IB 
Union Calendar No. 574 
116TH CONGRESS 
2D SESSION 
H. R. 3417 
[Report No. 116–691, Part I] 
To amend title XVIII of the Social Security Act to provide for patient 
improvements and rural and quality improvements under the Medicare 
program. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 21, 2019 
Mr. NEAL (for himself and Mr. BRADY) introduced the following bill; which 
was referred to the Committee on Ways and Means, and in addition to 
the Committee on Energy and Commerce, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
DECEMBER 24, 2020 
Reported from the Committee on Ways and Means with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
DECEMBER 24, 2020 
Committee on Energy and Commerce discharged; committed to the Committee 
of the Whole House on the State of the Union and ordered to be printed 
[For text of introduced bill, see copy of bill as introduced on June 21, 2019] 
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A BILL 
To amend title XVIII of the Social Security Act to provide 
for patient improvements and rural and quality improve-
ments under the Medicare program. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Beneficiary Education Tools, Telehealth, and Extenders 
Reauthorization Act of 2019’’ or the ‘‘BETTER Act of 
2019’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—PATIENT IMPROVEMENTS 
Sec. 101. Beneficiary enrollment notification and eligibility simplification. 
Sec. 102. Extension of funding outreach and assistance for low-income programs. 
Sec. 103. Medicare coverage of certain mental health telehealth services. 
Sec. 104. Requiring prescription drug plan sponsors to include real-time benefit 
information as part of such sponsor’s electronic prescription pro-
gram under the Medicare program. 
Sec. 105. Transitional coverage and retroactive Medicare part D coverage for cer-
tain low-income beneficiaries. 
TITLE II—RURAL AND QUALITY IMPROVEMENTS 
Sec. 201. Medicare GME treatment of hospitals establishing new medical resi-
dency training programs after hosting medical resident rotators 
for short durations. 
Sec. 202. Extension of the work geographic index floor under the Medicare pro-
gram. 
Sec. 203. Extension of funding for quality measure endorsement, input, and selec-
tion under Medicare program. 
Sec. 204. Improving measurements under the skilled nursing facility value-based 
purchasing program under the Medicare program. 
TITLE I—PATIENT 
IMPROVEMENTS 
SEC. 101. BENEFICIARY ENROLLMENT NOTIFICATION AND 
ELIGIBILITY SIMPLIFICATION. 
(a) ELIGIBILITY AND ENROLLMENT NOTICES.— 
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(1) AS
PART
OF
SOCIAL
SECURITY
ACCOUNT 
STATEMENT FOR INDIVIDUALS ATTAINING AGES 63 TO 
65.—Section 1143(a) of the Social Security Act (42 
U.S.C. 1320b–13(a)) is amended by adding at the end 
the following new paragraph: 
‘‘(4) MEDICARE ELIGIBILITY INFORMATION.— 
‘‘(A) IN GENERAL.—In the case of statements 
provided on or after the date that is 2 years after the 
date of the enactment of this paragraph to individ-
uals who are attaining ages 63, 64, and 65, the state-
ment shall also include a notice containing the infor-
mation described in subparagraph (B). 
‘‘(B) CONTENTS
OF
NOTICE.—The notice re-
quired under subparagraph (A) shall include a clear, 
simple explanation of— 
‘‘(i) eligibility for benefits under the Medi-
care program under title XVIII, and in par-
ticular benefits under part B of such title; 
‘‘(ii) the reasons a late enrollment penalty 
for failure to timely enroll could be assessed and 
how such late enrollment penalty is calculated, 
in particular for benefits under part B; 
‘‘(iii) the availability of relief from the late 
enrollment penalty and retroactive enrollment 
under section 1837(h) (including as such section 
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is 
applied 
under 
sections 
1818(c) 
and 
1818A(c)(3)), with examples of circumstances 
under which such relief may be granted and ex-
amples of circumstances under which such relief 
would not be granted; 
‘‘(iv) coordination of benefits (including 
primary and secondary coverage scenarios) pur-
suant to section 1862(b), in particular for bene-
fits under part B of such title; and 
‘‘(v) information for populations, such as 
residents of Puerto Rico and veterans, for whom 
there are special considerations with respect to 
enrollment, eligibility, and coordination of bene-
fits under title XVIII. 
‘‘(C) DEVELOPMENT OF NOTICE.— 
‘‘(i) IN GENERAL.—The Secretary, in co-
ordination with the Commissioner of Social Se-
curity, and taking into consideration informa-
tion collected pursuant to clause (ii), shall, not 
later than 12 months after the last day of the pe-
riod for the request of information described in 
clause (ii), develop the notice to be provided pur-
suant to subparagraph (A). 
‘‘(ii) REQUEST
FOR
INFORMATION.—Not 
later than 6 months after the date of the enact-
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ment of this paragraph, the Secretary shall re-
quest 
written 
information, 
including 
rec-
ommendations, from stakeholders (including the 
groups described in subparagraph (D)) on the 
information to be included in the notice. 
