Title: To amend title XVIII of the Social Security Act to provide for technical amendments to the Merit-based Incentive Payment System under Medicare.
Policy area: Health

Summary:
This bill revises provisions related to performance and payment under Medicare's Merit-based Incentive Payment System.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4987 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 4987

    To amend title XVIII of the Social Security Act to provide for 
technical amendments to the Merit-based Incentive Payment System under 
                               Medicare.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 8, 2018

Mr. Burgess (for himself, Mr. Gene Green of Texas, Mr. Roskam, and Mr. 
    Levin) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to provide for 
technical amendments to the Merit-based Incentive Payment System under 
                               Medicare.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. TECHNICAL AMENDMENTS TO PUBLIC LAW 114-10.

    (a) MIPS Transition.--Section 1848 of the Social Security Act (42 
U.S.C. 1395w-4) is amended--
            (1) in subsection (q)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (B), by striking 
                        ``items and services'' and inserting ``covered 
                        professional services (as defined in subsection 
                        (k)(3)(A))''; and
                            (ii) in subparagraph (C)(iv)--
                                    (I) by amending subclause (I) to 
                                read as follows:
                                    ``(I) The minimum number (as 
                                determined by the Secretary) of--
                                            ``(aa) for performance 
                                        periods beginning before 
                                        January 1, 2018, individuals 
                                        enrolled under this part who 
                                        are treated by the eligible 
                                        professional for the 
                                        performance period involved; 
                                        and
                                            ``(bb) for performance 
                                        periods beginning on or after 
                                        January 1, 2018, individuals 
                                        enrolled under this part who 
                                        are furnished covered 
                                        professional services (as 
                                        defined in subsection 
                                        (k)(3)(A)) by the eligible 
                                        professional for the 
                                        performance period involved.'';
                                    (II) in subclause (II), by striking 
                                ``items and services'' and inserting 
                                ``covered professional services (as 
                                defined in subsection (k)(3)(A))''; and
                                    (III) by amending subclause (III) 
                                to read as follows:
                                    ``(III) The minimum amount (as 
                                determined by the Secretary) of--
                                            ``(aa) for performance 
                                        periods beginning before 
                                        January 1, 2018, allowed 
                                        charges billed by such 
                                        professional under this part 
                                        for such performance period; 
                                        and
                                            ``(bb) for performance 
                                        periods beginning on or after 
                                        January 1, 2018, allowed 
                                        charges for covered 
                                        professional services (as 
                                        defined in subsection 
                                        (k)(3)(A)) billed by such 
                                        professional for such 
                                        performance period.'';
                    (B) in paragraph (5)(D)--
                            (i) in clause (i)(I), by inserting 
                        ``subject to clause (iii),'' after ``clauses 
                        (i) and (ii) of paragraph (2)(A),''; and
                            (ii) by adding at the end the following new 
                        clause:
                            ``(iii) Transition years.--For each of the 
                        second, third, fourth, and fifth years for 
                        which the MIPS applies to payments, the 
                        performance score for the performance category 
                        described in paragraph (2)(A)(ii) shall not 
                        take into account the improvement of the 
                        professional involved.'';
                    (C) in paragraph (5)(E)--
                            (i) in clause (i)(I)(bb)--
                                    (I) in the heading by striking 
                                ``First 2 years'' and inserting ``First 
                                5 years''; and
                                    (II) by striking ``the first and 
                                second years'' and inserting ``each of 
                                the first through fifth years''; and
                            (ii) in clause (i)(II)(bb)--
                                    (I) in the heading, by striking ``2 
                                years'' and inserting ``5 years''; and
                                    (II) by striking the second 
                                sentence and inserting the following 
                                new sentences: ``For each of the 
                                second, third, fourth, and fifth years 
                                for which the MIPS applies to payments, 
                                not less than 10 percent and not more 
                                than 30 percent of such score shall be 
