‘‘(i) To optimize therapeutic outcomes through 
improved medication use, as such phrase is used in 
clause (i) of paragraph (2)(A). 
‘‘(ii) To improving care coordination so as to pre-
vent adverse health outcomes, such as preventable 
emergency department visits and hospital readmis-
sions. 
‘‘(iii) For any other purpose determined appro-
priate by the Secretary. 
‘‘(C) LIMITATIONS ON DATA USE.—A PDP sponsor shall 
not use data provided to the sponsor pursuant to subpara-
graph (A) for any of the following purposes: 
‘‘(i) To inform coverage determinations under this 
part.
H. R. 1892—151 
‘‘(ii) To conduct retroactive reviews of medically 
accepted indications determinations. 
‘‘(iii) To facilitate enrollment changes to a different 
prescription drug plan or an MA–PD plan offered by 
the same parent organization. 
‘‘(iv) To inform marketing of benefits. 
‘‘(v) For any other purpose that the Secretary 
determines is necessary to include in order to protect 
the identity of individuals entitled to, or enrolled for, 
benefits under this title and to protect the security 
of personal health information. 
‘‘(D) DATA
DESCRIBED.—The data described in this 
clause are standardized extracts (as determined by the 
Secretary) of claims data under parts A and B for items 
and services furnished under such parts for time periods 
specified by the Secretary. Such data shall include data 
as current as practicable.’’. 
TITLE IV—PART B IMPROVEMENT ACT 
AND OTHER PART B ENHANCEMENTS 
Subtitle A—Medicare Part B Improvement 
Act 
SEC. 50401. HOME INFUSION THERAPY SERVICES TEMPORARY TRANSI-
TIONAL PAYMENT. 
(a) IN GENERAL.—Section 1834(u) of the Social Security Act 
(42 U.S.C. 1395m(u)) is amended, by adding at the end the following 
new paragraph: 
‘‘(7) HOME INFUSION THERAPY SERVICES TEMPORARY TRANSI-
TIONAL PAYMENT.— 
‘‘(A) TEMPORARY TRANSITIONAL PAYMENT.— 
‘‘(i) IN GENERAL.—The Secretary shall, in accord-
ance with the payment methodology described in 
subparagraph (B) and subject to the provisions of this 
paragraph, provide a home infusion therapy services 
temporary transitional payment under this part to an 
eligible home infusion supplier (as defined in subpara-
graph (F)) for items and services described in subpara-
graphs (A) and (B) of section 1861(iii)(2)) furnished 
during the period specified in clause (ii) by such sup-
plier in coordination with the furnishing of transitional 
home infusion drugs (as defined in clause (iii)). 
‘‘(ii) PERIOD SPECIFIED.—For purposes of clause (i), 
the period specified in this clause is the period begin-
ning on January 1, 2019, and ending on the day before 
the date of the implementation of the payment system 
under paragraph (1)(A). 
‘‘(iii) 
TRANSITIONAL
HOME
INFUSION
DRUG 
DEFINED.—For purposes of this paragraph, the term 
‘transitional home infusion drug’ has the meaning 
given to the term ‘home infusion drug’ under section 
1861(iii)(3)(C)), except that clause (ii) of such section 
shall not apply if a drug described in such clause
H. R. 1892—152 
is identified in clauses (i), (ii), (iii) or (iv) of subpara-
graph (C) as of the date of the enactment of this 
paragraph. 
‘‘(B) PAYMENT
METHODOLOGY.—For purposes of this 
paragraph, the Secretary shall establish a payment meth-
odology, with respect to items and services described in 
subparagraph (A)(i). Under such payment methodology the 
Secretary shall— 
‘‘(i) create the three payment categories described 
in clauses (i), (ii), and (iii) of subparagraph (C); 
‘‘(ii) assign drugs to such categories, in accordance 
with such clauses; 
‘‘(iii) assign appropriate Healthcare Common 
Procedure Coding System (HCPCS) codes to each pay-
ment category; and 
‘‘(iv) establish a single payment amount for each 
such payment category, in accordance with subpara-
graph (D), for each infusion drug administration cal-
endar day in the individual’s home for drugs assigned 
to such category. 
‘‘(C) PAYMENT CATEGORIES.— 
‘‘(i) PAYMENT
CATEGORY
1.—The Secretary shall 
create a payment category 1 and assign to such cat-
egory drugs which are covered under the Local Cov-
erage Determination on External Infusion Pumps (LCD 
number L33794) and billed with the following HCPCS 
codes (as identified as of January 1, 2018, and as 
subsequently modified by the Secretary): J0133, J0285, 
J0287, J0288, J0289, J0895, J1170, J1250, J1265, 
J1325, J1455, J1457, J1570, J2175, J2260, J2270, 
J2274, J2278, J3010, or J3285. 
