190 
‘‘(I) the patient’s clinical 
problems at the time items 
and services are furnished 
during an episode of care, 
such as the clinical conditions 
or diagnoses, whether or not 
inpatient 
hospitalization 
is 
anticipated or occurs, and the 
principal procedures or serv-
ices 
planned 
or 
furnished; 
and 
‘‘(II) other factors deter-
mined appropriate by the Sec-
retary. 
‘‘(iii) 
PATIENT
CONDITION 
GROUPS.—In establishing the pa-
tient 
condition 
groups 
under 
clause (i), the Secretary shall take 
into account— 
‘‘(I) the patient’s clinical 
history at the time of each 
medical visit, such as the pa-
tient’s combination of chronic 
conditions, current health sta-
tus, and recent significant his-
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tory (such as hospitalization 
and major surgery during a 
previous period, such as 3 
months); and 
‘‘(II) other factors deter-
mined appropriate by the Sec-
retary, such as eligibility sta-
tus under this title (including 
eligibility 
under 
section 
226(a), 226(b), or 226A, and 
dual eligibility under this title 
and title XIX). 
‘‘(E) DRAFT CARE EPISODE AND PA-
TIENT
CONDITION
GROUPS
AND
CLASSI-
FICATION
CODES.—Not later than 120 
days after the end of the comment pe-
riod described in subparagraph (C), 
the Secretary shall post on the Inter-
net website of the Centers for Medi-
care & Medicaid Services a draft list 
of the care episode and patient condi-
tion codes established under subpara-
graph (D) (and the criteria and char-
acteristics assigned to such code). 
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‘‘(F) SOLICITATION
OF
INPUT.—The 
Secretary shall seek, through the date 
that is 60 days after the Secretary 
posts the list pursuant to subpara-
graph (E), comments from physician 
specialty societies, applicable practi-
tioner organizations, and other stake-
holders, including representatives of 
individuals entitled to benefits under 
part A or enrolled under this part, re-
garding the care episode and patient 
condition groups (and codes) posted 
under subparagraph (E). In seeking 
such comments, the Secretary shall 
use one or more mechanisms (other 
than 
notice 
and 
comment 
rule-
making) that may include use of open 
door forums, town hall meetings, or 
other appropriate mechanisms. 
‘‘(G) OPERATIONAL
LIST
OF
CARE 
EPISODE
AND
PATIENT
CONDITION 
GROUPS
AND
CODES.—Not later than 
120 days after the end of the com-
ment period described in subpara-
graph (F), taking into account the 
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comments received under such sub-
paragraph, the Secretary shall post 
on the Internet website of the Cen-
ters for Medicare & Medicaid Serv-
ices an operational list of care epi-
sode and patient condition codes (and 
the criteria and characteristics as-
signed to such code). 
‘‘(H) SUBSEQUENT
REVISIONS.—Not 
later than November 1 of each year 
(beginning with 2016), the Secretary 
shall, through rulemaking, make revi-
sions to the operational lists of care 
episode and patient condition codes 
as the Secretary determines may be 
appropriate. Such revisions may be 
based on experience, new information 
developed 
pursuant 
to 
subsection 
(n)(9)(A), and input from the physi-
cian specialty societies, applicable 
practitioner organizations, and other 
stakeholders, including representa-
tives of individuals entitled to bene-
fits under part A or enrolled under 
this part. 
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‘‘(3) ATTRIBUTION OF PATIENTS TO PHY-
SICIANS OR PRACTITIONERS.— 
‘‘(A) IN GENERAL.—In order to fa-
cilitate the attribution of patients 
and episodes (in whole or in part) to 
one or more physicians or applicable 
practitioners furnishing items and 
services, the Secretary shall under-
take the steps described in the suc-
ceeding provisions of this paragraph. 
‘‘(B) DEVELOPMENT OF PATIENT RE-
LATIONSHIP
CATEGORIES
AND
CODES.— 
The Secretary shall develop patient 
relationship 
categories 
and 
codes 
that define and distinguish the rela-
tionship and responsibility of a physi-
cian or applicable practitioner with a 
patient at the time of furnishing an 
item or service. Such patient relation-
ship categories shall include different 
relationships of the physician or ap-
plicable practitioner to the patient 
(and the codes may reflect combina-
tions of such categories), such as a 
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physician or applicable practitioner 
who— 
‘‘(i) considers themself to have 
the primary responsibility for the 
general and ongoing care for the 
patient over extended periods of 
time; 
‘‘(ii) considers themself to be 
the lead physician or practitioner 
and who furnishes items and 
services and coordinates care fur-
nished by other physicians or 
practitioners for the patient dur-
ing an acute episode; 
‘‘(iii) furnishes items and serv-
ices to the patient on a con-
tinuing basis during an acute epi-
sode of care, but in a supportive 
rather than a lead role; 
‘‘(iv) furnishes items and serv-
ices to the patient on an occa-
sional basis, usually at the re-
quest of another physician or 
practitioner; or 
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‘‘(v) furnishes items and serv-
ices only as ordered by another 
physician or practitioner. 
‘‘(C) DRAFT LIST OF PATIENT RELA-
TIONSHIP CATEGORIES AND CODES.—Not 
later than 180 days after the date of 
the enactment of this subsection, the 
Secretary shall post on the Internet 
website of the Centers for Medicare & 
Medicaid Services a draft list of the 
patient relationship categories and 
codes developed under subparagraph 
(B). 
‘‘(D) 
STAKEHOLDER
INPUT.—The 
Secretary shall seek, through the date 
that is 60 days after the Secretary 
posts the list pursuant to subpara-
graph (C), comments from physician 
specialty societies, applicable practi-
tioner organizations, and other stake-
holders, including representatives of 
individuals entitled to benefits under 
part A or enrolled under this part, re-
garding the patient relationship cat-
egories and codes posted under sub-
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paragraph (C). In seeking such com-
ments, the Secretary shall use one or 
more mechanisms (other than notice 
and comment rulemaking) that may 
include open door forums, town hall 
meetings, or other appropriate mech-
anisms. 
‘‘(E) OPERATIONAL LIST OF PATIENT 
RELATIONSHIP
CATEGORIES
AND 
CODES.—Not later than 120 days after 
the end of the comment period de-
scribed in subparagraph (D), taking 
into account the comments received 
under such subparagraph, the Sec-
retary shall post on the Internet 
website of the Centers for Medicare & 
Medicaid Services an operational list 
of patient relationship categories and 
codes. 
‘‘(F) SUBSEQUENT
REVISIONS.—Not 
later than November 1 of each year 
(beginning with 2016), the Secretary 
shall, through rulemaking, make revi-
sions to the operational list of patient 
relationship categories and codes as 
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the 
Secretary 
determines 
appro-
priate. Such revisions may be based 
on experience, new information de-
veloped 
pursuant 
to 
subsection 
(n)(9)(A), and input from the physi-
cian specialty societies, applicable 
practitioner organizations, and other 
stakeholders, including representa-
tives of individuals entitled to bene-
fits under part A or enrolled under 
this part. 
‘‘(4) REPORTING
OF
INFORMATION
FOR 
RESOURCE USE MEASUREMENT.—Claims sub-
mitted for items and services furnished 
by a physician or applicable practitioner 
on or after January 1, 2016, shall, as de-
termined appropriate by the Secretary, 
include— 
‘‘(A) applicable codes established 
under paragraphs (2) and (3); and 
‘‘(B) the national provider identi-
fier of the ordering physician or ap-
plicable 
practitioner 
(if 
different 
from the billing physician or applica-
ble practitioner). 
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‘‘(5) METHODOLOGY FOR RESOURCE USE 
ANALYSIS.— 
‘‘(A) IN
GENERAL.—In order to 
evaluate the resources used to treat 
patients (with respect to care episode 
and patient condition groups), the 
Secretary shall— 
‘‘(i) use the patient relation-
ship codes reported on claims 
pursuant to paragraph (4) to at-
tribute patients (in whole or in 
part) to one or more physicians 
and applicable practitioners; 
‘‘(ii) use the care episode and 
patient condition codes reported 
on claims pursuant to paragraph 
(4) as a basis to compare similar 
patients and care episodes and 
patient condition groups; and 
‘‘(iii) conduct an analysis of 
resource use (with respect to care 
episodes and patient condition 
groups of such patients), as the 
Secretary 
determines 
appro-
priate. 
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‘‘(B) ANALYSIS OF PATIENTS OF PHY-
SICIANS
AND
PRACTITIONERS.—In con-
ducting the analysis described in sub-
paragraph (A)(iii) with respect to pa-
tients attributed to physicians and 
applicable 
practitioners, 
the 
Sec-
retary shall, as feasible— 
‘‘(i) use the claims data expe-
rience of such patients by patient 
condition codes during a common 
period, such as 12 months; and 
‘‘(ii) use the claims data expe-
rience of such patients by care 
episode codes— 
‘‘(I) in the case of episodes 
without 
a 
hospitalization, 
during periods of time (such 
as the number of days) deter-
mined appropriate by the Sec-
retary; and 
‘‘(II) in the case of epi-
sodes with a hospitalization, 
during periods of time (such 
as the number of days) before, 
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during, and after the hos-
pitalization. 
‘‘(C) MEASUREMENT
OF
RESOURCE 
USE.—In 
measuring 
such 
resource 
use, the Secretary— 
‘‘(i) shall use per patient total 
allowed amounts for all services 
under part A and this part (and, if 
the Secretary determines appro-
priate, part D) for the analysis of 
patient resource use, by care epi-
sode codes and by patient condi-
tion codes; and 
‘‘(ii) may, as determined ap-
propriate, use other measures of 
allowed amounts (such as sub-
totals for categories of items and 
services) and measures of utiliza-
tion of items and services (such as 
frequency of specific items and 
services and the ratio of specific 
items and services among attrib-
uted patients or episodes). 
‘‘(D) 
STAKEHOLDER
INPUT.—The 
Secretary shall seek comments from 
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the physician specialty societies, ap-
plicable practitioner organizations, 
and 
other 
stakeholders, 
including 
representatives of individuals enti-
tled to benefits under part A or en-
rolled under this part, regarding the 
resource use methodology established 
pursuant to this paragraph. In seek-
ing comments the Secretary shall use 
one or more mechanisms (other than 
notice and comment rulemaking) that 
may include open door forums, town 
hall meetings, or other appropriate 
mechanisms. 
‘‘(6) LIMITATION.—There shall be no 
administrative or judicial review under 
section 1869, section 1878, or otherwise 
of— 
‘‘(A) care episode and patient con-
dition groups and codes established 
under paragraph (2); 
‘‘(B) 
patient 
relationship 
cat-
egories and codes established under 
paragraph (3); and 
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‘‘(C) measurement of, and anal-
yses of resource use with respect to, 
care episode and patient condition 
codes and patient relationship codes 
pursuant to paragraph (5). 
