,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #diid  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,june #bf1 #bjad ,mr4 
,camp 7= himself1 ,mr4 ,lev91 ,mr4      
,brady ( ,texas1 ,mr4 ,mc,dermott1 ,mr4 
,blum5au]1 ,mr4 ,k9d1 ,mr4 ,tib]i1 &    
,mrs4 ,black7 introduc$ ! foll[+ bill2  
:i* 0 ref]r$ to ! ,committee on ,ways & 
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide = /&>diz$ po/-acute c>e         
assessm5t data = quality1 paym5t1 &     
dis*>ge plann+1 & = o!r purposes4  #a4  
,%ort title ,?is ,act may be cit$ z !   
,improv+ ,m$ic>e ,po/-,acute ,c>e       
,trans=mation ,act ( #bjad or ! ,,impact
 ,act ( #bjad 4  #b4 ,/&>dization (     
po/-acute c>e data  7a7 ,9 g5]al ,title 
,,xviii ( ! ,social ,security ,act is   
am5d$ by add+ at ! end ! foll[+ new     

section3  #ahii;,b4 ,/&>diz$ ,po/-,acute
 ,c>e 7,,pac7 assessm5t data = quality1 
paym5t1 & dis*>ge plann+  7a7           
,requirem5t = /&>diz$ assessm5t data    
7#a7 ,9 g5]al ,! ,secret>y %all--  7,a7 
require "u ! applicable report+         
provisions po/-acute c>e provid]s 7z    
def9$ 9 p>agraph 7#b77;,a77 to report-- 
7i7 /&>diz$ pati5t assessm5t data 9     
accordance ) subsection 7b72  7ii7 data 
on quality measures "u subsection       
7c77#a72 &  7iii7 data on res\rce use & 
o!r measures "u subsection 7d77#a72     
7,b7 require data describ$ 9 subp>agraph
 7,a7 to be /&>diz$ & int]op]able s z to
 all[ = ! ex*ange ( su* data among su*  
po/-acute c>e provid]s & o!r provid]s & 
! use by su* provid]s ( su* data t has  
be5 s ex*ang$1 includ+ by us+ common    
/&>ds & def9itions1 9 ord] to provide   
access to longitud9al in=mation = su*   
provid]s to facilitate coord9at$ c>e &  
improv$ ,m$ic>e b5efici>y outcomes2 &   
7,c7 9 accordance ) subsections 7b77#a7 
& 7c77#b71 modify ,,pac assessm5t       

in/rum5ts 7z def9$ 9 p>agraph 7#b77;,b77
 applicable to po/-acute c>e provid]s   
to--  7i7 provide = ! submission (      
/&>diz$ pati5t assessm5t data "u ?is    
title ) respect to su* provid]s2 &  7ii7
 enable comp>ison ( su* assessm5t data  
across all su* provid]s to :om su* data 
are applicable4  7#b7 ,def9itions ,=    
purposes ( ?is section3  7,a7 ,po/-acute
 c>e 7,,pac7 provid] ,! t]ms po/-acute  
c>e provid] & ,,pac provid] mean--  7i7 
a home heal? ag5cy2  7ii7 a skill$ nurs+
 facility2  7iii7 an inpati5t           
rehabilitation facility2 &  7iv7 a      
long-t]m c>e hospital 7o!r ?an a        
hospital classifi$ "u section           
#ahhf7;d77#a77;,b77iv77,,ii774  7,b7    
,,pac assessm5t in/rum5t ,! t]m ,,pac   
assessm5t in/rum5t means--  7i7 9 ! case
 ( home heal? ag5cies1 ! in/rum5t us$ = 
purposes ( report+ & assessm5t ) respect
 to ! ,outcome & ,assessm5t ,in=mation  
,set 7,,oasis71 z describ$ 9 sections   
#dhd4ee & #dhd4bej ( title #db1 ! ,code 
( ,f$]al ,regulations1 or any successor 

regulation1 or any o!r in/rum5t us$ )   
respect to home heal? ag5cies = su*     
purposes2  7ii7 9 ! case ( skill$ nurs+ 
facilities1 ! resid5t's assessm5t "u    
section #ahai7;b77#c72  7iii7 9 ! case (
 inpati5t rehabilitation facilities1 any
 ,m$ic>e b5efici>y assessm5t in/rum5t   
e/abli%$ by ! ,secret>y = purposes (    
section #ahhf7;j72 &  7iv7 9 ! case (   
long-t]m c>e hospitals1 ! ,m$ic>e       
b5efici>y assessm5t in/rum5t us$ )      
respect to su* hospitals = ! collection 
( data elem5ts necess>y to calculate    
quality measures z describ$ 9 ! ,augu/  
#ah1 #bjaa1 ,f$]al ,regi/] 7#gf ,f$4    
,reg4 #eaged-eagee71 includ+ = purposes 
( section #ahhf7m77#e77;,c71 or any o!r 
in/rum5t us$ ) respect to su* hospitals 
= su* purposes4  7,c7 ,applicable       
report+ provision ,! t]m applicable     
report+ provision means--  7i7 = home   
heal? ag5cies1 section                  
#ahie7;b77#c77;,b77v72  7ii7 = skill$   
nurs+ facilities1 section #ahhh7;e77#f72
  7iii7 = inpati5t rehabilitation       

facilities1 section #ahhf7;j77#g72 &    
7iv7 = long-t]m c>e hospitals1 section  
#ahhf7m77#e74  7,d7 ,,pac paym5t sy/em  
,! t]m ,,pac paym5t sy/em means--  7i7 )
 respect to a home heal? ag5cy1 !       
prospective paym5t sy/em "u section     
#ahie2  7ii7 ) respect to a skill$ nurs+
 facility1 ! prospective paym5t sy/em "u
 section #ahhh7;e72  7iii7 ) respect to 
an inpati5t rehabilitation facility1 !  
prospective paym5t sy/em "u section     
#ahhf7;j72 &  7iv7 ) respect to a       
long-t]m c>e hospital1 ! prospective    
paym5t sy/em "u section #ahhf7m74  7,e7 
,specifi$ application date ,! t]m       
specifi$ application date means !       
foll[+3  7i7 ,quality measures ,9 ! case
 ( quality measures "u subsection       
7c77#a7--  7,i7 ) respect to ! doma9    
describ$ 9 subsection 7c77#a77;,a7      
7relat+ to functional /atus1 cognitive  
function1 & *anges 9 function &         
cognitive function7--  7aa7 = ,,pac     
provid]s describ$ 9 clauses 7ii7 & 7iii7
 ( p>agraph 7#b77;,a71 ,octob] #a1      

#bjaf2  7bb7 = ,,pac provid]s describ$ 9
 clause 7iv7 ( su* p>agraph1 ,octob] #a1
 #bjah2 &  7cc7 = ,,pac provid]s        
describ$ 9 clause 7i7 ( su* p>agraph1   
,janu>y #a1 #bjai2  7,,ii7 ) respect to 
! doma9 describ$ 9 subsection           
7c77#a77;,b7 7relat+ to sk9 integrity & 
*anges 9 sk9 integrity7--  7aa7 = ,,pac 
provid]s describ$ 9 clauses 7ii71 7iii71
 & 7iv7 ( p>agraph 7#b77;,a71 ,octob]   
#a1 #bjaf2 &  7bb7 = ,,pac provid]s     
describ$ 9 clause 7i7 ( su* p>agraph1   
,janu>y #a1 #bjag2  7,,iii7 ) respect to
 ! doma9 describ$ 9 subsection          
7c77#a77;,c7 7relat+ to m$ication       
reconciliation7--  7aa7 = ,,pac provid]s
 describ$ 9 clause 7i7 ( su* p>agraph1  
,janu>y #a1 #bjag2 &  7bb7 = ,,pac      
provid]s describ$ 9 clauses 7ii71 7iii71
 & 7iv7 ( su* p>agraph1 ,octob] #a1     
#bjah2  7,,iv7 ) respect to ! doma9     
describ$ 9 subsection 7c77#a77;,d7      
7relat+ to incid5ce ( major falls7--    
7aa7 = ,,pac provid]s describ$ 9 clauses
 7ii71 7iii71 & 7iv7 ( p>agraph         

