,,ib ,union ,calendar ,no4 #bhc #aacth ,,congress #b;d ,session ,h4 ,r4 #bhaj ,report ,no4 #aac-beg1 ,parts ,i and ,,ii ,,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 ,november #ab1 #bjac ,reported from the ,committee on ,energy and ,commerce with an amendment ,strike out all after the enacting clause and insert the part printed in italic ,november #ab1 #bjac ,the ,committee on the ,judiciary discharged ,november #ab1 #bjac ,referral to the ,committee on ,ways and ,means extended for a period ending not later than ,december #b1 #bjac ,december #b1 #bjac ,referral to the ,committee on ,ways and ,means extended for a period ending not later than ,january #aj1 #bjad ,january #aj1 #bjad ,referral to the ,committee on ,ways and ,means extended for a period ending not later than ,march #ad1 #bjad ,march #ad1 #bjad ,additional sponsors3 ,mr4 ,cassidy1 ,mr4 ,bucshon1 ,mrs4 ,christensen1 ,mr4 ,gingrey of ,georgia1 ,mr4 ,stockman1 ,mr4 ,thornberry1 ,mr4 ,benishek1 ,mr4 ,murphy of ,pennsylvania1 ,mr4 ,gosar1 ,ms4 ,matsui1 ,ms4 ,castor of ,florida1 ,mr4 ,engel1 ,mr4 ,cuellar1 ,mr4 ,sessions1 ,mr4 ,young of ,alaska1 ,mr4 ,gene ,green of ,texas1 ,mr4 ,olson1 ,mrs4 ,ellmers1 ,mr4 ,roe of ,tennessee1 ,mrs4 ,blackburn1 ,mr4 ,latta1 ,mrs4 ,mc,morris ,rodgers1 ,mr4 ,terry1 ,mr4 ,rogers of ,michigan1 ,mr4 ,walden1 ,mr4 ,bilirakis1 ,ms4 ,schakowsky1 ,mr4 ,braley of ,iowa1 ,mrs4 ,capps1 ,mr4 ,carter1 ,mr4 ,barton1 ,mr4 ,whitfield1 ,mr4 ,lance1 ,mr4 ,holding1 ,mr4 ,westmoreland1 ,mr4 ,latham1 ,mrs4 ,brooks of ,indiana1 ,mr4 ,walberg1 ,mr4 ,rice of ,south ,carolina1 ,mr4 ,loebsack1 ,mr4 ,coffman1 ,mr4 ,bera of ,california1 ,mr4 ,ruiz1 ,mr4 ,stivers1 ,mr4 ,mc,kinley1 ,mr4 ,kennedy1 ,mr4 ,ben ,ray ,lujn of ,new ,mexico1 ,mr4 ,rush1 ,mr4 ,yoder1 ,mr4 ,marino1 ,mr4 ,mc,nerney1 and ,mr4 ,langevin ,march #ad1 #bjad ,reported from the ,committee on ,ways and ,means with an amendment1 committed to the ,committee of the ,whole ,house on the ,state of the ,union1 and ordered to be printed ,strike out all after the enacting clause and insert the part printed in boldface roman ,for text of introduced bill1 see copy of bill as introduced on ,july #bd1 #bjac ,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 7phase ,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 each 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 7phase ,,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 as defined by nationally recognized multispecialty boards of certification or equivalent certification boards4 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 nationally recognized multispecialty boards of certification 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 quality 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 beginning not later than #f months after the first day of the first performance period1 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 testing and evaluation1 including through the demonstration program under subsection 7e71 and approval under subsection 7f72 7,d7 applicable ,alternative ,payment ,models are tested and 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 ,the ,secretary shall enter into the first contract under subparagraph 7,a7 to be in effect ,january #a1 #bjai4 7,c7 ,competitive procedures ,competitive procedures 7as defined in section #d7e7 of the ,office of ,federal ,procurement ,policy ,act 7#da ,u4,s4,c4 #djc7e77 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 ,recommendations to ,secretary 7i7 ,in general ,under the process under subsection 7b71 the ,,apm contracting entity shall at least quarterly recommend1 in accordance with clause 7ii71 to the ,secretary-- 7,i7 ,alternative ,payment ,models submitted under subsection 7c7 to be tested and evaluated through a demonstration program under subsection 7e72 and 7,,ii7 ,alternative ,payment ,models submitted under subsection 7c7 to be implemented under subsection 7f7 without testing and evaluation through such a demonstration program4 ,such a recommendation under subclause 7,i7 may be made with respect to a model for which a waiver would be required under paragraph 7#b74 ,any reference in this subsection to an ,alternative ,payment ,model under this clause is a reference to such model as may be modified under clause 7iii74 7ii7 ,requirements ,in recommending an ,alternative ,payment ,model under clause 7i71 each of the following shall apply3 7,i7 ,the ,,apm contracting entity may recommend an ,alternative ,payment ,model under clause 7i77,i7 only if the entity determines that the model satisfies the criteria described in subparagraph 7,b71 including the criteria described in subparagraph 7,b77iv74 7,,ii7 ,the ,,apm contracting entity may recommend an ,alternative ,payment ,model under clause 7i77,,ii7 only if the entity determines that the model satisfies the criteria described in subparagraph 7,c71 including the criteria described in subparagraph 7,c77iii74 7,,iii7 ,the ,,apm contracting entity shall include with the recommended ,alternative ,payment ,model recommendations for rules of coordination described in clause 7v74 7iii7 ,modifications by ,,apm contracting entity ,for purposes of this subparagraph1 to the extent necessary to meet the applicable requirements of clause 7ii71 the ,,apm contracting entity may modify an ,alternative ,payment ,model submitted under subsection 7c7 to ensure that the model would-- 7,i7 reduce spending under this title without reducing the quality of care2 or 7,,ii7 improve the quality of care without increasing spending under this title4 7iv7 ,forms of modifications ,such a modification under clause 7iii7 may include one or more of the following3 7,i7 ,a change to the payment arrangement under which eligible professionals participating in such model would be paid for covered professional services furnished under such model4 7,,ii7 ,a change to the criteria for eligible professionals to be eligible to participate under such model in order to ensure that the requirement described in subclause 7,i7 or 7,,ii7 is satisfied4 7,,iii7 ,a change to the rules of coordination described in clause 7v74 7,,iv7 ,the application of a withhold mechanism under the payment arrangement under which the distribution of withheld amounts is based on the success of the model in meeting spending reduction requirements4 7,v7 ,such other change as the contracting entity may specify4 7v7 ,rules of coordination for application of payment arrangements under models 7,i7 ,in general ,rules of coordination described in this clause for an ,alternative ,payment ,model shall be designed to determine1 for purposes of applying subsection 7a7 and section #ahdh7;d77#af71 under what circumstances an eligible professional is treated as having a payment arrangement under a particular model4 7,,ii7 ,nonduplication of payment ,such rules of coordination shall ensure coordination and nonduplication of payment of services that might be covered under more than one payment arrangement or under section #ahdh7;d77#af74 7,,iii7 ,application to non-,,apm payment ,in applying such rules of coordination for purposes of section #ahdh7;d77#af71 an eligible professional shall not be treated as having a payment arrangement in effect under such a model for any covered professional services not treated as furnished under the model4 7,b7 ,criteria for recommending models for demonstration ,for purposes of subparagraph 7,a77ii77,i71 the criteria described in this subparagraph1 with respect to an ,alternative ,payment ,model1 are each of the following3 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 7iv74 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 a meaningful evaluation of the likely effect of expanding the demonstration4 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 a meaningful evaluation of the likely effect of expanding the demonstration4 7iii7 ,such model1 including if tested and 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 proposal for such model demonstrates-- 7,i7 the significant likelihood to successfully manage the cost of furnishing items and services under this title so as to not result in expenditures under this title being greater than expenditures under this title if the ,,apm were not implemented2 and 7,,ii7 the ability to maintain or improve the overall quality of patient care provided to individuals enrolled under this part4 7v7 ,the model provides for a payment arrangement-- 7,i7 that specifies the items and services covered under the arrangement and specifies rules of coordination described in subparagraph 7,a77v7 between the items and services covered under the arrangement and other items and services not covered under the arrangement2 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 ,for purposes of subparagraph 7,a77ii77,,ii71 the criteria described in this subparagraph1 with respect to an ,alternative ,payment ,model1 is that the model has already been tested and evaluated for a sufficient enough period and through such testing and evaluation the model was shown-- 7i7 to have satisfied the criteria described in each of clauses 7i71 7ii71 7iii71 and 7v7 of subparagraph 7,b72 and 7ii7 7,i7 to have reduced spending under this title without reducing the quality of care2 or 7,,ii7 to have improved the quality of patient care without increasing such 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 the ,,apm contracting entity1 the ,,apm contracting entity shall submit to the ,secretary and the model submitter 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,a77i77,i71 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,a77i77,,ii7 and the data and analyses on such recommended models that support the criteria described in subparagraph 7,c74 7iii7 ,explanation for no recommendations ,for any year beginning with #bjae that the ,,apm contracting entity does not recommend any models under subparagraph 7,a77i71 the entity shall instead satisfy this clause by submitting to the ,secretary and making publicly available an explanation for not having any such recommendations4 7iv7 ,justifications for recommendations ,in submitting data and analyses under subclause 7,i7 or 7,,ii7 of clause 7ii7 with respect to a model1 the ,,apm contracting entity shall include a specific explanation of how the model would 7and recommendations for ensuring that the model will7 meet the criteria described in subparagraph 7,b7 or 7,c71 respectively4 7v7 ,confirmation of spending estimates by ,,cms ,chief ,actuary ,for each ,alternative ,payment ,model described in subclause 7,i7 or 7,,ii7 of clause 7ii71 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services shall submit to the ,secretary a determination of whether or not the ,chief ,actuary confirms that the model satisfies the criterion described in subparagraph 7,b77iv77,i7 or 7,c77ii71 respectively4 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 solely in order for such model to be tested and evaluated under the demonstration program4 7,b7 ,approval ,not later than #ahj 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 approved 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 ,,apm providers 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#d74 ,the duration of a demonstration program under this subsection1 with respect to such a model1 shall be #c years4 7#b7 ,approval by ,secretary of models for demonstration 7,a7 ,in general ,not later than #ahj days after the date of receipt of a submission under subsection 7d77#a77;,d77ii71 with respect to an ,alternative ,payment ,model recommended under subsection 7d77#a77;,a77i77,i71 the ,secretary shall-- 7i7 review the basis for such recommendation in order to assess1 taking into account the determination of the ,chief ,actuary under subsection 7d77#a77;,d77v7 with respect to such model1 if the model is significantly likely to-- 7,i7 reduce spending under this title without reducing the quality of care2 or 7,,ii7 improve the quality of care without increasing spending under this title2 7ii7 assess whether the model is significantly likely to result in participation under such model of a sufficient number of those eligible professionals for whom the model was designed consistent with clause 7i7 to be able to evaluate the likely effect of expanding the demonstration2 and 7iii7 approve such model for a demonstration program under this subsection1 including as modified under subparagraph 7,b71 only if the ,secretary determines-- 7,i7 the model is significantly likely to satisfy the criterion described in subclause 7,i7 or 7,,ii7 of clause 7i72 7,,ii7 the model is significantly likely to result in the participation of a sufficient number of eligible professionals described in clause 7ii72 7,,iii7 the model applies rules of coordination described in subparagraph 7,c7 applicable to such model2 and 7,,iv7 the model satisfies the criteria described in subsection 7d77#a77;,b74 ,the ,secretary shall periodically make available a list of such models approved under clause 7iii74 7,b7 ,modifications by ,secretary 7i7 ,before approval ,for purposes of subparagraph 7,a71 the ,secretary may modify an ,alternative ,payment ,model recommended under subsection 7d77#a77;,a77i77,i7 to ensure that the model meets the requirements described in subparagraph 7,a77iii74 ,such a modification may include one or more of the following3 7,i7 ,a change to the payment arrangement under which eligible professionals participating in such model would be paid for covered professional services furnished under such model4 7,,ii7 ,a change to the criteria for eligible professionals to be eligible to participate under such model in order to ensure that such requirements are satisfied4 7,,iii7 ,a change to the rules of coordination described in subparagraph 7,c74 7,,iv7 ,the application of a withhold mechanism under the payment arrangement under which the distribution of withheld amounts is based on the success of the model in meeting spending reduction requirements4 7,v7 ,such other change as the ,secretary may specify4 7ii7 ,termination or modification during demonstration ,the ,secretary shall terminate or modify the design and implementation of an ,alternative ,payment ,model approved under subparagraph 7,a77iii7 for a demonstration program1 after testing has begun1 unless the ,secretary determines 7and the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services1 with respect to program spending under this title1 certifies7 that the model is expected to continue to satisfy the requirements described in such paragraph relating to quality of care and reduced spending4 ,such termination may occur at any time after such testing has begun and before completion of the testing4 7,c7 ,rules of coordination for application of payment arrangements under models 7i7 ,in general ,rules of coordination described in this subparagraph for an ,alternative ,payment ,model shall be designed to determine1 for purposes of applying subsection 7a7 and section #ahdh7;d77#af71 under what circumstances an eligible professional is treated as having a payment arrangement under a particular model4 7ii7 ,nonduplication of payment ,such rules of coordination shall ensure coordination and nonduplication of payment of services that might be covered under more than one payment arrangement or under section #ahdh7;d77#af74 7iii7 ,application to non-,,apm payment ,in applying such rules for purposes of section #ahdh7;d77#af71 an eligible professional shall not be treated as having a payment arrangement in effect under such a model for any covered professional services not treated as furnished under the model4 7#c7 ,participating ,,apm providers 7,a7 ,in general ,to participate under a demonstration program under this subsection1 with respect to an ,alternative ,payment ,model1 an eligible professional shall enter into a contract with the ,administrator of the ,centers for ,medicare ,medicaid ,services under this subsection4 ,for purposes of this section1 such an eligible professional who so participates under such an ,alternative ,payment ,model in this section is referred to as a participating ,,apm provider4 7,b7 ,requirements ,the ,secretary shall establish criteria for eligible professionals to enter into contracts under this paragraph for purposes of participation under a demonstration program with respect to an ,alternative ,payment ,model4 ,such criteria shall ensure participation under such model of a sufficient number of eligible professionals for whom the model was designed in order to satisfy the criterion described in paragraph 7#b77;,a77iii77,,ii74 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 ,,apm providers 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 ,,apm providers 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 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 appropriated and as of the date of the enactment of this section1 #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 appropriated 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 ,,apm providers 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 ,,apm 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 ,assessment ,with respect to each ,alternative ,payment ,model recommended under subsection 7d77#a77;,a77i77,,ii7 or 7e77#d77;,e77ii77,i71 the ,secretary shall review the basis for such recommendation and assess and determine1 in consultation with the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services1 whether the model is significantly likely to continue to result in meeting the criterion described in subsection 7e77#b77;,a77iii77,i71 with or without a modification described in paragraph 7#e74 7#b7 ,implementation through rulemaking 7,a7 ,publication of ,,nprm ,if the ,secretary determines that such a model is significantly likely to meet such criterion1 the ,secretary shall publish as part of the applicable physician fee schedule rulemaking process 7specified in paragraph 7#c77 a notice of proposed rulemaking to implement such model1 including as modified under paragraph 7#e74 7,b7 ,comments by ,med,p,a,c ,not later than #ij days after the date of issuance of such notice with respect to a model1 the ,medicare ,payment ,advisory ,commission shall submit comments on the proposed rule for such model to ,congress and to the ,secretary4 ,such comments shall include an evaluation of 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,c7 ,final rule and conditions ,the ,secretary shall publish as part of the applicable physician fee schedule rulemaking process 7specified in paragraph 7#c77 a final notice implementing such proposed rule1 including as modified under paragraph 7#e71 as an eligible ,,apm only if-- 7i7 the ,secretary determines that such model is expected to-- 7,i7 reduce spending under this title without reducing the quality of care2 or 7,,ii7 improve the quality of patient care without increasing spending2 7ii7 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services certifies that such model would reduce 7or would not result in any increase in7 spending under this title2 7iii7 the ,secretary determines that such model would not deny or limit the coverage or provision of benefits under this title for applicable individuals2 7iv7 the ,secretary determines that the model is significantly likely to result in the participation of a sufficient number of appropriate eligible professionals for whom the model was designed in order to satisfy the criterion described in subsection 7d77#b77;,a77iii77,,ii72 7v7 the ,secretary determines that the model applies rules of coordination described in paragraph 7#f72 and 7vi7 the ,secretary determines that model meets such other criteria as the ,secretary may determine4 7#c7 ,applicable physician fee schedule rulemaking process ,for purposes of paragraph 7#b71 in the case of an ,alternative ,payment ,model recommended under subsection 7d77#a77;,a77ii7 or 7e77#d77;,e77ii77,i7-- 7,a7 on or before ,april #a of a year1 the applicable physician fee schedule rulemaking process is the process for publication by ,november #a of that year of the fee schedule amounts under this section for the succeeding year2 or 7,b7 after ,april #a of a year1 the applicable physician fee schedule rulemaking process is the process for publication by ,november #a of the following year of the fee schedule amounts under this section for the second succeeding year4 7#d7 ,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 7#e7 ,modifications by ,secretary ,for purposes of this subsection1 the ,secretary may modify an ,alternative ,payment ,model recommended under subsection 7d77#a77;,a77i77,,ii7 or 7e77#d77;,e77ii77,i7 to ensure that the model meets the requirements under paragraph 7#a77;,b74 ,such a modification may include one or more of the following3 7,a7 ,a change to the payment arrangement under which eligible professionals participating in such model would be paid for covered professional services furnished under such model4 7,b7 ,a change to the criteria for eligible professionals to be eligible to participate under such model in order to ensure that such requirements are satisfied4 7,c7 ,a change to the rules of coordination described in paragraph 7#f74 7,d7 ,the application of a withhold mechanism under the payment arrangement under which the distribution of withheld amounts is based on the success of the model in meeting spending reduction requirements4 7,e7 ,such other change as the ,secretary may specify4 7#f7 ,rules of coordination for application of payment arrangements under models 7,a7 ,in general ,rules of coordination described in this paragraph for an ,alternative ,payment ,model shall be designed to determine1 for purposes of applying subsection 7a7 and section #ahdh7;d77#af71 under what circumstances an eligible professional is treated as having a payment arrangement under a particular model4 7,b7 ,nonduplication of payment ,such rules of coordination shall ensure coordination and nonduplication of payment of services that might be covered under more than one payment arrangement or under section #ahdh7;d77#af74 7,c7 ,application to non-,,apm payment ,in applying such rules for purposes of section #ahdh7;d77#af71 an eligible professional shall not be treated as having a payment arrangement in effect under such a model for any covered professional services not treated as furnished under the model4 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 7d7 ,adjustment to ,medicare payment localities 7#a7 ,in general ,section #ahdh7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;e77 is amended by adding at the end the following new