,i #aacth ,,congress #ast ,session ,h4 ,r4 #bhaj ,,in ,,the ,,house ,,of ,,representatives ,july #bd1 #bjac ,mr4 ,burgess 7for himself1 ,mr4 ,pallone1 ,mr4 ,upton1 ,mr4 ,waxman1 ,mr4 ,pitts1 and ,mr4 ,dingell7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means and the ,judiciary1 for a period to be subsequently determined by the ,speaker1 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 reform the sustainable growth rate and ,medicare payment for physicians' services1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,medicare ,patient ,access and ,quality ,improvement ,act of #bjac4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,reform of sustainable growth rate 7,,sgr7 and ,medicare payment for physicians' services4 ,sec4 #c4 ,expanding availability of ,medicare data4 ,sec4 #d4 ,encouraging care coordination and medical homes4 ,sec4 #e4 ,miscellaneous4 #b4 ,reform of sustainable growth rate 7,,sgr7 and ,medicare payment for physicians' services 7a7 ,stabilizing fee updates 7,phase ,i7 7#a7 ,repeal of ,,sgr payment methodology ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is amended-- 7,a7 in subsection 7d7-- 7i7 in paragraph 7#a77;,a71 by inserting or a subsequent paragraph or section #ahdh;,a after paragraph 7#d72 and 7ii7 in paragraph 7#d7-- 7,i7 in the heading1 by striking years beginning with #bjja and inserting #bjja1 #bjjb1 and #bjjc2 and 7,,ii7 in subparagraph 7,a71 by striking a year beginning with #bjja and inserting #bjja1 #bjjb1 and #bjjc2 and 7,b7 in subsection 7f7-- 7i7 in paragraph 7#a77;,b71 by inserting through #bjac after of such succeeding year2 and 7ii7 in paragraph 7#b71 by inserting and ending with #bjac after beginning with #bjjj4 7#b7 ,update of rates for #bjad through #bjah ,subsection 7d7 of section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is amended by adding at the end the following new paragraph3 7#ae7 ,update for #bjad through #bjah ,the update to the single conversion factor established in paragraph 7#a77;,c7 for each of #bjad through #bjah shall be #j4e percent4 4 7b7 ,quality update incentive program 7,phase ,,ii7 7#a7 ,in general ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d71 as amended by subsection 7a71 is further amended-- 7,a7 in subsection 7d71 by adding at the end the following new paragraph3 7#af7 ,update beginning with #bjai 7,a7 ,in general ,subject to subparagraph 7,b71 the update to the single conversion factor established in paragraph 7#a77;,c7 for each year beginning with #bjai shall be #j4e percent4 7,b7 ,adjustment ,in the case of an eligible professional 7as defined in subsection 7k77#c77 who does not have a payment arrangement described in section #ahdh;,a7a7 in effect1 the update under subparagraph 7,a7 for a year beginning with #bjai shall be adjusted by the applicable quality adjustment determined under subsection 7q77#c7 for the year involved4 2 and 7,b7 in subsection 7i77#a7-- 7i7 by striking and at the end of subparagraph 7,d72 7ii7 by striking the period at the end of subparagraph 7,e7 and inserting 1 and2 and 7iii7 by adding at the end the following new subparagraph3 7,f7 the implementation of subsection 7q74 4 7#b7 ,enhancing physician quality reporting system to support quality update incentive program ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is amended-- 7,a7 in subsection 7k77#a71 in the first sentence1 by inserting and1 if applicable1 clinical practice improvement activities1 after quality measures2 7,b7 in subsection 7k77#b7-- 7i7 in subparagraph 7,c7-- 7,i7 in the subparagraph heading1 by striking and subsequent years and inserting through #bjah2 and 7,,ii7 in clause 7i71 by inserting 7before #bjai7 after subsequent year2 7ii7 by redesignating subparagraph 7,d7 as subparagraph 7,e72 7iii7 by inserting after subparagraph 7,c7 the following new subparagraph3 7,d7 ,for #bjai and subsequent years ,for purposes of reporting data on quality measures and1 as applicable clinical practice improvement activities1 for covered professional services furnished during the performance period 7as defined in subsection 7q77#b77;,b77 with respect to #bjai and the performance period with respect to each subsequent year1 subject to subsection 7q77#a77;,d71 the quality measures and clinical practice improvement activities specified under this paragraph shall be1 with respect to an eligible professional1 the quality measures and1 as applicable1 clinical practice improvement activities within the final core measure set under paragraph 7#i77;,f7 applicable to the peer cohort of such provider and year involved4 2 and 7iv7 in subparagraph 7,e71 as redesignated by subparagraph 7,b77ii7 of this paragraph1 by striking and subsequent years2 7,c7 in subsection 7k77#c7-- 7i7 in the paragraph heading1 by striking ,covered professional services and eligible professionals defined and inserting ,definitions2 and 7ii7 by adding at the end the following new subparagraphs3 7,c7 ,clinical practice improvement activities ,the term clinical practice improvement activity means an activity that relevant eligible professional organizations and other relevant stakeholders identify as improving clinical practice or care delivery and that the ,secretary determines1 when effectively executed1 is likely to result in improved outcomes4 7,d7 ,eligible professional organization ,the term eligible professional organization means a professional organization that is recognized by the ,american ,board of ,medical ,specialties1 ,american ,osteopathic ,association1 ,american ,board of ,physician ,specialties1 or an equivalent certification board4 7,e7 ,peer cohort ,the term peer cohort means a peer cohort identified on the list under paragraph 7#i77;,b71 as updated under clause 7ii7 of such paragraph4 2 7,d7 in subsection 7k77#g71 by striking and the application of paragraphs 7#d7 and 7#e7 and inserting 1 the application of paragraphs 7#d7 and 7#e71 and the implementation of paragraph 7#i72 7,e7 by adding at the end of subsection 7k7 the following new paragraph3 7#i7 ,establishment of final core measure sets 7,a7 ,in general ,under the system under this subsection-- 7i7 for each peer cohort identified under subparagraph 7,b7 and in accordance with this paragraph1 there shall be published a final core measure set under subparagraph 7,f71 which shall consist of quality measures and may also consist of clinical practice improvement activities1 with respect to which eligible professionals shall1 subject to subsection 7m77#c77;,c71 be assessed for purposes of determining1 for years beginning with #bjai1 the quality adjustment under subsection 7q77#c7 applicable to such professionals2 and 7ii7 each eligible professional shall self-identify1 in accordance with subparagraph 7,b71 within such a peer cohort for purposes of such assessments4 7,b7 ,peer cohorts ,the ,secretary shall identify 7and publish a list of7 peer cohorts by which eligible professionals shall self-identify for purposes of this subsection and subsection 7q7 with respect to a performance period 7as defined in subsection 7q77#b77;,b77 for a year beginning with #bjai4 ,for purposes of this subsection and subsection 7q71 the ,secretary shall develop one or more peer cohorts for multispecialty groups1 each of which shall be included as a peer cohort under this subparagraph4 ,such self-identification will be made through such a process and at such time as specified under the system under this subsection4 ,such list-- 7i7 shall include1 as peer cohorts1 provider specialties defined by the ,american ,board of ,medical ,specialties or equivalent certification boards and such other cohorts as established under this section in order to capture classifications of providers across eligible professional organizations and other practice areas1 groupings1 or categories2 and 7ii7 shall be updated from time to time4 7,c7 ,quality measures for core measure sets 7i7 ,development ,under the system under this subsection there shall be established a process for the development of quality measures under this subparagraph for purposes of potential inclusion of such measures in core measure sets under this paragraph4 ,under such process-- 7,i7 there shall be coordination1 to the extent possible1 across organizations developing such measures2 7,,ii7 eligible professional organizations and other relevant stakeholders may submit best practices and clinical practice guidelines for the development of quality measures that address quality domains 7as defined