‘‘(ii) PAYMENT CATEGORY 2.—The Secretary shall 
create a payment category 2 and assign to such cat-
egory drugs which are covered under such local cov-
erage determination and billed with the following 
HCPCS codes (as identified as of January 1, 2018, 
and as subsequently modified by the Secretary): J1555 
JB, J1559 JB, J1561 JB, J1562 JB, J1569 JB, or J1575 
JB. 
‘‘(iii) PAYMENT CATEGORY 3.—The Secretary shall 
create a payment category 3 and assign to such cat-
egory drugs which are covered under such local cov-
erage determination and billed with the following 
HCPCS codes (as identified as of January 1, 2018, 
and as subsequently modified by the Secretary): J9000, 
J9039, J9040, J9065, J9100, J9190, J9200, J9360, or 
J9370. 
‘‘(iv) INFUSION DRUGS NOT OTHERWISE INCLUDED.— 
With respect to drugs that are not included in payment 
category 1, 2, or 3 under clause (i), (ii), or (iii), respec-
tively, the Secretary shall assign to the most appro-
priate of such categories, as determined by the Sec-
retary, drugs which are— 
‘‘(I) covered under such local coverage deter-
mination and billed under HCPCS codes J7799 
or J7999 (as identified as of July 1, 2017, and 
as subsequently modified by the Secretary); or
H. R. 1892—153 
‘‘(II) billed under any code that is implemented 
after the date of the enactment of this paragraph 
and included in such local coverage determination 
or included in subregulatory guidance as a home 
infusion drug described in subparagraph (A)(i). 
‘‘(D) PAYMENT AMOUNTS.— 
‘‘(i) IN
GENERAL.—Under the payment method-
ology, the Secretary shall pay eligible home infusion 
suppliers, with respect to items and services described 
in subparagraph (A)(i) furnished during the period 
described in subparagraph (A)(ii) by such supplier to 
an individual, at amounts equal to the amounts deter-
mined under the physician fee schedule established 
under section 1848 for services furnished during the 
year for codes and units of such codes described in 
clauses (ii), (iii), and (iv) with respect to drugs included 
in the payment category under subparagraph (C) speci-
fied in the respective clause, determined without 
application of the geographic adjustment under sub-
section (e) of such section. 
‘‘(ii) PAYMENT AMOUNT FOR CATEGORY 1.—For pur-
poses of clause (i), the codes and units described in 
this clause, with respect to drugs included in payment 
category 1 described in subparagraph (C)(i), are one 
unit of HCPCS code 96365 plus three units of HCPCS 
code 96366 (as identified as of January 1, 2018, and 
as subsequently modified by the Secretary). 
‘‘(iii) PAYMENT AMOUNT FOR CATEGORY 2.—For pur-
poses of clause (i), the codes and units described in 
this clause, with respect to drugs included in payment 
category 2 described in subparagraph (C)(i), are one 
unit of HCPCS code 96369 plus three units of HCPCS 
code 96370 (as identified as of January 1, 2018, and 
as subsequently modified by the Secretary). 
‘‘(iv) PAYMENT AMOUNT FOR CATEGORY 3.—For pur-
poses of clause (i), the codes and units described in 
this clause, with respect to drugs included in payment 
category 3 described in subparagraph (C)(i), are one 
unit of HCPCS code 96413 plus three units of HCPCS 
code 96415 (as identified as of January 1, 2018, and 
as subsequently modified by the Secretary). 
‘‘(E) CLARIFICATIONS.— 
‘‘(i) INFUSION DRUG ADMINISTRATION DAY.—For pur-
poses of this subsection, with respect to the furnishing 
of transitional home infusion drugs or home infusion 
drugs to an individual by an eligible home infusion 
supplier or a qualified home infusion therapy supplier, 
a reference to payment to such supplier for an infusion 
drug administration calendar day in the individual’s 
home shall refer to payment only for the date on which 
professional 
services 
(as 
described 
in 
section 
1861(iii)(2)(A)) were furnished to administer such 
drugs to such individual. For purposes of the previous 
sentence, an infusion drug administration calendar day 
shall include all such drugs administered to such indi-
vidual on such day.