                                based on performance with respect to 
                                the category described in clause (ii) 
                                of paragraph (2)(A). Nothing in the 
                                previous sentence shall be construed, 
                                with respect to a performance period 
                                for a year described in the previous 
                                sentence, as preventing the Secretary 
                                from basing 30 percent of such score 
                                for such year with respect to the 
                                category described in such clause (ii), 
                                if the Secretary determines, based on 
                                information posted under subsection 
                                (r)(2)(I) that sufficient resource use 
                                measures are ready for adoption for use 
                                under the performance category under 
                                paragraph (2)(A)(ii) for such 
                                performance period.'';
                    (D) in paragraph (6)(D)--
                            (i) in clause (i), in the second sentence, 
                        by striking ``Such performance threshold'' and 
                        inserting ``Subject to clauses (iii) and (iv), 
                        such performance threshold'';
                            (ii) in clause (ii)--
                                    (I) in the first sentence, by 
                                inserting ``(beginning with 2019 and 
                                ending with 2024)'' after ``for each 
                                year of the MIPS''; and
                                    (II) in the second sentence, by 
                                inserting ``subject to clause (iii),'' 
                                after ``For each such year,'';
                            (iii) in clause (iii)--
                                    (I) in the heading, by striking 
                                ``2'' and inserting ``5''; and
                                    (II) in the first sentence, by 
                                striking ``two years'' and inserting 
                                ``five years''; and
                            (iv) by adding at the end the following new 
                        clause:
                            ``(iv) Additional special rule for third, 
                        fourth and fifth years of mips.--For purposes 
                        of determining MIPS adjustment factors under 
                        subparagraph (A), in addition to the 
                        requirements specified in clause (iii), the 
                        Secretary shall increase the performance 
                        threshold with respect to each of the third, 
                        fourth, and fifth years to which the MIPS 
                        applies to ensure a gradual and incremental 
                        transition to the performance threshold 
                        described in clause (i) (as estimated by the 
                        Secretary) with respect to the sixth year to 
                        which the MIPS applies.'';
                    (E) in paragraph (6)(E)--
                            (i) by striking ``In the case of items and 
                        services'' and inserting ``In the case of 
                        covered professional services (as defined in 
                        subsection (k)(3)(A))''; and
                            (ii) by striking ``under this part with 
                        respect to such items and services'' and 
                        inserting ``under this part with respect to 
                        such covered professional services''; and
                    (F) in paragraph (7), in the first sentence, by 
                striking ``items and services'' and inserting ``covered 
                professional services (as defined in subsection 
                (k)(3)(A))'';
            (2) in subsection (r)(2), by adding at the end the 
        following new subparagraph:
                    ``(I) Information.--The Secretary shall, not later 
                than December 31st of each year (beginning with 2018), 
                post on the Internet website of the Centers for 
                Medicare & Medicaid Services information on resource 
                use measures in use under subsection (q), resource use 
                measures under development and the time-frame for such 
                development, potential future resource use measure 
                topics, a description of stakeholder engagement, and 
                the percent of expenditures under part A and this part 
                that are covered by resource use measures.''; and
            (3) in subsection (s)(5)(B), by striking ``section 
        1833(z)(2)(C)'' and inserting ``section 1833(z)(3)(D)''.
    (b) Physician-Focused Payment Model Technical Advisory Committee 
Provision of Initial Proposal Feedback.--Section 1868(c)(2)(C) of the 
Social Security Act (42 U.S.C. 1395ee(c)(2)(C)) is amended to read as 
follows:
                    ``(C) Committee review of models submitted.--The 
                Committee, on a periodic basis--
                            ``(i) shall review models submitted under 
                        subparagraph (B);
                            ``(ii) may provide individuals and 
                        stakeholder entities who submitted such models 
                        with--
                                    ``(I) initial feedback on such 
                                models regarding the extent to which 
                                such models meet the criteria described 
                                in subparagraph (A); and
                                    ``(II) an explanation of the basis 
                                for the feedback provided under 
                                subclause (I); and
                            ``(iii) shall prepare comments and 
                        recommendations regarding whether such models 
                        meet the criteria described in subparagraph (A) 
                        and submit such comments and recommendations to 
                        the Secretary.''.
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