under clause 7ii77 for potential inclusion in such core measure sets2 7,,iii7 there is encouraged to be developed1 as appropriate1 meaningful outcome measures 7or quality of life measures in cases for which outcomes may not be a valid measurement71 functional status measures1 and patient experience measures2 and 7,,iv7 measures developed under this clause shall be developed1 to the extent possible1 in accordance with best practices and clinical practice guidelines4 7ii7 ,quality domains ,for purposes of this paragraph1 the term quality domains means at least the following domains3 7,i7 ,clinical care4 7,,ii7 ,safety4 7,,iii7 ,care coordination4 7,,iv7 ,patient and caregiver experience4 7,v7 ,population health and prevention4 7,d7 ,process for establishing core measure sets 7i7 ,in general ,under the system under this subsection1 for purposes of subparagraph 7,a71 there shall be established a process to approve final core measure sets under this paragraph for peer cohorts4 ,each such final core measure set shall be composed of quality measures 7and1 as applicable1 clinical practice improvement activities7 with respect to which eligible professionals within such peer cohort shall report under this subsection and be assessed under subsection 7q74 ,such process shall provide-- 7,i7 for the establishment of criteria1 which shall be made publicly available before the request is made under clause 7ii71 for selecting such measures and activities for potential inclusion in such a final core measure set2 and 7,,ii7 that all peer cohorts1 and to the extent practicable all quality domains1 are addressed by measures and1 as applicable1 clinical practice improvement activities selected to be included in a core measure set under this paragraph1 which may include through the use of such a measure or clinical practice improvement activity that addresses more than one such domain or cohort4 7ii7 ,solicitation of public input on quality measures and clinical practice improvement activities ,under the process established under clause 7i71 relevant eligible professional organizations and other relevant stakeholders shall be requested to identify and submit quality measures and clinical practice improvement activities 7as defined in paragraph 7#c77;,c77 for selection under this paragraph4 ,for purposes of the previous sentence1 measures and activities may be submitted regardless of whether such measures were previously published in a proposed rule or endorsed by an entity with a contract under section #ahij7;a74 7,e7 ,core measure sets 7i7 ,in general ,under the process established under subparagraph 7,d77i71 the ,secretary-- 7,i7 shall select1 from quality measures described in clause 7ii7 applicable to a peer cohort1 quality measures to be included in a core measure set for such cohort2 7,,ii7 shall1 to the extent there are insufficient quality measures applicable to a peer cohort to address one or more applicable quality domains1 select to be included in a core measure set for such cohort such clinical practice improvement activities described in clause 7ii77,,iv7 as are needed and available to sufficiently address such an applicable domain with respect to such peer cohort2 and 7,,iii7 may select1 to the extent determined appropriate1 any additional clinical practice improvement activities described in clause 7ii77,,iv7 applicable to a peer cohort to be included in a core measure set for such cohort4 ,activities selected under this paragraph shall be selected with consideration of best practices and clinical practice guidelines identified under subparagraph 7,c77i77,,ii74 7ii7 ,sources of quality measures and clinical practice improvement activities ,a quality measure or clinical practice improvement activity selected for inclusion in a core measure set under the process under subparagraph 7,d77i7 shall be-- 7,i7 a measure endorsed by a consensus-based entity2 7,,ii7 a measure developed under paragraph 7#b77;,c7 or a measure otherwise applied or developed for a similar purpose under this section2 7,,iii7 a measure developed under subparagraph 7,c72 or 7,,iv7 a measure or activity submitted under subparagraph 7,d77ii74 ,a measure or activity may be selected under this subparagraph1 regardless of whether such measure or activity was previously published in a proposed rule4 ,a measure so selected shall be evidence-based but 7other than a measure described in subclause 7,i77 shall not be required to be consensus-based4 7iii7 ,transparency ,before publishing in a final regulation a core measure set under clause 7i7 as a final core measure set under subparagraph 7,f71 the ,secretary shall-- 7,i7 submit for publication in applicable specialty-appropriate peer-reviewed journals such core measure set under clause 7i7 and the method for developing and selecting measures within such set1 including clinical and other data supporting such measures1 and1 as applicable1 the method for selecting clinical practice improvement activities included within such set2 and 7,,ii7 regardless of whether or not the core measure set or method is published in such a journal under subclause 7,i71 provide for notice of the proposed regulation in the ,federal ,register1 including with respect to the applicable methods and data described in subclause 7,i71 and a period for public comment thereon4 7,f7 ,final core measure sets ,not later than ,november #ae of the year prior to the first day of a performance period1 the ,secretary shall publish a final regulation in the ,federal ,register that includes a final core measure set 7and the applicable methods and data described in subparagraph 7,e77iii77,i77 for each peer cohort to be applied for such performance period4 7,g7 ,periodic review and updates 7i7 ,in general ,in carrying out this paragraph1 under the system under this subsection1 there shall periodically be reviewed-- 7,i7 the quality measures and clinical practice improvement activities selected for inclusion in final core measure sets under this paragraph for each year such measures and activities are to be applied under this subsection or subsection 7q7 to ensure that such measures and activities continue to meet the conditions applicable to such measures and activities for such selection2 and 7,,ii7 the final core measure sets published under subparagraph 7,f7 for each year such sets are to be applied to peer cohorts of eligible professionals to ensure that each applicable set continues to meet the conditions applicable to such sets before being so published4 7ii7 ,collaboration with stakeholders ,in carrying out clause 7i71 relevant eligible professional organizations and other relevant stakeholders may identify and submit updates to quality measures and clinical practice improvement activities selected under this paragraph for inclusion in final core measure sets as well as any additional quality measures and clinical practice improvement activities4 ,not later than ,november #ae of the year prior to the first day of a performance period1 submissions under this clause shall be reviewed4 7iii7 ,additional1 and updates to1 measures and activities ,based on the review conducted under this subparagraph for a period1 as needed1 there shall be-- 7,i7 selected additional1 and updates to1 quality measures and clinical practice improvement activities selected under this paragraph for potential inclusion in final core measure sets in the same manner such quality measures and clinical practice improvement activities are selected under this paragraph for such potential inclusion2 7,,ii7 removed1 from final core measure sets1 quality measures and clinical practice improvement activities that are no longer meaningful2 and 7,,iii7 updated final core measure sets published under subparagraph 7,f7 in the same manner as such sets are approved under such subparagraph4 ,for purposes of this subsection and subsection 7q71 a final core measure set1 as updated under this subparagraph1 shall be treated in the same manner as a final core measure set published under subparagraph 7,f74 7iv7 ,transparency 7,i7 ,notification required for certain updates ,in the case of an update under subclause 7,,ii7 or 7,,iii7 of clause 7iii7 that adds1 materially changes1 or removes a measure or activity from a measure set1 such update shall not apply under this subsection or subsection 7q7 unless notification of such update is made available to applicable eligible professionals4 7,,ii7 ,public availability of updated final core