‘‘(7) ADMINISTRATION.—Chapter 35 of 
title 44, United States Code, shall not 
apply to this section. 
‘‘(8) DEFINITIONS.—In this section: 
‘‘(A) PHYSICIAN.—The term ‘physi-
cian’ has the meaning given such 
term in section 1861(r)(1). 
‘‘(B) APPLICABLE
PRACTITIONER.— 
The 
term 
‘applicable 
practitioner’ 
means— 
‘‘(i) 
a 
physician 
assistant, 
nurse practitioner, and clinical 
nurse specialist (as such terms 
are 
defined 
in 
section 
1861(aa)(5)); and 
‘‘(ii) 
beginning 
January 
1, 
2017, such other eligible profes-
sionals (as defined in subsection 
(k)(3)(B)) as specified by the Sec-
retary. 
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‘‘(9) CLARIFICATION.—The provisions of 
sections 1890(b)(7) and 1890A shall not 
apply to this subsection.’’. 
SEC. 3. PRIORITIES AND FUNDING FOR QUALITY MEASURE 
DEVELOPMENT. 
Section 1848 of the Social Security Act (42 
U.S.C. 1395w–4), as amended by subsections 
(c) and (h) of section 2, is further amended by 
inserting at the end the following new sub-
section: 
‘‘(s) PRIORITIES AND FUNDING FOR QUALITY 
MEASURE DEVELOPMENT.— 
‘‘(1) PLAN IDENTIFYING MEASURE DEVEL-
OPMENT PRIORITIES AND TIMELINES.— 
‘‘(A) DRAFT MEASURE DEVELOPMENT 
PLAN.— 
‘‘(i) DRAFT PLAN.— 
‘‘(I) IN GENERAL.—Not later 
than October 1, 2014, the Sec-
retary shall develop, and post 
on the Internet website of the 
Centers for Medicare & Med-
icaid Services, a draft plan for 
the development of quality 
measures 
for 
application 
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under the applicable provi-
sions. 
‘‘(II) REQUIREMENT.—Such 
plan shall address how meas-
ures used by private payers 
and integrated delivery sys-
tems could be incorporated 
under such subsection. 
‘‘(ii) CONSIDERATION.—In devel-
oping the draft plan under sub-
paragraph (A), the Secretary shall 
consider— 
‘‘(I) 
gap 
analyses 
con-
ducted by the entity with a 
contract under section 1890(a) 
or other contractors or enti-
ties; and 
‘‘(II) 
whether 
measures 
are applicable across health 
care settings. 
‘‘(iii) 
PRIORITIES.—In 
devel-
oping the draft plan under sub-
paragraph (A), the Secretary shall 
give priority to the following 
types of measures: 
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‘‘(I) Outcome measures in-
cluding patient reported out-
come and functional status 
measures. 
‘‘(II) 
Patient 
experience 
measures. 
‘‘(III) 
Care 
coordination 
measures. 
‘‘(IV) Measures of appro-
priate use of services, includ-
ing measures of over use. 
‘‘(iv) DEFINITION OF APPLICABLE 
PROVISIONS.—In this subsection, 
the term ‘applicable provisions’ 
means the following provisions: 
‘‘(I) Subsection (q)(2)(B)(i). 
‘‘(II) Section 1833(z)(2)(C). 
‘‘(B) 
STAKEHOLDER
INPUT.—The 
Secretary shall accept through De-
cember 1, 2014, comments on the 
draft plan posted under paragraph 
(1)(A) 
from 
the 
public, 
including 
health care providers, payers, con-
sumers, and other stakeholders. 
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‘‘(C) OPERATIONAL MEASURE DEVEL-
OPMENT
PLAN.—Not later than Feb-
ruary 1, 2015, taking into account the 
comments received under subpara-
graph (B), the Secretary shall post on 
the Internet website of the Centers 
for Medicare & Medicaid Services an 
operational plan for the development 
of quality measures for use under 
subsection (q)(2)(A)(i). 
‘‘(2) CONTRACTS
AND
OTHER
ARRANGE-
MENTS
FOR
QUALITY
MEASURE
DEVELOP-
MENT.— 
‘‘(A) IN
GENERAL.—The Secretary 
shall enter into contracts or other ar-
rangements with entities for the pur-
pose of developing, improving, updat-
ing, or expanding quality measures 
for application under the applicable 
provisions. Such entities may include 
physician 
specialty 
societies 
and 
other practitioner organizations. 
‘‘(B) PRIORITIZATION.— 
‘‘(i) IN
GENERAL.—In entering 
into contracts or other arrange-
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ments under subparagraph (A), 
the Secretary shall give priority 
to the development of the types of 
measures described in paragraph 
(1)(A)(iii). 
‘‘(ii) 
CONSIDERATION.—In 
se-
lecting measures for development 
under this subsection, the Sec-
retary 
shall 
consider 
whether 
such measures would be elec-
tronically specified. 
‘‘(3) ANNUAL
REPORT
BY
THE
SEC-
RETARY.— 
‘‘(A) IN GENERAL.—Not later than 
February 1, 2016, and annually there-
after, the Secretary shall post on the 
Internet website of the Centers for 
Medicare & Medicaid Services a re-
port on the progress made in devel-
oping quality measures for applica-
tion under the applicable provisions. 
‘‘(B) REQUIREMENTS.—Each report 
submitted pursuant to paragraph (1) 
shall include the following: 
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‘‘(i) A description of the Sec-
retary’s efforts to implement this 
subsection. 
‘‘(ii) With respect to the meas-
ures developed during the pre-
vious year— 
‘‘(I) a description of the 
total number of quality meas-
ures developed and the types 
of such measures, such as an 
outcome or patient experi-
ence measure; 
‘‘(II) the name of each 
measure developed; 
‘‘(III) the name of the de-
veloper and steward of each 
measure; 
‘‘(IV) with respect to each 
type of measure, an estimate 
of the total amount expended 
under this title to develop all 
measures of such type; and 
‘‘(V) whether the measure 
would be electronically speci-
fied. 
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‘‘(iii) With respect to measures 
in development at the time of the 
report— 
‘‘(I) the information de-
scribed in clause (ii), if avail-
able; and 
‘‘(II) a timeline for comple-
tion of the development of 
such measures. 
‘‘(iv) 
An 
update 
on 
the 
progress in developing the types 
of measures described in para-
graph (1)(A)(iii), including a de-
scription of issues affecting such 
progress. 
‘‘(v) A list of quality topics 
and concepts that are being con-
sidered for development of meas-
ures and the rationale for the se-
lection of topics and concepts in-
cluding their relationship to gap 
analyses. 
‘‘(vi) A description of any up-
dates to the plan under para-
graph (1) (including newly identi-
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fied gaps and the status of pre-
viously identified gaps) and the 
inventory of measures applicable 
under the applicable provisions. 
‘‘(vii) Other information the 
Secretary determines to be appro-
priate. 
‘‘(4) STAKEHOLDER
INPUT.—With re-
spect to measures applicable under the 
applicable provisions, the Secretary shall 
seek stakeholder input with respect to— 
‘‘(A) the identification of gaps 
where no quality measures exist, par-
ticularly with respect to the types of 
measures 
described 
in 
paragraph 
(1)(A)(iii); 
‘‘(B) prioritizing quality measure 
development to address such gaps; 
and 
‘‘(C) other areas related to quality 
measure development determined ap-
propriate by the Secretary. 
‘‘(5) FUNDING.—For purposes of car-
rying out this subsection, the Secretary 
shall provide for the transfer, from the 
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Federal Supplementary Medical Insur-
ance Trust Fund under section 1841, of 
$15,000,000 to the Centers for Medicare & 
Medicaid Services Program Management 
Account for each of fiscal years 2014 
through 2018. Amounts transferred under 
this paragraph shall remain available 
through the end of fiscal year 2021.’’. 
SEC. 4. ENCOURAGING CARE MANAGEMENT FOR INDIVID-
UALS WITH CHRONIC CARE NEEDS. 
Section 1848(b) of the Social Security 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 en-
courage the management of care by 
an applicable provider (as defined in 
subparagraph 
(B)) 
for 
individuals 
with chronic care needs the Sec-
retary shall— 
‘‘(i) establish one or more 
HCPCS codes for chronic care 
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management services for such in-
dividuals; and 
‘‘(ii) subject to subparagraph 
(D), make payment (as the Sec-
retary determines to be appro-
priate) under this section for such 
management services furnished 
on or after January 1, 2015, by an 
applicable provider. 
‘‘(B) 
APPLICABLE
PROVIDER
DE-
FINED.—For purposes of this para-
graph, the term ‘applicable provider’ 
means a physician (as defined in sec-
tion 1861(r)(1)), physician assistant or 
nurse practitioner (as defined in sec-
tion 1861(aa)(5)(A)), or clinical nurse 
specialist 
(as 
defined 
in 
section 
1861(aa)(5)(B)) who furnishes services 
as part of a patient-centered medical 
home or a comparable specialty prac-
tice that— 
‘‘(i) is recognized as such a 
medical home or comparable spe-
cialty practice by an organization 
that is recognized by the Sec-
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214 
retary for purposes of such rec-
ognition as such a medical home 
or practice; or 
‘‘(ii) meets such other com-
parable qualifications as the Sec-
retary determines to be appro-
priate. 
‘‘(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
PAY-
MENT.—In carrying out this para-
graph, with respect to chronic care 
management services, the Secretary 
shall— 
‘‘(i) make payment to only one 
applicable provider for such serv-
ices furnished to an individual 
during a period; 
‘‘(ii) not make payment under 
subparagraph (A) if such payment 
would be duplicative of payment 
that is otherwise made under this 
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title for such services (such as in 
the case of hospice care or home 
health services); and 
‘‘(iii) not require that an an-
nual wellness visit (as defined in 
section 1861(hhh)) or an initial 
preventive physical examination 
(as defined in section 1861(ww)) 
be furnished as a condition of 
payment for such management 
services.’’. 
SEC. 5. ENSURING ACCURATE VALUATION OF SERVICES 
UNDER THE PHYSICIAN FEE SCHEDULE. 
(a) AUTHORITY TO COLLECT AND USE INFOR-
MATION ON PHYSICIANS’ SERVICES IN THE DETER-
MINATION 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’ SERV-
ICES
IN
THE
DETERMINATION
OF
REL-
ATIVE VALUES.— 
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‘‘(i) COLLECTION
OF
INFORMA-
TION.—Notwithstanding any other 
provision of law, the Secretary 
may collect or obtain information 
on the resources directly or indi-
rectly related to furnishing serv-
ices for which payment is made 
under the fee schedule estab-
lished under subsection (b). Such 
information may be collected or 
obtained from any eligible profes-
sional or any other source. 