7#b77;,a71 ,octob] #a1 #bjaf2 &  7bb7 = 
,,pac provid]s describ$ 9 clause 7i7 (  
su* p>agraph1 ,janu>y #a1 #bjai2 &  7,v7
 ) respect to ! doma9 describ$ 9        
subsection 7c77#a77;,e7 7relat+ to      
accurately communicat+ ! exi/5ce ( &    
provid+ = ! transf] ( heal? in=mation & 
c>e pref]5ces7--  7aa7 = ,,pac provid]s 
describ$ 9 clauses 7ii71 7iii71 & 7iv7 (
 p>agraph 7#b77;,a71 ,octob] #a1 #bjah2 
&  7bb7 = ,,pac provid]s describ$ 9     
clause 7i7 ( su* p>agraph1 ,janu>y #a1  
#bjai4  7ii7 ,res\rce use & o!r measures
 ,9 ! case ( res\rce use & o!r measures 
"u subsection 7d77#a7--  7,i7 = ,,pac   
provid]s describ$ 9 clauses 7ii71 7iii71
 & 7iv7 ( p>agraph 7#b77;,a71 ,octob]   
#a1 #bjaf2 &  7,,ii7 = ,,pac provid]s   
describ$ 9 clause 7i7 ( su* p>agraph1   
,janu>y #a1 #bjag4  7,f7 ,m$ic>e        
b5efici>y ,! t]m ,m$ic>e b5efici>y means
 an individual entitl$ to b5efits "u "p 
,a or1 z appropriate1 enroll$ = b5efits 
"u "p ,b4  7b7 ,/&>diz$ pati5t assessm5t
 data  7#a7 ,requirem5t = report+       

assessm5t data  7,a7 ,9 g5]al ,beg9n+ n 
lat] ?an ,octob] #a1 #bjah1 = ,,pac     
provid]s describ$ 9 clauses 7ii71 7iii71
 & 7iv7 ( subsection 7a77#b77;,a7 &     
,janu>y #a1 #bjai1 = ,,pac provid]s     
describ$ 9 clause 7i7 ( su* subsection1 
! ,secret>y %all require ,,pac provid]s 
to submit to ! ,secret>y1 "u !          
applicable report+ provisions & ?r\gh ! 
use ( ,,pac assessm5t in/rum5ts1 !      
/&>diz$ pati5t assessm5t data describ$ 9
 subp>agraph 7,b74 ,! ,secret>y %all    
require su* data be submitt$ ) respect  
to admission & dis*>ge ( an individual  
7& may be submitt$ m frequ5tly z !      
,secret>y deems appropriate74  7,b7     
,/&>diz$ pati5t assessm5t data describ$ 
,= purposes ( subp>agraph 7,a71 !       
/&>diz$ pati5t assessm5t data describ$ 9
 ?is subp>agraph is data requir$ = at   
lea/ ! quality measures describ$ 9      
subsection 7c77#a7 & t is ) respect to !
 foll[+ categories3  7i7 ,functional    
/atus1 su* z mobility1 self c>e1 &      
hi/ory ( major falls--  7,i7 9 ! p]iod  

imm$iately prior to ! reason = acute    
hospitalization2 or  7,,ii7 9 ! case (  
no antec$5t acute hospitalization1 9 !  
p]iod prior to ! use ( po/-acute c>e    
s]vices4  7ii7 ,cognitive function1 su* 
z ability to express ideas & to und]/&1 
& m5tal /atus1 su* z depression &       
dem5tia4  7iii7 ,special s]vices1       
treatm5ts1 & int]v5tions1 su* z ne$ =   
v5tilator use1 dialysis1 *emo!rapy1     
c5tral l9e placem5t1 & total p>5t]al    
nutrition4  7iv7 ,m$ical conditions &   
co-morbidities1 su* z diabetes1         
conge/ive he>t failure1 & pressure      
ulc]s4  7v7 ,impairm5ts1 su* z          
incont95ce & an impair$ ability to he>1 
see1 or swall[4  7vi7 ,o!r categories   
deem$ necess>y & appropriate by !       
,secret>y4  7#b7 ,alignm5t ( claims data
 ) /&>diz$ pati5t assessm5t data ,to !  
ext5t practicable1 n lat] ?an ,octob]   
#a1 #bjah1 = ,,pac provid]s describ$ 9  
clauses 7ii71 7iii71 & 7iv7 ( subsection
 7a77#b77;,a71 & ,janu>y #a1 #bjai1 =   
,,pac provid]s describ$ 9 clause 7i7 (  

su* subsection1 ! ,secret>y %all mat*   
claims data ) assessm5t data pursuant to
 ?is section = purposes ( assess+ prior 
s]vice use & concurr5t s]vice use1 su* z
 antec$5t hospital or ,,pac provid] use1
 & may use su* mat*$ data = su* o!r uses
 z ! ,secret>y det]m9es appropriate4    
7#c7 ,replacem5t ( c]ta9 exi/+ data     
elem5ts ,9 ! case ( pati5t assessm5t    
data be+ us$ ) respect to a ,,pac       
assessm5t in/rum5t t duplicates or      
ov]laps ) /&>diz$ pati5t assessm5t data 
)9 a category describ$ 9 p>agraph 7#a71 
! ,secret>y %all1 z soon z practicable1 
revise or replace su* exi/+ data ) !    
/&>diz$ data4  7#d7 ,cl>ification       
,/&>diz$ pati5t assessm5t data submitt$ 
pursuant to ?is subsection %all n be us$
 to require individuals to be provid$   
po/-acute c>e by a specific type ( ,,pac
 provid] 9 ord] = su* c>e to be eligible
 = paym5t "u ?is title4  7c7 ,quality   
measures  7#a7 ,requirem5t = report+    
quality measures ,n lat] ?an ! specifi$ 
application date1 z applicable to       

measures & ,,pac provid]s1 ! ,secret>y  
%all specify quality measures on :i*    
,,pac provid]s are requir$ "u !         
applicable report+ provisions to submit 
/&>diz$ pati5t assessm5t data describ$ 9
 subsection 7b77#a7 & o!r necess>y data 
specifi$ by ! ,secret>y4 ,su* measures  
%all be ) respect to at lea/ ! foll[+   
doma9s3  7,a7 ,functional /atus1        
cognitive function1 & *anges 9 function 
& cognitive function4  7,b7 ,sk9        
integrity & *anges 9 sk9 integrity4     
7,c7 ,m$ication reconciliation4  7,d7   
,incid5ce ( major falls4  7,e7          
,accurately communicat+ ! exi/5ce ( &   
provid+ = ! transf] ( heal? in=mation & 
c>e pref]5ces ( an individual to !      
individual1 family c>egiv] ( !          
individual1 & provid]s ( s]vices furni%+
 items & s]vices to ! individual1 :5 !  
individual transitions--  7i7 f a       
hospital or critical access hospital to 
ano!r applicable sett+1 includ+ a ,,pac 
provid] or ! home ( ! individual2 or    
7ii7 f a ,,pac provid] to ano!r         