measure sets ,subparagraph 7,e77iii7 shall apply with respect to measure sets updated under subclause 7,,ii7 or 7,,iii7 of clause 7iii7 in the same manner as such subparagraph applies to applicable core measure sets under subparagraph 7,e74 7,h7 ,coordination with existing programs ,the development and selection of quality measures and clinical practice improvement activities under this paragraph shall1 as appropriate1 be coordinated with the development and selection of existing measures and requirements1 such as the development of the ,physician ,compare ,website under subsection 7m77#e77;,g7 and the application of resource use management under subsection 7n74 ,to the extent feasible1 such measures and activities shall align with measures used by other payers and with measures and activities in use under other programs in order to streamline the process of such development and selection under this paragraph4 ,the ,secretary shall develop a plan to integrate reporting on quality measures under this subsection with reporting requirements under subsection 7o7 relating to the meaningful use of certified ,,ehr technology4 7,i7 ,consultation with relevant eligible professional organizations and other relevant stakeholders ,relevant eligible professional organizations 7as defined in paragraph 7#c77;,d77 and other relevant stakeholders1 including ,state and national medical societies1 shall be consulted in carrying out this paragraph4 7,j7 ,optional application ,the process under section #ahij;,a is not required to apply to the development or selection of measures under this paragraph4 2 and 7,f7 in subsection 7m77#c77;,c77i71 by adding at the end the following new sentence3 ,such process shall1 beginning for #bjai1 treat eligible professionals in such a group practice as reporting on measures for purposes of application of subsections 7q7 and 7a77#h77;,a77iii7 if1 in lieu of reporting measures under subsection 7k77#b77;,d71 the group practice reports measures determined appropriate by the ,secretary44 7#c7 ,establishment of quality update incentive program 7,a7 ,in general ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is amended by adding at the end the following new subsection3 7q7 ,quality update incentive program 7#a7 ,establishment 7,a7 ,in general ,the ,secretary shall establish an eligible professional quality update incentive program 7in this section referred to as the quality update incentive program7 under which-- 7i7 there is developed and applied1 in accordance with paragraph 7#b71 appropriate methodologies for assessing the performance of eligible professionals with respect to quality measures and clinical practice improvement activities included within the final core measure sets published under subsection 7k77#i77;,f7 applicable to the peer cohorts of such providers2 7ii7 there is applied1 consistent with the system under subsection 7k71 methods for collecting information needed for such assessments 7which shall involve the minimum amount of administrative burden required to ensure reliable results72 and 7iii7 the applicable update adjustments under paragraph 7#c7 are determined by such assessments4 7,b7 ,definitions 7i7 ,eligible professional ,in this subsection1 the term eligible professional has the meaning given such term in subsection 7k77#c71 except that such term shall not include a professional who has a payment arrangement described in section #ahdh;,a7a77#a7 in effect4 7ii7 ,peer cohorts2 clinical practice improvement activities2 eligible professional organizations ,in this subsection1 the terms peer cohort1 clinical practice improvement activity1 and eligible professional organization have the meanings given such terms in subsection 7k77#c74 7,c7 ,consultation with eligible professional organizations and other relevant stakeholders ,eligible professional organizations and other relevant stakeholders1 including ,state and national medical societies1 shall be consulted in carrying out this subsection4 7,d7 ,application at group practice level ,the ,secretary shall establish a process1 consistent with subsection 7m77#c77;,c71 under which the provisions of this subsection are applied to eligible professionals in a group practice if the group practice reports measures determined appropriate by the ,secretary under such subsection4 7,e7 ,coordination with existing programs ,the application of measures and clinical practice improvement activities and assessment of performance under this subsection shall1 as appropriate1 be coordinated with the application of measures and assessment of performance under other provisions of this section4 7#b7 ,assessing performance with respect to final core measure sets for applicable peer cohorts 7,a7 ,establishment of methods for assessment 7i7 ,in general ,under the quality update incentive program1 the ,secretary shall-- 7,i7 establish one or more methods1 applicable with respect to a performance period1 to assess 7using a scoring scale of #j to #ajj7 the performance of an eligible professional with respect to1 subject to paragraph 7#a77;,d71 quality measures and clinical practice improvement activities included within the final core measure set published under subsection 7k77#i77;,f7 applicable for the period to the peer cohort in which the provider self-identified under subsection 7k77#i77;,b7 for such period2 and 7,,ii7 subject to paragraph 7#a77;,d71 compute a composite score for such provider for such performance period with respect to the measures and activities included within such final core measure set4 7ii7 ,methods ,such methods shall1 with respect to an eligible professional1 provide that the performance of such professional shall1 subject to paragraph 7#a77;,d71 be assessed for a performance period with respect to the quality measures and clinical practice improvement activities within the final core measure set for such period for the peer cohort of such professional and on which information is collected from such professional4 7iii7 ,weighting of measures ,such a method may provide for the assignment of different scoring weights or1 as appropriate1 other factors-- 7,i7 for quality measures and clinical practice improvement activities2 7,,ii7 based on the type or category of measure or activity2 and 7,,iii7 based on the extent to which a quality measure or clinical practice improvement activity meaningfully assesses quality4 7iv7 ,risk adjustment ,such a method shall provide for appropriate risk adjustments4 7v7 ,incorporation of other methods of measuring physician quality ,in establishing such methods1 there shall be1 as appropriate1 incorporated comparable methods of measurement from physician quality incentive programs under this subsection4 7,b7 ,performance period ,there shall be established a period 7in this subsection referred to as a performance period71 with respect to a year 7beginning with #bjai7 for which the quality adjustment is applied under paragraph 7#c71 to assess performance on quality measures and clinical practice improvement activities4 ,each such performance period shall be a period of #ab consecutive months and shall end as close as possible to the beginning of the year for which such adjustment is applied4 7#c7 ,quality adjustment taking into account quality assessments 7,a7 ,quality adjustment ,for purposes of subsection 7d77#af71 if the composite score computed under paragraph 7#b77;,a7 for an eligible professional for a year 7beginning with #bjai7 is-- 7i7 a score of #fg or higher1 the quality adjustment under this paragraph for the eligible professional and year is #a percentage point2 7ii7 a score of at least #cd1 but below #fg1 the quality adjustment under this paragraph for the eligible professional and year is zero2 or 7iii7 a score below #cd1 the quality adjustment under this paragraph for the eligible professional and year is #a percentage point4 7,b7 ,no effect on subsequent years' quality adjustments ,each such quality adjustment shall be made each year without regard to the update adjustment for a previous year under this paragraph4 7#d7 ,transition for new eligible professionals ,in the case of a physician1 practitioner1 or other supplier that during a performance period1 with respect to a year for which a quality adjustment is applied under paragraph 7#c71 first becomes an eligible professional 7and had not previously submitted claims under this title as a person1 as an entity1 or as part of a physician group or under a different billing