,i #aadth ,,congress #ast ,session ,h4 ,r4 #b ,,in ,,the ,,house ,,of ,,representatives ,march #bd1 #bjae ,mr4 ,burgess 7for himself1 ,mr4 ,upton1 ,mr4 ,levin1 ,mr4 ,ryan of ,wisconsin1 ,mr4 ,pallone1 ,mr4 ,pitts1 ,mr4 ,gene ,green of ,texas1 ,mr4 ,brady of ,texas1 ,mr4 ,mc,dermott1 ,mr4 ,boustany1 and ,mr4 ,sessions7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 the ,judiciary1 ,agriculture1 ,natural ,resources1 and the ,budget1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to repeal the ,medicare sustainable growth rate and strengthen ,medicare access by improving physician payments and making other improvements1 to reauthorize the ,children's ,health ,insurance ,program1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,title ,i--,,sgr ,repeal and ,medicare ,provider ,payment ,modernization ,sec4 #aja4 ,repealing the sustainable growth rate 7,,sgr7 and improving ,medicare payment for physicians' services4 ,sec4 #ajb4 ,priorities and funding for measure development4 ,sec4 #ajc4 ,encouraging care management for individuals with chronic care needs4 ,sec4 #ajd4 ,empowering beneficiary choices through continued access to information on physicians' services4 ,sec4 #aje4 ,expanding availability of ,medicare data4 ,sec4 #ajf4 ,reducing administrative burden and other provisions4 ,title ,,ii--,medicare and ,other ,health ,extenders ,subtitle ,a--,medicare ,extenders ,sec4 #bja4 ,extension of work ,,gpci floor4 ,sec4 #bjb4 ,extension of therapy cap exceptions process4 ,sec4 #bjc4 ,extension of ambulance add-ons4 ,sec4 #bjd4 ,extension of increased inpatient hospital payment adjustment for certain low-volume hospitals4 ,sec4 #bje4 ,extension of the ,medicare-dependent hospital 7,,mdh7 program4 ,sec4 #bjf4 ,extension for specialized ,medicare ,advantage plans for special needs individuals4 ,sec4 #bjg4 ,extension of funding for quality measure endorsement1 input1 and selection4 ,sec4 #bjh4 ,extension of funding outreach and assistance for low-income programs4 ,sec4 #bji4 ,extension and transition of reasonable cost reimbursement contracts4 ,sec4 #baj4 ,extension of home health rural add-on4 ,subtitle ,b--,other ,health ,extenders ,sec4 #baa4 ,permanent extension of the qualifying individual 7,,qi7 program4 ,sec4 #bab4 ,permanent extension of transitional medical assistance 7,,tma74 ,sec4 #bac4 ,extension of special diabetes program for type ,i diabetes and for ,indians4 ,sec4 #bad4 ,extension of abstinence education4 ,sec4 #bae4 ,extension of personal responsibility education program 7,,prep74 ,sec4 #baf4 ,extension of funding for family-to-family health information centers4 ,sec4 #bag4 ,extension of health workforce demonstration project for low-income individuals4 ,sec4 #bah4 ,extension of maternal1 infant1 and early childhood home visiting programs4 ,sec4 #bai4 ,tennessee ,,dsh allotment for fiscal years #bjae through #bjbe4 ,sec4 #bbj4 ,delay in effective date for ,medicaid amendments relating to beneficiary liability settlements4 ,sec4 #bba4 ,extension of funding for community health centers1 the ,national ,health ,service ,corps1 and teaching health centers4 ,title ,,iii--,,chip ,sec4 #cja4 #b-year extension of the ,children's ,health ,insurance ,program4 ,sec4 #cjb4 ,extension of express lane eligibility4 ,sec4 #cjc4 ,extension of outreach and enrollment program4 ,sec4 #cjd4 ,extension of certain programs and demonstration projects4 ,sec4 #cje4 ,report of ,inspector ,general of ,,hhs on use of express lane option under ,medicaid and ,,chip4 ,title ,,iv--,offsets ,subtitle ,a--,medicare ,beneficiary ,reforms ,sec4 #dja4 ,limitation on certain medigap policies for newly eligible ,medicare beneficiaries4 ,sec4 #djb4 ,income-related premium adjustment for parts ,b and ,d4 ,subtitle ,b--,other ,offsets ,sec4 #daa4 ,medicare payment updates for post-acute providers4 ,sec4 #dab4 ,delay of reduction to ,medicaid ,,dsh allotments4 ,sec4 #dac4 ,levy on delinquent providers4 ,sec4 #dad4 ,adjustments to inpatient hospital payment rates4 ,title ,v--,miscellaneous ,subtitle ,a--,protecting the ,integrity of ,medicare ,sec4 #eja4 ,prohibition of inclusion of ,social ,security account numbers on ,medicare cards4 ,sec4 #ejb4 ,preventing wrongful ,medicare payments for items and services furnished to incarcerated individuals1 individuals not lawfully present1 and deceased individuals4 ,sec4 #ejc4 ,consideration of measures regarding ,medicare beneficiary smart cards4 ,sec4 #ejd4 ,modifying ,medicare durable medical equipment face-to-face encounter documentation requirement4 ,sec4 #eje4 ,reducing improper ,medicare payments4 ,sec4 #ejf4 ,improving senior ,medicare patrol and fraud reporting rewards4 ,sec4 #ejg4 ,requiring valid prescriber ,national ,provider ,identifiers on pharmacy claims4 ,sec4 #ejh4 ,option to receive ,medicare ,summary ,notice electronically4 ,sec4 #eji4 ,renewal of ,,mac contracts4 ,sec4 #eaj4 ,study on pathway for incentives to ,states for ,state participation in medicaid data match program4 ,sec4 #eaa4 ,guidance on application of ,common ,rule to clinical data registries4 ,sec4 #eab4 ,eliminating certain civil money penalties2 gainsharing study and report4 ,sec4 #eac4 ,modification of ,medicare home health surety bond condition of participation requirement4 ,sec4 #ead4 ,oversight of ,medicare coverage of manual manipulation of the spine to correct subluxation4 ,sec4 #eae4 ,national expansion of prior authorization model for repetitive scheduled non-emergent ambulance transport4 ,sec4 #eaf4 ,repealing duplicative ,medicare secondary payor provision4 ,sec4 #eag4 ,plan for expanding data in annual ,,cert report4 ,sec4 #eah4 ,removing funds for ,medicare ,improvement ,fund added by ,,impact ,act of #bjad4 ,sec4 #eai4 ,rule of construction4 ,subtitle ,b--,other provisions ,sec4 #eba4 ,extension of two-midnight ,,pama rules on certain medical review activities4 ,sec4 #ebb4 ,requiring bid surety bonds and ,state licensure for entities submitting bids under the ,medicare ,,dmepos competitive acquisition program4 ,sec4 #ebc4 ,payment for global surgical packages4 ,sec4 #ebd4 ,extension of ,secure ,rural ,schools and ,community ,self-,determination ,act of #bjjj4 ,sec4 #ebe4 ,exclusion from ,,paygo scorecards4 ,i ,,sgr ,repeal and ,medicare ,provider ,payment ,modernization #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;,a7-- 7,i7 by inserting and ending with #bjbe after beginning with #bjja2 and 7,,ii7 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 #bjad after years beginning with #bjja2 and 7,,ii7 in subparagraph 7,a71 by inserting and ending with #bjad after a year beginning with #bjja2 and 7,b7 in subsection 7f7-- 7i7 in paragraph 7#a77;,b71 by inserting through #bjad after of each succeeding year2 and 7ii7 in paragraph 7#b71 in the matter preceding subparagraph 7,a71 by inserting and ending with #bjad after beginning with #bjjj4 7#b7 ,update of rates for #bjae and subsequent years ,subsection 7d7 of section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is amended-- 7,a7 in paragraph 7#a77;,a71 by adding at the end the following3 ,there shall be two separate conversion factors for each year beginning with #bjbf1 one for items and services furnished by a qualifying ,,apm participant 7as defined in section #ahcc7z77#b77 7referred to in this subsection as the qualifying ,,apm conversion factor7 and the other for other items and services 7referred to in this subsection as the nonqualifying ,,apm conversion factor71 equal to the respective conversion factor for the previous year 7or1 in the case of #bjbf1 equal to the single conversion factor for #bjbe7 multiplied by the update established under paragraph 7#bj7 for such respective conversion factor for such year42 7,b7 in paragraph 7#a77;,d71 by inserting 7or1 beginning with #bjbf1 applicable conversion factor7 after single conversion factor2 and 7,c7 by striking paragraph 7#af7 and inserting the following new paragraphs3 7#af7 ,update for ,january through ,june of #bjae ,subject to paragraphs 7#g77;,b71 7#h77;,b71 7#i77;,b71 7#aj77;,b71 7#aa77;,b71 7#ab77;,b71 7#ac77;,b71 7#ad77;,b71 and 7#ae77;,b71 in lieu of the update to the single conversion factor established in paragraph 7#a77;,c7 that would otherwise apply for #bjae for the period beginning on ,january #a1 #bjae1 and ending on ,june #cj1 #bjae1 the update to the single conversion factor shall be #j4j percent4 7#ag7 ,update for ,july through ,december of #bjae ,the update to the single conversion factor established in paragraph 7#a77;,c7 for the period beginning on ,july #a1 #bjae1 and ending on ,december #ca1 #bjae1 shall be #j4e percent4 7#ah7 ,update for #bjaf through #bjai ,the update to the single conversion factor established in paragraph 7#a77;,c7 for #bjaf and each subsequent year through #bjai shall be #j4e percent4 7#ai7 ,update for #bjbj through #bjbe ,the update to the single conversion factor established in paragraph 7#a77;,c7 for #bjbj and each subsequent year through #bjbe shall be #j4j percent4 7#bj7 ,update for #bjbf and subsequent years ,for #bjbf and each subsequent year1 the update to the qualifying ,,apm conversion factor established under paragraph 7#a77;,a7 is #j4ge percent1 and the update to the nonqualifying ,,apm conversion factor established under such paragraph is #j4be percent4 4 7#c7 ,med,p,a,c reports 7,a7 ,initial report ,not later than ,july #a1 #bjag1 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 #bjba1 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 7,c7 ,report on update to physicians' services under ,medicare ,not later than ,july #a1 #bjai1 the ,medicare ,payment ,advisory ,commission shall submit to ,congress a report on-- 7i7 the payment update for professional services applied under the ,medicare program under title ,,xviii of the ,social ,security ,act for the period of years #bjae through #bjai2 7ii7 the effect of such update on the efficiency1 economy1 and quality of care provided under such program2 7iii7 the effect of such update on ensuring a sufficient number of providers to maintain access to care by ,medicare beneficiaries2 and 7iv7 recommendations for any future payment updates for professional services under such program to ensure adequate access to care is maintained for ,medicare beneficiaries4 7b7 ,consolidation of certain current law performance programs with new merit-,based ,incentive ,payment ,system 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 #bjae or any subsequent payment year and inserting each of #bjae through #bjah2 7ii7 in clause 7ii77,,iii71 by striking each subsequent year and inserting #bjah2 and 7iii7 in clause 7iii7-- 7,i7 in the heading1 by striking and subsequent years2 7,,ii7 by striking and each subsequent year2 and 7,,iii7 by striking 1 but in no case shall the applicable percent be less than #ie percent4 7,b7 ,continuation of meaningful use determinations for ,,mips ,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 ,,mips ,with respect to #bjai 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 ,,mips 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 #bjae or any subsequent year and inserting each of #bjae through #bjah2 and 7ii7 in clause 7ii77,,ii71 by striking and each subsequent year and inserting 1 #bjag1 and #bjah4 7,b7 ,continuation of quality measures and processes for ,,mips ,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 ,,mips and for certain professionals volunteering to report ,the ,secretary shall1 in accordance with subsection 7q77#a77;,f71 carry out the provisions of this subsection-- 7,a7 for purposes of subsection 7q72 and 7,b7 for eligible professionals who are not ,,mips eligible professionals 7as defined in subsection 7q77#a77;,c77 for the year involved4 2 and 7ii7 in subsection 7m7-- 7,i7 by redesignating 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 ,,mips and for certain professionals volunteering to report ,the ,secretary shall1 in accordance with subsection 7q77#a77;,f71 carry out the processes under this subsection-- 7,a7 for purposes of subsection 7q72 and 7,b7 for eligible professionals who are not ,,mips eligible professionals 7as defined in subsection 7q77#a77;,c77 for the year involved4 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 with respect to specific physicians and groups of physicians the ,secretary determines appropriate1 and for services furnished on or after ,january #a1 #bjag1 with respect to all physicians and groups of physicians4 ,such payment modifier shall not be applied for items and services furnished on or after ,january #a1 #bjai4 4 7,b7 ,continuation of value-based payment modifier measures for ,,mips ,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 ,,mips ,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 #bjai and each subsequent year1 the ,secretary shall1 in accordance with subsection 7q77#a77;,f71 carry out this paragraph for purposes of subsection 7q744 7c7 ,merit-,based ,incentive ,payment ,system 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 ,merit-,based ,incentive ,payment ,system 7#a7 ,establishment 7,a7 ,in general ,subject to the succeeding provisions of this subsection1 the ,secretary shall establish an eligible professional ,merit-based ,incentive ,payment ,system 7in this subsection referred to as the ,,mips7 under which the ,secretary shall-- 7i7 develop a methodology for assessing the total performance of each ,,mips 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 ,,mips eligible professional for a performance period for a year to determine and apply a ,,mips adjustment factor 7and1 as applicable1 an additional ,,mips adjustment factor7 under paragraph 7#f7 to the professional for the year4 ,notwithstanding subparagraph 7,c77ii71 under the ,,mips1 the ,secretary shall permit any eligible professional 7as defined in subsection 7k77#c77;,b77 to report on applicable measures and activities described in paragraph 7#b77;,b74 7,b7 ,program implementation ,the ,,mips shall apply to payments for items and services furnished on or after ,january #a1 #bjai4 7,c7 ,,mips eligible professional defined 7i7 ,in general ,for purposes of this subsection1 subject to clauses 7ii7 and 7iv71 the term ,,mips eligible professional means-- 7,i7 for the first and second years for which the ,,mips 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 a certified registered nurse anesthetist 7as defined in section #ahfa7;bb77#b771 and a group that includes such professionals2 and 7,,ii7 for the third year for which the ,,mips 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,i71 such other eligible professionals 7as defined in subsection 7k77#c77;,b77 as specified by the ,secretary1 and a group that includes such professionals4 7ii7 ,exclusions ,for purposes of clause 7i71 the term ,,mips eligible professional does not include1 with respect to a year1 an eligible professional 7as defined in subsection 7k77#c77;,b77 who-- 7,i7 is a qualifying ,,apm participant 7as defined in section #ahcc7z77#b772 7,,ii7 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 ,,mips2 or 7,,iii7 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 #bjai and #bjbj1 the reference in subparagraph 7,a7 of such paragraph to #be percent was instead a reference to #bj percent2 7,,ii7 with respect to #bjba and #bjbb-- 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 #bjbc 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 a low-volume threshold to apply for purposes of clause 7ii77,,iii71 which may include one or more or a combination of the following3 7,i7 ,the minimum number 7as determined by the ,secretary7 of individuals enrolled under this part who are treated by the 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 ,,mips 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 ,,mips eligible professional 7including pursuant to clauses 7ii7 and 7v77 with respect to a year1 in no case shall a ,,mips adjustment factor 7or additional ,,mips adjustment factor7 under paragraph 7#f7 apply to such individual for such year4 7vii7 ,partial qualifying ,,apm participant clarifications 7,i7 ,treatment as ,,mips eligible professional ,in the case of an eligible professional who is a partial qualifying ,,apm participant1 with respect to a year1 and who1 for the performance period for such year1 reports on applicable measures and activities described in paragraph 7#b77;,b7 that are required to be reported by such a professional under the ,,mips1 such eligible professional is considered to be a ,,mips eligible professional with respect to such year4 7,,ii7 ,not eligible for qualifying ,,apm participant payments ,in no case shall an eligible professional who is a partial qualifying ,,apm participant1 with respect to a year1 be considered a qualifying ,,apm participant 7as defined in paragraph 7#b7 of section #ahcc7z77 for such year or be eligible for the additional payment under paragraph 7#a7 of such section for such year4 7,d7 ,application to group practices 7i7 ,in general ,under the ,,mips3 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 ,,mips 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 ,,mips 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 range of items and services furnished by the ,,mips eligible professionals in the group practice involved4 7,e7 ,use of registries ,under the ,,mips1 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,g7 ,accounting for risk factors 7i7 ,risk factors ,taking into account the relevant studies conducted and recommendations made in reports under section #b7;d7 of the ,improving ,medicare ,post-,acute ,care ,transformation ,act of #bjad1 and1 as appropriate1 other information1 including information collected before completion of such studies and recommendations1 the ,secretary1 on an ongoing basis1 shall1 as the ,secretary determines appropriate and based on an individual's health status and other risk factors-- 7,i7 assess appropriate adjustments to quality measures1 resource use measures1 and other measures used under the ,,mips2 and 7,,ii7 assess and implement appropriate adjustments to payment adjustments1 composite performance scores1 scores for performance categories1 or scores for measures or activities under the ,,mips4 7#b7 ,measures and activities under performance categories 7,a7 ,performance categories ,under the ,,mips1 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 included in the final measures list published under subparagraph 7,d77i7 for such year and the list of quality measures described in subparagraph 7,d77vi7 used by qualified clinical data registries under subsection 7m77#c77;,e74 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 7r7 as appropriate1 and1 as feasible and applicable1 accounting for the cost of drugs under part ,d4 7iii7 ,clinical practice improvement activities ,for the performance category described in subparagraph 7,a77iii71 clinical practice improvement activities 7as defined in subparagraph 7,c77v77,,iii77 under subcategories specified by the ,secretary for such period1 which shall include at least the following3 7,i7 ,the subcategory of expanded practice access1 such as same day appointments for urgent needs and after hours access to clinician advice4 7,,ii7 ,the subcategory of population management1 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 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 such as the establishment of care plans for individuals with complex care needs1 beneficiary self-management assessment and 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 #ae 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 the 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 physicians1 such as measures for inpatient hospitals1 for purposes of the performance categories described in clauses 7i7 and 7ii7 of subparagraph 7,a74 ,for purposes of the previous sentence1 the ,secretary may not use measures for hospital outpatient departments1 except in the case of items and services furnished by emergency physicians1 radiologists1 and anesthesiologists4 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 ,application of measures and activities to non-patient-facing professionals ,in carrying out this paragraph1 with respect to measures and activities specified in subparagraph 7,b7 for performance categories described in subparagraph 7,a71 the ,secretary-- 7,i7 shall give consideration to the circumstances of professional types 7or subcategories of those types determined by practice characteristics7 who typically furnish services that do not involve face-to-face interaction with a patient2 and 7,,ii7 may1 to the extent feasible and appropriate1 take into account such circumstances and apply under this subsection with respect to ,,mips eligible professionals of such professional types or subcategories1 alternative measures or activities that fulfill the goals of the applicable performance category4 ,in carrying out the previous sentence1 the ,secretary shall consult with professionals of such professional types or subcategories4 7v7 ,clinical practice improvement activities 7,i7 ,request for information ,in initially applying subparagraph 7,b77iii71 the ,secretary shall use a request for information to solicit recommendations from stakeholders to identify activities described in such subparagraph and specifying criteria for such activities4 7,,ii7 ,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-- 7aa7 identifying activities described in subparagraph 7,b77iii72 7bb7 specifying criteria for such activities2 and 7cc7 determining whether a ,,mips eligible professional meets such criteria4 7,,iii7 ,clinical practice improvement activities defined ,for purposes of this subsection1 the term clinical practice improvement activity means an activity that relevant eligible professional organizations and other relevant stakeholders identify as improving clinical practice or care delivery and that the ,secretary determines1 when effectively executed1 is likely to result in improved outcomes4 7,d7 ,annual list of quality measures available for ,,mips assessment 7i7 ,in general ,under the ,,mips1 the ,secretary1 through notice and comment rulemaking and subject to the succeeding clauses of this subparagraph1 shall1 with respect to the performance period for a year1 establish an annual final list of quality measures from which ,,mips eligible professionals may choose for purposes of assessment under this subsection for such performance period4 ,pursuant to the previous sentence1 the ,secretary shall-- 7,i7 not later than ,november #a of the year prior to the first day of the first performance period under the ,,mips1 establish and publish in the ,federal ,register a final list of quality measures2 and 7,,ii7 not later than ,november #a of the year prior to the first day of each subsequent performance period1 update the final list of quality measures from the previous year 7and publish such updated final list in the ,federal ,register71 by-- 7aa7 removing from such list1 as appropriate1 quality measures1 which may include the removal of measures that are no longer meaningful 7such as measures that are topped out72 7bb7 adding to such list1 as appropriate1 new quality measures2 and 7cc7 determining whether or not quality measures on such list that have undergone substantive changes should be included in the updated list4 7ii7 ,call for quality measures 7,i7 ,in general ,eligible professional organizations and other relevant stakeholders shall be requested to identify and submit quality measures to be considered for selection under this subparagraph in the annual list of quality measures published under clause 7i7 and to identify and submit updates to the measures on such list4 ,for purposes of the previous sentence1 measures may be submitted regardless of whether such measures were previously published in a proposed rule or endorsed by an entity with a contract under section #ahij7;a74 7,,ii7 ,eligible professional organization defined ,in this subparagraph1 the term eligible professional organization means a professional organization as defined by nationally recognized specialty boards of certification or equivalent certification boards4 7iii7 ,requirements ,in selecting quality measures for inclusion in the annual final list under clause 7i71 the ,secretary shall-- 7,i7 provide that1 to the extent practicable1 all quality domains 7as defined in subsection 7s77#a77;,b77 are addressed by such measures2 and 7,,ii7 ensure that such selection is consistent with the process for selection of measures under subsections 7k71 7m71 and 7p77#b74 7iv7 ,peer review ,before including a new measure in the final list of measures published under clause 7i7 for a year1 the ,secretary shall submit for publication in applicable specialty-appropriate1 peer-reviewed journals such measure and the method for developing and selecting such measure1 including clinical and other data supporting such measure4 7v7 ,measures for inclusion ,the final list of quality measures published under clause 7i7 shall include1 as applicable1 measures under subsections 7k71 7m71 and 7p77#b71 including quality measures from among-- 7,i7 measures endorsed by a consensus-based entity2 7,,ii7 measures developed under subsection 7s72 and 7,,iii7 measures submitted under clause 7ii77,i74 ,any measure selected for inclusion in