applicable sett+1 includ+ a diff]5t     
,,pac provid]1 a hospital1 a critical   
access hospital1 or ! home ( !          
individual4  7#b7 ,report+ ?r\gh ,,pac  
assessm5t in/rum5ts  7,a7 ,9 g5]al ,to !
 ext5t possible1 ! ,secret>y %all       
require su* report+ by a ,,pac provid] (
 quality measures "u p>agraph 7#a7 ?r\gh
 ! use ( a ,,pac assessm5t in/rum5t &   
%all modify su* ,,pac assessm5t in/rum5t
 z necess>y to enable ! use ( su*       
in/rum5t ) respect to su* quality       
measures4  7,b7 ,limitation ,! ,secret>y
 may n make significant modifications to
 a ,,pac assessm5t in/rum5t m ?an once  
p] cal5d> ye> or fiscal ye>1 z          
applicable1 unless ! ,secret>y publi%es 
9 ! ,f$]al ,regi/] a ju/ification = su* 
significant modification4  7#c7         
,adju/m5ts  7,a7 ,9 g5]al ,! ,secret>y  
%all consid] apply+ adju/m5ts to !      
quality measures "u ?is subsection tak+ 
into consid]ation ! /udies "u section   
#b7;d7 ( ! ,,impact ,act ( #bjad4  7,b7 
,risk adju/m5t ,su* quality measures    

%all be risk adju/$1 z det]m9$          
appropriate by ! ,secret>y4  7d7        
,res\rce use & o!r measures  7#a7       
,requirem5t = res\rce use & o!r measures
 ,n lat] ?an ! specifi$ application     
date1 z applicable to measures & ,,pac  
provid]s1 ! ,secret>y %all specify      
res\rce use & o!r measures on :i* ,,pac 
provid]s are requir$ "u ! applicable    
report+ provisions to submit any        
necess>y data specifi$ by ! ,secret>y1  
:i* may include /&>diz$ assessm5t data 9
 addition to claims data4 ,su* measures 
%all be ) respect to at lea/ ! foll[+   
doma9s3  7,a7 ,res\rce use measures1    
includ+ total e/imat$ ,m$ic>e sp5d+ p]  
b5efici>y4  7,b7 ,dis*>ge to community4 
7,c7 ,measures to reflect all-condition 
risk-adju/$ pot5tially prev5table       
hospital readmission rates4  7#b7       
,align+ me?odology adju/m5ts  7,a7 ,l5g?
 ( episode ,) respect to ! l5g? ( an    
episode1 ! ,secret>y %all1 to ! ext5t ! 
,secret>y det]m9es appropriate1 align   
res\rce use & o!r measures specifi$ "u  

?is subsection ) respect to ! doma9     
describ$ 9 p>agraph 7#a77;,a7 ) !       
me?odology us$ = purposes ( section     
#ahhf7o77#b77;,b77ii74  7,b7 ,geographic
 & o!r adju/m5ts ,! ,secret>y %all      
/&>dize measures ) respect to ! doma9   
describ$ 9 p>agraph 7#a77;,a7 =         
geographic paym5t rate diff]5ces &      
paym5t diff]5tials 7& o!r adju/m5ts1 z  
applicable7 consi/5t ) ! me?odology     
publi%$ 9 ! ,f$]al ,regi/] on ,augu/    
#ah1 #bjaa 7#gf ,f$4 ,reg4 #eafbd ?r\gh 
#eafbf71 or any subsequ5t modifications 
made to ! me?odology4  7,c7 ,m$ic>e     
sp5d+ p] b5efici>y ,! ,secret>y %all    
adju/1 z appropriate1 measures ) respect
 to ! doma9 describ$ 9 p>agraph         
7#a77;,a7 = ! factors appli$ "u section 
#ahhf7o77#b77;,b77ii74  7#c7 ,adju/m5ts 
7,a7 ,9 g5]al ,! ,secret>y %all consid] 
apply+ adju/m5ts to ! res\rce use & o!r 
measures specifi$ "u ?is subsection )   
respect to ! doma9 describ$ 9 p>agraph  
7#a77;,a71 tak+ into consid]ation !     
/udies "u section #b7;d7 ( ! ,,impact   

,act ( #bjad4  7,b7 ,risk adju/m5t ,su* 
res\rce use & o!r measures %all be risk 
adju/$1 z det]m9$ appropriate by !      
,secret>y4  7e7 ,measurem5t             
implem5tation phases2 ,selection (      
quality measures & res\rce use & o!r    
measures  7#a7 ,measurem5t implem5tation
 phases ,9 ! case ( quality measures    
specifi$ "u subsection 7c77#a7 & res\rce
 use & o!r measures specifi$ "u         
subsection 7d77#a71 ! provisions ( ?is  
section %all be implem5t$ 9 accordance )
 ! foll[+ phases3  7,a7 ,initial        
implem5tation phase ,! initial          
implem5tation phase1 ) respect to su* a 
measure1 %all1 9 accordance )           
subsections 7c7 & 7d71 z applicable1    
consi/ (--  7i7 measure specification1  
includ+ in=m+ ! public ( ! measure's    
num]ator1 d5om9ator1 exclusions1 & any  
o!r aspects ! ,secret>y det]m9es        
necess>y2  7ii7 data collection1        
includ+1 9 ! case ( quality measures1   
requir+ ,,pac provid]s to report data   
elem5ts ne$$ to calculate su* a measure2

 &  7iii7 data analysis1 includ+1 9 !   
case ( res\rce use & o!r measures1 ! use
 ( claims data to calculate su* a       
measure4  7,b7 ,second implem5tation    
phase ,! second implem5tation phase1 )  
respect to su* a measure1 %all consi/ ( 
! provision ( fe$back reports to ,,pac  
provid]s1 9 accordance ) subsection 7f74
  7,c7 ,?ird implem5tation phase ,! ?ird
 implem5tation phase1 ) respect to su* a
 measure1 %all consi/ ( public report+ (
 ,,pac provid]s' p]=mance on su* measure
 9 accordance ) subsection 7g74  7#b7   
,cons5sus-bas$ entity  7,a7 ,9 g5]al    
,subject to subp>agraph 7,b71 ea*       
measure specifi$ by ! ,secret>y "u ?is  
section %all be endors$ by ! entity ) a 
contract "u section #ahij7;a74  7,b7    
,exception ,9 ! case ( a specifi$ area  
or m$ical topic det]m9$ appropriate by !
 ,secret>y = :i* a feasible & practical 
measure has n be5 endors$ by ! entity ) 
a contract "u section #ahij7;a71 !      
,secret>y may specify a measure t is n s
 endors$ z long z due consid]ation is   

giv5 to measures t h be5 endors$ or     
adopt$ by a cons5sus organization       
id5tifi$ by ! ,secret>y4  7#c7 ,treatm5t
 ( application ( pre-rulemak+ process   
7measure applications p>tn]%ip process7 
7,a7 ,9 g5]al ,subject to subp>agraph   
7,b71 ! provisions ( section #ahij;,a   
%all apply 9 ! case ( a quality measure 
specifi$ "u subsection 7c7 or a res\rce 
use or o!r measure specifi$ "u          
subsection 7d74  7,b7 ,exceptions  7i7  
,exp$it$ proc$ures ,= purposes (        
satisfy+ subp>agraph 7,a71 ! ,secret>y  
may use exp$it$ proc$ures1 su* z ad-hoc 
reviews1 z necess>y1 9 ! case ( a       
quality measure specifi$ "u subsection  
7c7 or a res\rce use or o!r measure     
specifi$ 9 subsection 7d7 requir$ )     
respect to data submissions "u !        
applicable report+ provisions be=e "o   
ye> aft] ! specifi$ application date    
applicable to su* a measure & provid]   
involv$4  7ii7 ,option to waive         
provisions ,! ,secret>y may waive !     
application ( ! provisions ( section    