‘‘(iii) NOTICE IMPROVEMENT.—Beginning 4 
years after the date of enactment of this para-
graph, and not less than once every two years 
thereafter, the Secretary, in coordination with 
the Commissioner of Social Security, shall— 
‘‘(I) review the content of the notice to 
be provided under subparagraph (A); 
‘‘(II) solicit recommendations on the 
notice through a request for information 
process as described in clause (ii); and 
‘‘(III) update and revise such notice as 
the Secretary deems appropriate. 
‘‘(D) GROUPS
FOR
CONSULTATION.—For pur-
poses of subparagraph (C)(ii), the groups described in 
this clause include the following: 
‘‘(i) Individuals who are 60 years of age or 
older. 
‘‘(ii) Veterans. 
‘‘(iii) Individuals with disabilities. 
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‘‘(iv) Individuals with end stage renal dis-
ease. 
‘‘(v) Low-income individuals and families. 
‘‘(vi) Employers (including human re-
sources professionals). 
‘‘(vii) States (including representatives of 
State-run Health Insurance Exchanges, Medicaid 
offices, and Departments of Insurance). 
‘‘(viii) State Health Insurance Assistance 
Programs. 
‘‘(ix) Health insurers. 
‘‘(x) Health insurance agents and brokers. 
‘‘(xi) Such other groups as specified by the 
Secretary. 
‘‘(E) POSTING OF NOTICE ON WEBSITES.—The 
Commissioner of Social Security and the Secretary 
shall post the notice required under subparagraph (A) 
in a prominent location on the public Internet 
website of the Social Security Administration and on 
the public Internet website of the Centers for Medicare 
& Medicaid Services, respectively. 
‘‘(F) REIMBURSEMENT OF COSTS.— 
‘‘(i) IN GENERAL.—Effective for fiscal years 
beginning in the year in which the date of enact-
ment of this paragraph occurs, the Commissioner 
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of Social Security and the Secretary shall enter 
into an agreement which shall provide funding 
to cover the administrative costs of the Commis-
sioner’s activities under this paragraph. Such 
agreement shall— 
‘‘(I) provide funds to the Commissioner 
for the full cost of the Social Security Ad-
ministration’s work related to the imple-
mentation of this paragraph, including any 
costs incurred prior to the finalization of 
such agreement; 
‘‘(II) provide such funding quarterly 
in advance of the applicable quarter based 
on estimating methodology agreed to by the 
Commissioner and the Secretary; and 
‘‘(III) require an annual accounting 
and reconciliation of the actual costs in-
curred and funds provided under this para-
graph. 
‘‘(ii) LIMITATION.—In no case shall funds 
from the Social Security Administration’s Limi-
tation on Administrative Expenses be used to 
carry out activities related to the implementa-
tion of this paragraph, except as the Commis-
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sioner determines is necessary in developing the 
agreement under clause (i). 
‘‘(G) NO
EFFECT
ON
OBLIGATION
TO
MAIL 
STATEMENTS.—Nothing in this paragraph shall be 
construed to relieve the Commissioner of Social Secu-
rity from any requirement under subsection (c), in-
cluding the requirement to mail a statement on an 
annual basis to each eligible individual who is not re-
ceiving benefits under title II and for whom a mail-
ing address can be determined through such methods 
as the Commissioner determines to be appropriate.’’. 
(2) INDIVIDUALS
IN
MEDICARE
WAITING
PE-
RIOD.—Title XI of the Social Security Act (42 U.S.C. 
1301 et seq.) is amended by inserting after section 
1144 the following new section: 
‘‘MEDICARE ENROLLMENT NOTIFICATION AND ELIGIBILITY 
NOTICES FOR INDIVIDUALS IN MEDICARE WAITING PERIOD 
‘‘SEC. 1144A. (a) NOTICES.— 
‘‘(1) IN GENERAL.—The Commissioner of Social 
Security shall distribute the notice to be provided 
pursuant to section 1143(a)(4), as may be modified 
under paragraph (2), to individuals in the 24-month 
waiting period under section 226(b). 
‘‘(2) AUTHORITY TO MODIFY NOTICE.—The Sec-
retary, in coordination with the Commissioner of So-
cial Security, may modify the notice to be distributed 
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under paragraph (1) as necessary to take into ac-
count the individuals described in such paragraph. 
‘‘(3) POSTING OF NOTICE ON WEBSITES.—The 
Commissioner of Social Security and the Secretary 
shall post the notice required to be distributed under 
paragraph (1) in a prominent location on the public 
Internet website of the Social Security Administra-
tion and on the public Internet website of the Centers 
for Medicare & Medicaid Services, respectively. 
‘‘(b) TIMING.—Beginning not later than 2 years after 
the date of the enactment of this section, a notice required 
under subsection (a)(1) shall be mailed to an individual 
no less than two times in accordance with the following: 
‘‘(1) The notice shall be provided to such indi-
vidual not later than 3 months prior to the date on 
which such individual’s enrollment period begins as 
provided under section 1837. 