paragraph3 7#f7 ,use of ,m,s,as as fee schedule areas in ,california 7,a7 ,in general ,subject to the succeeding provisions of this paragraph and notwithstanding the previous provisions of this subsection1 for services furnished on or after ,january #a1 #bjag1 the fee schedule areas used for payment under this section applicable to ,california shall be the following3 7i7 ,each ,metropolitan ,statistical ,area 7each in this paragraph referred to as an ,,msa71 as defined by the ,director of the ,office of ,management and ,budget as of ,december #ca of the previous year1 shall be a fee schedule area4 7ii7 ,all areas not included in an ,,msa shall be treated as a single rest-of-,state fee schedule area4 7,b7 ,transition for ,m,s,as previously in rest-of-,state payment locality or in locality #c 7i7 ,in general ,for services furnished in ,california during a year beginning with #bjag and ending with #bjba in an ,,msa in a transition area 7as defined in subparagraph 7,d771 subject to subparagraph 7,c71 the geographic index values to be applied under this subsection for such year shall be equal to the sum of the following3 7,i7 ,current law component ,the old weighting factor 7described in clause 7ii77 for such year multiplied by the geographic index values under this subsection for the fee schedule area that included such ,,msa that would have applied in such area 7as estimated by the ,secretary7 if this paragraph did not apply4 7,,ii7 ,,msa-based component ,the ,,msa-based weighting factor 7described in clause 7iii77 for such year multiplied by the geographic index values computed for the fee schedule area under subparagraph 7,a7 for the year 7determined without regard to this subparagraph74 7ii7 ,old weighting factor ,the old weighting factor described in this clause-- 7,i7 for #bjag1 is #e_/f2 and 7,,ii7 for each succeeding year1 is the old weighting factor described in this clause for the previous year minus #a_/f4 7iii7 ,,msa-based weighting factor ,the ,,msa-based weighting factor described in this clause for a year is #a minus the old weighting factor under clause 7ii7 for that year4 7,c7 ,hold harmless ,for services furnished in a transition area in ,california during a year beginning with #bjag1 the geographic index values to be applied under this subsection for such year shall not be less than the corresponding geographic index values that would have applied in such transition area 7as estimated by the ,secretary7 if this paragraph did not apply4 7,d7 ,transition area defined ,in this paragraph1 the term transition area means each of the following fee schedule areas for #bjac3 7i7 ,the rest-of-,state payment locality4 7ii7 ,payment locality #c4 7,e7 ,references to fee schedule areas ,effective for services furnished on or after ,january #a1 #bjag1 for ,california1 any reference in this section to a fee schedule area shall be deemed a reference to a fee schedule area established in accordance with this paragraph4 4 7#b7 ,conforming amendment to definition of fee schedule area ,section #ahdh7;j77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#b77 is amended by striking ,the term and inserting ,except as provided in subsection 7e77#f77;,d71 the term4 7e7 ,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#g7 ,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 7i7 ,in general ,only with respect to fee schedules established for #bjaf1 #bjag1 and #bjah 7and not for subsequent years71 the ,secretary shall-- 7,i7 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 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 7,,ii7 make such adjustments for each such year so as only to result in such a reduction for such year4 7ii7 ,no effect on subsequent years ,a reduction under this subparagraph for a year shall not affect any reduction for any subsequent year4 7iii7 ,rule of construction relating to undervalued codes ,nothing in this subparagraph shall be construed as preventing the ,secretary from increasing the relative values for codes that are undervalued4 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,m7 for fiscal years #bjaf1 #bjag1 and #bjah4 4 7#c7 ,disclosure of data used to establish multiple procedure payment reduction policy ,the ,secretary of ,health and ,human ,services shall make publicly available the data used to establish the multiple procedure payment reduction policy to the professional component of imaging services in the final rule published in the ,federal ,register1 v4 #gg1 n4 #bbb1 ,november #af1 #bjab1 pages #fhhia-fichj under the physician fee schedule under section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d74 #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 paragraph 7#d77;,b7 of section #ahgd7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7e77 and the second sentence of paragraph 7#d77;,d7 of such section1 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 non-public analyses 7as determined appropriate by the ,secretary of ,health and ,human ,services7 or provide or sell such data to registered or authorized users and subscribers1 including to providers of services and suppliers1 for non-public use 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 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 for non-public use including 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;,e77 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 and disseminating risk-adjusted1 scientifically valid analysis and research to support quality improvement or patient safety1 provided that any public reporting of identifiable provider data shall only be conducted with prior consent of such provider4 #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 provider 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 provider1 make payment 7as the ,secretary determines to be appropriate7 under the fee schedule under this section using such ,,hcpcs codes4 7,b7 ,applicable provider defined ,for purposes of this paragraph1 the term applicable provider means a physician 7as defined in section #ahfa7r77#a77 or a physician assistant or nurse practitioner 7as defined in section #ahfa7;aa77#e77;,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 provider payment ,in carrying out this paragraph1 the ,secretary shall only make payment to a single applicable provider 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 on 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 for #bjai and each subsequent year 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;b7 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 7#d7 ,report on clinical decision support mechanisms ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit to ,congress a report on the extent to which clinical decision support mechanisms and other provider support tools could be used to further program objectives under section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d77 and recommendation for how such mechanisms and tools should be so used4 7b7 ,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 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,,sgr ,repeal and ,medicare ,beneficiary ,access ,act of #bjac4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,repealing the sustainable growth rate 7,,sgr7 and improving medicare payment for physicians' services4 ,sec4 #c4 ,priorities and funding for quality measure development4 ,sec4 #d4 ,encouraging care management for individuals with chronic care needs4 ,sec4 #e4 ,ensuring accurate valuation of services under the physician fee schedule4 ,sec4 #f4 ,promoting evidence-based care4 ,sec4 #g4 ,empowering beneficiary choices through access to information on physicians' services4 ,sec4 #h4 ,expanding claims data availability to improve care4 ,sec4 #i4 ,reducing administrative burden and other provisions4 #b4 ,repealing the sustainable growth rate 7,,sgr7 and improving medicare payment for physicians' services 7a7 ,stabilizing fee updates 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 after paragraph 7#d72 and 7ii7 in paragraph 7#d7-- 7,i7 in the heading1 by inserting and ending with #bjac after years beginning with #bjja2 and 7,,ii7 in subparagraph 7,a71 by inserting and ending with #bjac after a year beginning with #bjja2 and 7,b7 in subsection 7f7-- 7i7 in paragraph 7#a77;,b71 by inserting through #bjac after of each 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 and subsequent years ,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 paragraphs3 7#ae7 ,update for #bjad through #bjaf ,the update to the single conversion factor established in paragraph 7#a77;,c7 for each of #bjad through #bjaf shall be #j4e percent4 7#af7 ,update for #bjag through #bjbc ,the update to the single conversion factor established in paragraph 7#a77;,c7 for each of #bjag through #bjbc shall be zero percent4 7#ag7 ,update for #bjbd and subsequent years ,the update to the single conversion factor established in paragraph 7#a77;,c7 for #bjbd and each subsequent year shall be-- 7,a7 for items and services furnished by a qualifying ,,apm participant 7as defined in section #ahcc7z77#b77 for such year1 #b percent2 and 7,b7 for other items and services1 #a percent4 4 7#c7 ,med,p,a,c reports 7,a7 ,initial report ,not later than ,july #a1 #bjaf1 the ,medicare ,payment ,advisory ,commission shall submit to ,congress a report on the relationship between-- 7i7 physician and other health professional utilization and expenditures 7and the rate of increase of such utilization and expenditures7 of items and services for which payment is made under section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d72 and 7ii7 total utilization and expenditures 7and the rate of increase of such utilization and expenditures7 under parts ,a1 ,b1 and ,d of title ,,xviii of such ,act4 ,such report shall include a methodology to describe such relationship and the impact of changes in such physician and other health professional practice and service ordering patterns on total utilization and expenditures under parts ,a1 ,b1 and ,d of such title4 7,b7 ,final report ,not later than ,july #a1 #bjbj1 the ,medicare ,payment ,advisory ,commission shall submit to ,congress a report on the relationship described in subparagraph 7,a71 including the results determined from applying the methodology included in the report submitted under such subparagraph4 7b7 ,consolidation of certain current law performance programs with new value-based performance incentive program 7#a7 ,,ehr meaningful use incentive program 7,a7 ,sunsetting separate meaningful use payment adjustments ,section #ahdh7;a77#g77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g77;,a77 is amended-- 7i7 in clause 7i71 by striking or any subsequent payment year and inserting or #bjaf2 7ii7 in clause 7ii7-- 7,i7 in the matter preceding subclause 7,i71 by striking ,subject to clause 7iii71 for and inserting ,for2 7,,ii7 in subclause 7,i71 by adding at the end and2 7,,iii7 in subclause 7,,ii71 by striking 2 and and inserting a period2 and 7,,iv7 by striking subclause 7,,iii72 and 7iii7 by striking clause 7iii74 7,b7 ,continuation of meaningful use determinations for ,,vbp program ,section #ahdh7o77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#b77 is amended-- 7i7 in subparagraph 7,a71 in the matter preceding clause 7i7-- 7,i7 by striking ,for purposes of paragraph 7#a71 an and inserting ,an2 and 7,,ii7 by inserting 1 or pursuant to subparagraph 7,d7 for purposes of subsection 7q71 for a performance period under such subsection for a year after under such subsection for a year2 and 7ii7 by adding at the end the following new subparagraph3 7,d7 ,continued application for purposes of ,,vbp program ,with respect to #bjag and each subsequent payment year1 the ,secretary shall1 for purposes of subsection 7q7 and in accordance with paragraph 7#a77;,f7 of such subsection1 determine whether an eligible professional who is a ,,vbp eligible professional 7as defined in subsection 7q77#a77;,c77 for such year is a meaningful ,,ehr user under this paragraph for the performance period under subsection 7q7 for such year4 4 7#b7 ,quality reporting 7,a7 ,sunsetting separate quality reporting incentives ,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 or any subsequent year and inserting or #bjaf2 and 7ii7 in clause 7ii77,,ii71 by striking and each subsequent year4 7,b7 ,continuation of quality measures and processes for ,,vbp program ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is amended-- 7i7 in subsection 7k71 by adding at the end the following new paragraph3 7#i7 ,continued application for purposes of ,,vbp program ,the ,secretary shall1 in accordance with subsection 7q77#a77;,f71 carry out the provisions of this subsection for purposes of subsection 7q74 2 and 7ii7 in subsection 7m7-- 7,i7 by redesignating the paragraph 7#g7 added by section #ajcbg7;a7 of ,public ,law #aaa-adh as paragraph 7#h72 and 7,,ii7 by adding at the end the following new paragraph3 7#i7 ,continued application for purposes of ,,vbp program ,the ,secretary shall1 in accordance with subsection 7q77#a77;,f71 carry out the processes under this subsection for purposes of subsection 7q74 4 7#c7 ,value-based payments 7,a7 ,sunsetting separate value-based payments ,clause 7iii7 of section #ahdh7p77#d77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7p77#d77;,b77 is amended to read as follows3 7iii7 ,application ,the ,secretary shall apply the payment modifier established under this subsection for items and services furnished on or after ,january #a1 #bjae1 but before ,january #a1 #bjag1 with respect to specific physicians and groups of physicians the ,secretary determines appropriate4 ,such payment modifier shall not be applied for items and services furnished on or after ,january #a1 #bjag4 4 7,b7 ,continuation of value-based payment modifier measures for ,,vbp program ,section #ahdh7p7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7p77 is amended-- 7i7 in paragraph 7#b71 by adding at the end the following new subparagraph3 7,c7 ,continued application for purposes of ,,vbp program ,the ,secretary shall1 in accordance with subsection 7q77#a77;,f71 carry out subparagraph 7,b7 for purposes of subsection 7q74 2 and 7ii7 in paragraph 7#c71 by adding at the end the following3 ,with respect to #bjag and each subsequent year1 the ,secretary shall1 in accordance with subsection 7q77#a77;,f71 carry out this paragraph for purposes of subsection 7q744 7c7 ,value-based performance 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 ,value-based performance incentive program 7#a7 ,establishment 7,a7 ,in general ,subject to the succeeding provisions of this subsection1 the ,secretary shall establish an eligible professional value-based performance incentive program 7in this subsection referred to as the ,,vbp program7 under which the ,secretary shall-- 7i7 develop a methodology for assessing the total performance of each ,,vbp eligible professional according to performance standards under paragraph 7#c7 for a performance period 7as established under paragraph 7#d77 for a year2 7ii7 using such methodology1 provide for a composite performance score in accordance with paragraph 7#e7 for each such professional for each performance period2 and 7iii7 use such composite performance score of the ,,vbp eligible professional for a performance period for a year to make ,,vbp program incentive payments under paragraph 7#g7 to the professional for the year4 7,b7 ,program implementation ,the ,,vbp program shall apply to payments for items and services furnished on or after ,january #a1 #bjag4 7,c7 ,,vbp eligible professional defined 7i7 ,in general ,for purposes of this subsection1 subject to clauses 7ii7 and 7iv71 the term ,,vbp eligible professional means-- 7,i7 for the first and second years for which the ,,vbp program applies to payments 7and for the performance period for such first and second year71 a physician 7as defined in section #ahfa7r77#a771 a physician assistant1 nurse practitioner1 and clinical nurse specialist 7as such terms are defined in section #ahfa7;aa77#e771 and a certified registered nurse anesthetist 7as defined in section #ahfa7;bb77#b772 and 7,,ii7 for the third year for which the ,,vbp program applies to payments 7and for the performance period for such third year7 and for each succeeding year 7and for the performance period for each such year71 the professionals described in subclause 7,i7 and such other eligible professionals 7as defined in subsection 7k77#c77;,b77 as specified by the ,secretary4 7ii7 ,exclusions ,for purposes of clause 7i71 the term ,,vbp eligible professional does not include1 with respect to a year1 an eligible professional 7as defined in subsection 7k77#c77;,b77-- 7,i7 who is a qualifying ,,apm participant 7as defined in section #ahcc7z77#b772 7,,ii7 who1 subject to clause 7vii71 is a partial qualifying ,,apm participant 7as defined in clause 7iii77 for the most recent period for which data are available and who1 for the performance period with respect to such year1 does not report on applicable measures and activities described in paragraph 7#b77;,b7 that are required to be reported by such a professional under the ,,vbp program2 or 7,,iii7 who1 for the performance period with respect to such year1 does not exceed the low-volume threshold measurement selected under clause 7iv74 7iii7 ,partial qualifying ,,apm participant ,for purposes of this subparagraph1 the term partial qualifying ,,apm participant means1 with respect to a year1 an eligible professional for whom the ,secretary determines the minimum payment percentage 7or percentages71 as applicable1 described in paragraph 7#b7 of section #ahcc7z7 for such year have not been satisfied1 but who would be considered a qualifying ,,apm participant 7as defined in such paragraph7 for such year if-- 7,i7 with respect to #bjag and #bjah1 the reference in subparagraph 7,a7 of such paragraph to #be percent was instead a reference to #bj percent2 7,,ii7 with respect to #bjai and #bjbj-- 7aa7 the reference in subparagraph 7,b77i7 of such paragraph to #ej percent was instead a reference to #dj percent2 and 7bb7 the references in subparagraph 7,b77ii7 of such paragraph to #ej percent and #be percent of such paragraph were instead references to #dj percent and #bj percent1 respectively2 and 7,,iii7 with respect to #bjba and subsequent years-- 7aa7 the reference in subparagraph 7,c77i7 of such paragraph to #ge percent was instead a reference to #ej percent2 and 7bb7 the references in subparagraph 7,c77ii7 of such paragraph to #ge percent and #be percent of such paragraph were instead references to #ej percent and #bj percent1 respectively4 7iv7 ,selection of low-volume threshold measurement ,the ,secretary shall select one of the following low-volume threshold measurements to apply for purposes of clause 7ii77,,iii73 7,i7 ,the minimum number 7as determined by the ,secretary7 of individuals enrolled under this part who are treated by the ,,vbp eligible professional for the performance period involved4 7,,ii7 ,the minimum number 7as determined by the ,secretary7 of items and services furnished to individuals enrolled under this part by such professional for such performance period4 7,,iii7 ,the minimum amount 7as determined by the ,secretary7 of allowed charges billed by such professional under this part for such performance period4 7v7 ,treatment of new ,medicare enrolled eligible professionals ,in the case of a professional who first becomes a ,medicare enrolled eligible professional during the performance period for a year 7and had not previously submitted claims under this title such as a person1 an entity1 or a part of a physician group or under a different billing number or tax identifier71 such professional shall not be treated under this subsection as a ,,vbp eligible professional until the subsequent year and performance period for such subsequent year4 7vi7 ,clarification ,in the case of items and services furnished during a year by an individual who is not a ,,vbp eligible professional 7including pursuant to clauses 7ii7 and 7v77 with respect to a year1 in no case shall a reduction under paragraph 7#f7 or a ,,vbp program incentive payment under paragraph 7#g7 apply to such individual for such year4 7vii7 ,partial qualifying ,,apm participant clarification ,in the case of an eligible professional who is a partial qualifying ,,apm participant1 with respect to a year1 and who for the performance period for such year reports on applicable measures and activities described in paragraph 7#b77;,b7 that are required to be reported by such a professional under the ,,vbp program1 such eligible professional is considered to be a ,,vbp eligible professional with respect to such year4 7,d7 ,application to group practices 7i7 ,in general ,under the ,,vbp program3 7,i7 ,quality performance category ,the ,secretary shall establish and apply a process that includes features of the provisions of subsection 7m77#c77;,c7 for ,,vbp eligible professionals in a group practice with respect to assessing performance of such group with respect to the performance category described in clause 7i7 of paragraph 7#b77;,a74 7,,ii7 ,other performance categories ,the ,secretary may establish and apply a process that includes features of the provisions of subsection 7m77#c77;,c7 for ,,vbp eligible professionals in a group practice with respect to assessing the performance of such group with respect to the performance categories described in clauses 7ii7 through 7iv7 of such paragraph4 7ii7 ,ensuring comprehensiveness of group practice assessment ,the process established under clause 7i7 shall to the extent practicable reflect the full range of items and services furnished by the ,,vbp eligible professionals in the group practice involved4 7iii7 ,clarification ,,vbp eligible professionals electing to be a virtual group under paragraph 7#e77;,j7 shall not be considered ,,vbp eligible professionals in a group practice for purposes of applying this subparagraph4 7,e7 ,use of registries ,under the ,,vbp program1 the ,secretary shall encourage the use of qualified clinical data registries pursuant to subsection 7m77#c77;,e7 in carrying out this subsection4 7,f7 ,application of certain provisions ,in applying a provision of subsection 7k71 7m71 7o71 or 7p7 for purposes of this subsection1 the ,secretary shall-- 7i7 adjust the application of such provision to ensure the provision is consistent with the provisions of this subsection2 and 7ii7 not apply such provision to the extent that the provision is duplicative with a provision of this