,,ii ,calendar ,no4 #bhj #aacth ,,congress #ast ,session ,s4 #ahga ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #ai1 #bjac,mr4 ,baucus1 from the ,committee on ,finance1 reported the following original bill2 which was read twice and placed on the calendar ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to repeal the ,medicare sustainable growth rate formula and to improve beneficiary access under the ,medicare program1 and for other purposes4 #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 of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,,title ,i--,medicare ,payment for ,physicians' ,services,sec4 #aja4 ,repealing the sustainable growth rate 7,,sgr7 and improving ,medicare payment for physicians' services4,sec4 #ajb4 ,priorities and funding for quality measure development4,sec4 #ajc4 ,encouraging care management for individuals with chronic care needs4,sec4 #ajd4 ,ensuring accurate valuation of services under the physician fee schedule4,sec4 #aje4 ,promoting evidence-based care4,sec4 #ajf4 ,empowering beneficiary choices through access to information on physicians' services4,sec4 #ajg4 ,expanding claims data availability to improve care4,,title ,,ii--,extensions and ,other ,provisions,subtitle ,a--,medicare ,extensions,sec4 #bja4 ,work geographic adjustment4,sec4 #bjb4 ,medicare payment for therapy services4,sec4 #bjc4 ,medicare ambulance services4,sec4 #bjd4 ,revision of the ,medicare-dependent hospital 7,,mdh7 program4,sec4 #bje4 ,revision of ,medicare inpatient hospital payment adjustment for low-volume hospitals4,sec4 #bjf4 ,specialized ,medicare ,advantage plans for special needs individuals4,sec4 #bjg4 ,reasonable cost reimbursement contracts4,sec4 #bjh4 ,quality measure endorsement and selection4,sec4 #bji4 ,permanent extension of funding outreach and assistance for low-income programs4,subtitle ,b--,medicaid and ,other ,extensions,sec4 #baa4 ,qualifying individual program4,sec4 #bab4 ,transitional ,medical ,assistance4,sec4 #bac4 ,express lane eligibility4,sec4 #bad4 ,pediatric quality measures4,sec4 #bae4 ,special diabetes programs4,subtitle ,c--,human ,services ,extensions,sec4 #bba4 ,abstinence education grants4,sec4 #bbb4 ,personal responsibility education program4,sec4 #bbc4 ,family-to-family health information centers4,sec4 #bbd4 ,health workforce demonstration project for low-income individuals4,subtitle ,d--,program ,integrity,sec4 #bca4 ,reducing improper ,medicare payments4,sec4 #bcb4 ,authority for ,medicaid fraud control units to investigate and prosecute complaints of abuse and neglect of ,medicaid patients in home and community-based settings4,sec4 #bcc4 ,improved use of funds received by the ,,hhs ,inspector ,general from oversight and investigative activities4,sec4 #bcd4 ,preventing and reducing improper ,medicare and ,medicaid expenditures4,subtitle ,e--,other ,provisions,sec4 #bda4 ,commission on ,improving ,patient ,directed ,health ,care4,sec4 #bdb4 ,expansion of the definition of inpatient hospital services for certain cancer hospitals4,sec4 #bdc4 ,quality measures for certain post-acute care providers relating to notice and transfer of patient health information and patient care preferences4,sec4 #bdd4 ,criteria for medically necessary1 short inpatient hospital stays4,sec4 #bde4 ,transparency of reasons for excluding additional procedures from the ,medicare ambulatory surgical center 7,,asc7 approved list4,sec4 #bdf4 ,supervision in critical access hospitals4,sec4 #bdg4 ,requiring ,state licensure of bidding entities under the competitive acquisition program for certain durable medical equipment1 prosthetics1 orthotics1 and supplies 7,,dmepos74,sec4 #bdh4 ,recognition of attending physician assistants as attending physicians to serve hospice patients4,sec4 #bdi4 ,remote patient monitoring pilot projects4,sec4 #bej4 ,community-,based ,institutional ,special ,needs ,plan ,demonstration ,program4,sec4 #bea4 ,applying ,,cmmi waiver authority to ,,pace in order to foster innovations4,sec4 #beb4 ,improve and modernize ,medicaid data systems and reporting4,sec4 #bec4 ,fairness in ,medicaid supplemental needs trusts4,sec4 #bed4 ,helping ,ensure ,life- and ,limb-,saving ,access to ,podiatric ,physicians4,sec4 #bee4 ,demonstration program to improve community mental health services4,sec4 #bef4 ,annual ,medicaid ,,dsh report4,sec4 #beg4 ,implementation4 ,i ,medicare ,payment for ,physicians' ,services #aja4 ,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 #bjbc ,the update to the single conversion factor established in paragraph 7#a77;,c7 for each of #bjad through #bjbc shall be zero percent4 7#af7 ,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 #ahfa7r771 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 #aj or fewer 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 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 paragraph1 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 shall 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 ,thirty percent of such score shall be based on performance with respect to the category described in clause 7i7 of paragraph 7#b77;,a74 7,,ii7 ,resource use ,thirty percent of such score shall be based on performance with respect to the category described in clause 7ii7 of paragraph 7#b77;,a74 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 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 7,i7 ,in general ,subject to subclause 7,,ii71 the percentages described in subclauses 7,i7 and 7,,ii7 of clause 7i71 including after application of clause 7ii71 shall be equal4 7,,ii7 ,exception ,for the first #b years for which the ,,vbp program applies1 after application of clause 7ii71 the ,secretary may increase the percentage applicable under subclause 7,i7 or 7,,ii7 of clause 7i7 as long as the ,secretary decreases the percentage applicable under the other subclause by an equal number of percentage points and the number of percentage points applicable under each of subclauses 7,i7 and 7,,ii7 is not less than #ae4 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 ,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 do 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 do 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 ,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,c7 ,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 #aj or fewer professionals 7with priority given to such practices located in rural areas1 health professional shortage areas 7as designated in section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act71 medically underserved areas1 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 #be1jjj1jjj for each of fiscal years #bjad through #bjah4 ,of amounts transferred under the preceding sentence1 not less than #aj1jjj1jjj shall be available for technical assistance to small practices 7consisting of #aj or fewer professionals7 in health professional shortage areas 7as so designated74 ,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 registries1 as described in subsection 7m77#c77;,e74 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 those based on type of provider1 practice size1 geographic location1 and patient mix2 7ii7 provide recommendations for improving such program2 7iii7 evaluate the impact of technical assistance funding under section #ahdh7q77#ab7 of the ,social ,security ,act1 as added by paragraph 7#a71 on the ability of professionals to improve within such program or successfully transition to an alternative payment model 7as defined in section #ahcc7z77#c7 of the ,social ,security ,act1 as added by subsection 7e77#a771 with priority for such evaluation given to practices located in rural areas1 health professional shortage areas 7as designated in section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act71 and medically underserved areas2 and 7iv7 provide recommendations for optimizing the use of such technical assistance funds4 7,b7 ,study to examine alignment of quality measures used in public and private programs 7i7 ,in general ,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-- 7,i7 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 selected ,state ,medicaid programs under title ,,xix of such ,act1 and private payer arrangements2 and 7,,ii7 makes recommendations on how to reduce the administrative burden involved in applying such quality measures4 7ii7 ,requirements ,the report under clause 7i7 shall-- 7,i7 consider those measures applicable to individuals entitled to1 or enrolled for1 benefits under such part ,a1 or enrolled under such part ,b and individuals under the age of #fe2 and 7,,ii7 focus on those measures that comprise the most significant component of the quality performance category of 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 7,c7 ,study to examine rural and health professional shortage area alternative payment models ,not later than ,october #a1 #bjai1 and ,october #a1 #bjba1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report that examines the transition of professionals in rural areas1 health professional shortage areas 7as designated in section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act71 or medically underserved areas to an alternative payment model 7as defined in section #ahcc7z77#c7 of the ,social ,security ,act1 as added by subsection 7e77#a774 ,such report shall make recommendations for removing administrative barriers to practices in rural areas1 health professional shortage areas1 and medically underserved areas to participation in such models4 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;,c77ii7 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;,f7 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 law1 and other than payments made under title ,,xix in a ,state in which no medical home or alternative payment model is available under the ,state program under that title74 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 7,,aa7 bears more than nominal financial risk if actual aggregate expenditures exceeds expected aggregate expenditures2 or 7,,bb7 is a medical home 7with respect to beneficiaries under title ,,xix7 that meets criteria comparable to medical homes expanded under section #aaae;,a7c74 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 law1 and other than payments made under title ,,xix in a ,state in which no medical home or alternative payment model is available under the ,state program under that title4 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 7,,aa7 bears more than nominal financial risk if actual aggregate expenditures exceeds expected aggregate expenditures2 or 7,,bb7 is a medical home 7with respect to beneficiaries under title ,,xix7 that meets criteria comparable to medical homes expanded under section #aaae;,a7c74 7#c7 ,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#d7 ,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 #aj or fewer professionals4 7xxiii7 ,focusing primarily on title ,,xix1 working in conjunction with the ,center for ,medicaid and ,,chip ,services within the ,centers for ,medicare ,medicaid ,services4 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 7#d7 ,construction regarding telehealth services ,nothing in the provisions of1 or amendments made by1 this ,act shall be construed as precluding an alternative payment model or a qualifying ,,apm participant 7as those terms are defined in section #ahcc7z7 of the ,social ,security ,act1 as added by paragraph 7#a77 from furnishing a telehealth service for which payment is not made under section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m774 7#e7 ,plan for integrating ,medicare advantage alternative payment models ,not later than ,july #a1 #bjae1 the ,secretary of ,health and ,human ,services shall submit to ,congress a plan to integrate ,medicare ,advantage alternative payment models that take into account a budget neutral value-based modifier4 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 program4 ,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 program4 ,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 ,medicare program4 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 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 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 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 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 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 #ahfa7r74 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 #ahij;,a7b77#b7 and #ahij;,b shall not apply to this subsection4 4 #ajb4 ,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 #aja1 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 #ajc4 ,encouraging care management for individuals with chronic care needs 7a7 ,in general ,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 7b7 ,education and outreach 7#a7 ,campaign 7,a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall conduct an education and outreach campaign to inform professionals who furnish items and services under part ,b of title ,,xviii of the ,social ,security ,act and individuals enrolled under such part of the benefits of chronic care management services described in section #ahdh7;b77#h7 of the ,social ,security ,act1 as added by subsection 7a71 and encourage such individuals with chronic care needs to receive such services4 7,b7 ,requirements ,such campaign shall-- 7i7 be directed by the ,office of ,rural ,health ,policy of the ,department of ,health and ,human ,services and the ,office of ,minority ,health of the ,centers for ,medicare ,medicaid ,services2 and 7ii7 focus on encouraging participation by underserved rural populations and racial and ethnic minority populations4 7#b7 ,report 7,a7 ,in general ,not later than ,december #ca1 #bjag1 the ,secretary shall submit to ,congress a report on the use of chronic care management services described in such section #ahdh7;b77#h7 by individuals living in rural areas and by racial and ethnic minority populations4 ,such report shall-- 7i7 identify barriers to receiving chronic care management services2 and 7ii7 make recommendations for increasing the appropriate use of chronic care management services4 #ajd4 ,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 #aje4 ,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 criteria1 only developed or endorsed by national professional medical specialty societies or other provider-led entities1 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 provider-led 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 only from among appropriate use criteria developed or endorsed by national professional medical specialty societies or other provider-led 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 based on studies that are published and reviewable by stakeholders4 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 that is comparable to the process under such subsection4 ,with respect to appropriate use criteria1 such process shall replicate the provider-developed or provider-endorsed criteria framework for appropriate use criteria for applicable imaging services 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 applicability of the provider-developed or provider-endorsed criteria framework for appropriate use criteria for applicable imaging services under subsection 7p72 7ii7 the implementation of provider-developed or provider-endorsed appropriate use criteria for such applicable imaging services2 and 7iii7 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 #ajf4 ,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 #aja and by section #ajb4 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 ,compare2 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#h71 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 #ajg4 ,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 paragraphs3 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 entity1 or through an approved alternative method 7as defined in subparagraph 7,g771 in order for entities described in such clauses to conduct analyses for non-public uses1 such as for the purposes described in clause 7i77,,ii7 7but excluding the purposes described in subparagraph 7,c774 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 for employers with respect to analyses ,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 in analyses 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 of analyses or data ,an entity described in subparagraph 7,b7 that is provided or sold analyses under this paragraph1 or an entity described in subparagraph 7,a77iii7 that receives data under this paragraph through a qualified data enclave or an approved alternative method1 shall not redisclose or make public such analyses1 such data1 or analyses using such data4 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 virtual private network 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 paragraph 7#f7 and such other terms the ,secretary may specify4 7,g7 ,approved alternative method ,for purposes of this paragraph1 the term approved alternative method means a method of providing access to the data described in subparagraph 7,a77iii7 7other than through a qualified data enclave7 to entities described in such paragraph that the ,secretary determines meets the following3 7i7 ,the method is as secure as a qualified data enclave4 7ii7 ,the method meets the requirements applicable to a qualified data enclave under subclauses 7,,ii7 and 7,,iii7 of subparagraph 7,f77ii74 7iii7 ,the method meets other requirements determined appropriate by the ,secretary4 7,h7 ,annual reports ,any qualified entity that provides or sells analyses pursuant to subparagraph 7,a77ii71 or provides access to a data through an approved data enclave or an approved alternative method1 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 data pursuant to subparagraph 7,a77iii71 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 7#f7 ,civil monetary penalties for a breach of a data use agreement ,a data use agreement under this subsection shall provide for civil monetary penalties 7as determined appropriate by the ,secretary7 for a breach of such agreement4 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 ,,ii ,extensions and ,other ,provisions ,a ,medicare ,extensions #bja4 ,work geographic adjustment ,section #ahdh7;e77#a77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;e77#a77;,e77 is amended by striking and before ,january #a1 #bjad14 #bjb4 ,medicare payment for therapy services 7a7 ,repeal of therapy cap and #a-year extension of threshold for manual medical review ,section #ahcc7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7g77 is amended-- 7#a7 in paragraph 7#d7-- 7,a7 by striking ,this subsection and inserting ,except as provided in paragraph 7#e77;,c71 this subsection2 and 7,b7 by inserting the following before the period at the end3 or with respect to services furnished on or after the date of enactment of the ,,sgr ,repeal and ,medicare ,beneficiary ,access ,act of #bjac4 7#b7 in paragraph 7#e77;,c7-- 7,a7 in clause 7i71 by inserting and before ,january #a1 #bjae1 after #bjab12 and 7,b7 by adding at the end the following new clause3 7iii7 ,with respect to services furnished during the period beginning on the date of enactment of the ,,sgr ,repeal and ,medicare ,beneficiary ,access ,act of #bjac1 and ending on ,december #ca1 #bjad1 the provisions of this paragraph shall only apply to the extent necessary to carry out the manual medical review process under this subparagraph4 4 7b7 ,medical review of outpatient therapy services 7#a7 ,medical review of outpatient therapy services ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel71 as amended by section #aja7;e71 is amended by adding at the end the following new subsection3 7aa7 ,medical review of outpatient therapy services 7#a7 ,in general 7,a7 ,process for medical review ,the ,secretary shall implement a process for the medical review 7as described in paragraph 7#b77 of outpatient therapy services 7as defined in paragraph 7#aj77 and1 subject to paragraph 7#ab71 apply such process to such services furnished on or after ,january #a1 #bjae1 focusing on services identified under subparagraph 7,b74 7,b7 ,identification of services for review ,under the process1 the ,secretary shall identify services for medical review1 using such factors as the ,secretary determines appropriate1 which may include the following3 7i7 ,services furnished by a therapy provider 7as defined in paragraph 7#aj77 whose pattern of billing is higher compared to peers4 7ii7 ,services furnished by a therapy provider who1 in a prior period1 has a high claims denial percentage or is least compliant with other applicable requirements under this title4 7iii7 ,services furnished by a therapy provider that is newly enrolled under this title4 7iv7 ,services furnished by a therapy provider who has questionable billing practices1 such as billing medically unlikely units of services in a day4 7v7 ,services furnished to treat a type of medical condition4 7vi7 ,services identified by use of the standardized data elements required to be reported under section #ahcd7p74 7vii7 ,services furnished by a single therapy provider or a group that includes a therapy provider identified by factors described in this subparagraph4 7viii7 ,other services as determined appropriate by the ,secretary4 7#b7 ,medical review 7,a7 ,prior authorization medical review 7i7 ,in general ,subject to the succeeding provisions of this subparagraph1 the ,secretary shall use prior authorization medical review for outpatient therapy services furnished to an individual above one or more thresholds established by the ,secretary1 such as a dollar threshold or a threshold based on factors such as the type of outpatient therapy service or setting4 7ii7 ,ending application of prior authorization for a therapy provider ,the ,secretary shall end the application of prior authorization medical review to outpatient therapy services furnished by a therapy provider if the ,secretary determines that the provider has a low denial rate under such prior authorization4 ,the ,secretary may subsequently reapply prior authorization medical review to such therapy provider if the ,secretary determines it to be appropriate4 7iii7 ,prior authorization of multiple services ,the ,secretary shall1 where practicable1 provide for prior authorization medical review for multiple services at a single time1 such as services in a therapy plan of care described in section #ahfa7p77#b74 7,b7 ,other types of medical review ,the ,secretary may use pre-payment review or post-payment review for services identified