such list that is not endorsed by a consensus-based entity shall have a focus that is evidence-based4 7vi7 ,exception for qualified clinical data registry measures ,measures used by a qualified clinical data registry under subsection 7m77#c77;,e7 shall not be subject to the requirements under clauses 7i71 7iv71 and 7v74 ,the ,secretary shall publish the list of measures used by such qualified clinical data registries on the ,internet website of the ,centers for ,medicare ,medicaid ,services4 7vii7 ,exception for existing quality measures ,any quality measure specified by the ,secretary under subsection 7k7 or 7m71 including under subsection 7m77#c77;,e71 and any measure of quality of care established under subsection 7p77#b7 for the reporting period or performance period under the respective subsection beginning before the first performance period under the ,,mips-- 7,i7 shall not be subject to the requirements under clause 7i7 7except under items 7aa7 and 7cc7 of subclause 7,,ii7 of such clause7 or to the requirement under clause 7iv72 and 7,,ii7 shall be included in the final list of quality measures published under clause 7i7 unless removed under clause 7i77,,ii77aa74 7viii7 ,consultation with relevant eligible professional organizations and other relevant stakeholders ,relevant eligible professional organizations and other relevant stakeholders1 including ,state and national medical societies1 shall be consulted in carrying out this subparagraph4 7ix7 ,optional application ,the process under section #ahij;,a is not required to apply to the selection of measures under this subparagraph4 7#c7 ,performance standards 7,a7 ,establishment ,under the ,,mips1 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 consider the following3 7i7 ,historical performance standards4 7ii7 ,improvement4 7iii7 ,the opportunity for continued improvement4 7#d7 ,performance period ,the ,secretary shall establish a performance period 7or periods7 for a year 7beginning with #bjai74 ,such performance period 7or periods7 shall begin and end prior to the beginning of such year and be as close as possible to such year4 ,in this subsection1 such performance period 7or periods7 for a year shall be referred to as the performance period for the year4 7#e7 ,composite performance score 7,a7 ,in general ,subject to the succeeding provisions of this paragraph and taking into account1 as available and applicable1 paragraph 7#a77;,g71 the ,secretary shall develop a methodology for assessing the total performance of each ,,mips 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 7using a scoring scale of #j to #ajj7 for each such professional for the performance period for such year4 ,in this subsection such a composite assessment for such a professional with respect to a performance period shall be referred to as the composite performance score for such professional for such performance period4 7,b7 ,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 ,,mips 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 and qualified clinical data registries for reporting quality measures ,under the methodology established under subparagraph 7,a71 the ,secretary shall-- 7,i7 encourage ,,mips 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 technology and qualified clinical data registries2 and 7,,ii7 with respect to a performance period1 with respect to a year1 for which a ,,mips 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,c7 ,clinical practice improvement activities performance score 7i7 ,rule for certification ,a ,,mips eligible professional who is in a practice that is certified as a patient-centered medical home or comparable specialty practice1 as determined by the ,secretary1 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 ,,mips 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 a minimum score of one-half of the highest potential score for the performance category described in paragraph 7#b77;,a77iii7 for such performance period4 7iii7 ,subcategories ,a ,,mips eligible professional shall not be required to perform activities in each subcategory under paragraph 7#b77;,b77iii7 or participate in an alternative payment model in order to achieve the highest potential score for the performance category described in paragraph 7#b77;,a77iii74 7,d7 ,achievement and improvement 7i7 ,taking into account improvement ,beginning with the second year to which the ,,mips applies1 in addition to the achievement of a ,,mips eligible professional1 if data sufficient to measure improvement is available1 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 ,subject to clause 7i71 under the methodology developed under subparagraph 7,a71 the ,secretary may assign a higher scoring weight under subparagraph 7,f7 with respect to the achievement of a ,,mips eligible professional than with respect to any improvement of such professional applied under clause 7i7 with respect to a measure1 activity1 or category described in paragraph 7#b74 7,e7 ,weights for the performance categories 7i7 ,in general ,under the methodology developed under subparagraph 7,a71 subject to subparagraph 7,f77i7 and clause 7ii71 the composite performance score shall be determined as follows3 7,i7 ,quality 7aa7 ,in general ,subject to item 7bb71 thirty percent of such score shall be based on performance with respect to the category described in clause 7i7 of paragraph 7#b77;,a74 ,in applying the previous sentence1 the ,secretary shall1 as feasible1 encourage the application of outcome measures within such category4 7bb7 ,first #b years ,for the first and second years for which the ,,mips applies to payments1 the percentage applicable under item 7aa7 shall be increased in a manner such that the total percentage points of the increase under this item for the respective year equals the total number of percentage points by which the percentage applied under subclause 7,,ii77bb7 for the respective year is less than #cj percent4 7,,ii7 ,resource use 7aa7 ,in general ,subject to item 7bb71 thirty percent of such score shall be based on performance with respect to the category described in clause 7ii7 of paragraph 7#b77;,a74 7bb7 ,first #b years ,for the first year for which the ,,mips applies to payments1 not more than #aj percent of such score shall be based on performance with respect to the category described in clause 7ii7 of paragraph 7#b77;,a74 ,for the second year for which the ,,mips applies to payments1 not more than #ae 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 subject to subclauses 7,i77bb7 and 7,,ii77bb7 of clause 7i71 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 7,f7 ,certain flexibility for weighting performance categories1 measures1 and activities ,under the methodology under subparagraph 7,a71 if there are not sufficient measures and activities 7described in paragraph 7#b77;,b77 applicable and available to each type of eligible professional involved1 the ,secretary shall assign different scoring weights 7including a weight of #j7-- 7i7 which may vary from the scoring weights specified in subparagraph 7,e71 for each performance category based on the extent to which the category is applicable to the type of eligible professional involved2 and 7ii7 for 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 and available to the type of eligible professional involved4 7,g7 ,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,h7 ,inclusion of quality measure data from other 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 ,,mips eligible professionals with respect to items and services furnished to individuals who are not individuals entitled to benefits under part ,a or enrolled under part ,b4 7,i7 ,use of voluntary virtual groups for certain assessment purposes 7i7 ,in general ,in the case of ,,mips 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 with respect to the performance categories described in clauses 7i7 and 7ii7 of paragraph 7#b77;,a7-- 7,i7 the assessment of performance provided under such methodology with respect to such performance categories 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 with respect to the composite performance score provided under this paragraph for such performance period for each such ,,mips eligible professional in such virtual group1 the components of the composite performance score that assess performance with respect to such performance categories shall be based on the assessment of the combined performance under subclause 7,i7 for such performance categories and performance period4 7ii7 ,election of practices to be a virtual group ,the ,secretary shall1 in accordance with the requirements under clause 7iii71 establish and have in place a process to allow an individual ,,mips eligible professional or a group practice consisting of not more than #aj ,,mips eligible professionals to elect1 with respect to a performance period for a year to be a virtual group under this subparagraph with at least one other such individual ,,mips eligible professional or group practice4 ,such a virtual group may be based on appropriate classifications of providers1 such as by geographic areas or by provider specialties defined by nationally recognized specialty boards of certification or equivalent certification boards4 7iii7 ,requirements ,the requirements for the process under clause 7ii7 shall-- 7,i7 provide that 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 7,,ii7 provide that an individual ,,mips eligible professional and a group practice described in clause 7ii7 may elect to be in no more than one virtual group for a performance period and that1 in the case of such a group practice that elects to be in such virtual group for such performance period1 such election applies to all ,,mips eligible professionals in such group practice2 7,,iii7 provide that a virtual group be a combination of tax identification numbers2 7,,iv7 provide for formal written agreements among ,,mips eligible professionals electing to be a virtual group under this subparagraph2 and 7,v7 include such other requirements as the ,secretary determines appropriate4 7#f7 ,,mips payments 7,a7 ,,mips adjustment factor ,taking into account paragraph 7#a77;,g71 the ,secretary shall specify a ,,mips adjustment factor for each ,,mips eligible professional for a year4 ,such ,,mips adjustment factor for a ,,mips eligible professional for a year shall be in the form of a percent and shall be determined-- 7i7 by comparing the composite performance score of the eligible professional for such year to the performance threshold established under subparagraph 7,d77i7 for such year2 7ii7 in a manner such that the adjustment factors specified under this subparagraph for a year result in differential payments under this paragraph reflecting that-- 7,i7 ,,mips eligible professionals with composite performance scores for such year at or above such performance threshold for such year receive zero or positive payment adjustment factors for such year in accordance with clause 7iii71 with such professionals having higher composite performance scores receiving higher adjustment factors2 and 7,,ii7 ,,mips eligible professionals with composite performance scores for such year below such performance threshold for such year receive negative payment adjustment factors for such year in accordance with clause 7iv71 with such professionals having lower composite performance scores receiving lower adjustment factors2 7iii7 in a manner such that ,,mips eligible professionals with composite scores described in clause 7ii77,i7 for such year1 subject to clauses 7i7 and 7ii7 of subparagraph 7,f71 receive a zero or positive adjustment factor on a linear sliding scale such that an adjustment factor of #j percent is assigned for a score at the performance threshold and an adjustment factor of the applicable percent specified in subparagraph 7,b7 is assigned for a score of #ajj2 and 7iv7 in a manner such that-- 7,i7 subject to subclause 7,,ii71 ,,mips eligible professionals with composite performance scores described in clause 7ii77,,ii7 for such year receive a negative payment adjustment factor on a linear sliding scale such that an adjustment factor of #j percent is assigned for a score at the performance threshold and an adjustment factor of the negative of the applicable percent specified in subparagraph 7,b7 is assigned for a score of #j2 and 7,,ii7 ,,mips eligible professionals with composite performance scores that are equal to or greater than #j1 but not greater than #a_/d of the performance threshold specified under subparagraph 7,d77i7 for such year1 receive a negative payment adjustment factor that is equal to the negative of the applicable percent specified in subparagraph 7,b7 for such year4 7,b7 ,applicable percent defined ,for purposes of this paragraph1 the term applicable percent means-- 7i7 for #bjai1 #d percent2 7ii7 for #bjbj1 #e percent2 7iii7 for #bjba1 #g percent2 and 7iv7 for #bjbb and subsequent years1 #i percent4 7,c7 ,additional ,,mips adjustment factors for exceptional performance ,for #bjai and each subsequent year through #bjbd1 in the case of a ,,mips eligible professional with a composite performance score for a year at or above the additional performance threshold under subparagraph 7,d77ii7 for such year1 in addition to the ,,mips adjustment factor under subparagraph 7,a7 for the eligible professional for such year1 subject to subparagraph 7,f77iv71 the ,secretary shall specify an additional positive ,,mips adjustment factor for such professional and year4 ,such additional ,,mips adjustment factors shall be in the form of a percent and determined by the ,secretary in a manner such that professionals having higher composite performance scores above the additional performance threshold receive higher additional ,,mips adjustment factors4 7,d7 ,establishment of performance thresholds 7i7 ,performance threshold ,for each year of the ,,mips1 the ,secretary shall compute a performance threshold with respect to which the composite performance score of ,,mips eligible professionals shall be compared for purposes of determining adjustment factors under subparagraph 7,a7 that are positive1 negative1 and zero4 ,such performance threshold for a year shall be the mean or median 7as selected by the ,secretary7 of the composite performance scores for all ,,mips eligible professionals with respect to a prior period specified by the ,secretary4 ,the ,secretary may reassess the selection of the mean or median under the previous sentence every #c years4 7ii7 ,additional performance threshold for exceptional performance ,in addition to the performance threshold under clause 7i71 for each year of the ,,mips1 the ,secretary shall compute an additional performance threshold for purposes of determining the additional ,,mips adjustment factors under subparagraph 7,c74 ,for each such year1 the ,secretary shall apply either of the following methods for computing such additional performance threshold for such a year3 7,i7 ,the threshold shall be the score that is equal to the #beth percentile of the range of possible composite performance scores above the performance threshold determined under clause 7i74 7,,ii7 ,the threshold shall be the score that is equal to the #beth percentile of the actual composite performance scores for ,,mips eligible professionals with composite performance scores at or above the performance threshold with respect to the prior period described in clause 7i74 7iii7 ,special rule for initial #b years ,with respect to each of the first two years to which the ,,mips applies1 the ,secretary shall1 prior to the performance period for such years1 establish a performance threshold for purposes of determining ,,mips adjustment factors under subparagraph 7,a7 and a threshold for purposes of determining additional ,,mips adjustment factors under subparagraph 7,c74 ,each such performance threshold shall-- 7,i7 be based on a period prior to such performance periods2 and 7,,ii7 take into account-- 7aa7 data available with respect to performance on measures and activities that may be used under the performance categories under subparagraph 7#b77;,b72 and 7bb7 other factors determined appropriate by the ,secretary4 7,e7 ,application of ,,mips adjustment factors ,in the case of items and services furnished by a ,,mips eligible professional during a year 7beginning with #bjai71 the amount otherwise paid under this part with respect to such items and services and ,,mips eligible professional for such year1 shall be multiplied by-- 7i7 #a1 plus 7ii7 the sum of-- 7,i7 the ,,mips adjustment factor determined under subparagraph 7,a7 divided by #ajj1 and 7,,ii7 as applicable1 the additional ,,mips adjustment factor determined under subparagraph 7,c7 divided by #ajj4 7,f7 ,aggregate application of ,,mips adjustment factors 7i7 ,application of scaling factor 7,i7 ,in general ,with respect to positive ,,mips adjustment factors under subparagraph 7,a77ii77,i7 for eligible professionals whose composite performance score is above the performance threshold under subparagraph 7,d77i7 for such year1 subject to subclause 7,,ii71 the ,secretary shall increase or decrease such adjustment factors by a scaling factor in order to ensure that the budget neutrality requirement of clause 7ii7 is met4 7,,ii7 ,scaling factor limit ,in no case may the scaling factor applied under this clause exceed #c4j4 7ii7 ,budget neutrality requirement 7,i7 ,in general ,subject to clause 7iii71 the ,secretary shall ensure that the estimated amount described in subclause 7,,ii7 for a year is equal to the estimated amount described in subclause 7,,iii7 for such year4 7,,ii7 ,aggregate increases ,the amount described in this subclause is the estimated increase in the aggregate allowed charges resulting from the application of positive ,,mips adjustment factors under subparagraph 7,a7 7after application of the scaling factor described in clause 7i77 to ,,mips eligible professionals whose composite performance score for a year is above the performance threshold under subparagraph 7,d77i7 for such year4 7,,iii7 ,aggregate decreases ,the amount described in this subclause is the estimated decrease in the aggregate allowed charges resulting from the application of negative ,,mips adjustment factors under subparagraph 7,a7 to ,,mips eligible professionals whose composite performance score for a year is below the performance threshold under subparagraph 7,d77i7 for such year4 7iii7 ,exceptions 7,i7 ,in the case that all ,,mips eligible professionals receive composite performance scores for a year that are below the performance threshold under subparagraph 7,d77i7 for such year1 the negative ,,mips adjustment factors under subparagraph 7,a7 shall apply with respect to such ,,mips eligible professionals and the budget neutrality requirement of clause 7ii7 and the additional adjustment factors under clause 7iv7 shall not apply for such year4 7,,ii7 ,in the case that1 with respect to a year1 the application of clause 7i7 results in a scaling factor equal to the maximum scaling factor specified in clause 7i77,,ii71 such scaling factor shall apply and the budget neutrality requirement of clause 7ii7 shall not apply for such year4 7iv7 ,additional incentive payment adjustments 7,i7 ,in general ,subject to subclause 7,,ii71 in specifying the ,,mips additional adjustment factors under subparagraph 7,c7 for each applicable ,,mips eligible professional for a year1 the ,secretary shall ensure that the estimated aggregate increase in payments under this part resulting from the application of such additional adjustment factors for ,,mips eligible professionals in a year shall be equal 7as estimated by the ,secretary7 to #ejj1jjj1jjj for each year beginning with #bjai and ending with #bjbd4 7,,ii7 ,limitation on additional incentive payment adjustments ,the ,,mips additional adjustment factor under subparagraph 7,c7 for a year for an applicable ,,mips eligible professional whose composite performance score is above the additional performance threshold under subparagraph 7,d77ii7 for such year shall not exceed #aj percent4 ,the application of the previous sentence may result in an aggregate amount of additional incentive payments that are less than the amount specified in subclause 7,i74 7#g7 ,announcement of result of adjustments ,under the ,,mips1 the ,secretary shall1 not later than #cj days prior to ,january #a of the year involved1 make available to ,,mips eligible professionals the ,,mips adjustment factor 7and1 as applicable1 the additional ,,mips adjustment factor7 under paragraph 7#f7 applicable to the eligible professional for items and services furnished by the professional for such year4 ,the ,secretary may include such information in the confidential feedback under paragraph 7#ab74 7#h7 ,no effect in subsequent years ,the ,,mips adjustment factors and additional ,,mips adjustment factors under paragraph 7#f7 shall apply only with respect to the year involved1 and the ,secretary shall not take into account such adjustment factors in making payments to a ,,mips eligible professional under this part in a subsequent year4 7#i7 ,public reporting 7,a7 ,in general ,the ,secretary shall1 in an easily understandable format1 make available on the ,physician ,compare ,internet website of the ,centers for ,medicare ,medicaid ,services the following3 7i7 ,information regarding the performance of ,,mips eligible professionals under the ,,mips1 which-- 7,i7 shall include the composite score for each such ,,mips eligible professional and the performance of each such ,,mips eligible professional with respect to each performance category2 and 7,,ii7 may include the performance of each such ,,mips eligible professional with respect to each measure or activity specified in paragraph 7#b77;,b74 7ii7 ,the names of eligible professionals in eligible alternative payment models 7as defined in section #ahcc7z77#c77;,d77 and1 to the extent feasible1 the names of such eligible alternative payment models and performance of such models4 7,b7 ,disclosure ,the information made available under this paragraph shall indicate1 where appropriate1 that publicized information may not be representative of the eligible professional's entire patient population1 the variety of services furnished by the eligible professional1 or the health conditions of individuals treated4 7,c7 ,opportunity to review and submit corrections ,the ,secretary shall provide for an opportunity for a professional described in subparagraph 7,a7 to review1 and submit corrections for1 the information to be made public with respect to the professional under such subparagraph prior to such information being made public4 7,d7 ,aggregate information ,the ,secretary shall periodically post on the ,physician ,compare ,internet website aggregate information on the ,,mips1 including the range of composite scores for all ,,mips eligible professionals and the range of the performance of all ,,mips eligible professionals with respect to each performance category4 7#aj7 ,consultation ,the ,secretary shall consult with stakeholders in carrying out the ,,mips1 including for the identification of measures and activities under paragraph 7#b77;,b7 and the methodologies developed under paragraphs 7#e77;,a7 and 7#f7 and regarding the use of qualified clinical data registries4 ,such consultation shall include the use of a request for information or other mechanisms determined appropriate4 7#aa7 ,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 ,,mips eligible professionals in practices of #ae or fewer professionals 7with priority given to such practices located in rural areas1 health professional shortage areas 7as designated under in section #ccb7;a77#a77;,a7 of such ,act71 and medically underserved areas1 and 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 technical assistance ,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 #bj1jjj1jjj for each of fiscal years #bjaf through #bjbj4 ,amounts transferred under this subparagraph for a fiscal year shall be available until expended4 7#ab7 ,feedback and information to improve performance 7,a7 ,performance feedback 7i7 ,in general ,beginning ,july #a1 #bjag1 the ,secretary-- 7,i7 shall make available timely 7such as quarterly7 confidential feedback to ,,mips eligible professionals on the performance of such professionals 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 such professionals on the performance of such professionals 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 ,with respect to the performance category described in paragraph 7#b77;,a77i71 feedback under this subparagraph shall1 to the extent an eligible professional chooses to participate in a data registry for purposes of this subsection 7including registries under subsections 7k7 and 7m771 be provided based on performance on quality measures reported through the use of such registries4 ,with respect to any other performance category described in paragraph 7#b77;,a71 the ,secretary shall encourage provision of feedback through qualified clinical data registries as described in subsection 7m77#c77;,e774 7iii7 ,use of data ,for purposes of clause 7i71 the ,secretary may use data1 with respect to a ,,mips 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 #bjah1 the ,secretary shall make available to ,,mips eligible professionals information1 with respect to individuals who are patients of such ,,mips eligible professionals1 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 may be made available under the previous sentence to such ,,mips eligible professionals by mechanisms determined appropriate by the ,secretary1 which may include use of a web-based portal4 ,such information may be made available in accordance with the same or similar terms as data are made available to accountable care organizations participating in the shared savings program under section #ahii4 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 ,,mips 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 such as 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 data1 such as averages and other measures of the distribution if appropriate1 of the total1 and components of1 allowed charges 7and other figures as determined appropriate by the ,secretary74 7#ac7 ,review 7,a7 ,targeted review ,the ,secretary shall establish a process under which a ,,mips eligible professional may seek an informal review of the calculation of the ,,mips adjustment factor 7or factors7 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#f7 with respect to a year 7other than with respect to the calculation of such eligible professional's ,,mips adjustment factor for such year or additional ,,mips adjustment factor for such year7 after the factors determined in subparagraph 7,a7 and subparagraph 7,c7 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 ,,mips adjustment factor under paragraph 7#f77;,a7 and the amount of the additional ,,mips adjustment factor under paragraph 7#f77;,c7 and the determination of such amounts4 7ii7 ,the establishment of the performance standards under paragraph 7#c7 and the performance period under paragraph 7#d74 7iii7 ,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#i74 7iv7 ,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 ,,mips ,not later than ,october #a1 #bjba1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report evaluating the eligible professional ,merit-based ,incentive ,payment ,system 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 composite performance scores and ,,mips adjustment factors 7and additional ,,mips adjustment factors7 for ,,mips eligible professionals 7as defined in subsection 7q77#a77;c7 of such section7 under such program1 and patterns relating to such scores and adjustment factors1 including 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#aa7 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 7e771 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 ,,mips 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 on role of independent risk managers ,not later than ,january #a1 #bjag1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report examining whether entities that pool financial risk for physician practices1 such as independent risk managers1 can play a role in supporting physician practices1 particularly small physician practices1 in assuming financial risk for the treatment of patients4 ,such report shall examine barriers that small physician practices currently face in assuming financial risk for treating patients1 the types of risk management entities that could assist physician practices in participating in two-sided risk payment models1 and how such entities could assist with risk management and with quality improvement activities4 ,such report shall also include an analysis of any existing legal barriers to such arrangements4 7,d7 ,study to examine rural and health professional shortage area alternative payment models ,not later than ,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 7e774 ,such report shall make recommendations for removing administrative barriers to practices1 including small practices consisting of #ae or fewer professionals1 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 #hj1jjj1jjj 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 #bjae through #bjai4 ,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 #bjaf 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 #bjaf 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 #bjae2 and 7,b7 by inserting and1 for reporting periods occurring in #bjaf and subsequent years1 the ,secretary may establish after shall establish4 7#c7 ,physician feedback program reports succeeded by reports under ,,mips ,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 #bjag ,reports under the ,program shall not be provided after ,december #ca1 #bjag4 ,see subsection 7q77#ab7 for reports under the eligible professionals ,merit-based ,incentive ,payment ,system4 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;,b77ii77,,ii7 after ,subject to subparagraph 7,b77ii74 7e7 ,promoting alternative payment models 7#a7 ,increasing transparency of physician-focused payment models ,section #ahfh of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ee7 is amended by adding at the end the following new subsection3 7c7 ,physician-,focused payment models 7#a7 ,technical advisory committee 7,a7 ,establishment ,there is established an ad hoc committee to be known as the ,physician-,focused ,payment ,model ,technical ,advisory ,committee 7referred to in this subsection as the ,committee74 7,b7 ,membership 7i7 ,number and appointment ,the ,committee shall be composed of #aa members appointed by the ,comptroller ,general of the ,united ,states4 7ii7 ,qualifications ,the membership of the ,committee shall include individuals with national recognition for their expertise in physician-focused payment models and related delivery of care4 ,no more than #e members of the ,committee shall be providers of services or suppliers1 or representatives of providers of services or suppliers4 7iii7 ,prohibition on federal employment ,a member of the ,committee shall not be an employee of the ,federal ,government4 7iv7 ,ethics disclosure ,the ,comptroller ,general shall establish a system for public disclosure by members of the ,committee of financial and other potential conflicts of interest relating to such members4 ,members of the ,committee shall be treated as employees of ,congress for purposes of applying title ,i of the ,ethics in ,government ,act of #aigh 7,public ,law #ie-eba74 7v7 ,date of initial appointments ,the initial appointments of members of the ,committee shall be made by not later than #ahj days after the date of enactment of this subsection4 7,c7 ,term2 vacancies 7i7 ,term ,the terms of members of the ,committee shall be for #c years except that the ,comptroller ,general shall designate staggered terms for the members first appointed4 7ii7 ,vacancies ,any member appointed to fill a vacancy occurring before the expiration of the term for which the member's predecessor was appointed shall be appointed only for the remainder of that term4 ,a member may serve after the expiration of that member's term until a successor has taken office4 ,a vacancy in the ,committee shall be filled in the manner in which the original appointment was made4 7,d7 ,duties ,the ,committee shall meet1 as needed1 to provide comments and recommendations to the ,secretary1 as described in paragraph 7#b77;,c71 on physician-focused payment models4 7,e7 ,compensation of members 7i7 ,in general ,except as provided in clause 7ii71 a member of the ,committee shall serve without compensation4 7ii7 ,travel expenses ,a member of the ,committee shall be allowed travel expenses1 including per diem in lieu of subsistence1 at rates authorized for an employee of an agency under subchapter ,i of chapter #eg of title #e1 ,united ,states ,code1 while away from the home or regular place of business of the member in the performance of the duties of the ,committee4 7,f7 ,operational and technical support 7i7 ,in general ,the ,assistant ,secretary for ,planning and ,evaluation shall provide technical and operational support for the ,committee1 which may be by use of a contractor4 ,the ,office of the ,actuary of the ,centers for ,medicare ,medicaid ,services shall provide to the ,committee actuarial assistance as needed4 7ii7 ,funding ,the ,secretary shall provide for the transfer1 from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 such amounts as are necessary to carry out this paragraph 7not to exceed #e1jjj1jjj7 for fiscal year #bjae and each subsequent fiscal year4 ,any amounts transferred under the preceding sentence for a fiscal year shall remain available until expended4 7,g7 ,application ,section #ad of the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall not apply to the ,committee4 7#b7 ,criteria and process for submission and review of physician-focused payment models 7,a7 ,criteria for assessing physician-focused payment models 7i7 ,rulemaking ,not later than ,november #a1 #bjaf1 the ,secretary shall1 through notice and comment rulemaking1 following a request for information1 establish criteria for physician-focused payment models1 including models for specialist physicians1 that could be used by the ,committee for making comments and recommendations pursuant to paragraph 7#a77;,d74 7ii7 ,med,p,a,c submission of comments ,during the comment period for the proposed rule described in clause 7i71 the ,medicare ,payment ,advisory ,commission may submit comments to the ,secretary on the proposed criteria under such clause4 7iii7 ,updating ,the ,secretary may update the criteria established under this subparagraph through rulemaking4 7,b7 ,stakeholder submission of physician-focused payment models ,on an ongoing basis1 individuals and stakeholder entities may submit to the ,committee proposals for physician-focused payment models that such individuals and entities believe meet the criteria described in subparagraph 7,a74 7,c7 ,committee review of models submitted ,the ,committee shall1 on a periodic basis1 review models submitted under subparagraph 7,b71 prepare comments and recommendations regarding whether such models meet the criteria described in subparagraph 7,a71 and submit such comments and recommendations to the ,secretary4 7,d7 ,secretary review and response ,the ,secretary shall review the comments and recommendations submitted by the ,committee under subparagraph 7,c7 and post a detailed response to such comments and recommendations on the ,internet website of the ,centers for ,medicare ,medicaid ,services4 7#c7 ,rule of construction ,nothing in this subsection shall be construed to impact the development or testing of models under this title or titles ,,xi1 ,,xix1 or ,,xxi4 4 7#b7 ,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 #bjai and ending with #bjbd and for which the professional is a qualifying ,,apm participant with respect to such year1 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 estimated aggregate payment amounts for such 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 in which payment for covered professional services furnished by a qualifying ,,apm participant in an alternative payment model-- 7i7 is made to an eligible alternative payment entity rather than directly to the qualifying ,,apm participant2 or 7ii7 is made on a basis other than a fee-for-service basis 7such as payment on a capitated basis74 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 under this subsection or subsection 7m7 shall be determined without regard to any additional payment under subsection 7m7 and this subsection1 respectively4 ,the amount of the additional payment under this subsection or subsection 7x7 shall be determined without regard to any additional payment under subsection 7x7 and this subsection1 respectively4 ,the amount of the additional payment under this subsection or subsection 7y7 shall be determined without regard to any additional payment 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 #bjai and #bjbj ,with respect to #bjai and #bjbj1 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 eligible alternative payment entity4 7,b7 #bjba and #bjbb ,with respect to #bjba and #bjbb1 an eligible professional described in either of the following clauses3 7i7 ,medicare payment 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 eligible alternative payment entity4 7ii7 ,combination all-payer and ,medicare payment 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 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 title71 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 eligible alternative payment entity2 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 to an eligible alternative payment entity2 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 arrangements 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 participates in an entity that-- 7,,aa7 bears more than nominal financial risk if actual aggregate expenditures exceeds expected aggregate expenditures2 or 7,,bb7 with respect to beneficiaries under title ,,xix1 is a medical home that meets criteria comparable to medical homes expanded under section #aaae;,a7c74 7,c7 ,beginning in #bjbc ,with respect to #bjbc and each subsequent year1 an eligible professional described in either of the following clauses3 7i7 ,medicare payment 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 eligible alternative payment entity4 7ii7 ,combination all-payer and ,medicare payment 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 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 title71 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 eligible alternative payment entity2 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 to an eligible alternative payment entity2 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 arrangements 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 participates in an entity that-- 7,,aa7 bears more than nominal financial risk if actual aggregate expenditures exceeds expected aggregate expenditures2 or 7,,bb7 with respect to beneficiaries under title ,,xix1 is a medical home that meets criteria comparable to medical homes expanded under section #aaae;,a7c74 7,d7 ,use of patient approach ,the ,secretary may base the determination of whether an eligible professional is a qualifying ,,apm participant under this subsection and the determination of whether an eligible professional is a partial qualifying ,,apm participant under section #ahdh7q77#a77;,c77iii7 by using counts of patients in lieu of using payments and using the same or similar percentage criteria 7as specified in this subsection and such section1 respectively71 as the ,secretary determines appropriate4 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;,b7 and includes a group that includes such professionals4 7,c7 ,alternative payment model 7,,apm7 ,the term alternative payment model means1 other than for purposes of subparagraphs 7,b77ii77,i77bb7 and 7,c77ii77,i77bb7 of paragraph 7#b71 any of the following3 7i7 ,a model under section #aaae;,a 7other than a health care innovation award74 7ii7 ,the shared savings program under section #ahii4 7iii7 ,a demonstration under section #ahff;,c4 7iv7 ,a demonstration required by ,federal law4 7,d7 ,eligible alternative payment entity ,the term eligible alternative payment entity means1 with respect to a year1 an entity that-- 7i7 participates in an alternative payment model that-- 7,i7 requires participants in such model to use certified ,,ehr technology 7as defined in subsection 7o77#d772 and 7,,ii7 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 7ii7 7,i7 bears financial risk for monetary losses under such alternative payment 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 entity is an eligible alternative payment entity 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#c7 ,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#d7 ,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 #ae or fewer professionals4 7xxiii7 ,focusing on risk-based models for small physician practices which may involve two-sided risk and prospective patient assignment1 and which examine risk-adjusted decreases in mortality rates1 hospital readmissions rates1 and other relevant and appropriate clinical measures4 7xxiv7 ,focusing primarily on title ,,xix1 working in conjunction with the ,center for ,medicaid and ,,chip ,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#e7 ,construction regarding telehealth services ,nothing in the provisions of1 or amendments made by1 this title 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#f7 ,integrating ,medicare ,advantage alternative payment models ,not later than ,july #a1 #bjaf1 the ,secretary of ,health and ,human ,services shall submit to ,congress a study that examines the feasibility of integrating alternative payment models in the ,medicare ,advantage payment system4 ,the study shall include the feasibility of including a value-based modifier and whether such modifier should be budget neutral4 7#g7 ,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-- 7i7 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 7ii7 identifies aspects of such alternative payment models that are vulnerable to fraudulent activity2 and 7iii7 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 subparagraph 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 7f7 ,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 ,merit-based ,incentive ,payment ,system 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 care episode groups and 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 #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 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 #abj 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 care episode groups2 and 7ii7 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 care episode groups and patient condition groups1 which account for a target of an estimated #a_/b of expenditures under parts ,a and ,b 7with such target increasing over time as appropriate72 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 occurs1 and the principal procedures or services 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 a 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 #bgj 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 #abj days after the ,secretary posts the list pursuant to subparagraph 7,e71 comments from physician specialty societies1 applicable practitioner organizations1 and other stakeholders1 including representatives of individuals entitled to benefits under part ,a or enrolled under this part1 regarding the care episode and patient condition groups 7and codes7 posted under subparagraph 7,e74 ,in seeking such comments1 the ,secretary shall use one or more mechanisms 7other than notice and comment rulemaking7 that may include use of open door forums1 town hall meetings1 or other appropriate mechanisms4 7,g7 ,operational list of care episode and patient condition groups and codes ,not later than #bgj 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 #bjah71 the ,secretary shall1 through rulemaking1 make revisions to the operational lists of care episode and patient condition codes as the ,secretary determines may be appropriate4 ,such revisions may be based on experience1 new information developed pursuant to subsection 7n77#i77;,a71 and input from the physician specialty societies1 applicable practitioner organizations1 and other stakeholders1 including representatives of individuals entitled to benefits under part ,a or enrolled under this part4 7#c7 ,attribution of patients to physicians or practitioners 7,a7 ,in general ,in order to facilitate the attribution of patients and episodes 7in whole or in part7 to one or more physicians or applicable practitioners furnishing items and services1 the ,secretary shall undertake the steps described in the succeeding provisions of this paragraph4 7,b7 ,development of patient relationship categories and codes ,the ,secretary shall develop patient relationship categories and codes that define and distinguish the relationship and responsibility of a physician or applicable practitioner with a patient at the time of furnishing an item or service4 ,such patient relationship categories shall include different relationships of the physician or applicable practitioner to the patient 7and the codes may reflect combinations of such categories71 such as a physician or applicable practitioner who-- 7i7 considers themself to have the primary responsibility for the general and ongoing care for the patient over extended periods of time2 7ii7 considers themself to be the lead physician or practitioner and who furnishes items and services and coordinates care furnished by other physicians or practitioners for the patient during an acute episode2 7iii7 furnishes items and services to the patient on a continuing basis during an acute episode of care1 but in a supportive rather than a lead role2 7iv7 furnishes items and services to the patient on an occasional basis1 usually at the request of another physician or practitioner2 or 7v7 furnishes items and services only as ordered by another physician or practitioner4 7,c7 ,draft list of patient relationship categories and codes ,not later than one year 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 #abj days after the ,secretary posts the list pursuant to subparagraph 7,c71 comments from physician specialty societies1 applicable practitioner organizations1 and other stakeholders1 including representatives of individuals entitled to benefits under part ,a or enrolled under this part1 regarding the patient relationship categories and codes posted under subparagraph 7,c74 ,in seeking such comments1 the ,secretary shall use one or more mechanisms 7other than notice and comment rulemaking7 that may include open door forums1 town hall meetings1 web-based forums1 or other appropriate mechanisms4 7,e7 ,operational list of patient relationship categories and codes ,not later than #bdj 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 #bjah71 the ,secretary shall1 through rulemaking1 make revisions to the operational list of patient relationship categories and codes as the ,secretary determines appropriate4 ,such revisions may be based on experience1 new information developed pursuant to subsection 7n77#i77;,a71 and input from the physician specialty societies1 applicable practitioner organizations1 and other stakeholders1 including representatives of individuals entitled to benefits under part ,a or enrolled under this part4 7#d7 ,reporting of information for resource use measurement ,claims submitted for items and services furnished by a physician or applicable practitioner on or after ,january #a1 #bjah1 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 shall1 as the ,secretary determines appropriate-- 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 patients74 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 charges 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 charges 7such as subtotals for categories of items and services7 and measures of utilization of items and services 7such as frequency of specific items and services and the ratio of specific items and services among attributed patients or episodes74 7,d7 ,stakeholder ,input ,the ,secretary shall seek comments from the physician specialty societies1 applicable practitioner organizations1 and other stakeholders1 including representatives of individuals entitled to benefits under part ,a or enrolled under this part1 regarding the resource use methodology established pursuant to this paragraph4 ,in seeking comments the ,secretary shall use one or more mechanisms 7other than notice and comment rulemaking7 that may include open door forums1 town hall meetings1 web-based forums1 or other appropriate mechanisms4 7#f7 ,implementation ,to the extent that the ,secretary contracts with an entity to carry out any part of the provisions of this subsection1 the ,secretary may not contract with an entity or an entity with a subcontract if the entity or subcontracting entity currently makes recommendations to the ,secretary on relative values for services under the fee schedule for physicians' services under this section4 7#g7 ,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#h7 ,administration ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to this section4 7#i7 ,definitions ,in this subsection3 7,a7 ,physician ,the term physician has the meaning given such term in section #ahfa7r77#a74 7,b7 ,applicable practitioner ,the term applicable practitioner means-- 7i7 a physician assistant1 nurse practitioner1 and clinical nurse specialist 7as such terms are defined in section #ahfa7;aa77#e771 and a certified registered nurse anesthetist 7as defined in section #ahfa7;bb77#b772 and 7ii7 beginning ,january #a1 #bjai1 such other eligible professionals 7as defined in subsection 7k77#c77;,b77 as specified by the ,secretary4 7#aj7 ,clarification ,the provisions of sections #ahij7;b77#g7 and #ahij;,a shall not apply to this subsection4 4 #ajb4 ,priorities and funding for measure development ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d71 as amended by subsections 7c7 and 7f7 of section #aja1 is further amended by inserting at the end the following new subsection3 7s7 ,priorities and funding for measure development 7#a7 ,plan identifying measure development