#ahij;,a 9 ! case ( a quality measure or
 res\rce use or o!r measure describ$ 9  
clause 7i71 if ! application ( su*      
provisions 7includ+ ?r\gh ! use ( an    
exp$it$ proc$ure describ$ 9 su* clause7 
w\ld result 9 ! inability ( ! ,secret>y 
to satisfy any deadl9e specifi$ 9 ?is   
section ) respect to su* measure4  7f7  
,fe$back reports to ,,pac provid]s  7#a7
 ,9 g5]al ,beg9n+ "o ye> aft] ! specifi$
 application date1 z applicable to ,,pac
 provid]s & quality measures & res\rce  
use & o!r measures "u ?is section1 !    
,secret>y1 includ+ ?r\gh a process      
consi/5t ) ! process appli$ "u section  
#ahhf7;b77#c77;,b77viii77,,vii7 = simil>
 purposes1 %all provide confid5tial     
fe$back reports to su* ,,pac provid]s on
 ! p]=mance ( su* provid]s ) respect to 
su* measures requir$ "u ! applicable    
provisions4  7#b7 ,frequ5cy ,to ! ext5t 
feasible1 ! ,secret>y %all provide      
fe$back reports describ$ 9 p>agraph 7#a7
 n less frequ5tly ?an on a qu>t]ly      
basis4 ,not)/&+ ! previ\s s5t5ce1 )     

respect to measures describ$ 9 su*      
p>agraph t are report$ on an annual     
basis1 ! ,secret>y may provide su*      
fe$back reports on annual basis4  7g7   
,public report+ ( ,,pac provid] p]=mance
  7#a7 ,9 g5]al ,subject to ! succe$+   
p>agraphs ( ?is subsection1 ! ,secret>y 
%all provide = public report+ ( ,,pac   
provid] p]=mance on quality measures "u 
subsection 7c77#a7 & ! res\rce use & o!r
 measures "u subsection 7d77#a71 includ+
 by e/abli%+ proc$ures = mak+ available 
to ! public in=mation reg>d+ ! p]=mance 
( individual ,,pac provid]s ) respect to
 su* measures4  7#b7 ,opportunity to    
review ,! proc$ures "u p>agraph 7#a7    
%all ensure t a ,,pac provid] has !     
opportunity to review & submit          
corrections to ! data & in=mation t is  
to be made public ) respect to ! provid]
 prior to su* data be+ made public4     
7#c7 ,tim+ ,su* proc$ures %all provide t
 ! data & in=mation describ$ 9 p>agraph 
7#a71 ) respect to a measure & ,,pac    
provid]1 is made publicly available     

beg9n+ n lat] ?an two ye>s aft] !       
specifi$ application date applicable to 
su* a measure & provid]4  7#d7          
,coord9ation ) exi/+ programs ,su*      
proc$ures %all provide t data &         
in=mation describ$ 9 p>agraph 7#a7 )    
respect to quality measures & res\rce   
use & o!r measures "u subsections       
7c77#a7 & 7d77#a7 %all be made publicly 
available consi/5t ) ! foll[+           
provisions3  7,a7 ,9 ! case ( home heal?
 ag5cies1 section                       
#ahie7;b77#c77;,b77v77,,iii74  7,b7 ,9 !
 case ( skill$ nurs+ facilities1        
sections #ahai7;i7 & #aiai7;i74  7,c7 ,9
 ! case ( inpati5t rehabilitation       
facilities1 section #ahhf7;j77#g77;,e74 
7,d7 ,9 ! case ( long-t]m c>e hospitals1
 section #ahhf7m77#e77;,e74  7h7        
,remov+1 susp5d+1 or add+ measures  7#a7
 ,9 g5]al ,! ,secret>y may remove1      
susp5d1 or add a quality measure or     
res\rce use or o!r measure describ$ 9   
subsection 7c77#a7 or 7d77#a71 s long z1
 subject to p>agraph 7#b71 ! ,secret>y  

publi%es 9 ! ,f$]al ,regi/] 7) a notice 
& comm5t p]iod7 a ju/ification = su*    
removal1 susp5sion1 or addition4  7#b7  
,exception ,9 ! case ( su* a quality    
measure or res\rce use or o!r measure = 
:i* !re is a reason to believe t !      
cont9u$ collection ( su* measure raises 
pot5tial safety conc]ns1 ! ,secret>y may
 promptly susp5d or remove su* measure &
 satisfy p>agraph 7#a7 by publi%+ 9 !   
,f$]al ,regi/] a ju/ification = su*     
susp5sion or removal 9 ! next rulemak+  
cycle foll[+ su* susp5sion or removal4  
7i7 ,use ( /&>diz$ assessm5t data1      
quality measures1 & res\rce use & o!r   
measures ,to in=m dis*>ge plann+ &      
incorporate ,m$ic>e b5efici>y pref]5ce  
7#a7 ,9 g5]al ,n lat] ?an ,janu>y #a1   
#bjaf1 & p]iodically !reaft] 7b n less  
frequ5tly ?an once e #e ye>s71 !        
,secret>y %all promulgate regulations to
 modify conditions ( p>ticipation &     
subsequ5t int]pretive guidance          
applicable to ,,pac provid]s1 hospitals1
 & critical access hospitals4 ,su*      

regulations & int]pretive guidance %all 
require su* provid]s to take into acc\nt
 quality1 res\rce use1 & o!r measures "u
 ! applicable report+ provisions 7:i*1 z
 available1 %all include measures       
specifi$ "u subsections 7c7 & 7d71 & o!r
 relevant measures7 9 ! dis*>ge plann+  
process4 ,specifically1 su* regulations 
& int]pretive guidance %all address !   
sett+s to :i* a pati5t may be dis*>g$ 9 
ord] to assi/ su* ,,pac provid]s1       
pati5ts1 & families ( su* pati5ts )     
dis*>ge plann+ f inpati5t sett+s1       
includ+ subsection 7d7 hospitals1       
critical access hospitals1 & hospitals  
describ$ 9 section                      
#ahhf7;d77#a77;,b77v71 & f ,,pac provid]
 sett+s4 ,9 addition1 su* regulations & 
int]pretive guidance %all include       
proc$ures to address--  7,a7 treatm5t   
pref]5ces ( pati5ts2 &  7,b7 goals ( c>e
 ( pati5ts4  7#b7 ,dis*>ge plann+ ,all  
requirem5ts appli$ pursuant to p>agraph 
7#a7 %all be us$ to help in=m & m&ate ! 
dis*>ge plann+ process4  7#c7           