under paragraph 7#a77;,b7 that are not subject to prior authorization medical review under subparagraph 7,a74 7,c7 ,limitation for law enforcement activities ,the ,secretary may determine that medical review under this subsection does not apply in the case where fraud may be involved4 7#c7 ,review contractors ,the ,secretary shall conduct prior authorization medical review of outpatient therapy services under this subsection using medicare administrative contractors 7as described in section #ahgd;,a7 or other review contractors 7other than contractors under section #ahic7;h7 or contractors paid on a contingent basis74 7#d7 ,no payment without prior authorization ,with respect to an outpatient therapy service for which prior authorization medical review under this subsection applies1 no payment shall be made under this part for the service unless a prior authorization determination is made1 in advance of furnishing such service1 that such service would meet the applicable requirements of section #ahfb7;a77#a77;,a74 7#e7 ,submission of information ,a therapy provider may submit the information necessary for medical review by fax1 by mail1 or by electronic means4 ,the ,secretary shall make available the electronic means described in the preceding sentence as soon as practicable1 but not later than #bd months after the date of enactment of this subsection4 7#f7 ,timeliness ,the ,secretary shall make a prior authorization determination under this subsection within #aj business days of the date of the ,secretary's receipt of medical documentation needed to make such determination or the ,secretary shall be deemed to have found the services to meet the applicable requirements of section #ahfb7;a77#a77;,a74 7#g7 ,construction ,with respect to an outpatient therapy service that has been affirmed by medical review under this subsection1 nothing in this subsection shall be construed to preclude the subsequent denial of a claim for such service that does not meet other applicable requirements under this ,act4 7#h7 ,beneficiary protections ,with respect to services furnished on or after ,january #a1 #bjae1 where payment may not be made as a result of application of medical review under this subsection1 section #ahgi shall apply in the same manner as such section applies to a denial that is made by reason of section #ahfb7;a77#a74 7#i7 ,implementation 7,a7 ,authority ,the ,secretary may implement the provisions of this subsection by interim final rule with comment period4 7,b7 ,administration ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to medical review under this subsection4 7#aj7 ,definitions ,for purposes of this subsection3 7,a7 ,outpatient therapy services ,the term outpatient therapy services means the following services for which payment is made under section #ahdh1 #ahcd7;g71 or #ahcd7k73 7i7 ,physical therapy services of the type described in section #ahfa7p74 7ii7 ,speech-language pathology services of the type described in such section though the application of section #ahfa7ll77#b74 7iii7 ,occupational therapy services of the type described in section #ahfa7p7 through the operation of section #ahfa7;g74 7,b7 ,therapy provider ,the term therapy provider means a provider of services 7as defined in section #ahfa7u77 or a supplier 7as defined in section #ahfa7;d77 who submits a claim for outpatient therapy services4 7#aa7 ,funding ,for purposes of implementing this subsection1 the ,secretary shall provide for the transfer1 from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 of #ce1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account for each fiscal year 7beginning with fiscal year #bjad74 ,amounts transferred under this paragraph shall remain available until expended4 7#ab7 ,scaling back 7,a7 ,periodic determinations ,beginning with #bjag1 and every two years thereafter1 the ,secretary shall-- 7i7 make a determination of the improper payment rate for outpatient therapy services for a #ab-month period2 and 7ii7 make such determination publicly available4 7,b7 ,scaling back ,if the improper payment rate for outpatient therapy services determined for a #ab-month period under subparagraph 7,a7 is #ej percent or less of the ,medicare fee-for-service improper payment rate for such period1 the ,secretary shall-- 7i7 reduce the amount and extent of medical review conducted for a prospective year under the process established in this subsection2 and 7ii7 return an appropriate portion of the funding provided for such year under paragraph 7#aa74 4 7#b7 ,,gao study and report 7,a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on the effectiveness of medical review of outpatient therapy services under section #ahcc7;aa7 of the ,social ,security ,act1 as added by paragraph 7#b74 ,such study shall include an analysis of-- 7i7 aggregate data on-- 7,i7 the number of individuals1 therapy providers1 and claims subject to such review2 and 7,,ii7 the number of reviews conducted under such section2 and 7ii7 the outcomes of such reviews4 7,b7 ,report ,not later than #c years after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study under subparagraph 7,a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 7c7 ,collection of standardized data elements for outpatient therapy services 7#a7 ,collection of standardized data elements for outpatient therapy services ,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 ,collection of standardized data elements for outpatient therapy services 7#a7 ,standardized data elements 7,a7 ,in general ,not later than #f months after the date of enactment of this subsection1 the ,secretary shall post on the ,internet website of the ,centers for ,medicare ,medicaid ,services a draft list of standardized data elements for individuals receiving outpatient therapy services4 7,b7 ,domains ,such standardized data elements shall include information with respect to the following domains1 as determined appropriate by the ,secretary3 7i7 ,demographic information4 7ii7 ,diagnosis4 7iii7 ,severity4 7iv7 ,affected body structures and functions4 7v7 ,limitations with activities of daily living and participation4 7vi7 ,functional status4 7vii7 ,other domains determined to be appropriate by the ,secretary4 7,c7 ,solicitation of input ,the ,secretary shall accept comments from stakeholders through the date that is #fj days after the date the ,secretary posts the draft list of standardized data elements pursuant to subparagraph 7,a74 ,in seeking such comments1 the ,secretary shall use one or more mechanisms to solicit input from stakeholders that may include use of open door forums1 town hall meetings1 requests for information1 or other mechanisms determined appropriate by the ,secretary4 7,d7 ,operational list of standardized data elements ,not later than #abj days after the end of the comment period described in subparagraph 7,c71 the ,secretary1 taking into account such comments1 shall post on the ,internet website of the ,centers for ,medicare ,medicaid ,services an operational list of standardized data elements4 7,e7 ,subsequent revisions ,subsequent revisions to the operational list of standardized data elements shall be made through rulemaking4 ,such revisions may be based on experience and input from stakeholders4 7#b7 ,system to report standardized data elements 7,a7 ,in general ,not later than #ah months after the date the ,secretary posts the operational list of standardized data elements pursuant to paragraph 7#a77;,d71 the ,secretary shall develop and implement an electronic system 7which may be a web portal7 for therapy providers to report the standardized data elements for individuals with respect to outpatient therapy services4 7,b7 ,consultation ,the ,secretary shall seek comments from stakeholders regarding the best way to report the standardized data elements4 7#c7 ,reporting 7,a7 ,frequency of reporting ,the ,secretary shall specify the frequency of reporting standardized data elements4 ,the ,secretary shall seek comments from stakeholders regarding the frequency of the reporting of such data elements4 7,b7 ,reporting requirement ,beginning on the date the system to report standardized data elements under this subsection is operational1 no payment shall be made under this part for outpatient therapy services furnished to an individual unless a therapy provider reports the standardized data elements for such individual4 7#d7 ,report on new payment system for outpatient therapy services 7,a7 ,in general ,not later than #ah months after the date described in paragraph 7#c77;,b71 the ,secretary shall submit to ,congress a report on the design of a new payment system for outpatient therapy services4 ,the report shall include an analysis of the standardized data elements collected and other appropriate data and information4 7,b7 ,features ,such report shall consider-- 7i7 appropriate adjustments to payment 7such as case mix and outliers72 7ii7 payments on an episode of care basis2 and 7iii7 reduced payment for multiple episodes4 7,c7 ,consultation ,the ,secretary shall consult with stakeholders regarding the design of such a new payment system4 7#e7 ,implementation 7,a7 ,funding ,for purposes of implementing this subsection1 the ,secretary shall provide for the transfer1 from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 of #g1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account for each of fiscal years #bjad through #bjah4 ,amounts transferred under this subparagraph shall remain available until expended4 7,b7 ,administration ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to specification of the standardized data elements and implementation of the system to report such standardized data elements under this subsection4 7,c7 ,limitation ,there shall be no administrative or judicial review under section #ahfi1 section #ahgh1 or otherwise of the specification of standardized data elements required under this subsection or the system to report such standardized data elements4 7,d7 ,definition of outpatient therapy services and therapy provider ,in this subsection1 the terms outpatient therapy services and therapy provider have the meaning given those term in section #ahcc7;aa74 4 7#b7 ,sunset of current claims-based collection of therapy data ,section #cjje7;g77#a7 of the ,middle ,class ,tax ,extension and ,job ,creation ,act of #bjab 7#db ,u4,s4,c4 #aciel note7 is amended1 in the first sentence1 by inserting and ending on the date the system to report standardized data elements under section #ahcd7p7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7p77 is implemented1 after ,january #a1 #bjac14 7d7 ,reporting of certain information ,section #ahdb7t7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieu7t77 is amended by adding at the end the following new paragraph3 7#c7 ,each request for payment1 or bill submitted1 by a therapy provider 7as defined in section #ahcc7;aa77#aj77 for an outpatient therapy service 7as defined in such section7 furnished by a therapy assistant on or after ,january #a1 #bjae1 shall include 7in a form and manner specified by the ,secretary7 an indication that the service was furnished by a therapy assistant4 4 #bjc4 ,medicare ambulance services 7a7 ,extension of certain ambulance add-on payments 7#a7 ,ground ,ambulance ,section #ahcd7l77#ac77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77#ac77;,a77 is amended by striking ,january #a1 #bjad and inserting ,january #a1 #bjai each place it appears4 7#b7 ,super ,rural ,ambulance ,section #ahcd7l77#ab77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77#ab77;,a77 is amended1 in the first sentence1 by striking ,january #a1 #bjad and inserting ,january #a1 #bjai4 7b7 ,requiring ambulance providers ,to submit cost and other information ,section #ahcd7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77 is amended by adding at the end the following new paragraph3 7#af7 ,submission of cost and other information 7,a7 ,development of data collection system ,the ,secretary shall develop a data collection system 7which may include use of a cost survey and standardized definitions7 for providers and suppliers of ambulance services to collect cost1 revenue1 utilization1 and other information determined appropriate by the ,secretary4 ,such system shall be designed to submit information-- 7i7 needed to evaluate the appropriateness of payment rates under this subsection2 7ii7 on the utilization of capital equipment and ambulance capacity2 and 7iii7 on different types of ambulance services furnished in different geographic locations1 including rural areas and low population density areas described in paragraph 7#ab74 7,b7 ,specification of data collection system 7i7 ,in general ,not later than ,january #a1 #bjae1 the ,secretary shall-- 7,i7 specify the data collection system under subparagraph 7,a72 and 7,,ii7 identify the providers and suppliers of ambulance services who would be required to submit the information under such data collection system4 7ii7 ,respondents ,subject to subparagraph 7,d77ii71 the ,secretary shall determine an appropriate sample of providers and suppliers of ambulance services to submit information under the data collection system each year4 7,c7 ,reporting of cost information ,beginning ,july #a1 #bjae1 a #e percent reduction to payments under this part shall be made for a #a-year period to a provider or supplier of ambulance services who-- 7i7 is identified under subparagraph 7,b77i77,,ii7 as being required to submit the information under the data collection system2 and 7ii7 does not submit such information4 7,d7 ,ongoing data collection 7i7 ,revision of data collection system ,the ,secretary may revise1 as the ,secretary determines appropriate1 the data collection system4 ,the ,secretary shall consult with providers and suppliers of ambulance services when revising such system4 7ii7 ,subsequent data collection ,in order to continue to evaluate the appropriateness of payment rates under this subsection1 the ,secretary shall require providers and suppliers of ambulance services to submit information for years after #bjae as the ,secretary determines appropriate1 but in no case less often than once every #c years4 7,e7 ,consultation ,the ,secretary shall consult with stakeholders in carrying out the development of the system and collection of information under this paragraph1 including the activities described in subparagraphs 7,a7 and 7,d74 ,such consultation shall include the use of requests for information and other mechanisms determined appropriate by the ,secretary4 7,f7 ,administration ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to the collection of information required under this subsection4 7,g7 ,limitations on review ,there shall be no administrative or judicial review under section #ahfi1 section #ahgh1 or otherwise of the data collection system or identification of respondents under this paragraph4 7,h7 ,funding for implementation ,for purposes of carrying out subparagraph 7,a71 the ,secretary shall provide for the transfer1 from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 of #a1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account for fiscal year #bjad4 ,amounts transferred under this subparagraph shall remain available until expended4 4 #bjd4 ,revision of the ,medicare-dependent hospital 7,,mdh7 program 7a7 ,permanent extension of payment methodology 7#a7 ,in general ,section #ahhf7;d77#e77;,g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,g77 is amended-- 7,a7 in clause 7i71 by striking and before ,october #a1 #bjac12 and 7,b7 in clause 7ii77,,ii71 by striking and before ,october #a1 #bjac14 7#b7 ,conforming amendments 7,a7 ,target amount ,section #ahhf7;b77#c77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,d77 is amended-- 7i7 in the matter preceding clause 7i71 by striking and before ,october #a1 #bjac12 and 7ii7 in clause 7iv71 by striking through fiscal year #bjac and inserting or a subsequent fiscal year4 7,b7 ,hospital value-based purchasing program ,section #ahhf7o77#g77;,d77ii77,i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7o77#g77;,d77ii77,i77 is amended by striking 7with respect to discharges occurring during fiscal year #bjab and #bjac74 7,c7 ,hospital readmission reduction program ,section #ahhf7q77#b77;,b77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77#b77;,b77i77 is amended by striking 7with respect to discharges occurring during fiscal years #bjab and #bjac74 7,d7 ,permitting hospitals to decline reclassification ,section #aceja7;e77#b7 of the ,omnibus ,budget ,reconciliation ,act of #aiic 7#db ,u4,s4,c4 #acieww note7 is amended by striking fiscal year #aiih1 fiscal year #aiii1 or fiscal year #bjjj through fiscal year #bjac and inserting or fiscal year #aiih or a subsequent fiscal year4 7b7 ,,gao study and report on ,medicare-dependent hospitals 7#a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on the following3 7,a7 ,the payor mix of medicare-dependent1 small rural hospitals 7as defined in section #ahhf7;d77#e77;,g77iv771 how such mix will trend in future years1 and whether or not the requirement under subclause 7,,iv7 of such section should be revised4 7,b7 ,the characteristics of medicare-dependent1 small rural hospitals that meet the requirement of such subclause 7,,iv7 through the application of paragraph 7a77iii77,a7 or 7a77iii77,b7 of section #dab4ajh of the ,code of ,federal ,regulations1 including ,medicare inpatient and outpatient utilization1 payor mix1 and financial status1 including ,medicare and total margins1 and whether or not ,medicare payments for such hospitals should be revised4 7,c7 ,such other items related to medicare-dependent1 small rural hospitals as the ,comptroller ,general determines appropriate4 7#b7 ,report ,not later than #ab months after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 7c7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the provisions of1 and the amendments made by1 this section through program instruction or otherwise4 #bje4 ,revision of ,medicare inpatient hospital payment adjustment for low-volume hospitals 7a7 ,in general ,section #ahhf7;d77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#ab77 is amended-- 7#a7 in subparagraph 7,b7-- 7,a7 in the subparagraph heading1 by inserting for fiscal years #bjje through #bjaj after increase2 and 7,b7 in the matter preceding clause 7i71 by striking and for discharges occurring in fiscal year #bjad and subsequent years2 7#b7 in subparagraph 7,c77i71 by striking fiscal years #bjaa1 #bjab1 and #bjac and inserting fiscal year #bjaa and subsequent fiscal years each place it appears2 and 7#c7 in subparagraph 7,d7-- 7,a7 in the heading1 by striking ,temporary applicable percentage increase and inserting ,applicable percentage increase for fiscal year #bjaa and subsequent fiscal years2 and 7,b7 by striking fiscal years #bjaa1 #bjab1 and #bjac and inserting fiscal year #bjaa or a subsequent fiscal year2 7b7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the provisions of1 and the amendments made by1 this section through program instruction or otherwise4 #bjf4 ,specialized ,medicare ,advantage plans for special needs individuals 7a7 ,extension ,section #ahei7;f77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#a77 is amended-- 7#a7 by striking enrollment4--,in the case and inserting 8enrollment4-- 7,a7 ,in general ,subject to subparagraphs 7,b7 and 7,c71 in the case 2 7#b7 in subparagraph 7,a71 as added by paragraph 7#a71 by striking and for periods before ,january #a1 #bjae2 and 7#c7 by adding at the end the following new subparagraphs3 7,b7 ,application to dual ,s,n,ps ,subparagraph 7,a7 shall only apply to a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77ii7 for periods before ,january #a1 #bjba4 7,c7 ,application to severe or disabling chronic condition ,s,n,ps ,subparagraph 7,a7 shall only apply to a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77iii7 for periods before ,january #a1 #bjah4 4 7b7 ,increased integration of dual ,s,n,ps 7#a7 ,in general ,section #ahei7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77 is amended-- 7,a7 in paragraph 7#c71 by adding at the end the following new subparagraph3 7,f7 ,the plan meets the requirements applicable under paragraph 7#h74 2 and 7,b7 by adding at the end the following new paragraph3 7#h7 ,increased integration of dual ,s,n,ps 7,a7 ,designated contact ,the ,secretary1 acting through the ,federal ,coordinated ,health ,care ,office 7,medicare-,medicaid ,coordination ,office7 established under section #bfjb of the ,patient ,protection and ,affordable ,care ,act 7in this paragraph referred to as the ,,mmco71 shall serve as a dedicated point of contact for ,states to address misalignments that arise with the integration of specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii7 under this paragraph4 ,consistent with such role1 the ,,mmco shall-- 7i7 establish a uniform process for disseminating to ,state ,medicaid agencies information under this title impacting contracts between such agencies and such plans under this subsection2 and 7ii7 establish basic resources for ,states interested in exploring such plans as a platform for integration4 7,b7 ,unified appeals process 7i7 ,in general ,not later than ,april #a1 #bjae1 the ,secretary shall establish procedures unifying the appeals procedures under sections #aheb7;g71 #aijb7;a77#c71 and #aijb7;a77#e7 for items and services provided by specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii7 under this title and title ,,xix4 ,the ,secretary shall solicit comment in developing such procedures from ,states1 plans1 beneficiary representatives1 and other relevant stakeholders4 7ii7 ,procedures ,to the extent compatible with a unified process1 the procedures established under clause 7i7 shall-- 7,i7 adopt the most protective provisions for the enrollee under current law1 including continuation of benefits under title ,,xix pending appeal if an appeal is filed in a timely manner2 7,,ii7 take into account differences in ,state plans under title ,,xix2 7,,iii7 be easily navigable by an enrollee2 and 7,,iv7 include the elements described in clause 7iii74 7iii7 ,elements described ,the following elements are described in this clause3 7,i7 ,single notification of all applicable appeal rights under this title and title ,,xix4 7,,ii7 ,notices written in plain language and available in a language and format that is accessible to the enrollee4 7,,iii7 ,unified timeframes for internal and external appeals processes1 such as an individual's filing of appeals1 a plan's acknowledgment and resolution of appeals1 and notification of appeals decisions4 7,,iv7 ,mechanisms