subsection4 7#b7 ,measures and activities under performance categories 7,a7 ,performance categories ,under the ,,vbp program1 the ,secretary shall use the following performance categories 7each of which is referred to in this subsection as a performance category7 in determining the composite performance score under paragraph 7#e73 7i7 ,quality4 7ii7 ,resource use4 7iii7 ,clinical practice improvement activities4 7iv7 ,meaningful use of certified ,,ehr technology4 7,b7 ,measures and activities specified for each category ,for purposes of paragraph 7#c77;,a7 and subject to subparagraph 7,c71 measures and activities specified for a performance period 7as established under paragraph 7#d77 for a year are as follows3 7i7 ,quality ,for the performance category described in subparagraph 7,a77i71 the quality measures established for such period under subsections 7k7 and 7m71 including under subsection 7m77#c77;,e71 and the measures of quality of care established for such period under subsection 7p77#b74 7ii7 ,resource use ,for the performance category described in subparagraph 7,a77ii71 the measurement of resource use for such period under subsection 7p77#c71 using the methodology under subsection 7r71 as appropriate1 and1 as feasible and applicable1 accounting for the cost of covered part ,d drugs4 7iii7 ,clinical practice improvement activities ,for the performance category described in subparagraph 7,a77iii71 clinical practice improvement activities under subcategories specified by the ,secretary for such period1 which shall include at least the following3 7,i7 ,the subcategory of expanded practice access1 which shall include activities such as same day appointments for urgent needs and after hours access to clinician advice4 7,,ii7 ,the subcategory of population management1 which shall include activities such as monitoring health conditions of individuals to provide timely health care interventions or participation in a qualified clinical data registry4 7,,iii7 ,the subcategory of care coordination1 which shall include activities such as timely communication of test results1 timely exchange of clinical information to patients and other providers1 and use of remote monitoring or telehealth4 7,,iv7 ,the subcategory of beneficiary engagement1 which shall include activities such as the establishment of care plans for individuals with complex care needs1 beneficiary self-management training1 and using shared decision-making mechanisms4 7,v7 ,the subcategory of patient safety and practice assessment1 such as through use of clinical or surgical checklists and practice assessments related to maintaining certification4 7,,vi7 ,the subcategory of participation in an alternative payment model 7as defined in section #ahcc7z77#c77;,c774 ,in establishing activities under this clause1 the ,secretary shall give consideration to the circumstances of small practices 7consisting of fewer than #bj professionals7 and practices located in rural areas and in health professional shortage areas 7as designated under section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act74 7iv7 ,meaningful ,,ehr use ,for the performance category described in subparagraph 7,a77iv71 the requirements established for such period under subsection 7o77#b7 for determining whether an eligible professional is a meaningful ,,ehr user4 7,c7 ,additional provisions 7i7 ,emphasizing outcome measures under quality performance category ,in applying subparagraph 7,b77i71 the ,secretary shall1 as feasible1 emphasize the application of outcome measures4 7ii7 ,application of additional system measures ,the ,secretary may use measures used for a payment system other than for physicians for purposes of the performance category described in subparagraph 7,a77i74 7iii7 ,global and population-based measures ,the ,secretary may use global measures1 such as global outcome measures1 and population-based measures for purposes of the performance category described in subparagraph 7,a77i74 7iv7 ,request for information for clinical practice improvement activities ,in initially applying subparagraph 7,b77iii71 the ,secretary shall use a request for information to solicit recommendations from stakeholders for identifying activities described in such subparagraph and specifying criteria for such activities4 7v7 ,contract authority for clinical practice improvement activities performance category ,in applying subparagraph 7,b77iii71 the ,secretary may contract with entities to assist the ,secretary in-- 7,i7 identifying activities described in subparagraph 7,b77iii72 7,,ii7 specifying criteria for such activities2 and 7,,iii7 determining whether a ,,vbp eligible professional meets such criteria4 7vi7 ,application of measures and activities to non-patient-facing providers ,in carrying out this paragraph1 with respect to measures and activities specified in subparagraph 7,b7 for performance categories described in subparagraph 7,a71 the ,secretary-- 7,i7 shall give consideration to the circumstances of professional types 7or subcategories of those types determined by practice characteristics7 who typically provide services that do not involve face-to-face interaction with a patient2 and 7,,ii7 may1 to the extent feasible and appropriate1 take into account such circumstances and apply under this subsection with respect to ,,vbp eligible professionals of such professional types or subcategories1 in lieu of such a measure or activity1 a comparable measure or activity that fulfills the goals of the applicable performance category4 ,in carrying out the previous sentence1 the ,secretary shall consult with professionals of such professional types or subcategories4 7#c7 ,performance standards 7,a7 ,establishment ,under the ,,vbp program1 the ,secretary shall establish performance standards with respect to measures and activities specified under paragraph 7#b77;,b7 for a performance period 7as established under paragraph 7#d77 for a year4 7,b7 ,considerations in establishing standards ,in establishing such performance standards with respect to measures and activities specified under paragraph 7#b77;,b71 the ,secretary shall take into account the following3 7i7 ,historical performance standards4 7ii7 ,improvement rates4 7iii7 ,the opportunity for continued improvement4 7#d7 ,performance period ,the ,secretary shall establish a performance period 7or periods7 for a year 7beginning with the year described in paragraph 7#a77;,b774 ,such performance period 7or periods7 shall begin and end prior to the beginning of such year and be as close as possible to such year4 ,in this subsection1 such performance period 7or periods7 for a year shall be referred to as the performance period for the year4 7#e7 ,composite performance score 7,a7 ,in general ,subject to the succeeding provisions of this paragraph and consistent with section #b7;g77#b7 of the ,,sgr ,repeal and ,medicare ,beneficiary ,access ,act of #bjac1 the ,secretary shall develop a methodology for assessing the total performance of each ,,vbp eligible professional according to performance standards under paragraph 7#c7 with respect to applicable measures and activities specified in paragraph 7#b77;,b7 with respect to each performance category applicable to such professional for a performance period 7as established under paragraph 7#d77 for a year4 ,using such methodology1 the ,secretary shall provide for a composite assessment 7in this subsection referred to as the composite performance score7 for each such professional for each performance period4 7,b7 ,weighting performance categories1 measures1 and activities ,under the methodology under subparagraph 7,a71 the ,secretary-- 7i7 may assign different scoring weights 7including a weight of #j7 for-- 7,i7 each performance category based on the extent to which the category is applicable to the type of eligible professional involved2 and 7,,ii7 each measure and activity specified under paragraph 7#b77;,b7 with respect to each such category based on the extent to which the measure or activity is applicable to the type of eligible professional involved2 and 7ii7 with respect to the performance category described in paragraph 7#b77;,a77i7-- 7,i7 shall assign a higher scoring weight to outcomes measures than to other measures and increase the scoring weight for outcome measures over time2 and 7,,ii7 may assign a higher scoring weight to patient experience measures4 7,c7 ,incentive to report2 encouraging use of certified ,,ehr technology for reporting quality measures 7i7 ,incentive to report ,under the methodology established under subparagraph 7,a71 the ,secretary shall provide that in the case of a ,,vbp eligible professional who fails to report on an applicable measure or activity that is required to be reported by the professional1 the professional shall be treated as achieving the lowest potential score applicable to such measure or activity4 7ii7 ,encouraging use of certified ,,ehr technology for reporting quality measures ,under the methodology established under subparagraph 7,a71 the ,secretary shall-- 7,i7 encourage ,,vbp eligible professionals to report on applicable measures with respect to the performance category described in paragraph 7#b77;,a77i7 through the use of certified ,,ehr technology2 and 7,,ii7 with respect to a performance period1 with respect to a year1 for which a ,,vbp eligible professional reports such measures through the use of such ,,ehr technology1 treat such professional as satisfying the clinical quality measures reporting requirement described in subsection 7o77#b77;,a77iii7 for such year4 7,d7 ,clinical practice improvement activities performance score 7i7 ,rule for accreditation ,a ,,vbp eligible professional who is in a practice that is certified as a patient-centered medical home or comparable specialty practice pursuant to subsection 7b77#h77;,b77i7 with respect to a performance period shall be given the highest potential score for the performance category described in paragraph 7#b77;,a77iii7 for such period4 7ii7 ,,apm participation ,participation by a ,,vbp eligible professional in an alternative payment model 7as defined in section #ahcc7z77#c77;,c77 with respect to a performance period shall earn such eligible professional one-half of the highest potential score for the performance category described in paragraph 7#b77;,a77iii7 for such performance period4 ,nothing in the previous sentence shall prevent such professional from earning more than one-half of such highest potential score for such performance period by performing additional activities with respect to such performance category4 7iii7 ,subcategories ,a ,,vbp eligible professional shall not be required to perform activities in each subcategory under paragraph 7#b77;,b77iii7 to achieve the highest potential score for the performance category described in paragraph 7#b77;,a77iii74 7,e7 ,distribution ,the ,secretary shall ensure that the application of the methodology developed under subparagraph 7,a7 results in a continuous distribution of performance scores1 which shall result in differential payments under paragraph 7#g74 7,f7 ,achievement and improvement 7i7 ,taking into account improvement ,beginning with the second year to which the ,,vbp program applies1 in addition to the achievement score of a ,,vbp eligible professional1 the methodology developed under subparagraph 7,a7-- 7,i7 in the case of the performance score for the performance category described in clauses 7i7 and 7ii7 of paragraph 7#b77;,a71 shall take into account the improvement of the professional2 and 7,,ii7 in the case of performance scores for other performance categories1 may take into account the improvement of the professional4 7ii7 ,assigning higher weight for achievement ,beginning with the fourth year to which the ,,vbp program applies1 under the methodology developed under subparagraph 7,a71 the ,secretary may assign a higher scoring weight under subparagraph 7,b7 with respect to the achievement score of a ,,vbp eligible professional with respect to a measure or activity specified under paragraph 7#b77;,b7 7or with respect to such a measure or activity and with respect to categories described in paragraph 7#b77;,a77 than to any improvement score applied under clause 7i7 with respect to such measure or activity 7or such measure or activity and categories74 7,g7 ,weights for the performance categories 7i7 ,in general ,under the methodology developed under subparagraph 7,a71 subject to clauses 7ii7 and 7iii71 the composite performance score shall be determined as follows3 7,i7 ,quality 7aa7 ,in general ,subject to item 7bb71 #cj percent of such score shall be based on performance with respect to the category described in clause 7i7 of paragraph 7#b77;,a74 7bb7 ,first #b years and test year ,for the first and second years for which the ,,vbp program applies to payments1 #fj percent of such score shall be based on performance with respect to the category described in clause 7i7 of paragraph 7#b77;,a74 ,with respect to the subsequent year1 the percent described in item 7aa7 of such score shall be based on performance with respect to such category only for purposes of feedback and #fj percent of such score shall be based on performance with respect to such category for any other purpose under this subsection4 7,,ii7 ,resource use 7aa7 ,in general ,subject to item 7bb71 #cj percent of such score shall be based on performance with respect to the category described in clause 7ii7 of paragraph 7#b77;,a74 7bb7 ,first #b years and test year ,for the first and second years for which the ,,vbp program applies to payments1 zero percent of such score shall be based on performance with respect to the category described in clause 7ii7 of paragraph 7#b77;,a74 ,with respect to the subsequent year1 the percent described in item 7aa7 of such score shall be based on performance with respect to such category only for purposes of feedback and zero percent of such score shall be based on performance with respect to such category for any other purpose under this subsection4 7,,iii7 ,clinical practice improvement activities ,fifteen percent of such score shall be based on performance with respect to the category described in clause 7iii7 of paragraph 7#b77;,a74 7,,iv7 ,meaningful use of certified ,,ehr technology ,twenty-five percent of such score shall be based on performance with respect to the category described in clause 7iv7 of paragraph 7#b77;,a74 7ii7 ,authority to adjust percentages in case of high ehr meaningful use adoption ,in any year in which the ,secretary estimates that the proportion of eligible professionals 7as defined in subsection 7o77#e77 who are meaningful ,,ehr users 7as determined under subsection 7o77#b77 is #ge percent or greater1 the ,secretary may reduce the percent applicable under clause 7i77,,iv71 but not below #ae percent4 ,if the ,secretary makes such reduction for a year1 the percentages applicable under one or more of subclauses 7,i71 7,,ii71 and 7,,iii7 of clause 7i7 for such year 7or1 in the case of a year described in clause 7i77,,ii77bb71 applicable under one or more of subclauses 7,i7 and 7,,iii77 shall be increased in a manner such that the total percentage points of the increase under this clause for such year equals the total number of percentage points reduced under the preceding sentence for such year4 7iii7 ,authority to adjust percentages for quality and resource use ,other than for a year described in clause 7i77,,ii77bb71 the percentages described in subclauses 7,i7 and 7,,ii7 of clause 7i71 including after application of clause 7ii71 shall be equal4 7,h7 ,resource use ,analysis of the performance category described in paragraph 7#b77;,a77ii7 shall include results from the methodology described in subsection 7r77#e71 as appropriate4 7,i7 ,inclusion of quality measure data from multiple payers ,in applying subsections 7k71 7m71 and 7p7 with respect to measures described in paragraph 7#b77;,b77i71 analysis of the performance category described in paragraph 7#b77;,a77i7 may include data submitted by ,,vbp eligible professionals with respect to multiple payers4 7,j7 ,use of voluntary virtual groups for certain assessment purposes 7i7 ,in general ,in the case of ,,vbp eligible professionals electing to be a virtual group under clause 7ii7 with respect to a performance period for a year1 for purposes of applying the methodology under subparagraph 7,a7-- 7,i7 the assessment of performance provided under such methodology with respect to the performance categories described in clauses 7i7 and 7ii7 of paragraph 7#b77;,a7 that is to be applied to each such professional in such group for such performance period shall be with respect to the combined performance of all such professionals in such group for such period2 and 7,,ii7 the composite score provided under this paragraph for such performance period with respect to each such performance category for each such ,,vbp eligible professional in such virtual group shall be based on the assessment of the combined performance under subclause 7,i7 for the performance category and performance period4 7ii7 ,election of practices to be a virtual group ,the ,secretary shall1 in accordance with clause 7iii71 establish and have in place a process to allow an individual ,,vbp eligible professional or a group practice consisting of not more than #aj ,,vbp eligible professionals to elect1 with respect to a performance period for a year1 for such individual ,,vbp eligible professional or all such ,,vbp eligible professionals in such group practice1 respectively1 to be a virtual group under this subparagraph with at least one other such individual ,,vbp eligible professional or group practice making such an election4 7iii7 ,requirements ,the process under clause 7ii7 shall provide that-- 7,i7 an election under such clause1 with respect to a performance period1 shall be made before the beginning of such performance period and may not be changed during such performance period2 and 7,,ii7 a practice described in such clause1 and each ,,vbp eligible professional in such practice1 may elect to be in no more than one virtual group for a performance period4 7#f7 ,funding for ,,vbp program incentive payments 7,a7 ,total amount for incentive payments ,the total amount for ,,vbp program incentive payments under paragraph 7#g7 for all ,,vbp eligible professionals for a year shall be equal to the total amount of the performance funding pool for all ,,vbp eligible professionals under subparagraph 7,b7 for such year1 as estimated by the ,secretary4 7,b7 ,performance funding pool 7i7 ,in general ,in the case of items and services furnished by a ,,vbp eligible professional during a year 7beginning with #bjag71 the otherwise applicable fee schedule amount 7as defined in clause 7iii77 with respect to such items and services and eligible professional for such year shall be reduced by the applicable percent under clause 7ii74 ,the total amount of such reductions for a year shall be referred to in this subsection as the performance funding pool for such year4 7ii7 ,applicable percent defined ,for purposes of clause 7i71 the term applicable percent means-- 7,i7 for #bjag1 #d percent2 7,,ii7 for #bjah1 #f percent2 7,,iii7 for #bjai1 #h percent2 7,,iv7 for #bjbj1 #aj percent2 and 7,v7 for #bjba and subsequent years1 a percent specified by the ,secretary 7but in no case less than #aj percent or more than #ab percent74 7iii7 ,otherwise applicable fee schedule amount ,for purposes of this subparagraph and paragraph 7#g71 the term otherwise applicable fee schedule amount means1 with respect to items and services furnished by a ,,vbp eligible professional during a year1 the fee schedule amount for such items and services and year that would otherwise apply 7without application of this subparagraph or paragraph 7#g77 with respect to such eligible professional under subsection 7b71 after application of subsection 7a77#c71 or under another fee schedule under this part4 7#g7 ,,vbp program incentive payments 7,a7 ,,vbp program incentive payment adjustment factor ,consistent with section #b7;g77#b7 of the ,,sgr ,repeal and ,medicare ,beneficiary ,access ,act of #bjac1 the ,secretary shall specify a ,,vbp program incentive payment adjustment factor for each ,,vbp eligible professional for a year4 ,such ,,vbp program incentive payment adjustment factor for a ,,vbp eligible professional for a year shall be determined-- 7i7 by the composite performance score of the eligible professional for such year2 7ii7 in a manner such that the adjustment factors specified under this subparagraph for a year results in differential payments under this paragraph reflecting the full range of the distribution of composite performance scores of ,,vbp eligible professionals determined under paragraph 7#e77;,e7 for such year1 with such professionals having higher composite performance scores receiving higher payment2 and 7iii7 in a manner such that the adjustment factors specified under this subparagraph for a year-- 7,i7 does not result in a payment reduction for such year by an amount that exceeds the applicable percent described in paragraph 7#f77;,b77ii7 for such year2 and 7,,ii7 does not result in a payment increase for such year by an amount that exceeds the applicable percent described in paragraph 7#f77;,b77ii7 for such year4 7,b7 ,calculation of ,,vbp program incentive payment amounts ,the ,,vbp program incentive payment amount with respect to items and services furnished by a ,,vbp eligible professional during a year shall be equal to the difference between-- 7i7 the product of-- 7,i7 the ,,vbp program incentive payment adjustment factor determined under subparagraph 7,a7 for such ,,vbp eligible professional for such year2 and 7,,ii7 the otherwise applicable fee schedule amount 7as defined in paragraph 7#f77;,b77iii77 with respect to such items and services and eligible professional for such year2 and 7ii7 the otherwise applicable fee schedule amount1 as reduced under paragraph 7#f77;,b71 with respect to such items and services1 eligible professional1 and year4 ,the application of the preceding sentence may result in the ,,vbp program incentive payment amount being #j4j with respect to an item or service furnished by a ,,vbp eligible professional4 7,c7 ,application of ,,vbp program incentive payment amount ,in the case of items and services furnished by a ,,vbp eligible professional during a year 7beginning with #bjag71 the otherwise applicable fee schedule amount1 as reduced under paragraph 7#f77;,b71 with respect to such items and services and eligible