‘‘(2) The notice shall subsequently be provided to 
such individual not later than one month prior to 
such date. 
‘‘(c) REIMBURSEMENT OF COSTS.— 
‘‘(1) IN GENERAL.—Effective for fiscal years be-
ginning in the year in which the date of enactment 
of this section occurs, the Commissioner of Social Se-
curity and the Secretary shall enter into an agree-
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ment which shall provide funding to cover the admin-
istrative costs of the Commissioner’s activities under 
this section. Such agreement shall— 
‘‘(A) provide funds to the Commissioner for 
the full cost of the Social Security Administra-
tion’s work related to the implementation of this 
section, including any costs incurred prior to the 
finalization of such agreement; 
‘‘(B) provide such funding quarterly in ad-
vance of the applicable quarter based on esti-
mating methodology agreed to by the Commis-
sioner and the Secretary; and 
‘‘(C) require an annual accounting and rec-
onciliation of the actual costs incurred and funds 
provided under this section. 
‘‘(2) LIMITATION.—In no case shall funds from 
the Social Security Administration’s Limitation on 
Administrative Expenses be used to carry out activi-
ties related to the implementation of this section, ex-
cept as the Commissioner determines is necessary in 
developing the agreement under paragraph (1).’’. 
(b) BENEFICIARY ENROLLMENT SIMPLIFICATION.— 
(1) EFFECTIVE
DATE
OF
COVERAGE.—Section 
1838(a) of the Social Security Act (42 U.S.C. 
1395q(a)) is amended— 
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(A) by amending paragraph (2) to read as 
follows: 
‘‘(2)(A) in the case of an individual who enrolls 
pursuant to subsection (d) of section 1837 before the 
month in which he first satisfies paragraph (1) or (2) 
of section 1836, the first day of such month, 
‘‘(B) in the case of an individual who first satis-
fies such paragraph in a month beginning before Jan-
uary 2021 and who enrolls pursuant to such sub-
section (d)— 
‘‘(i) in such month in which he first satis-
fies such paragraph, the first day of the month 
following the month in which he so enrolls, 
‘‘(ii) in the month following such month in 
which he first satisfies such paragraph, the first 
day of the second month following the month in 
which he so enrolls, or 
‘‘(iii) more than one month following such 
month in which he satisfies such paragraph, the 
first day of the third month following the month 
in which he so enrolls, 
‘‘(C) in the case of an individual who first satis-
fies such paragraph in a month beginning on or after 
January 1, 2021, and who enrolls pursuant to such 
subsection (d) in such month in which he first satis-
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fies such paragraph or in any subsequent month of 
his initial enrollment period, the first day of the 
month following the month in which he so enrolls, or 
‘‘(D) in the case of an individual who enrolls 
pursuant to subsection (e) of section 1837 in a month 
beginning— 
‘‘(i) before January 1, 2021, the July 1 fol-
lowing the month in which he so enrolls, or 
‘‘(ii) on or after January 1, 2021, the first 
day of the month following the month in which 
he so enrolls, or’’; and 
(B) by amending paragraph (3) to read as 
follows: 
‘‘(3) in the case of an individual who is deemed 
to have enrolled— 
‘‘(A) on or before the last day of the third 
month of his initial enrollment period, the first 
day of the month in which he first meets the ap-
plicable requirements of section 1836 or July 1, 
1973, whichever is later, or 
‘‘(B) on or after the first day of the fourth 
month of his initial enrollment period, and 
where such month begins— 
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‘‘(i) before January 1, 2021, as pre-
scribed under subparagraphs (B)(i), (B)(ii), 
(B)(iii), and (D) of paragraph (2), or 
‘‘(ii) on or after January 1, 2021, as 
prescribed under paragraph (2)(C).’’. 
(2) SPECIAL ENROLLMENT PERIODS FOR EXCEP-
TIONAL CIRCUMSTANCES.— 
(A) ENROLLMENT.—Section 1837 of the So-
cial Security Act (42 U.S.C. 1395p) is amended 
by adding at the end the following new sub-
section: 
‘‘(m) Beginning January 1, 2021, the Secretary may 
establish special enrollment periods in the case of individ-
uals who meet such exceptional conditions as the Secretary 
may provide, such as individuals who reside in an area 
with an emergency or disaster as determined by the Sec-
retary.’’. 
(B) COVERAGE
PERIOD.—Section 1838 of 
the Social Security Act (42 U.S.C. 1395q) is 
amended by adding at the end the following new 
subsection: 
‘‘(g) Notwithstanding subsection (a), in the case of an 
individual who enrolls during a special enrollment period 
pursuant to section 1837(m), the coverage period shall begin 
on a date the Secretary provides in a manner consistent 
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(to the extent practicable) with protecting continuity of 
health benefit coverage.’’. 