number or tax identifier71 the quality adjustment under this subsection applicable to such physician1 practitioner1 or supplier-- 7,a7 for such year1 with respect to such first performance period1 shall be zero2 and 7,b7 for a year1 with respect to a subsequent performance period1 shall be the quality adjustment that would otherwise be applied under this subsection4 7#e7 ,feedback 7,a7 ,feedback 7i7 ,ongoing feedback ,under the process under subsection 7m77#e77;,h71 there shall be provided1 as real time as possible1 but at least quarterly1 to each eligible professional feedback-- 7,i7 on the performance of such provider with respect to quality measures and clinical practice improvement activities within the final core measure set published under subsection 7k77#i77;,f7 for the applicable performance period and the peer cohort of such professional2 and 7,,ii7 to assess the progress of such professional under the quality update incentive program with respect to a performance period for a year4 7ii7 ,use of registries and other mechanisms ,feedback under this subparagraph shall1 to the extent an eligible professional chooses to participate in a data registry for purposes of this subsection 7including registries under subsections 7k7 and 7m771 be provided and based on performance received through the use of such registry1 and to the extent that an eligible professional chooses not to participate in such a registry for such purposes1 be provided through other similar mechanisms that allow for the provision of such feedback and receipt of such performance information4 7,b7 ,data mechanism ,under the quality update incentive program1 there shall be developed an electronic interactive eligible professional mechanism through which such a professional may receive performance data1 including data with respect to performance on the measures and activities developed and selected under this section4 ,such mechanism shall be developed in consultation with private payers and health insurance issuers 7as defined in section #bgia7;b77#b7 of the ,public ,health ,service ,act7 as appropriate4 7,c7 ,transfer of funds ,the ,secretary shall provide for the transfer of #ajj1jjj1jjj from the ,federal ,supplementary ,medical ,insurance ,trust ,fund established in section #ahda to the ,center for ,medicare ,medicaid ,services ,program ,management ,account to support such efforts to develop the infrastructure as necessary to carry out subsection 7k77#i7 and this subsection and for purposes of section #ahhi7;h74 ,such funds shall be so transferred on the date of the enactment of this subsection and shall remain available until expended4 4 7,b7 ,incentive to report under ,quality ,update ,incentive ,program ,section #ahdh7;a77#h77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#h77;,a77 is amended-- 7i7 in clause 7i71 by striking ,with respect to and inserting ,subject to clause 7iii71 with respect to2 and 7ii7 by adding at the end the following new clause3 7iii7 ,application to eligible professionals not reporting ,with respect to covered professional services 7as defined in subsection 7k77#c77 furnished by an eligible professional during #bjai or any subsequent year1 if the eligible professional does not submit data for the performance period 7as defined in subsection 7q77#b77;,b77 with respect to such year on1 subject to subsection 7q77#a77;,d71 the quality measures and1 as applicable1 clinical practice improvement activities within the final core measure set under subsection 7k77#i77;,f7 applicable to the peer cohort of such provider1 the fee schedule amount for such services furnished by such professional during the year 7including the fee schedule amount for purposes of determining a payment based on such amount7 shall be equal to #ie percent 7in lieu of the applicable percent7 of the fee schedule amount that would otherwise apply to such services under this subsection 7determined after application of paragraphs 7#c71 7#e71 and 7#g71 but without regard to this paragraph74 ,the ,secretary shall develop a minimum per year caseload threshold1 with respect to eligible professionals1 and the previous sentence shall not apply to eligible professionals with a caseload for a year below such threshold for such year4 4 7,c7 ,education on quality update incentive program ,section #ahhi of the ,social ,security ,act 7#db ,u4,s4,c4 #aciezz7 is amended by adding at the end the following new subsection3 7h7 ,quality update incentive program ,under this section1 information shall be disseminated to educate and assist eligible professionals 7as defined in section #ahdh7k77#c77 about the quality update incentive program under section #ahdh7q7 and quality measures under section #ahdh7k77#i7 through multiple approaches1 including a national dissemination strategy and outreach by medicare contractors4 4 7#d7 ,conforming amendments 7,a7 ,treatment of satisfactorily reporting ,,pqrs measures through participation in a qualified clinical data registry ,section #ahdh7m77#c77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#c77;,d77 is amended by striking ,for #bjad and subsequent years and inserting ,for each of #bjad through #bjah4 7,b7 ,coordinating enhanced ,,pqrs reporting with ,,ehr ,section #ahdh7o77#b77;,b77iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#b77;,b77iii77 is amended by striking subsection 7k77#b77;,c7 and inserting subparagraph 7,c7 or 7,d7 of subsection 7k77#b74 7,c7 ,coordinating ,,pqrs reporting period with quality update incentive program performance period ,section #ahdh7m77#f77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#f77;,c77 is amended-- 7i7 in clause 7i71 by striking and 7iii7 and inserting 1 7iii71 and 7iv72 and 7ii7 by adding at the end the following new clause3 7iv7 ,coordination with quality update incentive program ,for #bjai and each subsequent year the reporting period shall be coordinated with the performance period under subsection 7q77#b77;,b74 4 7,d7 ,coordinating ,,ehr reporting with quality update incentive program performance period ,section #ahdh7o77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#e77;,b77 is amended by adding at the end the following3 ,beginning for #bjai1 the ,,ehr reporting period shall be coordinated with the performance period under subsection 7q77#b77;,b744 7c7 ,advancing alternative payment models 7#a7 ,in general ,part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d et seq47 is amended by adding at the end the following new section3 #ahdh;,a4 ,advancing alternative payment models 7a7 ,payment model choice program ,payment for covered professional services 7as defined in section #ahdh7k77 that are furnished by an eligible professional 7as defined in such section7 under an ,alternative ,payment ,model specified on the list under subsection 7h7 7in this section referred to as an eligible ,,apm7 shall be made under this title in accordance with the payment arrangement under such model4 ,in applying the previous sentence1 such a professional with such a payment arrangement in effect1 shall be deemed for purposes of section #ahdh7;a77#h7 to be satisfactorily submitting data on quality measures for such covered professional services4 7b7 ,process for implementing eligible ,a,p,ms 7#a7 ,in general ,for purposes of subsection 7a7 and in accordance with this section1 the ,secretary shall establish a process under which-- 7,a7 a contract is entered into1 in accordance with paragraph 7#b72 7,b7 proposals for potential ,alternative ,payment ,models are submitted in accordance with subsection 7c72 7,c7 ,alternative ,payment ,models so proposed are recommended1 in accordance with subsection 7d71 for evaluation1 including through the demonstration program under subsection 7e71 and approval under subsection 7f72 7,d7 applicable ,alternative ,payment ,models are evaluated under such demonstration program2 7,e7 models are implemented as eligible ,a,p,ms in accordance with subsection 7f72 and 7,f7 a comprehensive list of all eligible ,a,p,ms is made publicly available1 in accordance with subsection 7h71 for application under subsection 7a74 7#b7 ,contract with ,,apm contracting entity 7,a7 ,in general ,for purposes of paragraph 7#a77;,a71 the ,secretary shall identify and have in effect a contract with an independent entity that has appropriate expertise to carry out the functions applicable to such entity under this section4 ,such entity shall be referred to in this section as the ,,apm contracting entity4 