,cl>ification ,su* regulations %all n   
require an individual to be provid$     
po/-acute c>e by a specific type ( ,,pac
 provid] 9 ord] = su* c>e to be eligible
 = paym5t "u ?is title4  7j7 ,/akehold] 
input ,be=e ! initial rulemak+ process  
to implem5t ?is section1 ! ,secret>y    
%all all[ = /akehold] input1 su* z ?r\gh
 t[n halls1 op5 door =ums1 & mail-box   
submissions4  7k7 ,fund+ ,= purposes (  
c>ry+ out ?is section1 ! ,secret>y %all 
provide = ! transf] to ! ,c5t]s =       
,m$ic>e  ,m$icaid ,s]vices ,program     
,managem5t ,acc\nt1 f ! ,f$]al ,hospital
 ,insurance ,tru/ ,fund "u section #ahag
 & ! ,f$]al ,supplem5t>y ,m$ical        
,insurance ,tru/ ,fund "u section #ahda1
 9 su* proportion z ! ,secret>y det]m9es
 appropriate1 ( #acj1jjj1jjj4 ,fifty    
p]c5t ( su* am\nt %all be available on !
 date ( ! enactm5t ( ?is section & fifty
 p]c5t ( su* am\nt %all be equally      
proportion$ = ea* ( fiscal ye>s #bjae   
?r\gh #bjai4 ,su* sums %all rema9       
available until exp5d$4  7l7 ,limitation

 ,!re %all be no adm9i/rative or        
judicial review "u sections #ahfi &     
#ahgh or o!rwise ( ! specification (    
/&>diz$ pati5t assessm5t data requir$1 !
 det]m9ation ( measures1 & ! sy/ems to  
report su* /&>diz$ data "u ?is section4 
7m7 ,non-,application ( ,pap]work       
,r$uction ,act ,*apt] #ce ( title #dd1  
,unit$ ,/ates ,code 7commonly ref]r$ to 
z ! ,pap]work ,r$uction ,act ( #aiie7   
%all n apply to ?is section & ! sections
 ref]5c$ 9 subsection 7a77#b77;,b7 t    
require modification 9 ord] to a*ieve ! 
/&>dization ( pati5t assessm5t data4  4 
7b7 ,/udies ( alt]native ,,pac paym5t   
models  7#a7 ,med,p,a,c ,us+ data f !   
,po/-,acute ,paym5t ,re=m ,demon/ration 
au?oriz$ "u section #ejjh ( ! ,deficit  
,r$uction ,act ( #bjje 7,public ,law    
#aji-aga7 or o!r data1 z available1 n   
lat] ?an ,june #cj1 #bjaf1 ! ,m$ic>e    
,paym5t ,advisory ,commission %all      
submit to ,congress a report t evaluates
 & recomm5ds features ( ,,pac paym5t    
sy/ems 7z def9$ 9 section               

#ahii;,b7a77#b77;,d7 ( ! ,social        
,security ,act1 z add$ by subsection    
7a77 t e/abli%1 or a unifi$ po/-acute   
c>e paym5t sy/em "u title ,,xviii ( !   
,social ,security ,act t e/abli%es1     
paym5t rates accord+ to *>act]i/ics (   
individuals 7su* z cognitive ability1   
functional /atus1 & impairm5ts7 in/ead (
 accord+ to ! po/-acute c>e sett+ :]e ! 
,m$ic>e b5efici>y involv$ is treat$4 ,to
 ! ext5t feasible1 su* report %all      
consid] ! impacts ( mov+ f ,,pac paym5ts
 sy/ems 7z def9$ 9 subsection           
7a77#b77;,d7 ( su* section #ahii;,b7 9  
exi/5ce z ( ! date ( ! enactm5t ( ?is   
,act to new po/-acute c>e paym5t sy/ems 
"u title ,,xviii ( ! ,social ,security  
,act4  7#b7 ,recomm5dations = ,,pac     
prospective paym5t  7,a7 ,report by     
,secret>y ,n lat] ?an #b ye>s aft] !    
date by :i* ! ,secret>y ( ,heal? &      
,human ,s]vices has collect$ #b ye>s (  
data on quality measures "u subsection  
7c7 ( section #ahii;,b1 z add$ by       
subsection 7a71 ! ,secret>y %all1 9     

consultation ) ! ,m$ic>e ,paym5t        
,advisory ,commission & appropriate     
/akehold]s1 submit to ,congress a       
report1 includ+--  7i7 recomm5dations & 
a te*nical prototype1 on a po/-acute c>e
 prospective paym5t sy/em "u title      
,,xviii ( ! ,social ,security ,act t    
w\ld--  7,i7 9 lieu ( ! rates t w\ld    
o!rwise apply "u ,,pac paym5ts sy/ems 7z
 def9$ 9 subsection 7a77#b77;,d7 ( su*  
section #ahii;,b71 base paym5ts "u su*  
title1 ) respect to items & s]vices     
furni%$ to an individual by a ,,pac     
provid] 7z def9$ 9 subsection           
7a77#b77;,a7 ( su* section71 accord+ to 
individual *>act]i/ics 7su* z cognitive 
ability1 functional /atus1 & impairm5ts7
 ( su* individual in/ead ( ! po/-acute  
c>e sett+ 9 :i* ! individual is furni%$ 
su* items & s]vices2  7,,ii7 acc\nt = ! 
cl9ical appropriat5ess ( items & s]vices
 s furni%$ & ,m$ic>e b5efici>y outcomes2
  7,,iii7 be design$ to incorporate 7or 
o!rwise acc\nt =7 /&>diz$ pati5t        
assessm5t data "u section #ahii;,b2 &   

7,,iv7 fur!r cl9ical integration1 su* z 
by motivat+ great] coord9ation ar\nd a  
s+le condition or proc$ure to integrate 
hospital sy/ems ) ,,pac provid]s 7z s   
def9$74  7ii7 recomm5dations on :i*     
,m$ic>e fee-=-s]vice regulations =      
po/-acute c>e paym5t sy/ems "u title    
,,xviii ( ! ,social ,security ,act %\ld 
be alt]$ 7su* z ! skill$ nurs+ facility 
#c-;day /ay & inpati5t rehabilitation   
facility #fj p]c5t rule72  7iii7 an     
analysis ( ! impact ( ! recomm5d$ paym5t
 sy/em describ$ 9 clause 7i7 on ,m$ic>e 
b5efici>y co/-%>+1 access to c>e1 &     
*oice ( sett+2  7iv7 a projection ( any 
pot5tial r$uction 9 exp5ditures "u title
 ,,xviii ( ! ,social ,security ,act t   
may be attributable to ! application ( !
 recomm5d$ paym5t sy/em describ$ 9      
clause 7i72 &  7v7 a review ( ! value ( 
subsection 7d7 hospitals 7z def9$ 9     
section #ahhf7;d77#a77;,b7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#a77;,b771 hospitals describ$
 9 section #ahhf7;d77#a77;,b77v7 ( su*  