H. R. 1892—154 
‘‘(ii) TREATMENT OF MULTIPLE DRUGS ADMINISTERED 
ON SAME INFUSION DRUG ADMINISTRATION DAY.—In the 
case that an eligible home infusion supplier, with 
respect to an infusion drug administration calendar 
day in an individual’s home, furnishes to such indi-
vidual transitional home infusion drugs which are not 
all assigned to the same payment category under 
subparagraph (C), payment to such supplier for such 
infusion drug administration calendar day in the 
individual’s home shall be a single payment equal to 
the amount of payment under this paragraph for the 
drug, among all such drugs so furnished to such indi-
vidual during such calendar day, for which the highest 
payment would be made under this paragraph. 
‘‘(F) ELIGIBLE HOME INFUSION SUPPLIERS.—In this para-
graph, the term ‘eligible home infusion supplier’ means 
a supplier that is enrolled under this part as a pharmacy 
that provides external infusion pumps and external infu-
sion pump supplies and that maintains all pharmacy licen-
sure requirements in the State in which the applicable 
infusion drugs are administered. 
‘‘(G) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement this para-
graph by program instruction or otherwise.’’. 
(b) CONFORMING AMENDMENTS.—(1) Section 1842(b)(6)(I) of the 
Social Security Act (42 U.S.C. 1395u(b)(6)(I)) is amended by 
inserting ‘‘or, in the case of items and services described in clause 
(i) of section 1834(u)(7)(A) furnished to an individual during the 
period described in clause (ii) of such section, payment shall be 
made to the eligible home infusion therapy supplier’’ after ‘‘payment 
shall be made to the qualified home infusion therapy supplier’’. 
(2) Section 5012(d) of the 21st Century Cures Act is amended 
by inserting the following before the period at the end: ‘‘, except 
that the amendments made by paragraphs (1) and (2) of subsection 
(c) shall apply to items and services furnished on or after January 
1, 2019’’. 
SEC. 50402. ORTHOTIST’S AND PROSTHETIST’S CLINICAL NOTES AS 
PART OF THE PATIENT’S MEDICAL RECORD. 
Section 1834(h) of the Social Security Act (42 U.S.C. 1395m(h)) 
is amended by adding at the end the following new paragraph: 
‘‘(5) 
DOCUMENTATION
CREATED
BY
ORTHOTISTS
AND 
PROSTHETISTS.—For purposes of determining the reasonable-
ness and medical necessity of orthotics and prosthetics, docu-
mentation created by an orthotist or prosthetist shall be consid-
ered part of the individual’s medical record to support docu-
mentation created by eligible professionals described in section 
1848(k)(3)(B).’’. 
SEC. 50403. INDEPENDENT ACCREDITATION FOR DIALYSIS FACILITIES 
AND ASSURANCE OF HIGH QUALITY SURVEYS. 
(a) ACCREDITATION AND SURVEYS.— 
(1) IN GENERAL.—Section 1865 of the Social Security Act 
(42 U.S.C. 1395bb) is amended— 
(A) in subsection (a)— 
(i) in paragraph (1), in the matter preceding 
subparagraph (A), by striking ‘‘or the conditions and 
requirements under section 1881(b)’’; and
H. R. 1892—155 
(ii) in paragraph (4), by inserting ‘‘(including a 
renal dialysis facility)’’ after ‘‘facility’’; and 
(B) by adding at the end the following new subsection: 
‘‘(e) With respect to an accreditation body that has received 
approval from the Secretary under subsection (a)(3)(A) for accredita-
tion of provider entities that are required to meet the conditions 
and requirements under section 1881(b), in addition to review and 
oversight authorities otherwise applicable under this title, the Sec-
retary shall (as the Secretary determines appropriate) conduct, 
with respect to such accreditation body and provider entities, any 
or all of the following as frequently as is otherwise required to 
be conducted under this title with respect to other accreditation 
bodies or other provider entities: 
‘‘(1) Validation surveys referred to in subsection (d). 
‘‘(2) Accreditation program reviews (as defined in section 
488.8(c) of title 42 of the Code of Federal Regulations, or 
a successor regulation). 
‘‘(3) Performance reviews (as defined in section 488.8(a) 
of title 42 of the Code of Federal Regulations, or a successor 
regulation).’’. 
(2) TIMING FOR ACCEPTANCE OF REQUESTS FROM ACCREDITA-
TION ORGANIZATIONS.—Not later than 90 days after the date 
of enactment of this Act, the Secretary of Health and Human 
Services shall begin accepting requests from national accredita-
tion bodies for a finding described in section 1865(a)(3)(A) of 
the Social Security Act (42 U.S.C. 1395bb(a)(3)(A)) for purposes 
of accrediting provider entities that are required to meet the 
conditions and requirements under section 1881(b) of such Act 
(42 U.S.C. 1395rr(b)). 
(b) REQUIREMENT FOR TIMING OF SURVEYS OF NEW DIALYSIS 
FACILITIES.—Section 1881(b)(1) of the Social Security Act (42 U.S.C. 