priorities and timelines 7,a7 ,draft measure development plan ,not later than ,january #a1 #bjaf1 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 provisions 7as defined in paragraph 7#e774 ,under such plan the ,secretary shall-- 7i7 address how measures used by private payers and integrated delivery systems could be incorporated under title ,,xviii2 7ii7 describe how coordination1 to the extent possible1 will occur across organizations developing such measures2 and 7iii7 take into account how clinical best practices and clinical practice guidelines should be used in the development of quality measures4 7,b7 ,quality domains ,for purposes of this subsection1 the term quality domains means at least the following domains3 7i7 ,clinical care4 7ii7 ,safety4 7iii7 ,care coordination4 7iv7 ,patient and caregiver experience4 7v7 ,population health and prevention4 7,c7 ,consideration ,in developing the draft plan under this paragraph1 the ,secretary shall consider-- 7i7 gap analyses conducted by the entity with a contract under section #ahij7;a7 or other contractors or entities2 7ii7 whether measures are applicable across health care settings2 7iii7 clinical practice improvement activities submitted under subsection 7q77#b77;,c77iv7 for identifying possible areas for future measure development and identifying existing gaps with respect to such measures2 and 7iv7 the quality domains applied under this subsection4 7,d7 ,priorities ,in developing the draft plan under this paragraph1 the ,secretary shall give priority to the following types of measures3 7i7 ,outcome measures1 including patient reported outcome and functional status measures4 7ii7 ,patient experience measures4 7iii7 ,care coordination measures4 7iv7 ,measures of appropriate use of services1 including measures of over use4 7,e7 ,stakeholder input ,the ,secretary shall accept through ,march #a1 #bjaf1 comments on the draft plan posted under paragraph 7#a77;,a7 from the public1 including health care providers1 payers1 consumers1 and other stakeholders4 7,f7 ,final measure development plan ,not later than ,may #a1 #bjaf1 taking into account the comments received under this subparagraph1 the ,secretary shall finalize the plan and post on the ,internet website of the ,centers for ,medicare ,medicaid ,services an operational plan for the development of quality measures for use under the applicable provisions4 ,such plan shall be updated as appropriate4 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 in accordance with the plan under paragraph 7#a7 quality measures for application under the applicable provisions4 ,such entities shall include organizations with quality measure development expertise4 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;,d74 7ii7 ,consideration ,in selecting measures for development under this subsection1 the ,secretary shall consider-- 7,i7 whether such measures would be electronically specified2 and 7,,ii7 clinical practice guidelines to the extent that such guidelines exist4 7#c7 ,annual report by the ,secretary 7,a7 ,in general ,not later than ,may #a1 #bjag1 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 subparagraph 7,a7 shall include the following3 7i7 ,a description of the ,secretary's efforts to implement this paragraph4 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 ,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 7v7 ,other information the ,secretary determines to be appropriate4 7#d7 ,stakeholder input ,with respect to paragraph 7#a71 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;,d72 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 ,definition of applicable provisions ,in this subsection1 the term applicable provisions means the following provisions3 7,a7 ,subsection 7q77#b77;,b77i74 7,b7 ,section #ahcc7z77#b77;,c74 7#f7 ,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 #bjae through #bjai4 ,amounts transferred under this paragraph shall remain available through the end of fiscal year #bjbb4 7#g7 ,administration ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to the collection of information for the development of quality measures4 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 for individuals with chronic care needs the ,secretary shall1 subject to subparagraph 7,b71 make payment 7as the ,secretary determines to be appropriate7 under this section for chronic care management services furnished on or after ,january #a1 #bjae1 by a physician 7as defined in section #ahfa7r77#a771 physician assistant or nurse practitioner 7as defined in section #ahfa7;aa77#e77;,a771 clinical nurse specialist 7as defined in section #ahfa7;aa77#e77;,b771 or certified nurse midwife 7as defined in section #ahfa7;gg77#b774 7,b7 ,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 services2 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 ,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-- 7,a7 identify barriers to receiving chronic care management services2 and 7,b7 make recommendations for increasing the appropriate use of chronic care management services4 #ajd4 ,empowering beneficiary choices through continued access to information on physicians' services 7a7 ,in general ,on an annual basis 7beginning with #bjae71 the ,secretary shall make publicly available1 in an easily understandable format1 information with respect to physicians and1 as appropriate1 other eligible professionals on items and services furnished to ,medicare beneficiaries under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7b7 ,type and manner of information ,the information made available under this section shall be similar to the type of information in the ,medicare ,provider ,utilization and ,payment ,data3 ,physician and ,other ,supplier ,public ,use ,file released by the ,secretary with respect to #bjab and shall be made available in a manner similar to the manner in which the information in such ,file is made available4 7c7 ,requirements ,the information made available under this section shall include1 at a minimum1 the following3 7#a7 ,information on the number of services furnished by the physician or other eligible professional under part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;j et seq471 which may include information on the most frequent services furnished or groupings of services4 7#b7 ,information on submitted charges and payments for services under such part4 7#c7 ,a unique identifier for the physician or other eligible professional that is available to the public1 such as a national provider identifier4 7d7 ,searchability ,the information made available under this section shall be searchable by at least the following3 7#a7 ,the specialty or type of the physician or other eligible professional4 7#b7 ,characteristics of the services furnished1 such as volume or groupings of services4 7#c7 ,the location of the physician or other eligible professional4 7e7 ,integration on physician compare ,beginning with #bjaf1 the ,secretary shall integrate the information made available under this section on ,physician ,compare4 7f7 ,definitions ,in this section3 7#a7 ,eligible professional2 physician2 ,secretary ,the terms eligible professional1 physician1 and ,secretary have the meaning given such terms in section #ajcca7;i7 of ,public ,law #aaa-adh4 7#b7 ,physician compare ,the term ,physician ,compare means the ,physician ,compare ,internet website of the ,centers for ,medicare ,medicaid ,services 7or a successor website74 #aje4 ,expanding availability of ,medicare data 7a7 ,expanding uses of ,medicare data by qualified entities 7#a7 ,additional analyses 7,a7 ,in general ,subject to subparagraph 7,b71 to the extent consistent with applicable information1 privacy1 security1 and disclosure laws 7including paragraph 7#c771 notwithstanding paragraph 7#d77;,b7 of section #ahgd7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7e77 and the second sentence of paragraph 7#d77;,d7 of such section1 beginning ,july #a1 #bjaf1 a qualified entity may use the combined data described in paragraph 7#d77;,b77iii7 of such section received by such entity under such section1 and information derived from the evaluation described in such paragraph 7#d77;,d71 to conduct additional non-public analyses 7as determined appropriate by the ,secretary7 and provide or sell such analyses to authorized users for non-public use 7including for the purposes of assisting providers of services and suppliers to develop and participate in quality and patient care improvement activities1 including developing new models of care74 7,b7 ,limitations with respect to analyses 7i7 ,employers ,any analyses provided or sold under subparagraph 7,a7 to an employer described in paragraph 7#i77;,a77iii7 may only be used by such employer for purposes of providing health insurance to employees and retirees of the employer4 7ii7 ,health insurance issuers ,a qualified entity may not provide or sell an analysis to a health insurance issuer described in paragraph 7#i77;,a77iv7 unless the issuer is providing the qualified entity with data under section #ahgd7;e77#d77;,b77iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7e77#d77;,b77iii774 7#b7 ,access to certain data 7,a7 ,access ,to the extent consistent with applicable information1 privacy1 security1 and disclosure laws 7including paragraph 7#c771 notwithstanding paragraph 7#d77;,b7 of section #ahgd7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7e77 and the second sentence of paragraph 7#d77;,d7 of such section1 beginning ,july #a1 #bjaf1 a qualified entity may-- 7i7 provide or sell the combined data described in paragraph 7#d77;,b77iii7 of such section to authorized users described in clauses 7i71 7ii71 and 7v7 of paragraph 7#i77;,a7 for non-public use1 including for the purposes described in subparagraph 7,b72 or 7ii7 subject to subparagraph 7,c71 provide ,medicare claims data to authorized users described in clauses 7i71 7ii71 and 7v71 of paragraph 7#i77;,a7 for non-public use1 including for the purposes described in subparagraph 7,b74 7,b7 ,purposes described ,the purposes described in this subparagraph are assisting providers of services and suppliers in developing and participating in quality and patient care improvement activities1 including developing new models of care4 7,c7 ,medicare claims data must be provided at no cost ,a qualified entity may not charge a fee for providing the data under subparagraph 7,a77ii74 7#c7 ,protection of information 7,a7 ,in general ,except as provided in subparagraph 7,b71 an analysis or data that is provided or sold under paragraph 7#a7 or 7#b7 shall not contain information that individually identifies a patient4 7,b7 ,information on patients of the provider of services or supplier ,to the extent consistent with applicable information1 privacy1 security1 and disclosure laws1 an analysis or data that is provided or sold to a provider of services or supplier under paragraph 7#a7 or 7#b7 may contain information that individually identifies a patient of such provider or supplier1 including with respect to items and services furnished to the patient by other providers of services or suppliers4 7,c7 ,prohibition on using analyses or data for marketing purposes ,an authorized user shall not use an analysis or data provided or sold under paragraph 7#a7 or 7#b7 for marketing purposes4 7#d7 ,data use agreement ,a qualified entity and an authorized user described in clauses 7i71 7ii71 and 7v7 of paragraph 7#i77;,a7 shall enter into an agreement regarding the use of any data that the qualified entity is providing or selling to the authorized user under paragraph 7#b74 ,such agreement shall describe the requirements for privacy and security of the data and1 as determined appropriate by the ,secretary1 any prohibitions on using such data to link to other individually identifiable sources of information4 ,if the authorized user is not a covered entity under the rules promulgated pursuant to the ,health ,insurance ,portability and ,accountability ,act of #aiif1 the agreement shall identify the relevant regulations1 as determined by the ,secretary1 that the user shall comply with as if it were acting in the capacity of such a covered entity4 7#e7 ,no redisclosure of analyses or data 7,a7 ,in general ,except as provided in subparagraph 7,b71 an authorized user that is provided or sold an analysis or data under paragraph 7#a7 or 7#b7 shall not redisclose or make public such analysis or data or any analysis using such data4 7,b7 ,permitted redisclosure ,a provider of services or supplier that is provided or sold an analysis or data under paragraph 7#a7 or 7#b7 may1 as determined by the ,secretary1 redisclose such analysis or data for the purposes of performance improvement and care coordination activities but shall not make public such analysis or data or any analysis using such data4 7#f7 ,opportunity for providers of services and suppliers to review ,prior to a qualified entity providing or selling an analysis to an authorized user under paragraph 7#a71 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 such provider or supplier with the opportunity to appeal and correct errors in the manner described in section #ahgd7;e77#d77;,c77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7e77#d77;,c77ii774 7#g7 ,assessment for a breach 7,a7 ,in general ,in the case of a breach of a data use agreement under this section or section #ahgd7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7e771 the ,secretary shall impose an assessment on the qualified entity both in the case of-- 7i7 an agreement between the ,secretary and a qualified entity2 and 7ii7 an agreement between a qualified entity and an authorized user4 7,b7 ,assessment ,the assessment under subparagraph 7,a7 shall be an amount up to #ajj for each individual entitled to1 or enrolled for1 benefits under part ,a of title ,,xviii of the ,social ,security ,act or enrolled for benefits under part ,b of such title-- 7i7 in the case of an agreement described in subparagraph 7,a77i71 for whom the ,secretary provided data on to the qualified entity under paragraph 7#b72 and 7ii7 in the case of an agreement described in subparagraph 7,a77ii71 for whom the qualified entity provided data on to the authorized user under paragraph 7#b74 7,c7 ,deposit of amounts collected ,any amounts collected pursuant to this paragraph shall be deposited in ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of the ,social ,security ,act 7#db ,u4,s4,c4 #aciet74 7#h7 ,annual reports ,any qualified entity that provides or sells an analysis or data under paragraph 7#a7 or 7#b7 shall annually submit to the ,secretary a report that includes-- 7,a7 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 7,b7 a description of the topics and purposes of such analyses2 7,c7 information on the entities who received the data under paragraph 7#b71 the uses of the data1 and the total amount of fees received for providing1 selling1 or sharing the data2 and 7,d7 other information determined appropriate by the ,secretary4 7#i7 ,definitions ,in this subsection and subsection 7b73 7,a7 ,authorized user ,the term authorized user means the following3 7i7 ,a provider of services4 7ii7 ,a supplier4 7iii7 ,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 ,act74 7v7 ,a medical society or hospital association4 7vi7 ,any entity not described in clauses 7i7 through 7v7 that is approved by the ,secretary 7other than an employer or health insurance issuer not described in clauses 7iii7 and 7iv71 respectively1 as determined by the ,secretary74 7,b7 ,provider of services ,the term provider of services has the meaning given such term in section #ahfa7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7u774 7,c7 ,qualified entity ,the term qualified entity has the meaning given such term in section #ahgd7;e77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7e774 7,d7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7,e7 ,supplier ,the term supplier has the meaning given such term in section #ahfa7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7d774 7b7 ,access to ,medicare data by qualified clinical data registries ,to facilitate quality improvement 7#a7 ,access 7,a7 ,in general ,to the extent consistent with applicable information1 privacy1 security1 and disclosure laws1 beginning ,july #a1 #bjaf1 the ,secretary shall1 at the request of a qualified clinical data registry under section #ahdh7m77#c77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#c77;,e771 provide the data described in subparagraph 7,b7 7in a form and manner determined to be appropriate7 to such qualified clinical data registry for purposes of linking such data with clinical outcomes data and performing risk-adjusted1 scientifically valid analyses and research to support quality improvement or patient safety1 provided that any public reporting of such analyses or research that identifies a provider of services or supplier shall only be conducted with the opportunity of such provider or supplier to appeal and correct errors in the manner described in subsection 7a77#f74 7,b7 ,data described ,the data described in this subparagraph is-- 7i7 claims data under the ,medicare program under title ,,xviii of the ,social ,security ,act2 and 7ii7 if the ,secretary determines appropriate1 claims data under the ,medicaid program under title ,,xix of such ,act and the ,state ,children's ,health ,insurance ,program under title ,,xxi of such ,act4 7#b7 ,fee ,data described in paragraph 7#a77;,b7 shall be provided to a qualified clinical data registry under paragraph 7#a7 at a fee equal to the cost of providing such data4 ,any fee collected pursuant to the preceding sentence shall be deposited in the ,centers for ,medicare ,medicaid ,services ,program ,management ,account4 7c7 ,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 ,beginning ,july #a1 #bjaf1 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 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 #bjaf1 after deposited2 and 7#b7 by inserting the following before the period at the end3 1 and1 beginning ,july #a1 #bjaf1 into the ,centers for ,medicare ,medicaid ,services ,program ,management ,account4 #ajf4 ,reducing administrative burden and other provisions 7a7 ,medicare physician and practitioner opt-,out to private contract 7#a7 ,indefinite1 continuing automatic extension of opt out election 7,a7 ,in general ,section #ahjb7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;a7b77#c77 is amended-- 7i7 in subparagraph 7,b77ii71 by striking during the #b-year period beginning on the date the affidavit is signed and inserting during the applicable #b-year period 7as defined in subparagraph 7,d772 7ii7 in subparagraph 7,c71 by striking during the #b-year period described in subparagraph 7,b77ii7 and inserting during the applicable #b-year period2 and 7iii7 by adding at the end the following new subparagraph3 7,d7 ,applicable #b-year periods for effectiveness of affidavits ,in this subsection1 the term applicable #b-year period means1 with respect to an affidavit of a physician or practitioner under subparagraph 7,b71 the #b-year period beginning on the date the affidavit is signed and includes each subsequent #b-year period unless the physician or practitioner involved provides notice to the ,secretary 7in a form and manner specified by the ,secretary71 not later than #cj days before the end of the previous #b-year period1 that the physician or practitioner does not want to extend the application of the affidavit for such subsequent #b-year period4 4 7,b7 ,effective date ,the amendments made by subparagraph 7,a7 shall apply to affidavits entered into on or after the date that is #fj days after the date of the enactment of this ,act4 7#b7 ,public availability of information on opt-out physicians and practitioners ,section #ahjb7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;a7b77 is amended-- 7,a7 in paragraph 7#e71 by adding at the end the following new subparagraph3 7,d7 ,opt-out physician or practitioner ,the term opt-out physician or practitioner means a physician or practitioner who has in effect an affidavit under paragraph 7#c77;,b74 2 7,b7 by redesignating paragraph 7#e7 as paragraph 7#f72 and 7,c7 by inserting after paragraph 7#d7 the following new paragraph3 7#e7 ,posting of information on opt-out physicians and practitioners 7,a7 ,in general ,beginning not later than ,february #a1 #bjaf1 the ,secretary shall make publicly available through an appropriate publicly accessible website of the ,department of ,health and ,human ,services information on the number and characteristics of opt-out physicians and practitioners and shall update such information on such website not less often than annually4 7,b7 ,information to be included ,the information to be made available under subparagraph 7,a7 shall include at least the following with respect to opt-out physicians and practitioners3 7i7 ,their number4 7ii7 ,their physician or professional specialty or other designation4 7iii7 ,their geographic distribution4 7iv7 ,the timing of their becoming opt-out physicians and practitioners1 relative1 to the extent feasible1 to when they first enrolled in the program under this title and with respect to applicable #b-year periods4 7v7 ,the proportion of such physicians and practitioners who billed for emergency or urgent care services4 4 7b7 ,gainsharing study and report ,not later than #f months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in consultation with the ,inspector ,general of the ,department of ,health and ,human ,services1 shall submit to ,congress a report with legislative recommendations to amend existing fraud and abuse laws1 through exceptions1 safe harbors1 or other narrowly targeted provisions1 to permit gainsharing or similar arrangements between physicians and hospitals that improve care while reducing waste and increasing efficiency4 ,the report shall-- 7#a7 consider whether such provisions should apply to ownership interests1 compensation arrangements1 or other relationships2 7#b7 describe how the recommendations address accountability1 transparency1 and quality1 including how best to limit inducements to stint on care1 discharge patients prematurely1 or otherwise reduce or limit medically necessary care2 and 7#c7 consider whether a portion of any savings generated by such arrangements should accrue to the ,medicare program under title ,,xviii of the ,social ,security ,act4 7c7 ,promoting interoperability of electronic health record systems 7#a7 ,recommendations for achieving widespread ,,ehr interoperability 7,a7 ,objective ,as a consequence of a significant ,federal investment in the implementation of health information technology through the ,medicare and ,medicaid ,,ehr incentive programs1 ,congress declares it a national objective to achieve widespread exchange of health information through interoperable certified ,,ehr technology nationwide by ,december #ca1 #bjah4 7,b7 ,definitions ,in this paragraph3 7i7 ,widespread interoperability ,the term widespread interoperability means interoperability between certified ,,ehr technology systems employed by meaningful ,,ehr users under the ,medicare and ,medicaid ,,ehr incentive programs and other clinicians and health care providers on a nationwide basis4 7ii7 ,interoperability ,the term interoperability means the ability of two or more health information systems or components to exchange clinical and other information and to use the information that has been exchanged using common standards as to provide access to longitudinal information for health care providers in order to facilitate coordinated care and improved patient outcomes4 7,c7 ,establishment of metrics ,not later than ,july #a1 #bjaf1 and in consultation with stakeholders1 the ,secretary shall establish metrics to be used to determine if and to the extent that the objective described in subparagraph 7,a7 has been achieved4 7,d7 ,recommendations if objective not achieved ,if the ,secretary of ,health and ,human ,services determines that the objective described in subparagraph 7,a7 has not been achieved by ,december #ca1 #bjah1 then the ,secretary shall submit to ,congress a report1 by not later than ,december #ca1 #bjai1 that identifies barriers to such objective and recommends actions that the ,federal ,government can take to achieve such objective4 ,such recommended actions may include recommendations-- 7i7 to adjust payments for not being meaningful ,,ehr users under the ,medicare ,,ehr incentive programs2 and 7ii7 for criteria for decertifying certified ,,ehr technology products4 7#b7 ,preventing blocking the sharing of information 7,a7 ,for meaningful use ,,ehr professionals ,section #ahdh7o77#b77;,a77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#b77;,a77ii77 is amended by inserting before the period at the end the following3 1 and the professional demonstrates 7through a process specified by the ,secretary1 such as the use of an attestation7 that the professional has not knowingly and willfully taken action 7such as to disable functionality7 to limit or restrict the compatibility or interoperability of the certified ,,ehr technology4 7,b7 ,for meaningful use ,,ehr hospitals ,section #ahhf7n77#c77;,a77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7n77#c77;,a77ii77 