,act 7#db ,u4,s4,c4                     
#acieww7d77#a77;,b77v771 & critical     
access hospitals describ$ 9 section     
#ahbj7;c77#b77;,b7 ( su* ,act 7#db      
,u4,s4,c4 #acie;i-#d7;c77#b77;,b77      
collet+ & report+ to ! ,secret>y /&>diz$
 pati5t assessm5t data ) respect to     
inpati5t hospital s]vices furni%$ by su*
 a hospital or critical access hospital 
to individuals :o are entitl$ to b5efits
 "u "p ,a ( title ,,xviii ( su* ,act or1
 z appropriate1 enroll$ = b5efits "u "p 
,b ( su* title4  7,b7 ,report by        
,med,p,a,c ,n lat] ?an ! fir/ ,june #cj?
 foll[+ ! date on :i* ! report is       
requir$ "u subp>agraph 7,a71 ! ,m$ic>e  
,paym5t ,advisory ,commission %all      
submit to ,congress a report1 includ+   
recomm5dations & a te*nical prototype1  
on a po/-acute c>e prospective paym5t   
sy/em "u title ,,xviii ( ! ,social      
,security ,act t w\ld satisfy ! crit]ia 
describ$ 9 subp>agraph 7,a74  7#c7      
,m$ic>e b5efici>y def9$ ,= purposes (   
?is subsection1 ! t]m ,m$ic>e b5efici>y 

has ! mean+ giv5 su* t]m 9 section      
#ahii;,b7a77#b7 ( ! ,social ,security   
,act1 z add$ by subsection 7a74  7c7    
,paym5t consequ5ces "u ! applicable     
report+ provisions  7#a7 ,home heal?    
ag5cies ,section #ahie7;b77#c77;,b77v7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acie;fff7b77#c77;,b77v77 is am5d$--   
7,a7 9 subclause 7,i71 by /rik+         
subclause 7,,ii7 & ins]t+ subclauses    
7,,ii7 & 7,,iv72  7,b7 9 subclause      
7,,ii71 by /rik+ ,= #bjjg & ins]t+      
,subject to subclause 7,,iv77cc71 =     
#bjjg2  7,c7 9 subclause 7,,iii71 by    
ins]t+ & subclause 7,,iv77aa7 aft]      
subclause 7,,ii72 &  7,d7 by add+ at !  
end ! foll[+ new subclause3  7,,iv7     
,submission ( additional data  7aa7 ,9  
g5]al ,= ! ye> beg9n+ on ! specifi$     
application date 7z def9$ 9 subsection  
7a77#b77;,e7 ( section #ahii;,b71 z     
applicable ) respect to home heal?      
ag5cies & quality measures "u subsection
 7c77#a7 ( su* section & measures "u    
subsection 7d77#a7 ( su* section1 & ea* 

subsequ5t ye>1 ea* home heal? ag5cy %all
 submit to ! ,secret>y data on su*      
quality measures & any necess>y data    
specifi$ by ! ,secret>y "u su*          
subsection 7d77#a74  7bb7 ,/&>diz$      
pati5t assessm5t data ,= #bjai & ea*    
subsequ5t ye>1 9 addition to su* data   
describ$ 9 item 7aa71 ea* home heal?    
ag5cy %all submit to ! ,secret>y /&>diz$
 pati5t assessm5t data requir$ "u       
subsection 7b77#a7 ( section #ahii;,b4  
7cc7 ,non-duplication ,to ! ext5t su*   
/&>diz$ data "u subsection 7b77#a7 ( su*
 section #ahii;,b1 data on quality      
measures requir$ "u subsection 7c77#a7 (
 su* section1 or necess>y data requir$  
"u subsection 7d77#a7 ( su* section are 
duplicative ( any o!r data requir$ to be
 report$ "u ?is subclause1 ! submission 
( su* /&>diz$ data1 data on su* quality 
measures1 or necess>y data1             
respectively1 %all be requir$ "u ?is    
subclause 9 lieu ( ! submission ( su*   
o!r data4  7dd7 ,submission ,su* data   
%all be submitt$ 9 ! =m & mann]1 & at ! 

"t1 specifi$ by ! ,secret>y = purposes (
 subclause 7,,ii74  4  7#b7 ,inpati5t   
rehabilitation facilities ,section      
#ahhf7;j77#g7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acieww7j77#g77 is      
am5d$--  7,a7 9 subp>agraph 7,a77i71 by 
/rik+ subp>agraph 7,c7 & ins]t+         
subp>agraphs 7,c7 & 7,f72  7,b7 9       
subp>agraph 7,c71 by /rik+ ,= fiscal ye>
 & ins]t+ ,subject to subp>agraph       
7,f77iii71 = fiscal ye>2  7,c7 9        
subp>agraph 7,e71 by ins]t+ &           
subp>agraph 7,f77i7 aft] subp>agraph    
7,c72 &  7,d7 by add+ at ! end ! foll[+ 
new subp>agraph3  7,f7 ,submission (    
additional data  7i7 ,9 g5]al ,= !      
fiscal ye> beg9n+ on ! specifi$         
application date 7z def9$ 9 subsection  
7a77#b77;,e7 ( section #ahii;,b71 z     
applicable ) respect to inpati5t        
rehabilitation facilities & quality     
measures "u subsection 7c77#a7 ( su*    
section & measures "u subsection 7d77#a7
 ( su* section1 & ea* subsequ5t fiscal  
ye>1 9 addition to su* data on ! quality

 measures describ$ 9 subp>agraph 7,c71  
ea* rehabilitation facility %all submit 
to ! ,secret>y data on ! quality        
measures "u su* subsection 7c77#a7 & any
 necess>y data specifi$ by ! ,secret>y  
"u su* subsection 7d77#a74  7ii7        
,/&>diz$ pati5t assessm5t data ,= fiscal
 ye> #bjai & ea* subsequ5t fiscal ye>1 9
 addition to su* data describ$ 9 clause 
7i71 ea* rehabilitation facility %all   
submit to ! ,secret>y /&>diz$ pati5t    
assessm5t data requir$ "u subsection    
7b77#a7 ( section #ahii;,b4  7iii7      
,non-duplication ,to ! ext5t su* /&>diz$
 data "u subsection 7b77#a7 ( su*       
section #ahii;,b1 data on quality       
measures requir$ "u subsection 7c77#a7 (
 su* section1 or necess>y data requir$  
"u subsection 7d77#a7 ( su* section are 
duplicative ( any o!r data requir$ to be
 report$ "u ?is subp>agraph1 !          
submission ( su* /&>diz$ data1 data on  
su* quality measures1 or necess>y data1 
respectively1 %all be requir$ "u ?is    
subp>agraph 9 lieu ( ! submission ( su* 

o!r data4  7iv7 ,submission ,su* data   
%all be submitt$ 9 ! =m & mann]1 & at ! 
"t1 specifi$ by ! ,secret>y = purposes (
 subp>agraph 7,c74  4  7#c7 ,long-t]m   
c>e hospitals ,section #ahhf7m77#e7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7m77#e77 is am5d$--  7,a7 9      
subp>agraph 7,a77i71 by /rik+           
subp>agraph 7,c7 & ins]t+ subp>agraphs  
7,c7 & 7,f72  7,b7 9 subp>agraph 7,c71  
by /rik+ ,= rate ye> & ins]t+ ,subject  
to subp>agraph 7,f77iii71 = rate ye>2   
7,c7 9 subp>agraph 7,e71 by ins]t+ &    
subp>agraph 7,f77i7 aft] subp>agraph    
7,c72 &  7,d7 by add+ at ! end ! foll[+ 
new subp>agraph3  7,f7 ,submission (    
additional data  7i7 ,9 g5]al ,= ! rate 
ye> beg9n+ on ! specifi$ application    
date 7z def9$ 9 subsection 7a77#b77;,e7 
( section #ahii;,b71 z applicable )     
respect to long-t]m c>e hospitals &     
quality measures "u subsection 7c77#a7 (
 su* section & measures "u subsection   
7d77#a7 ( su* section1 & ea* subsequ5t  
rate ye>1 9 addition to ! data on !     