(C) 
CONFORMING
AMENDMENT.—Section 
1839(b) of the Social Security Act (42 U.S.C. 
1395r(b)) is amended, in the first sentence, by 
striking ‘‘or (l)’’ and inserting ‘‘, (l), or (m)’’. 
(3) TECHNICAL
CORRECTION.—Section 1839(b) 
of the Social Security Act (42 U.S.C. 1395r(b)) is 
amended by adding at the end the following new sen-
tence: ‘‘For purposes of determining any increase 
under this subsection for individuals whose enroll-
ment occurs on or after January 1, 2021, the second 
sentence of this subsection shall be applied by sub-
stituting ‘close of the month’ for ‘close of the enroll-
ment period’ each place it appears.’’. 
(4) REPORT.—Not later than January 1, 2021, 
the Secretary of Health and Human Services shall 
submit to the Committee on Ways and Means and 
Committee on Energy and Commerce of the House of 
Representatives and the Committee on Finance and 
Special Committee on Aging of the Senate a report 
including recommendations on how to align existing 
Medicare enrollment periods under title XVIII of the 
Social Security Act, including the general enrollment 
period under part B of such title and the annual elec-
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tion period under the Medicare Advantage program 
under part C of such title and under the prescription 
drug program under part D of such title. Such rec-
ommendations shall be consistent with the goals of 
maximizing coverage continuity and choice and eas-
ing beneficiary transition. 
SEC. 102. EXTENSION OF FUNDING OUTREACH AND ASSIST-
ANCE FOR LOW-INCOME PROGRAMS. 
(a) ADDITIONAL FUNDING FOR STATE HEALTH INSUR-
ANCE 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), section 610 of the American Tax-
payer 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 Medi-
care Act of 2014 (Public Law 113–93), section 208 of the 
Medicare Access and CHIP Reauthorization Act of 2015 
(Public Law 114–10), and section 50207 of the Bipartisan 
Budget Act of 2018 (Public Law 115–123), is amended— 
(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by striking ‘‘and’’ at the end; 
(3) in clause (ix), by striking the period at the 
end and inserting ‘‘; and’’; and 
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(4) by inserting after clause (ix) the following 
new clause: 
‘‘(x) for each of fiscal years 2020 
through 2022, of $15,000,000.’’. 
(b) ADDITIONAL FUNDING FOR AREA AGENCIES ON 
AGING.—Subsection (b)(1)(B) of such section 119, as so 
amended, is amended— 
(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by striking ‘‘and’’ at the end; 
(3) in clause (ix), by striking the period at the 
end and inserting ‘‘; and’’; and 
(4) by inserting after clause (ix) the following 
new clause: 
‘‘(x) for each of fiscal years 2020 
through 2022, of $15,000,000.’’. 
(c) ADDITIONAL FUNDING FOR AGING AND DISABILITY 
RESOURCE CENTERS.—Subsection (c)(1)(B) of such section 
119, as so amended, is amended— 
(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by striking ‘‘and’’ at the end; 
(3) in clause (ix), by striking the period at the 
end and inserting ‘‘; and’’; and 
(4) by inserting after clause (ix) the following 
new clause: 
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(and as subsequently modified by the Secretary),’’ be-
fore ‘‘and any additional service’’; 
(4) in paragraph (6)(A), by striking ‘‘paragraph 
(4)(C)’’ and inserting ‘‘paragraph (4)(C)(i)’’; 
(5) in paragraph (7), by striking ‘‘The geo-
graphic requirements’’ and inserting ‘‘Subject to 
paragraph (8)(D), the geographic requirements’’; and 
(6) by adding at the end the following new para-
graph: 
‘‘(8) TREATMENT
OF
MENTAL
HEALTH
TELE-
HEALTH SERVICES.— 
‘‘(A) NON-APPLICATION
OF
ORIGINATING 
SITE
REQUIREMENTS.—The requirements de-
scribed in paragraph (4)(C)(i) shall not apply 
with respect to telehealth services furnished on or 
after January 1, 2021, that are mental health 
telehealth services. Nothing in the previous sen-
tence shall waive any applicable State law re-
quirements. 
‘‘(B) INCLUSION OF CERTAIN SITES.—With 
respect to telehealth services described in sub-
paragraph (A), the term ‘originating site’ shall 
include the home of the eligible telehealth indi-
vidual at which the individual is located at the 
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time the service is furnished via a telecommuni-
cations system. 
‘‘(C) 
NO
ORIGINATING
SITE
FACILITY 
FEE.—No facility fee shall be paid under para-
graph (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). 