is amended by inserting before the period at the end the following3 1 and the hospital demonstrates 7through a process specified by the ,secretary1 such as the use of an attestation7 that the hospital has not knowingly and willfully taken action 7such as to disable functionality7 to limit or restrict the compatibility or interoperability of the certified ,,ehr technology4 7,c7 ,effective date ,the amendments made by this subsection shall apply to meaningful ,,ehr users as of the date that is one year after the date of the enactment of this ,act4 7#c7 ,study and report on the feasibility of establishing a mechanism to compare certified ,,ehr technology products 7,a7 ,study ,the ,secretary shall conduct a study to examine the feasibility of establishing one or more mechanisms to assist providers in comparing and selecting certified ,,ehr technology products4 ,such mechanisms may include-- 7i7 a website with aggregated results of surveys of meaningful ,,ehr users on the functionality of certified ,,ehr technology products to enable such users to directly compare the functionality and other features of such products2 and 7ii7 information from vendors of certified products that is made publicly available in a standardized format4 ,the aggregated results of the surveys described in clause 7i7 may be made available through contracts with physicians1 hospitals1 or other organizations that maintain such comparative information described in such clause4 7,b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on mechanisms that would assist providers in comparing and selecting certified ,,ehr technology products4 ,the report shall include information on the benefits of1 and resources needed to develop and maintain1 such mechanisms4 7#d7 ,definitions ,in this subsection3 7,a7 ,the term certified ,,ehr technology has the meaning given such term in section #ahdh7o77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#d774 7,b7 ,the term meaningful ,,ehr user has the meaning given such term under the ,medicare ,,ehr incentive programs4 7,c7 ,the term ,medicare and ,medicaid ,,ehr incentive programs means-- 7i7 in the case of the ,medicare program under title ,,xviii of the ,social ,security ,act1 the incentive programs under section #ahad7l77#c71 section #ahdh7o71 subsections 7l7 and 7m7 of section #ahec1 and section #ahhf7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7l77#c71 #aciew-#d7o71 #aciew-#bc1 #acieww7n772 and 7ii7 in the case of the ,medicaid program under title ,,xix of such ,act1 the incentive program under subsections 7a77#c77;,f7 and 7t7 of section #aijc of such ,act 7#db ,u4,s4,c4 #acif;b74 7,d7 ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7d7 ,,gao studies and reports on the use of telehealth under ,federal programs and on remote patient monitoring services 7#a7 ,study on telehealth services ,the ,comptroller ,general of the ,united ,states shall conduct a study on the following3 7,a7 ,how the definition of telehealth across various ,federal programs and ,federal efforts can inform the use of telehealth in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7,b7 ,issues that can facilitate or inhibit the use of telehealth under the ,medicare program under such title1 including oversight and professional licensure1 changing technology1 privacy and security1 infrastructure requirements1 and varying needs across urban and rural areas4 7,c7 ,potential implications of greater use of telehealth with respect to payment and delivery system transformations under the ,medicare program under such title ,,xviii and the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 7,d7 ,how the ,centers for ,medicare ,medicaid ,services monitors payments made under the ,medicare program under such title ,,xviii to providers for telehealth services4 7#b7 ,study on remote patient monitoring services 7,a7 ,in general ,the ,comptroller ,general of the ,united ,states shall conduct a study-- 7i7 of the dissemination of remote patient monitoring technology in the private health insurance market2 7ii7 of the financial incentives in the private health insurance market relating to adoption of such technology2 7iii7 of the barriers to adoption of such services under the ,medicare program under title ,,xviii of the ,social ,security ,act2 7iv7 that evaluates the patients1 conditions1 and clinical circumstances that could most benefit from remote patient monitoring services2 and 7v7 that evaluates the challenges related to establishing 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 ,definitions ,for purposes of this paragraph3 7i7 ,remote patient monitoring services ,the term remote patient monitoring services means services furnished through remote patient monitoring technology4 7ii7 ,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#c7 ,reports ,not later than #bd months after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress-- 7,a7 a report containing the results of the study conducted under paragraph 7#a72 and 7,b7 a report containing the results of the study conducted under paragraph 7#b74 ,a report required under this paragraph shall be submitted together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 ,the ,comptroller ,general may submit one report containing the results described in subparagraphs 7,a7 and 7,b7 and the recommendations described in the previous sentence4 7e7 ,rule of construction regarding health care providers 7#a7 ,in general ,subject to paragraph 7#c71 the development1 recognition1 or implementation of any guideline or other standard under any ,federal health care provision shall not be construed to establish the standard of care or duty of care owed by a health care provider to a patient in any medical malpractice or medical product liability action or claim4 7#b7 ,definitions ,for purposes of this subsection3 7,a7 ,federal health care provision ,the term ,federal health care provision means any provision of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 title ,i or subtitle ,b of title ,,ii of the ,health ,care and ,education ,reconciliation ,act of #bjaj 7,public ,law #aaa-aeb71 or title ,,xviii or ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq41 #db ,u4,s4,c4 #acif et seq474 7,b7 ,health care provider ,the term health care provider means any individual1 group practice1 corporation of health care professionals1 or hospital-- 7i7 licensed1 registered1 or certified under ,federal or ,state laws or regulations to provide health care services2 or 7ii7 required to be so licensed1 registered1 or certified but that is exempted by other statute or regulation4 7,c7 ,medical malpractice or medical product liability action or claim ,the term medical malpractice or medical product liability action or claim means a medical malpractice action or claim 7as defined in section #dca7g7 of the ,health ,care ,quality ,improvement ,act of #aihf 7#db ,u4,s4,c4 #aaaea7g777 and includes a liability action or claim relating to a health care provider's prescription or provision of a drug1 device1 or biological product 7as such terms are defined in section #bja of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cba7 or section #cea of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bfb774 7,d7 ,state ,the term ,state includes the ,district of ,columbia1 ,puerto ,rico1 and any other commonwealth1 possession1 or territory of the ,united ,states4 7#c7 ,no preemption ,nothing in paragraph 7#a7 or any provision of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 title ,i or subtitle ,b of title ,,ii of the ,health ,care and ,education ,reconciliation ,act of #bjaj 7,public ,law #aaa-aeb71 or title ,,xviii or ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq41 #db ,u4,s4,c4 #acif et seq47 shall be construed to preempt any ,state or common law governing medical professional or medical product liability actions or claims4 ,,ii ,medicare and ,other ,health ,extenders ,a ,medicare ,extenders #bja4 ,extension of work ,,gpci floor ,section #ahdh7;e77#a77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;e77#a77;,e77 is amended by striking ,april #a1 #bjae and inserting ,january #a1 #bjah4 #bjb4 ,extension of therapy cap exceptions process 7a7 ,in general ,section #ahcc7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7g77 is amended-- 7#a7 in paragraph 7#e77;,a71 in the first sentence1 by striking ,march #ca1 #bjae and inserting ,december #ca1 #bjag2 and 7#b7 in paragraph 7#f77;,a7-- 7,a7 by striking ,march #ca1 #bjae and inserting ,december #ca1 #bjag2 and 7,b7 by striking #bjab1 #bjac1 #bjad1 or the first three months of #bjae and inserting #bjab through #bjag4 7b7 ,targeted reviews under manual medical review process for outpatient therapy services 7#a7 ,in general ,section #ahcc7;g77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7g77#e77 is amended-- 7,a7 in subparagraph 7,c77i71 by inserting 1 subject to subparagraph 7,e71 after manual medical review process that2 and 7,b7 by adding at the end the following new subparagraph3 7,e7 7i7 ,in place of the manual medical review process under subparagraph 7,c77i71 the ,secretary shall implement a process for medical review under this subparagraph under which the ,secretary shall identify and conduct medical review for services described in subparagraph 7,c77i7 furnished by a provider of services or supplier 7in this subparagraph referred to as a therapy provider7 using such factors as the ,secretary determines to be appropriate4 7ii7 ,such factors may include the following3 7,i7 ,the therapy provider has had a high claims denial percentage for therapy services under this part or is less compliant with applicable requirements under this title4 7,,ii7 ,the therapy provider has a pattern of billing for therapy services under this part that is aberrant compared to peers or otherwise has questionable billing practices for such services1 such as billing medically unlikely units of services in a day4 7,,iii7 ,the therapy provider is newly enrolled under this title or has not previously furnished therapy services under this part4 7,,iv7 ,the services are furnished to treat a type of medical condition4 7,v7 ,the therapy provider is part of group that includes another therapy provider identified using the factors determined under this subparagraph4 7iii7 ,for purposes of carrying out this subparagraph1 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 fiscal years #bjae and #bjaf1 to remain available until expended4 ,such funds may not be used by a contractor under section #ahic7;h7 for medical reviews under this subparagraph4 7iv7 ,the targeted review process under this subparagraph shall not apply to services for which expenses are incurred beyond the period for which the exceptions process under subparagraph 7,a7 is implemented4 4 7#b7 ,effective date ,the amendments made by this subsection shall apply with respect to requests described in section #ahcc7;g77#e77;,c77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7g77#e77;,c77i77 with respect to which the ,secretary of ,health and ,human ,services has not conducted medical review under such section by a date 7not later than #ij days after the date of the enactment of this ,act7 specified by the ,secretary4 #bjc4 ,extension of ambulance add-ons 7a7 ,ground ,ambulance ,section #ahcd7l77#ac77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77#ac77;,a77 is amended by striking ,april #a1 #bjae and inserting ,january #a1 #bjah each place it appears4 7b7 ,super rural ground 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 ,april #a1 #bjae and inserting ,january #a1 #bjah4 #bjd4 ,extension of increased inpatient hospital payment adjustment for certain low-volume hospitals ,section #ahhf7;d77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#ab77 is amended-- 7#a7 in subparagraph 7,b71 in the matter preceding clause 7i71 by striking in fiscal year #bjae 7beginning on ,april #a1 #bjae71 fiscal year #bjaf1 and subsequent fiscal years and inserting in fiscal year #bjah and subsequent fiscal years2 7#b7 in subparagraph 7,c77i71 by striking fiscal years #bjaa through #bjad and fiscal year #bjae 7before ,april #a1 #bjae71 and inserting fiscal years #bjaa through #bjag1 each place it appears2 and 7#c7 in subparagraph 7,d71 by striking fiscal years #bjaa through #bjad and fiscal year #bjae 7before ,april #a1 #bjae71 and inserting fiscal years #bjaa through #bjag14 #bje4 ,extension of the ,medicare-dependent hospital 7,,mdh7 program 7a7 ,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 ,april #a1 #bjae and inserting ,october #a1 #bjag2 and 7#b7 in clause 7ii77,,ii71 by striking ,april #a1 #bjae and inserting ,october #a1 #bjag4 7b7 ,conforming amendments 7#a7 ,extension of target amount ,section #ahhf7;b77#c77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,d77 is amended-- 7,a7 in the matter preceding clause 7i71 by striking ,april #a1 #bjae and inserting ,october #a1 #bjag2 and 7,b7 in clause 7iv71 by striking through fiscal year #bjad and the portion of fiscal year #bjae before ,april #a1 #bjae and inserting through fiscal year #bjag4 7#b7 ,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 through the first #b quarters of fiscal year #bjae and inserting through fiscal year #bjag4 #bjf4 ,extension for specialized ,medicare ,advantage plans for special needs individuals ,section #ahei7;f77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#a77 is amended by striking #bjag and inserting #bjai4 #bjg4 ,extension of funding for quality measure endorsement1 input1 and selection ,section #ahij7;d77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7d77#b77 is amended by striking and #ae1jjj1jjj for the first #f months of fiscal year #bjae and inserting and #cj1jjj1jjj for each of fiscal years #bjae through #bjag4 #bjh4 ,extension of funding outreach and assistance for low-income programs 7a7 ,additional funding for state health insurance programs ,subsection 7a77#a77;,b7 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-adh71 section #faj of the ,american ,taxpayer ,relief ,act of #bjab 7,public ,law #aab-bdj71 section #aaaj of the ,pathway for ,,sgr ,reform ,act of #bjac 7,public ,law #aac-fg71 and section #aaj of the ,protecting ,access to ,medicare ,act of #bjad 7,public ,law #aac-ic71 is amended-- 7#a7 in clause 7iv71 by striking and at the end2 7#b7 by striking clause 7v72 and 7#c7 by adding at the end the following new clauses3 7v7 for fiscal year #bjae1 of #g1ejj1jjj2 7vi7 for fiscal year #bjaf1 of #ac1jjj1jjj2 and 7vii7 for fiscal year #bjag1 of #ac1jjj1jjj4 4 7b7 ,additional funding for area agencies on aging ,subsection 7b77#a77;,b7 of such section #aai1 as so amended1 is amended-- 7#a7 in clause 7iv71 by striking and at the end2 7#b7 by striking clause 7v72 and 7#c7 by inserting after clause 7iv7 the following new clauses3 7v7 for fiscal year #bjae1 of #g1ejj1jjj2 7vi7 for fiscal year #bjaf1 of #g1ejj1jjj2 and 7vii7 for fiscal year #bjag1 of #g1ejj1jjj4 4 7c7 ,additional funding for aging and disability resource centers ,subsection 7c77#a77;,b7 of such section #aai1 as so amended1 is amended-- 7#a7 in clause 7iv71 by striking and at the end2 7#b7 by striking clause 7v72 and 7#c7 by inserting after clause 7iv7 the following new clauses3 7v7 for fiscal year #bjae1 of #e1jjj1jjj2 7vi7 for fiscal year #bjaf1 of #e1jjj1jjj2 and 7vii7 for fiscal year #bjag1 of #e1jjj1jjj4 4 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-- 7#a7 in clause 7iv71 by striking and at the end2 7#b7 by striking clause 7v72 and 7#c7 by inserting after clause 7iv7 the following new clauses3 7v7 for fiscal year #bjae1 of #e1jjj1jjj2 7vi7 for fiscal year #bjaf1 of #ab1jjj1jjj2 and 7vii7 for fiscal year #bjag1 of #ab1jjj1jjj4 4 #bji4 ,extension and transition of 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 7#b7 in clause 7iii77,i71 by inserting cost plan service after ,with respect to any portion of the2 7#c7 in clause 7iii77,,ii71 by inserting cost plan service after ,with respect to any other portion of such2 and 7#d7 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 7ii71 or where such contract has been extended or renewed but the eligible organization has informed the ,secretary in writing not later than a date determined appropriate by the ,secretary that such organization voluntarily plans not to seek renewal of the reasonable cost reimbursement contract1 the following shall apply3 7,i7 ,notwithstanding such clause1 such contract may be extended or renewed for the two years subsequent to #bjaf4 ,the final year in which such contract is extended or renewed is referred to in this subsection as the last reasonable cost reimbursement contract year for the contract4 7,,ii7 ,the organization may not enroll a new enrollee under such contract during the last reasonable cost reimbursement contract year for the contract 7but may continue to enroll new enrollees through the end of the year immediately preceding such year7 unless such enrollee is any of the following3 7aa7 ,an individual who chooses enrollment in the reasonable cost contract during the annual election period with respect to such last year4 7bb7 ,an individual whose spouse1 at the time of the individual's enrollment is an enrollee under the reasonable cost reimbursement contract4 7cc7 ,an individual who is covered under an employer group health plan that offers coverage through the reasonable cost reimbursement contract4 7dd7 ,an individual who becomes entitled to benefits under part ,a1 or enrolled under part ,b1 and was enrolled in a plan offered by the eligible organization immediately prior to the individual's enrollment under the reasonable cost reimbursement contract4 7,,iii7 ,not later than a date determined appropriate by the ,secretary prior to the beginning of the last reasonable cost reimbursement contract year for the contract1 the organization shall provide notice to the ,secretary as to whether the organization will apply to have the contract converted over1 in whole or in part1 and offered as a ,medicare ,advantage plan under part ,c for the year following the last reasonable cost reimbursement contract year for the contract4 7,,iv7 ,if the organization provides the notice described in subclause 7,,iii7 that the contract will be converted1 in whole or in part1 the organization shall1 not later than a date determined appropriate by the ,secretary1 provide the ,secretary with such information as the ,secretary determines appropriate in order to carry out section #ahea7;c77#d7 and to carry out section #ahed7;a77#e71 including subparagraph 7,c77ii7 of such section4 7,v7 ,in the case that the organization enrolls a new enrollee under such contract during the last reasonable cost reimbursement contract year for the contract1 the organization shall provide the individual with a notification that such year is the last year for such contract4 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 converted1 in whole or in part1 the following shall apply3 7,i7 ,the deemed enrollment under section #ahea7;c77#d74 7,,ii7 ,the special rule for quality increase under section #ahec7o77#d77;,c74 7,,iii7 ,during the last reasonable cost reimbursement contract year for the contract and the year immediately preceding such year1 the eligible organization1 or the corporate parent organization of the eligible organization1 shall be permitted to offer an ,,ma plan in the area that such contract is being offered and enroll ,medicare ,advantage eligible individuals in such ,,ma plan and such cost plan4 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 #bjag1 an ,,ma eligible individual described in clause 7i7 or 7ii7 of subparagraph 7,b7 is deemed1 unless the individual elects otherwise1 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 the last reasonable cost reimbursement contract year of the contract 7as described in subclause 7,i7 of section #ahgf7;h77#e77;,c77iv77 pursuant to such section2 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 entity that has a common ownership interest of control7 that entered into such contract2 and 7,,iii7 is offered in the service area where the individual resides2 7v7 in the case of reasonable cost reimbursement contracts that provide coverage under parts ,a and ,b 7and1 to the extent the ,secretary determines it to be feasible1 contracts that provide only part ,b coverage71 the difference between the estimated premiums 7and other individuals costs as determined applicable by the ,secretary7 for the applicable ,,ma plan and the estimated premiums 7and such costs7 for the predecessor cost plan does not exceed a threshold established by the ,secretary2 and 7vi7 the applicable ,,ma plan-- 7,i7 provides coverage for enrollees transitioning from the converted reasonable cost reimbursement contract to such plan to maintain current providers of services and suppliers and course of treatment at the time of enrollment for a period of at least #ij days after enrollment2 and 7,,ii7 during such period1 pays such providers of services and suppliers for items and services furnished to the enrollee an amount that is not less than the amount of payment applicable for such 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 is not1 for such previous plan year1 enrolled in a prescription drug plan 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 is enrolled in a prescription drug plan 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 and notification of deemed individuals ,not later than #de days before the first day of the annual1 coordinated election period under subsection 7e77#c7 for plan years beginning on or after ,january #a1 #bjag1 the ,secretary shall identify and notify 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;,f714 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#d744 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 in the heading1 by striking ,notification to newly eligible ,medicare ,advantage eligible individuals and inserting the following3 ,notifications required4-- 7i7 ,notification to newly eligible ,medicare ,advantage eligible individuals 2 and 7#b7 by adding at the end the following new clause3 7ii7 ,notification related to certain deemed elections ,the ,secretary shall require a ,medicare ,advantage organization that is offering a ,medicare ,advantage plan that has been converted from a reasonable cost reimbursement contract pursuant to section #ahgf7;h77#e77;,c77iv7 to mail1 not later than #cj days prior to the first day of the annual1 coordinated election period under subsection 7e77#c7 of a year1 to any individual enrolled under such contract and 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 with respect to such plan 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 7,,iv7 information about the special period for elections under subsection 7e77#b77;,f72 and 7,v7 other information the ,secretary may specify4 4 7d7 ,treatment of transition plan for quality rating for payment purposes ,section #ahec7o77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7o77#d77 is amended by adding at the end the following new subparagraph3 7,c7 ,special rule for first #c plan years for plans that were converted from a reasonable cost reimbursement contract ,for purposes of applying paragraph 7#a7 and section #ahed7;b77#a77;,c7 for the first #c plan years under this part in the case of an ,,ma plan to which deemed enrollment applies under section #ahea7;c77#d7-- 7i7 such plan shall not be treated as a new ,,ma plan 7as defined in paragraph 7#c77;,a77iii77,,ii772 and 7ii7 in determining the star rating of the plan under subparagraph 7,a71 to the extent that ,medicare ,advantage data for such plan is not available for a measure used to determine such star rating1 the ,secretary shall use data from the period in which such plan was a reasonable cost reimbursement contract4 4 #baj4 ,extension of home health rural add-on ,section #dba7;a7 of the ,medicare ,prescription ,drug1 ,improvement1 and ,modernization ,act of #bjjc 7,public ,law #ajh-agc2 #aag ,stat4 #bbhc2 #db ,u4,s4,c4 #acie;fff note71 as amended by section #ebja7;b7 of the ,deficit ,reduction ,act of #bjje 7,public ,law #aji-aga2 #abj ,stat4 #df7 and by section #caca7;c7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh2 #abd ,stat4 #dbh71 is amended by striking ,january #a1 #bjaf and inserting ,january #a1 #bjah each place it appears4 ,b ,other ,health ,extenders #baa4 ,permanent extension of the qualifying individual 7,,qi7 program 7a7 ,permanent extension ,section #aijb7;a77#aj77;,e77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,e77iv77 is amended by striking 7but only for premiums payable with respect to months during the period beginning with ,january #aiih1 and ending with ,march #bjae74 7b7 ,allocations ,section #aicc7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#c7;g77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 by striking subparagraphs 7,a7 through 7,h72 7,b7 in subparagraph 7,v71 by striking and at the end2 7,c7 in subparagraph 7,w71 by striking the period at the end and inserting a semicolon2 7,d7 by redesignating subparagraphs 7,i7 through 7,w7 as subparagraphs 7,a7 through 7,o71 respectively2 and 7,e7 by adding at the end the following new subparagraphs3 7,p7 for the period that begins on ,april #a1 #bjae1 and ends