130 
SEC. 4. ENCOURAGING CARE MANAGEMENT FOR INDIVID-
UALS WITH CHRONIC CARE NEEDS. 
(a) IN GENERAL.—Section 1848(b) of the Social Se-
curity Act (42 U.S.C. 1395w–4(b)) is amended by adding 
at the end the following new paragraph: 
‘‘(8) ENCOURAGING
CARE
MANAGEMENT
FOR 
INDIVIDUALS WITH CHRONIC CARE NEEDS.— 
‘‘(A) IN GENERAL.—In order to encourage 
the management of care by an applicable pro-
vider (as defined in subparagraph (B)) for indi-
viduals with chronic care needs the Secretary 
shall— 
‘‘(i) establish one or more HCPCS 
codes for chronic care management serv-
ices for such individuals; and 
‘‘(ii) subject to subparagraph (D), 
make payment (as the Secretary deter-
mines to be appropriate) under this section 
for such management services furnished on 
or after January 1, 2015, by an applicable 
provider. 
‘‘(B) APPLICABLE PROVIDER DEFINED.— 
For purposes of this paragraph, the term ‘ap-
plicable provider’ means a physician (as defined 
in section 1861(r)(1)), physician assistant or 
nurse practitioner (as defined in section
131 
1861(aa)(5)(A)), or clinical nurse specialist (as 
defined in section 1861(aa)(5)(B)) who fur-
nishes services as part of a patient-centered 
medical home or a comparable specialty practice 
that— 
‘‘(i) is recognized as such a medical 
home or comparable specialty practice by 
an organization that is recognized by the 
Secretary for purposes of such recognition 
as such a medical home or practice; or 
‘‘(ii) meets such other comparable 
qualifications as the Secretary determines 
to be appropriate. 
‘‘(C) BUDGET NEUTRALITY.—The budget 
neutrality 
provision 
under 
subsection 
(c)(2)(B)(ii)(II) shall apply in establishing the 
payment under subparagraph (A)(ii). 
‘‘(D) POLICIES RELATING TO PAYMENT.— 
In carrying out this paragraph, with respect to 
chronic care management services, the Sec-
retary shall— 
‘‘(i) make payment to only one appli-
cable provider for such services furnished 
to an individual during a period;
132 
‘‘(ii) not make payment under sub-
paragraph (A) if such payment would be 
duplicative of payment that is otherwise 
made under this title for such services 
(such as in the case of hospice care or 
home health services); and 
‘‘(iii) not require that an annual 
wellness visit (as defined in section 
1861(hhh)) or an initial preventive phys-
ical examination (as defined in section 
1861(ww)) be furnished as a condition of 
payment for such management services.’’. 
(b) EDUCATION AND OUTREACH.— 
(1) CAMPAIGN.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services (in this subsection 
referred to as the ‘‘Secretary’’) shall conduct an 
education and outreach campaign to inform 
professionals who furnish items and services 
under part B of title XVIII of the Social Secu-
rity Act and individuals enrolled under such 
part of the benefits of chronic care management 
services described in section 1848(b)(8) of the 
Social Security Act, as added by subsection (a),
133 
and encourage such individuals with chronic 
care needs to receive such services. 
(B) 
REQUIREMENTS.—Such 
campaign 
shall— 
(i) be directed by the Office of Rural 
Health Policy of the Department of Health 
and Human Services and the Office of Mi-
nority Health of the Centers for Medicare 
& Medicaid Services; and 
(ii) focus on encouraging participation 
by underserved rural populations and ra-
cial and ethnic minority populations. 
(2) REPORT.— 
(A) IN GENERAL.—Not later than Decem-
ber 31, 2017, the Secretary shall submit to 
Congress a report on the use of chronic care 
management services described in such section 
1848(b)(8) by individuals living in rural areas 
and by racial and ethnic minority populations. 
Such report shall— 
(i) identify barriers to receiving chron-
ic care management services; and 
(ii) make recommendations for in-
creasing the appropriate use of chronic 
care management services.