‘‘(D) FACE-TO-FACE
INITIAL
ASSESSMENT; 
REASSESSMENTS.—Payment may not be made 
for mental health telehealth services under this 
paragraph (if such payment would not otherwise 
be allowed under this subsection without applica-
tion of this paragraph or paragraph (7)) fur-
nished to an eligible telehealth individual un-
less— 
‘‘(i) within the 6-month period prior to 
the provision of such mental health tele-
health services, the individual receives a 
face-to-face clinical assessment, without the 
use of telehealth, by a physician described 
in subparagraph (F)(i) or a practitioner 
described in subparagraph (F)(ii) of the 
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needs of such individual for such services; 
and 
‘‘(ii) the individual receives a reassess-
ment (at a frequency specified by the Sec-
retary) by a physician so described or a 
practitioner so described of the needs of such 
individual for such services. 
‘‘(E) MENTAL HEALTH TELEHEALTH SERV-
ICES DEFINED.—For purposes of this paragraph, 
the term ‘mental health telehealth service’ means 
services identified by CPT codes 90832, 90834, 
and 90837 (and as subsequently modified by the 
Secretary). 
‘‘(F) PHYSICIAN
AND
PRACTITIONER
DE-
SCRIBED.—For purposes of subparagraph (D): 
‘‘(i) 
PHYSICIAN.—A 
physician 
de-
scribed in this clause is a physician, as de-
fined in section 1861(r)(1). 
‘‘(ii) PRACTITIONER.—A practitioner 
described in this clause is a practitioner de-
scribed in any of clauses (i), (iv), or (v) of 
section 1842(b)(18)(C).’’. 
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SEC. 104. REQUIRING PRESCRIPTION DRUG PLAN SPON-
SORS TO INCLUDE REAL-TIME BENEFIT IN-
FORMATION AS PART OF SUCH SPONSOR’S 
ELECTRONIC 
PRESCRIPTION 
PROGRAM 
UNDER THE MEDICARE PROGRAM. 
Section 1860D–4(e)(2) of the Social Security Act (42 
U.S.C. 1395w–104(e)(2)) is amended— 
(1) in subparagraph (D), by striking ‘‘To the ex-
tent’’ and inserting ‘‘Except as provided in subpara-
graph (F), to the extent’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(F) REAL-TIME BENEFIT INFORMATION.— 
‘‘(i) IN GENERAL.—Not later than Jan-
uary 1, 2021, the program shall implement 
real-time benefit tools that are capable of 
integrating with a prescribing health care 
professional’s electronic prescribing or elec-
tronic health record system for the trans-
mission of formulary and benefit informa-
tion in real time to prescribing health care 
professionals. With respect to a covered part 
D drug, such tools shall be capable of trans-
mitting such information specific to an in-
dividual enrolled in a prescription drug 
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plan. Such information shall include the 
following: 
‘‘(I) A list of any clinically-ap-
propriate alternatives to such drug in-
cluded in the formulary of such plan. 
‘‘(II) Cost-sharing information for 
such drug and such alternatives, in-
cluding a description of any variance 
in cost sharing based on the pharmacy 
dispensing such drug or such alter-
natives. 
‘‘(III) Information relating to 
whether such drug is included in the 
formulary of such plan and any prior 
authorization or other utilization man-
agement requirements applicable to 
such drug and such alternatives so in-
cluded. 
‘‘(ii) ELECTRONIC
TRANSMISSION.— 
The provisions of subclauses (I) and (II) of 
clause (ii) of subparagraph (E) shall apply 
to an electronic transmission described in 
clause (i) in the same manner as such pro-
visions apply with respect to an electronic 
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transmission described in clause (i) of such 
subparagraph. 
‘‘(iii) SPECIAL RULE FOR 2021.—The 
program shall be deemed to be in compli-
ance with clause (i) for 2021 if the program 
complies with the provisions of section 
423.160(b)(7) of title 42, Code of Federal 
Regulations (or a successor regulation), for 
such year.’’. 
SEC. 105. TRANSITIONAL COVERAGE AND RETROACTIVE 
MEDICARE PART D COVERAGE FOR CERTAIN 
LOW-INCOME BENEFICIARIES. 
Section 1860D–14 of the Social Security Act (42 
U.S.C. 1395w–114) is amended— 
(1) by redesignating subsection (e) as subsection 
(f); and 
(2) by adding after subsection (d) the following 
new subsection: 
‘‘(e) LIMITED INCOME NEWLY ELIGIBLE TRANSITION 
PROGRAM.— 
‘‘(1) IN
GENERAL.—Beginning not later than 
January 1, 2021, the Secretary shall carry out a pro-
gram to provide transitional coverage for covered part 
D drugs for LI NET eligible individuals in accord-
ance with this subsection. 
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‘‘(2) LI NET ELIGIBLE INDIVIDUAL DEFINED.— 
For purposes of this subsection, the term ‘LI NET eli-
gible individual’ means a part D eligible individual 
who— 
‘‘(A) meets the requirements of clauses (ii) 
and (iii) of subsection (a)(3)(A); and 
‘‘(B) has not yet enrolled in a prescription 
drug plan or an MA–PD plan, or, who has so 
enrolled, but with respect to whom coverage 
under such plan has not yet taken effect. 