on ,december #ca1 #bjae1 the total allocation amount is #ece1jjj1jjj2 and 7,q7 for #bjaf and1 subject to paragraph 7#d71 for each subsequent year1 the total allocation amount is #ihj1jjj1jjj4 2 7#b7 in paragraph 7#c71 by striking 7,p71 7,r71 7,t71 or 7,v7 and inserting or 7,p72 and 7#c7 by adding at the end the following new paragraph3 7#d7 ,adjustment to allocations ,the ,secretary may increase the allocation amount under paragraph 7#b77,q7 for a year 7beginning with #bjag7 up to an amount that does not exceed the product of the following3 7,a7 ,maximum allocation amount for previous year ,in the case of #bjag1 the allocation amount for #bjaf1 or in the case of a subsequent year1 the maximum allocation amount allowed under this paragraph for the previous year4 7,b7 ,increase in part ,b premium ,the monthly premium rate determined under section #ahci for the year divided by the monthly premium rate determined under such section for the previous year4 7,c7 ,increase in part ,b enrollment ,the average number of individuals 7as estimated by the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services in ,september of the previous year7 to be enrolled under part ,b of title ,,xviii for months in the year divided by the average number of such individuals 7as so estimated7 under this subparagraph with respect to enrollments in months in the previous year4 4 #bab4 ,permanent extension of transitional medical assistance 7,,tma7 7a7 ,in general ,section #aibe of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#f7 is amended-- 7#a7 by striking subsection 7f72 and 7#b7 by redesignating subsection 7g7 as subsection 7f74 7b7 ,conforming amendment ,section #aijb7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#a77 is amended to read as follows3 7#a7 ,beginning ,april #a1 #aiij1 for provisions relating to the extension of eligibility for medical assistance for certain families who have received aid pursuant to a ,state plan approved under part ,a of title ,,iv and have earned income1 see section #aibe4 4 #bac4 ,extension of special diabetes program for type ,i diabetes and for ,indians 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 #bjae and inserting #bjag4 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 #bjae and inserting #bjag4 #bad4 ,extension of abstinence education 7a7 ,in general ,section #eaj of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 is amended-- 7#a7 in subsection 7a71 striking #bjae and inserting #bjag2 and 7#b7 in subsection 7d71 by inserting and an additional #ge1jjj1jjj for each of fiscal years #bjaf and #bjag after #bjae4 7b7 ,budget scoring ,notwithstanding section #beg7;b77#b7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe1 the baseline shall be calculated assuming that no grant shall be made under section #eaj of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 after fiscal year #bjag4 7c7 ,reallocation of unused funding ,the remaining unobligated balances of the amount appropriated for fiscal years #bjaf and #bjag by section #eaj7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj7;d77 for which no application has been received by the ,funding ,opportunity ,announcement deadline1 shall be made available to ,states that require the implementation of each element described in subparagraphs 7,a7 through 7,h7 of the definition of abstinence education in section #eaj7;b77#b74 ,the remaining unobligated balances shall be reallocated to such ,states that submit a valid application consistent with the original formula for this funding4 #bae4 ,extension of personal responsibility education program 7,,prep7 ,section #eac of the ,social ,security ,act 7#db ,u4,s4,c4 #gac7 is amended-- 7#a7 in paragraphs 7#a77;,a7 and 7#d77;,a7 of subsection 7a71 by striking #bjae and inserting #bjag each place it appears2 7#b7 in subsection 7a77#d77;,b77i71 by striking 1 #bjac1 #bjad1 and #bjae and inserting through #bjag2 and 7#c7 in subsection 7f71 by striking #bjae and inserting #bjag4 #baf4 ,extension of funding for family-to-family health information centers ,section #eja7;c77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gja7;c77#a77;,a77 is amended-- 7#a7 by striking clause 7vi72 and 7#b7 by adding after clause 7v7 the following new clause3 7vi7 #e1jjj1jjj for each of fiscal years #bjae through #bjag4 4 #bag4 ,extension of 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 #bjae and inserting #bjag4 #bah4 ,extension of maternal1 infant1 and early childhood home visiting programs ,section #eaa7;j77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;j77 is amended-- 7#a7 by striking and at the end of subparagraph 7,e72 7#b7 in subparagraph 7,f7-- 7,a7 by striking for the period beginning on ,october #a1 #bjad1 and ending on ,march #ca1 #bjae and inserting for fiscal year #bjae2 7,b7 by striking an amount equal to the amount provided in subparagraph 7,e7 and inserting #djj1jjj1jjj2 and 7,c7 by striking the period at the end and inserting a semicolon2 and 7#c7 by adding at the end the following new subparagraphs3 7,g7 for fiscal year #bjaf1 #djj1jjj1jjj2 and 7,h7 for fiscal year #bjag1 #djj1jjj1jjj4 4 #bai4 ,tennessee ,,dsh allotment for fiscal years #bjae through #bjbe ,section #aibc7;f77#f77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77#f77;,a77 is amended by adding at the end the following3 7vi7 ,allotment for fiscal years #bjae through #bjbe ,notwithstanding any other provision of this subsection1 any other provision of law1 or the terms of the ,tenn,care ,demonstration ,project in effect for the ,state1 the ,,dsh allotment for ,tennessee for fiscal year #bjae1 and for each fiscal year thereafter through fiscal year #bjbe1 shall be #ec1ajj1jjj for each such fiscal year4 4 #bbj4 ,delay in effective date for ,medicaid amendments relating to beneficiary liability settlements ,section #bjb7;c7 of the ,bipartisan ,budget ,act of #bjac 7division ,a of ,public ,law #aac-fg2 #db ,u4,s4,c4 #acif;a note71 as amended by section #baa of the ,protecting ,access to ,medicare ,act of #bjad 7,public ,law #aac-ic2 #abh ,stat4 #ajdg7 is amended by striking ,october #a1 #bjaf and inserting ,october #a1 #bjag4 #bba4 ,extension of funding for community health centers1 the ,national ,health ,service ,corps1 and teaching health centers 7a7 ,funding for ,community ,health ,centers and the ,national ,health ,service ,corps 7#a7 ,community health centers ,section #ajejc7;b77#a77;,e7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bed;b-#b7;b77#a77;,e77 is amended by striking for fiscal year #bjae and inserting for each of fiscal years #bjae through #bjag4 7#b7 ,national ,health ,service ,corps ,section #ajejc7;b77#b77;,e7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bed;b-#b7;b77#b77;,e77 is amended by striking for fiscal year #bjae and inserting for each of fiscal years #bjae through #bjag4 7b7 ,extension of teaching health centers program ,section #cdj;,h7g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;h7g77 is amended by inserting and #fj1jjj1jjj for each of fiscal years #bjaf and #bjag before the period at the end4 7c7 ,application ,amounts appropriated pursuant to this section for fiscal year #bjaf and fiscal year #bjag are subject to the requirements contained in ,public ,law #aac-bce for funds for programs authorized under sections #ccj through #cdj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b-#bef74 ,,iii ,,chip #cja4 #b-year extension of the ,children's ,health ,insurance ,program 7a7 ,funding ,section #bajd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7a77 is amended-- 7#a7 in paragraph 7#ag71 by striking and at the end2 7#b7 in paragraph 7#ah77;,b71 by striking the period at the end and inserting a semicolon2 and 7#c7 by adding at the end the following new paragraphs3 7#ai7 for fiscal year #bjaf1 #ai1cjj1jjj1jjj2 and 7#bj7 for fiscal year #bjag1 for purposes of making #b semi-annual allotments-- 7,a7 #b1hej1jjj1jjj for the period beginning on ,october #a1 #bjaf1 and ending on ,march #ca1 #bjag2 and 7,b7 #b1hej1jjj1jjj for the period beginning on ,april #a1 #bjag1 and ending on ,september #cj1 #bjag4 4 7b7 ,allotments 7#a7 ,in general ,section #bajd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7m77 is amended-- 7,a7 in the subsection heading1 by striking ,through #bjae;and inserting and ,thereafter2 7,b7 in paragraph 7#b7-- 7i7 in the paragraph heading1 by striking #bjad and inserting #bjaf2 and 7ii7 by striking subparagraph 7,b7 and inserting the following new subparagraph3 7,b7 ,fiscal year #bjac and each succeeding fiscal year ,subject to paragraphs 7#e7 and 7#g71 from the amount made available under paragraphs 7#af7 through 7#ai7 of subsection 7a7 for fiscal year #bjac and each succeeding fiscal year1 respectively1 the ,secretary shall compute a ,state allotment for each ,state 7including the ,district of ,columbia and each commonwealth and territory7 for each such fiscal year as follows3 7i7 ,rebasing in fiscal year #bjac and each succeeding odd-numbered fiscal year ,for fiscal year #bjac and each succeeding odd-numbered fiscal year 7other than fiscal years #bjae and #bjag71 the allotment of the ,state is equal to the ,federal payments to the ,state that are attributable to 7and countable toward7 the total amount of allotments available under this section to the ,state in the preceding fiscal year 7including payments made to the ,state under subsection 7n7 for such preceding fiscal year as well as amounts redistributed to the ,state in such preceding fiscal year71 multiplied by the allotment increase factor under paragraph 7#f7 for such odd-numbered fiscal year4 7ii7 ,growth factor update for fiscal year #bjad and each succeeding even-numbered fiscal year ,except as provided in clauses 7iii7 and 7iv71 for fiscal year #bjad and each succeeding even-numbered fiscal year1 the allotment of the ,state is equal to the sum of-- 7,i7 the amount of the ,state allotment under clause 7i7 for the preceding fiscal year2 and 7,,ii7 the amount of any payments made to the ,state under subsection 7n7 for such preceding fiscal year1 multiplied by the allotment increase factor under paragraph 7#f7 for such even-numbered fiscal year4 7iii7 ,special rule for #bjaf ,for fiscal year #bjaf1 the allotment of the ,state is equal to the ,federal payments to the ,state that are attributable to 7and countable toward7 the total amount of allotments available under this section to the ,state in the preceding fiscal year 7including payments made to the ,state under subsection 7n7 for such preceding fiscal year as well as amounts redistributed to the ,state in such preceding fiscal year71 but determined as if the last two sentences of section #baje7;b7 were in effect in such preceding fiscal year and then multiplying the result by the allotment increase factor under paragraph 7#f7 for fiscal year #bjaf4 7iv7 ,reduction in #bjah ,for fiscal year #bjah1 with respect to the allotment of the ,state for fiscal year #bjag1 any amounts of such allotment that remain available for expenditure by the ,state in fiscal year #bjah shall be reduced by one-third4 2 7,c7 in paragraph 7#d71 by inserting or #bjag after #bjae2 7,d7 in paragraph 7#f7-- 7i7 in subparagraph 7,a71 by striking #bjae and inserting #bjag2 and 7ii7 in the second sentence1 by striking or fiscal year #bjad and inserting fiscal year #bjad1 or fiscal year #bjaf2 7,e7 in paragraph 7#h7-- 7i7 in the paragraph heading1 by striking fiscal year #bjae and inserting fiscal years #bjae and #bjag2 and 7ii7 by inserting or fiscal year #bjag after #bjae2 7,f7 by redesignating paragraphs 7#d7 through 7#h7 as paragraphs 7#e7 through 7#i71 respectively2 and 7,g7 by inserting after paragraph 7#c7 the following new paragraph3 7#d7 ,for fiscal year #bjag 7,a7 ,first half ,subject to paragraphs 7#e7 and 7#g71 from the amount made available under subparagraph 7,a7 of paragraph 7#bj7 of subsection 7a7 for the semi-annual period described in such paragraph1 increased by the amount of the appropriation for such period under section #cja7;b77#b7 of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae1 the ,secretary shall compute a ,state allotment for each ,state 7including the ,district of ,columbia and each commonwealth and territory7 for such semi-annual period in an amount equal to the first half ratio 7described in subparagraph 7,d77 of the amount described in subparagraph 7,c74 7,b7 ,second half ,subject to paragraphs 7#e7 and 7#g71 from the amount made available under subparagraph 7,b7 of paragraph 7#bj7 of subsection 7a7 for the semi-annual period described in such paragraph1 the ,secretary shall compute a ,state allotment for each ,state 7including the ,district of ,columbia and each commonwealth and territory7 for such semi-annual period in an amount equal to the amount made available under such subparagraph1 multiplied by the ratio of-- 7i7 the amount of the allotment to such ,state under subparagraph 7,a72 to 7ii7 the total of the amount of all of the allotments made available under such subparagraph4 7,c7 ,full year amount based on rebased amount ,the amount described in this subparagraph for a ,state is equal to the ,federal payments to the ,state that are attributable to 7and countable towards7 the total amount of allotments available under this section to the ,state in fiscal year #bjaf 7including payments made to the ,state under subsection 7n7 for fiscal year #bjaf as well as amounts redistributed to the ,state in fiscal year #bjaf71 multiplied by the allotment increase factor under paragraph 7#f7 for fiscal year #bjag4 7,d7 ,first half ratio ,the first half ratio described in this subparagraph is the ratio of-- 7i7 the sum of-- 7,i7 the amount made available under subsection 7a77#bj77;,a72 and 7,,ii7 the amount of the appropriation for such period under section #cja7;b77#b7 of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae2 to 7ii7 the sum of the-- 7,i7 amount described in clause 7i72 and 7,,ii7 the amount made available under subsection 7a77#bj77;,b74 4 7#b7 ,conforming amendments -- 7,a7 ,section #bajd7;c77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7c77#a77 is amended by striking 7m77#d7 and inserting 7m77#e74 7,b7 ,section #bajd7m7 of such ,act 7#db ,u4,s4,c4 #acig;dd7m771 as amended by paragraph 7#a71 is further amended-- 7i7 by striking the allotment increase factor determined under paragraph 7#e7 each place it appears in paragraphs 7#a7 7#b77;,a71 and 7#c7 and inserting the allotment increase factor determined under paragraph 7#f72 7ii7 in paragraph 7#a7-- 7,i7 by striking paragraph 7#d7 each place it appears in subparagraphs 7,a7 and 7,b7 and inserting paragraph 7#e72 and 7,,ii7 by striking the allotment increase factor determined under paragraph 7#e7 each place it appears and inserting the allotment increase factor determined under paragraph 7#f72 7iii7 in paragraph 7#b77;,a71 by striking the allotment increase factor under paragraph 7#e7 and inserting the allotment increase factor under paragraph 7#f72 7iv7 in paragraph 7#c7-- 7,i7 by striking paragraphs 7#d7 and 7#f7 and inserting paragraphs 7#e7 and 7#g72 and 7,,ii7 by striking the allotment increase factor under paragraph 7#e7 and inserting the allotment increase factor under paragraph 7#f72 7v7 in paragraph 7#e7 7as redesignated by paragraph 7#a77;,f771 by striking paragraph 7#a71 7#b71 or 7#c7 and inserting paragraph 7#a71 7#b71 7#c71 or 7#d72 7vi7 in paragraph 7#g7 7as redesignated by paragraph 7#a77;,f771 by striking subject to paragraph 7#d7 and inserting subject to paragraph 7#e72 and 7vii7 in paragraph 7#i71 7as redesignated by paragraph 7#a77;,f771 by striking paragraph 7#c7 and inserting paragraph 7#c7 or 7#d74 7,c7 ,section #bajd7n77#c77;,b77ii7 of such ,act 7#db ,u4,s4,c4 #acig;dd7n77#c77;,b77ii77 is amended by striking subsection 7m77#e77;,b7 and inserting subsection 7m77#f77;,b74 7,d7 ,section #baaa7;b77#b77;,b77i7 of such ,act 7#db ,u4,s4,c4 #acigkk7b77#b77;,b77i77 is amended by striking section #bajd7m77#d7 and inserting section #bajd7m77#e74 7#c7 ,one-time appropriation for fiscal year #bjag ,there is appropriated to the ,secretary of ,health and ,human ,services1 out of any money in the ,treasury not otherwise appropriated1 #ad1gjj1jjj1jjj to accompany the allotment made for the period beginning on ,october #a1 #bjaf1 and ending on ,march #ca1 #bjag1 under paragraph 7#bj77;,a7 of section #bajd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7a77 7as added by subsection 7a77#a771 to remain available until expended4 ,such amount shall be used to provide allotments to ,states under paragraph 7#c7 of section #bajd7m7 of such ,act 7#db ,u4,s4,c4 #acig;dd7m77 7as amended by paragraph 7#a77;,c77 for the first #f months of fiscal year #bjag in the same manner as allotments are provided under subsection 7a77#bj77;,a7 of such section #bajd and subject to the same terms and conditions as apply to the allotments provided from such subsection 7a77#bj77;,a74 7c7 ,extension of qualifying states option ,section #baje7;g77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7g77#d77 is amended-- 7#a7 in the paragraph heading1 by striking #bjae and inserting #bjag2 and 7#b7 in subparagraph 7,a71 by striking #bjae and inserting #bjag4 7d7 ,extension of the child enrollment contingency fund 7#a7 ,in general ,section #bajd7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7n77 is amended-- 7,a7 in paragraph 7#b7-- 7i7 in subparagraph 7,a77ii7-- 7,i7 by striking #bjaj through #bjad and inserting #bjaj1 #bjaa1 #bjab1 #bjac1 #bjad1 and #bjaf2 and 7,,ii7 by inserting and #bjag after #bjae2 and 7ii7 in subparagraph 7,b7-- 7,i7 by striking #bjaj through #bjad and inserting #bjaj1 #bjaa1 #bjab1 #bjac1 #bjad1 and #bjaf2 and 7,,ii7 by inserting and #bjag after #bjae2 and 7,b7 in paragraph 7#c77;,a71 in the matter preceding clause 7i71 by striking fiscal year #bjji1 fiscal year #bjaj1 fiscal year #bjaa1 fiscal year #bjab1 fiscal year #bjac1 fiscal year #bjad1 or a semi-annual allotment period for fiscal year #bjae and inserting any of fiscal years #bjji through #bjad1 fiscal year #bjaf1 or a semi-annual allotment period for fiscal year #bjae or #bjag4 #cjb4 ,extension of 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 #bjae and inserting #bjag4 #cjc4 ,extension of outreach and enrollment program ,section #baac of the ,social ,security ,act 7#db ,u4,s4,c4 #acigmm7 is amended-- 7#a7 in subsection 7a77#a71 by striking #bjae and inserting #bjag2 and 7#b7 in subsection 7g71 by inserting and #dj1jjj1jjj for the period of fiscal years #bjaf and #bjag after #bjae4 #cjd4 ,extension of certain programs and demonstration projects 7a7 ,childhood obesity demonstration project ,section #aaci;,a7e77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a7e77#h77 is amended by inserting 1 and #aj1jjj1jjj for the period of fiscal years #bjaf and #bjag after #bjad4 7b7 ,pediatric quality measures program ,section #aaci;,a7i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a7i77 is amended in the first sentence by inserting before the period at the end the following3 1 and there is appropriated for the period of fiscal years #bjaf and #bjag1 #bj1jjj1jjj for the purpose of carrying out this section 7other than subsections 7e71 7f71 and 7g774 #cje4 ,report of ,inspector ,general of ,,hhs on use of express lane option under ,medicaid and ,,chip ,not later than #ah months after the date of the enactment of this ,act1 the ,inspector ,general of the ,department of ,health and ,human ,services shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report that-- 7#a7 provides data on the number of individuals enrolled in the ,medicaid program under title ,,xix of the ,social ,security ,act 7referred to in this section as ,medicaid7 and the ,children's ,health ,insurance ,program under title ,,xxi of such ,act 7referred to in this section as ,,chip7 through the use of the ,express ,lane option under section #aijb7;e77#ac7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ac772 7#b7 assesses the extent to which individuals so enrolled meet the eligibility requirements under ,medicaid or ,,chip 7as applicable72 and 7#c7 provides data on ,federal and ,state expenditures under ,medicaid and ,,chip for individuals so enrolled and disaggregates such data between expenditures made for individuals who meet the eligibility requirements under ,medicaid or ,,chip 7as applicable7 and expenditures made for individuals who do not meet such requirements4 ,,iv ,offsets ,a ,medicare ,beneficiary ,reforms #dja4 ,limitation on certain medigap policies for newly eligible ,medicare beneficiaries ,section #ahhb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7 is amended by adding at the end the following new subsection3 7z7 ,limitation on certain medigap policies for newly eligible ,medicare beneficiaries 7#a7 ,in general ,notwithstanding any other provision of this section1 on or after ,january #a1 #bjbj1 a medicare supplemental policy that provides coverage of the part ,b deductible1 including any such policy 7or rider to such a policy7 issued under a waiver granted under subsection 7p77#f71 may not be sold or issued to a newly eligible ,medicare beneficiary4 7#b7 ,newly eligible ,medicare beneficiary defined ,in this subsection1 the term newly eligible ,medicare beneficiary means an individual who is neither of the following3 7,a7 ,an individual who has attained age #fe before ,january #a1 #bjbj4 7,b7 ,an individual who was entitled to benefits under part ,a pursuant to section #bbf7;b7 or #bbf;,a1 or deemed to be eligible for benefits under section #bbf7;a71 before ,january #a1 #bjbj4 7#c7 ,treatment of waivered ,states ,in the case of a ,state described in subsection 7p77#f71 nothing in this section shall be construed as preventing the ,state from modifying its alternative simplification program under such subsection so as to eliminate the coverage of the part ,b deductible for any medical supplemental policy sold or issued under such program to a newly eligible ,medicare beneficiary on or after ,january #a1 #bjbj4 7#d7 ,treatment of references to certain policies ,in the case of a newly eligible ,medicare beneficiary1 except as the ,secretary may otherwise provide1 any reference in this section to a medicare supplemental policy which has a benefit package classified as ,c or ,f shall be deemed1 as of ,january #a1 #bjbj1 to be a reference to a medicare supplemental policy which has a benefit package classified as ,d or ,g1 respectively4 7#e7 ,enforcement ,the penalties described in clause 7ii7 of subsection 7d77#c77;,a7 shall apply with respect to a violation of paragraph 7#a7 in the same manner as it applies to a violation of clause 7i7 of such subsection4 4 #djb4 ,income-related premium adjustment for parts ,b and ,d 7a7 ,in general ,section #ahci7;i77#c77;,c77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7i77#c77;,c77i77 is amended-- 7#a7 by inserting after ,in general4-- the following3 7,i7 ,subject to paragraphs 7#e7 and 7#f71 for years before #bjah3 2 and 7#b7 by adding at the end the following3 7,,ii7 ,subject to paragraph 7#e71 for years beginning with #bjah3 ,if the modified adjusted gross income is3,the applicable percentage is3 ,more than #he1jjj but not more than #ajg1jjjce percent ,more than #ajg1jjj but not more than #acc1ejjej percent ,more than #acc1ejj but not more than #afj1jjj #fe percent ,more than #afj1jjjhj percent4 4 7b7 ,conforming amendments ,section #ahci7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7i77 is amended-- 7#a7 in paragraph 7#b77;,a71 by inserting 7or1 beginning with #bjah1 #he1jjj7 after #hj1jjj2 7#b7 in paragraph 7#c77;,a77i71 by inserting applicable before table2 7#c7 in paragraph 7#e77;,a7-- 7,a7 in the matter before clause 7i71 by inserting 7other than #bjah and #bjai7 after #bjjg2 and 7,b7 in clause 7ii71 by inserting 7or1 in the case of a calendar year beginning with #bjbj1 ,august #bjah7 after ,august #bjjf2 and 7#d7 in paragraph 7#f71 in the matter before subparagraph 7,a71 by striking #bjai and inserting #bjag4 ,b ,other ,offsets #daa4 ,medicare payment updates for post-acute providers 7a7 ,s,n,fs ,section #ahhh7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7e77-- 7#a7 in paragraph 7#e77;,b7-- 7,a7 in clause 7i71 by striking clause 7ii7 and inserting clauses 7ii7 and 7iii72 7,b7 in clause 7ii71 by inserting subject to clause 7iii71 after each subsequent fiscal year12 and 7,c7 by adding at the end the following new clause3 7iii7 ,special rule for fiscal year #bjah ,for fiscal year #bjah 7or other similar annual period specified in clause 7i771 the skilled nursing facility market basket percentage1 after application of clause 7ii71 is equal to #a percent4 2 and 7#b7 in paragraph 7#f77;,a77i71 by striking paragraph 7#e77;,b77ii7 and inserting clauses 7ii7 and 7iii7 of paragraph 7#e77;,b74 7b7 ,i,r,fs ,section #ahhf7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7j77 is amended-- 7#a7 in paragraph 7#c77;,c7-- 7,a7 in clause 7i71 by striking clause 7ii7 and inserting clauses 7ii7 and 7iii72 7,b7 in clause 7ii71 by striking ,after and inserting ,subject to clause 7iii71 after2 and 7,c7 by adding at the end the following new clause3 7iii7 ,special rule for fiscal year #bjah ,the increase factor to be applied under this subparagraph for fiscal year #bjah1 after the application of clause 