134 
SEC. 5. ENSURING ACCURATE VALUATION OF SERVICES 
UNDER THE PHYSICIAN FEE SCHEDULE. 
(a) AUTHORITY TO COLLECT AND USE INFORMA-
TION ON PHYSICIANS’ SERVICES IN THE DETERMINATION 
OF RELATIVE VALUES.— 
(1) IN
GENERAL.—Section 1848(c)(2) of the 
Social Security Act (42 U.S.C. 1395w–4(c)(2)) is 
amended by adding at the end the following new 
subparagraph: 
‘‘(M) AUTHORITY TO COLLECT AND USE 
INFORMATION
ON
PHYSICIANS’ SERVICES
IN 
THE DETERMINATION OF RELATIVE VALUES.— 
‘‘(i) COLLECTION OF INFORMATION.— 
Notwithstanding any other provision of 
law, the Secretary may collect or obtain in-
formation on the resources directly or indi-
rectly related to furnishing services for 
which payment is made under the fee 
schedule established under subsection (b). 
Such information may be collected or ob-
tained from any eligible professional or any 
other source. 
‘‘(ii) USE
OF
INFORMATION.—Not-
withstanding any other provision of law, 
subject to clause (v), the Secretary may 
(as the Secretary determines appropriate)
135 
use information collected or obtained pur-
suant to clause (i) in the determination of 
relative values for services under this sec-
tion. 
‘‘(iii) TYPES OF INFORMATION.—The 
types of information described in clauses 
(i) and (ii) may, at the Secretary’s discre-
tion, include any or all of the following: 
‘‘(I) Time involved in furnishing 
services. 
‘‘(II) Amounts and types of prac-
tice expense inputs involved with fur-
nishing services. 
‘‘(III) Prices (net of any dis-
counts) for practice expense inputs, 
which may include paid invoice prices 
or other documentation or records. 
‘‘(IV) Overhead and accounting 
information for practices of physicians 
and other suppliers. 
‘‘(V) Any other element that 
would improve the valuation of serv-
ices under this section. 
‘‘(iv) 
INFORMATION
COLLECTION 
MECHANISMS.—Information may be col-
136 
lected or obtained pursuant to this sub-
paragraph from any or all of the following: 
‘‘(I) Surveys of physicians, other 
suppliers, providers of services, manu-
facturers, and vendors. 
‘‘(II) Surgical logs, billing sys-
tems, or other practice or facility 
records. 
‘‘(III) Electronic health records. 
‘‘(IV) Any other mechanism de-
termined appropriate by the Sec-
retary. 
‘‘(v) TRANSPARENCY OF USE OF IN-
FORMATION.— 
‘‘(I) IN
GENERAL.—Subject to 
subclauses (II) and (III), if the Sec-
retary uses information collected or 
obtained under this subparagraph in 
the determination of relative values 
under this subsection, the Secretary 
shall disclose the information source 
and discuss the use of such informa-
tion in such determination of relative 
values through notice and comment 
rulemaking.
137 
‘‘(II) THRESHOLDS FOR USE.— 
The Secretary may establish thresh-
olds in order to use such information, 
including the exclusion of information 
collected or obtained from eligible pro-
fessionals who use very high resources 
(as determined by the Secretary) in 
furnishing a service. 
‘‘(III) DISCLOSURE OF INFORMA-
TION.—The Secretary shall make ag-
gregate information available under 
this subparagraph but shall not dis-
close information in a form or manner 
that identifies an eligible professional 
or a group practice, or information 
collected or obtained pursuant to a 
nondisclosure agreement. 
‘‘(vi) INCENTIVE TO PARTICIPATE.— 
The Secretary may provide for such pay-
ments under this part to an eligible profes-
sional that submits such solicited informa-
tion under this subparagraph as the Sec-
retary determines appropriate in order to 
compensate such eligible professional for 
such submission. Such payments shall be
138 
provided in a form and manner specified 
by the Secretary. 