‘‘(3) TRANSITIONAL COVERAGE.—For purposes of 
this subsection, the term ‘transitional coverage’ means 
with respect to an LI NET eligible individual— 
‘‘(A) immediate access to covered part D 
drugs at the point of sale during the period that 
begins on the first day of the month such indi-
vidual is determined to meet the requirements of 
clauses (ii) and (iii) of subsection (a)(3)(A) and 
ends on the date that coverage under a prescrip-
tion drug plan or MA–PD plan takes effect with 
respect to such individual; and 
‘‘(B) in the case of an LI NET eligible indi-
vidual who is a full-benefit dual eligible indi-
vidual (as defined in section 1935(c)(6)) or a re-
cipient of supplemental security income benefits 
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under title XVI, retroactive coverage (in the form 
of reimbursement of the amounts that would 
have been paid under this part had such indi-
vidual been enrolled in a prescription drug plan 
or MA–PD plan) of covered part D drugs pur-
chased by such individual during the period that 
begins on the date that is the later of— 
‘‘(i) the date that such individual was 
first eligible for a low-income subsidy under 
this part; or 
‘‘(ii) the date that is 36 months prior 
to the date such individual enrolls in a pre-
scription drug plan or MA–PD plan, 
and ends on the date that coverage under such 
plan takes effect. 
‘‘(4) PROGRAM ADMINISTRATION.— 
‘‘(A) SINGLE POINT OF CONTACT.—The Sec-
retary shall, to the extent feasible, administer the 
program under this subsection through a con-
tract with a single program administrator. 
‘‘(B) BENEFIT
DESIGN.—The Secretary 
shall ensure that the transitional coverage pro-
vided to LI NET eligible individuals under this 
subsection— 
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‘‘(i) provides access to all covered part 
D drugs under an open formulary; 
‘‘(ii) permits all pharmacies deter-
mined by the Secretary to be in good stand-
ing to process claims under the program; 
‘‘(iii) is consistent with such require-
ments as the Secretary considers necessary 
to improve patient safety and ensure appro-
priate dispensing of medication; and 
‘‘(iv) meets such other requirements as 
the Secretary may establish. 
‘‘(5) RELATIONSHIP TO OTHER PROVISIONS OF 
THIS TITLE; WAIVER AUTHORITY.— 
‘‘(A) IN
GENERAL.—The following provi-
sions shall not apply with respect to the program 
under this subsection: 
‘‘(i) Paragraphs (1) and (3)(B) of sec-
tion 1860D–4(a) (relating to dissemination 
of general information; availability of infor-
mation on changes in formulary through 
the internet). 
‘‘(ii) Subparagraphs (A) and (B) of 
section 1860D–4(b)(3) (relating to require-
ments on development and application of 
formularies; formulary development). 
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‘‘(iii) Paragraphs (1)(C) and (2) of 
section 1860D–4(c) (relating to medication 
therapy management program). 
‘‘(B) WAIVER AUTHORITY.—The Secretary 
may waive such other requirements of title XI 
and this title as may be necessary to carry out 
the purposes of the program established under 
this subsection.’’. 
TITLE II—RURAL AND QUALITY 
IMPROVEMENTS 
SEC. 201. MEDICARE GME TREATMENT OF HOSPITALS ES-
TABLISHING 
NEW 
MEDICAL 
RESIDENCY 
TRAINING PROGRAMS AFTER HOSTING MED-
ICAL RESIDENT ROTATORS FOR SHORT DU-
RATIONS. 
(a) REDETERMINATION OF APPROVED FTE RESIDENT 
AMOUNT.—Section 1886(h)(2)(F) of the Social Security Act 
(42 U.S.C. 1395ww(h)(2)(F)) is amended— 
(1) by inserting ‘‘(i)’’ before ‘‘In the case of’’; 
and 
(2) by adding at the end the following: 
‘‘(ii) In applying this subparagraph in the 
case of a hospital that trains residents and has 
not entered into a GME affiliation agreement (as 
defined by the Secretary for purposes of para-
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graph (4)(H)(ii)), on or after the date of the en-
actment of this clause, the Secretary shall not es-
tablish an FTE resident amount until such time 
as the Secretary determines that the hospital has 
trained at least 1.0 full-time-equivalent resident 
in an approved medical residency training pro-
gram in a cost reporting period. 