7,b7 ,timing for first contract ,as soon as practicable1 but not later than one year after the date of the enactment of this section1 the ,secretary shall enter into the first contract under subparagraph 7,a74 7,c7 ,competitive procedures ,competitive procedures 7as defined in section #d7e7 of the ,office of ,federal ,procurement ,policy ,act 7#da ,u4,s4,c4 #djc7e777 shall be used to enter into a contract under subparagraph 7,a74 7c7 ,submission of proposed ,alternative ,payment ,models ,beginning not later than #ij days after the date the ,secretary enters into a contract under subsection 7b77#b7 with the ,,apm contracting entity1 physicians1 eligible professional organizations1 health care provider organizations1 and other entities may submit to the ,,apm contracting entity proposals for ,alternative ,payment ,models for application under this section4 ,such a proposal of a model shall include suggestions for measures to be used under subsection 7e77#a77;,b7 for purposes of evaluating such model4 ,in reviewing submissions under this subsection for purposes of making recommendations under subsection 7d77#a71 the contracting entity shall focus on submissions for such models that are intended to improve care coordination and quality for patients through modifying the manner in which physicians and other providers are paid under this title4 7d7 ,recommendation by ,,apm contracting entity of proposed models 7#a7 ,recommendation 7,a7 ,in general ,under the process under subsection 7b71 the ,,apm contracting entity shall at least annually recommend to the ,secretary-- 7i7 based on the criteria described in subparagraph 7,b71 ,alternative ,payment ,models submitted under subsection 7c7 to be evaluated through a demonstration program under subsection 7e72 and 7ii7 based on the criteria described in subparagraph 7,c71 ,alternative ,payment ,models submitted under subsection 7c7 for purposes of implementation under subsection 7f71 without evaluation through such a demonstration program4 ,such a recommendation may be made with respect to a model for which a waiver would be required under paragraph 7#b74 7,b7 ,criteria for recommending models for demonstration ,the ,,apm contracting entity shall make a recommendation under subparagraph 7,a77i71 with respect to an ,alternative ,payment ,model1 only if the entity determines that the model satisfies each of the following criteria3 7i7 ,the model has been supported by meaningful clinical and non-clinical data1 with respect to a sufficient population sample1 that indicates the model would be successful at addressing each of the abilities described in clause 7v74 7ii7 7,i7 ,in the case of a model that has already been evaluated and supported by data with respect to a population of individuals enrolled under this part1 if the model were evaluated under the demonstration under subsection 7e7 such a population would represent a sufficient number of individuals enrolled under this part to ensure meaningful evaluation4 7,,ii7 ,in the case of a model that has not been so evaluated and supported by data with respect to such a population1 the population that would be furnished services under such model if the model were evaluated under the demonstration under subsection 7e7 would represent a sufficient number of individuals enrolled under this part to ensure meaningful evaluation4 7iii7 ,such model1 including if evaluated under the demonstration under subsection 7e71 would not deny or limit the coverage or provision of benefits under this title for applicable individuals4 7iv7 ,the implementation of such model as an eligible ,,apm under this section is expected-- 7,i7 to reduce spending under this title without reducing the quality of care2 or 7,,ii7 improve the quality of patient care without increasing spending4 7v7 ,the proposal for such model demonstrates-- 7,i7 the potential to successfully manage the cost of furnishing items and services under this title so as to not result in expenditures under this title for individuals participating under such ,,apm being greater than expenditures under this title for such individuals if the ,,apm were not implemented2 7,,ii7 the ability to maintain or improve the overall patient care2 and 7,,iii7 the ability to maintain or improve the quality of care provided to individuals enrolled under this part who participate under such mode4 7vi7 ,the model provides for a payment arrangement-- 7,i7 covering at least items and services furnished under this part by eligible professionals participating in the model2 7,,ii7 in the case such payment arrangement does not provide for payment under the fee schedule under section #ahdh for such items and services furnished by such eligible professionals1 that provides for a payment adjustment based on meaningful ,,ehr use comparable to such adjustment that would otherwise apply under section #ahdh2 and 7,,iii7 that provides for a payment adjustment based on quality measures comparable to such adjustment that would otherwise apply under section #ahdh4 7,c7 ,criteria for recommending models for approval without evaluation under demonstration ,the ,,apm contracting entity may make a recommendation under subparagraph 7,a77ii71 with respect to an ,alternative ,payment ,model1 only if the entity determines that the model has already been evaluated for a sufficient enough period and through such evaluation the model was shown-- 7i7 to have satisfied the criteria described in each of clauses 7i71 7ii71 7iii71 and 7vi7 of subparagraph 7,b72 7ii7 to demonstrate each of the abilities described in clause 7v7 of such subparagraph2 and 7iii7 7,i7 to reduce spending under this title without reducing the quality of care2 or 7,,ii7 improve the quality of patient care without increasing spending4 7,d7 ,transparency and disclosures 7i7 ,disclosures ,not later than #ij days after receipt of a submission of a model under subsection 7c7 by an entity1 the ,,apm contracting entity shall submit to the ,secretary and such entity and make publicly available a notification on whether or not1 and if so how1 the model meets criteria for recommending such model under subparagraph 7,a71 including whether or not such model requires a waiver under paragraph 7#b74 ,in the case that the ,,apm contracting entity determines not to recommend such model under this paragraph1 such notification shall include an explanation of the reasons for not making such a recommendation4 ,any information made publicly available pursuant to the previous sentence shall not include proprietary data4 7ii7 ,submission of recommended models ,the ,,apm contracting entity shall at least quarterly submit to the ,secretary1 the ,medicare ,payment ,advisory ,commission1 and the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services the following3 7,i7 ,the models recommended under subparagraph 7,a77i71 including any such models that require a waiver under paragraph 7#b71 and the data and analyses on such recommended models that support the criteria described in subparagraph 7,b74 7,,ii7 ,the models recommended under subparagraph 7,a77ii71 including any such models that require a waiver under paragraph 7#b71 and the data and analyses on such recommended models that support the criteria described in subparagraph 7,c74 ,for any year beginning with #bjae that the ,,apm contracting does not recommend any models under subparagraph 7,a71 the entity shall instead satisfy this clause by submitting to the ,secretary and making publicly available an explanation for not having any such recommendations4 7#b7 ,models requiring waiver approval 7,a7 ,in general ,in the case that an ,alternative ,payment ,model recommended under paragraph 7#a77;,a77i7 would require a waiver from any requirement under this title1 in determining approval of such model1 the ,secretary may make such a waiver in order for such model to be evaluated under the demonstration program 7if described in clause 7i7 of such paragraph74 7,b7 ,approval ,not later than #ij days after the date of the receipt of such submission for a model1 the ,secretary shall notify the ,,apm contracting entity and the entity submitting such model under subsection 7c7 whether or not such a waiver for such model is provided and the reason for any denial of such a waiver4 7e7 ,demonstration 7#a7 ,in general ,subject to paragraphs 7#e71 7#f71 and 7#g71 the ,secretary may conduct a demonstration program1 with respect to an ,alternative ,payment ,model approved under paragraph 7#b71 