1395rr(b)(1)) is amended by adding at the end the following new 
sentence: ‘‘Beginning 180 days after the date of the enactment 
of this sentence, an initial survey of a provider of services or 
a renal dialysis facility to determine if the conditions and require-
ments under this paragraph are met shall be initiated not later 
than 90 days after such date on which both the provider enrollment 
form (without regard to whether such form is submitted prior 
to or after such date of enactment) has been determined by the 
Secretary to be complete and the provider’s enrollment status 
indicates approval is pending the results of such survey.’’. 
SEC. 50404. MODERNIZING THE APPLICATION OF THE STARK RULE 
UNDER MEDICARE. 
(a) CLARIFICATION OF THE WRITING REQUIREMENT AND SIGNA-
TURE REQUIREMENT FOR ARRANGEMENTS PURSUANT TO THE STARK 
RULE.— 
(1) WRITING REQUIREMENT.—Section 1877(h)(1) of the Social 
Security Act (42 U.S.C. 1395nn(h)(1)) is amended by adding 
at the end the following new subparagraph: 
‘‘(D) WRITTEN REQUIREMENT CLARIFIED.—In the case of any 
requirement pursuant to this section for a compensation 
arrangement to be in writing, such requirement shall be satis-
fied by such means as determined by the Secretary, including 
by a collection of documents, including contemporaneous docu-
ments evidencing the course of conduct between the parties 
involved.’’.
H. R. 1892—156 
(2) SIGNATURE
REQUIREMENT.—Section 1877(h)(1) of the 
Social Security Act (42 U.S.C. 1395nn(h)(1)), as amended by 
paragraph (1), is further amended by adding at the end the 
following new subparagraph: 
‘‘(E) SPECIAL RULE FOR SIGNATURE REQUIREMENTS.— 
In the case of any requirement pursuant to this section 
for a compensation arrangement to be in writing and signed 
by the parties, such signature requirement shall be met 
if— 
‘‘(i) not later than 90 consecutive calendar days 
immediately following the date on which the compensa-
tion arrangement became noncompliant, the parties 
obtain the required signatures; and 
‘‘(ii) the compensation arrangement otherwise com-
plies with all criteria of the applicable exception.’’. 
(b) INDEFINITE HOLDOVER FOR LEASE ARRANGEMENTS AND PER-
SONAL SERVICES ARRANGEMENTS PURSUANT TO THE STARK RULE.— 
Section 1877(e) of the Social Security Act (42 U.S.C. 1395nn(e)) 
is amended— 
(1) in paragraph (1), by adding at the end the following 
new subparagraph: 
‘‘(C) HOLDOVER LEASE ARRANGEMENTS.—In the case of 
a holdover lease arrangement for the lease of office space 
or equipment, which immediately follows a lease arrange-
ment described in subparagraph (A) for the use of such 
office space or subparagraph (B) for the use of such equip-
ment and that expired after a term of at least 1 year, 
payments made by the lessee to the lessor pursuant to 
such holdover lease arrangement, if— 
‘‘(i) the lease arrangement met the conditions of 
subparagraph (A) for the lease of office space or 
subparagraph (B) for the use of equipment when the 
arrangement expired; 
‘‘(ii) the holdover lease arrangement is on the same 
terms and conditions as the immediately preceding 
arrangement; and 
‘‘(iii) the holdover arrangement continues to satisfy 
the conditions of subparagraph (A) for the lease of 
office space or subparagraph (B) for the use of equip-
ment.’’; and 
(2) in paragraph (3), by adding at the end the following 
new subparagraph: 
‘‘(C) HOLDOVER PERSONAL SERVICE ARRANGEMENT.—In 
the case of a holdover personal service arrangement, which 
immediately follows an arrangement described in subpara-
graph (A) that expired after a term of at least 1 year, 
remuneration from an entity pursuant to such holdover 
personal service arrangement, if— 
‘‘(i) the personal service arrangement met the 
conditions of subparagraph (A) when the arrangement 
expired; 
‘‘(ii) the holdover personal service arrangement is 
on the same terms and conditions as the immediately 
preceding arrangement; and 
‘‘(iii) the holdover arrangement continues to satisfy 
the conditions of subparagraph (A).’’.
H. R. 1892—157 
Subtitle B—Additional Medicare 
Provisions 
SEC. 50411. MAKING PERMANENT THE REMOVAL OF THE RENTAL CAP 
FOR DURABLE MEDICAL EQUIPMENT UNDER MEDICARE 
WITH RESPECT TO SPEECH GENERATING DEVICES. 