‘‘(iii) In applying this subparagraph for 
cost reporting periods beginning on or after the 
date of enactment of this clause, in the case of 
a hospital that, as of such date of enactment, has 
an approved FTE resident amount based on the 
training in an approved medical residency pro-
gram or programs of— 
‘‘(I) less than 1.0 full-time-equivalent 
resident in any cost reporting period begin-
ning before October 1, 1997, as determined 
by the Secretary; or 
‘‘(II) no more than 3.0 full-time-equiv-
alent residents in any cost reporting period 
beginning on or after October 1, 1997, and 
before the date of the enactment of this 
clause, as determined by the Secretary, 
in lieu of such FTE resident amount the Sec-
retary shall, in accordance with the methodology 
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described in section 413.77(e) of title 42 of the 
Code of Federal Regulations (or any successor 
regulation), establish a new FTE resident 
amount if the hospital trains at least 1.0 full- 
time-equivalent resident (in the case of a hos-
pital described in subclause (I)) or more than 3.0 
full-time-equivalent residents (in the case of a 
hospital described in subclause (II)) in a cost re-
porting period beginning on or after such date of 
enactment and before the date that is 5 years 
after such date of enactment. 
‘‘(iv) For purposes of carrying out this sub-
paragraph for cost reporting periods beginning 
on or after the date of the enactment of this 
clause, a hospital shall report full-time-equiva-
lent residents on its cost report for a cost report-
ing period if the hospital trains at least 1.0 full- 
time-equivalent residents in an approved med-
ical residency training program or programs in 
such period. 
‘‘(v) As appropriate, the Secretary may 
consider information from any cost reporting pe-
riod necessary to establish a new FTE resident 
amount as described in clause (iii).’’. 
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(b) REDETERMINATION OF FTE RESIDENT LIMITA-
TION.—Section 1886(h)(4)(H)(i) of the Social Security Act 
(42 U.S.C. 1395ww(h)(4)(H)(i)) is amended— 
(1) by inserting ‘‘(I)’’ before ‘‘The Secretary’’; 
and 
(2) by adding at the end the following: 
‘‘(II) In applying this clause in the 
case of a hospital that, on or after the date 
of the enactment of this subclause, begins 
training residents in a new approved med-
ical residency training program or pro-
grams (as defined by the Secretary), the 
Secretary shall not determine a limitation 
applicable to the hospital under subpara-
graph (F) until such time as the Secretary 
determines that the hospital has trained at 
least 1.0 full-time-equivalent resident in 
such new approved medical residency train-
ing program or programs in a cost report-
ing period. 
‘‘(III) In applying this clause in the 
case of a hospital that, as of the date of the 
enactment of this subclause, has a limita-
tion under subparagraph (F), based on a 
cost reporting period beginning before Octo-
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ment and before the date that is 5 years 
after such date of enactment. 
‘‘(V) An adjustment to the limitation 
applicable to a hospital made pursuant to 
subclause (III) or (IV) shall be made in a 
manner consistent with the methodology, as 
appropriate, in section 413.79(e) of title 42, 
Code of Federal Regulations (or any suc-
cessor regulation). As appropriate, the Sec-
retary may consider information from any 
cost reporting periods necessary to make 
such an adjustment to the limitation.’’. 
(c) TECHNICAL
AND CONFORMING AMENDMENTS.— 
Section 1886 of the Social Security Act (42 U.S.C. 1395ww) 
is amended— 
(1) in subsection (d)(5)(B)(viii), by striking 
‘‘subsection (h)(4)(H)’’ and inserting ‘‘paragraphs 
(2)(F)(iv) and (4)(H) of subsection (h)’’; and 
(2) in subsection (h)— 
(A) in paragraph (4)(H)(iv), by striking 
‘‘an rural area’’ and inserting ‘‘a rural area’’; 
and 
(B) in paragraph (7)(E), by striking 
‘‘under this’’ and all that follows through the pe-
riod at the end and inserting the following: 
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‘‘under this paragraph, paragraph (8), clause 
(i), (ii), (iii), or (v) of paragraph (2)(F), or 
clause (i) or (vi) of paragraph (4)(H).’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to payment under section 1886 of the 
Social Security Act (42 U.S.C. 1395ww) for cost reporting 
periods beginning on or after the date of the enactment of 
this Act. 
SEC. 202. EXTENSION OF THE WORK GEOGRAPHIC INDEX 
FLOOR UNDER THE MEDICARE PROGRAM. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘2020’’ 
and inserting ‘‘2023’’. 
SEC. 203. EXTENSION OF FUNDING FOR QUALITY MEASURE 
ENDORSEMENT, 
INPUT, 
AND 
SELECTION 
UNDER MEDICARE PROGRAM. 
(a) IN GENERAL.—Section 1890(d)(2) of the Social Se-
curity Act (42 U.S.C. 1395aaa(d)(2)) is amended— 
(1) by striking ‘‘and $7,500,000’’ and inserting 
‘‘$7,500,000’’; and 
(2) by striking ‘‘and 2019.’’ and inserting ‘‘and 
2019, and $30,000,000 for each of fiscal years 2020 
through 2022.’’. 
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(b) INPUT
FOR REMOVAL
OF MEASURES.—Section 
1890(b) of the Social Security Act (42 U.S.C. 1395aaa(b)) 
is amended by inserting after paragraph (3) the following: 
‘‘(4) REMOVAL OF MEASURES.—The entity may 
provide input to the Secretary on quality and effi-
ciency measures described in paragraph (7)(B) that 
could be considered for removal.’’. 