‘‘(ii) USE
OF
INFORMATION.— 
Notwithstanding any other provi-
sion of law, subject to clause (v), 
the Secretary may (as the Sec-
retary 
determines 
appropriate) 
use information collected or ob-
tained pursuant to clause (i) in 
the determination of relative val-
ues for services under this sec-
tion. 
‘‘(iii) TYPES OF INFORMATION.— 
The 
types 
of 
information 
de-
scribed in clauses (i) and (ii) may, 
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at the Secretary’s discretion, in-
clude any or all of the following: 
‘‘(I) Time involved in fur-
nishing services. 
‘‘(II) Amounts and types of 
practice expense inputs in-
volved with furnishing serv-
ices. 
‘‘(III) Prices (net of any 
discounts) 
for 
practice 
ex-
pense inputs, which may in-
clude paid invoice prices or 
other 
documentation 
or 
records. 
‘‘(IV) Overhead and ac-
counting 
information 
for 
practices of physicians and 
other suppliers. 
‘‘(V) Any other element 
that would improve the valu-
ation of services under this 
section. 
‘‘(iv) INFORMATION COLLECTION 
MECHANISMS.—Information may be 
collected or obtained pursuant to 
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this subparagraph from any or all 
of the following: 
‘‘(I) Surveys of physicians, 
other suppliers, providers of 
services, manufacturers, and 
vendors. 
‘‘(II) Surgical logs, billing 
systems, or other practice or 
facility records. 
‘‘(III) 
Electronic 
health 
records. 
‘‘(IV) Any other mecha-
nism determined appropriate 
by the Secretary. 
‘‘(v) TRANSPARENCY OF USE OF 
INFORMATION.— 
‘‘(I) IN
GENERAL.—Subject 
to subclauses (II) and (III), if 
the Secretary uses informa-
tion 
collected 
or 
obtained 
under this subparagraph in 
the determination of relative 
values under this subsection, 
the Secretary shall disclose 
the information source and 
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discuss the use of such infor-
mation in such determination 
of relative values through no-
tice and comment rulemaking. 
‘‘(II) 
THRESHOLDS
FOR 
USE.—The Secretary may es-
tablish thresholds in order to 
use such information, includ-
ing the exclusion of informa-
tion 
collected 
or 
obtained 
from 
eligible 
professionals 
who use very high resources 
(as determined by the Sec-
retary) in furnishing a serv-
ice. 
‘‘(III) DISCLOSURE
OF
IN-
FORMATION.—The 
Secretary 
shall make aggregate informa-
tion available under this sub-
paragraph but shall not dis-
close information in a form or 
manner that identifies an eli-
gible professional or a group 
practice, or information col-
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lected or obtained pursuant 
to a nondisclosure agreement. 
‘‘(vi) INCENTIVE
TO
PARTICI-
PATE.—The Secretary may provide 
for such payments under this part 
to an eligible professional that 
submits such solicited informa-
tion under this subparagraph as 
the Secretary determines appro-
priate in order to compensate 
such eligible professional for such 
submission. Such payments shall 
be provided in a form and man-
ner specified by the Secretary. 
‘‘(vii) ADMINISTRATION.—Chap-
ter 35 of title 44, United States 
Code, shall not apply to informa-
tion collected or obtained under 
this subparagraph. 
‘‘(viii) DEFINITION OF ELIGIBLE 
PROFESSIONAL.—In this subpara-
graph, the term ‘eligible profes-
sional’ has the meaning given 
such term in subsection (k)(3)(B). 
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‘‘(ix) FUNDING.—For purposes 
of carrying out this subpara-
graph, in addition to funds other-
wise appropriated, the Secretary 
shall provide for the transfer, 
from the Federal Supplementary 
Medical Insurance Trust Fund 
under section 1841, of $2,000,000 
to the Centers for Medicare & 
Medicaid Services Program Man-
agement Account for each fiscal 
year beginning with fiscal year 
2014. Amounts transferred under 
the preceding sentence for a fis-
cal 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— 
(A) in subparagraph (D), by strik-
ing ‘‘and’’ at the end; 
(B) in subparagraph (E), by strik-
ing the period at the end and insert-
ing ‘‘, and’’; and 
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(C) by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) the collection and use of in-
formation in the determination of rel-
ative 
values 
under 
subsection 
(c)(2)(M).’’. 
(b) 
AUTHORITY
FOR
ALTERNATIVE
AP-
PROACHES TO ESTABLISHING PRACTICE EXPENSE 
RELATIVE VALUES.—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 
APPROACHES TO ESTABLISHING PRACTICE 
EXPENSE
RELATIVE
VALUES.—The Sec-
retary may establish or adjust prac-
tice expense relative values under 
this subsection using cost, charge, or 
other data from suppliers or pro-
viders of services, including informa-
tion collected or obtained under sub-
paragraph (M).’’. 
(c) REVISED AND EXPANDED IDENTIFICATION 
OF POTENTIALLY MISVALUED CODES.—Section 
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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 poten-
tially 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 cri-
teria: 
‘‘(I) Codes that have expe-
rienced the fastest growth. 
‘‘(II) Codes that have expe-
rienced substantial changes 
in practice expenses. 
‘‘(III) Codes that describe 
new technologies or services 
within an appropriate time 
period (such as 3 years) after 
the relative values are ini-
tially 
established 
for 
such 
codes. 
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‘‘(XVI) 
Codes 
as 
deter-
mined appropriate by the Sec-
retary.’’. 
(d) TARGET FOR RELATIVE VALUE ADJUST-
MENTS FOR MISVALUED SERVICES.— 
(1) IN GENERAL.—Section 1848(c)(2) of 
the Social Security Act (42 U.S.C. 1395w– 
4(c)(2)), as amended by subsections (a) 
and (b), is amended by adding at the end 
the following new subparagraph: 
‘‘(O) TARGET
FOR
RELATIVE
VALUE 
ADJUSTMENTS
FOR
MISVALUED
SERV-
ICES.—With respect to fee schedules 
established for each of 2015 through 
2018, the following shall apply: 
‘‘(i) DETERMINATION OF NET RE-
DUCTION
IN
EXPENDITURES.—For 
each year, the Secretary shall de-
termine the estimated net reduc-
tion in expenditures under the fee 
schedule under this section with 
respect to the year as a result of 
adjustments to the relative values 
established under this paragraph 
for misvalued codes. 
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‘‘(ii) BUDGET
NEUTRAL
REDIS-
TRIBUTION OF FUNDS IF TARGET MET 
AND COUNTING OVERAGES TOWARDS 
THE
TARGET
FOR
THE
SUCCEEDING 
YEAR.—If the estimated net reduc-
tion in expenditures determined 
under clause (i) for the year is 
equal to or greater than the tar-
get for the year— 
‘‘(I) reduced expenditures 
attributable to such adjust-
ments shall be redistributed 
for the year in a budget neu-
tral manner in accordance 
with subparagraph (B)(ii)(II); 
and 
‘‘(II) the amount by which 
such 
reduced 
expenditures 
exceeds the target for the 
year shall be treated as a re-
duction in expenditures de-
scribed in clause (i) for the 
succeeding year, for purposes 
of determining whether the 
target has or has not been 
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met under this subparagraph 
with respect to that year. 
‘‘(iii) EXEMPTION FROM BUDGET 
NEUTRALITY IF TARGET NOT MET.—If 
the estimated net reduction in ex-
penditures 
determined 
under 
clause (i) for the year is less than 
the target for the year, reduced 
expenditures in an amount equal 
to the target recapture amount 
shall not be taken into account in 
applying subparagraph (B)(ii)(II) 
with respect to fee schedules be-
ginning with 2015. 
‘‘(iv) 
TARGET
RECAPTURE 
AMOUNT.—For purposes of clause 
(iii), the target recapture amount 
is, with respect to a year, an 
amount equal to the difference 
between— 
‘‘(I) the target for the year; 
and 
‘‘(II) the estimated net re-
duction in expenditures deter-
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mined under clause (i) for the 
year. 
‘‘(v) TARGET.—For purposes of 
this subparagraph, with respect 
to a year, the target is calculated 
as 0.5 percent of the estimated 
amount of expenditures under the 
fee schedule under this section 
for the year.’’. 
(2) CONFORMING AMENDMENT.—Section 
1848(c)(2)(B)(v) of the Social Security Act 
(42 U.S.C. 1395w–4(c)(2)(B)(v)) is amended 
by adding at the end the following new 
subclause: 
‘‘(VIII) 
REDUCTIONS
FOR 
MISVALUED SERVICES IF TARGET 
NOT
MET.—Effective for fee 
schedules 
beginning 
with 
2015, 
reduced 
expenditures 
attributable to the application 
of 
the 
target 
recapture 
amount described in subpara-
graph (O)(iii).’’. 
(e) PHASE-IN
OF
SIGNIFICANT
RELATIVE 
VALUE UNIT (RVU) REDUCTIONS.— 
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(1) IN GENERAL.—Section 1848(c) of the 
Social Security Act (42 U.S.C. 1395w–4(c)) 
is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(7) PHASE-IN OF SIGNIFICANT RELATIVE 
VALUE
UNIT
(RVU)
REDUCTIONS.—Effective 
for fee schedules established beginning 
with 2015, if the total relative value units 
for a service for a year would otherwise 
be decreased by an estimated amount 
equal to or greater than 20 percent as 
compared to the total relative value units 
for the previous year, the applicable ad-
justments in work, practice expense, and 
malpractice relative value units shall be 
phased-in over a 2-year period.’’. 
(2) 
CONFORMING
AMENDMENTS.—Sec-
tion 1848(c)(2) of the Social Security Act 
(42 U.S.C. 1395w–4(c)(2)) is amended— 
(A) in subparagraph (B)(ii)(I), by 
striking ‘‘subclause (II)’’ and inserting 
‘‘subclause (II) and paragraph (7)’’; 
and 
(B) in subparagraph (K)(iii)(VI)— 
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(i) by striking ‘‘provisions of 
subparagraph (B)(ii)(II)’’ and in-
serting ‘‘provisions of subpara-
graph (B)(ii)(II) and paragraph 
(7)’’; and 
(ii) by striking ‘‘under sub-
paragraph (B)(ii)(II)’’ and insert-
ing 
‘‘under 
subparagraph 
(B)(ii)(I)’’. 
(f) AUTHORITY TO SMOOTH RELATIVE VAL-
UES
WITHIN
GROUPS
OF
SERVICES.—Section 
1848(c)(2)(C) of the Social Security Act (42 
U.S.C. 1395w–4(c)(2)(C)) is amended— 
(1) in each of clauses (i) and (iii), by 
striking ‘‘the service’’ and inserting ‘‘the 
service or group of services’’ each place it 
appears; and 
(2) in the first sentence of clause (ii), 
by inserting ‘‘or group of services’’ before 
the period. 