to allow the plan to track and resolve grievances4 7,c7 ,requirement for unified appeals 7i7 ,in general ,for #bjaf and subsequent years1 the contract of a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77ii7 with a ,state ,medicaid agency under this subsection shall require the use of unified appeals procedures as described in subparagraph 7,b74 7ii7 ,consideration of application for other ,s,n,ps ,the ,secretary shall consider applying the unified appeals process described in subparagraph 7,b7 to specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77i7 and subsection 7b77#f77;,b77iii74 7,d7 ,requirement for full integration for certain dual ,s,n,ps 7i7 ,requirement ,subject to the succeeding provisions of this subparagraph1 for #bjah and subsequent years1 a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77ii7 shall-- 7,i7 integrate all benefits under this title and title ,,xix2 and 7,,ii7 meet the requirements of a fully integrated plan described in section #ahec7;a77#a77;,b77iv77,,ii7 7other than the requirement that the plan have similar average levels of frailty1 as determined by the ,secretary1 as the ,,pace program71 including with respect to long-term care services or behavioral health services to the extent ,state law permits capitation of those services under such plan4 7ii7 ,initial sanctions for failure to meet requirement for #bjah or #bjai ,for each of #bjah and #bjai1 if the ,secretary determines that a plan has failed to meet the requirement described in clause 7i71 the ,secretary shall impose one of the following on the plan3 7,i7 ,a reduction in payments under this part4 7,,ii7 ,closing enrollment in the plan4 7,,iii7 ,sanctioning the plan in accordance with section #aheg7;g74 7,,iv7 ,other reasonable action 7other than the sanction described in clause 7iii77 the ,secretary determines appropriate4 7iii7 ,sanctions for failure to meet requirement for #bjbj and subsequent years ,for #bjbj and subsequent years1 if the ,secretary determines that a plan has failed to meet the requirement described in clause 7i71 the plan shall be deemed to no longer meet the definition of a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77ii74 7iv7 ,limitation ,this subparagraph shall not apply to a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77ii7 that only enrolls individuals for whom the only medical assistance to which the individuals are entitled under the ,state plan is medicare cost sharing described in section #aije7p77#c77;,a77ii74 4 7#b7 ,conforming amendment to responsibilities of ,federal ,coordinated ,health ,care ,office 7,,mmco7 ,section #bfjb7;d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #acae;b7d77 is amended by adding at the end the following new paragraph3 7#f7 ,to act as a designated contact for ,states under subsection 7f77#h77;,a7 of section #ahei of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 with respect to the integration of specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii7 of such section4 4 7c7 ,improvements to care management requirements for severe or disabling chronic condition ,s,n,ps ,section #ahei7;f77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#e77 is amended-- 7#a7 by striking all ,s,n,ps4--,the requirements and inserting 8all ,s,n,ps4-- 7,a7 ,in general ,subject to subparagraph 7,b71 the requirements 2 7#b7 by redesignating subparagraphs 7,a7 and 7,b7 as clauses 7i7 and 7ii71 respectively1 and indenting appropriately2 7#c7 in clause 7ii71 as redesignated by paragraph 7#b71 by redesignating clauses 7i7 through 7iii7 as subclauses 7,i7 through 7,,iii71 respectively1 and indenting appropriately2 and 7#d7 by adding at the end the following new subparagraph3 7,b7 ,improvements to care management requirements for severe or disabling chronic condition ,s,n,ps ,for #bjaf and subsequent years1 in the case of a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77iii71 the requirements described in this paragraph include the following3 7i7 ,the interdisciplinary team under subparagraph 7,a77ii77,,iii7 includes a team of providers with demonstrated expertise1 including training in an applicable specialty1 in treating individuals similar to the targeted population of the plan4 7ii7 ,requirements developed by the ,secretary to provide face-to-face encounters with individuals enrolled in the plan4 7iii7 ,as part of the model of care under clause 7i7 of subparagraph 7,a71 the results of the initial assessment and annual reassessment under clause 7ii77,i7 of such subparagraph of each individual enrolled in the plan are addressed in the individual's individualized care plan under clause 7ii77,,ii7 of such subparagraph4 7iv7 ,as part of the annual evaluation and approval of such model of care1 the ,secretary shall take into account whether the plan fulfilled the previous year's goals 7as required under the model of care74 7v7 ,the ,secretary shall establish a minimum benchmark for each element of the model of care of a plan4 ,the ,secretary shall only approve a plan's model of care under this paragraph if each element of the model of care meets the minimum benchmark applicable under the preceding sentence4 4 7d7 ,,gao ,study on ,quality ,improvement 7#a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on how the ,secretary of ,health and ,human ,services could change the quality measurement system under the ,medicare ,advantage program under part ,c of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq47 to allow an accurate comparison of the quality of care provided by specialized ,,ma plans for special needs individuals 7as defined in section #ahei7;b77#f7 of such ,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f771 both for individual plans and such plans overall1 compared to the quality of care delivered by the original ,medicare fee-for-service program under parts ,a and ,b of such title and other ,medicare ,advantage plans under such part ,c across similar populations4 7#b7 ,report ,not later than ,july #a1 #bjaf1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 7e7 ,changes to quality ratings and measurement of ,s,n,ps ,section #ahec7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7o77 is amended by adding at the end the following new paragraph3 7#f7 ,changes to quality ratings of ,s,n,ps 7,a7 ,emphasis on improvement across ,s,n,ps ,subject to subparagraph 7,b71 beginning in plan year #bjaf1 in the case of a specialized ,,ma plan for special needs individuals1 the ,secretary shall increase the emphasis on the plan's improvement or decline in performance when determining the star rating of the plan under this subsection for the year as follows3 7i7 ,at least #be percent1 but not more than #cc percent1 of the total star rating of the plan shall be based on improvement or decline in performance4 7ii7 ,improvement or decline in performance under this subparagraph shall be measured based on net change in the individual star rating measures of the plan1 with appropriate weight given to specific individual star ratings measures1 such as readmission rates1 as determined by the ,secretary4 7iii7 ,the ,secretary shall make an appropriate adjustment to the improvement rating of a plan under this subparagraph if the plan has achieved a #e-star rating or the highest rating possible overall or for an individual measure in order to ensure that the plan is not punished in cases where it is not possible to improve4 7,b7 ,no application to certain plans ,subparagraph 7,a7 shall not apply1 with respect to a year1 to a specialized ,,ma plan for special needs individuals that has a rating that does not exceed two-and-one-half stars4 7,c7 ,quality ,measurement at the ,plan ,level 7i7 ,in general ,the ,secretary may require reporting for and apply under this subsection quality measures at the plan level for specialized ,,ma plan for special needs individuals instead of at the contract level4 7ii7 ,consideration ,the ,secretary shall take into consideration the minimum number of enrollees in a specialized ,,ma plan for special needs individuals in order to determine if a valid measurement of quality at the plan level is possible under clause 7i74 7iii7 ,application ,if the ,secretary applies quality measurement at the plan level under this subparagraph-- 7,i7 such quality measurement shall include ,medicare ,health ,outcomes ,survey 7,,hos71 ,healthcare ,effectiveness ,data and ,information ,set 7,,hedis71 and ,consumer ,assessment of ,healthcare ,providers and ,systems 7,,cahps7 measures2 and 7,,ii7 payment and other administrative actions linked to quality measurement 7including the #e-star rating system under this subsection7 shall be applied at the plan level in accordance with this subparagraph4 4 #bjg4 ,reasonable cost reimbursement contracts 7a7 ,one-year transition and notice regarding transition ,section #ahgf7;h77#e77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciemm7h77#e77;,c77 is amended-- 7#a7 in clause 7ii71 in the matter preceding subclause 7,i71 by striking ,for any and inserting ,subject to clause 7iv71 for any2 and 7#b7 by adding at the end the following new clauses3 7iv7 ,in the case of an eligible organization that is offering a reasonable cost reimbursement contract that may no longer be extended or renewed because of the application of clause 7ii7-- 7,i7 notwithstanding such clause1 such contract may be extended or renewed for one last reasonable cost reimbursement contract year2 7,,ii7 the organization may not enroll any new enrollees under such contract during such last reasonable cost reimbursement contract year2 and 7,,iii7 on a date determined by the ,secretary prior to the beginning of such last reasonable cost reimbursement contract year1 the organization shall provide notice to the ,secretary as to whether or not the organization will apply to have the contract converted over and offered as a ,medicare ,advantage plan under part ,c for the year following such last reasonable cost reimbursement contract year4 7v7 ,if an eligible organization that is offering a reasonable cost reimbursement contract that is extended or renewed pursuant to clause 7iv7 provides the notice described in clause 7iv77,,iii7 that the contract will be converted-- 7,i7 the deemed enrollment under section #ahea7;c77#d7 shall apply2 and 7,,ii7 the special rule for quality increases under #ahec7o77#c77;,a77iv7 shall apply4 4 7b7 ,deemed enrollment from reasonable cost reimbursement contracts converted to ,medicare ,advantage plans 7#a7 ,in general ,section #ahea7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;c77 is amended-- 7,a7 in paragraph 7#a71 by striking ,such elections and inserting ,subject to paragraph 7#d71 such elections2 and 7,b7 by adding at the end the following3 7#d7 ,deemed enrollment relating to converted reasonable cost reimbursement contracts 7,a7 ,in general ,on the first day of the annual1 coordinated election period under subsection 7e77#c7 for plan years beginning on or after ,january #a1 #bjaf1 an ,,ma eligible individual described in clause 7i7 or 7ii7 of subparagraph 7,b7 is deemed to have elected to receive benefits under this title through an applicable ,,ma plan 7and shall be enrolled in such plan7 beginning with such plan year1 if-- 7i7 the individual is enrolled in a reasonable cost reimbursement contract under section #ahgf7;h7 in the previous plan year2 7ii7 such reasonable cost reimbursement contract was extended or renewed for one last reasonable cost reimbursement contract year pursuant to section #ahgf7;h77#e77;,c77iv72 7iii7 the eligible organization that is offering such reasonable cost reimbursement contract provided the notice described in subclause 7,,iii7 of such section that the contract was to be converted2 7iv7 the applicable ,,ma plan-- 7,i7 is the plan that was converted from the reasonable cost reimbursement contract described in clause 7iii72 7,,ii7 is offered by the same entity 7or an organization affiliated with such entity7 that entered into such contract2 and 7,,iii7 is offered in the service area where the individual resides2 7v7 the amount of the ,,ma monthly basic beneficiary premium for such applicable ,,ma plan with respect to the plan year does not exceed monthly premiums under such reasonable cost reimbursement contract for the previous plan year by more than #aj percent2 7vi7 the applicable ,,ma plan provides benefits1 premiums1 and access to providers that are comparable to the benefits1 premiums1 and access to providers under such reasonable cost reimbursement contract for the previous plan year2 and 7vii7 the applicable ,,ma plan-- 7,i7 allows enrollees transitioning from the converted reasonable cost contract to such plan to maintain current providers and course of treatment at the time of enrollment for at least #ij days after enrollment2 and 7,,ii7 during such period1 pays non-contracting providers for items and services furnished to the enrollee an amount that is not less than the amount of payment applicable for those items and services under the original medicare fee-for-service program under parts ,a and ,b4 7,b7 ,,ma eligible individuals described 7i7 ,without prescription drug coverage ,an ,,ma eligible individual described in this clause1 with respect to a plan year1 is an ,,ma eligible individual who is enrolled in a reasonable cost reimbursement contract under section #ahgf7;h7 in the previous plan year and who does not1 for such previous plan year1 receive any prescription drug coverage under part ,d1 including coverage under section #ahfj;,d-#bb4 7ii7 ,with prescription drug coverage ,an ,,ma eligible individual described in this clause1 with respect to a plan year1 is an ,,ma eligible individual who is enrolled in a reasonable cost reimbursement contract under section #ahgf7;h7 in the previous plan year and who1 for such previous plan year1 receives prescription drug coverage under part ,d-- 7,i7 through such contract2 or 7,,ii7 through a prescription drug plan1 if the sponsor of such plan is the same entity 7or an organization affiliated with such entity7 that entered into such contract4 7,c7 ,applicable ,,ma plan defined ,in this paragraph1 the term applicable ,,ma plan means1 in the case of an individual described in-- 7i7 subparagraph 7,b77i71 an ,,ma plan that is not an ,,ma-,,pd plan2 and 7ii7 subparagraph 7,b77ii71 an ,,ma-,,pd plan4 7,d7 ,identification of deemed individuals ,not later than #cj days before the first day of the annual1 coordinated election period under subsection 7e77#c7 for plan years beginning on or after ,january #a1 #bjaf1 the ,secretary shall identify the individuals who will be subject to deemed elections under subparagraph 7,a7 on the first day of such period4 4 7#b7 ,beneficiary option to discontinue or change ,,ma plan or ,,ma-,,pd plan after deemed enrollment 7,a7 ,in general ,section #ahea7;e77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;e77#d77 is amended by adding at the end the following3 7,f7 ,special period for certain deemed elections 7i7 ,in general ,at any time during the period beginning after the last day of the annual1 coordinated election period under paragraph 7#c7 in which an individual is deemed to have elected to enroll in an ,,ma plan or ,,ma-,,pd plan under subsection 7c77#d7 and ending on the last day of ,february of the first plan year for which the individual is enrolled in such plan1 such individual may change the election under subsection 7a77#a7 7including changing the ,,ma plan or ,,ma-,,pd plan in which the individual is enrolled74 7ii7 ,limitation of one change ,an individual may exercise the right under clause 7i7 only once during the applicable period described in such clause4 ,the limitation under this clause shall not apply to changes in elections effected during an annual1 coordinated election period under paragraph 7#c7 or during a special enrollment period under paragraph 7#d74 4 7,b7 ,conforming amendments 7i7 ,plan requirement for open enrollment ,section #ahea7;e77#f77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;e77#f77;,a77 is amended by striking paragraph 7#a71 and inserting paragraph 7#a71 during the period described in paragraph 7#b77;,f71 4 7ii7 ,part ,d ,section #ahfj;,d-#a7;b77#a77;,b7 of such ,act 7#db ,u4,s4,c4 #aciew-#aja7;b77#a77;,b77 is amended-- 7,i7 in clause 7ii71 by adding and paragraph 7#d7 after paragraph 7#c77;,a72 and 7,,ii7 in clause 7iii7 by striking and 7,e7 and inserting 7,e71 and 7,f74 7#c7 ,treatment of ,,esrd for deemed enrollment ,section #ahea7;a77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;a77#c77;,b77 is amended by adding at the end the following flush sentence3 ,an individual who develops end-stage renal disease while enrolled in a reasonable cost reimbursement contract under section #ahgf7;h7 shall be treated as an ,,ma eligible individual for purposes of applying the deemed enrollment under subsection 7c77#d74 4 7c7 ,information requirements ,section #ahea7;d77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;d77#b77;,b77 is amended-- 7#a7 by striking the subparagraph heading and inserting the following3 7i7 ,notification to newly eligible ,medicare ,advantage eligible individuals4--2 and 7#b7 by adding at the end the following3 7ii7 ,notification related to certain deemed elections ,the ,secretary shall1 not later than #ae days prior to the first day of the annual1 coordinated election period under subsection 7e77#c7 of a year1 mail to any individual identified by the ,secretary under subsection 7c77#d77;,d7 for such year-- 7,i7 a notification that such individual will1 on such day1 be deemed to have made an election to receive benefits under this title through an ,,ma plan or ,,ma-,,pd plan 7and shall be enrolled in such plan7 for the next plan year under subsection 7c77#d77;,a71 but that the individual may make a different election during the annual1 coordinated election period for such year2 7,,ii7 the information described in subparagraph 7,a72 7,,iii7 a description of the differences between such ,,ma plan or ,,ma-,,pd plan and the reasonable cost reimbursement contract in which the individual was most recently enrolled with respect to benefits covered under such plans1 including cost-sharing1 premiums1 drug coverage1 and provider networks2 and 7,,iv7 information about the special period for elections under subsection 7e77#b77;,f74 4 7d7 ,treatment of transition plan for quality rating for payment purposes ,section #ahec7o77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7o77#c77;,a77 is amended by adding at the end the following new clause3 7iv7 ,special rule for first #b plan years for plans that were converted from a reasonable cost reimbursement contract ,in applying paragraph 7#a7 for the first #b plan years under this part in the case of a plan that is a new ,,ma plan 7as defined in clause 7iii77,,ii77 to which deemed enrollment applies under section #ahea7;e77#d71 the ,secretary shall use the star rating that applied to the converted reasonable cost reimbursement contract for the year preceding the first plan year for such plan under this part4 4 #bjh4 ,quality measure endorsement and selection 7a7 ,contract with an entity regarding input on the selection of measures 7#a7 ,in general ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended-- 7,a7 by redesignating section #ahij;,a as section #ahij;,b2 and 7,b7 by inserting after section #ahij the following new section3 #ahij;,a ,contract with an entity regarding input on the selection of measures 7a7 ,contract 7#a7 ,in general ,for purposes of activities conducted under this ,act1 the ,secretary shall identify and have in effect a contract with an entity that meets the requirements described in subsection 7c74 ,such contract shall provide that the entity will perform the duties described in subsection 7b74 7#b7 ,timing for first contract ,the first contract under paragraph 7#a7 shall begin on ,october #a1 #bjad4 7#c7 ,period of contract ,a contract under paragraph 7#a7 shall be for a period of #c years 7except as may be renewed after a subsequent bidding process74 7#d7 ,competitive procedures ,competitive procedures 7as defined in section #d7e7 of the ,office of ,federal ,procurement ,policy ,act 7#da ,u4,s4,c4 #djc7e777 shall be used to enter into a contract under paragraph 7#a74 7b7 ,duties ,the duties described in this subsection are the following3 7c7 ,requirements described ,the requirements described in this subsection are the following3 7#a7 ,private nonprofit1 board membership1 membership fees1 and not a measure developer ,the requirements described in paragraphs 7#a71 7#b71 7#g71 and 7#h7 of section #ahij7;c74 7#b7 ,experience ,the entity has at least #d years of experience working with quality and efficiency measures4 4 7#b7 ,duties of entity 7,a7 ,transfer of priority setting process ,paragraph 7#a7 of section #ahij7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7b77 is redesignated as paragraph 7#a7 of section #ahij;,a7b7 of such ,act1 as added by paragraph 7#a74 7,b7 ,transfer of multi-stakeholder process ,paragraphs 7#g7 and 7#h7 of such section #ahij7;b7 are redesignated as paragraphs 7#b7 and 7#c71 respectively1 of section #ahij;,a7b7 of such ,act1 as added by paragraph 7#a7 and amended by subparagraph 7,a74 7,c7 ,additional duties ,section #ahij;,a7b7 of such ,act1 as added by paragraph 7#a7 and amended by subparagraphs 7,a7 and 7,b71 is amended by adding at the end the following new paragraphs3 7#d7 ,facilitation to better coordinate and align public and private sector use of quality measures 7,a7 ,in general ,the entity shall facilitate increased coordination and alignment between the public and private sector with respect to quality and efficiency measures4 7,b7 ,reports ,the entity shall prepare and make available to the public annual reports on its findings under this paragraph4 ,such public availability shall include posting each report on the ,internet website of the entity4 7#e7 ,gap analysis ,the entity shall conduct an ongoing analysis of-- 7,a7 gaps in endorsed quality and efficiency measures1 which shall include measures that are within priority areas identified by the ,secretary under the national strategy established under section #cii;,,hh of the ,public ,health ,service ,act2 and 7,b7 areas where quality measures are unavailable or inadequate to identify or address such gaps4 7#f7 ,annual report to congress and the ,secretary2 ,secretarial publication and comment 7,a7 ,annual report ,by not later than ,march #a of each year1 the entity shall submit to ,congress and the ,secretary a report containing-- 7i7 a description of-- 7,i7 the recommendations made under paragraph 7#a72 7,,ii7 the matters