Title: To amend title XVIII of the Social Security Act to improve measurements under the skilled nursing facility value-based purchasing program under the Medicare program, and for other purposes.
Policy area: Health

Summary:
This bill modifies requirements relating to the Medicare skilled nursing facility (SNF) value-based purchasing program, which provides incentive payments to SNFs based on their quality of care.
Currently, all Medicare SNFs are included in the program, and their quality of care is determined based on a hospital readmissions measure. The bill excludes from the program SNFs for which there is not a minimum number of applicable cases or measures, as set by the Centers for Medicare & Medicaid Services (CMS), for the performance period. Additionally, the bill allows the CMS to apply up to 10 additional quality measures, including measures relating to patient safety and care coordination.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3406 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 3406

To amend title XVIII of the Social Security Act to improve measurements 
under the skilled nursing facility value-based purchasing program under 
             the Medicare program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 21, 2019

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

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to improve measurements 
under the skilled nursing facility value-based purchasing program under 
             the Medicare program, and for other purposes.

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

SECTION 1. IMPROVING MEASUREMENTS UNDER THE SKILLED NURSING FACILITY 
              VALUE-BASED PURCHASING PROGRAM UNDER THE MEDICARE 
              PROGRAM.

    (a) In General.--Section 1888(h) of the Social Security Act (42 
U.S.C. 1395yy(h)) is amended--
            (1) in paragraph (1), by adding at the end the following 
        new subparagraph:
                    ``(C) Exclusions.--With respect to payments for 
                services furnished on or after October 1, 2021, this 
                subsection shall not apply to a facility for which 
                there are not a minimum number (as determined by the 
                Secretary) of--
                            ``(i) cases for the measures that apply to 
                        the facility for the performance period for the 
                        applicable fiscal year; or
                            ``(ii) measures that apply to the facility 
                        for the performance period for the applicable 
                        fiscal year.'';
            (2) in paragraph (2)(A)--
                    (A) by striking ``The Secretary shall apply'' and 
                inserting ``The Secretary--
                            ``(i) shall apply'';
                    (B) by striking the period at the end and inserting 
                ``; and''; and
                    (C) by adding at the end the following:
                            ``(ii) may, with respect to payments for 
                        services furnished on or after October 1, 2022, 
                        apply additional measures determined 
                        appropriate by the Secretary, which may include 
                        measures of functional status, patient safety, 
                        care coordination, or patient experience.
                Subject to the succeeding sentence, in the case that 
                the Secretary applies additional measures under clause 
                (ii), the Secretary shall consider and apply, as 
                appropriate, quality measures specified under section 
                1899B(c)(1). In no case may the Secretary apply more 
                than 10 measures under this subparagraph.'';
            (3) in subparagraph (A) of each of paragraphs (3) and (4), 
        by striking ``measure'' and inserting ``measures''; and
            (4) by adding at the end the following new paragraph:
            ``(12) Validation.--
                    ``(A) In general.--The Secretary shall apply to the 
                measures applied under this subsection and the data 
                submitted under subsection (e)(6) a process to validate 
                such measures and data, as appropriate, which may be 
                similar to the process specified in section 
                1886(b)(3)(B)(viii)(XI) for validating inpatient 
                hospital measures.
                    ``(B) Funding.--For purposes of carrying out this 
                paragraph, the Secretary shall provide for the 
                transfer, from the Federal Hospital Insurance Trust 
                Fund established under section 1817, of $5,000,000 to 
                the Centers for Medicare & Medicaid Services Program 
                Management Account for each of fiscal years 2022 
                through 2024.''.
    (b) Report by MedPAC.--Not later than March 15, 2021, the Medicare 
Payment Advisory Commission shall submit to Congress a report on 
establishing a prototype value-based payment program under a unified 
prospective payment system for post-acute care services under the 
Medicare program under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.). Such report--
            (1) shall--
                    (A) consider design elements such as--
                            (i) measures that are important to the 
                        Medicare program and to beneficiaries under 
                        such program;
                            (ii) methodologies for scoring provider 
                        performance and effects on payment; and
                            (iii) other elements determined appropriate 
                        by the Commission; and
                    (B) analyze the effects of implementing such 
                prototype program; and
            (2) may--
                    (A) discuss the possible effects, with respect to 
                the Medicare program, on program spending, post-acute 
                care providers, patient outcomes, and other effects 
                determined appropriate by the Commission; and
                    (B) include recommendations with respect to such 
                prototype program, as determined appropriate by the 
                Commission, to Congress and the Secretary of Health and 
                Human Services.
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