7ii71 shall be #a percent4 2 and 7#b7 in paragraph 7#g77;,a77i71 by striking paragraph 7#c77;,d7 and inserting subparagraphs 7,c77iii7 and 7,d7 of paragraph 7#c74 7c7 ,h,h,as ,section #ahie7;b77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b77#c77;,b77 is amended-- 7#a7 in clause 7iii71 by adding at the end the following3 ,notwithstanding the previous sentence1 the home health market basket percentage increase for #bjah shall be #a percent42 and 7#b7 in clause 7vi77,i71 by inserting 7except #bjah7 after each subsequent year4 7d7 ,hospice ,section #ahad7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7i77 is amended-- 7#a7 in paragraph 7#a77;,c7-- 7,a7 in clause 7ii77,,vii71 by striking clause 7iv711 and inserting clauses 7iv7 and 7vi712 7,b7 in clause 7iii71 by striking clause 7iv71 and inserting clauses 7iv7 and 7vi712 7,c7 in clause 7iv71 by striking ,after determining and inserting ,subject to clause 7vi71 after determining2 and 7,d7 by adding at the end the following new clause3 7vi7 ,for fiscal year #bjah1 the market basket percentage increase under clause 7ii77,,vii7 or 7iii71 as applicable1 after application of clause 7iv71 shall be #a percent4 2 and 7#b7 in paragraph 7#e77;,a77i71 by striking paragraph 7#a77;,c77iv7 and inserting clauses 7iv7 and 7vi7 of paragraph 7#a77;,c74 7e7 ,l,t,c,hs ,section #ahhf7m77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7m77#c77 is amended-- 7#a7 in subparagraph 7,a71 in the matter preceding clause 7i71 by striking ,in implementing and inserting ,subject to subparagraph 7,c71 in implementing2 and 7#b7 by adding at the end the following new subparagraph3 7,c7 ,additional special rule ,for fiscal year #bjah1 the annual update under subparagraph 7,a7 for the fiscal year1 after application of clauses 7i7 and 7ii7 of subparagraph 7,a71 shall be #a percent4 4 #dab4 ,delay of reduction to ,medicaid ,,dsh allotments ,section #aibc7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77 is amended-- 7#a7 in paragraph 7#g77;,a7-- 7,a7 in clause 7i71 by striking #bjag through #bjbd and inserting #bjah through #bjbe2 7,b7 by striking clause 7ii7 and inserting the following new clause3 7ii7 ,aggregate reductions ,the aggregate reductions in ,,dsh allotments for all ,states under clause 7i77,i7 shall be equal to-- 7,i7 #b1jjj1jjj1jjj for fiscal year #bjah2 7,,ii7 #c1jjj1jjj1jjj for fiscal year #bjai2 7,,iii7 #d1jjj1jjj1jjj for fiscal year #bjbj2 7,,iv7 #e1jjj1jjj1jjj for fiscal year #bjba2 7,v7 #f1jjj1jjj1jjj for fiscal year #bjbb2 7,,vi7 #g1jjj1jjj1jjj for fiscal year #bjbc2 7,,vii7 #h1jjj1jjj1jjj for fiscal year #bjbd2 and 7,,viii7 #h1jjj1jjj1jjj for fiscal year #bjbe4 2 and 7,c7 by adding at the end the following new clause3 7v7 ,distribution of aggregate reductions ,the ,secretary shall distribute the aggregate reductions under clause 7ii7 among ,states in accordance with subparagraph 7,b74 2 and 7#b7 in paragraph 7#h71 by striking #bjbd and inserting #bjbe4 #dac4 ,levy on delinquent providers 7a7 ,in general ,paragraph 7#c7 of section #fcca7;h7 of the ,internal ,revenue ,code of #aihf is amended by striking #cj percent and inserting #ajj percent4 7b7 ,effective date ,the amendment made by this section shall apply to payments made after #ahj days after the date of the enactment of this ,act4 #dad4 ,adjustments to inpatient hospital payment rates ,section #g7;b7 of the ,,tma1 ,abstinence ,education1 and ,,qi ,programs ,extension ,act of #bjjg 7,public ,law #aaj-ij71 as amended by the ,american ,taxpayer ,relief ,act of #bjab 7,public ,law #aab-bdj71 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in the matter preceding subparagraph 7,a71 by striking 1 #bjji1 or #bjaj and inserting or #bjji2 and 7,b7 in subparagraph 7,b7-- 7i7 in clause 7i71 by striking and at the end2 7ii7 in clause 7ii71 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following new clause3 7iii7 make an additional adjustment to the standardized amounts under such section #ahhf7;d7 of an increase of #j4e percentage points for discharges occurring during each of fiscal years #bjah through #bjbc and not make the adjustment 7estimated to be an increase of #c4b percent7 that would otherwise apply for discharges occurring during fiscal year #bjah by reason of the completion of the adjustments required under clause 7ii74 2 7#b7 in paragraph 7#c7-- 7,a7 by striking shall be construed and all that follows through providing authority and inserting shall be construed as providing authority2 and 7,b7 by inserting and each succeeding fiscal year through fiscal year #bjbc after #bjag2 7#c7 by redesignating paragraphs 7#c7 and 7#d7 as paragraphs 7#d7 and 7#e71 respectively2 and 7#d7 by inserting after paragraph 7#b7 the following new paragraph3 7#c7 ,prohibition ,the ,secretary shall not make an additional prospective adjustment 7estimated to be a decrease of #j4ee percent7 to the standardized amounts under such section #ahhf7;d7 to offset the amount of the increase in aggregate payments related to documentation and coding changes for discharges occurring during fiscal year #bjaj4 4 ,v ,miscellaneous ,a ,protecting the ,integrity of ,medicare #eja4 ,prohibition of inclusion of ,social ,security account numbers on ,medicare cards 7a7 ,in general ,section #bje7;c77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;c77#b77;,c77 is amended-- 7#a7 by moving clause 7x71 as added by section #adad7;a77#b7 of the ,patient ,protection and ,affordable ,care ,act1 #f ems to the left2 7#b7 by redesignating clause 7x71 as added by section #b7;a77#a7 of the ,social ,security ,number ,protection ,act of #bjaj1 and clause 7xi7 as clauses 7xi7 and 7xii71 respectively2 and 7#c7 by adding at the end the following new clause3 7xiii7 ,the ,secretary of ,health and ,human ,services1 in consultation with the ,commissioner of ,social ,security1 shall establish cost-effective procedures to ensure that a ,social ,security account number 7or derivative thereof7 is not displayed1 coded1 or embedded on the ,medicare card issued to an individual who is entitled to benefits under part ,a of title ,,xviii or enrolled under part ,b of title ,,xviii and that any other identifier displayed on such card is not identifiable as a ,social ,security account number 7or derivative thereof74 4 7b7 ,implementation ,in implementing clause 7xiii7 of section #bje7;c77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;c77#b77;,c771 as added by subsection 7a77#c71 the ,secretary of ,health and ,human ,services shall do the following3 7#a7 ,in general ,establish a cost-effective process that involves the least amount of disruption to1 as well as necessary assistance for1 ,medicare beneficiaries and health care providers1 such as a process that provides such beneficiaries with access to assistance through a toll-free telephone number and provides outreach to providers4 7#b7 ,consideration of ,medicare beneficiary identified ,consider implementing a process1 similar to the process involving ,railroad ,retirement ,board beneficiaries1 under which a ,medicare beneficiary identifier which is not a ,social ,security account number 7or derivative thereof7 is used external to the ,department of ,health and ,human ,services and is convertible over to a ,social ,security account number 7or derivative thereof7 for use internal to such ,department and the ,social ,security ,administration4 7c7 ,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 following transfers from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 and from the ,federal ,supplementary ,medical ,insurance ,trust ,fund established under section #ahda of such ,act 7#db ,u4,s4,c4 #aciet71 in such proportions as the ,secretary determines appropriate3 7#a7 ,to the ,centers for ,medicare ,medicaid ,program ,management ,account1 transfers of the following amounts3 7,a7 ,for fiscal year #bjae1 #fe1jjj1jjj1 to be made available through fiscal year #bjah4 7,b7 ,for each of fiscal years #bjaf and #bjag1 #ec1jjj1jjj1 to be made available through fiscal year #bjah4 7,c7 ,for fiscal year #bjah1 #dh1jjj1jjj1 to be made available until expended4 7#b7 ,to the ,social ,security ,administration ,limitation on ,administration ,account1 transfers of the following amounts3 7,a7 ,for fiscal year #bjae1 #bg1jjj1jjj1 to be made available through fiscal year #bjah4 7,b7 ,for each of fiscal years #bjaf and #bjag1 #bb1jjj1jjj1 to be made available through fiscal year #bjah4 7,c7 ,for fiscal year #bjah1 #bg1jjj1jjj1 to be made available until expended4 7#c7 ,to the ,railroad ,retirement ,board ,limitation on ,administration ,account1 the following amount3 7,a7 ,for fiscal year #bjae1 #c1jjj1jjj1 to be made available until expended4 7d7 ,effective date 7#a7 ,in general ,clause 7xiii7 of section #bje7;c77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;c77#b77;,c771 as added by subsection 7a77#c71 shall apply with respect to ,medicare cards issued on and after an effective date specified by the ,secretary of ,health and ,human ,services1 but in no case shall such effective date be later than the date that is four years after the date of the enactment of this ,act4 7#b7 ,reissuance ,the ,secretary shall provide for the reissuance of ,medicare cards that comply with the requirements of such clause not later than four years after the effective date specified by the ,secretary under paragraph 7#a74 #ejb4 ,preventing wrongful ,medicare payments for items and services furnished to incarcerated individuals1 individuals not lawfully present1 and deceased individuals 7a7 ,requirement for the ,secretary ,to establish policies and claims edits relating to incarcerated individuals1 individuals not lawfully present1 and deceased individuals ,section #ahgd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7 is amended by adding at the end the following new subsection3 7f7 ,requirement for the ,secretary ,to establish policies and claims edits relating to incarcerated individuals1 individuals not lawfully present1 and deceased individuals ,the ,secretary shall establish and maintain procedures1 including procedures for using claims processing edits1 updating eligibility information to improve provider accessibility1 and conducting recoupment activities such as through recovery audit contractors1 in order to ensure that payment is not made under this title for items and services furnished to an individual who is one of the following3 7#a7 ,an individual who is incarcerated4 7#b7 ,an individual who is not lawfully present in the ,united ,states and who is not eligible for coverage under this title4 7#c7 ,a deceased individual4 4 7b7 ,report ,not later than #ah months after the date of the enactment of this section1 and periodically thereafter as determined necessary by the ,office of ,inspector ,general of the ,department of ,health and ,human ,services1 such ,office shall submit to ,congress a report on the activities described in subsection 7f7 of section #ahgd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk71 as added by subparagraph 7a71 that have been conducted since such date of enactment4 #ejc4 ,consideration of measures regarding ,medicare beneficiary smart cards ,to the extent the ,secretary of ,health and ,human ,services determines that it is cost effective and technologically viable to use electronic ,medicare beneficiary and provider cards 7such as cards that use smart card technology1 including an embedded and secure integrated circuit chip71 as presented in the ,government ,accountability ,office report required by the conference report accompanying the ,consolidated ,appropriations ,act1 #bjad 7,public ,law #aac-gf71 the ,secretary shall consider such measures as determined appropriate by the ,secretary to implement such use of such cards for beneficiary and provider use under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 ,in the case that the ,secretary considers measures under the preceding sentence1 the ,secretary shall submit to the ,committees on ,ways and ,means and ,energy and ,commerce of the ,house of ,representatives1 and to the ,committee on ,finance of the ,senate1 a report outlining the considerations undertaken by the ,secretary under such sentence4 #ejd4 ,modifying ,medicare durable medical equipment face-to-face encounter documentation requirement 7a7 ,in general ,section #ahcd7;a77#aa77;,b77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77#aa77;,b77ii77 is amended-- 7#a7 by striking the physician documenting that2 and 7#b7 by striking has had a face-to-face encounter and inserting documenting such physician1 physician assistant1 practitioner1 or specialist has had a face-to-face encounter4 7b7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the amendments made by subsection 7a7 by program instruction or otherwise4 #eje4 ,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 or other 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#b74 ,the activities described in the preceding sentence shall be conducted on a regular basis4 7#b7 ,information to be provided through activities ,the information to be provided under such payment outreach and education program shall include information the ,secretary determines to be appropriate which may include the following information3 7,a7 ,a list of the providers' or suppliers' 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 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#c7 ,priority ,a medicare administrative contractor shall give priority to activities under such program that will reduce improper payments that are one or more of the following3 7,a7 ,are for items and services that have the highest rate of improper payment4 7,b7 ,are for items and service that have the greatest total dollar amount of improper payments4 7,c7 ,are due to clear misapplication or misinterpretation of ,medicare policies4 7,d7 ,are clearly due to common and inadvertent clerical or administrative errors4 7,e7 ,are due to other types of errors that the ,secretary determines could be prevented through activities under the program4 7#d7 ,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 the types 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 time frame the ,secretary determines appropriate which may be on a quarterly basis4 7,b7 ,information ,the information described in subparagraph 7,a7 shall include information such as the following3 7i7 ,providers of services and suppliers that have the highest rate of improper payments4 7ii7 ,providers of services and suppliers that have the greatest total dollar amounts of improper payments4 7iii7 ,items and services furnished in the region that have the highest rates of improper payments4 7iv7 ,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 program4 7#e7 ,communications ,communications with providers of services and suppliers under an improper payment outreach and education program are subject to the standards and requirements of subsection 7g74 4 7b7 ,use of certain funds recovered by ,r,a,cs ,section #ahic7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h77 is amended-- 7#a7 in paragraph 7#b71 by inserting or paragraph 7#aj7 after paragraph 7#a77;,c72 and 7#b7 by adding at the end the following new paragraph3 7#aj7 ,use of certain recovered funds 7,a7 ,in general ,after application of paragraph 7#a77;,c71 the ,secretary shall retain a portion of the amounts recovered by recovery audit contractors for each year under this section which shall be available to the program management account of the ,centers for ,medicare ,medicaid ,services for purposes of1 subject to subparagraph 7,b71 carrying out sections #ahcc7z71 #ahcd7l77#af71 and #ahgd;,a7a77#d77;,g71 carrying out section #ead7;b7 of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae1 and implementing strategies 7such as claims processing edits7 to help reduce the error rate of payments under this title4 ,the amounts retained under the preceding sentence shall not exceed an amount equal to #ae percent of the amounts recovered under this subsection1 and shall remain available until expended4 7,b7 ,limitation ,except for uses that support claims processing 7including edits7 or system functionality for detecting fraud1 amounts retained under subparagraph 7,a7 may not be used for technological-related infrastructure1 capital investments1 or information systems4 7,c7 ,no reduction in payments to recovery audit contractors ,nothing in subparagraph 7,a7 shall reduce amounts available for payments to recovery audit contractors under this subsection4 4 #ejf4 ,improving senior ,medicare patrol and fraud reporting rewards 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall develop a plan to revise the incentive program under section #bjc7;b7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acie;b-#e7;b77 to encourage greater participation by individuals to report fraud and abuse in the ,medicare program4 ,such plan shall include recommendations for-- 7#a7 ways to enhance rewards for individuals reporting under the incentive program1 including rewards based on information that leads to an administrative action2 and 7#b7 extending the incentive program to the ,medicaid program4 7b7 ,public ,awareness and ,education ,campaign ,the plan developed under subsection 7a7 shall also include recommendations for the use of the ,senior ,medicare ,patrols authorized under section #daa of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjcb7 to conduct a public awareness and education campaign to encourage participation in the revised incentive program under subsection 7a74 7c7 ,submission of ,plan ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary shall submit to ,congress the plan developed under subsection 7a74 #ejg4 ,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 #bjaf and subsequent plan years1 the ,secretary shall require a claim for a covered part ,d drug for a part ,d eligible individual enrolled in a prescription drug plan under this part or an ,,ma-,,pd plan under part ,c to include a prescriber ,national ,provider ,identifier that is determined to be valid under the procedures established under subparagraph 7,b77i74 7,b7 ,procedures 7i7 ,validity of prescriber ,national ,provider ,identifiers ,the ,secretary1 in consultation with appropriate stakeholders1 shall establish procedures for determining the validity of prescriber ,national ,provider ,identifiers under subparagraph 7,a74 7ii7 ,informing beneficiaries of reason for denial ,the ,secretary shall establish procedures to ensure that1 in the case that a claim for a covered part ,d drug of an individual described in subparagraph 7,a7 is denied because the claim does not meet the requirements of this paragraph1 the individual is properly informed at the point of service of the reason for the denial4 7,c7 ,report ,not later than ,january #a1 #bjah1 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,b77i74 4 #ejh4 ,option to receive ,medicare ,summary ,notice electronically 7a7 ,in general ,section #ahjf of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#g7 is amended by adding at the end the following new subsection3 7c7 ,format of statements from ,secretary 7#a7 ,electronic option beginning in #bjaf ,subject to paragraph 7#b71 for statements described in subsection 7a7 that are furnished for a period in #bjaf or a subsequent year1 in the case that an individual described in subsection 7a7 elects1 in accordance with such form1 manner1 and time specified by the ,secretary1 to receive such statement in an electronic format1 such statement shall be furnished to such individual for each period subsequent to such election in such a format and shall not be mailed to the individual4 7#b7 ,limitation on revocation option 7,a7 ,in general ,subject to subparagraph 7,b71 the ,secretary may determine a maximum number of elections described in paragraph 7#a7 by an individual that may be revoked by the individual4 7,b7 ,minimum of one revocation option ,in no case may the ,secretary determine a maximum number under subparagraph 7,a7 that is less than one4 7#c7 ,notification ,the ,secretary shall ensure that1 in the most cost effective manner and beginning ,january #a1 #bjag1 a clear notification of the option to elect to receive statements described in subsection 7a7 in an electronic format is made available1 such as through the notices distributed under section #ahjd1 to individuals described in subsection 7a74 4 7b7 ,encouraged expansion of electronic statements ,to the extent to which the ,secretary of ,health and ,human ,services determines appropriate1 the ,secretary shall-- 7#a7 apply an option similar to the option described in subsection 7c77#a7 of section #ahjf of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#g7 7relating to the provision of the ,medicare ,summary ,notice in an electronic format71 as added by subsection 7a71 to other statements and notifications under title ,,xviii of such ,act 7#db ,u4,s4,c4 #acie et seq472 and 7#b7 provide such ,medicare ,summary ,notice and any such other statements and notifications on a more frequent basis than is otherwise required under such title4 #eji4 ,renewal of ,,mac contracts 7a7 ,in general ,section #ahgd;,a7b77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a7;b77#a77;,b77 is amended by striking #e years and inserting #aj years4 7b7 ,application ,the amendments made by subsection 7a7 shall apply to contracts entered into on or after1 and to contracts in effect as of1 the date of the enactment of this ,act4 7c7 ,contractor performance transparency ,section #ahgd;,a7b77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a7;b77#c77;,a77 is amended by adding at the end the following new clause3 7iv7 ,contractor performance transparency ,to the extent possible without compromising the process for entering into and renewing contracts with medicare administrative contractors under this section1 the ,secretary shall make available to the public the performance of each medicare administrative contractor with respect to such performance requirements and measurement standards4 4 #eaj4 ,study on pathway for incentives to ,states for ,state participation in medicaid data match program ,section #ahic7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7g77 is amended by adding at the end the following new paragraph3 7#c7 ,incentives for ,states ,the ,secretary shall study and1 as appropriate1 may specify incentives for ,states to work with the ,secretary for the purposes described in paragraph 7#a77;,a77ii74 ,the application of the previous sentence may include use of the waiver authority described in paragraph 7#b74 4 #eaa4 ,guidance on application of ,common ,rule to clinical data registries ,not later than one year after the date of the enactment of this section1 the ,secretary of ,health and ,human ,services shall issue a clarification or modification with respect to the application of subpart ,a of part #df of title #de1 ,code of ,federal ,regulations1 governing the protection of human subjects in research 7and commonly known as the ,common ,rule71 to activities1 including quality improvement activities1 involving clinical data registries1 including entities that are qualified clinical data registries pursuant to section #ahdh7m77#c77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#c77;,e774 #eab4 ,eliminating certain civil money penalties2 gainsharing study and report 7a7 ,eliminating civil money penalties for inducements to physicians ,to limit services that are not medically necessary 7#a7 ,in general ,section #aabh;,a7b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7b77#a77 is amended by inserting medically necessary after reduce or limit4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall apply to payments made on or after the date of the enactment of this ,act4 7b7 ,gainsharing study and report ,not later than #ab months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in consultation with the ,inspector ,general of the ,department of ,health and ,human ,services1 shall submit to ,congress a report with options for amending existing fraud and abuse laws in1 and regulations related to1 titles ,,xi and ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #cja et seq471 through exceptions1 safe harbors1 or other narrowly targeted provisions1 to permit gainsharing arrangements that otherwise would be subject to the civil money penalties described in paragraphs 7#a7 and 7#b7 of section #aabh;,a7b7 of such ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7b771 or similar arrangements between physicians and hospitals1 and that improve care while reducing waste and increasing efficiency4 ,the report shall-- 7#a7 consider whether such provisions should apply to ownership interests1 compensation arrangements1 or other relationships2 7#b7 describe how the recommendations address accountability1 transparency1 and quality1 including how best to limit inducements to stint on care1 discharge patients prematurely1 or otherwise reduce or limit medically necessary care2 and 7#c7 consider whether a portion of any savings generated by such arrangements 7as compared to an historical benchmark or other metric specified by the ,secretary to determine the impact of delivery and payment system changes under such title ,,xviii on expenditures made under such title7 should accrue to the ,medicare