‘‘(vii) ADMINISTRATION.—Chapter 35 
of title 44, United States Code, shall not 
apply to information collected or obtained 
under this subparagraph. 
‘‘(viii) DEFINITION OF ELIGIBLE PRO-
FESSIONAL.—In this subparagraph, the 
term ‘eligible professional’ has the meaning 
given such term in subsection (k)(3)(B). 
‘‘(ix) FUNDING.—For purposes of car-
rying out this subparagraph, in addition to 
funds otherwise appropriated, the Sec-
retary shall provide for the transfer, from 
the Federal Supplementary Medical Insur-
ance Trust Fund under section 1841, of 
$2,000,000 to the Centers for Medicare & 
Medicaid Services Program Management 
Account for each fiscal year beginning with 
fiscal year 2014. Amounts transferred 
under the preceding sentence for a fiscal 
year shall be available until expended.’’. 
(2) 
LIMITATION
ON
REVIEW.—Section 
1848(i)(1) of the Social Security Act (42 U.S.C. 
1395w–4(i)(1)) is amended—
139 
(A) in subparagraph (D), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (E), by striking the 
period at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(F) the collection and use of information 
in the determination of relative values under 
subsection (c)(2)(M).’’. 
(b) AUTHORITY FOR ALTERNATIVE APPROACHES TO 
ESTABLISHING
PRACTICE
EXPENSE
RELATIVE
VAL-
UES.—Section 1848(c)(2) of the Social Security Act (42 
U.S.C. 1395w–4(c)(2)), as amended by subsection (a), is 
amended by adding at the end the following new subpara-
graph: 
‘‘(N) AUTHORITY FOR ALTERNATIVE AP-
PROACHES
TO
ESTABLISHING
PRACTICE
EX-
PENSE RELATIVE VALUES.—The Secretary may 
establish or adjust practice expense relative val-
ues under this subsection using cost, charge, or 
other data from suppliers or providers of serv-
ices, including information collected or obtained 
under subparagraph (M).’’. 
(c) REVISED AND EXPANDED IDENTIFICATION OF 
POTENTIALLY
MISVALUED
CODES.—Section
140 
1848(c)(2)(K)(ii) of the Social Security Act (42 U.S.C. 
1395w–4(c)(2)(K)(ii)) is amended to read as follows: 
‘‘(ii) 
IDENTIFICATION
OF
POTEN-
TIALLY MISVALUED CODES.—For purposes 
of identifying potentially misvalued codes 
pursuant to clause (i)(I), the Secretary 
shall examine codes (and families of codes 
as appropriate) based on any or all of the 
following criteria: 
‘‘(I) Codes that have experienced 
the fastest growth. 
‘‘(II) Codes that have experi-
enced substantial changes in practice 
expenses. 
‘‘(III) Codes that describe new 
technologies or services within an ap-
propriate time period (such as 3 
years) after the relative values are ini-
tially established for such codes. 
‘‘(IV) Codes which are multiple 
codes that are frequently billed in con-
junction with furnishing a single serv-
ice. 
‘‘(V) Codes with low relative val-
ues, particularly those that are often
141 
billed multiple times for a single treat-
ment. 
‘‘(VI) Codes that have not been 
subject to review since implementation 
of the fee schedule. 
‘‘(VII) Codes that account for 
the majority of spending under the 
physician fee schedule. 
‘‘(VIII) Codes for services that 
have experienced a substantial change 
in the hospital length of stay or proce-
dure time. 
‘‘(IX) Codes for which there may 
be a change in the typical site of serv-
ice since the code was last valued. 
‘‘(X) Codes for which there is a 
significant difference in payment for 
the same service between different 
sites of service. 
‘‘(XI) Codes for which there may 
be anomalies in relative values within 
a family of codes. 
‘‘(XII) Codes for services where 
there may be efficiencies when a serv-