(c) PRIORITIZATION OF MEASURE ENDORSEMENT.— 
Section 1890(b) of the Social Security Act (42 U.S.C. 
1395aaa(b)) is amended by adding at the end the following: 
‘‘(9) PRIORITIZATION
OF
MEASURE
ENDORSE-
MENT.—The entity— 
‘‘(A) during the period beginning on the 
date of the enactment of this paragraph and end-
ing on December 31, 2023, shall prioritize the 
endorsement of measures relating to maternal 
morbidity and mortality by the entity with a 
contract under subsection (a) in connection with 
endorsement of measures described in paragraph 
(2); and 
‘‘(B) on and after January 1, 2024, may 
prioritize the endorsement of such measures by 
such entity.’’. 
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SEC. 
204. 
IMPROVING 
MEASUREMENTS 
UNDER 
THE 
SKILLED NURSING FACILITY VALUE-BASED 
PURCHASING PROGRAM UNDER THE MEDI-
CARE PROGRAM. 
(a) IN GENERAL.—Section 1888(h) of the Social Secu-
rity Act (42 U.S.C. 1395yy(h)) is amended— 
(1) in paragraph (1), by adding at the end the 
following new subparagraph: 
‘‘(C) EXCLUSIONS.—With respect to pay-
ments for services furnished on or after October 
1, 2021, this subsection shall not apply to a fa-
cility for which there are not a minimum num-
ber (as determined by the Secretary) of— 
‘‘(i) cases for the measures that apply 
to the facility for the performance period for 
the applicable fiscal year; or 
‘‘(ii) measures that apply to the facil-
ity for the performance period for the appli-
cable fiscal year.’’; 
(2) in paragraph (2)(A)— 
(A) by striking ‘‘The Secretary shall apply’’ 
and inserting ‘‘The Secretary— 
‘‘(i) shall apply’’; 
(B) by striking the period at the end and 
inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
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‘‘(ii) may, with respect to payments 
for services furnished on or after October 1, 
2022, apply additional measures deter-
mined appropriate by the Secretary, which 
may include measures of functional status, 
patient safety, care coordination, or patient 
experience. 
Subject to the succeeding sentence, in the case 
that the Secretary applies additional measures 
under clause (ii), the Secretary shall consider 
and apply, as appropriate, quality measures 
specified under section 1899B(c)(1). In no case 
may the Secretary apply more than 10 measures 
under this subparagraph.’’; 
(3) in subparagraph (A) of each of paragraphs 
(3) and (4), by striking ‘‘measure’’ and inserting 
‘‘measures’’; and 
(4) by adding at the end the following new para-
graph: 
‘‘(12) VALIDATION.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
apply to the measures applied under this sub-
section and the data submitted under subsection 
(e)(6) a process to validate such measures and 
data, as appropriate, which may be similar to 
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the 
process 
specified 
in 
section 
1886(b)(3)(B)(viii)(XI) for validating inpatient 
hospital measures. 
‘‘(B) FUNDING.—For purposes of carrying 
out this paragraph, the Secretary shall provide 
for the transfer, from the Federal Hospital In-
surance Trust Fund established under section 
1817, of $5,000,000 to the Centers for Medicare 
& Medicaid Services Program Management Ac-
count for each of fiscal years 2022 through 
2024.’’. 
(b) REPORT BY MEDPAC.—Not later than March 15, 
2021, the Medicare Payment Advisory Commission shall 
submit to Congress a report on establishing a prototype 
value-based payment program under a unified prospective 
payment system for post-acute care services under the Medi-
care program under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.). Such report— 
(1) shall— 
(A) consider design elements such as— 
(i) measures that are important to the 
Medicare program and to beneficiaries 
under such program; 
(ii) methodologies for scoring provider 
performance and effects on payment; and 
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(iii) other elements determined appro-
priate by the Commission; and 
(B) analyze the effects of implementing such 
prototype program; and 
(2) may— 
(A) discuss the possible effects, with respect 
to the Medicare program, on program spending, 
post-acute care providers, patient outcomes, and 
other effects determined appropriate by the Com-
mission; and 
(B) include recommendations with respect 
to such prototype program, as determined appro-
priate by the Commission, to Congress and the 
Secretary of Health and Human Services. 
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Union Calendar No. 574 
116TH CONGRESS 
2D SESSION 
H. R. 3417 
[Report No. 116–691, Part I] 
A BILL 
To amend title XVIII of the Social Security Act to 
provide for patient improvements and rural and 
quality improvements under the Medicare pro-
gram. 
DECEMBER 24, 2020 
Reported from the Committee on Ways and Means with 
an amendment 
DECEMBER 24, 2020 
Committee on Energy and Commerce discharged; com-
mitted to the Committee of the Whole House on the 
State of the Union and ordered to be printed 
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