(g) GAO STUDY AND REPORT ON RELATIVE 
VALUE SCALE UPDATE COMMITTEE.— 
(1) STUDY.—The Comptroller General 
of the United States (in this subsection 
referred to as the ‘‘Comptroller General’’) 
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shall conduct a study of the processes 
used by the Relative Value Scale Update 
Committee 
(RUC) 
to 
provide 
rec-
ommendations to the Secretary of Health 
and Human Services regarding relative 
values for specific services under the 
Medicare physician fee schedule under 
section 1848 of the Social Security Act (42 
U.S.C. 1395w–4). 
(2) REPORT.—Not later than 1 year 
after the date of the enactment of this 
Act, the Comptroller General shall submit 
to Congress a report containing the re-
sults of the study conducted under para-
graph (1). 
(h) ADJUSTMENT TO MEDICARE PAYMENT LO-
CALITIES.— 
(1) IN GENERAL.—Section 1848(e) of the 
Social Security Act (42 U.S.C. 1395w–4(e)) 
is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(6) USE
OF
MSAS
AS
FEE
SCHEDULE 
AREAS IN CALIFORNIA.— 
‘‘(A) IN
GENERAL.—Subject to the 
succeeding provisions of this para-
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graph and notwithstanding the pre-
vious provisions of this subsection, 
for services furnished on or after Jan-
uary 1, 2017, the fee schedule areas 
used for payment under this section 
applicable to California shall be the 
following: 
‘‘(i) Each Metropolitan Statis-
tical Area (each in this paragraph 
referred to as an ‘MSA’), as de-
fined by the Director of the Office 
of Management and Budget as of 
December 31 of the previous year, 
shall be a fee schedule area. 
‘‘(ii) All areas not included in 
an MSA shall be treated as a sin-
gle rest-of-State fee schedule area. 
‘‘(B) TRANSITION
FOR
MSAS
PRE-
VIOUSLY IN REST-OF-STATE PAYMENT LO-
CALITY OR IN LOCALITY 3.— 
‘‘(i) IN GENERAL.—For services 
furnished in California during a 
year beginning with 2017 and 
ending with 2021 in an MSA in a 
transition area (as defined in sub-
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paragraph (D)), subject to sub-
paragraph (C), the geographic 
index values to be applied under 
this subsection for such year shall 
be equal to the sum of the fol-
lowing: 
‘‘(I) CURRENT
LAW
COMPO-
NENT.—The old weighting fac-
tor (described in clause (ii)) 
for such year multiplied by 
the geographic index values 
under this subsection for the 
fee schedule area that in-
cluded such MSA that would 
have applied in such area (as 
estimated by the Secretary) if 
this paragraph did not apply. 
‘‘(II) 
MSA-BASED
COMPO-
NENT.—The 
MSA-based 
weighting factor (described in 
clause (iii)) for such year mul-
tiplied 
by 
the 
geographic 
index values computed for the 
fee schedule area under sub-
paragraph (A) for the year 
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(determined without regard 
to this subparagraph). 
‘‘(ii) OLD WEIGHTING FACTOR.— 
The 
old 
weighting 
factor 
de-
scribed in this clause— 
‘‘(I) for 2017, is 5⁄6; and 
‘‘(II) for each succeeding 
year, is the old weighting fac-
tor described in this clause 
for the previous year minus 
1⁄6. 
‘‘(iii) 
MSA-BASED
WEIGHTING 
FACTOR.—The 
MSA-based 
weighting factor described in this 
clause for a year is 1 minus the 
old weighting factor under clause 
(ii) for that year. 
‘‘(C) HOLD
HARMLESS.—For serv-
ices furnished in a transition area in 
California during a year beginning 
with 2017, the geographic index val-
ues to be applied under this sub-
section for such year shall not be less 
than the corresponding geographic 
index values that would have applied 
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in such transition area (as estimated 
by the Secretary) if this paragraph 
did not apply. 
‘‘(D) TRANSITION AREA DEFINED.—In 
this paragraph, the term ‘transition 
area’ means each of the following fee 
schedule areas for 2013: 
‘‘(i) The rest-of-State payment 
locality. 
‘‘(ii) Payment locality 3. 
‘‘(E) REFERENCES TO FEE SCHEDULE 
AREAS.—Effective 
for 
services 
fur-
nished on or after January 1, 2017, 
for California, any reference in this 
section to a fee schedule area shall be 
deemed a reference to a fee schedule 
area established in accordance with 
this paragraph.’’. 
(2) CONFORMING AMENDMENT TO DEFINI-
TION
OF
FEE
SCHEDULE
AREA.—Section 
1848(j)(2) of the Social Security Act (42 
U.S.C. 1395w–4(j)(2)) is amended by strik-
ing ‘‘The term’’ and inserting ‘‘Except as 
provided 
in 
subsection 
(e)(6)(D), 
the 
term’’. 
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SEC. 6. PROMOTING EVIDENCE-BASED CARE. 
(a) RECOGNIZING
APPROPRIATE
USE
CRI-
TERIA FOR CERTAIN IMAGING SERVICES.— 
(1) IN GENERAL.—Section 1834 of the 
Social Security Act (42 U.S.C. 1395m) is 
amended by adding at the end the fol-
lowing new subsection: 
‘‘(p) RECOGNIZING APPROPRIATE USE CRI-
TERIA FOR CERTAIN IMAGING SERVICES.— 
‘‘(1) PROGRAM ESTABLISHED.— 
‘‘(A) IN
GENERAL.—The Secretary 
shall establish a program to promote 
the use of appropriate use criteria (as 
defined in subparagraph (B)) for ap-
plicable imaging services (as defined 
in subparagraph (C)) furnished in an 
applicable setting (as defined in sub-
paragraph (D)) by ordering profes-
sionals and furnishing professionals 
(as defined in subparagraphs (E) and 
(F), respectively). 
‘‘(B) APPROPRIATE USE CRITERIA DE-
FINED.—In this subsection, the term 
‘appropriate use criteria’ means cri-
teria to assist ordering professionals 
and furnishing professionals in mak-
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ing the most appropriate treatment 
decision for a specific clinical condi-
tion. To the extent feasible, such cri-
teria shall be evidence-based. 
‘‘(C) APPLICABLE
IMAGING
SERVICE 
DEFINED.—In this subsection, the term 
‘applicable imaging service’ means an 
advanced diagnostic imaging service 
(as defined in subsection (e)(1)(B)) for 
which the Secretary determines— 
‘‘(i) one or more applicable ap-
propriate use criteria specified 
under paragraph (2) apply; 
‘‘(ii) there are one or more 
qualified clinical decision support 
mechanisms listed under para-
graph (3)(C); and 
‘‘(iii) one or more of such 
mechanisms is available free of 
charge. 
‘‘(D) 
APPLICABLE
SETTING
DE-
FINED.—In this subsection, the term 
‘applicable setting’ means a physi-
cian’s office, a hospital outpatient de-
partment (including an emergency 
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department), an ambulatory surgical 
center, and any other outpatient set-
ting determined appropriate by the 
Secretary. 
‘‘(E) ORDERING
PROFESSIONAL
DE-
FINED.—In this subsection, the term 
‘ordering professional’ means a physi-
cian (as defined in section 1861(r)) or 
a practitioner described in section 
1842(b)(18)(C) who orders an applica-
ble imaging service for an individual. 
‘‘(F) FURNISHING PROFESSIONAL DE-
FINED.—In this subsection, the term 
‘furnishing professional’ means a phy-
sician (as defined in section 1861(r)) 
or a practitioner described in section 
1842(b)(18)(C) who furnishes an appli-
cable imaging service for an indi-
vidual. 
‘‘(2) ESTABLISHMENT OF APPLICABLE AP-
PROPRIATE USE CRITERIA.— 
‘‘(A) IN GENERAL.—Not later than 
November 15, 2015, the Secretary 
shall through rulemaking, and in con-
sultation 
with 
physicians, 
practi-
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tioners, 
and 
other 
stakeholders, 
specify applicable appropriate use 
criteria for applicable imaging serv-
ices from among appropriate use cri-
teria developed or endorsed by na-
tional professional medical specialty 
societies or other entities. 
‘‘(B) 
CONSIDERATIONS.—In 
speci-
fying applicable appropriate use cri-
teria under subparagraph (A), the 
Secretary shall take into account 
whether the criteria— 
‘‘(i) 
have 
stakeholder 
con-
sensus; 
‘‘(ii) have been determined to 
be scientifically valid and are evi-
dence based; and 
‘‘(iii) are in the public domain. 
‘‘(C) 
REVISIONS.—The 
Secretary 
shall periodically update and revise 
(as appropriate) such specification of 
applicable appropriate use criteria. 
‘‘(D) TREATMENT
OF
MULTIPLE
AP-
PLICABLE APPROPRIATE USE CRITERIA.— 
In the case where the Secretary de-
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termines that more than one appro-
priate use criteria applies with re-
spect to an applicable imaging serv-
ice, the Secretary shall specify one or 
more applicable appropriate use cri-
teria under this paragraph for the 
service. 
‘‘(3) MECHANISMS
FOR
CONSULTATION 
WITH
APPLICABLE
APPROPRIATE
USE
CRI-
TERIA.— 
‘‘(A) 
IDENTIFICATION
OF
MECHA-
NISMS TO CONSULT WITH APPLICABLE AP-
PROPRIATE USE CRITERIA.— 
‘‘(i) 
IN
GENERAL.—The 
Sec-
retary shall specify one or more 
qualified clinical decision support 
mechanisms that could be used by 
ordering professionals to consult 
with applicable appropriate use 
criteria for applicable imaging 
services. 
‘‘(ii) CONSULTATION.—The Sec-
retary shall consult with physi-
cians, practitioners, and other 
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stakeholders in specifying mecha-
nisms under this paragraph. 
‘‘(iii) INCLUSION
OF
CERTAIN 
MECHANISMS.—Mechanisms 
speci-
fied under this paragraph may in-
clude any or all of the following 
that meet the requirements de-
scribed in subparagraph (B)(ii): 
‘‘(I) Use of clinical deci-
sion support modules in cer-
tified EHR technology (as de-
fined in section 1848(o)(4)). 
‘‘(II) Use of private sector 
clinical 
decision 
support 
mechanisms that are inde-
pendent from certified EHR 
technology, which may in-
clude use of clinical decision 
support mechanisms available 
from medical specialty organi-
zations. 
‘‘(III) Use of a clinical de-
cision support mechanism es-
tablished by the Secretary. 