program under title ,,xviii of the ,social ,security ,act4 #eac4 ,modification of ,medicare home health surety bond condition of participation requirement ,section #ahfa7o77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7o77#g77 is amended to read as follows3 7#g7 provides the ,secretary with a surety bond-- 7,a7 in a form specified by the ,secretary and in an amount that is not less than the minimum of #ej1jjj2 and 7,b7 that the ,secretary determines is commensurate with the volume of payments to the home health agency2 and 4 #ead4 ,oversight of ,medicare coverage of manual manipulation of the spine to correct subluxation 7a7 ,in general ,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 ,medical review of spinal subluxation services 7#a7 ,in general ,the ,secretary shall implement a process for the medical review 7as described in paragraph 7#b77 of treatment by a chiropractor described in section #ahfa7r77#e7 by means of manual manipulation of the spine to correct a subluxation 7as described in such section7 of an individual who is enrolled under this part and apply such process to such services furnished on or after ,january #a1 #bjag1 focusing on services such as-- 7,a7 services furnished by a such a chiropractor whose pattern of billing is aberrant compared to peers2 and 7,b7 services furnished by such a chiropractor who1 in a prior period1 has a services denial percentage in the #heth percentile or greater1 taking into consideration the extent that service denials are overturned on appeal4 7#b7 ,medical review 7,a7 ,prior authorization medical review 7i7 ,in general ,subject to clause 7ii71 the ,secretary shall use prior authorization medical review for services described in paragraph 7#a7 that are furnished to an individual by a chiropractor described in section #ahfa7r77#e7 that are part of an episode of treatment that includes more than #ab services4 ,for purposes of the preceding sentence1 an episode of treatment shall be determined by the underlying cause that justifies the need for services1 such as a diagnosis code4 7ii7 ,ending application of prior authorization medical review ,the ,secretary shall end the application of prior authorization medical review under clause 7i7 to services described in paragraph 7#a7 by such a chiropractor if the ,secretary determines that the chiropractor has a low denial rate under such prior authorization medical review4 ,the ,secretary may subsequently reapply prior authorization medical review to such chiropractor if the ,secretary determines it to be appropriate and the chiropractor has1 in the time period subsequent to the determination by the ,secretary of a low denial rate with respect to the chiropractor1 furnished such services described in paragraph 7#a74 7iii7 ,early request for prior authorization review permitted ,nothing in this subsection shall be construed to prevent such a chiropractor from requesting prior authorization for services described in paragraph 7#a7 that are to be furnished to an individual before the chiropractor furnishes the twelfth such service to such individual for an episode of treatment4 7,b7 ,type of review ,the ,secretary may use pre-payment review or post-payment review of services described in section #ahfa7r77#e7 that are not subject to prior authorization medical review under subparagraph 7,a74 7,c7 ,relationship to law enforcement activities ,the ,secretary may determine that medical review under this subsection does not apply in the case where potential fraud may be involved4 7#c7 ,no payment without prior authorization ,with respect to a service described in paragraph 7#a7 for which prior authorization medical review under this subsection applies1 the following shall apply3 7,a7 ,prior authorization determination ,the ,secretary shall make a determination1 prior to the service being furnished1 of whether the service would or would not meet the applicable requirements of section #ahfb7;a77#a77;,a74 7,b7 ,denial of payment ,subject to paragraph 7#e71 no payment may be made under this part for the service unless the ,secretary determines pursuant to subparagraph 7,a7 that the service would meet the applicable requirements of such section #ahfb7;a77#a77;,a74 7#d7 ,submission of information ,a chiropractor described in section #ahfa7r77#e7 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 practicable4 7#e7 ,timeliness ,if the ,secretary does not make a prior authorization determination under paragraph 7#c77;,a7 within #ad business days of the date of the receipt of medical documentation needed to make such determination1 paragraph 7#c77;,b7 shall not apply4 7#f7 ,application of limitation on beneficiary liability ,where payment may not be made as a result of the application of paragraph 7#b77;,b71 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#g7 ,review by contractors ,the medical review described in paragraph 7#b7 may be conducted by medicare administrative contractors pursuant to section #ahgd;,a7a77#d77;,g7 or by any other contractor determined appropriate by the ,secretary that is not a recovery audit contractor4 7#h7 ,multiple services ,the ,secretary shall1 where practicable1 apply the medical review under this subsection in a manner so as to allow an individual described in paragraph 7#a7 to obtain1 at a single time rather than on a service-by-service basis1 an authorization in accordance with paragraph 7#c77;,a7 for multiple services4 7#i7 ,construction ,with respect to a service described in paragraph 7#a7 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#aj7 ,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 4 7b7 ,improving documentation of services 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall1 in consultation with stakeholders 7including the ,american ,chiropractic ,association7 and representatives of medicare administrative contractors 7as defined in section #ahgd;,a7a77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a7;a77#c77;,a7771 develop educational and training programs to improve the ability of chiropractors to provide documentation to the ,secretary of services described in section #ahfa7r77#e7 in a manner that demonstrates that such services are1 in accordance with section #ahfb7;a77#a7 of such ,act 7#db ,u4,s4,c4 #aciey7a77#a771 reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member4 7#b7 ,timing ,the ,secretary shall make the educational and training programs described in paragraph 7#a7 publicly available not later than ,january #a1 #bjaf4 7#c7 ,funding ,the ,secretary shall use funds made available under paragraph 7#aj7 of section #ahic7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h771 as added by section #eje1 to carry out this subsection4 7c7 ,,gao study and report 7#a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on the effectiveness of the process for medical review of services furnished as part of a treatment by means of manual manipulation of the spine to correct a subluxation implemented under subsection 7z7 of section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel71 as added by subsection 7a74 ,such study shall include an analysis of-- 7,a7 aggregate data on-- 7i7 the number of individuals1 chiropractors1 and claims for services subject to such review2 and 7ii7 the number of reviews conducted under such section2 and 7,b7 the outcomes of such reviews4 7#b7 ,report ,not later than four years after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 including recommendations for such legislation and administrative action with respect to the process for medical review implemented under subsection 7z7 of section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 as the ,comptroller ,general determines appropriate4 #eae4 ,national expansion of prior authorization model for repetitive scheduled non-emergent ambulance transport 7a7 ,initial expansion 7#a7 ,in general ,in implementing the model described in paragraph 7#b7 proposed to be tested under subsection 7b7 of section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a71 the ,secretary of ,health and ,human ,services shall revise the testing under subsection 7b7 of such section to cover1 effective not later than ,january #a1 #bjaf1 ,states located in medicare administrative contractor 7,,mac7 regions ,l and #aa 7consisting of ,delaware1 the ,district of ,columbia1 ,maryland1 ,new ,jersey1 ,pennsylvania1 ,north ,carolina1 ,south ,carolina1 ,west ,virginia1 and ,virginia74 7#b7 ,model described ,the model described in this paragraph is the testing of a model of prior authorization for repetitive scheduled non-emergent ambulance transport proposed to be carried out in ,new ,jersey1 ,pennsylvania1 and ,south ,carolina4 7#c7 ,funding ,the ,secretary shall allocate funds made available under section #aaae;,a7f77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7f77#a77;,b77 to carry out this subsection4 7b7 ,national expansion ,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 ,prior authorization for repetitive scheduled non-emergent ambulance transports 7,a7 ,in general ,beginning ,january #a1 #bjag1 if the expansion to all ,states of the model of prior authorization described in paragraph 7#b7 of section #eae7;a7 of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae meets the requirements described in paragraphs 7#a7 through 7#c7 of section #aaae;,a7c71 then the ,secretary shall expand such model to all ,states4 7,b7 ,funding ,the ,secretary shall use funds made available under section #ahic7;h77#aj7 to carry out this paragraph4 7,c7 ,clarification regarding budget neutrality ,nothing in this paragraph may be construed to limit or modify the application of section #aaae;,a7b77#c77;,b7 to models described in such section1 including with respect to the model described in subparagraph 7,a7 and expanded beginning on ,january #a1 #bjag1 under such subparagraph4 4 #eaf4 ,repealing duplicative ,medicare secondary payor provision 7a7 ,in general ,section #ahfb7;b77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7b77#e77 is amended by inserting at the end the following new subparagraph3 7,e7 ,end date ,the provisions of this paragraph shall not apply to information required to be provided on or after ,july #a1 #bjaf4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date of the enactment of this ,act and shall apply to information required to be provided on or after ,january #a1 #bjaf4 #eag4 ,plan for expanding data in annual ,,cert report ,not later than ,june #cj1 #bjae1 the ,secretary of ,health and ,human ,services shall submit to the ,committee on ,finance of the ,senate1 and to the ,committees on ,energy and ,commerce and ,ways and ,means of the ,house of ,representatives-- 7#a7 a plan for including1 in the annual report of the ,comprehensive ,error ,rate ,testing 7,,cert7 program1 data on services 7or groupings of services7 7other than medical visits7 paid under the physician fee schedule under section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 where the fee schedule amount is in excess of #bej and where the error rate is in excess of #bj percent2 and 7#b7 to the extent practicable by such date1 specific examples of services described in paragraph 7#a74 #eah4 ,removing funds for ,medicare ,improvement ,fund added by ,,impact ,act of #bjad ,section #ahih7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;iii7b77#a771 as amended by section #c7;e77#c7 of the ,,impact ,act of #bjad 7,public ,law #aac-ahe71 is amended by striking #aie1jjj1jjj and inserting #j4 #eai4 ,rule of construction ,except as explicitly provided in this subtitle1 nothing in this subtitle1 including the amendments made by this subtitle1 shall be construed as preventing the use of notice and comment rulemaking in the implementation of the provisions of1 and the amendments made by1 this subtitle4 ,b ,other provisions #eba4 ,extension of two-midnight ,,pama rules on certain medical review activities ,section #aaa of the ,protecting ,access to ,medicare ,act of #bjad 7,public ,law #aac-ic2 #db ,u4,s4,c4 #acie;ddd note7 is amended-- 7#a7 in subsection 7a71 by striking the first #f months of fiscal year #bjae and inserting through the end of fiscal year #bjae2 7#b7 in subsection 7b71 by striking ,march #ca1 #bjae and inserting ,september #cj1 #bjae2 and 7#c7 by adding at the end the following new subsection3 7c7 ,construction ,except as provided in subsections 7a7 and 7b71 nothing in this section shall be construed as limiting the ,secretary's authority to pursue fraud and abuse activities under such section #ahic7;h7 or otherwise4 4 #ebb4 ,requiring bid surety bonds and ,state licensure for entities submitting bids under the ,medicare ,,dmepos competitive acquisition program 7a7 ,bid surety bonds ,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 subparagraphs3 7,g7 ,requiring bid bonds for bidding entities ,with respect to rounds of competitions beginning under this subsection for contracts beginning not earlier than ,january #a1 #bjag1 and not later than ,january #a1 #bjai1 an entity may not submit a bid for a competitive acquisition area unless1 as of the deadline for bid submission1 the entity has obtained 7and provided the ,secretary with proof of having obtained7 a bid surety bond 7in this paragraph referred to as a bid bond7 in a form specified by the ,secretary consistent with subparagraph 7,h7 and in an amount that is not less than #ej1jjj and not more than #ajj1jjj for each competitive acquisition area in which the entity submits the bid4 7,h7 ,treatment of bid bonds submitted 7i7 ,for bidders that submit bids at or below the median and are offered but do not accept the contract ,in the case of a bidding entity that is offered a contract for any product category for a competitive acquisition area1 if-- 7,i7 the entity's composite bid for such product category and area was at or below the median composite bid rate for all bidding entities included in the calculation of the single payment amounts for such product category and area2 and 7,,ii7 the entity does not accept the contract offered for such product category and area1 the bid bond submitted by such entity for such area shall be forfeited by the entity and the ,secretary shall collect on it4 7ii7 ,treatment of other bidders ,in the case of a bidding entity for any product category for a competitive acquisition area1 if the entity does not meet the bid forfeiture conditions in subclauses 7,i7 and 7,,ii7 of clause 7i7 for any product category for such area1 the bid bond submitted by such entity for such area shall be returned within #ij days of the public announcement of the contract suppliers for such area4 4 7b7 ,state licensure 7#a7 ,in general ,section #ahdg7;b77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;b77#b77;,a77 is amended by adding at the end the following new clause3 7v7 ,the entity meets applicable ,state licensure requirements4 4 7#b7 ,construction ,nothing in the amendment made by paragraph 7#a7 shall be construed as affecting the authority of the ,secretary of ,health and ,human ,services to require ,state licensure of an entity under the ,medicare competitive acquisition program under section #ahdg of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7 before the date of the enactment of this ,act4 7c7 ,,gao report on bid bond impact on small suppliers 7#a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study that evaluates the effect of the bid surety bond requirement under the amendment made by subsection 7a7 on the participation of small suppliers in the ,medicare ,,dmepos competitive acquisition program under section #ahdg of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c74 7#b7 ,report ,not later than #f months after the date contracts are first awarded subject to such bid surety bond requirement1 the ,comptroller ,general shall submit to ,congress a report on the study conducted under paragraph 7#a74 ,such report shall include recommendations for changes in such requirement in order to ensure robust participation by legitimate small suppliers in the ,medicare ,,dmepos competition acquisition program4 #ebc4 ,payment for global surgical packages 7a7 ,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#h7 ,global surgical packages 7,a7 ,prohibition of implementation of rule regarding global surgical packages 7i7 ,in general ,the ,secretary shall not implement the policy established in the final rule published on ,november #ac1 #bjad 7#gi ,fed4 ,reg4 #fgedh et seq471 that requires the transition of all #aj-;day and #ij-;day global surgery packages to #j-;day global periods4 7ii7 ,construction ,nothing in clause 7i7 shall be construed to prevent the ,secretary from revaluing misvalued codes for specific surgical services or assigning values to new or revised codes for surgical services4 7,b7 ,collection of data on services included in global surgical packages 7i7 ,in general ,subject to clause 7ii71 the ,secretary shall through rulemaking develop and implement a process to gather1 from a representative sample of physicians1 beginning not later than ,january #a1 #bjag1 information needed to value surgical services4 ,such information shall include the number and level of medical visits furnished during the global period and other items and services related to the surgery and furnished during the global period1 as appropriate4 ,such information shall be reported on claims at the end of the global period or in another manner specified by the ,secretary4 ,for purposes of carrying out this paragraph 7other than clause 7iii771 the ,secretary shall transfer from the ,federal ,supplemental ,medical ,insurance ,trust ,fund under section #ahda #b1jjj1jjj to the ,center for ,medicare ,medicaid ,services ,program ,management ,account for fiscal year #bjae4 ,amounts transferred under the previous sentence shall remain available until expended4 7ii7 ,reassessment and potential sunset ,every #d years1 the ,secretary shall reassess the value of the information collected pursuant to clause 7i74 ,based on such a reassessment and by regulation1 the ,secretary may discontinue the requirement for collection of information under such clause if the ,secretary determines that the ,secretary has adequate information from other sources1 such as qualified clinical data registries1 surgical logs1 billing systems or other practice or facility records1 and electronic health records1 in order to accurately value global surgical services under this section4 7iii7 ,inspector ,general audit ,the ,inspector ,general of the ,department of ,health and ,human ,services shall audit a sample of the information reported under clause 7i7 to verify the accuracy of the information so reported4 7,c7 ,improving accuracy of pricing for surgical services ,for years beginning with #bjai1 the ,secretary shall use the information reported under subparagraph 7,b77i7 as appropriate and other available data for the purpose of improving the accuracy of valuation of surgical services under the physician fee schedule under this section4 4 7b7 ,incentive for reporting information on global surgical services ,section #ahdh7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77 is amended by adding at the end the following new paragraph3 7#i7 ,information reporting on services included in global surgical packages ,with respect to services for which a physician is required to report information in accordance with subsection 7c77#h77;,b77i71 the ,secretary may through rulemaking delay payment of #e percent of the amount that would otherwise be payable under the physician fee schedule under this section for such services until the information so required is reported4 4 #ebd4 ,extension of ,secure ,rural ,schools and ,community ,self-,determination ,act of #bjjj 7a7 ,payments for fiscal years #bjad and #bjae 7#a7 ,payments required ,section #aja of the ,secure ,rural ,schools and ,community ,self-,determination ,act of #bjjj 7#af ,u4,s4,c4 #gaaa7 is amended by striking #bjac both places it appears and inserting #bjae4 7#b7 ,prompt payment ,payments for fiscal year #bjad under title ,i of the ,secure ,rural ,schools and ,community ,self-,determination ,act of #bjjj 7#af ,u4,s4,c4 #gaaa et seq471 as amended by this section1 shall be made not later than #de days after the date of the enactment of this ,act4 7#c7 ,reduction in fiscal year #bjad payments on account of previous #be- and #ej-percent payments ,section #aja of the ,secure ,rural ,schools and ,community ,self-,determination ,act of #bjjj 7#af ,u4,s4,c4 #gaaa7 is amended by adding at the end the following new subsection3 7c7 ,special ,rule for fiscal year #bjad payments 7#a7 ,state payment ,if an eligible county in a ,state that will receive a share of the ,state payment for fiscal year #bjad has already received1 or will receive1 a share of the #be-percent payment for fiscal year #bjad distributed to the ,state before the date of the enactment of this subsection1 the amount of the ,state payment shall be reduced by the amount of that eligible county's share of the #be-percent payment4 7#b7 ,county payment ,if an eligible county that will receive a county payment for fiscal year #bjad has already received a #ej-percent payment for that fiscal year1 the amount of the county payment shall be reduced by the amount of the #ej-percent payment4 4 7#d7 ,shares of ,california state payment ,section #ajc7;d77#b7 of the ,secure ,rural ,schools and ,community ,self-,determination ,act of #bjjj 7#af ,u4,s4,c4 #gaac7;d77#b77 is amended by striking #bjac and inserting #bjae4 7b7 ,use of fiscal year #bjac elections and reservations for fiscal years #bjad and #bjae ,section #ajb of the ,secure ,rural ,schools and ,community ,self-,determination ,act of #bjjj 7#af ,u4,s4,c4 #gaab7 is amended-- 7#a7 in subsection 7b77#a71 by adding at the end the following new subparagraph3 7,c7 ,effect of late payment for fiscal years #bjad and #bjae ,the election otherwise required by subparagraph 7,a7 shall not apply for fiscal year #bjad or #bjae4 2 7#b7 in subsection 7b77#b7-- 7,a7 in subparagraph 7,a71 by adding at the end the following new sentence3 ,if such two-fiscal year period included fiscal year #bjac1 the county election to receive a share of the #be-percent payment or #ej-percent payment1 as applicable1 also shall be effective for fiscal years #bjad and #bjae42 and 7,b7 in subparagraph 7,b71 by striking #bjac the second place it appears and inserting #bjae2 and 7#c7 in subsection 7d7-- 7,a7 by adding at the end of paragraph 7#a7 the following new subparagraph3 7,e7 ,effect of late payment for fiscal year #bjad ,the election made by an eligible county under subparagraph 7,b71 7,c71 or 7,d7 for fiscal year #bjac1 or deemed to be made by the county under paragraph 7#c77;,b7 for that fiscal year1 shall be effective for fiscal years #bjad and #bjae4 2 and 7,b7 by adding at the end of paragraph 7#c7 the following new subparagraph3 7,c7 ,effect of late payment for fiscal year #bjad ,this paragraph does not apply for fiscal years #bjad and #bjae4 4 7c7 ,special projects on ,federal land ,title ,,ii of the ,secure ,rural ,schools and ,community ,self-,determination ,act of #bjjj 7#af ,u4,s4,c4 #gaba et seq47 is amended-- 7#a7 in section #bjc7;a77#a7 7#af ,u4,s4,c4 #gabc7;a77#a771 by striking ,september #cj for fiscal year #bjjh 7or as soon thereafter as the ,secretary concerned determines is practicable71 and each ,september #cj thereafter for each succeeding fiscal year through fiscal year #bjac and inserting ,september #cj of each fiscal year 7or a later date specified by the ,secretary concerned for the fiscal year72 7#b7 in section #bjd7;e77#c77;,b77iii7 7#af ,u4,s4,c4 #gabd7;e77#c77;,b77iii771 by striking each of fiscal years #bjaj through #bjac and inserting fiscal year #bjaj and fiscal years thereafter2 7#c7 in section #bjg7;a7 7#af ,u4,s4,c4 #gabg7;a771 by striking ,september #cj1 #bjjh 7or as soon thereafter as the ,secretary concerned determines is practicable71 and each ,september #cj thereafter for each succeeding fiscal year through fiscal year #bjac and inserting ,september #cj of each fiscal year 7or a later date specified by the ,secretary concerned for the fiscal year72 and 7#d7 in section #bjh 7#af ,u4,s4,c4 #gabh7-- 7,a7 in subsection 7a71 by striking #bjac and inserting #bjag2 and 7,b7 in subsection 7b71 by striking #bjad and inserting #bjah4 7d7 ,county funds ,section #cjd of the ,secure ,rural ,schools and ,community ,self-,determination ,act of #bjjj 7#af ,u4,s4,c4 #gadd7 is amended-- 7#a7 in subsection 7a71 by striking #bjac and inserting #bjag2 and 7#b7 in subsection 7b71 by striking #bjad and inserting #bjah4 7e7 ,authorization of appropriations ,section #djb of the ,secure ,rural ,schools and ,community ,self-,determination ,act of #bjjj 7#af ,u4,s4,c4 #gaeb7 is amended by striking for each of fiscal years #bjjh through #bjac4 #ebe4 ,exclusion from ,,paygo scorecards 7a7 ,statutory ,pay-,as-,you-,go scorecards ,the budgetary effects of this ,act shall not be entered on either ,,paygo scorecard maintained pursuant to section #d7;d7 of the ,statutory ,pay-,as-,you-,go ,act of #bjaj4 7b7 ,senate ,,paygo scorecards ,the budgetary effects of this ,act shall not be entered on any ,,paygo scorecard maintained for purposes of section #bja of ,s4 ,con4 ,res4 #ba 7#aajth ,congress74