quality measures describ$ 9 subp>agraph 
7,c71 ea* long-t]m c>e hospital 7o!r ?an
 a hospital classifi$ "u subsection     
7b77#c77;,b77iv77,,ii77 %all submit to !
 ,secret>y data on ! quality measures "u
 su* subsection 7c77#a7 & any necess>y  
data specifi$ by ! ,secret>y "u su*     
subsection 7d77#a74  7ii7 ,/&>diz$      
pati5t assessm5t data ,= rate ye> #bjai 
& ea* subsequ5t rate ye>1 9 addition to 
su* data describ$ 9 clause 7i71 ea*     
long-t]m c>e hospital 7o!r ?an a        
hospital classifi$ "u subsection        
7b77#c77;,b77iv77,,ii77 %all submit to !
 ,secret>y /&>diz$ pati5t assessm5t data
 requir$ "u subsection 7b77#a7 ( section
 #ahii;,b4  7iii7 ,non-duplication ,to !
 ext5t su* /&>diz$ data "u subsection   
7b77#a7 ( su* section #ahii;,b1 data on 
quality measures requir$ "u subsection  
7c77#a7 ( su* section1 or necess>y data 
requir$ "u subsection 7d77#a7 ( su*     
section are duplicative ( any o!r data  
requir$ to be report$ "u ?is            
subp>agraph1 ! submission ( su* /&>diz$ 

data1 data on su* quality measures1 or  
necess>y data1 respectively1 %all be    
requir$ "u ?is subp>agraph 9 lieu ( !   
submission ( su* o!r data4  7iv7        
,submission ,su* data %all be submitt$ 9
 ! =m & mann]1 & at ! "t1 specifi$ by ! 
,secret>y = purposes ( subp>agraph 7,c74
  4  7#d7 ,skill$ nurs+ facilities  7,a7
 ,9 g5]al ,p>agraph 7#f7 ( section      
#ahhh7;e7 ( ! ,social ,security ,act is 
am5d$ to read z foll[s3  7#f7 ,report+ (
 assessm5t & quality data  7,a7         
,r$uction 9 update = failure to report  
7i7 ,9 g5]al ,= fiscal ye>s beg9n+ on or
 aft] ! specifi$ application date 7z    
def9$ 9 subsection 7a77#b77;,e7 (       
section #ahii;,b71 z applicable )       
respect to skill$ nurs+ facilities &    
quality measures "u subsection 7c77#a7 (
 su* section & measures "u subsection   
7d77#a7 ( su* section1 9 ! case ( a     
skill$ nurs+ facility t does n submit1 9
 accordance ) subp>agraph 7,b7 ) respect
 to su* a fiscal ye>1 data on ! quality 
measures specifi$ "u su* subsection     

7c77#a71 any necess>y data specifi$ by !
 ,secret>y "u su* subsection 7d77#a71 & 
7= fiscal ye>s beg9n+ on or aft] ,octob]
 #a1 #bjah7 /&>diz$ pati5t assessm5t    
data specifi$ "u subsection 7b77#a7 (   
su* section1 aft] det]m9+ ! p]c5tage    
describ$ 9 p>agraph 7#e77;,b77i71 & aft]
 application ( p>agraph 7#e77;,b77ii71 !
 ,secret>y %all r$uce su* p]c5tage =    
paym5t rates dur+ su* fiscal ye> by #b  
p]c5tage po9ts4  7ii7 ,special rule ,!  
application ( ?is subp>agraph may result
 9 ! p]c5tage describ$ 9 p>agraph       
7#e77;,b77i71 aft] application (        
p>agraph 7#e77;,b77ii71 be+ less ?an    
#j4j = a fiscal ye>1 & may result 9     
paym5t rates "u ?is subsection = a      
fiscal ye> be+ less ?an su* paym5t rates
 = ! prec$+ fiscal ye>4  7iii7          
,noncumulative application ,any r$uction
 "u clause 7i7 %all apply only ) respect
 to ! fiscal ye> involv$ & ! ,secret>y  
%all n take into acc\nt su* r$uction 9  
comput+ ! paym5t am\nt "u ?is subsection
 = a subsequ5t fiscal ye>4  7,b7        

,assessm5t & measure data  7i7 ,9 g5]al 
,a skill$ nurs+ facility1 or a facility 
describ$ 9 p>agraph 7#g77;,b71 %all     
submit to ! ,secret>y1 9 a mann] & )9 ! 
timeframes prescrib$ by ! ,secret>y--   
7,i7 ! resid5t assessm5t data necess>y  
to develop & implem5t ! rates "u ?is    
subsection2  7,,ii7 = fiscal ye>s beg9n+
 on or aft] ! specifi$ application date 
7z def9$ 9 subsection 7a77#b77;,e7 (    
section #ahii;,b71 z applicable )       
respect to skill$ nurs+ facilities &    
quality measures "u subsection 7c77#a7 (
 su* section & measures "u subsection   
7d77#a7 ( su* section1 data on su*      
quality measures "u su* subsection      
7c77#a7 & any necess>y data specifi$ by 
! ,secret>y "u su* subsection 7d77#a72 &
  7,,iii7 = fiscal ye>s beg9n+ on or    
aft] ,octob] #a1 #bjah1 /&>diz$ pati5t  
assessm5t data requir$ "u subsection    
7b77#a7 ( section #ahii;,b4  ,to ! ext5t
 su* /&>diz$ data "u subsection 7b77#a7 
( su* section1 data on quality measures 
requir$ "u subsection 7c77#a7 ( su*     

section1 or necess>y data requir$ "u    
subsection 7d77#a7 ( su* section are    
duplicative ( any o!r data requir$ to be
 report$ "u ?is subp>agraph1 !          
submission ( su* /&>diz$ data1 data on  
su* quality measures1 or necess>y data1 
respectively1 %all be requir$ "u ?is    
subp>agraph 9 lieu ( ! submission ( su* 
o!r data4  7ii7 ,use ( /&>d in/rum5t ,= 
purposes ( meet+ ! requirem5t "u clause 
7i71 a skill$ nurs+ facility1 or a      
facility describ$ 9 p>agraph 7#g77;,b71 
may submit ! resid5t assessm5t data     
requir$ "u section #ahai7;b77#c71 us+ ! 
/&>d in/rum5t designat$ by ! ,/ate "u   
section #ahai7;e77#e74  4  7,b7 ,fund+ =
 nurs+ home comp>e website ,section     
#ahai7;i7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;i-#c7;i77 is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 
7#c7 ,fund+ ,! ,secret>y %all transf] to
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices  
,program ,managem5t ,acc\nt1 f ! ,f$]al 
,hospital ,insurance ,tru/ ,fund "u     
section #ahag a "o-"t allocation (      