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‘‘(B) QUALIFIED CLINICAL DECISION 
SUPPORT MECHANISMS.— 
‘‘(i) IN GENERAL.—For purposes 
of this subsection, a qualified 
clinical decision support mecha-
nism is a mechanism that the Sec-
retary determines meets the re-
quirements described in clause 
(ii). 
‘‘(ii) REQUIREMENTS.—The re-
quirements 
described 
in 
this 
clause are the following: 
‘‘(I) The mechanism makes 
available to the ordering pro-
fessional 
applicable 
appro-
priate use criteria specified 
under paragraph (2) and the 
supporting documentation for 
the applicable imaging serv-
ice ordered. 
‘‘(II) In the case where 
there are more than one ap-
plicable appropriate use cri-
teria 
specified 
under 
such 
paragraph for an applicable 
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imaging service, the mecha-
nism indicates the criteria 
that it uses for the service. 
‘‘(III) The mechanism de-
termines the extent to which 
an applicable imaging service 
ordered is consistent with the 
applicable 
appropriate 
use 
criteria so specified. 
‘‘(IV) The mechanism gen-
erates and provides to the or-
dering professional a certifi-
cation or documentation that 
documents that the qualified 
clinical 
decision 
support 
mechanism was consulted by 
the ordering professional. 
‘‘(V) The mechanism is up-
dated on a timely basis to re-
flect revisions to the speci-
fication of applicable appro-
priate use criteria under such 
paragraph. 
‘‘(VI) 
The 
mechanism 
meets privacy and security 
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standards 
under 
applicable 
provisions of law. 
‘‘(VII) The mechanism per-
forms such other functions as 
specified by the Secretary, 
which may include a require-
ment to provide aggregate 
feedback to the ordering pro-
fessional. 
‘‘(C) LIST OF MECHANISMS FOR CON-
SULTATION
WITH
APPLICABLE
APPRO-
PRIATE USE CRITERIA.— 
‘‘(i) INITIAL
LIST.—Not later 
than April 1, 2016, the Secretary 
shall publish a list of mechanisms 
specified under this paragraph. 
‘‘(ii) 
PERIODIC
UPDATING
OF 
LIST.—The Secretary shall periodi-
cally update the list of qualified 
clinical decision support mecha-
nisms specified under this para-
graph. 
‘‘(4) CONSULTATION
WITH
APPLICABLE 
APPROPRIATE USE CRITERIA.— 
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‘‘(A) CONSULTATION
BY
ORDERING 
PROFESSIONAL.—Beginning with Janu-
ary 1, 2017, subject to subparagraph 
(C), with respect to an applicable im-
aging service ordered by an ordering 
professional that would be furnished 
in an applicable setting and paid for 
under an applicable payment system 
(as defined in subparagraph (D)), an 
ordering professional shall— 
‘‘(i) consult with a qualified 
decision support mechanism list-
ed under paragraph (3)(C); and 
‘‘(ii) provide to the furnishing 
professional the information de-
scribed in clauses (i) through (iii) 
of subparagraph (B). 
‘‘(B) 
REPORTING
BY
FURNISHING 
PROFESSIONAL.—Beginning with Janu-
ary 1, 2017, subject to subparagraph 
(C), with respect to an applicable im-
aging service furnished in an applica-
ble setting and paid for under an ap-
plicable payment system (as defined 
in subparagraph (D)), payment for 
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such service may only be made if the 
claim for the service includes the fol-
lowing: 
‘‘(i) Information about which 
qualified clinical decision support 
mechanism was consulted by the 
ordering 
professional 
for 
the 
service. 
‘‘(ii) Information regarding— 
‘‘(I) whether the service 
ordered would adhere to the 
applicable 
appropriate 
use 
criteria specified under para-
graph (2); 
‘‘(II) whether the service 
ordered would not adhere to 
such criteria; or 
‘‘(III) whether such cri-
teria was not applicable to the 
service ordered. 
‘‘(iii) The national provider 
identifier of the ordering profes-
sional (if different from the fur-
nishing professional). 
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‘‘(C) EXCEPTIONS.—The provisions 
of subparagraphs (A) and (B) and 
paragraph (6)(A) shall not apply to 
the following: 
‘‘(i) EMERGENCY SERVICES.—An 
applicable imaging service or-
dered for an individual with an 
emergency medical condition (as 
defined in section 1867(e)(1)). 
‘‘(ii) INPATIENT
SERVICES.—An 
applicable imaging service or-
dered for an inpatient and for 
which payment is made under 
part A. 
‘‘(iii) 
ALTERNATIVE
PAYMENT 
MODELS.—An applicable imaging 
service ordered by an ordering 
professional with respect to an in-
dividual attributed to an alter-
native payment model (as defined 
in section 1833(z)(3)(C)). 
‘‘(iv) SIGNIFICANT
HARDSHIP.— 
An applicable imaging service or-
dered by an ordering professional 
who the Secretary may, on a case- 
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by-case basis, exempt from the ap-
plication of such provisions if the 
Secretary determines, subject to 
annual renewal, that consultation 
with applicable appropriate use 
criteria would result in a signifi-
cant hardship, such as in the case 
of a professional who practices in 
a rural area without sufficient 
Internet access. 
‘‘(D) APPLICABLE
PAYMENT
SYSTEM 
DEFINED.—In this subsection, the term 
‘applicable payment system’ means 
the following: 
‘‘(i) The physician fee sched-
ule 
established 
under 
section 
1848(b). 
‘‘(ii) The prospective payment 
system for hospital outpatient de-
partment services under section 
1833(t). 
‘‘(iii) The ambulatory surgical 
center payment systems under 
section 1833(i). 
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‘‘(5) IDENTIFICATION OF OUTLIER ORDER-
ING PROFESSIONALS.— 
‘‘(A) IN GENERAL.—With respect to 
applicable imaging services furnished 
beginning with 2017, the Secretary 
shall determine, on a periodic basis 
(which may be annually), ordering 
professionals who are outlier order-
ing professionals. 
‘‘(B) OUTLIER
ORDERING
PROFES-
SIONALS.—The determination of an 
outlier ordering professional shall— 
‘‘(i) be based on low adher-
ence to applicable appropriate 
use criteria specified under para-
graph (2), which may be based on 
comparison to other ordering pro-
fessionals; and 
‘‘(ii) include data for ordering 
professionals for whom prior au-
thorization 
under 
paragraph 
(6)(A) applies. 
‘‘(C) USE OF TWO YEARS OF DATA.— 
The Secretary shall use two years of 
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data to identify outlier ordering pro-
fessionals under this paragraph. 
‘‘(D) CONSULTATION
WITH
STAKE-
HOLDERS.—The Secretary shall con-
sult with physicians, practitioners 
and other stakeholders in developing 
methods to identify outlier ordering 
professionals under this paragraph. 
‘‘(6) PRIOR AUTHORIZATION FOR ORDER-
ING PROFESSIONALS WHO ARE OUTLIERS.— 
‘‘(A) IN GENERAL.—Beginning Jan-
uary 1, 2020, subject to paragraph 
(4)(C), with respect to services fur-
nished during a year, the Secretary 
shall, for a period determined appro-
priate by the Secretary, apply prior 
authorization for applicable imaging 
services that are ordered by an 
outlier ordering professional identi-
fied under paragraph (5). 
‘‘(B) FUNDING.—For purposes of 
carrying out this paragraph, the Sec-
retary shall provide for the transfer, 
from 
the 
Federal 
Supplementary 
Medical Insurance Trust Fund under 
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section 1841, of $5,000,000 to the Cen-
ters for Medicare & Medicaid Serv-
ices Program Management Account 
for each of fiscal years 2019 through 
2021. Amounts transferred under the 
preceding 
sentence 
shall 
remain 
available until expended.’’. 
(2) CONFORMING AMENDMENT.—Section 
1833(t)(16) of the Social Security Act (42 
U.S.C. 1395l(t)(16)) is amended by adding 
at the end the following new subpara-
graph: 
‘‘(E) APPLICATION OF APPROPRIATE 
USE
CRITERIA
FOR
CERTAIN
IMAGING 
SERVICES.—For provisions relating to 
the application of appropriate use 
criteria for certain imaging services, 
see section 1834(p).’’. 
(b) ESTABLISHMENT
OF APPROPRIATE USE 
PROGRAM FOR OTHER PART B SERVICES.—Sec-
tion 1834 of the Social Security Act (42 U.S.C. 
1395m), as amended by subsection (a), is 
amended by adding at the end the following 
new subsection: 
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‘‘(q) ESTABLISHMENT OF APPROPRIATE USE 
PROGRAM FOR OTHER PART B SERVICES.— 
‘‘(1) ESTABLISHMENT.— 
‘‘(A) IN
GENERAL.—The Secretary 
may establish an appropriate use pro-
gram for services under this part 
(other than applicable imaging serv-
ices under subsection (p)) using a 
process similar to the process under 
such subsection. 
‘‘(B) 
REQUIREMENTS.—In 
deter-
mining whether to establish a pro-
gram under subparagraph (A), the 
Secretary shall take into consider-
ation— 
‘‘(i) the implementation of ap-
propriate use criteria for applica-
ble imaging services under sub-
section (p); and 
‘‘(ii) the report under para-
graph (2). 
‘‘(C) INPUT FROM STAKEHOLDERS IN 
ADVANCE
OF
RULEMAKING.—Before 
issuing a notice of proposed rule-
making to establish a program under 
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subparagraph (A), the Secretary shall 
issue an advance notice of proposed 
rulemaking. 
‘‘(2) REPORT ON EXPERIENCE OF IMAGING 
APPROPRIATE USE CRITERIA PROGRAM.—Not 
later than 18 months after the date of the 
enactment of this subsection, the Comp-
troller General of the United States shall 
submit to Congress a report that includes 
a description of the extent to which ap-
propriate use criteria could be used for 
other services under this part, such as ra-
diation therapy and clinical diagnostic 
laboratory services.’’. 
SEC. 7. EMPOWERING BENEFICIARY CHOICES THROUGH 
ACCESS TO INFORMATION ON PHYSICIANS’ 
SERVICES. 
(a) TRANSFERRING
FREESTANDING
PHYSI-
CIAN COMPARE PROVISION TO THE SOCIAL SECU-
RITY ACT.— 
(1) IN GENERAL.—Section 10331 of Pub-
lic Law 111–148 is transferred and redes-
ignated as subsection (t) of section 1848 
of the Social Security Act (42 U.S.C. 
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1395w–4), as amended by subsections (c) 
and (h) of section 2 and by section 3. 