Section 1834(a)(2)(A)(iv) of the Social Security Act (42 U.S.C. 
1395m(a)(2)(A)(iv)) is amended by striking ‘‘and before October 1, 
2018,’’. 
SEC. 50412. INCREASED CIVIL AND CRIMINAL PENALTIES AND 
INCREASED SENTENCES FOR FEDERAL HEALTH CARE 
PROGRAM FRAUD AND ABUSE. 
(a) INCREASED CIVIL MONEY PENALTIES AND CRIMINAL FINES.— 
(1) INCREASED CIVIL MONEY PENALTIES.—Section 1128A of 
the Social Security Act (42 U.S.C. 1320a–7a) is amended— 
(A) in subsection (a), in the matter following paragraph 
(10)— 
(i) by striking ‘‘$10,000’’ and inserting ‘‘$20,000’’ 
each place it appears; 
(ii) by striking ‘‘$15,000’’ and inserting ‘‘$30,000’’; 
and 
(iii) by striking ‘‘$50,000’’ and inserting ‘‘$100,000’’ 
each place it appears; and 
(B) in subsection (b)— 
(i) in paragraph (1), in the flush text following 
subparagraph (B), by striking ‘‘$2,000’’ and inserting 
‘‘$5,000’’; 
(ii) in paragraph (2), by striking ‘‘$2,000’’ and 
inserting ‘‘$5,000’’; and 
(iii) in paragraph (3)(A)(i), by striking ‘‘$5,000’’ 
and inserting ‘‘$10,000’’. 
(2) INCREASED CRIMINAL FINES.—Section 1128B of such Act 
(42 U.S.C. 1320a–7b) is amended— 
(A) in subsection (a), in the matter following paragraph 
(6)— 
(i) by striking ‘‘$25,000’’ and inserting ‘‘$100,000’’; 
and 
(ii) by striking ‘‘$10,000’’ and inserting ‘‘$20,000’’; 
(B) in subsection (b)— 
(i) in paragraph (1), in the flush text following 
subparagraph (B), by striking ‘‘$25,000’’ and inserting 
‘‘$100,000’’; and 
(ii) in paragraph (2), in the flush text following 
subparagraph (B), by striking ‘‘$25,000’’ and inserting 
‘‘$100,000’’; 
(C) in subsection (c), by striking ‘‘$25,000’’ and 
inserting ‘‘$100,000’’; 
(D) in subsection (d), in the flush text following para-
graph (2), by striking ‘‘$25,000’’ and inserting ‘‘$100,000’’; 
and 
(E) in subsection (e), by striking ‘‘$2,000’’ and inserting 
‘‘$4,000’’. 
(b) INCREASED SENTENCES FOR FELONIES INVOLVING FEDERAL 
HEALTH CARE PROGRAM FRAUD AND ABUSE.—
H. R. 1892—158 
(1) FALSE
STATEMENTS
AND
REPRESENTATIONS.—Section 
1128B(a) of the Social Security Act (42 U.S.C. 1320a–7b(a)) 
is amended, in the matter following paragraph (6), by striking 
‘‘not more than five years or both, or (ii)’’ and inserting ‘‘not 
more than 10 years or both, or (ii)’’. 
(2) ANTIKICKBACK.—Section 1128B(b) of such Act (42 U.S.C. 
1320a–7b(b)) is amended— 
(A) in paragraph (1), in the flush text following 
subparagraph (B), by striking ‘‘not more than five years’’ 
and inserting ‘‘not more than 10 years’’; and 
(B) in paragraph (2), in the flush text following 
subparagraph (B), by striking ‘‘not more than five years’’ 
and inserting ‘‘not more than 10 years’’. 
(3) FALSE STATEMENT OR REPRESENTATION WITH RESPECT 
TO CONDITIONS OR OPERATIONS OF FACILITIES.—Section 1128B(c) 
of such Act (42 U.S.C. 1320a–7b(c)) is amended by striking 
‘‘not more than five years’’ and inserting ‘‘not more than 10 
years’’. 
(4) EXCESS CHARGES.—Section 1128B(d) of such Act (42 
U.S.C. 1320a–7b(d)) is amended, in the flush text following 
paragraph (2), by striking ‘‘not more than five years’’ and 
inserting ‘‘not more than 10 years’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall apply to acts committed after the date of the enactment 
of this Act. 
SEC. 50413. REDUCING THE VOLUME OF FUTURE EHR-RELATED 
SIGNIFICANT HARDSHIP REQUESTS. 
Section 1848(o)(2)(A) of the Social Security Act (42 U.S.C. 
1395w–4(o)(2)(A)) and section 1886(n)(3)(A) of such Act (42 U.S.C. 