professional for such year shall be increased1 if applicable1 by the ,,vbp program incentive payment amount determined under subparagraph 7,b7 with respect to such items and services1 professional1 and year4 7,d7 ,budget neutrality ,in specifying the ,,vbp program incentive payment adjustment factor for each ,,vbp eligible professional for a year under subparagraph 7,a71 the ,secretary shall ensure that the total amount of ,,vbp program incentive payment amounts under this paragraph for all ,,vbp eligible professionals in a year shall be equal to the performance funding pool for such year under paragraph 7#f71 as estimated by the ,secretary4 7#h7 ,announcement of result of adjustments ,under the ,,vbp program1 the ,secretary shall1 not later than #fj days prior to the year involved1 make available to each ,,vbp eligible professional the ,,vbp program incentive payment adjustment factor under paragraph 7#g7 and the payment reduction under paragraph 7#f7 applicable to the eligible professional for items and services furnished by the professional in such year4 ,the ,secretary may include such information in the confidential feedback under paragraph 7#ac74 7#i7 ,no effect in subsequent years ,the ,,vbp program incentive payment under paragraph 7#g7 and the payment reduction under paragraph 7#f7 shall each apply only with respect to the year involved1 and the ,secretary shall not take into account such ,,vbp program incentive payment or payment reduction in making payments to a ,,vbp eligible professional under this part in a subsequent year4 7#aj7 ,public reporting 7,a7 ,in general ,the ,secretary shall1 in an easily understandable format1 make available on the ,physician ,compare ,internet website under subsection 7t7 the following3 7i7 ,information regarding the performance of ,,vbp eligible professionals under the ,,vbp program1 which-- 7,i7 shall include the composite score for each such ,,vbp eligible professional and the performance of each such ,,vbp eligible professional with respect to each performance category2 and 7,,ii7 may include the performance of each such ,,vbp eligible professional with respect to each measure or activity specified in paragraph 7#b77;,b74 7ii7 ,the names of eligible professionals in eligible alternative payment models 7as defined in section #ahcc7z77#c77;,d77 and1 to the extent feasible1 the names of such eligible alternative payment models and performance of such models4 7,b7 ,disclosure ,the information made available under this paragraph shall indicate1 where appropriate1 that publicized information may not be representative of the eligible professional's entire patient population1 the variety of services furnished by the eligible professional1 or the health conditions of individuals treated4 7,c7 ,opportunity to review and submit corrections ,the ,secretary shall provide for an opportunity for a professional described in subparagraph 7,a7 to review1 and submit corrections for1 the information to be made public with respect to the professional under such subparagraph prior to such information being made public4 7,d7 ,aggregate information ,the ,secretary shall periodically post on the ,physician ,compare ,internet website aggregate information on the ,,vbp program1 including the range of composite scores for all ,,vbp eligible professionals and the range of the performance of all ,,vbp eligible professionals with respect to each performance category4 7#aa7 ,consultation ,the ,secretary shall consult with stakeholders in carrying out the ,,vbp program1 including for the identification of measures and activities under paragraph 7#b77;,b7 and the methodologies developed under paragraphs 7#e77;,a7 and 7#g74 ,such consultation shall include the use of a request for information or other mechanisms determined appropriate4 7#ab7 ,technical assistance to small practices and practices in health professional shortage areas 7,a7 ,in general ,the ,secretary shall enter into contracts or agreements with appropriate entities 7such as quality improvement organizations1 regional extension centers 7as described in section #cjab7;c7 of the ,public ,health ,service ,act71 or regional health collaboratives7 to offer guidance and assistance to ,,vbp eligible professionals in practices of fewer than #bj professionals 7with priority given to such practices located in rural areas1 health professional shortage areas 7as designated under in section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act71 or practices with low composite scores7 with respect to-- 7i7 the performance categories described in clauses 7i7 through 7iv7 of paragraph 7#b77;,a72 or 7ii7 how to transition to the implementation of and participation in an alternative payment model as described in section #ahcc7z77#c77;,c74 7,b7 ,funding for implementation ,for purposes of implementing subparagraph 7,a71 the ,secretary shall provide for the transfer from the ,federal ,supplementary ,medical ,insurance ,trust ,fund established under section #ahda to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account of #ej1jjj1jjj for each of fiscal years #bjad through #bjah4 ,amounts transferred under this subparagraph for a fiscal year shall be available until expended4 7#ac7 ,feedback and information to improve performance 7,a7 ,performance feedback 7i7 ,in general ,beginning ,july #a1 #bjae1 the ,secretary-- 7,i7 shall make available timely 7such as quarterly7 confidential feedback to each ,,vbp eligible professional on the performance of such professional with respect to the performance categories under clauses 7i7 and 7ii7 of paragraph 7#b77;,a72 and 7,,ii7 may make available confidential feedback to each such professional on the performance of such professional with respect to the performance categories under clauses 7iii7 and 7iv7 of such paragraph4 7ii7 ,mechanisms ,the ,secretary may use one or more mechanisms to make feedback available under clause 7i71 which may include use of a web-based portal or other mechanisms determined appropriate by the ,secretary4 ,the ,secretary shall encourage provision of feedback through qualified clinical data registries as described in subsection 7m77#c77;,e774 7iii7 ,use of data ,for purposes of clause 7i71 the ,secretary may use data1 with respect to a ,,vbp eligible professional1 from periods prior to the current performance period and may use rolling periods in order to make illustrative calculations about the performance of such professional4 7iv7 ,disclosure exemption ,feedback made available under this subparagraph shall be exempt from disclosure under section #eeb of title #e1 ,united ,states ,code4 7v7 ,receipt of information ,the ,secretary may use the mechanisms established under clause 7ii7 to receive information from professionals1 such as information with respect to this subsection4 7,b7 ,additional information 7i7 ,in general ,beginning ,july #a1 #bjaf1 the ,secretary shall make available to each ,,vbp eligible professional information1 with respect to individuals who are patients of such ,,vbp eligible professional1 about items and services for which payment is made under this title that are furnished to such individuals by other suppliers and providers of services1 which may include information described in clause 7ii74 ,such information shall be made available under the previous sentence to such ,,vbp eligible professionals by mechanisms determined appropriate by the ,secretary1 which may include use of a web-based portal4 ,such information shall be made available in accordance with the same or similar terms as data are made available to accountable care organizations under section #ahii1 including a beneficiary opt-out4 7ii7 ,type of information ,for purposes of clause 7i71 the information described in this clause1 is the following3 7,i7 ,with respect to selected items and services 7as determined appropriate by the ,secretary7 for which payment is made under this title and that are furnished to individuals1 who are patients of a ,,vbp eligible professional1 by another supplier or provider of services during the most recent period for which data are available 7such as the most recent three-month period71 the name of such providers furnishing such items and services to such patients during such period1 the types of such items and services so furnished1 and the dates such items and services were so furnished4 7,,ii7 ,historical averages 7and other measures of the distribution if appropriate7 of the total1 and components of1 allowed charges 7and other figures as determined appropriate by the ,secretary7 for care episodes for such period4 7#ad7 ,review 7,a7 ,targeted review ,the ,secretary shall establish a process under which a ,,vbp eligible professional may seek an informal review of the calculation of the ,,vbp program incentive payment adjustment factor applicable to such eligible professional under this subsection for a year4 ,the results of a review conducted pursuant to the previous sentence shall not be taken into account for purposes of paragraph 7#g7 with respect to a year 7other than with respect to the calculation of such eligible professional's ,,vbp program incentive payment adjustment factor for such year7 after the factors determined in subparagraph 7,a7 of such paragraph have been determined for such year4 7,b7 ,limitation ,except as provided for in subparagraph 7,a71 there shall be no administrative or judicial review under section #ahfi1 section #ahgh1 or otherwise of the following3 7i7 ,the methodology used to determine the amount of the ,,vbp program incentive payment adjustment factor under paragraph 7#g7 and the determination of such amount4 7ii7 ,the determination of the amount of funding available for such ,,vbp program incentive payments under paragraph 7#f77;,a7 and the payment reduction under paragraph 7#f77;,b77i74 7iii7 ,the establishment of the performance standards under paragraph 7#c7 and the performance period under paragraph 7#d74 7iv7 ,the identification of measures and activities specified under paragraph 7#b77;,b7 and information made public or posted on the ,physician ,compare ,internet website of the ,centers for ,medicare ,medicaid ,services under paragraph 7#aj74 7v7 ,the methodology developed under paragraph 7#e7 that is used to calculate performance scores and the calculation of such scores1 including the weighting of measures and activities under such methodology4 4 7#b7 ,,gao reports 7,a7 ,evaluation of eligible professional ,,vbp program ,not later than ,october #a1 #bjah1 and ,october #a1 #bjba1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report evaluating the eligible professional value-based performance incentive program under subsection 7q7 of section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d71 as added by paragraph 7#a74 ,such report shall-- 7i7 examine the distribution of the performance and incentive payments for ,,vbp eligible professionals 7as defined in subsection 7q77#a77;,c7 of such section7 under such program1 and patterns relating to such performance and incentive payments1 including based on type of provider1 practice size1 geographic location1 and patient mix2 and 7ii7 provide recommendations for improving such program4 7,b7 ,study to examine alignment of quality measures used in public and private programs ,not later than #ah months after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report that-- 7i7 compares the similarities and differences in the use of quality measures under the original medicare fee-for-service program under parts ,a and ,b of title ,,xviii of the ,social ,security ,act1 the ,medicare ,advantage program under part ,c of such title1 and private payer arrangements2 and 7ii7 makes recommendations on how to reduce the administrative burden involved in applying such quality measures4 7#c7 ,funding for implementation ,for purposes of implementing the provisions of and the amendments made by this section1 the ,secretary of ,health and ,human ,services shall provide for the transfer of #ej1jjj1jjj from the ,supplementary ,medical ,insurance ,trust ,fund established under section #ahda of the ,social ,security ,act 7#db ,u4,s4,c4 #aciet7 to the ,centers for ,medicare ,medicaid ,program ,management ,account for each of the fiscal years #bjad through #bjag4 ,amounts transferred under this paragraph shall be available until expended4 7d7 ,improving quality reporting for composite scores 7#a7 ,changes for group reporting option 7,a7 ,in general ,section #ahdh7m77#c77;,c77ii77 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#c77;,c77ii77 is amended by inserting and1 for #bjad and subsequent years1 may provide after shall provide4 7,b7 ,clarification of qualified clinical data registry reporting to group practices ,section #ahdh7m77#c77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#c77;,d77 is amended by inserting and1 for #bjae and subsequent years1 subparagraph 7,a7 or 7,c7 after subparagraph 7,a74 7#b7 ,changes for multiple reporting periods and alternative criteria for satisfactory reporting ,section #ahdh7m77#e77;,f77 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#e77;,f77 is amended-- 7,a7 by striking and subsequent years and inserting through reporting periods occurring in #bjac2 and 7,b7 by inserting and1 for reporting periods occurring in #bjad and subsequent years1 the ,secretary may establish following shall establish4 7#c7 ,physician feedback program reports succeeded by reports under ,,vbp program ,section #ahdh7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7n77 is amended by adding at the end the following new paragraph3 7#aa7 ,reports ending with #bjaf ,reports under the ,program shall not be provided after ,december #ca1 #bjaf4 ,see subsection 7q77#ac7 for reports beginning with #bjag4 4 7#d7 ,coordination with satisfying meaningful ,,ehr use clinical quality measure reporting requirement ,section #ahdh7o77#b77;,a77iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#b77;,a77iii77 is amended by inserting and subsection 7q77#e77;,c77ii77,,ii7 after ,subject to subparagraph 7,b77ii74 7e7 ,promoting alternative payment models 7#a7 ,incentive payments for participation in eligible alternative payment models ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is amended by adding at the end the following new subsection3 7z7 ,incentive payments for participation in eligible alternative payment models 7#a7 ,payment incentive 7,a7 ,in general ,in the case of covered professional services furnished by an eligible professional during a year that is in the period beginning with #bjag and ending with #bjbb and for which the professional is a qualifying ,,apm participant1 in addition to the amount of payment that would otherwise be made for such covered professional services under this part for such year1 there also shall be paid to such professional an amount equal to #e percent of the payment amount for the covered professional services under this part for the preceding year4 ,for purposes of the previous sentence1 the payment amount for the preceding year may be an estimation for the full preceding year based on a period of such preceding year that is less than the full year4 ,the ,secretary shall establish policies to implement this subparagraph in cases where payment for covered professional services furnished by a qualifying ,,apm participant in an alternative payment model is made to an entity participating in the alternative payment model rather than directly to the qualifying ,,apm participant4 7,b7 ,form of payment ,payments under this subsection shall be made in a lump sum1 on an annual basis1 as soon as practicable4 7,c7 ,treatment of payment incentive ,payments under this subsection shall not be taken into account for purposes of determining actual expenditures under an alternative payment model and for purposes of determining or rebasing any benchmarks used under the alternative payment model4 7,d7 ,coordination ,the amount of the additional payment for an item or service under this subsection or subsection 7m7 shall be determined without regard to any additional payment for the item or service under subsection 7m7 and this subsection1 respectively4 ,the amount of the additional payment for an item or service under this subsection or subsection 7x7 shall be determined without regard to any additional payment for the item or service under subsection 7x7 and this subsection1 respectively4 ,the amount of the additional payment for an item or service under this subsection or subsection 7y7 shall be determined without regard to any additional payment for the item or service under subsection 7y7 and this subsection1 respectively4 7#b7 ,qualifying ,,apm participant ,for purposes of this subsection1 the term qualifying ,,apm participant means the following3 7,a7 #bjag and #bjah ,with respect to #bjag and #bjah1 an eligible professional for whom the ,secretary determines that at least #be percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available 7which may be less than a year7 were attributable to such services furnished under this part through an entity that participates in an eligible alternative payment model with respect to such services4 7,b7 #bjai and #bjbj ,with respect to #bjai and #bjbj1 an eligible professional described in either of the following clauses3 7i7 ,medicare revenue threshold option ,an eligible professional for whom the ,secretary determines that at least #ej percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available 7which may be less than a year7 were attributable to such services furnished under this part through an entity that participates in an eligible alternative payment model with respect to such services4 7ii7 ,combination all-payer and ,medicare revenue threshold option ,an eligible professional-- 7,i7 for whom the ,secretary determines1 with respect to items and services furnished by such professional during the most recent period for which data are available 7which may be less than a year71 that at least #ej percent of the sum of-- 7aa7 payments described in clause 7i72 and 7bb7 all other payments1 regardless of payer 7other than payments made by the ,secretary of ,defense or the ,secretary of ,veterans ,affairs under chapter #ee of title #aj1 ,united ,states ,code1 or title #ch1 ,united ,states ,code1 or any other provision of law71 meet the requirement described in clause 7iii77,i7 with respect to payments described in item 7aa7 and meet the requirement described in clause 7iii77,,ii7 with respect to payments described in item 7bb72 7,,ii7 for whom the ,secretary determines at least #be percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available 7which may be less than a year7 were attributable to such services furnished under this part through an entity that participates in an eligible alternative payment model with respect to such services2 and 7,,iii7 who provides to the ,secretary such information as is necessary for the ,secretary to make a determination under subclause 7,i71 with respect to such professional4 7iii7 ,requirement ,for purposes of clause 7ii77,i7-- 7,i7 the requirement described in this subclause1 with respect to payments described in item 7aa7 of such clause1 is that such payments are made under an eligible alternative payment model2 and 7,,ii7 the requirement described in this subclause1 with respect to payments described in item 7bb7 of such clause1 is that such payments are made under an arrangement in which-- 7aa7 quality measures comparable to measures under the performance category described in section #ahdh7q77#b77;,b77i7 apply2 7bb7 certified ,,ehr technology is used2 and 7cc7 the eligible professional bears more than nominal financial risk if actual aggregate expenditures exceeds expected aggregate expenditures4 7,c7 ,beginning in #bjba ,with respect to #bjba and each subsequent year1 an eligible professional described in either of the following clauses3 7i7 ,medicare revenue threshold option ,an eligible professional for whom the ,secretary determines that at least #ge percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available 7which may be less than a year7 were attributable to such services furnished under this part through an entity that participates in an eligible alternative payment model with respect to such services4 7ii7 ,combination all-payer and ,medicare revenue threshold option ,an eligible professional-- 7,i7 for whom the ,secretary determines1 with respect to items and services furnished by such professional during the most recent period for which data are available 7which may be less than a year71 that at least #ge percent of the sum of-- 7aa7 payments described in clause 7i72 and 7bb7 all other payments1 regardless of payer 7other than payments made by the ,secretary of ,defense or the ,secretary of ,veterans ,affairs under chapter #ee of title #aj1 ,united ,states ,code1 or title #ch1 ,united ,states ,code1 or any other provision of law71 meet the requirement described in clause 7iii77,i7 with respect to payments described in item 7aa7 and meet the requirement described in clause 7iii77,,ii7 with respect to payments described in item 7bb72 7,,ii7 for whom the ,secretary determines at least #be percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available 7which may be less than a year7 were attributable to such services furnished under this part through an entity that participates in an eligible alternative payment model with respect to such services2 and 7,,iii7 who provides to the ,secretary such information as is necessary for the ,secretary to make a determination under subclause 7,i71 with respect to such professional4 7iii7 ,requirement ,for purposes of clause 7ii77,i7-- 7,i7 the requirement described in this subclause1 with respect to payments described in item 7aa7 of such clause1 is that such payments are made under an eligible alternative payment model2 and 7,,ii7 the requirement described in this subclause1 with respect to payments described in item 7bb7 of such clause1 is that such payments are made under an arrangement in which-- 7aa7 quality measures comparable to measures under the performance category described in section #ahdh7q77#b77;,b77i7 apply2 7bb7 certified ,,ehr technology is used2 and 7cc7 the eligible professional bears more than nominal financial risk if actual aggregate expenditures exceeds expected aggregate expenditures4 7#b7 ,additional definitions ,in this subsection3 7,a7 ,covered professional services ,the term covered professional services has the meaning given that term in section #ahdh7k77#c77;,a74 7,b7 ,eligible professional ,the