nize transitional care as an episode of services 
that crosses multiple care settings, providers of 
services, and suppliers. The payment with re-
spect to transitional care services furnished by 
a transitional care clinician shall be made, not-
withstanding any other provision of this title, to 
the qualified transitional care entity which em-
ploys, or has a contract with, the clinician for 
the furnishing of such services. 
‘‘(B) HIT 
INCENTIVE
PAYMENT.—The 
Secretary may provide for an additional pay-
ment with respect to transitional care services 
to encourage transitional care clinicians and 
qualified transitional care entities to use health 
information technology in the provision of such 
services. 
‘‘(C) NO
PAYMENT
FOR
REQUIRED
DIS-
CHARGE PLANNING SERVICES.—Payment shall 
not be made for transitional care services under 
this subsection for an entity insofar as such 
services are otherwise required to be provided 
through the discharge planning process under 
section 1861(ee) or under conditions of partici-
pation for the entity under section 1866. 
‘‘(2) PERFORMANCE MEASURES.— 
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‘‘(A) ACCOUNTABILITY.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall establish a method whereby qualified 
transitional care entities responsible for 
furnishing transitional care services are 
held accountable for process and outcome 
based on performance measures specified 
by the Secretary from those that have been 
endorsed by the National Quality Forum 
or similar standard-setting organization or 
are otherwise used in other quality pro-
grams under this title or title XIX. 
‘‘(ii) DEVELOPMENT
AND
ENDORSE-
MENT OF PERFORMANCE MEASURE SET.— 
For purposes of carrying out clause (i), the 
Secretary shall enter into an arrange-
ment— 
‘‘(I) with the National Quality 
Forum for the evaluation, endorse-
ment, and recommendation of addi-
tional performance measures for tran-
sitional care services and to identify 
remaining gaps in available measures, 
including measures to both the send-
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ing and receiving side of the transi-
tion; and 
‘‘(II) 
with 
the 
Agency 
for 
Healthcare Research and Quality to 
support measure development, to fill 
gaps in available measures, to conduct 
comparative effectiveness research of 
transitional care models and tools, 
and to provide for the ongoing main-
tenance of the set of performance 
measures for transitional care serv-
ices. 
‘‘(B) PAY FOR PERFORMANCE.—As soon 
as practicable after reliable process and out-
come performance measures have been endorsed 
and specified under subparagraph (A), the Sec-
retary shall provide that the payment amounts 
under paragraph (1) for transitional care serv-
ices shall be linked to performance on such 
measures. 
‘‘(C) PUBLIC REPORTING.—The Secretary 
shall establish a mechanism to publicly report 
on a qualifying transitional care entity’s per-
formance on such measures, including providing 
benchmarks to identify high performers and 
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those practices that contribute to lower hospital 
readmission rates. 
‘‘(D) DISSEMINATION OF INFORMATION ON 
BEST PRACTICES.—The Secretary shall dissemi-
nate information on best practices used by tran-
sitional care clinicians and qualified transitional 
care entities in furnishing transitional care 
services for purposes of application in other set-
tings, such as in conditions of participation 
under this title, under the Quality Improvement 
Organization Program under part B of title XI, 
and public-private quality alliances, such as the 
Hospital Quality Alliance. 
‘‘(3) PREVENTION OF INAPPROPRIATE STEER-
ING.—The Secretary shall promulgate such regula-
tions as the Secretary deems necessary to address 
any protections needed, beyond those otherwise pro-
vided under law and regulations, to prevent inappro-
priate steering of qualified individuals to providers 
of services, suppliers, qualified transitional care enti-
ties, or transitional care clinicians, under this part 
or inappropriate limitations on access to needed 
transitional care services under this part.’’. 
(c) COORDINATION WITH HOSPITAL DISCHARGE 
PLANNING.—Section 1861(ee)(2) of such Act (42 U.S.C. 
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1395x(ee)(2)) is amended by adding at the end the fol-
lowing: 
‘‘(I) In the case of subsection (d) hospitals 
and critical care hospitals, the hospital must— 
‘‘(i) identify, as soon as practicable 
after admission, those patients who are 
qualified individuals described in para-
graph (3) of section 1861(iii); and 
‘‘(ii) provide to such patients and 
their primary caregivers a list of transi-
tional care entities available under such 
section to arrange for the provision of 
transitional care services, a list of transi-
tional care services provided under this 
part, and a notice that the transitional 
care service benefit under such section is 
provided to qualified individuals with no 
deductible or cost sharing. 
Nothing in subparagraph (I) shall be construed 
as preventing a hospital or critical care hospital 
from entering into an agreement with a quali-
fied transitional care entity or a transitional 
care clinician for the furnishing of transitional 
care services to the hospital’s patients.’’. 
(d) EVALUATION; REPORT.— 
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(1) IN GENERAL.—The Secretary of Health and 
Human Services shall evaluate the performance of 
the transitional care benefit under the amendments 
made by this section by measuring the following, 
both for individuals receiving transitional care serv-
ices and for individuals not receiving such services: 
(A) Admission rates to health care facili-
ties. 
(B) Hospital readmission rates. 
(C) Cost of transitional care and all other 
health care services. 
(D) Quality of transitional care experi-
ences. 
(E) Measures of quality and efficiency. 
(F) Beneficiary experience. 
(G) Health outcomes. 
(H) Reductions in expenditures under this 
title over time. 
(2) REPORT.—The Secretary shall submit a re-
port to Congress no later than April 1, 2016, on the 
performance measures achieved by the transitional 
care benefit in the first 2 years of implementation. 
After submitting such report, the Secretary may ex-
pand the benefit to moderate-risk and lower-risk in-
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dividuals under section 1861(iii)(3)(B) of the Social 
Security Act, as added by subsection (a). 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2013. 
Æ 
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