1395ww(n)(3)(A)) are each amended in the last sentence by striking 
‘‘by requiring’’ and all that follows through ‘‘this paragraph’’. 
SEC. 50414. STRENGTHENING RULES IN CASE OF COMPETITION FOR 
DIABETIC TESTING STRIPS. 
(a) SPECIAL RULE
IN CASE
OF COMPETITION
FOR DIABETIC 
TESTING STRIPS.— 
(1) IN GENERAL.—Paragraph (10) of section 1847(b) of the 
Social Security Act (42 U.S.C. 1395w–3(b)) is amended— 
(A) in subparagraph (A), by striking the second sen-
tence and inserting the following new sentence: ‘‘With 
respect to bids to furnish such types of products on or 
after January 1, 2019, the volume for such types of products 
shall be determined by the Secretary through the use of 
multiple sources of data (from mail order and non-mail 
order Medicare markets), including market-based data 
measuring sales of diabetic testing strip products that are 
not exclusively sold by a single retailer from such mar-
kets.’’; and 
(B) by adding at the end the following new subpara-
graphs: 
‘‘(C) DEMONSTRATION
OF
ABILITY
TO
FURNISH
TYPES 
OF
DIABETIC
TESTING
STRIP
PRODUCTS.—With respect to 
bids to furnish diabetic testing strip products on or after 
January 1, 2019, an entity shall attest to the Secretary 
that the entity has the ability to obtain an inventory of 
the types and quantities of diabetic testing strip products
H. R. 1892—168 
extent practicable, be nonproprietary and interoper-
able. 
‘‘(iii) OTHER REQUIREMENTS.—In designating data 
exchange standards under this paragraph, the Sec-
retary shall, to the extent practicable, incorporate— 
‘‘(I) interoperable standards developed and 
maintained by an international voluntary con-
sensus standards body, as defined by the Office 
of Management and Budget; 
‘‘(II) interoperable standards developed and 
maintained by intergovernmental partnerships, 
such as the National Information Exchange Model; 
and 
‘‘(III) interoperable standards developed and 
maintained by Federal entities with authority over 
contracting and financial assistance. 
‘‘(B) 
DATA
EXCHANGE
STANDARDS
FOR
FEDERAL 
REPORTING.— 
‘‘(i) DESIGNATION.—The head of the department 
or agency responsible for administering a program 
referred to in this section shall, in consultation with 
an interagency work group established by the Office 
of Management and Budget, and considering State 
government perspectives, designate data exchange 
standards to govern Federal reporting and exchange 
requirements under applicable Federal law. 
‘‘(ii) REQUIREMENTS.—The data exchange reporting 
standards required by clause (i) shall, to the extent 
practicable— 
‘‘(I) incorporate a widely accepted, nonpropri-
etary, searchable, computer-readable format; 
‘‘(II) be consistent with and implement 
applicable accounting principles; 
‘‘(III) be implemented in a manner that is 
cost-effective and improves program efficiency and 
effectiveness; and 
‘‘(IV) be capable of being continually upgraded 
as necessary. 
‘‘(iii) INCORPORATION OF NONPROPRIETARY STAND-
ARDS.—In designating data exchange standards under 
this paragraph, the Secretary shall, to the extent prac-
ticable, incorporate existing nonproprietary standards, 
such as the eXtensible Mark up Language. 
‘‘(iv) RULE
OF
CONSTRUCTION.—Nothing in this 
paragraph shall be construed to require a change to 
existing data exchange standards for Federal reporting 
about a program referred to in this section, if the 
head of the department or agency responsible for 
administering the program finds the standards to be 
effective and efficient.’’. 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 
shall take effect on the date that is 2 years after the date of 
enactment of this Act. 
SEC. 50607. ALLOCATION OF FUNDS. 
Section 511(j) of the Social Security Act (42 U.S.C. 711(j)) 
is amended by adding at the end the following:
H. R. 1892—174 
the risk of the child entering foster care remains high 
despite the provision of the services or programs. 
‘‘(iii) With respect to the services and programs 
specified in subparagraphs (A) and (B) of paragraph 
(1), information on the specific promising, supported, 
or well-supported practices the State plans to use to 
provide the services or programs, including a descrip-
tion of— 
‘‘(I) the services or programs and whether the 
practices used are promising, supported, or well- 
supported; 
‘‘(II) how the State plans to implement the 
services or programs, including how implementa-
tion of the services or programs will be continu-
ously monitored to ensure fidelity to the practice 
model and to determine outcomes achieved and 
how information learned from the monitoring will 
be used to refine and improve practices; 
‘‘(III) how the State selected the services or 
programs; 
‘‘(IV) the target population for the services 
or programs; and 
‘‘(V) how each service or program provided 
will be evaluated through a well-designed and rig-
orous process, which may consist of an ongoing, 
cross-site evaluation approved by the Secretary. 