term eligible professional has the meaning given that term in section #ahdh7k77#c77;,b74 7,c7 ,alternative payment model 7,,apm7 ,the term alternative payment model means any of the following3 7i7 ,a model under section #aaae;,a 7other than a health care innovation award74 7ii7 ,an accountable care organization under section #ahii4 7iii7 ,a demonstration under section #ahff;,c4 7iv7 ,a demonstration required by ,federal law4 7,d7 ,eligible alternative payment model 7,,apm7 7i7 ,in general ,the term eligible alternative payment model means1 with respect to a year1 an alternative payment model-- 7,i7 that requires use of certified ,,ehr technology 7as defined in subsection 7o77#d772 7,,ii7 that provides for payment for covered professional services based on quality measures comparable to measures under the performance category described in section #ahdh7q77#b77;,b77i72 and 7,,iii7 that satisfies the requirement described in clause 7ii74 7ii7 ,additional requirement ,for purposes of clause 7i77,,iii71 the requirement described in this clause1 with respect to a year and an alternative payment model1 is that the alternative payment model-- 7,i7 is one in which one or more entities bear financial risk for monetary losses under such model that are in excess of a nominal amount2 or 7,,ii7 is a medical home expanded under section #aaae;,a7c74 7#c7 ,limitation ,there shall be no administrative or judicial review under section #ahfi1 #ahgh1 or otherwise1 of the following3 7,a7 ,the determination that an eligible professional is a qualifying ,,apm participant under paragraph 7#b7 and the determination that an alternative payment model is an eligible alternative payment model under paragraph 7#c77;,d74 7,b7 ,the determination of the amount of the #e percent payment incentive under paragraph 7#a77;,a71 including any estimation as part of such determination4 4 7#b7 ,coordination conforming amendments ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is further amended-- 7,a7 in subsection 7x77#c71 by adding at the end the following new sentence3 ,the amount of the additional payment for a service under this subsection and subsection 7z7 shall be determined without regard to any additional payment for the service under subsection 7z7 and this subsection1 respectively42 and 7,b7 in subsection 7y77#c71 by adding at the end the following new sentence3 ,the amount of the additional payment for a service under this subsection and subsection 7z7 shall be determined without regard to any additional payment for the service under subsection 7z7 and this subsection1 respectively44 7#c7 ,encouraging development and testing of certain models ,section #aaae;,a7b77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77 is amended-- 7,a7 in subparagraph 7,b71 by adding at the end the following new clauses3 7xxi7 ,focusing primarily on physicians' services 7as defined in section #ahdh7;j77#c77 furnished by physicians who are not primary care practitioners4 7xxii7 ,focusing on practices of fewer than #bj professionals4 2 and 7,b7 in subparagraph 7,c77viii71 by striking other public sector or private sector payers and inserting other public sector payers1 private sector payers1 or ,statewide payment models4 7f7 ,study and report on fraud related to alternative payment models under the ,medicare program 7#a7 ,study ,the ,secretary of ,health and ,human ,services1 in consultation with the ,inspector ,general of the ,department of ,health and ,human ,services1 shall conduct a study that-- 7,a7 examines the applicability of the ,federal fraud prevention laws to items and services furnished under title ,,xviii of the ,social ,security ,act for which payment is made under an alternative payment model 7as defined in section #ahcc7z77#c77;,c7 of such ,act 7#db ,u4,s4,c4 #aciel7z77#c77;,c7772 7,b7 identifies aspects of such alternative payment models that are vulnerable to fraudulent activity2 and 7,c7 examines the implications of waivers to such laws granted in support of such alternative payment models1 including under any potential expansion of such models4 7#b7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a74 ,such report shall include recommendations for actions to be taken to reduce the vulnerability of such alternative payment models to fraudulent activity4 ,such report also shall include1 as appropriate1 recommendations of the ,inspector ,general for changes in ,federal fraud prevention laws to reduce such vulnerability4 7g7 ,improving payment accuracy 7#a7 ,studies and reports of effect of certain information on quality and resource use 7,a7 ,study using existing ,medicare data 7i7 ,study ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall conduct a study that examines the effect of individuals' socioeconomic status on quality and resource use outcome measures for individuals under the ,medicare program 7such as to recognize that less healthy individuals may require more intensive interventions74 ,the study shall use information collected on such individuals in carrying out such program1 such as urban and rural location1 eligibility for ,medicaid 7recognizing and accounting for varying ,medicaid eligibility across ,states71 and eligibility for benefits under the supplemental security income 7,,ssi7 program4 ,the ,secretary shall carry out this paragraph acting through the ,assistant ,secretary for ,planning and ,evaluation4 7ii7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under clause 7i74 7,b7 ,study using other data 7i7 ,study ,the ,secretary shall conduct a study that examines the impact of risk factors1 such as those described in section #ahdh7p77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7p77#c771 race1 health literacy1 limited ,english proficiency 7,,lep71 and patient activation1 on quality and resource use outcome measures under the ,medicare program 7such as to recognize that less healthy individuals may require more intensive interventions74 ,in conducting such study the ,secretary may use existing ,federal data and collect such additional data as may be necessary to complete the study4 7ii7 ,report ,not later than #e years after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under clause 7i74 7,c7 ,examination of data in conducting studies ,in conducting the studies under subparagraphs 7,a7 and 7,b71 the ,secretary shall examine what non-,medicare data sets1 such as data from the ,american ,community ,survey 7,,acs71 can be useful in conducting the types of studies under such paragraphs and how such data sets that are identified as useful can be coordinated with ,medicare administrative data in order to improve the overall data set available to do such studies and for the administration of the ,medicare program4 7,d7 ,recommendations to account for information in payment adjustment mechanisms ,if the studies conducted under subparagraphs 7,a7 and 7,b7 find a relationship between the factors examined in the studies and quality and resource use outcome measures1 then the ,secretary shall also provide recommendations for how the ,centers for ,medicare ,medicaid ,services should-- 7i7 obtain access to the necessary data 7if such data is not already being collected7 on such factors1 including recommendations on how to address barriers to the ,centers in accessing such data2 and 7ii7 account for such factors in determining payment adjustments based on quality and resource use outcome measures under the eligible professional value-based performance incentive program under section #ahdh7q7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77 and1 as the ,secretary determines appropriate1 other similar provisions of title ,,xviii of such ,act4 7,e7 ,funding ,there are hereby appropriated from the ,federal ,supplemental ,medical ,insurance ,trust ,fund to the ,secretary to carry out this paragraph #f1jjj1jjj1 to remain available until expended4 7#b7 ,,cms activities 7,a7 ,hierarchal ,condition ,category 7,,hcc7 improvement ,taking into account the relevant studies conducted and recommendations made in reports under paragraph 7#a71 the ,secretary1 on an ongoing basis1 shall estimate how an individual's health status and other risk factors affect quality and resource use outcome measures and1 as feasible1 shall incorporate information from quality and resource use outcome measurement 7including care episode and patient condition groups7 into the eligible professional value-based performance incentive program under section #ahdh7q7 of the ,social ,security ,act and1 as the ,secretary determines appropriate1 other similar provisions of title ,,xviii of such ,act4 7,b7 ,accounting for other factors in payment adjustment mechanisms 7i7 ,in general ,taking into account the studies conducted and recommendations made in reports under paragraph 7#a71 the ,secretary shall account for identified factors 7other than those applied under subparagraph 7,a77 with an effect on quality and resource use outcome measures when determining payment adjustments under the eligible professional value-based performance incentive program under section #ahdh7q7 of the ,social ,security ,act and1 as the ,secretary determines appropriate1 other similar provisions of title ,,xviii of such ,act4 7ii7 ,accessing data ,the ,secretary shall collect or otherwise obtain access to the data necessary to carry out this paragraph through existing and new data sources4 7iii7 ,periodic analyses ,the ,secretary shall carry out periodic analyses1 at least every #c years1 based on the factors referred to in clause 7i7 so as to monitor changes in possible relationships4 7,c7 ,funding ,there are hereby appropriated from the ,federal ,supplemental ,medical ,insurance ,trust ,fund to the ,secretary to carry out this paragraph #aj1jjj1jjj1 to remain available until expended4 7#c7 ,strategic plan for accessing race and ethnicity data ,not later than #ah months after the date of the enactment of this ,act1 the ,secretary shall develop and report to ,congress on a strategic plan for collecting or otherwise accessing data on race and ethnicity for purposes of carrying out the eligible professional value-based performance incentive program under section #ahdh7q7 of the ,social ,security ,act and1 as the ,secretary determines appropriate1 other similar provisions of title ,,xviii of such ,act4 7h7 ,collaborating with the physician1 practitioner1 and other stakeholder communities to improve resource use measurement ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d71 as amended by subsection 7c71 is further amended by adding at the end the following new subsection3 7r7 ,collaborating with the physician1 practitioner1 and other stakeholder communities ,to improve resource use measurement 7#a7 ,in general ,in order to involve the physician1 practitioner1 and other stakeholder communities in enhancing the infrastructure for resource use measurement1 including for purposes of the value-based performance incentive program under subsection 7q7 and alternative payment models under section #ahcc7z71 the ,secretary shall undertake the steps described in the succeeding provisions of this subsection4 7#b7 ,development of care episode and patient condition groups and classification codes 7,a7 ,in general ,in order to classify similar patients into distinct care episode groups and distinct patient condition groups1 the ,secretary shall undertake the steps described in the succeeding provisions of this paragraph4 7,b7 ,public availability of existing efforts to design an episode grouper ,not later than #fj days after the date of the enactment of this subsection1 the ,secretary shall post on the ,internet website of the ,centers for ,medicare ,medicaid ,services a list of the episode groups developed pursuant to subsection 7n77#i77;,a7 and related descriptive information4 7,c7 ,stakeholder input ,the ,secretary shall accept1 through the date that is #fj days after the day the ,secretary posts the list pursuant to subparagraph 7,b71 suggestions from physician specialty societies1 applicable practitioner organizations1 and other stakeholders for episode groups in addition to those posted pursuant to such subparagraph1 and specific clinical criteria and patient characteristics to classify patients into-- 7i7 distinct care episode groups2 and 7ii7 distinct patient condition groups4 7,d7 ,development of proposed classification codes 7i7 ,in general ,taking into account the information described in subparagraph 7,b7 and the information received under subparagraph 7,c71 the ,secretary shall-- 7,i7 establish distinct care episode groups and distinct patient condition groups1 which account for at least an estimated two-thirds of expenditures under parts ,a and ,b2 and 7,,ii7 assign codes to such groups4 7ii7 ,care episode groups ,in establishing the care episode groups under clause 7i71 the ,secretary shall take into account-- 7,i7 the patient's clinical problems at the time items and services are furnished during an episode of care1 such as the clinical conditions or diagnoses1 whether or not inpatient hospitalization is anticipated or occurs1 and the principal procedures or services planned or furnished2 and 7,,ii7 other factors determined appropriate by the ,secretary4 7iii7 ,patient condition groups ,in establishing the patient condition groups under clause 7i71 the ,secretary shall take into account-- 7,i7 the patient's clinical history at the time of each medical visit1 such as the patient's combination of chronic conditions1 current health status1 and recent significant history 7such as hospitalization and major surgery during a previous period1 such as #c months72 and 7,,ii7 other factors determined appropriate by the ,secretary1 such as eligibility status under this title 7including eligibility under section #bbf7;a71 #bbf7;b71 or #bbf;,a1 and dual eligibility under this title and title ,,xix74 7,e7 ,draft care episode and patient condition groups and classification codes ,not later than #abj days after the end of the comment period described in subparagraph 7,c71 the ,secretary shall post on the ,internet website of the ,centers for ,medicare ,medicaid ,services a draft list of the care episode and patient condition codes established under subparagraph 7,d7 7and the criteria and characteristics assigned to such code74 7,f7 ,solicitation of input ,the ,secretary shall seek1 through the date that is #fj days after the ,secretary posts the list pursuant to subparagraph 7,e71 comments from physician specialty societies1 applicable practitioner organizations1 and other stakeholders1 including representatives of individuals entitled to benefits under part ,a or enrolled under this part1 regarding the care episode and patient condition groups 7and codes7 posted under subparagraph 7,e74 ,in seeking such comments1 the ,secretary shall use one or more mechanisms 7other than notice and comment rulemaking7 that may include use of open door forums1 town hall meetings1 or other appropriate mechanisms4 7,g7 ,operational list of care episode and patient condition groups and codes ,not later than #abj days after the end of the comment period described in subparagraph 7,f71 taking into account the comments received under such subparagraph1 the ,secretary shall post on the ,internet website of the ,centers for ,medicare ,medicaid ,services an operational list of care episode and patient condition codes 7and the criteria and characteristics assigned to such code74 7,h7 ,subsequent revisions ,not later than ,november #a of each year 7beginning with #bjaf71 the ,secretary shall1 through rulemaking1 make revisions to the operational lists of care episode and patient condition codes as the ,secretary determines may be appropriate4 ,such revisions may be based on experience1 new information developed pursuant to subsection 7n77#i77;,a71 and input from the physician specialty societies1 applicable practitioner organizations1 and other stakeholders1 including representatives of individuals entitled to benefits under part ,a or enrolled under this part4 7#c7 ,attribution of patients to physicians or practitioners 7,a7 ,in general ,in order to facilitate the attribution of patients and episodes 7in whole or in part7 to one or more physicians or applicable practitioners furnishing items and services1 the ,secretary shall undertake the steps described in the succeeding provisions of this paragraph4 7,b7 ,development of patient relationship categories and codes ,the ,secretary shall develop patient relationship categories and codes that define and distinguish the relationship and responsibility of a physician or applicable practitioner with a patient at the time of furnishing an item or service4 ,such patient relationship categories shall include different relationships of the physician or applicable practitioner to the patient 7and the codes may reflect combinations of such categories71 such as a physician or applicable practitioner who-- 7i7 considers themself to have the primary responsibility for the general and ongoing care for the patient over extended periods of time2 7ii7 considers themself to be the lead physician or practitioner and who furnishes items and services and coordinates care furnished by other physicians or practitioners for the patient during an acute episode2 7iii7 furnishes items and services to the patient on a continuing basis during an acute episode of care1 but in a supportive rather than a lead role2 7iv7 furnishes items and services to the patient on an occasional basis1 usually at the request of another physician or practitioner2 or 7v7 furnishes items and services only as ordered by another physician or practitioner4 7,c7 ,draft list of patient relationship categories and codes ,not later than #ahj days after the date of the enactment of this subsection1 the ,secretary shall post on the ,internet website of the ,centers for ,medicare ,medicaid ,services a draft list of the patient relationship categories and codes developed under subparagraph 7,b74 7,d7 ,stakeholder ,input ,the ,secretary shall seek1 through the date that is #fj days after the ,secretary posts the list pursuant to subparagraph 7,c71 comments from physician specialty societies1 applicable practitioner organizations1 and other stakeholders1 including representatives of individuals entitled to benefits under part ,a or enrolled under this part1 regarding the patient relationship categories and codes posted under subparagraph 7,c74 ,in seeking such comments1 the ,secretary shall use one or more mechanisms 7other than notice and comment rulemaking7 that may include open door forums1 town hall meetings1 or other appropriate mechanisms4 7,e7 ,operational list of patient relationship categories and codes ,not later than #abj days after the end of the comment period described in subparagraph 7,d71 taking into account the comments received under such subparagraph1 the ,secretary shall post on the ,internet website of the ,centers for ,medicare ,medicaid ,services an operational list of patient relationship categories and codes4 7,f7 ,subsequent revisions ,not later than ,november #a of each year 7beginning with #bjaf71 the ,secretary shall1 through rulemaking1 make revisions to the operational list of patient relationship categories and codes as the ,secretary determines appropriate4 ,such revisions may be based on experience1 new information developed pursuant to subsection 7n77#i77;,a71 and input from the physician specialty societies1 applicable practitioner organizations1 and other stakeholders1 including representatives of individuals entitled to benefits under part ,a or enrolled under this part4 7#d7 ,reporting of information for resource use measurement ,claims submitted for items and services furnished by a physician or applicable practitioner on or after ,january #a1 #bjaf1 shall1 as determined appropriate by the ,secretary1 include-- 7,a7 applicable codes established under paragraphs 7#b7 and 7#c72 and 7,b7 the national provider identifier of the ordering physician or applicable practitioner 7if different from the billing physician or applicable practitioner74 7#e7 ,methodology for resource use analysis 7,a7 ,in general ,in order to evaluate the resources used to treat patients 7with respect to care episode and patient condition groups71 the ,secretary shall-- 7i7 use the patient relationship codes reported on claims pursuant to paragraph 7#d7 to attribute patients 7in whole or in part7 to one or more physicians and applicable practitioners2 7ii7 use the care episode and patient condition codes reported on claims pursuant to paragraph 7#d7 as a basis to compare similar patients and care episodes and patient condition groups2 and 7iii7 conduct an analysis of resource use 7with respect to care episodes and patient condition groups of such patients71 as the ,secretary determines appropriate4 7,b7 ,analysis of patients of physicians and practitioners ,in conducting the analysis described in subparagraph 7,a77iii7 with respect to patients attributed to physicians and applicable practitioners1 the ,secretary shall1 as feasible-- 7i7 use the claims data experience of such patients by patient condition codes during a common period1 such as #ab months2 and 7ii7 use the claims data experience of such patients by care episode codes-- 7,i7 in the case of episodes without a hospitalization1 during periods of time 7such as the number of days7 determined appropriate by the ,secretary2 and 7,,ii7 in the case of episodes with a hospitalization1 during periods of time 7such as the number of days7 before1 during1 and after the hospitalization4 7,c7 ,measurement of resource use ,in measuring such resource use1 the ,secretary-- 7i7 shall use per patient total allowed amounts for all services under part ,a and this part 7and1 if the ,secretary determines appropriate1 part ,d7 for the analysis of patient resource use1 by care episode codes and by patient condition codes2 and 7ii7 may1 as determined appropriate1 use other measures of allowed amounts 7such as subtotals for categories of items and services7 and measures of utilization of items and services 7such as frequency of specific items and services and the ratio of specific items and services among attributed patients or episodes74 7,d7 ,stakeholder ,input ,the ,secretary shall seek comments from the physician specialty societies1 applicable practitioner organizations1 and other stakeholders1 including representatives of individuals entitled to benefits under part ,a or enrolled under this part1 regarding the resource use methodology established pursuant to this paragraph4 ,in seeking comments the ,secretary shall use one or more mechanisms 7other than notice and comment rulemaking7 that may include open door forums1 town hall meetings1 or other appropriate mechanisms4 7#f7 ,limitation ,there shall be no administrative or judicial review under section #ahfi1 section #ahgh1 or otherwise of-- 7,a7 care episode and patient condition groups and codes established under paragraph 7#b72 7,b7 patient relationship categories and codes established under paragraph 7#c72 and 7,c7 measurement of1 and analyses of resource use with respect to1 care episode and patient condition codes and patient relationship codes pursuant to paragraph 7#e74 7#g7 ,administration ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to this section4 7#h7 ,definitions ,in this section3 7,a7 ,physician ,the term physician has the meaning given such term in section #ahfa7r77#a74 7,b7 ,applicable practitioner ,the term applicable practitioner means-- 7i7 a physician assistant1 nurse practitioner1 and clinical nurse specialist 7as such terms are defined in section #ahfa7;aa77#e772 and 7ii7 beginning ,january #a1 #bjag1 such other eligible professionals 7as defined in subsection 7k77#c77;,b77 as specified by the ,secretary4 7#i7 ,clarification ,the provisions of sections #ahij7;b77#g7 and #ahij;,a shall not apply to this subsection4 4 #c4 ,priorities and funding for quality measure development ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d71 as amended by subsections 7c7 and 7h7 of section #b1 is further amended by inserting at the end the following new subsection3 7s7 ,priorities and funding for quality measure development 7#a7 ,plan identifying measure development priorities and timelines 7,a7 ,draft measure development plan 7i7 ,draft plan 7,i7 ,in general ,not later than ,october #a1 #bjad1 the ,secretary shall develop1 and post on the ,internet website of the ,centers for ,medicare ,medicaid ,services1 a draft plan for the development of quality measures for application under the applicable provisions4 7,,ii7 ,requirement ,such plan shall address how measures used by private payers and integrated delivery systems could be incorporated under such subsection4 7ii7 ,consideration ,in developing the draft plan under subparagraph 7,a71 the ,secretary shall consider-- 7,i7 gap analyses conducted by the entity with a contract under section #ahij7;a7 or other contractors or entities2 and 7,,ii7 whether measures are applicable across health care settings4 7iii7 ,priorities ,in developing the draft plan under subparagraph 7,a71 the ,secretary shall give priority to the following types of measures3 7,i7 ,outcome measures including patient reported outcome and functional status measures4 7,,ii7 ,patient experience measures4 7,,iii7 ,care coordination measures4 7,,iv7 ,measures of appropriate use of services1 including measures of over use4 7iv7 ,definition of applicable provisions ,in this subsection1 the term applicable provisions means the following provisions3 7,i7 ,subsection 7q77#b77;,b77i74 7,,ii7 ,section #ahcc7z77#b77;,c74 7,b7 ,stakeholder input ,the ,secretary shall accept through ,december #a1 #bjad1 comments on the draft plan posted under paragraph 7#a77;,a7 from the public1 including health care providers1 payers1 consumers1 and other stakeholders4 7,c7 ,operational measure development plan ,not later than ,february #a1 #bjae1 taking into account the comments received under subparagraph 7,b71 the ,secretary shall post on the ,internet website of the ,centers for ,medicare ,medicaid ,services an operational plan for the development of quality measures for use under subsection 7q77#b77;,a77i74 7#b7 ,contracts and other arrangements for quality measure development 7,a7 ,in general ,the ,secretary shall enter into contracts or other arrangements with entities for the purpose of developing1 improving1 updating1 or expanding quality measures for application under the applicable provisions4 ,such entities may include physician specialty societies and other practitioner organizations4 7,b7 ,prioritization 7i7 ,in general ,in entering into contracts or other arrangements under subparagraph 7,a71 the ,secretary shall give priority to the development of the types of measures described in paragraph 7#a77;,a77iii74 7ii7 ,consideration ,in selecting measures for development under this subsection1 the ,secretary shall consider whether such measures would be electronically specified4 7#c7 ,annual report by the ,secretary 7,a7 ,in general ,not later than ,february #a1 #bjaf1 and annually thereafter1 the ,secretary shall post on the ,internet website of the ,centers for ,medicare ,medicaid ,services a report on the progress made in developing quality measures for application under the applicable provisions4 7,b7 ,requirements ,each report submitted pursuant to paragraph 7#a7 shall include the following3 7i7 ,a description of the ,secretary's efforts to implement this subsection4 7ii7 ,with respect to the measures developed during the previous year-- 7,i7 a description of the total number of quality measures developed and the types of such measures1 such as an outcome or patient experience measure2 7,,ii7 the name of each measure developed2 7,,iii7 the name of the developer and steward of each measure2 7,,iv7 with respect to each type of measure1 an estimate of the total amount expended under this title to develop all measures of such type2 and 7,v7 whether the measure would be electronically specified4 7iii7 ,with respect to measures in development at the time of the report-- 7,i7 the information described in clause 7ii71 if available2 and 7,,ii7 a timeline for completion of the development of such measures4 7iv7 ,an update on the progress in developing the types of measures described in paragraph 7#a77;,a77iii71 including a description of issues affecting such progress4 7v7 ,a list of quality topics and concepts that are being considered for development of measures and the rationale for the selection of topics and concepts including their relationship to gap analyses4 7vi7 ,a description of any updates to the plan under paragraph 7#a7 7including newly identified gaps and the status of previously identified gaps7 and the inventory of measures applicable under the applicable provisions4 7vii7 ,other information the ,secretary determines to be appropriate4 7#d7 ,stakeholder input ,with respect to measures applicable under the applicable provisions1 the ,secretary shall seek stakeholder input with respect to-- 7,a7 the identification of gaps where no quality measures exist1 particularly with respect to the types of measures described in paragraph 7#a77;,a77iii72 7,b7 prioritizing quality measure development to address such gaps2 and 7,c7 other areas related to quality measure development determined appropriate by the ,secretary4 7#e7 ,funding ,for purposes of carrying out this subsection1 the ,secretary shall provide for the transfer1 from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 of #ae1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account for each of fiscal years #bjad through #bjah4 ,amounts transferred under this paragraph shall remain available through the end of fiscal year #bjba4 4 #d4 ,encouraging care management for individuals with chronic care needs ,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 management for individuals with chronic care needs 7,a7 ,in general ,in order to encourage the management of care by an applicable provider 7as defined in subparagraph 7,b77 for individuals with chronic care needs the ,secretary shall-- 7i7 establish one or more ,,hcpcs codes for chronic care management services for such individuals2 and 7ii7 subject to subparagraph 7,d71 make payment 7as the ,secretary determines to be appropriate7 under this section for such management services furnished on or after ,january #a1 #bjae1 by an applicable provider4 7,b7 ,applicable provider defined ,for purposes of this paragraph1 the term applicable provider means a physician 7as defined in section #ahfa7r77#a771 physician assistant or nurse practitioner 7as defined in section #ahfa7;aa77#e77;,a771 or clinical nurse specialist 7as defined in section #ahfa7;aa77#e77;,b77 who furnishes services as part of a patient-centered medical home or a comparable specialty practice that-- 7i7 is recognized as such a medical home or comparable specialty practice by an organization that is recognized by the ,secretary for purposes of such recognition as such a medical home or practice2 or 7ii7 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 ,policies relating to payment ,in carrying out this paragraph1 with respect to chronic care management services1 the ,secretary shall-- 7i7 make payment to only one applicable provider for such services furnished to an individual during a period2 7ii7 not make payment under subparagraph 7,a7 if such payment would be duplicative of payment that is otherwise made under this title for such services 7such as in the case of hospice care or home health services72 and 7iii7 not require that an annual wellness visit 7as defined in section #ahfa7;hhh77 or an initial preventive physical examination 7as defined in section #ahfa7ww77 be furnished as a condition of payment for such management services4 4 #e4 ,ensuring accurate valuation of services under the physician fee schedule 7a7 ,authority ,to collect and use information on physicians' services in the determination of relative values 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 ,authority to collect and use information on physicians' services in the determination of relative values 7i7 ,collection of information ,notwithstanding any other provision of law1 the ,secretary may collect or obtain information on the resources directly or indirectly related to furnishing services for which payment is made under the fee schedule established under subsection 7b74 ,such information may be collected or obtained from any eligible professional or any other source4 7ii7 ,use of information ,notwithstanding any other provision of law1 subject to clause 7v71 the ,secretary may 7as the ,secretary determines appropriate7 use information collected or obtained pursuant to clause 7i7 in the determination of relative values for services under this section4 7iii7 ,types of information ,the types of information described in clauses 7i7 and 7ii7 may1 at the ,secretary's discretion1 include any or all of the following3 7,i7 ,time involved in furnishing services4 7,,ii7 ,amounts and types of practice expense inputs involved with furnishing services4 7,,iii7 ,prices 7net of any discounts7 for practice expense inputs1 which may include paid invoice prices or other documentation or records4 7,,iv7 ,overhead and accounting information for practices of physicians and other suppliers4 7,v7 ,any other element that would improve the valuation of services under this section4 7iv7 ,information collection mechanisms ,information may be collected or obtained pursuant to this subparagraph from any or all of the following3 7,i7 ,surveys of physicians1 other suppliers1 providers of services1 manufacturers1 and vendors4 7,,ii7 ,surgical logs1 billing systems1 or other practice or facility records4 7,,iii7 ,electronic health records4 7,,iv7 ,any other mechanism determined appropriate by the ,secretary4 7v7 ,transparency of use of information 7,i7 ,in general ,subject to subclauses 7,,ii7 and 7,,iii71 if the ,secretary uses information collected or obtained under this subparagraph in the determination of relative values under this subsection1 the ,secretary shall disclose the information source and discuss the use of such information in such determination of relative values through notice and comment rulemaking4 7,,ii7 ,thresholds for use ,the ,secretary may establish thresholds in order to use such information1 including the exclusion of information collected or obtained from eligible professionals who use very high resources 7as determined by the ,secretary7 in furnishing a service4 7,,iii7 ,disclosure of information ,the ,secretary shall make aggregate information available under this subparagraph but shall not disclose information in a form or manner that identifies an eligible professional or a group practice1 or information collected or obtained pursuant to a nondisclosure agreement4 7vi7 ,incentive to participate ,the ,secretary may provide for such payments under this part to an eligible professional that submits such solicited information under this subparagraph as the ,secretary determines appropriate in order to compensate such eligible professional for such submission4 ,such payments shall be provided in a form and manner specified by the ,secretary4 7vii7 ,administration ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to information collected or obtained under this subparagraph4 7viii7 ,definition of eligible professional ,in this subparagraph1 the term eligible professional has the meaning given such term in subsection 7k77#c77;,b74 7ix7 ,funding ,for purposes of carrying out this subparagraph1 in addition to funds otherwise appropriated1 the ,secretary shall provide for the transfer1 from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 of #b1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account for each fiscal year beginning with fiscal year #bjad4 ,amounts transferred under the preceding sentence for a fiscal year shall be available until expended4 4 7#b7 ,limitation on review ,section #ahdh7;i77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;i77#a77 is amended-- 7,a7 in subparagraph 7,d71 by striking and at the end2 7,b7 in subparagraph 7,e71 by striking the period at the end and inserting 1 and2 and 7,c7 by adding at the end the following new subparagraph3 7,f7 the collection and use of information in the determination of relative values under subsection 7c77#b77,m74 4 7b7 ,authority for alternative approaches ,to establishing practice expense relative values ,section #ahdh7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b771 as amended by subsection 7a71 is amended by adding at the end the following new subparagraph3 7,n7 ,authority for alternative approaches to establishing practice expense relative values ,the ,secretary may establish or adjust practice expense relative values under this subsection using cost1 charge1 or other data from suppliers or providers of services1 including information collected or obtained under subparagraph 7,m74 4 7c7 ,revised and expanded identification of potentially misvalued codes ,section #ahdh7;c77#b77,k77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77,k77ii77 is amended to read as follows3 7ii7 ,identification of potentially misvalued codes ,for purposes of identifying potentially misvalued codes pursuant to clause 7i77,i71 the ,secretary shall examine codes 7and families of codes as appropriate7 based on any or all of the following criteria3 7,i7 ,codes that have experienced the fastest growth4 7,,ii7 ,codes that have experienced substantial changes in practice expenses4 7,,iii7 ,codes that describe new technologies or services within an appropriate time period 7such as #c years7 after the relative values are initially established for such codes4 7,,iv7 ,codes which are multiple codes that are frequently billed in conjunction with furnishing a single service4 7,v7 ,codes with low relative values1 particularly those that are often billed multiple times for a single treatment4 7,,vi7 ,codes that have not been subject to review since implementation of the fee schedule4 7,,vii7 ,codes that account for the majority of spending under the physician fee schedule4 7,,viii7 ,codes for services that have experienced a substantial change in the hospital length of stay or procedure time4 7,,ix7 ,codes for which there may be a change in the typical site of service since the code was last valued4 7,x7 ,codes for which there is a significant difference in payment for the same service between different sites of service4 7,,xi7 ,codes for which there may be anomalies in relative values within a family of codes4 7,,xii7 ,codes for services where there may be efficiencies when a service is furnished at the same time as other services4 7,,xiii7 ,codes with high intra-service work per unit of time4 7,,xiv7 ,codes with high practice expense relative value units4 7,,xv7 ,codes with high cost supplies4 7,,xvi7 ,codes as determined appropriate by the ,secretary4 4 7d7 ,target for relative value adjustments for misvalued services 7#a7 ,in general ,section #ahdh7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b771 as amended by subsections 7a7 and 7b71 is amended by adding at the end the following new subparagraph3 7,o7 ,target for relative value adjustments for misvalued services ,with respect to fee schedules established for each of #bjae through #bjah1 the following shall apply3 7i7 ,determination of net reduction in expenditures ,for each year1 the ,secretary shall determine the estimated net reduction in expenditures under the fee schedule under this section with respect to the year as a result of adjustments to the relative values established under this paragraph for misvalued codes4 7ii7 ,budget neutral redistribution of funds if target met and counting overages towards the target for the succeeding year ,if the estimated net reduction in expenditures determined under clause 7i7 for the year is equal to or greater than the target for the year-- 7,i7 reduced expenditures attributable to such adjustments shall be redistributed for the year in a budget neutral manner in accordance with subparagraph 7,b77ii77,,ii72 and 7,,ii7 the amount by which such reduced expenditures exceeds the target for the year shall be treated as a reduction in expenditures described in clause 7i7 for the succeeding year1 for purposes of determining whether the target has or has not been met under this subparagraph with respect to that year4 7iii7 ,exemption from budget neutrality if target not met ,if the estimated net reduction in expenditures determined under clause 7i7 for the year is less than the target for the year1 reduced expenditures in an amount equal to the target recapture amount shall not be taken into account in applying subparagraph 7,b77ii77,,ii7 with respect to fee schedules beginning with #bjae4 7iv7 ,target recapture amount ,for purposes of clause 7iii71 the target recapture amount is1 with respect to a year1 an amount equal to the difference between-- 7,i7 the target for the year2 and 7,,ii7 the estimated net reduction in expenditures determined under clause 7i7 for the year4 7v7 ,target ,for purposes of this subparagraph1 with respect to a year1 the target is calculated as #j4e percent of the estimated amount of expenditures under the fee schedule under this section for the year4 4 7#b7 ,conforming amendment ,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 services if target not met ,effective for fee schedules beginning with #bjae1 reduced expenditures attributable to the application of the target recapture amount described in subparagraph 7,o77iii74 4 7e7 ,phase-in of significant relative value unit 7,,rvu7 reductions 7#a7 ,in general ,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#g7 ,phase-in of significant relative value unit 7,,rvu7 reductions ,effective for fee schedules established beginning with #bjae1 if the total relative value units for a service for a year would otherwise be decreased by an estimated amount equal to or greater than #bj percent as compared to the total relative value units for the previous year1 the applicable adjustments in work1 practice expense1 and malpractice relative value units shall be phased-in over a #b-year period4 4 7#b7 ,conforming amendments ,section #ahdh7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77 is amended-- 7,a7 in subparagraph 7,b77ii77,i71 by striking subclause 7,,ii7 and inserting subclause 7,,ii7 and paragraph 7#g72 and 7,b7 in subparagraph 7,k77iii77,,vi7-- 7i7 by striking provisions of subparagraph 7,b77ii77,,ii7 and inserting provisions of subparagraph 7,b77ii77,,ii7 and paragraph 7#g72 and 7ii7 by striking under subparagraph 7,b77ii77,,ii7 and inserting under subparagraph 7,b77ii77,i74 7f7 ,authority ,to smooth relative values within groups of services ,section #ahdh7;c77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,c77 is amended-- 7#a7 in each of clauses 7i7 and 7iii71 by striking the service and inserting the service or group of services each place it appears2 and 7#b7 in the first sentence of clause 7ii71 by inserting or group of services before the period4 7g7 ,,gao study and report on ,relative ,value ,scale ,update ,committee 7#a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this subsection referred to as the ,comptroller ,general7 shall conduct a study of the processes used by the ,relative ,value ,scale ,update ,committee 7,,ruc7 to provide recommendations to the ,secretary of ,health and ,human ,services regarding relative values for specific services under the ,medicare physician fee schedule under section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d74 7#b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a74 7h7 ,adjustment to ,medicare payment localities 7#a7 ,in general ,section #ahdh7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;e77 is amended by adding at the end the following new paragraph3 7#f7 ,use of ,m,s,as as fee schedule areas in ,california 7,a7 ,in general ,subject to the succeeding provisions of this paragraph and notwithstanding the previous provisions of this subsection1 for services furnished on or after ,january #a1 #bjag1 the fee schedule areas used for payment under this section applicable to ,california shall be the following3 7i7 ,each ,metropolitan ,statistical ,area 7each in this paragraph referred to as an ,,msa71 as defined by the ,director of the ,office of ,management and ,budget as of ,december #ca of the previous year1 shall be a fee schedule area4 7ii7 ,all areas not included in an ,,msa shall be treated as a single rest-of-,state fee schedule area4 7,b7 ,transition for ,m,s,as previously in rest-of-,state payment locality or in locality #c 7i7 ,in general ,for services furnished in ,california during a year beginning with #bjag and ending with #bjba in an ,,msa in a transition area 7as defined in subparagraph 7,d771 subject to subparagraph 7,c71 the geographic index values to be applied under this subsection for such year shall be equal to the sum of the following3 7,i7 ,current law component ,the old weighting factor 7described in clause 7ii77 for such year multiplied by the geographic index values under this