(2) 
CONFORMING
REDESIGNATIONS.— 
Section 1848(t) of the Social Security Act 
(42 U.S.C. 1395w–4(t)), as transferred and 
redesignated by paragraph (1), is further 
amended— 
(A) by striking the subsection 
heading and inserting the following 
new subsection heading: ‘‘PUBLIC RE-
PORTING OF PERFORMANCE AND OTHER 
INFORMATION
ON
PHYSICIAN
COM-
PARE.—’’; 
(B) by redesignating subsections 
(a) through (i) as paragraphs (1) 
through (9), respectively, and indent-
ing appropriately; 
(C) in paragraph (1), as redesig-
nated by subparagraph (B)— 
(i) 
by 
redesignating 
para-
graphs (1) and (2) as subpara-
graphs (A) and (B), respectively, 
and indenting appropriately; 
(ii) in subparagraph (B), as re-
designated by clause (i), by redes-
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ignating 
subparagraphs 
(A) 
through (G) as clauses (i) through 
(vii), respectively, and indenting 
appropriately; 
(D) in paragraph (2), as redesig-
nated by subparagraph (B), by redes-
ignating paragraphs (1) through (7) 
as subparagraphs (A) through (G), re-
spectively, 
and 
indenting 
appro-
priately; and 
(E) in paragraph (9), as redesig-
nated by subparagraph (B), by redes-
ignating paragraphs (1) through (4) 
as subparagraphs (A) through (D), re-
spectively, 
and 
indenting 
appro-
priately. 
(3) 
CONFORMING
AMENDMENTS.—Sec-
tion 1848(t) of the Social Security Act (42 
U.S.C. 1395w–4(t)), as amended by para-
graph (2), is further amended— 
(A) in paragraph (1)— 
(i) in subparagraph (A)— 
(I) by striking ‘‘the Medi-
care program under section 
1866(j) of the Social Security 
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Act (42 U.S.C. 1395cc(j))’’ and 
inserting ‘‘the program under 
this 
title 
under 
section 
1866(j)’’; and 
(II) by striking ‘‘of such 
Act (42 U.S.C. 1395w–4)’’; and 
(ii) in subparagraph (B), in 
the matter preceding clause (i)— 
(I) by striking ‘‘subsection 
(c)’’ and inserting ‘‘paragraph 
(3)’’; 
(II) by striking ‘‘the Medi-
care program under such sec-
tion 
1866(j)’’ 
and 
inserting 
‘‘the program under this title 
under section 1866(j)’’; and 
(III) by striking ‘‘this sec-
tion’’ and inserting ‘‘this sub-
section’’; 
(B) in paragraph (2)— 
(i) in the matter preceding 
subparagraph 
(A), 
by 
striking 
‘‘subsection (a)(2)’’ and inserting 
‘‘paragraph (1)(B)’’; 
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(ii) in subparagraph (D), by 
striking ‘‘the Medicare program’’ 
and inserting ‘‘the program under 
this title’’; and 
(iii) in each of subparagraphs 
(F) and (G), by striking ‘‘this sec-
tion’’ and inserting ‘‘this sub-
section’’; 
(C) in paragraph (3), by striking 
‘‘this section’’ and inserting ‘‘this sub-
section’’; 
(D) in paragraph (4)— 
(i) by striking ‘‘of the Social 
Security Act, as added by section 
3014 of this Act’’; and 
(ii) by striking ‘‘this section’’ 
and inserting ‘‘this subsection’’; 
(E) in paragraph (5)— 
(i) by striking ‘‘this subsection 
(a)(2)’’ and inserting ‘‘paragraph 
(1)(B)’’; and 
(ii) by striking ‘‘(Public Law 
110–275)’’; 
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(F) in paragraph (6), by striking 
‘‘subsection 
(a)(1)’’ 
and 
inserting 
‘‘paragraph (1)(A)’’; 
(G) in paragraph (7)— 
(i) by striking ‘‘subsection (f)’’ 
and inserting ‘‘paragraph (6)’’; 
and 
(ii) by striking ‘‘title XVIII of 
the Social Security Act’’ and in-
serting ‘‘this title’’; 
(H) in paragraph (8)— 
(i) by striking ‘‘subparagraphs 
(A) through (G) of subsection 
(a)(2)’’ and inserting ‘‘clauses (i) 
through (vii) of paragraph (1)(B)’’; 
(ii) by striking ‘‘title XVIII of 
the Social Security Act’’ and in-
serting ‘‘this title’’; and 
(iii) by striking ‘‘such title’’ 
and inserting ‘‘this title’’; and 
(I) in paragraph (9)— 
(i) in the matter preceding 
subparagraph 
(A), 
by 
striking 
‘‘this section’’ and inserting ‘‘this 
subsection’’; 
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(ii) in subparagraph (A), by 
striking ‘‘of the Social Security 
Act (42 U.S.C. 1395w–4)’’; 
(iii) in subparagraph (B), by 
striking ‘‘of such Act (42 U.S.C. 
1395x(r))’’; 
(iv) in subparagraph (C), by 
striking ‘‘subsection (a)(1)’’ and 
inserting ‘‘paragraph (1)(A)’’; and 
(v) by striking subparagraph 
(D). 
(b) PUBLIC
AVAILABILITY
OF
MEDICARE 
DATA.—Section 1848(t) of the Social Security 
Act (42 U.S.C. 1395w–4(t)), as amended by sub-
section (a), is further amended— 
(1) by redesignating paragraph (9) as 
paragraph (10); 
(2) by inserting after paragraph (8) 
the following new paragraph: 
‘‘(9) PUBLIC
AVAILABILITY
OF
ELIGIBLE 
PROFESSIONAL CLAIMS DATA.— 
‘‘(A) IN
GENERAL.—The Secretary 
shall make publicly available on Phy-
sician Compare the information de-
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scribed in subparagraph (B) with re-
spect to eligible professionals. 
‘‘(B) INFORMATION DESCRIBED.—The 
following information, with respect to 
an eligible professional, is described 
in this subparagraph: 
‘‘(i) Information on the num-
ber of services furnished by the 
eligible professional, which may 
include information on the most 
frequent services furnished or 
groupings of services. 
‘‘(ii) Information on submitted 
charges and payments for serv-
ices under this part. 
‘‘(iii) A unique identifier for 
the eligible professional that is 
available to the public, such as a 
national provider identifier. 
‘‘(C) SEARCHABILITY.—The informa-
tion made available under this para-
graph shall be searchable by at least 
the following: 
‘‘(i) The specialty or type of 
the eligible professional. 
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‘‘(ii) 
Characteristics 
of 
the 
services furnished, such as vol-
ume or groupings of services. 
‘‘(iii) The location of the eligi-
ble professional. 
‘‘(D) DISCLOSURE.—The informa-
tion made available under this para-
graph shall indicate, where appro-
priate, that publicized information 
may not be representative of the eli-
gible 
professional’s 
entire 
patient 
population, the variety of services 
furnished by the eligible professional, 
or the health conditions of individ-
uals treated. 
‘‘(E) IMPLEMENTATION.— 
‘‘(i) INITIAL IMPLEMENTATION.— 
Physician Compare shall include 
the information described in sub-
paragraph (B)— 
‘‘(I) with respect to physi-
cians, by not later than July 1, 
2015; and 
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‘‘(II) with respect to other 
eligible professionals, by not 
later than July 1, 2016. 
‘‘(ii) ANNUAL
UPDATING.—The 
information made available under 
this paragraph shall be updated 
on Physician Compare not less 
frequently than on an annual 
basis. 
‘‘(F) OPPORTUNITY TO REVIEW AND 
SUBMIT
CORRECTIONS.—The Secretary 
shall provide for an opportunity for 
an eligible professional to review, and 
submit corrections for, the informa-
tion to be made public with respect to 
the eligible professional under this 
paragraph prior to such information 
being made public.’’; and 
(3) in paragraph (10)(C), as redesig-
nated by paragraph (1), by inserting ‘‘(or 
a successor website)’’ before the period at 
the end. 
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SEC. 8. EXPANDING CLAIMS DATA AVAILABILITY TO IM-
PROVE CARE. 
(a) EXPANSION OF USES OF CLAIMS DATA BY 
QUALIFIED ENTITIES.—Section 1874(e) of the 
Social Security Act (42 U.S.C. 1395kk(e)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(5) EXPANSION
OF
USES
OF
CLAIMS 
DATA BY QUALIFIED ENTITIES.— 
‘‘(A) EXPANSION.—To the extent 
consistent with applicable informa-
tion, privacy, security, and disclosure 
laws, beginning July 1, 2014, notwith-
standing paragraph (4)(B) (other than 
clause (iii) of such paragraph) and 
the second sentence of paragraph 
(4)(D), a qualified entity may, as de-
termined appropriate by the Sec-
retary, do any or all of the following: 
‘‘(i)(I) Use the combined data 
described in paragraph (4)(B)(iii) 
to conduct analyses, other than 
for reports described in para-
graph (4), for entities described in 
subparagraph (B) for non-public 
uses, as determined appropriate 
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by the Secretary, such as for the 
purposes described in subclause 
(II). 
‘‘(II) The purposes described 
in this subclause are assisting 
providers of services and sup-
pliers in developing and partici-
pating in quality and patient care 
improvement activities (including 
developing new models of care), 
population health management, 
and disease monitoring, and the 
purposes described in subpara-
graph (C). 
‘‘(ii) Provide or sell such anal-
yses to entities described in sub-
paragraph (B). 
‘‘(iii) 
Provide 
entities 
de-
scribed in clauses (i), (ii), (v), and 
(vi) of subparagraph (B) with ac-
cess to the combined data de-
scribed in paragraph (4)(B)(iii) 
through a qualified data enclave 
(as defined in subparagraph (F)) 
that is maintained by the quali-
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fied entity in order for entities 
described in such clauses to con-
duct analyses for non-public uses, 
such as for the purposes de-
scribed in clause (i)(II). 
‘‘(B) ENTITIES DESCRIBED.—For the 
purpose of subparagraph (A) clauses 
(i) and (ii), the entities described in 
this subparagraph are the following: 
‘‘(i) A provider of services. 
‘‘(ii) A supplier. 
‘‘(iii) Subject to subparagraph 
(C), an employer (as defined in 
section 3(5) of the Employee Re-
tirement Insurance Security Act 
of 1974). 
‘‘(iv) A health insurance issuer 
(as defined in section 2791 of the 
Public Health Service Act) that 
provides data under paragraph 
(4)(B)(iii). 
‘‘(v) A medical society or hos-
pital association. 
‘‘(vi) Other entities approved 
by the Secretary (other than an 
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employer (as so defined) and a 
health insurance issuer (as so de-
fined)). 
‘‘(C) LIMITATION WITH RESPECT TO 
EMPLOYERS.—Any analyses provided 
or sold under this paragraph to an 
employer (as so defined) may only be 
used by such employer for purposes 
of providing health insurance to em-
ployees and retirees of the employer. 