described in clauses 7i7 and 7ii7 of paragraph 7#b77;,a72 7,,iii7 the results of the analysis under paragraph 7#e72 and 7,,iv7 the performance by the entity of the duties required under the contract entered into with the ,secretary under subsection 7a72 and 7ii7 any other items determined appropriate by the ,secretary4 7,b7 ,secretarial review and publication of annual report ,not later than #f months after receiving a report under subparagraph 7,a7 for a year1 the ,secretary shall-- 7i7 review such report2 and 7ii7 publish such report in the ,federal ,register1 together with any comments of the ,secretary on such report4 4 7,d7 ,additional amendments ,section #ahij;,a7b7 of such ,act1 as so added and amended1 is amended-- 7i7 in paragraph 7#b7-- 7,i7 in the heading of subparagraph 7,b7 by inserting and efficiency after ,quality2 7,,ii7 in subparagraph 7,b77i77,,iii71 by striking this ,act and inserting this title2 and 7,,iii7 by adding at the end the following new subparagraphs3 7,e7 ,input ,in providing the input described in subparagraph 7,a71 the multi-stakeholder groups-- 7i7 shall include a detailed description of the rationale for each recommendation made by the multi-stakeholder group1 including in areas relating to-- 7,i7 the expected impact that implementing the measure will have on individuals2 7,,ii7 the burden on providers of services and suppliers2 7,,iii7 the expected influence over the behavior of providers of services and suppliers2 7,,iv7 the applicability of a measure for more than one setting or program2 and 7,v7 other areas determined in consultation with the ,secretary2 and 7ii7 may consider whether it is appropriate to provide separate recommendations with respect to measures for internal use1 public reporting1 and payment provisions4 7,f7 ,equal representation ,in convening multi-stakeholder groups pursuant to this paragraph1 the entity shall1 to the extent feasible1 make every effort to ensure such groups are balanced across stakeholders4 2 and 7ii7 in paragraph 7#c71 by striking ,not later and all that follows through the period at the end and inserting the following3 ,not later than the applicable dates described in section #ahij;,b7a77#c7 of each year 7or1 as applicable1 the timeframe described in section #ahij;,a7a77#d771 the entity shall transmit to the ,secretary the input of the multi-stakeholder group under paragraph 7#b744 7b7 ,revisions to contract with consensus-based entity 7#a7 ,contract ,section #ahij7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7a77 is amended-- 7,a7 in paragraph 7#a71 by striking 1 such as the ,national ,quality ,forum12 and 7,b7 in paragraph 7#c71 by striking #d years and inserting #c years4 7#b7 ,duties ,section #ahij7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7b771 as amended by subsection 7a77#b71 is amended-- 7,a7 by redesignating paragraphs 7#b7 and 7#c7 as paragraphs 7#a7 and 7#b71 respectively2 7,b7 in paragraph 7#b71 as redesignated by subparagraph 7,a71 by striking paragraph 7#b7 and inserting paragraph 7#a72 7,c7 by striking paragraphs 7#e7 and 7#f72 and 7,d7 by adding at the end the following new paragraphs3 7#c7 ,facilitation to better coordinate and align public and private sector use of quality measures 7,a7 ,in general ,the entity shall facilitate increased coordination and alignment between the public and private sector with respect to quality and efficiency measures4 7,b7 ,reports ,the entity shall prepare and make available to the public annual reports on its findings under this paragraph4 ,such public availability shall include posting each report on the ,internet website of the entity4 7#d7 ,annual report to congress and the ,secretary2 secretarial publication and comment 7,a7 ,annual report ,by not later than ,march #a of each year1 the entity shall submit to ,congress and the ,secretary a report containing-- 7i7 a description of-- 7,i7 the coordination of quality initiatives under this ,act with quality initiatives implemented by other payers2 7,,ii7 areas in which evidence is insufficient to support endorsement of quality measures in priority areas identified by the ,secretary under the national strategy established under section #cii;,,hh of the ,public ,health ,service ,act and where targeted research may address such gaps2 and 7,,iii7 the performance by the entity of the duties required under the contract entered into with the ,secretary under subsection 7a72 and 7ii7 any other items determined appropriate by the ,secretary4 7,b7 ,secretarial review and publication of annual report ,not later than #f months after receiving a report under subparagraph 7,a7 for a year1 the ,secretary shall-- 7i7 review such report2 and 7ii7 publish such report in the ,federal ,register1 together with any comments of the ,secretary on such report4 4 7#c7 ,requirements ,section #ahij7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7c77 is amended by adding at the end the following new paragraph3 7#h7 ,not a measure developer ,the entity is not a measure developer4 4 7c7 ,revisions to duties of the ,secretary regarding use of measures 7#a7 ,in general ,section #ahij;,b7a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa-#a7;a771 as redesignated by subsection 7a77#a77;,a71 is amended-- 7,a7 by striking section #ahij7;b77#g77;,b7 each place it appears and inserting section #ahij;,a7b77#b77;,b72 7,b7 in paragraph 7#a7-- 7i7 by striking section #ahij7;b77#g7 and inserting section #ahij;,a7b77#b72 and 7ii7 by striking section #ahij and inserting section #ahij;,a2 7,c7 by striking paragraphs 7#b7 and 7#c7 and inserting the following3 7#b7 ,public availability of measures considered for selection ,subject to paragraph 7#d71 not later than ,october #a or ,december #ca of each year1 the ,secretary shall make available to the public a list of quality and efficiency measures described in section #ahij;,a7b77#b77;,b7 that the ,secretary is considering under this title4 ,the ,secretary shall provide for an appropriate balance of the number of measures to be made available by each such date in a year4 7#c7 ,transmission of multi-stakeholder input 7,a7 ,in general ,subject to paragraph 7#d71 not later than the applicable date described in subparagraph 7,b7 of each year1 the entity with a contract under section #ahij;,a shall1 pursuant to subsection 7b77#c7 of such section1 transmit to the ,secretary the input of multi-stakeholder groups described in paragraph 7#a74 7,b7 ,applicable date described ,the applicable date described in this subparagraph for a year is-- 7i7 ,february #a with respect to quality and efficiency measures made available under paragraph 7#b7 by ,october #a of the preceding year2 and 7ii7 ,april #a with respect to quality and efficiency measures made available under paragraph 7#b7 by ,december #ca of the preceding year4 2 7,d7 by redesignating-- 7i7 paragraph 7#f7 as paragraph 7#h72 and 7ii7 paragraphs 7#d7 and 7#e7 as paragraphs 7#e7 and 7#f71 respectively2 7,e7 by inserting after paragraph 7#c7 the following new paragraph3 7#d7 ,limited process for additional multi-stakeholder input ,in addition to the ,secretary making measures publically available pursuant to the dates described in paragraph 7#b7 and multi-stakeholder groups transmitting the input pursuant to the applicable dates described in paragraph 7#c7-- 7,a7 the ,secretary may1 at times that do not meet the time requirements described in paragraph 7#b71 make available to the public a limited number of quality and efficiency measures described in section #ahij;,a7b77#b7 that the ,secretary is considering under this title2 and 7,b7 if the ,secretary uses the authority under subparagraph 7,a71 the entity with a contract under section #ahij;,a shall1 pursuant to section #ahij;,a7b77#c71 transmit to the ,secretary on a timely basis the input from a multi-stakeholder group described in paragraph 7#a7 with respect to such measures4 2 7,f7 in paragraph 7#f71 as redesignated by subparagraph 7,d77ii71 by inserting or that has not been recommended by the multi-stakeholder group under section #ahij;,a7b77#b7 before the period at the end2 and 7,g7 by inserting after paragraph 7#f7 the following new paragraph3 7#g7 ,concordance rates ,for each year 7beginning with #bjae71 the ,secretary shall include a list of concordance rates for each type of provider of services and supplier in the annual final rule applicable to such type of provider or supplier4 4 7#b7 ,review ,section #ahij;,b7c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa-#a7;c771 as redesignated by subsection 7a77#a77;,a71 is amended-- 7,a7 in paragraph 7#a77;,a71 by striking section #ahij7;b77#g77;,b7 and inserting section #ahij;,a7b77#b77;,b72 and 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,a71 by striking and at the end2 7ii7 in subparagraph 7,b71 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following new subparagraph3 7,c7 take into consideration the benefits of the alignment of measures between the public and private sector4 4 7d7 ,funding for quality measure endorsement and selection 7#a7 ,fiscal year #bjad ,in addition to amounts transferred under section #cjad7;c7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 for purposes of carrying out section #ahij and section #ahij;,a 7other than subsections 7e7 and 7f771 the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 in such proportion as the ,secretary determines appropriate1 to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account of #g1jjj1jjj for fiscal year #bjad4 ,amounts transferred under the preceding sentence shall remain available until expended4 7#b7 ,fiscal years #bjae through #bjag ,section #ahij;,b of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa-#a71 as redesignated by subsection 7a77#a77;,a71 is amended by adding at the end the following new subsection3 7g7 ,funding 7#a7 ,in general ,for purposes of carrying out this section 7other than subsections 7e7 and 7f77 and sections #ahij and #ahij;,a1 the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 in such proportion as the ,secretary determines appropriate1 to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account of #be1jjj1jjj for each of fiscal years #bjae through #bjag4 7#b7 ,availability ,amounts transferred under paragraph 7#a7 shall remain available until expended4 4 7#c7 ,conforming amendment ,subsection 7d7 of section #ahij of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7 is repealed4 7e7 ,conforming amendments 7#a7 ,section #ahdh7m77#c77;,e77iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#c77;,e77iii77 is amended by striking section #ahij7;b77#g7 and #ahij;,a7a7 and inserting section #ahij;,a7b77#b7 and #ahij;,b7a74 7#b7 ,section #ahff;,d7b77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc-#d7;b77#b77;,c77 is amended by striking section #ahij and #ahij;,a and inserting sections #ahij1 #ahij;,a1 and #ahij;,b4 7#c7 ,section #ahii;,a7n77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc-#d7n77#b77;,a77 is amended by striking section #ahij7;b77#g77;,b7 and inserting section #ahij;,a7b77#b77;,b74 7f7 ,effective date 7#a7 ,in general ,the amendments made by this section shall take effect on ,october #a1 #bjad1 and shall apply with respect to contract periods under sections #ahij and #ahij;,a of the ,social ,security ,act that begin on or after such date4 7#b7 ,new contracts beginning with fiscal year #bjae ,the ,secretary of ,health and ,human ,services shall enter into a new contract under both sections #ahij and #ahij;,a of the ,social ,security ,act1 as amended by this ,act1 for a contract period beginning on ,october #a1 #bjad4 #bji4 ,permanent extension of funding outreach and assistance for low-income programs 7a7 ,additional funding for ,state health insurance programs ,subsection 7a77#a77;,b77iii7 of section #aai of the ,medicare ,improvements for ,patients and ,providers ,act of #bjjh 7#db ,u4,s4,c4 #acie;b-#c note71 as amended by section #ccjf of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 and section #faj of the ,american ,taxpayer ,relief ,act of #bjab 7,public ,law #aab-bdj71 is amended by inserting and for each subsequent fiscal year after fiscal year #bjac4 7b7 ,additional funding for area agencies on aging ,subsection 7b77#a77;,b7 of such section #aai1 as so amended1 is amended by inserting and for each subsequent fiscal year after fiscal year #bjac4 7c7 ,additional funding for aging and disability resource centers ,subsection 7c77#a77;,b7 of such section #aai1 as so amended1 is amended by inserting and for each subsequent fiscal year after fiscal year #bjac4 7d7 ,additional funding for contract with the national center for benefits and outreach enrollment ,subsection 7d77#b7 of such section #aai1 as so amended1 is amended by inserting and for each subsequent fiscal year after fiscal year #bjac4 ,b ,medicaid and ,other ,extensions #baa4 ,qualifying individual program 7a7 ,extension ,section #aijb7;a77#aj77;,e77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,e77iv77 is amended by striking ,december #bjac and inserting ,december #bjah4 7b7 ,eliminating limitations on eligibility ,section #aicc of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#c7 is amended by striking subsections 7b7 and 7e74 7c7 ,eliminating allocations ,section #aicc of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#c7 is amended by striking subsections 7c7 and 7g74 7d7 ,conforming amendments 7#a7 ,in general ,section #aicc of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#c71 as amended by subsections 7b7 and 7c71 is further amended-- 7,a7 by striking subsection 7a7 and inserting the following new subsection3 7a7 ,applicable ,,fmap ,with respect to assistance described in section #aijb7;a77#aj77;,e77iv7 furnished in a ,state1 the ,federal medical assistance percentage shall be equal to #ajj percent4 2 7,b7 by striking subsection 7d72 and 7,c7 by redesignating subsection 7f7 as subsection 7b74 7#b7 ,definition of ,,fmap ,section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended by striking section #aicc7;d7 and inserting section #aicc7;a74 7e7 ,effective date ,the amendments made by this section shall take effect on ,january #a1 #bjad1 and shall apply with respect to calendar quarters beginning on or after such date4 #bab4 ,transitional ,medical ,assistance 7a7 ,extension ,sections #aijb7;e77#a77;,b7 and #aibe7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#a77;,b71 #acifr-#f7;f77 are each amended by striking ,december #ca1 #bjac and inserting ,december #ca1 #bjah4 7b7 ,opt-out option for ,states that expand adult coverage and provide #ab-month continuous eligibility under ,medicaid and ,,chip 7#a7 ,in general ,section #aibe of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#f71 as amended by subsection 7a71 is further amended-- 7,a7 in subsection 7a7-- 7i7 in paragraph 7#a77;,a71 by striking paragraph 7#e7 and inserting paragraphs 7#e7 and 7#f72 and 7ii7 by adding at the end the following3 7#f7 ,opt-out option for ,states that expand adult coverage and provide #ab-month continuous eligibility under ,medicaid and ,,chip 7,a7 ,in general ,in the case of a ,state described in subparagraph 7,b71 the ,state may elect through a ,state plan amendment to have this section and sections #djh7;a77#aa77;,a71 #aijb7;a77#eb71 #aijb7;e77#a71 and #aica7;c77#b7 not apply to the ,state4 7,b7 ,state described ,a ,state is described in this subparagraph if the ,state is one of the #ej ,states or the ,district of ,columbia and-- 7i7 has elected to provide medical assistance to individuals under subclause 7,,viii7 of section #aijb7;a77#aj77;,a77i72 7ii7 has elected under section #aijb7;e77#ab77;,a7 the option to provide continuous eligibility for a #ab-month period for individuals under #ai years of age2 7iii7 has elected under section #aijb7;e77#ab77;,b7 the option to provide continuous eligibility for a #ab-month period for all categories of individuals described in that section2 and 7iv7 has elected to apply section #aijb7;e77#ab77;,a7 to the ,state child health plan under title ,,xxi4 2 and 7,b7 in subsection 7b77#a71 by striking subsection 7a77#e7 and inserting paragraphs 7#e7 and 7#f7 of subsection 7a74 7#b7 ,conforming amendment to #d-month requirement ,section #aijb7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#a771 as amended by subsection 7a71 is further amended-- 7,a7 in subparagraph 7,b71 by striking ,subparagraph 7,a7 and inserting ,subject to subparagraph 7,c71 subparagraph 7,a72 and 7,b7 by adding at the end the following3 7,c7 ,if a ,state has made an election under section #aibe7;a77#f71 subparagraph 7,a7 and section #aibe shall not apply to the ,state4 4 7c7 ,extension of #ab-month continuous eligibility option to certain adult enrollees under ,medicaid2 clarification of application to ,,chip 7#a7 ,in general ,section #aijb7;e77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ab77 is amended-- 7,a7 by redesignating subparagraphs 7,a7 and 7,b7 as clauses 7i7 and 7ii71 respectively2 7,b7 by inserting 7,a7 after 7#ab72 and 7,c7 by adding at the end the following3 7,b7 ,at the option of the ,state1 the plan may provide that an individual who is determined to be eligible for benefits under a ,state plan approved under this title under any of the following eligibility categories1 or who is redetermined to be eligible for such benefits under any of such categories1 shall be considered to meet the eligibility requirements met on the date of application and shall remain eligible for those benefits until the end of the #ab-month period following the date of the determination or redetermination of eligibility3 7i7 ,section #aijb7;a77#aj77;,a77i77,,viii74 7ii7 ,section #aica4 4 7#b7 ,application to ,,chip ,section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is amended-- 7,a7 by redesignating subparagraphs 7,e7 through 7,o7 as subparagraphs 7,f7 through 7,p71 respectively2 and 7,b7 by inserting after subparagraph 7,d71 the following3 7,e7 ,section #aijb7;e77#ab77;,a7 7relating to the ,state option for #ab-month continuous eligibility and enrollment74 4 7d7 ,conforming and technical amendments relating to section #aica transitional coverage requirements 7#a7 ,in general ,section #aica7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#a7;c77 is amended-- 7,a7 in paragraph 7#a7-- 7i7 in the paragraph heading1 by striking child and inserting spousal2 7ii7 by striking ,the provisions and inserting ,subject to paragraph 7#c71 the provisions2 and 7iii7 by striking child or2 7,b7 in paragraph 7#b71 by striking ,for continued and inserting ,subject to paragraph 7#c71 for continued2 and 7,c7 by adding at the end the following3 7#c7 ,opt-out option for ,states that expand adult coverage and provide #ab-month continuous eligibility under ,medicaid and ,,chip 7,a7 ,in general ,in the case of a ,state described in subparagraph 7,b71 the ,state may elect through a ,state plan amendment to have paragraphs 7#a7 and 7#b7 of this subsection and sections #djh7;a77#aa71 #aijb7;a77#eb71 #aijb7;e77#a71 and #aibe not apply to the ,state4 7,b7 ,state described ,a ,state is described in this subparagraph if the ,state is one of the #ej ,states or the ,district of ,columbia and-- 7i7 has elected to provide medical assistance to individuals under subclause 7,,viii7 of section #aijb7;a77#aj77;,a77i72 7ii7 has elected under section #aijb7;e77#ab77;,a7 the option to provide continuous eligibility for a #ab-month period for individuals under #ai years of age2 7iii7 has elected under section #aijb7;e77#ab77;,b7 the option to provide continuous eligibility for a #ab-month period for all categories of individuals described in that section2 and 7iv7 has elected to apply section #aijb7;e77#ab77;,a7 to the ,state child health plan under title ,,xxi4 4 7#b7 ,conforming amendment to section #djh ,section #djh7;a77#aa7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fjh7;a77#aa7 is amended-- 7,a7 in the paragraph heading1 by striking child and inserting spousal2 and 7,b7 in subparagraph 7,b7-- 7i7 in the subparagraph heading1 by striking ,child and inserting ,spousal2 and 7ii7 by striking child or4 7e7 ,conforming amendment relating to maintenance of effort for children ,section #aijb7;gg77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7gg77#d77 is amended by adding at the end the following3 7,c7 ,states that expand adult coverage and elect to opt-out of transitional coverage 7i7 ,in general ,for purposes of determining compliance with the requirements of paragraph 7#b71 a ,state which exercises the option under sections #aibe7;a77#f7 and #aica7;c77#c7 to provide no transitional medical assistance or other extended eligibility 7as applicable7 shall not1 as a result of exercising such option1 be considered to have in effect eligibility standards1 methodologies1 or procedures described in clause 7ii7 that are more restrictive than the standards1 methodologies1 or procedures in effect under the ,state plan or under a waiver of the plan on the date of enactment of the ,patient ,protection and ,affordable ,care ,act4 7ii7 ,standards1 methodologies1 or procedures described ,the eligibility standards1 methodologies1 or procedures described in this clause are those standards1 methodologies1 or procedures applicable to determining the eligibility for medical assistance of any child under #ai years of age 7or such higher age as the ,state may have elected74 4 7f7 ,effective date ,the amendments made by this section shall take effect on ,january #a1 #bjad4 #bac4 ,express lane eligibility ,section #aijb7;e77#ac77;,i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ac77;,i77 is amended by striking ,september #cj1 #bjad and inserting ,september #cj1 #bjae4 #bad4 ,pediatric quality measures 7a7 ,continuation of funding for pediatric quality measures for improving the quality of children's health care ,section #aaci;,b7e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;b7e77 is amended by adding at the end the following3 ,of the funds appropriated under this subsection1 not less than #ae1jjj1jjj shall be used to carry out section #aaci;,a7b744 7b7 ,elimination of restriction on medicaid quality measurement program ,section #aaci;,b7b77#e77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;b7b77#e77;,a77 is amended by striking ,the aggregate amount awarded by the ,secretary for grants and contracts for the development1 testing1 and validation of emerging and innovative evidence-based measures under such program shall equal the aggregate amount awarded by the ,secretary for grants under section #aaci;,a7b77#d77;,a7 4 #bae4 ,special diabetes programs 7a7 ,special diabetes programs for type ,i diabetes ,section #ccj;,b7b77#b77;,c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#b7;b77#b77;,c77 is amended by striking #bjad and inserting #bjai4 7b7 ,special diabetes programs for indians ,section #ccj;,c7c77#b77;,c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#c7;c77#b77;,c77 is amended by striking #bjad and inserting #bjai4 ,c ,human ,services ,extensions #bba4 ,abstinence education grants 7a7 ,in general ,section #eaj of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 is amended-- 7#a7 in subsection 7a71 in the matter preceding paragraph 7#a71 by striking #bjaj through #bjad and inserting #bjae through #bjai2 and 7#b7 in subsection 7d7-- 7,a7 by striking #bjaj through #bjad and inserting #bjae through #bjai2 and 7,b7 by striking the second sentence4 7b7 ,effective date ,the amendments made by this section shall take effect on ,october #a1 #bjad4 #bbb4 ,personal responsibility education program 7a7 ,in general ,section #eac of the ,social ,security ,act 7#db ,u4,s4,c4 #gac7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#a77;,a71 by striking #bjaj through #bjad and inserting #bjae through #bjai2 7,b7 in paragraph 7#d7-- 7i7 in subparagraph 7,a7-- 7,i7 by striking #bjaj or #bjaa and inserting #bjae or #bjaf2 7,,ii7 by striking #bjaj through #bjad and inserting #bjae through #bjai2 and 7,,iii7 by striking #bjab through #bjad and inserting #bjag through #bjai2 and 7ii7 in subparagraph 7,b77i7-- 7,i7 by striking #bjab1 #bjac1 and #bjad and inserting #bjag1 #bjah1 and #bjai2 and 7,,ii7 by striking #bjaj or #bjaa and inserting #bjae or #bjaf2 and 7,c7 in paragraph 7#e71 by striking #bjji and inserting #bjad2 7#b7 in subsection 7b77#b77;,a71 in the matter preceding clause 7i71 by inserting and youth at risk of becoming victims of sex trafficking 7as defined in section #ajc7aj7 of the ,trafficking ,victims ,protection ,act of #bjjj 7#bb ,u4,s4,c4 #gajb7aj777 or victims of a severe form of trafficking in persons described in paragraph 7#i77;,a7 of that ,act 7#bb ,u4,s4,c4 #gajb7i77;,a7 after adolescents2 7#c7 in subsection7c77#a71 by inserting youth at risk of becoming victims of sex trafficking 7as defined in section #ajc7aj7 of the ,trafficking ,victims ,protection ,act of #bjjj 7#bb ,u4,s4,c4 #gajb7aj777 or victims of a severe form of trafficking in persons described in paragraph 7#i77;,a7 of that ,act 7#bb ,u4,s4,c4 #gajb7i77;,a71 after youth in foster care12 and 7#d7 in subsection 7f71 by striking #bjaj through #bjad and inserting #bjae through #bjai4 7b7 ,effective date ,the amendments made by this section shall take effect on ,october #a1 #bjad4 #bbc4 ,family-to-family health information centers 7a7 ,in general ,section #eja7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gja7;c77 is amended-- 7#a7 in paragraph 7#a77;,a7-- 7,a7 in clause 7ii71 by striking and after the semicolon2 7,b7 in clause 7iii71 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following3 7iv7 #f1jjj1jjj for each of fiscal years #bjad through #bjah4 2 and 7#b7 by striking paragraph 7#e74 7b7 ,effective date ,the amendments made by this section shall take effect as if enacted on ,october #a1 #bjac4 #bbd4 ,health workforce demonstration project for low-income individuals ,section #bjjh7;c77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;g7c77#a77 is amended by striking through #bjad and inserting #bjab1 and only to carry out subsection 7a71 #he1jjj1jjj for each of fiscal years #bjac through #bjaf4 ,d ,program ,integrity #bca4 ,reducing improper ,medicare payments 7a7 ,medicare administrative contractor improper payment outreach and education program 7#a7 ,in general ,section #ahgd;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a7 is amended-- 7,a7 in subsection 7a77#d7-- 7i7 by redesignating subparagraph 7,g7 as subparagraph 7,h72 and 7ii7 by inserting after subparagraph 7,f7 the following new subparagraph3 7,g7 ,improper payment outreach and education program ,having in place an improper payment outreach and education program described in subsection 7h74 2 and 7,b7 by adding at the end the following new subsection3 7h7 ,improper payment outreach and education program 7#a7 ,in general ,in order to reduce improper payments under this title1 each medicare administrative contractor shall establish and have in place an improper payment outreach and education program under which the contractor1 through outreach1 education1 training1 and technical assistance activities1 shall provide providers of services and suppliers located in the region covered by the contract under this section with the information described in paragraph 7#c74 ,the activities described in the preceding sentence shall be conducted on a regular basis4 7#b7 ,forms of outreach1 education1 training1 and technical assistance activities ,the outreach1 education1 training1 and technical assistance activities under a payment outreach and education program shall be carried out through any of the following3 7,a7 ,emails and other electronic communications4 7,b7 ,webinars4 7,c7 ,telephone calls4 7,d7 ,in-person training4 7,e7 ,other forms of communications determined appropriate by the ,secretary4 7#c7 ,information to be provided through activities ,the information to be provided to providers of services and suppliers under a payment outreach and education program shall include all of the following information3 7,a7 ,a list of the provider's or supplier's most frequent and expensive payment errors over the last quarter4 7,b7 ,specific instructions regarding how to correct or avoid such errors in the future4 7,c7 ,a notice of all new topics that have been approved by the ,secretary for audits conducted by recovery audit contractors under section #ahic7;h74 7,d7 ,specific instructions to prevent future issues related to such new audits4 7,e7 ,other information determined appropriate by the ,secretary4 7#d7 ,error rate reduction training 7,a7 ,in general ,the activities under a payment outreach and education program shall include error rate reduction training4 7,b7 ,requirements 7i7 ,in general ,the training described in subparagraph 7,a7 shall-- 7,i7 be provided at least annually2 and 7,,ii7 focus on reducing the improper payments described in paragraph 7#e74 7,c7 ,invitation ,a medicare administrative contractor shall ensure that all providers of services and suppliers located in the region covered by the contract under this section are invited to attend the training described in subparagraph 7,a7 either in person or online4 7#e7 ,priority ,a medicare administrative contractor shall give priority to activities under the improper payment outreach and education program that will reduce improper payments for items and services that-- 7,a7 have the highest rate of improper payment2 7,b7 have the greatest total dollar amount of improper payments2 7,c7 are due to clear misapplication or misinterpretation of ,medicare policies2 7,d7 are clearly due to common and inadvertent clerical or administrative errors2 or 7,e7 are due to other types of errors that the ,secretary determines could be prevented through activities under the program4 7#f7 ,information on improper payments from recovery audit contractors 7,a7 ,in general ,in order to assist medicare administrative contractors in carrying out improper payment outreach and education programs1 the ,secretary shall provide each contractor with a complete list of improper payments identified by recovery audit contractors under section #ahic7;h7 with respect to providers of services and suppliers located in the region covered by the contract under this section4 ,such information shall be provided on a quarterly basis4 7,b7 ,information ,the information described in subparagraph 7,a7 shall include the following information3 7i7 ,the providers of services and suppliers that have the highest rate of improper payments4 7ii7 ,the providers of services and suppliers that have the greatest total dollar amounts of improper payments4 7iii7 ,the items and services furnished in the region that have the highest rates of improper payments4 7iv7 ,the items and services furnished in the region that are responsible for the greatest total dollar amount of improper payments4 7v7 ,other information the ,secretary determines would assist the contractor in carrying out the improper payment outreach and education program4 7,c7 ,format of information ,the information furnished to medicare administrative contractors by the ,secretary under this paragraph shall be transmitted in a manner that permits the contractor to easily identify the areas of the ,medicare program in which targeted outreach1 education1 training1 and technical assistance would be most effective4 ,in carrying out the preceding sentence1 the ,secretary shall ensure that-- 7i7 the information with respect to improper payments made to a provider of services or supplier clearly displays the name and address of the provider or supplier1 the amount of the improper payment1 and any other information the ,secretary determines appropriate2 and 7ii7 the information is in an electronic1 easily searchable database4 7#g7 ,communications ,all communications with providers of services and suppliers under a payment outreach and education program are subject to the standards and requirements of subsection 7g74 7#h7 ,funding ,after application of paragraph 7#a77;,c7 of section #ahic7;h71 the ,secretary shall retain a portion of the amounts recovered by recovery audit contractors under such section which shall be available to the program management account of the ,centers for ,medicare ,medicaid ,services for purposes of carrying out this subsection and to implement corrective actions to help reduce the error rate of payments under this title4 ,the amount retained under the preceding sentence shall not exceed an amount equal to #be percent of the amounts recovered under section #ahic7;h74 4 7#b7 ,funding conforming amendment ,section #ahic7;h77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h77#b77 is amended by inserting or section #ahgd7;h77#h7 after paragraph 7#a77;,c74 7#c7 ,effective date ,the amendments made by this subsection take effect on ,january #a1 #bjae4 7b7 ,transparency ,section #ahic7;h77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h77#h77 is amended-- 7#a7 by striking report4--,the ,secretary and inserting 8report4-- 7,a7 ,in general ,the ,secretary 2 and 7#b7 by adding at the end the following new subparagraph3 7,b7 ,inclusion of certain information 7i7 ,in general ,for reports submitted under this paragraph for #bjae or a subsequent year1 each such report shall include the information described in clause 7ii7 with respect to each of the following categories of audits carried out by recovery audit contractors under this subsection3 7,i7 ,automated4 7,,ii7 ,complex4 7,,iii7 ,medical necessity review4 7,,iv7 ,part ,a4 7,v7 ,part ,b4 7,,vi7 ,durable medical equipment4 7ii7 ,information described ,for purposes of clause 7i71 the information described in this clause1 with respect to a category of audit described in clause 7i71 is the result of all appeals for each individual level of appeals in such category4 4 7c7 ,recovery ,audit ,contractor ,demonstration ,project 7#a7 ,in general ,the ,secretary shall conduct a demonstration project under title ,,xviii of the ,social ,security ,act that-- 7,a7 targets audits by recovery audit contractors under section #ahic7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h77 with respect to high error providers of services and suppliers identified under paragraph 7#c72 and 7,b7 rewards low error providers of services and suppliers identified under such paragraph4 7#b7 ,scope 7,a7 ,duration ,the demonstration project shall be implemented not later than ,january #a1 #bjae1 and shall be conducted for a period of three years4 7,b7 ,demonstration area ,in determining the geographic area of the demonstration project1 the ,secretary shall consider the following3 7i7 ,the total number of providers of services and suppliers in the region4 7ii7 ,the diversity of types of providers of services and suppliers in the region4 7iii7 ,the level and variation of improper payment rates of and among individual providers of services and suppliers in the region4 7iv7 ,the inclusion of a mix of both urban and rural areas4 7#c7 ,identification of low error and high error providers of services and suppliers 7,a7 ,in general ,in conducting the demonstration project1 the ,secretary shall identify the following two groups of providers in accordance with this paragraph3 7i7 ,low error providers of services and suppliers4 7ii7 ,high error providers of services and suppliers4 7,b7 ,analysis ,for purposes of identifying the groups under subparagraph 7,a71 the ,secretary shall analyze the following as they relate to the total number and amount of claims submitted in the area and by each provider3 7i7 ,the improper payment rates of individual providers of services and suppliers4 7ii7 ,the amount of improper payments made to individual providers of services and suppliers4 7iii7 ,the frequency of errors made by the provider of services or supplier over time4 7iv7 ,other information determined appropriate by the ,secretary4 7,c7 ,assignment based on composite score ,the ,secretary shall assign selected providers of services and suppliers under the demonstration program based on a composite score determined using the analysis under subparagraph 7,b7 as follows3 7i7 ,providers of services and suppliers with high1 expensive1 and frequent errors shall receive a high score and be identified as high error providers of services and suppliers under subparagraph 7,a74 7ii7 ,providers of services and suppliers with few1 inexpensive1 and infrequent errors shall receive a low score and be identified as low error providers of services and suppliers under such subparagraph4 7iii7 ,only a small proportion of the total providers of services and suppliers and individual types of providers of services and suppliers in the geographic area of the demonstration project shall be assigned to either group identified under such subparagraph4 7,d7 ,timeframe of identification 7i7 ,in general ,any identification of a provider of services or a supplier under subparagraph 7,a7 shall be for a period of #ab months4 7ii7 ,reevaluation ,the ,secretary shall reevaluate each such identification at the end of such period4 7iii7 ,use of most current information ,in carrying out the reevaluation under clause 7ii7 with respect to a provider of services or supplier1 the ,secretary shall-- 7,i7 consider the most current information available with respect to the provider of services or supplier under the analysis under subparagraph 7,b72 and 7,,ii7 take into account improvement or regression of the provider of services or supplier4 7#d7 ,adjustment of record request maximum ,under the demonstration project1 the ,secretary shall establish procedures to-- 7,a7 increase the maximum record request made by recovery audit contractors to providers of services and suppliers identified as high error providers of services and suppliers under paragraph 7#c72 and 7,b7 decrease the maximum record request made by recovery audit contractors to providers of services and suppliers identified as low error providers of services and supplier under such paragraph4 7#e7 ,additional adjustments 7,a7 ,in general ,under the demonstration project1 the ,secretary may make additional adjustments to requirements for recovery audit contractors under section #ahic7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h77 and the conduct of audits with respect to low error providers of services and suppliers identified under paragraph 7#c7 and high error providers of services and suppliers identified under such paragraph as the ,secretary determines necessary in order to incentivize reductions in improper payment rates under title ,,xviii of such ,act 7#db ,u4,s4,c4 #acie et seq474 7,b7 ,limitation ,the ,secretary shall not exempt any group of providers of services or suppliers in the demonstration project from being subject to audit by a recovery audit contractor under such section #ahic7;h74 7#f7 ,evaluation and report 7,a7 ,evaluation ,the ,inspector ,general of the ,department of ,health and ,human ,services shall conduct an evaluation of the demonstration project under this subsection4 ,the evaluation shall include an analysis of-- 7i7 the error rates of providers of services and suppliers-- 7,i7 identified under paragraph 7#c7 as low error providers of services and suppliers2 7,,ii7 identified under such paragraph as high error providers of services and suppliers2 and 7,,iii7 that are located in the geographic area of the demonstration project and are not identified as either a low error or high error provider of services or supplier under such paragraph2 and 7ii7 any improvements in the error rates of those high error providers of services and suppliers identified under such paragraph4 7,b7 ,report ,not later than #ab months after completion of the demonstration project1 the ,inspector ,general shall submit to ,congress a report containing the results of the evaluation conducted under subparagraph 7,a71 together with recommendations on whether the demonstration project should be continued or expanded1 including on a permanent or nationwide basis4 7#g7 ,funding 7,a7 ,funding for implementation ,for purposes of carrying out the demonstration project under this subsection 7other than the evaluation and report under paragraph 7#f771 the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag 7#db ,u4,s4,c4 #acie;i7 and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda 7#db ,u4,s4,c4 #aciet71 in such proportion as the ,secretary determines appropriate1 of #aj1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account4 7,b7 ,funding for ,inspector ,general evaluation and report ,for purposes of carrying out the evaluation and report under paragraph 7#f71 the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under such section #ahag and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under such section #ahda1 in such proportion as the ,secretary determines appropriate1 of #bde1jjj to the ,inspector ,general of the ,department of ,health and ,human ,services4 7,c7 ,availability ,amounts transferred under subparagraph 7,a7 or 7,b7 shall remain available until expended4 7#h7 ,definitions ,in this section3 7,a7 ,demonstration project ,the term demonstration project means the demonstration project under this subsection4 7,b7 ,provider of services ,the term provider of services has the meaning given that term in section #ahfa7u74 7,c7 ,recovery audit contractor ,the term recovery audit contractor means an entity with a contract under section #ahic7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h774 7,d7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7,e7 ,supplier ,the term supplier has the meaning given that term in section #ahfa7;d74 #bcb4 ,authority for ,medicaid fraud control units to investigate and prosecute complaints of abuse and neglect of ,medicaid patients in home and community-based settings 7a7 ,in general ,section #aijc7q77#d77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7q77#d77;,a77 is amended to read as follows3 7#d7 7,a7 ,the entity's function includes a statewide program for the-- 7i7 investigation and prosecution1 or referral for prosecution or other action1 of complaints of abuse or neglect of patients in health care facilities which receive payments under the ,state plan under this title or under a waiver of such plan2 7ii7 at the option of the entity1 investigation and prosecution1 or referral for prosecution or other action1 of complaints of abuse or neglect of individuals in connection with any aspect of the provision of medical assistance and the activities of providers of such assistance in a home or community based setting that is paid for under the ,state plan under this title or under a waiver of such plan2 and 7iii7 at the option of the entity1 investigation and prosecution1 or referral for prosecution or other action1 of complaints of abuse or neglect of patients residing in board and care facilities4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on ,january #a1 #bjae4 #bcc4 ,improved use of funds received by the ,,hhs ,inspector ,general from oversight and investigative activities 7a7 ,in general ,section #aabh;,c7b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;c7b77 is amended to read as follows3 7b7 ,additional use of funds by ,inspector ,general 7#a7 ,collections from ,medicare and ,medicaid recovery actions ,notwithstanding section #ccjb of title #ca1 ,united ,states ,code1 or any other provision of law affecting the crediting of collections1 the ,inspector ,general of the ,department of ,health and ,human ,services may receive and retain three percent of all amounts collected pursuant to civil debt collection actions related to false claims or frauds involving the ,medicare program under title ,,xviii or the ,medicaid program under title ,,xix4 7#b7 ,crediting ,funds received by the ,inspector ,general under paragraph 7#a7 shall be deposited to the credit of any appropriation available for oversight and enforcement activities of the ,inspector ,general permitted under subsection 7a71 and shall remain available until expended4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to funds received from settlements finalized1 or judgements entered1 on or after the date of the enactment of this ,act4 #bcd4 ,preventing and reducing improper ,medicare and ,medicaid expenditures 7a7 ,requiring valid prescriber ,national ,provider ,identifiers on pharmacy claims ,section #ahfj;,d-#d7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77 is amended by adding at the end the following new paragraph3 7#d7 ,requiring valid prescriber ,national ,provider ,identifiers on pharmacy claims 7,a7 ,in general ,for plan year #bjae and subsequent plan years1 subject to subparagraph 7,b71 the ,secretary shall prohibit ,,pdp sponsors of prescription drug plans from paying claims for prescription drugs under this part that do not include a valid prescriber ,national ,provider ,identifier4 7,b7 ,procedures ,the ,secretary shall establish procedures for determining the validity of prescriber ,national ,provider ,identifiers under subparagraph 7,a74 7,c7 ,report ,not later than ,january #a1 #bjag1 the ,inspector ,general of the ,department of ,health and ,human ,services shall submit to ,congress a report on the effectiveness of the procedures established under subparagraph 7,b74 4 7b7 ,reforming how ,,cms tracks and corrects the vulnerabilities identified by ,recovery ,audit ,contractors ,section #ahic7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h77 is amended-- 7#a7 in paragraph 7#h71 as amended by section #bca1 by adding at the end the following new subparagraphs3 7,c7 ,inclusion of improper payment vulnerabilities identified ,for reports submitted under this paragraph for #bjae or a subsequent year1 each such report shall include-- 7i7 a description of-- 7,i7 the types and financial cost to the program under this title of improper payment vulnerabilities identified by recovery audit contractors under this subsection2 and 7,,ii7 how the ,secretary is addressing such improper payment vulnerabilities2 and 7ii7 an assessment of the effectiveness of changes made to payment policies and procedures under this title in order to address the vulnerabilities so identified4 7,d7 ,limitation ,the ,secretary shall ensure that each report submitted under subparagraph 7,a7 does not include information that the ,secretary determines would be sensitive or would otherwise negatively impact program integrity4 2 and 7#b7 by adding at the end the following new paragraph3 7#aj7 ,addressing improper payment vulnerabilities ,the ,secretary shall address improper payment vulnerabilities identified by recovery audit contractors under this subsection in a timely manner1 prioritized based on the risk to the program under this title4 4 7c7 ,strengthening ,medicaid program integrity through flexibility ,section #aicf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#f7 is amended-- 7#a7 in subsection 7a71 by inserting 1 or otherwise1 after entities2 and 7#b7 in subsection 7e7-- 7,a7 in paragraph 7#a71 in the matter preceding subparagraph 7,a71 by inserting 7including the costs of equipment1 salaries and benefits1 and travel and training7 after ,program under this section2 and 7,b7 in paragraph 7#c71 by striking by #ajj and inserting by #ajj1 or such number as determined necessary by the ,secretary to carry out the ,program under this section14 7d7 ,access to the ,national ,directory of ,new ,hires ,section #dec7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fec7;j77 is amended by adding at the end the following new paragraph3 7#ab7 ,information comparisons and disclosures to assist in administration of the ,medicare program and ,state health subsidy programs 7,a7 ,disclosure to the ,administrator of the ,centers for ,medicare ,medicaid ,services ,the ,administrator of the ,centers for ,medicare ,medicaid shall have access to the information in the ,national ,directory of ,new ,hires for purposes of determining the eligibility of an applicant for1 or enrollee in1 the ,medicare program under title ,,xviii or an applicable ,state health subsidy program 7as defined in section #adac7;e7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhc7;e774 7,b7 ,disclosure to the ,inspector ,general of the ,department of ,health and ,human ,services 7i7 ,in general ,if the ,inspector ,general of the ,department of ,health and ,human ,services transmits to the ,secretary the names and social security account numbers of individuals1 the ,secretary shall disclose to the ,inspector ,general information on such individuals and their employers maintained in the ,national ,directory of ,new ,hires4 7ii7 ,use of information ,the ,inspector ,general of the ,department of ,health and ,human ,services may use information provided under clause 7i7 only for purposes of -- 7,i7 determining the eligibility of an applicant for1 or enrollee in1 the ,medicare program under title ,,xviii or an applicable ,state health subsidy program 7as defined in section #adac7;e7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhc7;e772 or 7,,ii7 evaluating the integrity of the ,medicare program or an applicable ,state health subsidy program 7as so defined74 7,c7 ,disclosure to ,state agencies 7i7 ,in general ,if1 for purposes of determining the eligibility of an applicant for1 or an enrollee in1 an applicable ,state health subsidy program 7as defined in section #adac7;e7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhc7;e771 a ,state agency responsible for administering such program transmits to the ,secretary the names1 dates of birth1 and social security account numbers of individuals1 the ,secretary shall disclose to such ,state agency information on such individuals and their employers maintained in the ,national ,directory of ,new ,hires1 subject to this subparagraph4 7ii7 ,condition on disclosure by the ,secretary ,the ,secretary shall make a disclosure under clause 7i7 only to the extent that the ,secretary determines that the disclosure would not interfere with the effective operation of the program under this part4 7iii7 ,use and disclosure of information by ,state agencies 7,i7 ,in general ,a ,state agency may not use or disclose information provided under clause 7i7 except for purposes of determining the eligibility of an applicant for1 or an enrollee in1 a program referred to in clause 7i74 7,,ii7 ,information security ,the ,state agency shall have in effect data security and control policies that the ,secretary finds adequate to ensure the security of information obtained under clause 7i7 and to ensure that access to such information is restricted to authorized persons for purposes of authorized uses and disclosures4 7,,iii7 ,penalty for misuse of information ,an officer or employee of the ,state agency who fails to comply with this clause shall be subject to the sanctions under subsection 7l77#b7 to the same extent as if such officer or employee were an officer or employee of the ,united ,states4 7iv7 ,procedural requirements ,state agencies requesting information under clause 7i7 shall adhere to uniform procedures established by the ,secretary governing information requests and data matching under this paragraph4 7v7 ,reimbursement of costs ,the ,state agency shall reimburse the ,secretary1 in accordance with subsection 7k77#c71 for the costs incurred by the ,secretary in furnishing the information requested under this subparagraph4 4 7e7 ,improving the sharing of data between the ,federal ,government and ,state ,medicaid programs 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall establish a plan to encourage and facilitate the participation of ,states in the ,medicare-,medicaid ,data ,match ,program 7commonly referred to as the ,medi-,medi ,program7 under section #ahic7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7g774 7#b7 ,program revisions ,to improve ,medi-,medi ,data ,match ,program participation by ,states ,section #ahic7;g77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7g77#a77;,a77 is amended-- 7,a7 in the matter preceding clause 7i71 by inserting or otherwise after eligible entities2 7,b7 in clause 7i7-- 7i7 by inserting to review claims data after algorithms2 and 7ii7 by striking service1 time1 or patient and inserting provider1 service1 time1 or patient2 7,c7 in clause 7ii7-- 7i7 by inserting to investigate and recover amounts with respect to suspect claims after appropriate actions2 and 7ii7 by striking 2 and and inserting a semicolon2 7,d7 in clause 7iii71 by striking the period and inserting 2 and2 and 7,e7 by adding at end the following new clause3 7iv7 furthering the ,secretary's design1 development1 installation1 or enhancement of an automated data system architecture-- 7,i7 to collect1 integrate1 and assess data for purposes of program integrity1 program oversight1 and administration1 including the ,medi-,medi ,program2 and 7,,ii7 that improves the coordination of requests for data from ,states4 4 7#c7 ,providing states with data on improper payments made for items or services provided to dual eligible individuals 7,a7 ,in general ,the ,secretary shall develop and implement a plan that allows each ,state agency responsible for administering a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act access to relevant data on improper or fraudulent payments made under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for health care items or services provided to dual eligible individuals4 7,b7 ,dual eligible individual defined ,in this paragraph1 the term dual eligible individual means an individual who is entitled to1 or enrolled for1 benefits under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq471 or enrolled for benefits under part ,b of title ,,xviii of such ,act 7#db ,u4,s4,c4 #acie;j et seq471 and is eligible for medical assistance under a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 or under a waiver of such plan4 ,e ,other ,provisions #bda4 ,commission on ,improving ,patient ,directed ,health ,care 7a7 ,findings ,congress finds the following3 7#a7 ,in order to elevate the role of patient choices in the health care system1 the ,american public must engage in an informed1 national1 public debate on how the current health care system empowers and informs health care decision-making1 and what can be done to improve the likelihood patients receive the care they want and need4 7#b7 ,research suggests that patients often do not receive the care they want4 ,as a result1 the end of life is associated with a substantial burden of suffering by the patient and negative health and financial consequences that extend to family members and society4 7#c7 ,patients face a complex and fragmented health care system that may decrease the likelihood that health care choices are known and carried out4 ,the health care system should embed principles that take into account patient wishes4 7#d7 ,decisions concerning health care1 including end-of-life issues1 affect an increasing number of ,americans4 7#e7 ,medical advances are prolonging life expectancy in the ,united ,states both in acute life-threatening situations and protracted battles with illness4 ,these advances raise new challenges surrounding health care decision-making4 7#f7 ,the ,united ,states health care system should promote consideration of a person's preference in health care decision-making and end-of-life choices4 7b7 ,commission ,the ,social ,security ,act is amended by inserting after section #aaej;,b 7#db ,u4,s4,c4 #acbj;b-#bd7 the following new section3 #aaej;,c4 ,commission on ,improving ,patient ,directed ,health ,care 7a7 ,purposes ,the purposes of this section are to-- 7#a7 provide a forum for a nationwide public debate on improving patient self-determination in health care decision-making2 7#b7 identify strategies that ensure every ,american has the health care they want2 and 7#c7 provide recommendations to ,congress that result from the debate4 7b7 ,establishment ,the ,secretary shall establish an entity to be known as the ,commission on ,improving ,patient ,directed ,health ,care 7referred to in this section as the ,commission74 7c7 ,membership 7#a7 ,number and appointment ,the ,commission shall be composed of #ae members4 ,one member shall be the ,secretary4 ,the ,comptroller ,general of the ,united ,states shall appoint #ad members4 7#b7 ,qualifications ,the membership of the ,commission shall include-- 7,a7 health care consumers impacted by decision-making in advance of a health care crisis1 such as individuals of advanced age1 individuals with chronic1 terminal and mental illnesses1 family care givers1 and individuals with disabilities2 7,b7 providers in settings where crucial health care decision-making occurs1 such as those working in intensive care settings1 emergency room departments1 primary care settings1 nursing homes1 hospice1 or palliative care settings2 7,c7 payors ensuring patients get the level of care they want2 7,d7 experts in advance care planning1 hospice1 palliative care1 information technology1 bioethics1 aging policy1 disability policy1 pediatric ethics1 cultural sensitivity1 psychology1 and health care financing2 7,e7 individuals who represent culturally diverse perspectives on patient self-determination and end-of-life issues2 and 7,f7 members of the faith community4 7d7 ,period of appointment ,members of the ,commission shall be appointed for the life of the ,commission4 ,any vacancies shall not affect the power and duties of the ,commission but shall be filled in the same manner as the original appointment4 7e7 ,designation of the chairperson ,not later than #ae days after the date on which all members of the ,commission have been appointed1 the ,comptroller ,general shall designate the chairperson of the ,commission4 7f7 ,subcommittees ,the ,commission may establish subcommittees if doing so increases the efficiency of the ,commission in completing tasks4 7g7 ,duties 7#a7 ,hearings ,not later than #ij days after the date of designation of the chairperson under subsection 7e71 the ,commission shall hold no fewer than #h hearings to examine-- 7,a7 the current state of health care decision-making and advance care planning laws in the ,united ,states at the ,federal level and across the ,states1 as well as options for improving advance care planning tools1 especially with regard to use1 portability1 and storage2 7,b7 consumer-focused approaches that educate the ,american public about patient choices1 care planning1 and other end-of-life issues2 7,c7 the use of comprehensive1 patient-centered care plans by providers1 the impact care plans have on health care delivery1 and methods to expand the use of high quality care planning tools in both public and private health care systems2 7,d7 the role of electronic medical records and other technologies in improving patient-directed health care2 7,e7 innovative tools for improving patient experience with advanced illness1 such as palliative care1 hospice1 and other models2 7,f7 the role social determinants of health1 such as socio-economic status1 play in patient self-direction in health care2 7,g7 the use of culturally-competent tools for health care decision-making2 7,h7 strategies for educating providers on care planning1 palliative care1 hospice care1 and other issues surrounding honoring patient choices2 7,i7 the sociological and psychological factors that influence health care decision-making and end-of-life choices2 and 7,j7 the role of spirituality and religion in patient self-determination in health care4 7#b7 ,additional hearings ,the ,commission may hold additional hearings on subjects other than those listed in paragraph 7#a7 so long as such hearings are determined necessary by the ,commission in carrying out the purposes of this section4 ,such additional hearings do not have to be completed within the time period specified but shall not delay the other activities of the ,commission under this section4 7#c7 ,number and location of hearings and additional hearings ,the ,commission shall hold no fewer than #h hearings as indicated in paragraph 7#a7 and in sufficient number in order to receive information that reflects-- 7,a7 the geographic differences throughout the ,united ,states2 7,b7 diverse populations2 and 7,c7 a balance among urban and rural populations4 7#d7 ,interactive technology ,the ,commission may encourage public participation in hearings through interactive technology and other means as determined appropriate by the ,commission4 7#e7 ,report to the american people on patient directed health care ,not later than #ij days after the hearings described in paragraphs 7#a7 and 7#b7 are completed1 the ,commission shall prepare and make available to health care consumers through the ,internet and other appropriate public channels1 a report to be entitled1 ,report to the ,american ,people on ,patient ,directed ,health ,care4 ,such a report shall be understandable to the general public and include-- 7,a7 a summary of-- 7i7 the hearings described in such paragraphs2 7ii7 how the current health care system empowers and informs decision-making in advance of a health care crisis2 7iii7 factors that contribute to the provision of health care that does not adhere to patient wishes2 7iv7 the impact of care that does not follow patient choices1 particularly at the end-of-life1 on patients1 families1 providers1 and the health care system2 7v7 the laws surrounding advance care planning and health care decision-making including issues of portability1 use1 and storage2 7vi7 consumer-focused approaches to education of the ,american public about patient choices1 care planning1 and other end-of-life issues2 7vii7 the role of care plans in health care decision-making2 7viii7 the role of providers in ensuring patients receive the care they want2 7ix7 the role of electronic medical records and other technologies in improving patient directed health care2 7x7 the impact of social determinants on patient self-direction in health care services2 7xi7 the use of culturally competent methods for health care decision-making2 7xii7 the sociological and psychological factors that influence patient self-determination2 and 7xiii7 the role of spirituality and religion in health care decision-making and end-of-life care2 7,b7 best practices from communities1 providers1 and payors that document patient wishes and provide health care that adheres to those wishes2 and 7,c7 information on educating providers about health care decision-making and end-of-life issues4 7#f7 ,interim requirements ,not later than #ahj days after the date of completion of the hearings1 the ,commission shall prepare and make available to the public through the ,internet and other appropriate public channels1 an interim set of recommendations on patient self-determination in health care and ways to improve and strengthen the health care system based on the information and preferences expressed at the community meetings4 ,there shall be a #ij-;day public comment period on such recommendations4 7h7 ,recommendations ,not later than #abj days after the expiration of the public comment period described in subsection 7g77#f71 the ,commission shall submit to ,congress and the ,president a final set of recommendations4 ,the recommendations must be comprehensive and detailed4 ,the recommendations must contain recommendations or proposals for legislative or administrative action as the ,commission deems appropriate1 including proposed legislative language to carry out the recommendations or proposals4 7i7 ,administration 7#a7 ,executive director ,there shall be an ,executive ,director of the ,commission who shall be appointed by the chairperson of the ,commission in consultation with the members of the ,commission4 7#b7 ,compensation ,while serving on the business of the ,commission 7including travel time71 a member of the ,commission shall be entitled to compensation at the per diem equivalent of the rate provided for level ,,iv of the ,executive ,schedule under section #ecae of title #e1 ,united ,states ,code1 and while so serving away from home and the member's regular place of business1 a member may be allowed travel expenses1 as authorized by the chairperson of the ,commission4 ,for purposes of pay and employment benefits1 rights1 and privileges1 all personnel of the ,commission shall be treated as if they were employees of the ,senate4 7#c7 ,information from federal agencies ,the ,commission may secure directly from any ,federal department or agency such information as the ,commission considers necessary to carry out this section4 ,upon request of the ,commission the head of such department or agency shall furnish such information4 7#d7 ,postal services ,the ,commission may use the ,united ,states mails in the same manner and under the same conditions as other departments and agencies of the ,federal ,government4 7j7 ,detail ,not more than #e ,federal ,government employees employed by the ,department of ,labor1 #e ,federal ,government employees employed by the ,social ,security ,administration1 and #aj ,federal ,government employees employed by the ,department of ,health and ,human ,services may be detailed to the ,commission under this section without further reimbursement4 ,any detail of an employee shall be without interruption or loss of civil service status or privilege4 7k7 ,temporary and intermittent services ,the chairperson of the ,commission may procure temporary and intermittent services under section #caji7;b7 of title #e1 ,united ,states ,code1 at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level ,v of the ,executive ,schedule under section #ecaf of such title4 7l7 ,annual report ,not later than #a year after the date of enactment of this ,act1 and annually thereafter during the existence of the ,commission1 the ,commission shall report to ,congress and make public a detailed description of the expenditures of the ,commission used to carry out its duties under this section4 7m7 ,sunset of commission ,the ,commission shall terminate on the date that is #d years after the date on which all the members of the ,commission have been appointed under subsection 7c77#a7 and appropriations are first made available to carry out this section4 7n7 ,administration review and comments ,not later than #de days after receiving the final recommendations of the ,commission under subsection 7h71 the ,president shall submit a report to ,congress which shall contain-- 7#a7 additional views and comments on such recommendations2 and 7#b7 recommendations for such legislation and administrative action as the ,president considers appropriate4 7o7 ,required congressional action ,not later than #de days after receiving the report submitted by the ,president under subsection 7n71 each committee of jurisdiction of ,congress1 the ,committee on ,finance of the ,senate1 the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 the ,committee on ,ways and ,means of the ,house of ,representatives1 the ,committee on ,energy and ,commerce of the ,house of ,representatives1 and the ,committee on ,education and the ,workforce of the ,house of ,representatives1 shall hold at least #a hearing on such report and on the final recommendations of the ,commission submitted under subsection 7h74 7p7 ,authorization of appropriations 7#a7 ,in general ,there are authorized to be appropriated to carry out this section1 #c1jjj1jjj for each of fiscal years #bjad and #bjae4 7#b7 ,report to the ,american people on patient directed health care ,there are authorized to be appropriated for the preparation and dissemination of the ,report to the ,american ,people on ,patient ,directed ,health ,care described in subsection 7g77#e71 such sums as may be necessary for the fiscal year in which the report is required to be submitted4 4 #bdb4 ,expansion of the definition of inpatient hospital services for certain cancer hospitals ,section #ahfa7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7b77#c77 is amended-- 7#a7 by inserting 7,a7 after 7#c72 and 7#b7 by adding and after the semicolon at the end2 and 7#c7 by adding at the end the following new subparagraph3 