subsection for the fee schedule area that included such ,,msa that would have applied in such area 7as estimated by the ,secretary7 if this paragraph did not apply4 7,,ii7 ,,msa-based component ,the ,,msa-based weighting factor 7described in clause 7iii77 for such year multiplied by the geographic index values computed for the fee schedule area under subparagraph 7,a7 for the year 7determined without regard to this subparagraph74 7ii7 ,old weighting factor ,the old weighting factor described in this clause-- 7,i7 for #bjag1 is #e_/f2 and 7,,ii7 for each succeeding year1 is the old weighting factor described in this clause for the previous year minus #a_/f4 7iii7 ,,msa-based weighting factor ,the ,,msa-based weighting factor described in this clause for a year is #a minus the old weighting factor under clause 7ii7 for that year4 7,c7 ,hold harmless ,for services furnished in a transition area in ,california during a year beginning with #bjag1 the geographic index values to be applied under this subsection for such year shall not be less than the corresponding geographic index values that would have applied in such transition area 7as estimated by the ,secretary7 if this paragraph did not apply4 7,d7 ,transition area defined ,in this paragraph1 the term transition area means each of the following fee schedule areas for #bjac3 7i7 ,the rest-of-,state payment locality4 7ii7 ,payment locality #c4 7,e7 ,references to fee schedule areas ,effective for services furnished on or after ,january #a1 #bjag1 for ,california1 any reference in this section to a fee schedule area shall be deemed a reference to a fee schedule area established in accordance with this paragraph4 4 7#b7 ,conforming amendment to definition of fee schedule area ,section #ahdh7;j77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#b77 is amended by striking ,the term and inserting ,except as provided in subsection 7e77#f77;,d71 the term4 #f4 ,promoting evidence-based care 7a7 ,recognizing appropriate use criteria for certain imaging services 7#a7 ,in general ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7p7 ,recognizing appropriate use criteria for certain imaging services 7#a7 ,program established 7,a7 ,in general ,the ,secretary shall establish a program to promote the use of appropriate use criteria 7as defined in subparagraph 7,b77 for applicable imaging services 7as defined in subparagraph 7,c77 furnished in an applicable setting 7as defined in subparagraph 7,d77 by ordering professionals and furnishing professionals 7as defined in subparagraphs 7,e7 and 7,f71 respectively74 7,b7 ,appropriate use criteria defined ,in this subsection1 the term appropriate use criteria means criteria to assist ordering professionals and furnishing professionals in making the most appropriate treatment decision for a specific clinical condition4 ,to the extent feasible1 such criteria shall be evidence-based4 7,c7 ,applicable imaging service defined ,in this subsection1 the term applicable imaging service means an advanced diagnostic imaging service 7as defined in subsection 7e77#a77;,b77 for which the ,secretary determines-- 7i7 one or more applicable appropriate use criteria specified under paragraph 7#b7 apply2 7ii7 there are one or more qualified clinical decision support mechanisms listed under paragraph 7#c77;,c72 and 7iii7 one or more of such mechanisms is available free of charge4 7,d7 ,applicable setting defined ,in this subsection1 the term applicable setting means a physician's office1 a hospital outpatient department 7including an emergency department71 an ambulatory surgical center1 and any other outpatient setting determined appropriate by the ,secretary4 7,e7 ,ordering professional defined ,in this subsection1 the term ordering professional means a physician 7as defined in section #ahfa7r77 or a practitioner described in section #ahdb7;b77#ah77;,c7 who orders an applicable imaging service for an individual4 7,f7 ,furnishing professional defined ,in this subsection1 the term furnishing professional means a physician 7as defined in section #ahfa7r77 or a practitioner described in section #ahdb7;b77#ah77;,c7 who furnishes an applicable imaging service for an individual4 7#b7 ,establishment of applicable appropriate use criteria 7,a7 ,in general ,not later than ,november #ae1 #bjae1 the ,secretary shall through rulemaking1 and in consultation with physicians1 practitioners1 and other stakeholders1 specify applicable appropriate use criteria for applicable imaging services from among appropriate use criteria developed or endorsed by national professional medical specialty societies or other entities4 7,b7 ,considerations ,in specifying applicable appropriate use criteria under subparagraph 7,a71 the ,secretary shall take into account whether the criteria-- 7i7 have stakeholder consensus2 7ii7 have been determined to be scientifically valid and are evidence based2 and 7iii7 are in the public domain4 7,c7 ,revisions ,the ,secretary shall periodically update and revise 7as appropriate7 such specification of applicable appropriate use criteria4 7,d7 ,treatment of multiple applicable appropriate use criteria ,in the case where the ,secretary determines that more than one appropriate use criteria applies with respect to an applicable imaging service1 the ,secretary shall specify one or more applicable appropriate use criteria under this paragraph for the service4 7#c7 ,mechanisms for consultation with applicable appropriate use criteria 7,a7 ,identification of mechanisms to consult with applicable appropriate use criteria 7i7 ,in general ,the ,secretary shall specify one or more qualified clinical decision support mechanisms that could be used by ordering professionals to consult with applicable appropriate use criteria for applicable imaging services4 7ii7 ,consultation ,the ,secretary shall consult with physicians1 practitioners1 and other stakeholders in specifying mechanisms under this paragraph4 7iii7 ,inclusion of certain mechanisms ,mechanisms specified under this paragraph may include any or all of the following that meet the requirements described in subparagraph 7,b77ii73 7,i7 ,use of clinical decision support modules in certified ,,ehr technology 7as defined in section #ahdh7o77#d774 7,,ii7 ,use of private sector clinical decision support mechanisms that are independent from certified ,,ehr technology1 which may include use of clinical decision support mechanisms available from medical specialty organizations4 7,,iii7 ,use of a clinical decision support mechanism established by the ,secretary4 7,b7 ,qualified clinical decision support mechanisms 7i7 ,in general ,for purposes of this subsection1 a qualified clinical decision support mechanism is a mechanism that the ,secretary determines meets the requirements described in clause 7ii74 7ii7 ,requirements ,the requirements described in this clause are the following3 7,i7 ,the mechanism makes available to the ordering professional applicable appropriate use criteria specified under paragraph 7#b7 and the supporting documentation for the applicable imaging service ordered4 7,,ii7 ,in the case where there are more than one applicable appropriate use criteria specified under such paragraph for an applicable imaging service1 the mechanism indicates the criteria that it uses for the service4 7,,iii7 ,the mechanism determines the extent to which an applicable imaging service ordered is consistent with the applicable appropriate use criteria so specified4 7,,iv7 ,the mechanism generates and provides to the ordering professional a certification or documentation that documents that the qualified clinical decision support mechanism was consulted by the ordering professional4 7,v7 ,the mechanism is updated on a timely basis to reflect revisions to the specification of applicable appropriate use criteria under such paragraph4 7,,vi7 ,the mechanism meets privacy and security standards under applicable provisions of law4 7,,vii7 ,the mechanism performs such other functions as specified by the ,secretary1 which may include a requirement to provide aggregate feedback to the ordering professional4 7,c7 ,list of mechanisms for consultation with applicable appropriate use criteria 7i7 ,initial list ,not later than ,april #a1 #bjaf1 the ,secretary shall publish a list of mechanisms specified under this paragraph4 7ii7 ,periodic updating of list ,the ,secretary shall periodically update the list of qualified clinical decision support mechanisms specified under this paragraph4 7#d7 ,consultation with applicable appropriate use criteria 7,a7 ,consultation by ordering professional ,beginning with ,january #a1 #bjag1 subject to subparagraph 7,c71 with respect to an applicable imaging service ordered by an ordering professional that would be furnished in an applicable setting and paid for under an applicable payment system 7as defined in subparagraph 7,d771 an ordering professional shall-- 7i7 consult with a qualified decision support mechanism listed under paragraph 7#c77;,c72 and 7ii7 provide to the furnishing professional the information described in clauses 7i7 through 7iii7 of subparagraph 7,b74 7,b7 ,reporting by furnishing professional ,beginning with ,january #a1 #bjag1 subject to subparagraph 7,c71 with respect to an applicable imaging service furnished in an applicable setting and paid for under an applicable payment system 7as defined in subparagraph 7,d771 payment for such service may only be made if the claim for the service includes the following3 7i7 ,information about which qualified clinical decision support mechanism was consulted by the ordering professional for the service4 7ii7 ,information regarding-- 7,i7 whether the service ordered would adhere to the applicable appropriate use criteria specified under paragraph 7#b72 7,,ii7 whether the service ordered would not adhere to such criteria2 or 7,,iii7 whether such criteria was not applicable to the service ordered4 7iii7 ,the national provider identifier of the ordering professional 7if different from the furnishing professional74 7,c7 ,exceptions ,the provisions of subparagraphs 7,a7 and 7,b7 and paragraph 7#f77;,a7 shall not apply to the following3 7i7 ,emergency services ,an applicable imaging service ordered for an individual with an emergency medical condition 7as defined in section #ahfg7;e77#a774 7ii7 ,inpatient services ,an applicable imaging service ordered for an inpatient and for which payment is made under part ,a4 7iii7 ,alternative payment models ,an applicable imaging service ordered by an ordering professional with respect to an individual attributed to an alternative payment model 7as defined in section #ahcc7z77#c77;,c774 7iv7 ,significant hardship ,an applicable imaging service ordered by an ordering professional who the ,secretary may1 on a case-by-case basis1 exempt from the application of such provisions if the ,secretary determines1 subject to annual renewal1 that consultation with applicable appropriate use criteria would result in a significant hardship1 such as in the case of a professional who practices in a rural area without sufficient ,internet access4 7,d7 ,applicable payment system defined ,in this subsection1 the term applicable payment system means the following3 7i7 ,the physician fee schedule established under section #ahdh7;b74 7ii7 ,the prospective payment system for hospital outpatient department services under section #ahcc7t74 7iii7 ,the ambulatory surgical center payment systems under section #ahcc7;i74 7#e7 ,identification of outlier ordering professionals 7,a7 ,in general ,with respect to applicable imaging services furnished beginning with #bjag1 the ,secretary shall determine1 on a periodic basis 7which may be annually71 ordering professionals who are outlier ordering professionals4 7,b7 ,outlier ordering professionals ,the determination of an outlier ordering professional shall-- 7i7 be based on low adherence to applicable appropriate use criteria specified under paragraph 7#b71 which may be based on comparison to other ordering professionals2 and 7ii7 include data for ordering professionals for whom prior authorization under paragraph 7#f77;,a7 applies4 7,c7 ,use of two years of data ,the ,secretary shall use two years of data to identify outlier ordering professionals under this paragraph4 7,d7 ,consultation with stakeholders ,the ,secretary shall consult with physicians1 practitioners and other stakeholders in developing methods to identify outlier ordering professionals under this paragraph4 7#f7 ,prior authorization for ordering professionals who are outliers 7,a7 ,in general ,beginning ,january #a1 #bjbj1 subject to paragraph 7#d77;,c71 with respect to services furnished during a year1 the ,secretary shall1 for a period determined appropriate by the ,secretary1 apply prior authorization for applicable imaging services that are ordered by an outlier ordering professional identified under paragraph 7#e74 7,b7 ,funding ,for purposes of carrying out this paragraph1 the ,secretary shall provide for the transfer1 from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 of #e1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account for each of fiscal years #bjai through #bjba4 ,amounts transferred under the preceding sentence shall remain available until expended4 4 7#b7 ,conforming amendment ,section #ahcc7t77#af7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#af77 is amended by adding at the end the following new subparagraph3 7,e7 ,application of appropriate use criteria for certain imaging services ,for provisions relating to the application of appropriate use criteria for certain imaging services1 see section #ahcd7p74 4 7b7 ,establishment of appropriate use program for other part ,b services ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem71 as amended by subsection 7a71 is amended by adding at the end the following new subsection3 7q7 ,establishment of appropriate use program for other part b services 7#a7 ,establishment 7,a7 ,in general ,the ,secretary may establish an appropriate use program for services under this part 7other than applicable imaging services under subsection 7p77 using a process similar to the process under such subsection4 7,b7 ,requirements ,in determining whether to establish a program under subparagraph 7,a71 the ,secretary shall take into consideration-- 7i7 the implementation of appropriate use criteria for applicable imaging services under subsection 7p72 and 7ii7 the report under paragraph 7#b74 7,c7 ,input from stakeholders in advance of rulemaking ,before issuing a notice of proposed rulemaking to establish a program under subparagraph 7,a71 the ,secretary shall issue an advance notice of proposed rulemaking4 7#b7 ,report on experience of imaging appropriate use criteria program ,not later than #ah months after the date of the enactment of this subsection1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report that includes a description of the extent to which appropriate use criteria could be used for other services under this part1 such as radiation therapy and clinical diagnostic laboratory services4 4 #g4 ,empowering beneficiary choices through access to information on physicians' services 7a7 ,transferring freestanding physician compare provision to the ,social ,security ,act 7#a7 ,in general ,section #ajcca of ,public ,law #aaa-adh is transferred and redesignated as subsection 7t7 of section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d71 as amended by subsections 7c7 and 7h7 of section #b and by section #c4 7#b7 ,conforming redesignations ,section #ahdh7t7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7t771 as transferred and redesignated by paragraph 7#a71 is further amended-- 7,a7 by striking the subsection heading and inserting the following new subsection heading3 ,public reporting of performance and other information on ,physician ,compare4--2 7,b7 by redesignating subsections 7a7 through 7i7 as paragraphs 7#a7 through 7#i71 respectively1 and indenting appropriately2 7,c7 in paragraph 7#a71 as redesignated by subparagraph 7,b7-- 7i7 by redesignating paragraphs 7#a7 and 7#b7 as subparagraphs 7,a7 and 7,b71 respectively1 and indenting appropriately2 7ii7 in subparagraph 7,b71 as redesignated by clause 7i71 by redesignating subparagraphs 7,a7 through 7,g7 as clauses 7i7 through 7vii71 respectively1 and indenting appropriately2 7,d7 in paragraph 7#b71 as redesignated by subparagraph 7,b71 by redesignating paragraphs 7#a7 through 7#g7 as subparagraphs 7,a7 through 7,g71 respectively1 and indenting appropriately2 and 7,e7 in paragraph 7#i71 as redesignated by subparagraph 7,b71 by redesignating paragraphs 7#a7 through 7#d7 as subparagraphs 7,a7 through 7,d71 respectively1 and indenting appropriately4 7#c7 ,conforming amendments ,section #ahdh7t7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7t771 as amended by paragraph 7#b71 is further amended-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,a7-- 7,i7 by striking the ,medicare program under section #ahff7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7j77 and inserting the program under this title under section #ahff7;j72 and 7,,ii7 by striking of such ,act 7#db ,u4,s4,c4 #aciew-#d72 and 7ii7 in subparagraph 7,b71 in the matter preceding clause 7i7-- 7,i7 by striking subsection 7c7 and inserting paragraph 7#c72 7,,ii7 by striking the ,medicare program under such section #ahff7;j7 and inserting the program under this title under section #ahff7;j72 and 7,,iii7 by striking this section and inserting this subsection2 7,b7 in paragraph 7#b7-- 7i7 in the matter preceding subparagraph 7,a71 by striking subsection 7a77#b7 and inserting paragraph 7#a77;,b72 7ii7 in subparagraph 7,d71 by striking the ,medicare program and inserting the program under this title2 and 7iii7 in each of subparagraphs 7,f7 and 7,g71 by striking this section and inserting this subsection2 7,c7 in paragraph 7#c71 by striking this section and inserting this subsection2 7,d7 in paragraph 7#d7-- 7i7 by striking of the ,social ,security ,act1 as added by section #cjad of this ,act2 and 7ii7 by striking this section and inserting this subsection2 7,e7 in paragraph 7#e7-- 7i7 by striking this subsection 7a77#b7 and inserting paragraph 7#a77;,b72 and 7ii7 by striking 7,public ,law #aaj-bge72 7,f7 in paragraph 7#f71 by striking subsection 7a77#a7 and inserting paragraph 7#a77;,a72 7,g7 in paragraph 7#g7-- 7i7 by striking subsection 7f7 and inserting paragraph 7#f72 and 7ii7 by striking title ,,xviii of the ,social ,security ,act and inserting this title2 7,h7 in paragraph 7#h7-- 7i7 by striking subparagraphs 7,a7 through 7,g7 of subsection 7a77#b7 and inserting clauses 7i7 through 7vii7 of paragraph 7#a77;,b72 7ii7 by striking title ,,xviii of the ,social ,security ,act and inserting this title2 and 7iii7 by striking such title and inserting this title2 and 7,i7 in paragraph 7#i7-- 7i7 in the matter preceding subparagraph 7,a71 by striking this section and inserting this subsection2 7ii7 in subparagraph 7,a71 by striking of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d72 7iii7 in subparagraph 7,b71 by striking of such ,act 7#db ,u4,s4,c4 #aciex7r772 7iv7 in subparagraph 7,c71 by striking subsection 7a77#a7 and inserting paragraph 7#a77;,a72 and 7v7 by striking subparagraph 7,d74 7b7 ,public availability of ,medicare data ,section #ahdh7t7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7t771 as amended by subsection 7a71 is further amended-- 7#a7 by redesignating paragraph 7#i7 as paragraph 7#aj72 7#b7 by inserting after paragraph 7#h7 the following new paragraph3 7#i7 ,public availability of eligible professional claims data 7,a7 ,in general ,the ,secretary shall make publicly available on ,physician ,compare the information described in subparagraph 7,b7 with respect to eligible professionals4 7,b7 ,information described ,the following information1 with respect to an eligible professional1 is described in this subparagraph3 7i7 ,information on the number of services furnished by the eligible professional1 which may include information on the most frequent services furnished or groupings of services4 7ii7 ,information on submitted charges and payments for services under this part4 7iii7 ,a unique identifier for the eligible professional that is available to the public1 such as a national provider identifier4 7,c7 ,searchability ,the information made available under this paragraph shall be searchable by at least the following3 7i7 ,the specialty or type of the eligible professional4 7ii7 ,characteristics of the services furnished1 such as volume or groupings of services4 7iii7 ,the location of the eligible professional4 7,d7 ,disclosure ,the information made available under this paragraph shall indicate1 where appropriate1 that publicized information may not be representative of the eligible professional's entire patient population1 the variety of services furnished by the eligible professional1 or the health conditions of individuals treated4 7,e7 ,implementation 7i7 ,initial implementation ,physician ,compare shall include the information described in subparagraph 7,b7-- 7,i7 with respect to physicians1 by not later than ,july #a1 #bjae2 and 7,,ii7 with respect to other eligible professionals1 by not later than ,july #a1 #bjaf4 7ii7 ,annual updating ,the information made available under this paragraph shall be updated on ,physician ,compare not less frequently than on an annual basis4 7,f7 ,opportunity to review and submit corrections ,the ,secretary shall provide for an opportunity for an eligible professional to review1 and submit corrections for1 the information to be made public with respect to the eligible professional under this paragraph prior to such information being made public4 2 and 7#c7 in paragraph 7#aj77;,c71 as redesignated by paragraph 7#a71 by inserting 7or a successor website7 before the period at the end4 #h4 ,expanding claims data availability to improve care 7a7 ,expansion of uses of claims data by qualified entities ,section #ahgd7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7e77 is amended by adding at the end the following new paragraph3 7#e7 ,expansion of uses of claims data by qualified entities 7,a7 ,expansion ,to the extent consistent with applicable information1 privacy1 security1 and disclosure laws1 beginning ,july #a1 #bjad1 notwithstanding paragraph 7#d77;,b7 7other than clause 7iii7 of such paragraph7 and the second sentence of paragraph 7#d77;,d71 a qualified entity may1 as determined appropriate by the ,secretary1 do any or all of the following3 7i7 7,i7 ,use the combined data