‘‘(D) PROTECTION OF PATIENT IDEN-
TIFICATION.— 
‘‘(i) IN
GENERAL.—Except as 
provided in clause (ii), an analysis 
provided or sold under this para-
graph shall not contain informa-
tion that individually identifies a 
patient. 
‘‘(ii) INFORMATION ON PATIENTS 
OF THE PROVIDER OF SERVICES OR 
SUPPLIER.—An 
analysis 
that 
is 
provided or sold under this para-
graph to a provider of services or 
supplier may contain data that in-
dividually identifies a patient of 
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such provider or supplier but 
only with respect to items and 
services furnished by such pro-
vider or supplier to such patient. 
‘‘(iii) OPPORTUNITY
FOR
PRO-
VIDERS OF SERVICES AND SUPPLIERS 
TO
REVIEW.—Prior to a qualified 
entity providing or selling an 
analysis under this paragraph to 
an entity described in subpara-
graph (B), to the extent that such 
analysis would individually iden-
tify a provider of services or sup-
plier who is not being provided or 
sold such analysis, such qualified 
entity shall provide an oppor-
tunity for such provider or sup-
plier to review and submit correc-
tions to such analysis. 
‘‘(E) NO REDISCLOSURE.—An entity 
described in subparagraph (B) that is 
provided or sold an analysis under 
this paragraph shall not redisclose or 
make public such an analysis. 
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‘‘(F) REQUIREMENTS
FOR
A
QUALI-
FIED DATA ENCLAVE.— 
‘‘(i) DEFINITION.—For purposes 
of this paragraph, the term ‘quali-
fied data enclave’ means a data 
enclave that the Secretary deter-
mines meets the following: 
‘‘(I) The data enclave is a 
web-based 
portal 
or 
com-
parable mechanism. 
‘‘(II) Subject to the re-
quirements 
described 
in 
clause (ii) and such other re-
quirements as the Secretary 
may specify, the data enclave 
is capable of providing access 
to the combined data de-
scribed 
in 
subparagraph 
(A)(iii). 
‘‘(ii) ENCLAVE ACCESS REQUIRE-
MENTS.—The 
requirements 
de-
scribed in this clause are the fol-
lowing: 
‘‘(I) A qualified data en-
clave shall preclude any enti-
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ty that obtains access to the 
data from removing or ex-
tracting the data from such 
enclave. 
‘‘(II) Subject to the suc-
ceeding sentence, the enclave 
shall preclude access to data 
that individually identifies a 
patient, including data on the 
patient’s name and date of 
birth and such other data as 
the Secretary shall specify. 
Such data enclave may pro-
vide providers of services and 
suppliers with access to such 
individually identifiable pa-
tient data but only with re-
spect to items and services 
furnished by such provider or 
supplier to such patient. 
‘‘(III) Access to data in the 
enclave shall not be provided 
to any entity unless the quali-
fied entity and the entity have 
entered into a data use agree-
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ment, the terms of which con-
tain the requirements of this 
paragraph 
and 
such 
other 
terms 
the 
Secretary 
may 
specify. 
‘‘(G) ANNUAL REPORTS.—Any quali-
fied entity that provides or sells anal-
yses pursuant to subparagraph (A)(ii) 
or provides access to a qualified data 
enclave pursuant to subparagraph 
(A)(iii) shall annually submit to the 
Secretary a report that includes— 
‘‘(i) a summary of the analyses 
provided or sold, including the 
number of such analyses, the 
number of purchasers of such 
analyses, and the total amount of 
fees received for such analyses; 
‘‘(ii) a description of the top-
ics and purposes of such analyses; 
‘‘(iii) information on the enti-
ties who obtained access to the 
qualified data enclave, the uses of 
the data, and the total amount of 
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fees received for providing such 
access; and 
‘‘(iv) other information deter-
mined appropriate by the Sec-
retary.’’. 
(b) EXPANSION
OF
DATA
AVAILABLE
TO 
QUALIFIED ENTITIES.—Section 1874(e) of the 
Social Security Act (42 U.S.C. 1395kk(e)) is 
amended— 
(1) in the subsection heading, by 
striking ‘‘Medicare’’; and 
(2) in paragraph (3)— 
(A) by inserting after the first 
sentence the following new sentence: 
‘‘Effective July 1, 2014, if the Sec-
retary determines appropriate, the 
data described in this paragraph may 
also include standardized extracts (as 
determined 
by 
the 
Secretary) 
of 
claims data under titles XIX and XXI 
for assistance provided under such ti-
tles for one or more specified geo-
graphic areas and time periods re-
quested by a qualified entity.’’; and 
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(B) in the last sentence, by insert-
ing ‘‘or under titles XIX or XXI’’ be-
fore the period at the end. 
(c) ACCESS TO MEDICARE DATA BY QUALI-
FIED CLINICAL DATA REGISTRIES TO FACILITATE 
QUALITY IMPROVEMENT.—Section 1848(m)(3)(E) 
of the Social Security Act (42 U.S.C. 1395w– 
4(m)(3)(E)) is amended by adding at the end 
the following new clause: 
‘‘(vi) ACCESS TO MEDICARE DATA 
TO
FACILITATE
QUALITY
IMPROVE-
MENT.— 
‘‘(I) IN
GENERAL.—To the 
extent consistent with appli-
cable information, privacy, se-
curity, and disclosure laws, 
and subject to other require-
ments as the Secretary may 
specify, 
beginning 
July 
1, 
2014, the Secretary shall, if re-
quested by a qualified clinical 
data registry under this sub-
paragraph, 
subject 
to 
sub-
clauses (II) and (III), provide 
data as described in section 
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1874(e)(3) (in a form and man-
ner determined to be appro-
priate) to such registry for 
purposes of linking such data 
with clinical data and per-
forming 
analyses 
and 
re-
search to support quality im-
provement or patient safety. 
‘‘(II) PROTECTION.—A quali-
fied clinical data registry may 
not publicly report any data 
made available under sub-
clause (I) (or any analyses or 
research described in such 
subclause) that individually 
identifies a provider of serv-
ices, supplier, or individual 
unless the registry obtains the 
consent of such provider, sup-
plier, or individual prior to 
such reporting. 
‘‘(III) FEE.—The data de-
scribed in subclause (I) shall 
be made available to qualified 
clinical data registries at a fee 
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equal to the cost of making 
such data available. Any fee 
collected pursuant to the pre-
ceding sentence shall be de-
posited in the Centers for 
Medicare & Medicaid Services 
Program 
Management 
Ac-
count.’’. 
(d) REVISION OF PLACEMENT OF FEES.—Sec-
tion 1874(e)(4)(A) of the Social Security Act 
(42 U.S.C. 1395kk(e)(4)(A)) is amended, in the 
second sentence— 
(1) by inserting ‘‘, for periods prior to 
July 1, 2014,’’ after ‘‘deposited’’; and 
(2) by inserting the following before 
the period at the end: ‘‘, and, beginning 
July 1, 2014, into the Centers for Medi-
care & Medicaid Services Program Man-
agement Account’’. 
SEC. 9. REDUCING ADMINISTRATIVE BURDEN AND OTHER 
PROVISIONS. 
(a) MEDICARE PHYSICIAN AND PRACTITIONER 
OPT-OUT TO PRIVATE CONTRACT.— 
(1) INDEFINITE, CONTINUING AUTOMATIC 
EXTENSION OF OPT OUT ELECTION.— 
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(A) 
IN
GENERAL.—Section 
1802(b)(3) of the Social Security Act 
(42 U.S.C. 1395a(b)(3)) is amended— 
(i) in subparagraph (B)(ii), by 
striking ‘‘during the 2-year period 
beginning on the date the affi-
davit is signed’’ and inserting 
‘‘during the applicable 2-year pe-
riod (as defined in subparagraph 
(D))’’; 
(ii) in subparagraph (C), by 
striking ‘‘during the 2-year period 
described 
in 
subparagraph 
(B)(ii)’’ and inserting ‘‘during the 
applicable 2-year period’’; and 
(iii) by adding at the end the 
following new subparagraph: 
‘‘(D) APPLICABLE
2-YEAR
PERIODS 
FOR EFFECTIVENESS OF AFFIDAVITS.—In 
this subsection, the term ‘applicable 
2-year period’ means, with respect to 
an affidavit of a physician or practi-
tioner under subparagraph (B), the 2- 
year period beginning on the date the 
affidavit is signed and includes each 
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subsequent 2-year period unless the 
physician or practitioner involved 
provides notice to the Secretary (in a 
form and manner specified by the 
Secretary), not later than 30 days be-
fore the end of the previous 2-year 
period, that the physician or practi-
tioner does not want to extend the 
application of the affidavit for such 
subsequent 2-year period.’’. 
(B) EFFECTIVE DATE.—The amend-
ments made by subparagraph (A) 
shall apply to affidavits entered into 
on or after the date that is 60 days 
after the date of the enactment of this 
Act. 
(2) PUBLIC
AVAILABILITY
OF
INFORMA-
TION ON OPT-OUT PHYSICIANS AND PRACTI-
TIONERS.—Section 1802(b) of the Social 
Security 
Act 
(42 
U.S.C. 
1395a(b)) 
is 
amended— 
(A) in paragraph (5), by adding at 
the end the following new subpara-
graph: 
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‘‘(D) OPT-OUT PHYSICIAN OR PRACTI-
TIONER.—The term ‘opt-out physician 
or practitioner’ means a physician or 
practitioner who has in effect an affi-
davit under paragraph (3)(B).’’; 
(B) by redesignating paragraph 
(5) as paragraph (6); and 
(C) by inserting after paragraph 
(4) the following new paragraph: 
‘‘(5) POSTING OF INFORMATION ON OPT- 
OUT PHYSICIANS AND PRACTITIONERS.— 
‘‘(A) IN
GENERAL.—Beginning not 
later than February 1, 2015, the Sec-
retary shall make publicly available 
through an appropriate publicly ac-
cessible website of the Department of 
Health and Human Services informa-
tion on the number and characteris-
tics of opt-out physicians and practi-
tioners and shall update such infor-
mation on such website not less often 
than annually. 
‘‘(B) 
INFORMATION
TO
BE
IN-
CLUDED.—The information to be made 
available 
under 
subparagraph 
(A) 
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shall include at least the following 
with respect to opt-out physicians 
and practitioners: 
‘‘(i) Their number. 
‘‘(ii) Their physician or profes-
sional specialty or other designa-
tion. 
‘‘(iii) Their geographic dis-
tribution. 
‘‘(iv) The timing of their be-
coming opt-out physicians and 
practitioners, relative to when 
they first entered practice and 
with respect to applicable 2-year 
periods. 
‘‘(v) The proportion of such 
physicians and practitioners who 
billed for emergency or urgent 
care services.’’. 