‘‘(iv) A description of the consultation that the 
State agencies responsible for administering the State 
plans under this part and part B engage in with other 
State agencies responsible for administering health 
programs, including mental health and substance 
abuse prevention and treatment services, and with 
other public and private agencies with experience in 
administering child and family services, including 
community-based organizations, in order to foster a 
continuum of care for children described in paragraph 
(2) and their parents or kin caregivers. 
‘‘(v) A description of how the State shall assess 
children and their parents or kin caregivers to deter-
mine eligibility for services or programs specified in 
paragraph (1). 
‘‘(vi) A description of how the services or programs 
specified in paragraph (1) that are provided for or 
on behalf of a child and the parents or kin caregivers 
of the child will be coordinated with other child and 
family services provided to the child and the parents 
or kin caregivers of the child under the State plans 
in effect under subparts 1 and 2 of part B. 
‘‘(vii) Descriptions of steps the State is taking to 
support and enhance a competent, skilled, and profes-
sional child welfare workforce to deliver trauma- 
informed and evidence-based services, including— 
‘‘(I) ensuring that staff is qualified to provide 
services or programs that are consistent with the 
promising, supported, or well-supported practice 
models selected; and
H. R. 1892—218 
‘‘(2) any other agency consulted by the Secretary before 
approving a social impact partnership project or a feasibility 
study under section 2054. 
‘‘NO FEDERAL FUNDING FOR CREDIT ENHANCEMENTS 
‘‘SEC. 2059. No amount made available to carry out this subtitle 
may be used to provide any insurance, guarantee, or other credit 
enhancement to a State or local government under which a Federal 
payment would be made to a State or local government as the 
result of a State or local government failing to achieve an outcome 
specified in an agreement. 
‘‘AVAILABILITY OF FUNDS 
‘‘SEC. 2060. Amounts made available to carry out this subtitle 
shall remain available until 10 years after the date of the enactment 
of this subtitle. 
‘‘WEBSITE 
‘‘SEC. 2061. The Federal Interagency Council on Social Impact 
Partnerships shall establish and maintain a public website that 
shall display the following: 
‘‘(1) A copy of, or method of accessing, each notice published 
regarding a social impact partnership project pursuant to this 
subtitle. 
‘‘(2) A copy of each feasibility study funded under this 
subtitle. 
‘‘(3) For each State or local government that has entered 
into an agreement with the Secretary for a social impact part-
nership project, the website shall contain the following informa-
tion: 
‘‘(A) The outcome goals of the project. 
‘‘(B) A description of each intervention in the project. 
‘‘(C) The target population that will be served by the 
project. 
‘‘(D) The expected social benefits to participants who 
receive the intervention and others who may be impacted. 
‘‘(E) The detailed roles, responsibilities, and purposes 
of each Federal, State, or local government entity, inter-
mediary, service provider, independent evaluator, investor, 
or other stakeholder. 
‘‘(F) The payment terms, methodology used to calculate 
outcome payments, the payment schedule, and performance 
thresholds. 
‘‘(G) The project budget. 
‘‘(H) The project timeline. 
‘‘(I) The project eligibility criteria. 
‘‘(J) The evaluation design. 
‘‘(K) The metrics used to determine whether the pro-
posed outcomes have been achieved and how these metrics 
are measured. 
‘‘(4) A copy of the progress reports and the final reports 
relating to each social impact partnership project. 
‘‘(5) An estimate of the savings to the Federal, State, and 
local government, on a program-by-program basis and in the
H. R. 1892—229 
(3) REPORT.—Not later than April 1, 2019, the Secretary 
of Health and Human Services shall submit to the Committee 
on Ways and Means and the Committee on Energy and Com-
merce of the House of Representatives and the Committee 
on Finance of the Senate a report on the recommendations 
of such panel described in such paragraph. 
(4) NOTICE AND COMMENT RULEMAKING.—Not later than 
December 31, 2019, the Secretary of Health and Human Serv-
ices shall pursue notice and comment rulemaking on a case- 
mix system with respect to the prospective payment system 
for home health services under section 1895(b) of the Social 
Security Act (42 U.S.C. 1395fff(b)). 