described in paragraph 7#d77;,b77iii7 to conduct analyses1 other than for reports described in paragraph 7#d71 for entities described in subparagraph 7,b7 for non-public uses1 as determined appropriate by the ,secretary1 such as for the purposes described in subclause 7,,ii74 7,,ii7 ,the purposes described in this subclause are assisting providers of services and suppliers in developing and participating in quality and patient care improvement activities 7including developing new models of care71 population health management1 and disease monitoring1 and the purposes described in subparagraph 7,c74 7ii7 ,provide or sell such analyses to entities described in subparagraph 7,b74 7iii7 ,provide entities described in clauses 7i71 7ii71 7v71 and 7vi7 of subparagraph 7,b7 with access to the combined data described in paragraph 7#d77;,b77iii7 through a qualified data enclave 7as defined in subparagraph 7,f77 that is maintained by the qualified entity in order for entities described in such clauses to conduct analyses for non-public uses1 such as for the purposes described in clause 7i77,,ii74 7,b7 ,entities described ,for the purpose of subparagraph 7,a7 clauses 7i7 and 7ii71 the entities described in this subparagraph are the following3 7i7 ,a provider of services4 7ii7 ,a supplier4 7iii7 ,subject to subparagraph 7,c71 an employer 7as defined in section #c7e7 of the ,employee ,retirement ,insurance ,security ,act of #aigd74 7iv7 ,a health insurance issuer 7as defined in section #bgia of the ,public ,health ,service ,act7 that provides data under paragraph 7#d77;,b77iii74 7v7 ,a medical society or hospital association4 7vi7 ,other entities approved by the ,secretary 7other than an employer 7as so defined7 and a health insurance issuer 7as so defined774 7,c7 ,limitation with respect to employers ,any analyses provided or sold under this paragraph to an employer 7as so defined7 may only be used by such employer for purposes of providing health insurance to employees and retirees of the employer4 7,d7 ,protection of patient identification 7i7 ,in general ,except as provided in clause 7ii71 an analysis provided or sold under this paragraph shall not contain information that individually identifies a patient4 7ii7 ,information on patients of the provider of services or supplier ,an analysis that is provided or sold under this paragraph to a provider of services or supplier may contain data that individually identifies a patient of such provider or supplier but only with respect to items and services furnished by such provider or supplier to such patient4 7iii7 ,opportunity for providers of services and suppliers to review ,prior to a qualified entity providing or selling an analysis under this paragraph to an entity described in subparagraph 7,b71 to the extent that such analysis would individually identify a provider of services or supplier who is not being provided or sold such analysis1 such qualified entity shall provide an opportunity for such provider or supplier to review and submit corrections to such analysis4 7,e7 ,no redisclosure ,an entity described in subparagraph 7,b7 that is provided or sold an analysis under this paragraph shall not redisclose or make public such an analysis4 7,f7 ,requirements for a qualified data enclave 7i7 ,definition ,for purposes of this paragraph1 the term qualified data enclave means a data enclave that the ,secretary determines meets the following3 7,i7 ,the data enclave is a web-based portal or comparable mechanism4 7,,ii7 ,subject to the requirements described in clause 7ii7 and such other requirements as the ,secretary may specify1 the data enclave is capable of providing access to the combined data described in subparagraph 7,a77iii74 7ii7 ,enclave access requirements ,the requirements described in this clause are the following3 7,i7 ,a qualified data enclave shall preclude any entity that obtains access to the data from removing or extracting the data from such enclave4 7,,ii7 ,subject to the succeeding sentence1 the enclave shall preclude access to data that individually identifies a patient1 including data on the patient's name and date of birth and such other data as the ,secretary shall specify4 ,such data enclave may provide providers of services and suppliers with access to such individually identifiable patient data but only with respect to items and services furnished by such provider or supplier to such patient4 7,,iii7 ,access to data in the enclave shall not be provided to any entity unless the qualified entity and the entity have entered into a data use agreement1 the terms of which contain the requirements of this paragraph and such other terms the ,secretary may specify4 7,g7 ,annual reports ,any qualified entity that provides or sells analyses pursuant to subparagraph 7,a77ii7 or provides access to a qualified data enclave pursuant to subparagraph 7,a77iii7 shall annually submit to the ,secretary a report that includes-- 7i7 a summary of the analyses provided or sold1 including the number of such analyses1 the number of purchasers of such analyses1 and the total amount of fees received for such analyses2 7ii7 a description of the topics and purposes of such analyses2 7iii7 information on the entities who obtained access to the qualified data enclave1 the uses of the data1 and the total amount of fees received for providing such access2 and 7iv7 other information determined appropriate by the ,secretary4 4 7b7 ,expansion of data available to qualified entities ,section #ahgd7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7e77 is amended-- 7#a7 in the subsection heading1 by striking ,medicare2 and 7#b7 in paragraph 7#c7-- 7,a7 by inserting after the first sentence the following new sentence3 ,effective ,july #a1 #bjad1 if the ,secretary determines appropriate1 the data described in this paragraph may also include standardized extracts 7as determined by the ,secretary7 of claims data under titles ,,xix and ,,xxi for assistance provided under such titles for one or more specified geographic areas and time periods requested by a qualified entity42 and 7,b7 in the last sentence1 by inserting or under titles ,,xix or ,,xxi before the period at the end4 7c7 ,access to ,medicare data by qualified clinical data registries to facilitate quality improvement ,section #ahdh7m77#c77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#c77;,e77 is amended by adding at the end the following new clause3 7vi7 ,access to medicare data to facilitate quality improvement 7,i7 ,in general ,to the extent consistent with applicable information1 privacy1 security1 and disclosure laws1 and subject to other requirements as the ,secretary may specify1 beginning ,july #a1 #bjad1 the ,secretary shall1 if requested by a qualified clinical data registry under this subparagraph1 subject to subclauses 7,,ii7 and 7,,iii71 provide data as described in section #ahgd7;e77#c7 7in a form and manner determined to be appropriate7 to such registry for purposes of linking such data with clinical data and performing analyses and research to support quality improvement or patient safety4 7,,ii7 ,protection ,a qualified clinical data registry may not publicly report any data made available under subclause 7,i7 7or any analyses or research described in such subclause7 that individually identifies a provider of services1 supplier1 or individual unless the registry obtains the consent of such provider1 supplier1 or individual prior to such reporting4 7,,iii7 ,fee ,the data described in subclause 7,i7 shall be made available to qualified clinical data registries at a fee equal to the cost of making such data available4 ,any fee collected pursuant to the preceding sentence shall be deposited in the ,centers for ,medicare ,medicaid ,services ,program ,management ,account4 4 7d7 ,revision of placement of fees ,section #ahgd7;e77#d77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7e77#d77;,a77 is amended1 in the second sentence-- 7#a7 by inserting 1 for periods prior to ,july #a1 #bjad1 after deposited2 and 7#b7 by inserting the following before the period at the end3 1 and1 beginning ,july #a1 #bjad1 into the ,centers for ,medicare ,medicaid ,services ,program ,management ,account4 #i4 ,reducing administrative burden and other provisions 7a7 ,medicare physician and practitioner opt-out to private contract 7#a7 ,indefinite1 continuing automatic extension of opt out election 7,a7 ,in general ,section #ahjb7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;a7b77#c77 is amended-- 7i7 in subparagraph 7,b77ii71 by striking during the #b-year period beginning on the date the affidavit is signed and inserting during the applicable #b-year period 7as defined in subparagraph 7,d772 7ii7 in subparagraph 7,c71 by striking during the #b-year period described in subparagraph 7,b77ii7 and inserting during the applicable #b-year period2 and 7iii7 by adding at the end the following new subparagraph3 7,d7 ,applicable #b-year periods for effectiveness of affidavits ,in this subsection1 the term applicable #b-year period means1 with respect to an affidavit of a physician or practitioner under subparagraph 7,b71 the #b-year period beginning on the date the affidavit is signed and includes each subsequent #b-year period unless the physician or practitioner involved provides notice to the ,secretary 7in a form and manner specified by the ,secretary71 not later than #cj days before the end of the previous #b-year period1 that the physician or practitioner does not want to extend the application of the affidavit for such subsequent #b-year period4 4 7,b7 ,effective date ,the amendments made by subparagraph 7,a7 shall apply to affidavits entered into on or after the date that is #fj days after the date of the enactment of this ,act4 7#b7 ,public availability of information on opt-out physicians and practitioners ,section #ahjb7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;a7b77 is amended-- 7,a7 in paragraph 7#e71 by adding at the end the following new subparagraph3 7,d7 ,opt-out physician or practitioner ,the term opt-out physician or practitioner means a physician or practitioner who has in effect an affidavit under paragraph 7#c77;,b74 2 7,b7 by redesignating paragraph 7#e7 as paragraph 7#f72 and 7,c7 by inserting after paragraph 7#d7 the following new paragraph3 7#e7 ,posting of information on opt-out physicians and practitioners 7,a7 ,in general ,beginning not later than ,february #a1 #bjae1 the ,secretary shall make publicly available through an appropriate publicly accessible website of the ,department of ,health and ,human ,services information on the number and characteristics of opt-out physicians and practitioners and shall update such information on such website not less often than annually4 7,b7 ,information to be included ,the information to be made available under subparagraph 7,a7 shall include at least the following with respect to opt-out physicians and practitioners3 7i7 ,their number4 7ii7 ,their physician or professional specialty or other designation4 7iii7 ,their geographic distribution4 7iv7 ,the timing of their becoming opt-out physicians and practitioners1 relative to when they first entered practice and with respect to applicable #b-year periods4 7v7 ,the proportion of such physicians and practitioners who billed for emergency or urgent care services4 4 7b7 ,medicare non-participating physicians demonstration project 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall establish and implement a demonstration project 7in this section referred to as the demonstration project7 under title ,,xviii of the ,social ,security ,act to provide that payments for services under such title furnished by non-participating physicians 7as defined in section #ahfa7r77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7r77#a777 to individuals entitled to benefits under part ,a or enrolled under part ,b of such title are paid directly to such physicians4 ,the ,secretary shall carry out the demonstration project in a geographic area that is a statistically significant area no larger than a ,state4 7#b7 ,advance notice to physicians ,the ,secretary shall1 in a timely manner and prior to the beginning of the year in which payment will be made under the demonstration project1 notify physicians in the geographic area described in paragraph 7#a7 of the option to participate in the demonstration project4 7#c7 ,timetable for implementation 7,a7 ,demonstration start date ,the demonstration project shall apply with respect to services furnished beginning on ,january #a1 #bjae4 7,b7 #a-year duration ,the ,secretary shall implement the demonstration project such that payments are made under such demonstration project for a period of #a year4 7#d7 ,report ,not later than #ah months after the date of the conclusion of the demonstration project1 the ,secretary shall submit to ,congress a report analyzing the impact of the demonstration project4 ,such report shall include an analysis of the impact1 if any1 of the demonstration project upon the-- 7,a7 percentage and number of physicians who choose not to participate under title ,,xviii of the ,social ,security ,act and a comparison of such percentage and number to the previous year2 7,b7 percentage of claims submitted by and payments made to physicians in the demonstration that are unassigned and a comparison of unassigned claims and payments by non-participating physicians in the previous year2 7,c7 percentage and number of the physicians in the demonstration by specialty designation2 and 7,d7 access to services for which payment is made under such title for individuals entitled to benefits under part ,a or enrolled under part ,b of such title4 7#e7 ,beneficiary notice 7,a7 ,notice by ,secretary to beneficiaries ,the ,secretary shall notify individuals entitled to benefits under part ,a or enrolled under part ,b of title ,,xviii of the ,social ,security ,act in the geographic area in which the demonstration project is conducted of the implications of physician participation in the demonstration project4 7,b7 ,notice by physicians to patients ,a physician who elects to participate in the demonstration project shall notify individuals to whom the physician furnishes services for which payment will be provided under the demonstration project of such election4 ,such notification shall be provided prior to the provision of service and include a notification1 with respect to each such individual1 that-- 7i7 the right of the individual to payment is being reassigned to the physician2 7ii7 payment for services furnished by the physician to such individual will be made directly to the physician2 and 7iii7 the individual is responsible for the remaining amount1 which may be higher than would be the case if the physician participated in the ,medicare program4 7c7 ,gainsharing study and report ,not later than #f months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in consultation with the ,inspector ,general of the ,department of ,health and ,human ,services1 shall submit to ,congress a report with legislative recommendations to amend existing fraud and abuse laws1 through exceptions1 safe harbors1 or other narrowly targeted provisions1 to permit gainsharing or similar arrangements between physicians and hospitals that improve care while reducing waste and increasing efficiency4 ,the report shall-- 7#a7 consider whether such provisions should apply to ownership interests1 compensation arrangements1 or other relationships2 and 7#b7 describe how the recommendations address accountability1 transparency1 and quality1 including how best to limit inducements to stint on care1 discharge patients prematurely1 or otherwise reduce or limit medically necessary care2 and 7#c7 consider whether a portion of any savings generated by such arrangements should accrue to the ,medicare program under title ,,xviii of the ,social ,security ,act4 7d7 ,promoting interoperability of electronic health record systems 7#a7 ,recommendations for achieving widespread ,,ehr interoperability 7,a7 ,objective ,as a consequence of a significant ,federal investment in the implementation of health information technology through the ,medicare ,,ehr incentive programs1 ,congress declares it a national objective to achieve widespread and nationwide exchange of health information through interoperable certified ,,ehr technology by ,december #ca1 #bjai4 7,b7 ,definitions ,in this paragraph3 7i7 ,widespread interoperability ,the term widespread interoperability means nationwide interoperability between certified ,,ehr technology systems employed by meaningful ,,ehr users under the ,medicare ,,ehr incentive programs and other clinicians and health care providers4 7ii7 ,interoperability ,the term interoperability means the ability of two or more health information systems or components to exchange clinical and other information and to use the information that has been exchanged using common standards as to provide access to longitudinal information for health care providers in order to facilitate coordinated care and improved patient outcomes4 7,c7 ,establishment of metrics ,not later than ,december #ca1 #bjae1 and in consultation with stakeholders1 the ,secretary shall establish metrics to be used to determine if and to the extent that the objective described in subparagraph 7,a7 has been achieved4 7,d7 ,recommendations if objective not achieved ,if the ,secretary of ,health and ,human ,services determines that the objective described in subparagraph 7,a7 has not been achieved by ,december #ca1 #bjag1 then the ,secretary shall submit to ,congress a report1 by not later than ,december #ca1 #bjah1 that identifies barriers to such objective and recommends actions that the ,federal ,government can take to achieve such objective4 ,such recommended actions may include recommendations-- 7i7 to adjust payments for meaningful ,,ehr users under the ,medicare ,,ehr incentive programs2 and 7ii7 for criteria for decertifying certified ,,ehr technology products4 7#b7 ,preventing blocking the sharing of information 7,a7 ,for meaningful ,,ehr professionals ,section #ahdh7o77#b77;,a77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#b77;,a77ii77 is amended by inserting before the period at the end the following3 1 and the professional demonstrates 7through a process specified by the ,secretary1 such as the use of an attestation similar to that required in the health information technology donation safe harbor established under regulations under section #aabh;,b7b77#c77;,e77 that the professional has not and will not take any deliberate action to limit or restrict the use1 compatibility1 or interoperability of the certified ,,ehr technology4 7,b7 ,for meaningful ,,ehr hospitals ,section #ahhf7n77#c77;,a77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7n77#c77;,a77ii77 is amended by inserting before the period at the end the following3 1 and the hospital demonstrates 7through a process specified by the ,secretary1 such as the use of an attestation referred to in section #ahdh7o77#b77;,a77ii77 that the hospital has not and will not take any deliberate action to limit or restrict the use1 compatibility1 or interoperability of the certified ,,ehr technology4 7,c7 ,effective date ,the amendments made by this subsection shall apply to meaningful ,,ehr users as of the date that is #f months after the date of the enactment of this ,act4 7#c7 ,study and report on the feasibility of establishing a website to compare certified ,,ehr technology products 7,a7 ,study ,the ,secretary shall conduct a study to examine the feasibility of establishing a website 7in this subsection referred to as the website7 that includes aggregated results of surveys of meaningful ,,ehr users on the functionality of certified ,,ehr technology products to enable such users to directly compare the functionality and other features of such products4 ,such information may be made available through contracts with physician1 hospital1 or other organizations that maintain such comparative information4 7,b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the website4 ,the report shall include information on the benefits and resources of such a website4 7#d7 ,definitions ,in this subsection3 7,a7 ,the term certified ,,ehr technology has the meaning given such term in section #ahdh7o77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#d774 7,b7 ,the term meaningful ,,ehr hospital means an eligible hospital 7as defined in section #ahhf7n77#f77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7n77#f77;,a77 that is a meaningful ,,ehr user4 7,c7 ,the term meaningful ,,ehr professional means an eligible professional 7as defined in section #ahdh7o77#e77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#e77;,c77 who is a meaningful ,,ehr user4 7,d7 ,the term meaningful ,,ehr user has the meaning given such term under the ,medicare ,,ehr incentive programs4 7,e7 ,the term ,medicare ,,ehr incentive programs means the incentive programs under section #ahdh7o71 subsections 7l7 and 7m7 of section #ahec1 and section #ahhf7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o71 #aciew-#bc1 #acieww7n774 7,f7 ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7e7 ,,gao study and report on the use of telehealth under ,federal programs 7#a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on the following3 7,a7 ,how the definition of telehealth across various ,federal programs and federal efforts can inform the use of telehealth in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7,b7 ,issues that can facilitate or inhibit the use of telehealth under the ,medicare program under such title1 including oversight and professional licensure1 changing technology1 privacy and security1 infrastructure requirements1 and varying needs across urban and rural areas4 7,c7 ,potential implications of greater use of telehealth with respect to payment and delivery system transformations under the ,medicare program under such title ,,xviii and the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 7,d7 ,how the ,centers for ,medicare ,medicaid ,services conducts oversight of payments made under the ,medicare program under such title ,,xviii to providers for telehealth services4 7#b7 ,report ,not later than #bd months after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 7f7 ,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 ,march #ad1 #bjad ,reported from the ,committee on ,ways and ,means with an amendment1 committed to the ,committee of the ,whole ,house on the ,state of the ,union1 and ordered to be printed