7,b7 with respect to a hospital that is described in section #ahhf7;d77#a77;,b77v7 and that1 as of the date of the enactment of the ,,sgr ,repeal and ,medicare ,beneficiary ,access ,act of #bjac1 is located in the same building1 or on the same campus1 as another hospital1 items and services described in paragraphs 7#a7 and 7#b7 furnished on or after such date of enactment by the hospital described in such section or by others under arrangements with them made by the hospital2 4 #bdc4 ,quality measures for certain post-acute care providers relating to notice and transfer of patient health information and patient care preferences 7a7 ,development ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall provide for the development of one or more quality measures under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 to accurately communicate the existence and provide for the transfer of patient health information and patient care preferences when an individual transitions from a hospital to return home or move to other post-acute care settings4 7b7 ,use of measure developers ,the ,secretary shall arrange for the development of such measures by appropriate measure developers4 7c7 ,endorsement ,the ,secretary shall arrange for such developed measures to be submitted for endorsement to a consensus-based entity as described in section #ahij7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7a771 as amended by section #bjh4 7d7 ,use of measures ,the ,secretary shall1 through notice and comment rulemaking1 use such measures under the quality reporting programs with respect to-- 7#a7 inpatient hospitals under section #ahhf7;b77#c77;,b77viii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,b77viii772 7#b7 skilled nursing facilities under section #ahhh7;e7 of such ,act 7#db ,u4,s4,c4 #acieyy7e772 7#c7 home health services under section #ahie7;b77#c77;,b77v7 of such ,act 7#db ,u4,s4,c4 #acie;fff7b77#c77;,b77v772 and 7#d7 other providers of services 7as defined in section #ahfa7u7 of such ,act7 and suppliers 7as defined in section #ahfa7;d7 of such ,act7 that the ,secretary determines appropriate4 #bdd4 ,criteria for medically necessary1 short inpatient hospital stays 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall consult with1 and seek input from1 interested stakeholders to determine appropriate criteria for payment under the ,medicare program under title ,,viii of the ,social ,security ,act of an inpatient hospital admission that-- 7#a7 is medically necessary2 and 7#b7 is an inpatient hospital stay that is less than two midnights1 as described in section #dab4c of title #db1 ,code of ,federal ,regulation1 as finalized in the final rule published by the ,centers for ,medicare ,medicaid ,services in the ,federal ,register on ,august #ai1 #bjac 7#gh ,federal ,register #ejdif7 entitled ,medicare ,program2 ,hospital ,inpatient ,prospective ,payment ,systems for ,acute ,care ,hospitals and the ,long-,term ,care ,hospital ,prospective ,payment ,system and ,fiscal ,year #bjad ,rates2 ,quality ,reporting ,requirements for ,specific ,providers2 ,hospital ,conditions of ,participation2 ,payment ,policies ,related to ,patient ,status4 7b7 ,interested stakeholders ,in subsection 7a71 the term interested stakeholders means the following3 7#a7 ,hospitals4 7#b7 ,physicians 7#c7 ,medicare administrative contractors under section #ahgd;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a74 7#d7 ,recovery audit contractors under section #ahic7;h7 of such ,act 7#db ,u4,s4,c4 #acie;ddd7h774 7#e7 ,other parties determined appropriate by the ,secretary4 #bde4 ,transparency of reasons for excluding additional procedures from the ,medicare ambulatory surgical center 7,,asc7 approved list ,section #ahcc7;i77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7i77#a77 is amended by adding at the end the following3 ,in updating such lists for application in years beginning after ,december #ca1 #bjad1 for each procedure that was requested to be included on such lists during the public comment period but which the ,secretary does not propose 7in the final rule updating such lists7 to so include1 the ,secretary shall describe in such final rule the specific safety criteria for not including such procedure on such lists44 #bdf4 ,supervision in critical access hospitals 7a7 ,general supervision in critical access hospitals ,section #ahcd7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7g77 is amended by adding at the end the following new paragraph3 7#f7 ,supervision ,in the case of services furnished on or after the date of the enactment of this paragraph1 the level of supervision with respect to outpatient critical access hospital services shall be general supervision 7as defined by the ,secretary74 4 7b7 ,supervision of cardiac and pulmonary rehabilitation programs in critical access hospitals ,section #ahfa7;eee77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7eee77#b77;,b77 is amended by inserting 1 or in the case of a critical access hospital1 a physician1 or 7beginning on the date of enactment of the ,,sgr ,repeal and ,medicare ,beneficiary ,access ,act of #bjac7 a nurse practitioner1 clinical nurse specialist1 or physician assistant 7as such terms are defined in subsection 7aa77#e771 after a physician4 #bdg4 ,requiring ,state licensure of bidding entities under the competitive acquisition program for certain durable medical equipment1 prosthetics1 orthotics1 and supplies 7,,dmepos7 ,section #ahdg7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#a77 is amended by adding at the end the following new subparagraph3 7,g7 ,requiring ,state licensure of bidding entities ,with respect to rounds of competitions beginning on or after the date of enactment of this subparagraph1 the ,secretary may only accept a bid from an entity for an area if the entity meets applicable ,state licensure requirements for such area for all items in such bid4 4 #bdh4 ,recognition of attending physician assistants as attending physicians ,to serve hospice patients 7a7 ,recognition of attending physician assistants as attending physicians ,to serve hospice patients 7#a7 ,in general ,section #ahfa7;dd77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd77#c77;,b77 is amended-- 7,a7 by striking or nurse and inserting 1 the nurse2 and 7,b7 by inserting 1 or the physician assistant 7as defined in such subsection7 after subsection 7aa77#e774 7#b7 ,clarification of hospice role of physician assistants ,section #ahad7;a77#g77;,a77i77,i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7a77#g77;,a77i77,i77 is amended by inserting or a physician assistant after a nurse practitioner4 7b7 ,effective date ,the amendments made by this section shall apply to items and services furnished on or after ,january #a1 #bjae4 #bdi4 ,remote patient monitoring pilot projects 7a7 ,pilot projects 7#a7 ,in general ,not later than #i months after the date of the enactment of this ,act1 the ,secretary shall conduct pilot projects under title ,,xviii of the ,social ,security ,act for the purpose of providing incentives to home health agencies to furnish remote patient monitoring services that reduce expenditures under such title4 7#b7 ,site requirements 7,a7 ,urban and ,rural ,the ,secretary shall conduct the pilot projects under this section in both urban and rural areas4 7,b7 ,site in a small state ,the ,secretary shall conduct at least #a of the pilot projects in a ,state with a population of less than #a1jjj1jjj4 7b7 ,medicare beneficiaries within the scope of projects 7#a7 ,in general ,the ,secretary shall specify the criteria for identifying those ,medicare beneficiaries who shall be considered within the scope of the pilot projects under this section for purposes of the application of subsection 7c7 and for the assessment of the effectiveness of the home health agency in achieving the objectives of this section4 7#b7 ,criteria ,the criteria specified under paragraph 7#a7-- 7,a7 shall include conditions and clinical circumstances1 including congestive heart failure1 diabetes1 and chronic pulmonary obstructive disease1 and other conditions determined appropriate by the ,secretary2 and 7,b7 may provide for the inclusion in the projects of ,medicare beneficiaries who begin receiving home health services under title ,,xviii of the ,social ,security ,act after the date of the implementation of the projects4 7c7 ,incentives 7#a7 ,performance targets ,the ,secretary shall establish for each home health agency participating in a pilot project under this section a performance target using one of the following methodologies1 as determined appropriate by the ,secretary3 7,a7 ,adjusted historical performance target ,the ,secretary shall establish for the agency-- 7i7 a base expenditure amount equal to the average total payments made under parts ,a1 ,b1 and ,d of title ,,xviii of the ,social ,security ,act for ,medicare beneficiaries determined to be within the scope of the pilot project in a base period determined by the ,secretary2 and 7ii7 an annual per capita expenditure target for such beneficiaries1 reflecting the base expenditure amount adjusted for risk1 changes in costs1 and growth rates4 7,b7 ,comparative performance target ,the ,secretary shall establish for the agency a comparative performance target equal to the average total payments made under such parts ,a1 ,b1 and ,d during the pilot project for comparable individuals in the same geographic area that are not determined to be within the scope of the pilot project4 7#b7 ,payment ,subject to paragraph 7#c71 the ,secretary shall pay to each home health agency participating in a pilot project a payment for each year under the pilot project equal to a #ge percent share of the total ,medicare cost savings realized for such year relative to the performance target under paragraph 7#a74 7#c7 ,limitation on expenditures ,the ,secretary shall limit payments under this section in order to ensure that the aggregate expenditures under title ,,xviii of the ,social ,security ,act 7including payments under this subsection7 do not exceed the amount that the ,secretary estimates would have been expended if the pilot projects under this section had not been implemented1 including any reasonable costs incurred by the ,secretary in the administration of the pilot projects4 7#d7 ,no duplication in participation in shared savings programs ,a home health agency that participates in any of the following shall not be eligible to participate in the pilot projects under this section3 7,a7 ,a model tested or expanded under section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 that involves shared savings under title ,,xviii of such ,act or any other program or demonstration project that involves such shared savings4 7,b7 ,the independence at home medical practice demonstration program under section #ahff;,e of such ,act 7#db ,u4,s4,c4 #acie;cc-#e74 7d7 ,waiver authority ,the ,secretary may waive such provisions of titles ,,xi and ,,xviii of the ,social ,security ,act as the ,secretary determines to be appropriate for the conduct of the pilot projects under this section4 7e7 ,report to ,congress ,not later than #c years after the date that the first pilot project under this section is implemented1 the ,secretary shall submit to ,congress a report on the projects4 ,such report shall contain-- 7#a7 a detailed description of the projects1 including any changes in clinical outcomes for ,medicare beneficiaries under the projects1 ,medicare beneficiary satisfaction under the projects1 utilization of items and services under parts ,a1 ,b1 and ,d of title ,,xviii of the ,social ,security ,act by ,medicare beneficiaries under the projects1 and ,medicare per-beneficiary and ,medicare aggregate spending under the projects2 7#b7 a detailed description of issues related to the expansion of the projects under subsection 7f72 7#c7 recommendations for such legislation and administrative actions as the ,secretary considers appropriate2 and 7#d7 other items considered appropriate by the ,secretary4 7f7 ,expansion ,if the ,secretary determines that any of the pilot projects under this section enhance health outcomes for ,medicare beneficiaries and reduce expenditures under title ,,xviii of the ,social ,security ,act1 the ,secretary shall initiate comparable projects in additional areas4 7g7 ,payments have no effect on other ,medicare payments to home health agencies ,a payment under this section shall have no effect on the amount of payments that a home health agency would otherwise receive under title ,,xviii of the ,social ,security ,act for the provision of home health services4 7h7 ,study and report on the appropriate valuation for remote patient monitoring services under the ,medicare physician fee schedule 7#a7 ,study ,the ,secretary shall conduct a study on the appropriate valuation for remote patient monitoring services under the ,medicare physician fee schedule under section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 in order to accurately reflect the resources involved in furnishing such services4 7#b7 ,report ,not later than #f months after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under paragraph 7#a71 together with such recommendations as the ,secretary determines appropriate4 7i7 ,definitions ,in this section3 7#a7 ,home health agency ,the term home health agency has the meaning given that term in section #ahfa7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7o774 7#b7 ,remote patient monitoring services 7,a7 ,in general ,the term remote patient monitoring services means services furnished in the home using remote patient monitoring technology which-- 7i7 shall include patient monitoring or patient assessment2 and 7ii7 may include in-home technology-based professional consultations1 patient training services1 clinical observation1 treatment1 and any additional services that utilize technologies specified by the ,secretary4 7,b7 ,limitation ,the term remote patient monitoring services shall not include a telecommunication that consists solely of a telephone audio conversation1 facsimile1 or electronic text mail between a health care professional and a patient4 7#c7 ,remote patient monitoring technology ,the term remote patient monitoring technology means a coordinated system that uses one or more home-based or mobile monitoring devices that automatically transmit vital sign data or information on activities of daily living and may include responses to assessment questions collected on the devices wirelessly or through a telecommunications connection to a server that complies with the ,federal regulations 7concerning the privacy of individually identifiable health information7 promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif1 as part of an established plan of care for that patient that includes the review and interpretation of that data by a health care professional4 7#d7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 #bej4 ,community-,based ,institutional ,special ,needs ,plan ,demonstration ,program 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall establish a ,community-,based ,institutional ,special ,needs ,plan 7,,cbi-,,snp7 demonstration program to prevent and delay institutionalization under ,medicaid among targeted low-income ,medicare beneficiaries4 7b7 ,establishment ,the ,secretary shall enter into agreements with not more than #e specialized ,,ma plans for special needs individuals1 as defined in section #ahei7;b77#f77;,b77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f77;,b77i771 to conduct the ,,cbi-,,snp demonstration program4 ,under the ,,cbi-,,snp demonstration program1 a targeted low-income ,medicare beneficiary shall receive1 as supplemental benefits under section #aheb7;a77#c7 of such ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#c771 long-term care services or supports that-- 7#a7 the ,secretary determines appropriate for the purposes of the ,,cbi-,,snp demonstration program2 and 7#b7 for which payment may be made under the ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 of the ,state in which the targeted low-income ,medicare beneficiary is located4 7c7 ,eligible plans ,to be eligible to participate in the ,,cbi-,,snp demonstration program1 a specialized ,,ma plan for special needs individuals must-- 7#a7 serve special needs individuals 7as defined in section #ahei7;b77#f77;,b77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f77;,b77i772 7#b7 have experience in offering special needs plans for nursing home-eligible1 non-institutionalized ,medicare beneficiaries who live in the community2 7#c7 be located in a ,state that the ,secretary has determined will participate in the ,,cbi-,,snp demonstration program by agreeing to make available data necessary for purposes of conducting the independent evaluation required under subsection 7f72 and 7#d7 meet such other criteria as the ,secretary may require4 7d7 ,targeted low-income ,medicare beneficiary defined ,in this section1 the term targeted low-income ,medicare beneficiary means a ,medicare beneficiary who-- 7#a7 is enrolled in a specialized ,,ma plan for special needs individuals that has been selected to participate in the ,,cbi-,,snp demonstration program2 7#b7 is a subsidy eligible individual 7as defined in section #ahfj;,d-#ad7;a77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77;,a772 and 7#c7 is unable to perform #b or more activities of daily living 7as defined in section #ggjb;,b7c77#b77;,b7 of the ,internal ,revenue ,code of #aihf74 7e7 ,implementation deadline2 duration ,the ,,cbi-,,snp demonstration program shall be implemented not later than ,january #a1 #bjaf1 and shall be conducted for a period of #c years4 7f7 ,independent evaluation and reports 7#a7 ,independent evaluation ,not later than #b years after the completion of the ,,cbi-,,snp demonstration program1 the ,secretary shall provide for the evaluation of the ,,cbi-,,snp demonstration program by an independent third party4 ,the evaluation shall determine whether the ,,cbi-,,snp demonstration program has improved patient care and quality of life for the targeted low-income ,medicare beneficiaries participating in the ,,cbi-,,snp demonstration program4 ,specifically1 the evaluation shall determine if the ,,cbi-,,snp demonstration program has-- 7,a7 reduced hospitalizations or re-hospitalizations2 7,b7 reduced ,medicaid nursing home facility stays2 and 7,c7 reduced spenddown of income and assets for purposes of becoming eligible for ,medicaid4 7#b7 ,reports ,not later than #c years after the completion of the ,,cbi-,,snp demonstration program1 the ,secretary shall submit to ,congress a report containing the results of the evaluation conducted under paragraph 7#a71 together with such recommendations for legislative or administrative action as the ,secretary determines appropriate4 7g7 ,funding 7#a7 ,funding for implementation ,for purposes of carrying out the demonstration program under this section 7other than the evaluation and report under subsection 7f771 the ,secretary shall provide for the transfer from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of such ,act 7#db ,u4,s4,c4 #aciet71 in such proportion as the ,secretary determines appropriate1 of #c1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account4 7#b7 ,funding for evaluation and report ,for purposes of carrying out the evaluation and report under subsection 7f71 the ,secretary shall provide for the transfer from the ,federal ,hospital ,insurance ,trust ,fund under such section #ahag and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under such section #ahda1 in such proportion as the ,secretary determines appropriate1 of #ejj1jjj4 7#c7 ,availability ,amounts transferred under paragraph 7#a7 or 7#b7 shall remain available until expended4 7h7 ,budget neutrality ,in conducting the ,,cbi-,,snp demonstration program1 the ,secretary shall ensure that the aggregate payments made by the ,secretary do not exceed the amount which the ,secretary estimates would have been expended under titles ,,xviii and ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq41 #acif et seq47 if the ,,cbi-,,snp demonstration program had not been implemented4 7i7 ,paperwork ,reduction ,act ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to the testing and evaluation of the ,,cbi-,,snp demonstration program under this section4 #bea4 ,applying ,,cmmi waiver authority to ,,pace in order to foster innovations 7a7 ,,cmmi waiver authority ,subsection 7d77#a7 of section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 is amended-- 7#a7 by inserting 7other than subsections 7b77#a77;,a7 and 7c77#e7 of section #ahid7 after ,,xviii2 and 7#b7 by striking and #aijc7m77#b77;,a77iii7 and inserting #aijc7m77#b77;,a77iii71 and #aicd 7other than subsections 7b77#a77;,a7 and 7c77#e7 of such section74 7b7 ,sense of the ,senate ,it is the sense of the ,senate that the ,secretary of ,health and ,human ,services should use the waiver authority provided under the amendments made by this section to provide1 in a budget neutral manner1 programs of all-inclusive care for the elderly 7,,pace programs7 with increased operational flexibility to support the ability of such programs to improve and innovate and to reduce technical and administrative barriers that have hindered enrollment in such programs4 #beb4 ,improve and modernize ,medicaid data systems and reporting 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall implement a strategic plan to increase the usefulness of data about ,state ,medicaid programs reported by ,states to the ,centers for ,medicare ,medicaid ,services4 ,the strategic plan shall address redundancies and gaps in ,medicaid data systems and reporting through improvements to1 and modernization of1 computer and data systems4 ,areas for improvement under the plan shall include 7but not be limited to7 the following3 7#a7 ,the reporting of encounter data by managed care plans4 7#b7 ,the timeliness and quality of reported data1 including enrollment data4 7#c7 ,the consistency of data reported from multiple sources4 7#d7 ,information about ,state program policies4 7b7 ,implementation status report ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit a report to ,congress on the status of the implementation of the strategic plan required under subsection 7a74 7c7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary of ,health and ,human ,services for the period of fiscal years #bjae through #baji1 such sums as may be necessary to carry out this section4 #bec4 ,fairness in ,medicaid supplemental needs trusts 7a7 ,in general ,section #aiag7;d77#d77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifp7d77#d77;,a77 is amended by inserting the individual1 after for the benefit of such individual by4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to trusts established on or after the date of the enactment of this ,act4 #bed4 ,helping ,ensure ,life- and ,limb-,saving ,access to ,podiatric ,physicians 7a7 ,including podiatrists as physicians under the ,medicaid program 7#a7 ,in general ,section #aije7;a77#e77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#e77;,a77 is amended by striking section #ahfa7r77#a7 and inserting paragraphs 7#a7 and 7#c7 of section #ahfa7r74 7#b7 ,effective date 7,a7 ,in general ,except as provided in subparagraph 7,b71 the amendment made by paragraph 7#a7 shall apply to services furnished on or after the date of enactment of this ,act4 7,b7 ,extension of effective date for ,state law amendment ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 which the ,secretary of ,health and ,human ,services determines requires ,state legislation in order for the plan to meet the additional requirement imposed by the amendment made by paragraph 7#a71 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session is considered to be a separate regular session of the ,state legislature4 7b7 ,modifications to requirements for diabetic shoes to be included under medical and other health services under ,medicare 7#a7 ,in general ,section #ahfa7s77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#ab77 is amended to read as follows3 7#ab7 subject to section #djgb7;e7 of the ,omnibus ,budget ,reconciliation ,act of #aihg1 extra-depth shoes with inserts or custom molded shoes 7in this paragraph referred to as therapeutic shoes7 with inserts for an individual with diabetes1 if-- 7,a7 the physician who is managing the individual's diabetic condition-- 7i7 documents that the individual has diabetes2 7ii7 certifies that the individual is under a comprehensive plan of care related to the individual's diabetic condition2 and 7iii7 documents agreement with the prescribing podiatrist or other qualified physician 7as established by the ,secretary7 that it is medically necessary for the individual to have such extra-depth shoes with inserts or custom molded shoes with inserts2 7,b7 the therapeutic shoes are prescribed by a podiatrist or other qualified physician 7as established by the ,secretary7 who-- 7i7 examines the individual and determines the medical necessity for the individual to receive the therapeutic shoes2 and 7ii7 communicates in writing the medical necessity to the physician described in subparagraph 7,a7 for the individual to have therapeutic shoes along with findings that the individual has peripheral neuropathy with evidence of callus formation1 a history of pre-ulcerative calluses1 a history of previous ulceration1 foot deformity1 previous amputation1 or poor circulation2 and 7,c7 the therapeutic shoes are fitted and furnished by a podiatrist or other qualified supplier 7as established by the ,secretary71 such as a pedorthist or orthotist1 who is not the physician described in subparagraph 7,a7 7unless the ,secretary finds that the physician is the only such qualified individual in the area72 4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall apply with respect to items and services furnished on or after ,january #a1 #bjae4 #bee4 ,demonstration program to improve community mental health services 7a7 ,establishment ,not later than ,january #a1 #bjaf1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 in coordination with the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 shall award planning grants to not to exceed #aj ,states to enable such ,states to carry out #e-year demonstration programs to improve the provision of behavioral health services provided by certified community behavioral health clinics in the ,state4 7b7 ,eligibility 7#a7 ,application ,to be eligible to receive a grant under subsection 7a71 a ,state shall-- 7,a7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require2 7,b7 certify to the ,secretary that behavioral health providers that are provided assistance under the demonstration program meet the criteria for certified community behavioral health clinics under subsection 7c72 7,c7 conduct a financial assessment of the demonstration program to be carried out under the grant by providing a detailed estimate of eligible clinics and ,medicaid expenditures over the entire projected period of the demonstration program2 and 7,d7 comply with any other requirement determined appropriate by the ,secretary4 7#b7 ,waiver of ,medicaid requirement ,in approving ,states to conduct demonstration programs under this section1 the ,secretary shall waive section #aijb7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#a77 7relating to statewideness7 as may be necessary to conduct the demonstration program in accordance with the requirements of this section 7c7 ,criteria 7#a7 ,criteria for certified community behavioral health clinics ,the criteria referred to in subsection 7b77#a77;,b7 are that the center performs each of the following3 7,a7 ,provide services in locations that ensure services will be available and accessible promptly and in a manner which preserves human dignity and assures continuity of care4 7,b7 ,provide services in a mode of service delivery appropriate for the target population4 7,c7 ,provide individuals with a choice of service options1 including developmentally appropriate evidence based interventions1 where there is more than one efficacious treatment4 7,d7 ,employ a core clinical staff that is trained to provide evidence-based practices and is multidisciplinary and culturally and linguistically competent1 including the availability of translation or similar services and arrangements if the clinic is located in a geographic area of limited ,english-speaking ability4 7,e7 ,establish an emergency plan to support continuity of services for individuals during an emergency or disaster4 7,f7 ,demonstrate the capacity to comply with behavioral health and related health care quality measures promulgated by such entities as the ,national ,quality ,forum1 the ,national ,committee for ,quality ,assurance1 or other nationally recognized accrediting bodies4 7,g7 ,provide services to any individual residing or employed in the service area of the clinic and ensure that no patient or consumer will be denied mental health or other health care services due to an individual's inability to pay for such services4 7,h7 ,ensure that any fees or payments required by the clinic for such services will be imposed for individuals eligible for medical assistance under the ,state ,medicaid plan under title ,,xix of the ,social ,security ,act in accordance with the requirements of such ,state plan and for any other individuals will be reduced or waived to enable the clinic to comply with subparagraph 7,g71 including preparing a schedule of fees or payments for the provision of services that is consistent with locally prevailing rates or charges designed to cover the reasonable costs to the clinic of operation along with a corresponding schedule of discounts to be applied to the payment of such fees or payments1 such discounts to be adjusted on the basis of the patient's ability to pay4 7,i7 ,report required encounter data1 clinical outcomes data1 and quality data4 7,j7 ,provide1 directly or through contract1 to the extent covered for adults in the ,state ,medicaid plan under title ,,xix of the ,social ,security ,act and for children in accordance with section #aije7r7 of such ,act regarding early and periodic screening1 diagnosis1 and treatment1 each of the following services3 7i7 ,screening1 assessment1 and diagnosis1 including risk assessment4 7ii7 ,person-centered treatment planning or similar processes1 including risk assessment and crisis planning4 7iii7 ,outpatient mental health and substance use services1 including screening1 assessment1 diagnosis1 psychotherapy1 cognitive behavioral therapy1 applied behavioral analysis1 medication management1 and integrated treatment for trauma1 mental illness1 and substance abuse which shall be evidence-based 7including cognitive behavioral therapy1 long acting injectable medications1 and other such therapies which are evidence-based74 7iv7 ,outpatient clinic primary care screening and monitoring of key health indicators and health risk 7including screening for diabetes1 hypertension1 and cardiovascular disease and monitoring of weight1 height1 body mass index 7,,bmi71 blood pressure1 blood glucose or ,hb,a#a;,c1 and lipid profile74 7v7 ,crisis mental health services1 including #bd-;hour mobile crisis teams1 emergency crisis intervention services1 and crisis stabilization4 7vi7 ,targeted case management 7services to assist individuals gaining access to needed medical1 social1 educational1 and other services and applying for income security and other benefits to which they may be entitled71 and care coordination4 7vii7 ,psychiatric rehabilitation services including skills training1 assertive community treatment1 family psychoeducation1 disability self-management1 supported employment1 supported housing services1 therapeutic foster care services1 and such other evidence-based practices as the ,secretary may require4 7viii7 ,peer support and counselor services and family supports4 7,k7 ,maintain linkages1 and where possible enter into formal contracts1 agreements1 or partnerships with at least one federally qualified health center1 unless there is no such center serving the service area1 in order to ensure that the delivery of behavioral health care is integrated with primary and preventive care services1 so long as such linkages1 contract1 agreement1 or partnership meets requirements as prescribed by the ,secretary2 7,l7 ,maintain additional linkages and where possible enter into formal contracts with the following3 7i7 ,inpatient psychiatric facilities and substance use detoxification1 post-detoxification step-down services1 and residential programs4 7ii7 ,adult and youth peer support and counselor services4 7iii7 ,family support services for families of children with serious mental or substance use disorders4 7iv7 ,other community or regional services1 supports1 and providers1 including schools1 child welfare agencies1 juvenile and criminal justice agencies and facilities1 ,indian ,health ,service youth regional treatment centers1 housing agencies and programs1 employers1 ,state licensed and nationally accredited child placing agencies for therapeutic foster care service1 and other social and human services4 7v7 ,onsite or offsite access to primary care services4 7vi7 ,enabling services1 including outreach1 transportation1 and translation4 7vii7 ,health and wellness services1 including services for tobacco cessation4 7viii7 ,department of ,veterans ,affairs medical centers1 independent outpatient clinics1 drop-in centers1 and other facilities of the ,department as defined in section #ahja of title #ch1 ,united ,states ,code4 7ix7 ,inpatient acute care hospitals and hospital outpatient clinics4 7,m7 ,where feasible1 provide outreach and engagement to encourage individuals who could benefit from mental health care to freely participate in receiving the administrative services described in this subsection4 7,n7 ,where feasible1 provide intensive1 community-based mental health care for members of the armed forces and veterans1 particularly those members and veterans located in rural areas1 such care to be consistent with minimum clinical mental health guidelines promulgated by the ,veterans ,health ,administration including clinical guidelines contained in the ,uniform ,mental ,health ,services ,handbook of such ,administration4 7,o7 ,where feasible1 require certified community behavioral health clinics to provide valid and reliable trauma screening and functional or developmental assessment to determine need1 match services to needs1 and to measure progress over time4 7#b7 ,regulations ,prior to the selection of participating ,states1 and not later than #ah months after the date of the enactment of this ,act1 the ,secretary1 in consultation with the ,substance ,abuse and ,mental ,health ,services ,administration and the ,state ,mental ,health and ,substance ,abuse ,authorities1 shall issue final regulations for certifying non-profit and local government behavioral health authorities and ,indian ,health ,service tribal facilities as community behavioral health clinics4 7d7 ,requirements ,in awarding grants under this section1 the ,secretary shall-- 7#a7 ensure the geographic diversity of grantee ,states2 7#b7 ensure that certified community behavioral health clinics in such ,states that are located in rural areas1 as defined by the ,secretary1 and other mental health professional shortage areas are fairly and appropriately considered with the objective of facilitating access to mental health services in such areas2 7#c7 take into account the ability of clinics in such ,states to provide required services1 and the ability of such clinics to report required data as required under this section2 and 7#d7 take into account the ability of such ,states to provide such required services on a statewide basis4 7e7 ,exemption ,for purposes of this section1 certified community behavioral health clinics that receive payments under section #aijb7;bb7 of the ,social ,security ,act which are located in rural areas1 as defined by the ,secretary1 shall be exempt from the requirements contained in subparagraphs 7,a7 and 7,j77v7 of subsection 7c77#a74 7f7 ,treatment of certain services provided by community behavioral health clinics as medical assistance 7#a7 ,in general ,for purposes of the demonstration program under this section1 community behavioral health clinic services 7as defined in subsection 7h77#a77 that are provided by certified community behavioral health clinics receiving assistance under this section shall be considered medical assistance for purposes of payments to ,states under paragraph 7#c77;,c74 7#b7 ,grant condition ,as a condition of receiving a grant under this section1 a ,state shall agree to provide for payment for community behavioral health clinic services in accordance with the prospective payment system established by the ,secretary under paragraph 7#c74 7#c7 ,prospective payment system 7,a7 ,in general ,not later than #ah months after the date of enactment of this ,act1 the ,secretary shall establish a prospective payment system for community behavioral health clinic services furnished by a community behavioral health clinic receiving assistance under this section in the same manner as payments are required to be made under section #aijb7;bb7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7bb77 for services described in section #aije7;a77#b77;,c7 of such ,act 7#db ,u4,s4,c4 #acif;d7a77#b77;,c77 furnished by a ,federally-qualified health center and services described in section #aije7;a77#b77;,b7 of such ,act 7#db ,u4,s4,c4 #acif;d7a77#b77;,b77 furnished by a rural health clinic4 7,b7 ,requirements ,the prospective payment system established by the ,secretary under subparagraph 7,a7 shall provide that-- 7i7 no payment shall be made for inpatient care1 residential treatment1 room and board expenses1 or any other non-ambulatory services1 as determined by the ,secretary2 and 7ii7 no payment shall be made to satellite facilities of community behavioral health clinics if such facilities are established after the date of enactment of this ,act4 7,c7 ,payments to states ,the ,secretary shall pay each ,state awarded a grant under this section an amount each quarter equal to the enhanced ,,fmap 7as defined in section #baje7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7b77 but without regard to the second and third sentences of that section7 of the ,state's expenditures in the quarter for medical assistance for community behavioral health clinic services provided by certified community behavioral health clinics in the ,state that receive assistance under this section4 ,payments to ,states made under this subparagraph shall be considered to have been under1 and are subject to the requirements of1 section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b74 7g7 ,annual report 7#a7 ,in general ,not later than #a year after the date on which the first grants are awarded under this section1 and annually thereafter1 the ,secretary shall submit to ,congress an annual report on the use of funds provided under the demonstration program4 ,each such report shall include-- 7,a7 an assessment of access to community-based mental health services under the ,medicaid program in the ,states awarded such grants2 7,b7 an assessment of the quality and scope of services provided by certified community behavioral health clinics under the grants as compared against community-based mental health services provided in ,states that are not receiving such grants2 and 7,c7 an assessment of the impact of the demonstration programs on the costs of a full range of mental health services 7including inpatient1 emergency and ambulatory services74 7#b7 ,recommendations ,not later than ,december #ca1 #bjai1 the ,secretary shall submit to ,congress recommendations concerning whether the demonstration programs under this section should be continued and expanded on a national basis4 7h7 ,definitions ,in this section3 7#a7 ,community behavioral health clinic services ,the term community behavioral health clinic services means ambulatory behavioral health services of the type described in subparagraphs 7,j71 7,m71 7,n71 and 7,o7 of subsection 7c77#a7 that are provided by certified community behavioral health clinics receiving assistance under this section4 7#b7 ,state ,the term ,state has the meaning given such term for purposes of title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7i7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #ej1jjj1jjj for fiscal year #bjaf1 to remain available until expended4 #bef4 ,annual ,medicaid ,,dsh report ,section #aibc of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7 is amended by adding at the end the following3 7k7 ,annual report to ,congress 7#a7 ,in general ,beginning ,january #a1 #bjae1 and annually thereafter1 the ,secretary shall submit a report to ,congress on the program established under this section for making payment adjustments to disproportionate share hospitals for the purpose of providing ,congress with information relevant to determining an appropriate level of overall funding for such payment adjustments during and after the period in which aggregate reductions in the ,,dsh allotments to ,states are required under paragraphs 7#g7 and 7#h7 of subsection 7f74 7#b7 ,required report information ,except as otherwise provided1 each report submitted under this subsection shall include the following3 7,a7 ,information and data relating to changes in the number of uninsured individuals for the most recent year for which such data are available as compared to #bjac and as compared to the ,congressional ,budget ,office estimates of uninsured individuals made at the time of the enactment of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 and the ,health ,care and ,education ,reconciliation ,act of #bjaj 7,public ,law #aaa-aeb74 7,b7 ,information and data relating to the extent to which hospitals continue to incur uncompensated care costs from providing unreimbursed or under-reimbursed services to individuals who either are eligible for medical assistance under the ,state plan under this title or under a waiver of such plan or who have no health insurance 7or other source of third party coverage7 for such services4 7,c7 ,information and data relating to the extent to which hospitals continue to provide charity care and unreimbursed or under-reimbursed services1 or otherwise incur bad debt1 under the program established under this title1 the ,state ,children's ,health ,insurance ,program established under title ,,xxi1 and ,state or local indigent care programs1 as reported on cost reports submitted under title ,,xviii or such other data as the ,secretary determines appropriate4 7,d7 ,in the first report submitted under this section1 a methodology for estimating the amount of unpaid patient deductibles1 copayments and coinsurance incurred by hospitals for patients enrolled in qualified health plans through an ,american ,health ,benefits ,exchange1 using existing data and minimizing the administrative burden on hospitals to the extent possible1 and in subsequent reports1 data regarding such uncompensated care costs collected pursuant to such methodology4 7,e7 ,for each ,state1 information and data relating to the difference between the ,,dsh allotment for the ,state for the fiscal year that began on ,october #a of the year preceding the year in which the report is submitted and the aggregate amount of uncompensated care costs for all disproportionate share hospitals in the ,state4 7,f7 ,information and data relating to the extent to which there are certain vital hospital systems that are disproportionately experiencing high levels of uncompensated care and that have multiple other missions1 such as a commitment to graduate medical education1 the provision of tertiary and trauma care services1 providing public health and essential community services1 and providing comprehensive1 coordinated care4 7,g7 ,such other information and data relevant to the determination of the level of funding for1 and amount of1 ,state ,,dsh allotments as the ,secretary determines appropriate 7#c7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary for the period of fiscal years #bjae through #baji1 such sums as may be necessary to carry out this subsection4 4 #beg4 ,implementation ,to the extent the ,secretary of ,health and ,human ,services issues a regulation to carry out the provisions of this ,act1 the ,secretary shall1 unless otherwise specified in this ,act-- 7#a7 issue a notice of proposed rulemaking that includes the proposed regulation2 7#b7 provide a period of not less than #fj calendar days for comments on the proposed regulation2 7#c7 not more than #bd months following the date of publication of the proposed rule1 publish the final regulation or take alternative action 7such as withdrawing the rule or proposing a revised rule with a new comment period7 on the proposed regulation2 and 7#d7 not less than #cj days before the effective date of the final regulation1 publish the final regulation or take alternative action 7such as withdrawing the rule or proposing a revised rule with a new comment period7 on the proposed regulation4 ,december #ai1 #bjac,read twice and placed on the calendar