#aa1jjj1jjj4 ,! am\nt %all be available 
on ! date ( ! enactm5t ( ?is p>agraph4  
,su* sums %all rema9 available until    
exp5d$4 ,su* sums %all be us$ to        
implem5t section #aabh;,i7g74  4  7d7   
,improv+ paym5t accuracy "u ! ,,pac     
paym5t sy/ems & o!r ,m$ic>e paym5t      
sy/ems  7#a7 ,/udies & reports ( effect 
( c]ta9 in=mation on quality & res\rce  
use  7,a7 ,/udy us+ exi/+ ,m$ic>e data  
7i7 ,/udy ,! ,secret>y ( ,heal? & ,human
 ,s]vices 79 ?is subsection ref]r$ to z 
! ,secret>y7 %all conduct a /udy t      
exam9es ! effect ( individuals'         
socioeconomic /atus on quality measures 
& res\rce use & o!r measures =          
individuals "u ! ,m$ic>e program "u     
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie et seq47 7su* z to
 recognize t less heal?y individuals may
 require m int5sive int]v5tions74 ,!    
/udy %all use in=mation collect$ on su* 
individuals 9 c>ry+ out su* program1 su*
 z urban & rural location1 eligibility =
 ,m$icaid "u title ,,xix ( su* ,act 7#db

 ,u4,s4,c4 #acif et seq47 7recogniz+ &  
acc\nt+ = v>y+ ,m$icaid eligibility     
across ,/ates71 & eligibility = b5efits 
"u ! supplem5tal security income 7,,ssi7
 program4 ,! ,secret>y %all c>ry out ?is
 p>agraph act+ ?r\gh ! ,assi/ant        
,secret>y = ,plann+ & ,evaluation4  7ii7
 ,report ,n lat] ?an #b ye>s aft] ! date
 ( ! enactm5t ( ?is ,act1 ! ,secret>y   
%all submit to ,congress a report on !  
/udy conduct$ "u clause 7i74  7,b7 ,/udy
 us+ o!r data  7i7 ,/udy ,! ,secret>y   
%all conduct a /udy t exam9es ! impact (
 risk factors1 su* z ^? describ$ 9      
section #ahdh7p77#c7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7p77#c771 race1 heal? lit]acy1 
limit$ ,engli% pr(ici5cy 7,,lep71 &     
,m$ic>e b5efici>y activation1 on quality
 measures & res\rce use & o!r measures  
"u ! ,m$ic>e program 7su* z to recognize
 t less heal?y individuals may require m
 int5sive int]v5tions74 ,9 conduct+ su* 
/udy ! ,secret>y may use exi/+ ,f$]al   
data & collect su* additional data z may

 be necess>y to complete ! /udy4  7ii7  
,report ,n lat] ?an #e ye>s aft] ! date 
( ! enactm5t ( ?is ,act1 ! ,secret>y    
%all submit to ,congress a report on !  
/udy conduct$ "u clause 7i74  7,c7      
,exam9ation ( data 9 conduct+ /udies ,9 
conduct+ ! /udies "u subp>agraphs 7,a7 &
 7,b71 ! ,secret>y %all exam9e :at      
non-,m$ic>e data sets1 su* z data f !   
,am]ican ,community ,survey 7,,acs71 c  
be useful 9 conduct+ ! types ( /udies "u
 su* p>agraphs & h[ su* data sets t are 
id5tifi$ z useful c be coord9at$ )      
,m$ic>e adm9i/rative data 9 ord] to     
improve ! ov]all data set available to d
 su* /udies & = ! adm9i/ration ( !      
,m$ic>e program4  7,d7 ,recomm5dations  
to acc\nt = in=mation 9 paym5t adju/m5t 
me*anisms ,if ! /udies conduct$ "u      
subp>agraphs 7,a7 & 7,b7 f9d a          
relation%ip betwe5 ! factors exam9$ 9 ! 
/udies & quality measures & res\rce use 
& o!r measures1 !n ! ,secret>y %all also
 provide recomm5dations = h[ ! ,c5t]s = 
,m$ic>e  ,m$icaid ,s]vices %\ld--  7i7  

obta9 access to ! necess>y data 7if su* 
data is n already be+ collect$7 on su*  
factors1 includ+ recomm5dations on h[ to
 address b>ri]s to ! ,c5t]s 9 access+   
su* data2 &  7ii7 acc\nt = su* factors--
  7,i7 9 quality measures1 res\rce use  
measures1 & o!r measures "u subsections 
7c7 & 7d7 ( section #ahii;,b ( ! ,social
 ,security ,act1 z add$ by subsection   
7a71 & "u o!r applicable provisions (   
title ,,xviii ( su* ,act 7#db ,u4,s4,c4 
#acie et seq472 &  7,,ii7 9 det]m9+     
paym5t adju/m5ts bas$ on su* measures 9 
o!r applicable provisions ( su* title4  
7,e7 ,fund+ ,!re are h]eby appropriat$  
to ! ,secret>y f ! ,f$]al ,hospital     
,insurance ,tru/ ,fund "u section #ahag 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie;i7 & ! ,f$]al           
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund "u section #ahda ( su* ,act 7#db  
,u4,s4,c4 #aciet7 79 proportions det]m9$
 appropriate by ! ,secret>y7 to c>ry out
 ?is p>agraph #f1jjj1jjj1 to rema9      
available until exp5d$4  7#b7 ,,cms     

activities  7,a7 ,9 g5]al ,tak+ into    
acc\nt ! relevant /udies conduct$ &     
recomm5dations made 9 reports "u        
p>agraph 7#a7 &1 z appropriate1 o!r     
in=mation1 includ+ in=mation collect$   
be=e completion ( su* /udies &          
recomm5dations1 ! ,secret>y1 on an ongo+
 basis1 %all1 z ! ,secret>y det]m9es    
appropriate & bas$ on an individual's   
heal? /atus & o!r factors--  7i7 assess 
appropriate adju/m5ts to quality        
measures1 res\rce use measures1 & o!r   
measures "u title ,,xviii ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 7includ+ measures specifi$ 9      
subsections 7c7 & 7d7 ( section #ahii;,b
 ( su* ,act1 z add$ by subsection 7a772 
&  7ii7 assess & implem5t appropriate   
adju/m5ts to paym5ts "u su* title4  7,b7
 ,access+ data ,! ,secret>y %all collect
 or o!rwise obta9 access to ! data      
necess>y to c>ry out ?is p>agraph ?r\gh 
exi/+ & new data s\rces4  7,c7 ,p]iodic 
analyses ,! ,secret>y %all c>ry out     
p]iodic analyses1 at lea/ e #c ye>s1    

bas$ on ! factors ref]r$ to 9           
subp>agraph 7,a7 s z to monitor *anges 9
 possible relation%ips4  7,d7 ,fund+    
,!re are h]eby appropriat$ to !         
,secret>y f ! ,f$]al ,hospital          
,insurance ,tru/ ,fund "u section #ahag 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie;i7 & ! ,f$]al           
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund "u section #ahda ( su* ,act 7#db  
,u4,s4,c4 #aciet7 79 proportions det]m9$
 appropriate by ! ,secret>y7 to c>ry out
 ?is p>agraph #aj1jjj1jjj1 to rema9     
available until exp5d$4  7#c7 ,/rategic 
plan = access+ race & e?nicity data ,n  
lat] ?an #ah mon?s aft] ! date ( !      
enactm5t ( ?is ,act1 ! ,secret>y %all   
develop & report to ,congress on a      
/rategic plan = collect+ or o!rwise     
access+ data on race & e?nicity =       
purposes ( specify+ quality measures &  
res\rce use & o!r measures "u           
subsections 7c7 & 7d7 ( section #ahii;,b
 ( ! ,social ,security ,act1 z add$ by  
subsection 7a71 &1 z ! ,secret>y        

det]m9es appropriate1 o!r simil>        
provision (1 includ+ paym5t adju/m5ts   
"u1 title ,,xviii ( su* ,act 7#db       
,u4,s4,c4 #acie et seq474