(c) REPORTS.— 
(1) INTERIM REPORT.—Not later than March 15, 2022, the 
Medicare Payment Advisory Commission shall submit to Con-
gress an interim report on the application of a 30-day unit 
of service as the unit of service applied under section 1895(b)(2) 
of the Social Security Act (42 U.S.C. 1395fff(b)(2)), as amended 
by subsection (a), including an analysis of the level of payments 
provided to home health agencies as compared to the cost 
of delivering home health services, and any unintended con-
sequences, including with respect to behavioral changes and 
quality. 
(2) FINAL REPORT.—Not later than March 15, 2026, such 
Commission shall submit to Congress a final report on such 
application and any such consequences. 
SEC. 51002. INFORMATION TO SATISFY DOCUMENTATION OF MEDI-
CARE ELIGIBILITY FOR HOME HEALTH SERVICES. 
(a) PART A.—Section 1814(a) of the Social Security Act (42 
U.S.C. 1395f(a)) is amended by inserting before ‘‘For purposes of 
paragraph (2)(C),’’ the following new sentence: ‘‘For purposes of 
documentation for physician certification and recertification made 
under paragraph (2) on or after January 1, 2019, and made with 
respect to home health services furnished by a home health agency, 
in addition to using documentation in the medical record of the 
physician who so certifies or the medical record of the acute or 
post-acute care facility (in the case that home health services were 
furnished to an individual who was directly admitted to the home 
health agency from such a facility), the Secretary may use docu-
mentation in the medical record of the home health agency as 
supporting material, as appropriate to the case involved.’’. 
(b) PART B.—Section 1835(a) of the Social Security Act (42 
U.S.C. 1395n(a)) is amended by inserting before ‘‘For purposes 
of paragraph (2)(A),’’ the following new sentence: ‘‘For purposes 
of documentation for physician certification and recertification made 
under paragraph (2) on or after January 1, 2019, and made with 
respect to home health services furnished by a home health agency, 
in addition to using documentation in the medical record of the 
physician who so certifies or the medical record of the acute or 
post-acute care facility (in the case that home health services were 
furnished to an individual who was directly admitted to the home 
health agency from such a facility), the Secretary may use docu-
mentation in the medical record of the home health agency as 
supporting material, as appropriate to the case involved.’’.
H. R. 1892—230 
SEC. 51003. TECHNICAL AMENDMENTS TO PUBLIC LAW 114–10. 
(a) MIPS TRANSITION.—Section 1848 of the Social Security Act 
(42 U.S.C. 1395w–4) is amended— 
(1) in subsection (q)— 
(A) in paragraph (1)— 
(i) in subparagraph (B), by striking ‘‘items and 
services’’ and inserting ‘‘covered professional services 
(as defined in subsection (k)(3)(A))’’; and 
(ii) in subparagraph (C)(iv)— 
(I) by amending subclause (I) to read as fol-
lows: 
‘‘(I) The minimum number (as determined by 
the Secretary) of— 
‘‘(aa) for performance periods beginning 
before January 1, 2018, individuals enrolled 
under this part who are treated by the eligible 
professional 
for 
the 
performance 
period 
involved; and 
‘‘(bb) for performance periods beginning 
on or after January 1, 2018, individuals 
enrolled under this part who are furnished 
covered professional services (as defined in 
subsection (k)(3)(A)) by the eligible profes-
sional for the performance period involved.’’; 
(II) in subclause (II), by striking ‘‘items and 
services’’ and inserting ‘‘covered professional serv-
ices (as defined in subsection (k)(3)(A))’’; and 
(III) by amending subclause (III) to read as 
follows: 
‘‘(III) The minimum amount (as determined 
by the Secretary) of— 
‘‘(aa) for performance periods beginning 
before January 1, 2018, allowed charges billed 
by such professional under this part for such 
performance period; and 
‘‘(bb) for performance periods beginning 
on or after January 1, 2018, allowed charges 
for covered professional services (as defined 
in subsection (k)(3)(A)) billed by such profes-
sional for such performance period.’’; 
(B) in paragraph (5)(D)— 
(i) in clause (i)(I), by inserting ‘‘subject to clause 
(iii),’’ after ‘‘clauses (i) and (ii) of paragraph (2)(A),’’; 
and 
(ii) by adding at the end the following new clause: 
‘‘(iii) TRANSITION YEARS.—For each of the second, 
third, fourth, and fifth years for which the MIPS 
applies to payments, the performance score for the 
performance category described in paragraph (2)(A)(ii) 
shall not take into account the improvement of the 
professional involved.’’; 
(C) in paragraph (5)(E)— 
(i) in clause (i)(I)(bb)— 
(I) in the heading by striking ‘‘FIRST 2 YEARS’’ 
and inserting ‘‘FIRST 5 YEARS’’; and 
(II) by striking ‘‘the first and second years’’ 
and inserting ‘‘each of the first through fifth years’’;