(b) MEDICARE
NON-PARTICIPATING
PHYSI-
CIANS DEMONSTRATION PROJECT.— 
(1) IN
GENERAL.—The Secretary of 
Health and Human Services (in this sub-
section referred to as the ‘‘Secretary’’) 
shall establish and implement a dem-
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onstration project (in this section re-
ferred to as the ‘‘demonstration project’’) 
under title XVIII of the Social Security 
Act to provide that payments for services 
under such title furnished by non-partici-
pating physicians (as defined in section 
1861(r)(1) of the Social Security Act (42 
U.S.C. 1395x(r)(1))) to individuals entitled 
to benefits under part A or enrolled 
under part B of such title are paid di-
rectly to such physicians. The Secretary 
shall carry out the demonstration project 
in a geographic area that is a statistically 
significant area no larger than a State. 
(2) ADVANCE
NOTICE
TO
PHYSICIANS.— 
The Secretary shall, in a timely manner 
and prior to the beginning of the year in 
which payment will be made under the 
demonstration project, notify physicians 
in the geographic area described in para-
graph (1) of the option to participate in 
the demonstration project. 
(3) TIMETABLE FOR IMPLEMENTATION.— 
(A) DEMONSTRATION START DATE.— 
The 
demonstration 
project 
shall 
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apply with respect to services fur-
nished beginning on January 1, 2015. 
(B) 1-YEAR
DURATION.—The Sec-
retary 
shall 
implement 
the 
dem-
onstration project such that pay-
ments are made under such dem-
onstration project for a period of 1 
year. 
(4) REPORT.—Not later than 18 months 
after the date of the conclusion of the 
demonstration 
project, 
the 
Secretary 
shall submit to Congress a report ana-
lyzing the impact of the demonstration 
project. Such report shall include an 
analysis of the impact, if any, of the dem-
onstration project upon the— 
(A) percentage and number of 
physicians who choose not to partici-
pate under title XVIII of the Social 
Security Act and a comparison of 
such percentage and number to the 
previous year; 
(B) percentage of claims sub-
mitted by and payments made to phy-
sicians in the demonstration that are 
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unassigned and a comparison of un-
assigned claims and payments by 
non-participating physicians in the 
previous year; 
(C) percentage and number of the 
physicians in the demonstration by 
specialty designation; and 
(D) access to services for which 
payment is made under such title for 
individuals entitled to benefits under 
part A or enrolled under part B of 
such title. 
(5) BENEFICIARY NOTICE.— 
(A) NOTICE BY SECRETARY TO BENE-
FICIARIES.—The Secretary shall notify 
individuals entitled to benefits under 
part A or enrolled under part B of 
title XVIII of the Social Security Act 
in the geographic area in which the 
demonstration project is conducted of 
the implications of physician partici-
pation in the demonstration project. 
(B) NOTICE
BY
PHYSICIANS
TO
PA-
TIENTS.—A physician who elects to 
participate 
in 
the 
demonstration 
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project shall notify individuals to 
whom the physician furnishes serv-
ices for which payment will be pro-
vided 
under 
the 
demonstration 
project of such election. Such notifi-
cation shall be provided prior to the 
provision of service and include a no-
tification, with respect to each such 
individual, that— 
(i) the right of the individual 
to payment is being reassigned to 
the physician; 
(ii) payment for services fur-
nished by the physician to such 
individual will be made directly 
to the physician; and 
(iii) the individual is respon-
sible for the remaining amount, 
which may be higher than would 
be the case if the physician par-
ticipated in the Medicare pro-
gram. 
(c) GAINSHARING STUDY AND REPORT.—Not 
later than 6 months after the date of the en-
actment of this Act, the Secretary of Health 
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and Human Services, in consultation with the 
Inspector General of the Department of 
Health and Human Services, shall submit to 
Congress 
a 
report 
with 
legislative 
rec-
ommendations to amend existing fraud and 
abuse laws, through exceptions, safe harbors, 
or other narrowly targeted provisions, to per-
mit gainsharing or similar arrangements be-
tween physicians and hospitals that improve 
care while reducing waste and increasing effi-
ciency. The report shall— 
(1) consider whether such provisions 
should apply to ownership interests, com-
pensation arrangements, or other rela-
tionships; and 
(2) describe how the recommenda-
tions 
address 
accountability, 
trans-
parency, and quality, including how best 
to limit inducements to stint on care, dis-
charge patients prematurely, or other-
wise reduce or limit medically necessary 
care; and 
(3) consider whether a portion of any 
savings generated by such arrangements 
should accrue to the Medicare program 
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under title XVIII of the Social Security 
Act. 
(d) PROMOTING INTEROPERABILITY OF ELEC-
TRONIC HEALTH RECORD SYSTEMS.— 
(1) RECOMMENDATIONS
FOR
ACHIEVING 
WIDESPREAD EHR INTEROPERABILITY.— 
(A) OBJECTIVE.—As a consequence 
of a significant Federal investment in 
the implementation of health infor-
mation technology through the Medi-
care EHR incentive programs, Con-
gress declares it a national objective 
to achieve widespread and nation-
wide exchange of health information 
through interoperable certified EHR 
technology by December 31, 2019. 
(B) DEFINITIONS.—In this para-
graph: 
(i) 
WIDESPREAD
INTEROPER-
ABILITY.—The term ‘‘widespread 
interoperability’’ means nation-
wide 
interoperability 
between 
certified EHR technology systems 
employed 
by 
meaningful 
EHR 
users under the Medicare EHR in-
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centive programs and other clini-
cians and health care providers. 
(ii) 
INTEROPERABILITY.—The 
term ‘‘interoperability’’ means the 
ability of two or more health in-
formation systems or components 
to exchange clinical and other in-
formation and to use the informa-
tion that has been exchanged 
using common standards as to 
provide access to longitudinal in-
formation for health care pro-
viders in order to facilitate co-
ordinated care and improved pa-
tient outcomes. 
(C) ESTABLISHMENT
OF
METRICS.— 
Not later than December 31, 2015, and 
in consultation with stakeholders, the 
Secretary shall establish metrics to 
be used to determine if and to the ex-
tent that the objective described in 
subparagraph (A) has been achieved. 
(D) RECOMMENDATIONS
IF
OBJEC-
TIVE NOT ACHIEVED.—If the Secretary 
of Health and Human Services deter-
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mines that the objective described in 
subparagraph 
(A) 
has 
not 
been 
achieved by December 31, 2017, then 
the Secretary shall submit to Con-
gress a report, by not later than De-
cember 31, 2018, that identifies bar-
riers to such objective and rec-
ommends actions that the Federal 
Government can take to achieve such 
objective. Such recommended actions 
may include recommendations— 
(i) to adjust payments for 
meaningful EHR users under the 
Medicare 
EHR 
incentive 
pro-
grams; and 
(ii) for criteria for decerti-
fying certified EHR technology 
products. 
(2) PREVENTING BLOCKING THE SHARING 
OF INFORMATION.— 
(A) FOR MEANINGFUL EHR PROFES-
SIONALS.—Section 1848(o)(2)(A)(ii) of 
the Social Security Act (42 U.S.C. 
1395w–4(o)(2)(A)(ii)) is amended by 
inserting before the period at the end 
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the following: ‘‘, and the professional 
demonstrates 
(through 
a 
process 
specified by the Secretary, such as 
the use of an attestation similar to 
that required in the health informa-
tion technology donation safe harbor 
established under regulations under 
section 1128B(b)(3)(E)) that the pro-
fessional has not and will not take 
any deliberate action to limit or re-
strict the use, compatibility, or inter-
operability of the certified EHR tech-
nology’’. 
(B) FOR
MEANINGFUL
EHR
HOS-
PITALS.—Section 
1886(n)(3)(A)(ii) 
of 
the Social Security Act (42 U.S.C. 
1395ww(n)(3)(A)(ii)) is amended by in-
serting before the period at the end 
the following: ‘‘, and the hospital dem-
onstrates (through a process specified 
by the Secretary, such as the use of 
an attestation referred to in section 
1848(o)(2)(A)(ii)) that the hospital has 
not and will not take any deliberate 
action to limit or restrict the use, 
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compatibility, or interoperability of 
the certified EHR technology’’. 
(C) EFFECTIVE DATE.—The amend-
ments made by this subsection shall 
apply to meaningful EHR users as of 
the date that is 6 months after the 
date of the enactment of this Act. 
(3) STUDY AND REPORT ON THE FEASI-
BILITY OF ESTABLISHING A WEBSITE TO COM-
PARE
CERTIFIED
EHR
TECHNOLOGY
PROD-
UCTS.— 
(A) STUDY.—The Secretary shall 
conduct a study to examine the feasi-
bility of establishing a website (in 
this subsection referred to as the 
‘‘website’’) that includes aggregated 
results of surveys of meaningful EHR 
users on the functionality of certified 
EHR technology products to enable 
such users to directly compare the 
functionality and other features of 
such products. Such information may 
be made available through contracts 
with physician, hospital, or other or-
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ganizations that maintain such com-
parative information. 
(B) REPORT.—Not later than 1 
year after the date of the enactment 
of this Act, the Secretary shall submit 
to Congress a report on the website. 
The report shall include information 
on the benefits and resources of such 
a website. 
(4) DEFINITIONS.—In this subsection: 
(A) The term ‘‘certified EHR tech-
nology’’ has the meaning given such 
term in section 1848(o)(4) of the So-
cial Security Act (42 U.S.C. 1395w– 
4(o)(4)). 
(B) The term ‘‘meaningful EHR 
hospital’’ means an eligible hospital 
(as defined in section 1886(n)(6)(A) of 
the Social Security Act (42 U.S.C. 
1395ww(n)(6)(A)) that is a meaningful 
EHR user. 
(C) The term ‘‘meaningful EHR 
professional’’ means an eligible pro-
fessional 
(as 
defined 
in 
section 
1848(o)(5)(C) of the Social Security 
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Act (42 U.S.C. 1395w–4(o)(5)(C)) who 
is a meaningful EHR user. 
(D) The term ‘‘meaningful EHR 
user’’ has the meaning given such 
term under the Medicare EHR incen-
tive programs. 
(E) The term ‘‘Medicare EHR in-
centive programs’’ means the incen-
tive programs under section 1848(o), 
subsections (l) and (m) of section 
1853, and section 1886(n) of the Social 
Security Act (42 U.S.C. 1395w–4(o), 
1395w–23, 1395ww(n)). 
(F) The term ‘‘Secretary’’ means 
the Secretary of Health and Human 
Services. 
(e) GAO STUDY AND REPORT ON THE USE OF 
TELEHEALTH UNDER FEDERAL PROGRAMS.— 
(1) STUDY.—The Comptroller General 
of the United States shall conduct a study 
on the following: 
(A) How the definition of tele-
health across various Federal pro-
grams and federal efforts can inform 
the use of telehealth in the Medicare 
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