under which participating entities shall be paid under this title in accordance with the payment arrangement under such model and such model shall be evaluated by the independent evaluation entity under paragraph 7#c74 ,the duration of a demonstration program under this subsection1 with respect to such a model1 shall be #c years 7or a shorter period1 taking into account the applicable recommendation under subsection 7d77#a77;,a77i774 7#b7 ,approval by ,secretary of models for demonstration ,not later than #ij days after the date of receipt of a recommendation under subsection 7d77#a77;,a77i71 with respect to an ,alternative ,payment ,model1 the ,secretary shall approve such model for a demonstration program under this subsection only if the ,secretary determines the model satisfies the criteria described in subsection 7d77#a77;,b74 ,the ,secretary shall periodically make a available a list of such models so approved4 7#c7 ,participating entities ,to participate under a demonstration program under this subsection1 with respect to an ,alternative ,payment ,model1 a physician1 practitioner1 or other supplier shall enter into a contract with the ,administrator of the ,centers for ,medicare ,medicaid ,services under this subsection4 ,for purposes of this section1 such a physician1 practitioner1 or supplier who so participates under such an ,alternative ,payment ,model shall be referred to as a participating ,,apm provider4 7#d7 ,reporting and evaluation 7,a7 ,independent evaluation entity ,under this subsection1 the ,secretary shall enter into a contract with an independent entity to evaluate ,alternative ,payment ,models under demonstration programs under this subsection based on appropriate measures specified under subparagraph 7,b74 ,in this section1 such entity shall be referred to as the independent evaluation entity4 ,such contract shall be entered into in a timely manner so as to ensure evaluation of an ,alternative ,payment ,model under a demonstration program under this subsection may begin as soon as possible after the model is approved under paragraph 7#b74 7,b7 ,performance measures ,for purposes of this subsection1 the ,secretary shall specify-- 7i7 measures to evaluate ,alternative ,payment ,models under demonstration programs under this subsection1 which may include measures suggested under subsection 7c7 and shall be sufficient to allow for a comprehensive assessment of such a model2 and 7ii7 quality measures on which participating entities shall report1 which shall be similar to measures applicable under section #ahdh7k74 7,c7 ,reporting requirements ,a contract entered into with a participating ,,apm provider under paragraph 7#c7 shall require such provider to report on appropriate measures specified under subparagraph 7,b74 7,d7 ,periodic review ,the independent evaluation entity shall periodically review and analyze and submit such analysis to the ,secretary and the participating entities involved data reported under subparagraph 7,c7 and such other data as deemed necessary to evaluate the model4 7,e7 ,final evaluation ,not later than #f months after the date of completion of a demonstration program1 the independent evaluation entity shall submit to the ,secretary1 the ,medicare ,payment ,advisory ,commission1 and the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services 7and make publicly available7 a report on each model evaluated under such program4 ,such report shall include-- 7i7 outcomes on the clinical and claims data received through such program with respect to such model2 7ii7 recommendations on-- 7,i7 whether or not such model should be implemented as an eligible ,,apm under this section2 or 7,,ii7 whether or not the evaluation of such model under the demonstration program should be extended or expanded2 7iii7 the justification for each such recommendation described in clause 7ii72 and 7iv7 in the case of a recommendation to implement such model as an eligible ,,apm1 recommendations on standardized rules for purposes of such implementation4 7#e7 ,approval of extending evaluation under demonstration ,not later than #ij days after the date of receipt of a submission under paragraph 7#d77;,e71 the ,secretary shall1 including based on a recommendation submitted under such paragraph1 determine whether an ,alternative ,payment ,model may be extended or expanded under the demonstration program4 7#f7 ,termination ,the ,secretary shall terminate a demonstration program for a model under this subsection unless the ,secretary determines 7and the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services1 with respect to program spending under this title1 certifies71 after testing has begun1 that the model is expected to-- 7,a7 improve the quality of care 7as determined by the ,administrator of the ,centers for ,medicare ,medicaid ,services7 without increasing spending under this title2 7,b7 reduce spending under this title without reducing the quality of care2 or 7,c7 improve the quality of care and reduce spending4 ,such termination may occur at any time after such testing has begun and before completion of the testing4 7#g7 ,funding 7,a7 ,in general ,there are appropriated1 from amounts in the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda not otherwise appropriated1 #b1jjj1jjj1jjj for the purposes described in subparagraph 7,b71 of which no more than #b4e percent may be used for the purpose described in clause 7iii7 of such subparagraph4 ,amounts transferred under this subparagraph shall be available until expended4 7,b7 ,purposes ,amounts appropriated under subparagraph 7,a7 shall be used for-- 7i7 payments for items and services furnished by participating entities under an ,alternative ,payment ,model under a demonstration program under this subsection that-- 7,i7 would not otherwise be eligible for payment under this title2 or 7,,ii7 exceed the amount of payment that would otherwise be made for such items and services under this title if such items and services were not furnished under such demonstration program2 7ii7 the evaluations provided for under this section of models under such a demonstration program2 7iii7 payment to the contracting entity for carrying out its duties under this section2 and 7iv7 for otherwise carrying out this subsection4 7,c7 ,limitation ,the amounts appropriated under subparagraph 7,a7 are the only amounts authorized or appropriated to carry out the purposes described in subparagraph 7,b74 7f7 ,implementation of recommended models as eligible ,a,p,ms 7#a7 ,in general ,not later than the applicable date under paragraph 7#b71 the ,secretary shall1 implement an ,alternative ,payment ,model recommended under subsection 7d77#a77;,a77ii7 or 7e77#d77;,e77ii77,i7 as an eligible ,,apm only if-- 7,a7 the ,secretary determines that such model is expected to-- 7i7 reduce spending under this title without reducing the quality of care2 or 7ii7 improve the quality of patient care without increasing spending2 7,b7 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services certifies that such model would reduce 7or would not result in any increase in7 program spending under this title2 and 7,c7 the ,secretary determines that such model would not deny or limit the coverage or provision of benefits under this title for applicable individuals4 ,not later than #ij days after the date of issuance of a proposed rule1 with respect to an ,alternative ,payment ,model1 the ,medicare ,payment ,advisory ,commission shall submit comments to ,congress and the ,secretary evaluating the reports from the contracting entity and independent evaluation entity on such model regarding the model's impact on expenditures and quality of care under this title4 7#b7 ,applicable date ,for purposes of paragraph 7#a71 the applicable date under this paragraph-- 7,a7 for an ,alternative ,payment ,model recommended under subsection 7d77#a77;,a77ii7 is #ij days after the date of submission of such recommendation2 and 7,b7 for an ,alternative ,payment ,model recommended under subsection 7e77#d77;,e77ii77,i7 is #ij days after the date of submission of such recommendation 7#c7 ,justification for disapprovals ,in the case that an ,alternative ,payment ,model recommended under subsection 7d77#a77;,a77ii7 or 7e77#d77;,e77ii77,i7 is not implemented as an eligible ,,apm under this subsection1 the ,secretary shall make publicly available the rational1 in detail1 for such decision4 7g7 ,periodic review and termination 7#a7 ,periodic review ,in the case of an ,alternative ,payment ,model that has been implemented1 the ,secretary and the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services shall review such model every #c years to determine 7and certify1 in the case of the ,chief ,actuary and spending under this title71 for the previous #c years1 whether the model has-- 7,a7 reduced the quality of care1 or 7,b7 increased spending under this title1 compared to the quality of care or spending that would have resulted if the model had not been implemented4 7#b7 ,termination 7,a7 ,quality of care reduction termination ,if based upon such review the ,secretary determines under paragraph 7#a77;,a7 that the model has reduced the quality of care1 the ,secretary may terminate such model4 7,b7 ,spending increase termination ,unless such ,chief ,actuary certifies under paragraph 7#a77;,b7 that the expenditures under this title under the model do not exceed the expenditures that would otherwise have been made if the model had not been implemented for the period involved1 the ,secretary shall terminate such model4 7h7 ,dissemination of eligible ,a,p,ms ,under this section there shall be established a process for specifying1 and making publicly available a list of1 all eligible ,a,p,ms1 which shall include at least those implemented under subsection 7f7 and demonstrations carried out with respect to payments under section #ahdh through authority in existence as of the day before the date of the enactment of this section4 ,under such process such list shall be periodically updated and1 beginning with ,january #a1 #bjae1 and annually thereafter1 such list shall be published in the ,federal ,register4 4 7#b7 ,conforming amendment ,section #ahdh7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#a77 is amended by striking shall instead and inserting shall1 subject to section #ahdh;,a1 instead4 #c4 ,expanding availability of ,medicare data 7a7 ,expanding uses of ,medicare data by qualified entities 7#a7 ,in general ,to the extent consistent with applicable information1 privacy1 security1 and disclosure laws1 beginning with #bjad1 notwithstanding the second sentence of paragraph 7#d77;,d7 of section #ahgd7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7e771 a qualified entity may use data received by such entity under such section1 and information derived from the evaluation described in such paragraph 7#d77;,d71 for additional analyses 7as determined appropriate by the ,secretary of ,health and ,human ,services7 that such entity may provide or sell to providers of services and suppliers 7including for the purposes of assisting providers of services and suppliers to develop and participate in quality and patient care improvement activities1 including developing new models of care74 7#b7 ,definitions ,in this section3 7,a7 ,the term qualified entity has the meaning given such term in section #ahgd7;e77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7e774 7,b7 ,the terms supplier and provider of services have the meanings given such terms in subsections 7d7 and 7u71 respectively1 of section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex74 7b7 ,access to ,medicare data to providers of services and suppliers ,to facilitate development of alternative payment models and to qualified clinical data registries ,to facilitate quality improvement ,consistent with applicable laws and regulations with respect to privacy and other relevant matters1 the ,secretary shall provide ,medicare claims data for non-public use 7in a form and manner determined to be appropriate7 to-- 7#a7 qualified entities1 that may share with providers of services and suppliers that are registered or authorized users or subscribers1 in order to facilitate the development of new models of care 7including development of ,alternate ,payment ,models under section #ahdh;,a of the ,social ,security ,act1 models for small group specialty practices1 and care coordination models72 and 7#b7 qualified clinical data registries under section #ahdh7m77#c77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#c77;,e77 for purposes of linking such data with clinical outcomes data and performing analysis and research to support quality improvement4 #d4 ,encouraging care coordination and medical homes ,section #ahdh7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;b77 is amended by adding at the end the following new paragraph3 7#h7 ,encouraging care coordination and medical homes 7,a7 ,in general ,in order to promote the coordination of care by an applicable physician 7as defined in subparagraph 7,b77 for individuals with complex chronic care needs who are furnished items and services by multiple physicians and other suppliers and providers of services1 the ,secretary shall-- 7i7 develop one or more ,,hcpcs codes for complex chronic care management services for individuals with complex chronic care needs2 and 7ii7 for such services furnished on or after ,january #a1 #bjae1 by an applicable physician1 make payment 7as the ,secretary determines to be appropriate7 under the fee schedule under this section using such ,,hcpcs codes4 7,b7 ,applicable physician defined ,for purposes of this paragraph1 the term applicable physician means a physician 7as defined in section #ahfa7r77#a77 who-- 7i7 is certified as a medical home 7by achieving an accreditation status of level #c by the ,national ,committee for ,quality ,assurance72 7ii7 is recognized as a patient-centered specialty practice by the ,national ,committee for ,quality ,assurance2 7iii7 has received equivalent certification 7as determined by the ,secretary72 or 7iv7 meets such other comparable qualifications as the ,secretary determines to be appropriate4 7,c7 ,budget neutrality ,the budget neutrality provision under subsection 7c77#b77;,b77ii77,,ii7 shall apply in establishing the payment under subparagraph 7,a77ii74 7,d7 ,single applicable physician payment ,in carrying out this paragraph1 the ,secretary shall only make payment to a single applicable physician for complex chronic care management services furnished to an individual4 4 #e4 ,miscellaneous 7a7 ,solicitations1 recommendations1 and reports 7#a7 ,solicitation for recommendations on episodes of care definition ,the ,administrator of the ,centers for ,medicare ,medicaid ,services shall request eligible professional organizations 7as defined in section #ahdh7k77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7k77#c777 and other relevant stakeholders to submit recommendations for defining non-acute related episodes of care for purposes of applying such definition under subsections 7k7 and 7q7 of section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 and section #ahdh;,a of such ,act1 as added by subsections 7b7 and 7c7 of section #b4 7#b7 ,solicitation for recommendations on provider fee schedule payment bundles 7,a7 ,in general ,the ,administrator of the ,centers for ,medicare ,medicaid ,services shall solicit from eligible professional organizations 7as defined in section #ahdh7k77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7k77#c777 recommendations for payment bundles for chronic conditions and expensive1 high-volume services for which payment is made under title ,,xviii of such ,act4 7,b7 ,report to ,congress ,not later than #bd months after the date of the enactment of this ,act1 the ,administrator shall submit to ,congress a report proposals for such payment bundles4 7#c7 ,reports on ,modified ,,pfs ,system and payment system alternatives 7,a7 ,biannual progress reports ,not later than ,january #ae1 #bjaf1 and annually thereafter1 the ,secretary of ,health and ,human ,services shall submit to ,congress and post on the public ,internet website of the ,centers for ,medicare ,medicaid ,services a biannual progress report-- 7i7 on the implementation of paragraph 7#i7 of section #ahdh7k7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7k771 as added by section #b7;b77#b71 and the quality update incentive program under subsection 7q7 of section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d71 as added by section #b7;b77#c72 7ii7 that includes an evaluation of such paragraph and such quality update incentive program and recommendations with respect to such program and appropriate update mechanisms2 and 7iii7 on the actions taken to promote and fulfill the identification of eligible ,a,p,ms under section #ahdh;,a of the ,social ,security ,act1 as added by section #b7;c71 for application under such section #ahdh;,a4 7,b7 ,,gao and ,med,p,a,c reports 7i7 ,,gao report on initial stages of program ,the ,comptroller ,general of the ,united ,states shall submit to ,congress a report analyzing the extent to which the system under section #ahdh7k77#i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7k77#i77 and such quality update incentive program under section #ahdh7q7 of the ,social ,security ,act1 as added by section #b7;b71 as of such date1 is successfully satisfying performance objectives1 including with respect to-- 7,i7 the process for developing and selecting measures and activities under subsection 7k77#i7 of section #ahdh of such ,act 7#db ,u4,s4,c4 #aciew-#d72 7,,ii7 the process for assessing performance against such measures and activities under subsection 7q7 of such section2 and 7,,iii7 the adequacy of the measures and activities so selected4 7ii7 ,evaluation by ,,gao and ,med,p,a,c on implementation of quality update incentive program 7,i7 ,,gao ,the ,comptroller ,general of the ,united ,states shall evaluate the initial phase of the quality update incentive program under subsection 7q7 of section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 and shall submit to ,congress1 not later than #bjai1 a report with recommendations for improving such quality update incentive program4 7,,ii7 ,med,p,a,c ,in the course of its ,march ,report to ,congress on ,medicare payment policy1 ,med,p,a,c shall analyze the initial phase of such quality update incentive program and make recommendations1 as appropriate1 for improving such quality update incentive program4 7iii7 ,med,p,a,c report on payment system alternatives 7,i7 ,in general ,not later than ,june #ae1 #bjaf1 the ,medicare ,payment ,advisory ,commission shall submit to ,congress a report that analyzes multiple options for alternative payment models in lieu of section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d74 ,in analyzing such models1 the ,medicare ,payment ,advisory ,commission shall examine at least the following models3 7aa7 ,accountable care organization payment models4 7bb7 ,primary care medical home payment models4 7cc7 ,bundled or episodic payments for certain conditions and services4 7dd7 ,gainsharing arrangements 7,,ii7 ,items to be included ,such report shall include information on how each recommended new payment model will achieve maximum flexibility to reward high-quality1 efficient care4 7,c7 ,tracking expenditure growth and access ,beginning in #bjae1 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services shall track expenditure growth and beneficiary access to physicians' services under section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 and shall post on the public ,internet website of the ,centers for ,medicare ,medicaid ,services annual reports on such topics4 7b7 ,relative values under the ,medicare physician fee schedule 7#a7 ,eligible physicians reporting system to improve accuracy of relative values ,section #ahdh7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77 is amended by adding at the end the following new paragraph3 7#h7 ,physician reporting system to improve accuracy of relative values 7,a7 ,in general ,the ,secretary shall implement a system for the periodic reporting by physicians of data on the accuracy of relative values under this subsection1 such as data relating to service volume and time4 ,such data shall be submitted in a form and manner specified by the ,secretary and shall1 as appropriate1 incorporate data from existing sources of data1 patient scheduling systems1 cost accounting systems1 and other similar systems4 7,b7 ,identification of reporting cohort ,not later than ,january #a1 #bjae1 the ,secretary shall establish a mechanism for physicians to participate under the reporting system under this paragraph1 all of whom shall collectively be referred to under this paragraph as the reporting group4 ,the reporting group shall include physicians across settings that collectively represent a range of specialties and practitioner types1 furnish a range of physicians' services1 and serve a range of patient populations4 7,c7 ,incentive to report ,under the system under this paragraph1 the ,secretary may provide for such payments under this part to physicians included in the reporting group as the ,secretary determines appropriate to compensate such physicians for reporting data under the system4 ,such payments shall be provided in such form and manner as specified by the ,secretary4 ,in carrying out this subparagraph1 reporting by such a physician under this paragraph shall not be treated as the furnishing of physicians' services for purposes of applying this section4 7,d7 ,funding ,to carry out this paragraph 7other than with respect to payments made under subparagraph 7,c771 in addition to funds otherwise appropriated1 the ,secretary shall provide for the transfer from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of #a1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account for each fiscal year beginning with fiscal year #bjad4 ,amounts transferred under this subparagraph for a fiscal year shall be available until expended4 4 7#b7 ,relative value adjustments for misvalued physicians' services 7,a7 ,in general ,section #ahdh7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77 is amended by adding at the end the following new subparagraph3 7,m7 ,adjustments for misvalued physicians' services ,with respect to fee schedules established for #bjaf1 #bjag1 and #bjah1 the ,secretary shall-- 7i7 identify1 based on the data reported under paragraph 7#h7 and other relevant data1 misvalued services for which adjustments to the relative values established under this paragraph would result in a net reduction in expenditures under the fee schedule under this section1 with respect to such year1 of not more than #a percent of the projected amount of expenditures under such fee schedule for such year2 and 7ii7 make such adjustments for each such year so as to result in such a net reduction for such year4 4 7,b7 ,budget neutrality ,section #ahdh7;c77#b77;,b77v7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,b77v77 is amended by adding at the end the following new subclause3 7,,viii7 ,reductions for misvalued physicians' services ,reduced expenditures attributable to subparagraph 7,m74 4 7c7 ,rule of construction regarding health care provider standards of care 7#a7 ,in general ,the development1 recognition1 or implementation of any guideline or other standard under any ,federal health care provision shall not be construed to establish the standard of care or duty of care owed by a health care provider to a patient in any medical malpractice or medical product liability action or claim4 7#b7 ,definitions ,for purposes of this subsection3 7,a7 ,the term ,federal health care provision means any provision of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 title ,i and subtitle ,b of title ,,iii of the ,health ,care and ,education ,reconciliation ,act of #bjaj 7,public ,law #aaa-aeb71 and titles ,,xviii and ,,xix of the ,social ,security ,act4 7,b7 ,the term health care provider means any individual or entity-- 7i7 licensed1 registered1 or certified under ,federal or ,state laws or regulations to provide health care services2 or 7ii7 required to be so licensed1 registered1 or certified but that is exempted by other statute or regulation4 7,c7 ,the term medical malpractice or medical liability action or claim means a medical malpractice action or claim 7as defined in section #dca7g7 of the ,health ,care ,quality ,improvement ,act of #aihf 7#db ,u4,s4,c4 #aaaea7g777 and includes a liability action or claim relating to a health care provider's prescription or provision of a drug1 device1 or biological product 7as such terms are defined in section #bja of the ,federal ,food1 ,drug1 and ,cosmetic ,act or section #cea of the ,public ,health ,service ,act74 7,d7 ,the term ,state includes the ,district of ,columbia1 ,puerto ,rico1 and any other commonwealth1 possession1 or territory of the ,united ,states4 7#c7 ,no preemption ,no provision of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 title ,i or subtitle ,b of title ,,iii of the ,health ,care and ,education ,reconciliation ,act of #bjaj 7,public ,law #aaa-aeb71 or title ,,xviii or ,,xix of the ,social ,security ,act shall be construed to preempt any ,state or common law governing medical professional or medical product liability actions or claims4