,,ib ,union ,cal5d> ,no4 #dgj #aad? ,,congress #b;d ,session ,h4 ,r4 #ebgc ,report ,no4 #aad-fjd1 ,"p ,i ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,may #ah1 #bjaf ,mr4 ,tib]i 7= himself & ,mr4 ,mc,dermott7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,ways & ,means1 & 9 addition to ! ,committee on ,en]gy & ,comm]ce1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,june #g1 #bjaf ,report$ f ! ,committee on ,ways & ,means ) an am5dm5t ,/rike out all aft] ! enact+ clause & ins]t ! "p pr9t$ 9 italic ,june #g1 #bjaf,! ,committee on ,en]gy & ,comm]ce dis*>g$2 committ$ to ! ,committee ( ! ,:ole ,h\se on ! ,/ate ( ! ,union & ord]$ to be printed,for text ( introduc$ bill1 see copy ( bill z introduc$ on ,may #ah1 #bjaf ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to provide = regulatory relief "u ! ,m$ic>e program = c]ta9 provid]s ( s]vices & suppli]s & increas$ transp>5cy 9 hospital cod+ & enrollm5t data1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,help+ ,hospitals ,improve ,pati5t ,c>e ,act ( #bjaf4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,title ,i--,provisions ,relat+ to ,m$ic>e ,"p ,a ,sec4 #aja4 ,developm5t ( ,m$ic>e /udy = ,,hcpcs v]sion ( ,,ms-,,drg codes = simil> hospital s]vices4 ,sec4 #ajb4 ,e/abli%+ b5efici>y equity 9 ! ,m$ic>e hospital readmission program4 ,sec4 #ajc4 ,five-ye> ext5sion ( ! rural community hospital demon/ration program4 ,sec4 #ajd4 ,regulatory relief = ,l,t,c,hs4 ,sec4 #aje4 ,sav+s f ,,ipps ,,macra pay-= ?r\gh n apply+ docum5tation & cod+ adju/m5ts4 ,title ,,ii--,provisions ,relat+ to ,m$ic>e ,"p ,b ,sec4 #bja4 ,cont9u+ ,m$ic>e paym5t "u ,,hopd prospective paym5t sy/em = s]vices furni%$ by mid-build (f-campus outpati5t dep>tm5ts ( provid]s4 ,sec4 #bjb4 ,treatm5t ( canc] hospitals 9 (f-campus outpati5t dep>tm5t ( a provid] policy4 ,sec4 #bjc4 ,treatm5t ( eligible pr(essionals 9 ambulatory surgical c5t]s = mean+ful use & ,,mips4 ,title ,,iii--,o!r ,m$ic>e ,provisions ,sec4 #cja4 ,delay 9 au?ority to t]m9ate contracts = ,m$ic>e ,advantage plans fail+ to a*ieve m9imum quality rat+s4 ,sec4 #cjb4 ,requirem5t = enrollm5t data report+ = ,m$ic>e4 ,sec4 #cjc4 ,updat+ ! ,welcome to ,m$ic>e package4 ,i ,provisions ,relat+ to ,m$ic>e ,"p ,a #aja4 ,developm5t ( ,m$ic>e /udy = ,,hcpcs v]sion ( ,,ms-,,drg codes = simil> hospital s]vices ,section #ahhf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7t7 ,relat+ simil> inpati5t & outpati5t hospital s]vices 7#a7 ,developm5t ( ,,hcpcs v]sion ( ,,ms-,,drg codes 7,a7 ,9 g5]al ,n lat] ?an ,janu>y #a1 #bjah1 ! ,secret>y %all develop ,,hcpcs v]sions = ,,ms-,d,r,gs t is simil> to ! ,,icd-#aj-,,pcs = su* ,,ms-,d,r,gs su* t1 to ! ext5t possible1 ! ,,ms-,,drg assignm5t %all be simil> = a claim cod$ ) ! ,,hcpcs v]sion z an id5tical claim cod$ ) a ,,icd-#aj-,,pcs code4 7,b7 ,cov]age ( surgical ,,ms-,d,r,gs ,9 c>ry+ out subp>agraph 7,a71 ! ,secret>y %all develop ,,hcpcs v]sions ( ,,ms-,,drg codes = n few] ?an #aj surgical ,,ms-,d,r,gs4 7,c7 ,publication & dissem9ation ( ! ,,hcpcs v]sions ( ,,ms-,d,r,gs 7i7 ,9 g5]al ,! ,secret>y %all develop a ,,hcpcs ,,ms-,,drg def9itions manual & s(tw>e t is simil> to ! def9itions manual & s(tw>e = ,,icd-#aj-,,pcs codes = su* ,,ms-,d,r,gs4 ,! ,secret>y %all po/ ! ,,hcpcs ,,ms-,,drg def9itions manual & s(tw>e on ! ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 ,! ,,hcpcs ,,ms-,,drg def9itions manual & s(tw>e %all be 9 ! public doma9 & available = use & r$i/ribution )\t *>ge4 7ii7 ,use ( previ\s analysis done by ,med,p,a,c ,9 develop+ ! ,,hcpcs ,,ms-,,drg def9itions manual & s(tw>e "u clause 7i71 ! ,secret>y %all consult ) ! ,m$ic>e ,paym5t ,advisory ,commission & %all consid] ! analysis done by su* ,commission 9 translat+ outpati5t surgical claims into inpati5t surgical ,,ms-,d,r,gs 9 prep>+ *apt] #g 7relat+ to hospital %ort-/ay policy issues7 ( its ,m$ic>e & ! ,heal? ,c>e ,deliv]y ,sy/em report submitt$ to ,congress 9 ,june #bjae4 7,d7 ,def9ition & ref]5ce ,9 ?is p>agraph3 7i7 ,,hcpcs ,! t]m ,,hcpcs means1 ) respect to hospital items & s]vices1 ! code "u ! ,heal?c>e ,common ,proc$ure ,cod+ ,sy/em 7,,hcpcs7 7or a successor code7 = su* items & s]vices4 7ii7 ,,icd-#aj-,,pcs ,! t]m ,,icd-#aj-,,pcs means ! ,int]national ,classification ( ,diseases1 #aj? ,revision1 ,proc$ure ,cod+ ,sy/em1 & includes a subsequ5t revision ( su* ,int]national ,classification ( ,diseases1 ,proc$ure ,cod+ ,sy/em4 4 #ajb4 ,e/abli%+ b5efici>y equity 9 ! ,m$ic>e hospital readmission program 7a7 ,transitional adju/m5t = dual eligible population ,section #ahhf7q77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77#c77 is am5d$-- 7#a7 9 subp>agraph 7,a71 by ins]t+ subject to subp>agraph 7,d71 aft] purposes ( p>agraph 7#a712 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ,transitional adju/m5t = dual eligibles 7i7 ,9 g5]al ,9 det]m9+ a hospital's adju/m5t factor "u ?is p>agraph = purposes ( mak+ paym5ts = dis*>ges occurr+ dur+ & aft] fiscal ye> #bjai1 & be=e ! application ( clause 7i7 ( subp>agraph 7,e71 ! ,secret>y %all assign hospitals to gr\ps 7z def9$ by ! ,secret>y "u clause 7ii77 & apply ! applicable provisions ( ?is subsection us+ a me?odology 9 a mann] t all[s = sep>ate comp>ison ( hospitals )9 ea* su* gr\p1 z det]m9$ by ! ,secret>y4 7ii7 ,def9+ gr\ps ,= purposes ( ?is subp>agraph1 ! ,secret>y %all def9e gr\ps ( hospitals bas$ on _! ov]all proportion1 ( ! inpati5ts :o are entitl$ to1 or enroll$ =1 b5efits "u "p ,a1 :o are full-b5efit dual eligible individuals 7z def9$ 9 section #aice7;c77#f774 ,9 def9+ gr\ps1 ! ,secret>y %all consult ! ,m$ic>e ,paym5t ,advisory ,commission & may consid] ! analysis done by su* ,commission 9 prep>+ ! portion ( its report submitt$ to ,congress 9 ,june #bjac relat+ to readmissions4 7iii7 ,m9imiz+ report+ burd5 on hospitals ,9 c>ry+ out ?is subp>agraph1 ! ,secret>y %all n impose any additional report+ requirem5ts on hospitals4 7iv7 ,budget neutral design me?odology ,! ,secret>y %all design ! me?odology to implem5t ?is subp>agraph s t ! e/imat$ total am\nt ( r$uctions 9 paym5ts "u ?is subsection equals ! e/imat$ total am\nt ( r$uctions 9 paym5ts t w\ld o!rwise occur "u ?is subsection if ?is subp>agraph did n apply4 4 7b7 ,subsequ5t adju/m5ts bas$ on ,,impact reports ,section #ahhf7q77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77#c771 z am5d$ by subsection 7a71 is fur!r am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,*anges 9 risk adju/m5t 7i7 ,consid]ation ( recomm5dations 9 ,,impact reports ,! ,secret>y may take into acc\nt ! /udies conduct$ & ! recomm5dations made by ! ,secret>y "u section #b7;d77#a7 ( ! ,,impact ,act ( #bjad 7,public ,law #aac-ahe2 #db ,u4,s4,c4 #acielll note7 ) respect to ! application "u ?is subsection ( risk adju/m5t me?odologies4 ,no?+ 9 ?is clause %all be con/ru$ z preclud+ consid]ation ( ! use ( gr\p+s ( hospitals4 4 7c7 ,med,p,a,c /udy on readmissions program ,! ,m$ic>e ,paym5t ,advisory ,commission %all conduct a /udy to review ov]all hospital readmissions describ$ 9 section #ahhf7q77#e77;,e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77#e77;,e77 & :e!r su* readmissions are relat$ to any *anges 9 outpati5t & em]g5cy s]vices furni%$4 ,! ,commission %all submit to ,congress a report on su* /udy 9 its report to ,congress 9 ,june #bjag4 7d7 ,address+ issue ( c]ta9 pati5ts ,subp>agraph 7,e7 ( section #ahhf7q77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77#c771 z add$ by subsection 7b71 is fur!r am5d$ by add+ at ! end ! foll[+ new clause3 7ii7 ,consid]ation ( exclusion ( pati5t cases bas$ on ,v or o!r appropriate codes ,9 promulgat+ regulations to c>ry out ?is subsection ) respect to dis*>ges occurr+ aft] fiscal ye> #bjah1 ! ,secret>y may consid] ! use ( ,v or o!r ,,icd-relat$ codes = removal ( a readmission4 ,! ,secret>y may consid] modify+ measures "u ?is subsection to incorporate ,v or o!r ,,icd-relat$ codes at ! same "t z o!r *anges are be+ made "u ?is subp>agraph4 4 7e7 ,removal ( c]ta9 readmissions ,subp>agraph 7,e7 ( section #ahhf7q77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77#c771 z add$ by subsection 7b7 & am5d$ by subsection 7d71 is fur!r am5d$ by add+ at ! end ! foll[+ new clause3 7iii7 ,removal ( c]ta9 readmissions ,9 promulgat+ regulations to c>ry out ?is subsection1 ) respect to dis*>ges occurr+ aft] fiscal ye> #bjah1 ! ,secret>y may consid] removal z a readmission ( an admission t is classifi$ )9 "o or m ( ! foll[+3 transplants1 end-/age r5al disease1 burns1 trauma1 psy*osis1 or sub/ance abuse4 ,! ,secret>y may consid] modify+ measures "u ?is subsection to remove readmissions at ! same "t z o!r *anges are be+ made "u ?is subp>agraph4 4 #ajc4 ,five-ye> ext5sion ( ! rural community hospital demon/ration program 7a7 ,ext5sion ,section #daj;,a ( ! ,m$ic>e ,prescription ,drug1 ,improvem5t1 & ,mod]nization ,act ( #bjjc 7,public ,law #ajh-agc2 #db ,u4,s4,c4 #acieww note71 z am5d$ by sections #cabc & #ajcac ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh71 is am5d$-- 7#a7 9 subsection 7a77#e71 by /rik+ #e-ye> ext5sion p]iod & ins]t+ #aj-ye> ext5sion p]iod2 & 7#b7 9 subsection 7g7-- 7,a7 9 ! subsection head+1 by /rik+ ,five-,ye> & ins]t+ ,t5-,ye>2 7,b7 9 p>agraph 7#a71 by /rik+ additional #e-ye> & ins]t+ additional #aj-ye>2 7,c7 by /rik+ #e-ye> ext5sion p]iod & ins]t+ #aj-ye> ext5sion p]iod ea* place x appe>s2 7,d7 9 p>agraph 7#d77;,b7-- 7i7 9 ! matt] prec$+ clause 7i71 by ins]t+ ea* #e-ye> p]iod 9 aft] hospital dur+2 & 7ii7 9 clause 7i71 by ins]t+ ea* applicable #e-ye> p]iod 9 aft] ! fir/ day (2 & 7,e7 by add+ at ! end ! foll[+ new p>agraphs3 7#e7 ,o!r hospitals 9 demon/ration program ,dur+ ! second #e ye>s ( ! #aj-ye> ext5sion p]iod1 ! ,secret>y %all apply ! provisions ( p>agraph 7#d7 to rural community hospitals t are n describ$ 9 p>agraph 7#d7 b are p>ticipat+ 9 ! demon/ration program "u ?is section z ( ,decemb] #cj1 #bjad1 9 a simil> mann] z su* provisions apply to rural community hospitals describ$ 9 p>agraph 7#d74 7#f7 ,expansion ( demon/ration program to rural areas 9 any ,/ate 7,a7 ,9 g5]al ,! ,secret>y %all1 not)/&+ subsection 7a77#b7 or p>agraph 7#b7 ( ?is subsection1 n lat] ?an #abj days aft] ! date ( ! enactm5t ( ?is p>agraph1 issue a solicitation = applications to select up to ! maximum numb] ( additional rural community hospitals locat$ 9 any ,/ate to p>ticipate 9 ! demon/ration program "u ?is section = ! second #e ye>s ( ! #aj-ye> ext5sion p]iod )\t exce$+ ! limitation "u p>agraph 7#c7 ( ?is subsection4 7,b7 ,priority ,9 det]m9+ :i* rural community hospitals t submitt$ an application pursuant to ! solicitation "u subp>agraph 7,a7 to select = p>ticipation 9 ! demon/ration program1 ! ,secret>y-- 7i7 %all give priority to rural community hospitals locat$ 9 "o ( ! #bj ,/ates ) ! l[e/ population d5sities 7z det]m9$ by ! ,secret>y us+ ! #bjae ,/ati/ical ,ab/ract ( ! ,unit$ ,/ates72 & 7ii7 may consid]-- 7,i7 closures ( hospitals locat$ 9 rural areas 9 ! ,/ate 9 :i* ! rural community hospital is locat$ dur+ ! #e-ye> p]iod imm$iately prec$+ ! date ( ! enactm5t ( ?is p>agraph2 & 7,,ii7 ! population d5sity ( ! ,/ate 9 :i* ! rural community hospital is locat$4 4 7b7 ,*ange 9 tim+ = report ,subsection 7e7 ( su* section #daj;,a is am5d$-- 7#a7 by /rik+ ,n lat] ?an #f mon?s aft] ! completion ( ! demon/ration program "u ?is section & ins]t+ ,n lat] ?an ,augu/ #a1 #bjah2 & 7#b7 by /rik+ su* program & ins]t+ ! demon/ration program "u ?is section4 #ajd4 ,regulatory relief = ,l,t,c,hs 7a7 ,te*nical *ange to ! ,m$ic>e long-t]m c>e hospital moratorium exception 7#a7 ,9 g5]al ,section #aad7;d77#g7 ( ! ,m$ic>e1 ,m$icaid1 & ,,s*ip ,ext5sion ,act ( #bjjg 7#db ,u4,s4,c4 #acieww note71 z am5d$ by sections #cajf7;b7 & #ajcab7;b7 ( ,public ,law #aaa-adh1 section #abjf7;b77#b7 ( ! ,pa?way = ,,sgr ,re=m ,act ( #bjac 7division ,b ( ,public ,law #aac-fg71 & section #aab ( ! ,protect+ ,access to ,m$ic>e ,act ( #bjad1 is am5d$ by /rik+ ,! moratorium "u p>agraph 7#a77;,a7 & ins]t+ ,any moratorium "u p>agraph 7#a74 7#b7 ,effective date ,! am5dm5t made by p>agraph 7#a7 %all take effect z if includ$ 9 ! enactm5t ( section #aab ( ! ,protect+ ,access to ,m$ic>e ,act ( #bjad4 7b7 ,modification to ,m$ic>e long-t]m c>e hospital high co/ outli] paym5ts ,section #ahhf7m7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7m77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,treatm5t ( high co/ outli] paym5ts 7,a7 ,adju/m5t to ! /&>d ,f$]al paym5t rate = e/imat$ high co/ outli] paym5ts ,"u ! sy/em describ$ 9 p>agraph 7#a71 = fiscal ye>s beg9n+ on or aft] ,octob] #a1 #bjag1 ! ,secret>y %all r$uce ! /&>d ,f$]al paym5t rate z if ! e/imat$ aggregate am\nt ( high co/ outli] paym5ts = /&>d ,f$]al paym5t rate dis*>ges = ea* su* fiscal ye> w\ld be equal to #h p]c5t ( e/imat$ aggregate paym5ts = /&>d ,f$]al paym5t rate dis*>ges = ea* su* fiscal ye>4 7,b7 ,limitation on high co/ outli] paym5t am\nts ,not)/&+ subp>agraph 7,a71 ! ,secret>y %all set ! fix$ loss am\nt = high co/ outli] paym5ts su* t ! e/imat$ aggregate am\nt ( high co/ outli] paym5ts made = /&>d ,f$]al paym5t rate dis*>ges = fiscal ye>s beg9n+ on or aft] ,octob] #a1 #bjag1 %all be equal to #ii4fhge p]c5t ( #h p]c5t ( e/imat$ aggregate paym5ts = /&>d ,f$]al paym5t rate dis*>ges = ea* su* fiscal ye>4 7,c7 ,waiv] ( budget neutrality ,any r$uction 9 paym5ts result+ f ! application ( subp>agraph 7,b7 %all n be tak5 into acc\nt 9 apply+ any budget neutrality provision "u su* sy/em4 7,d7 ,no effect on site neutral high co/ outli] paym5t rate ,?is p>agraph %all n apply ) respect to ! computation ( ! applicable site neutral paym5t rate "u p>agraph 7#f74 4 #aje4 ,sav+s f ,,ipps ,,macra pay-= ?r\gh n apply+ docum5tation & cod+ adju/m5ts ,section #g7;b77#a77;,b77iii7 ( ! ,,tma1 ,ab/95ce ,education1 & ,,qi ,programs ,ext5sion ,act ( #bjjg 7,public ,law #aaj-ij71 z am5d$ by section #fca7;b7 ( ! ,am]ican ,taxpay] ,relief ,act ( #bjab 7,public ,law #abb-bdj7 & section #dad7a77;,b77iii7 ( ! ,m$ic>e ,access & ,,*ip ,reau?orization ,act ( #bjae 7,public ,law #aad-aj71 is am5d$ by /rik+ an increase ( #j4e p]c5tage po9ts = dis*>ges occurr+ dur+ ea* ( fiscal ye>s #bjah ?r\gh #bjbc & ins]t+ an increase ( #j4deij p]c5tage po9ts = dis*>ges occurr+ dur+ fiscal ye> #bjah & #j4e p]c5tage po9ts = dis*>ges occurr+ dur+ ea* ( fiscal ye>s #bjai ?r\gh #bjbc4 ,,ii ,provisions ,relat+ to ,m$ic>e ,"p ,b #bja4 ,cont9u+ ,m$ic>e paym5t "u ,,hopd prospective paym5t sy/em = s]vices furni%$ by mid-build (f-campus outpati5t dep>tm5ts ( provid]s 7a7 ,9 g5]al ,section #ahcc7t77#ba7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#ba77 is am5d$-- 7#a7 9 subp>agraph 7,b7-- 7,a7 9 clause 7i71 by /rik+ clause 7ii7 & ins]t+ ! subsequ5t provisions ( ?is subp>agraph2 & 7,b7 by add+ at ! end ! foll[+ new clauses3 7iii7 ,deem$ treatm5t = #bjag ,= purposes ( apply+ clause 7ii7 ) respect to applicable items & s]vices furni%$ dur+ #bjag1 a dep>tm5t ( a provid] 7z s def9$7 n describ$ 9 su* clause is deem$ to be bill+ "u ?is subsection ) respect to cov]$ ,,opd s]vices furni%$ prior to ,novemb] #b1 #bjae1 if ! ,secret>y receiv$ f ! provid] prior to ,decemb] #b1 #bjae1 an atte/ation 7pursuant to section #dac4fe7;b77#c7 ( title #db ( ! ,code ( ,f$]al ,regulations7 t su* dep>tm5t 0 a dep>tm5t ( a provid] 7z s def9$74 7iv7 ,alt]native exception beg9n+ ) #bjah ,= purposes ( p>agraph 7#a77;,b77v7 & ?is p>agraph ) respect to applicable items & s]vices furni%$ dur+ #bjah or a subsequ5t ye>1 ! t]m (f-campus outpati5t dep>tm5t ( a provid] also %all n include a dep>tm5t ( a provid] 7z s def9$7 t is n describ$ 9 clause 7ii7 if-- 7,i7 ! ,secret>y receives f ! provid] an atte/ation 7pursuant to su* section #dac4fe7;b77#c77 n lat] ?an ,decemb] #ca1 #bjaf 7or1 if lat]1 #fj days aft] ! date ( ! enactm5t ( ?is clause71 t su* dep>tm5t met ! requirem5ts ( a dep>tm5t ( a provid] specifi$ 9 section #dac4fe ( title #db ( ! ,code ( ,f$]al ,regulations2 7,,ii7 ! provid] includes su* dep>tm5t z "p ( ! provid] on its enrollm5t =m 9 accordance ) ! enrollm5t process "u section #ahff7;j72 & 7,,iii7 ! dep>tm5t met ! mid-build requirem5t ( clause 7v7 & ! ,secret>y receives1 n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is clause1 f ! *ief executive (fic] or *ief op]at+ (fic] ( ! provid] a writt5 c]tification t ! dep>tm5t met su* requirem5t4 7v7 ,mid-build requirem5t describ$ ,! mid-build requirem5t ( ?is clause is1 ) respect to a dep>tm5t ( a provid]1 t be=e ,novemb] #b1 #bjae1 ! provid] _h a b9d+ writt5 agreem5t ) an outside unrelat$ p>ty = ! actual con/ruction ( su* dep>tm5t4 7vii7 ,audit ,n lat] ?an ,decemb] #ca1 #bjah1 ! ,secret>y %all audit ! compliance ) requirem5ts ( clause 7iv7 ) respect to ea* dep>tm5t ( a provid] to :i* su* clause applies4 ,if ! ,secret>y f9ds z a result ( an audit "u ?is clause t ! applicable requirem5ts 7 n met ) respect to su* dep>tm5t1 ! dep>tm5t %all n be exclud$ f ! t]m (f-campus outpati5t dep>tm5t ( a provid] "u su* clause4 7viii7 ,implem5tation ,= purposes ( implem5t+ clauses 7iii7 ?r\gh 7vii73 7,i7 ,not)/&+ any o!r provision ( law1 ! ,secret>y may implem5t su* clauses by program in/ruction or o!rwise4 7,,ii7 ,sub*apt] ,i ( *apt] #ce ( title #dd1 ,unit$ ,/ates ,code1 %all n apply4 7,,iii7 ,= purposes ( c>ry+ out ?is subp>agraph ) respect to clauses 7iii7 & 7iv7 7& clause 7vii7 ins(> z x relates to clause 7iv771 ! ,secret>y %all provide = ! transf] f ! ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda1 ( #aj1jjj1jjj to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt to rema9 available until ,decemb] #ca1 #bjah4 2 & 7#b7 9 subp>agraph 7,e71 by add+ at ! end ! foll[+ new clause3 7iv7 ,! det]m9ation ( an audit "u subp>agraph 7,b77vii74 4 7b7 ,effective date ,! am5dm5ts made by ?is section %all be effective z if includ$ 9 ! enactm5t ( section #fjc ( ! ,bip>tisan ,budget ,act ( #bjae 7,public ,law #aad-gd74 #bjb4 ,treatm5t ( canc] hospitals 9 (f-campus outpati5t dep>tm5t ( a provid] policy 7a7 ,9 g5]al ,section #ahcc7t77#ba77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#ba77;,b771 z am5d$ by section #bja7;a71 is am5d$-- 7#a7 by ins]t+ aft] clause 7v7 ! foll[+ new clause3 7vi7 ,exclusion = c]ta9 canc] hospitals ,= purposes ( p>agraph 7#a77;,b77v7 & ?is p>agraph ) respect to applicable items & s]vices furni%$ dur+ #bjag or a subsequ5t ye>1 ! t]m (f-campus outpati5t dep>tm5t ( a provid] also %all n include a dep>tm5t ( a provid] 7z s def9$7 t is n describ$ 9 clause 7ii7 if ! provid] is a hospital describ$ 9 section #ahhf7;d77#a77;,b77v7 &-- 7,i7 9 ! case ( a dep>tm5t t met ! requirem5ts ( section #dac4fe ( title #db ( ! ,code ( ,f$]al ,regulations aft] ,novemb] #a1 #bjae1 & be=e ! date ( ! enactm5t ( ?is clause1 ! ,secret>y receives f ! provid] an atte/ation t su* dep>tm5t met su* requirem5ts n lat] ?an #fj days aft] su* date ( enactm5t2 or 7,,ii7 9 ! case ( a dep>tm5t t meets su* requirem5ts aft] su* date ( enactm5t1 ! ,secret>y receives f ! provid] an atte/ation t su* dep>tm5t meets su* requirem5ts n lat] ?an #fj days aft] ! date su* requirem5ts are fir/ met ) respect to su* dep>tm5t4 2 7#b7 9 clause 7vii71 by ins]t+ aft] ! fir/ s5t5ce ! foll[+3 ,n lat] ?an #b ye>s aft] ! date ! ,secret>y receives an atte/ation "u clause 7vi7 relat+ to compliance ( a dep>tm5t ( a provid] ) requirem5ts ref]r$ to 9 su* clause1 ! ,secret>y %all audit ! compliance ) su* requirem5ts ) respect to ! dep>tm5t42 & 7#c7 9 clause 7viii77,,iii71 by add+ at ! end ! foll[+3 ,= purposes ( c>ry+ out ?is subp>agraph ) respect to clause 7vi7 7& clause 7vii7 ins(> z x relates to su* clause71 ! ,secret>y %all provide = ! transf] f ! ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda1 ( #b1jjj1jjj to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt to rema9 available until exp5d$4 7b7 ,(fsett+ sav+s ,section #ahcc7t77#ah7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#ah77 is am5d$-- 7#a7 9 subp>agraph 7,b71 by ins]t+ 1 subject to subp>agraph 7,c71 aft] %all2 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,t>get ,,pcr adju/m5t ,9 apply+ section #dai4dc7;i7 ( title #db ( ! ,code ( ,f$]al ,regulations to implem5t ! appropriate adju/m5t "u ?is p>agraph = s]vices furni%$ on or aft] ,janu>y #a1 #bjah1 ! ,secret>y %all use a t>get ,,pcr t is #a4j p]c5tage po9ts less ?an ! t>get ,,pcr t w\ld o!rwise apply4 ,9 addition to ! p]c5tage po9t r$uction "u ! previ\s s5t5ce1 ! ,secret>y may consid] mak+ an additional p]c5tage po9t r$uction to su* t>get ,,pcr t takes into acc\nt paym5t rates = applicable items & s]vices describ$ 9 p>agraph 7#ba77;,c7 o!r ?an = s]vices furni%$ by hospitals describ$ 9 section #ahhf7;d77#a77;,b77v74 ,9 mak+ any budget neutrality adju/m5ts "u ?is subsection = #bjah or a subsequ5t ye>1 ! ,secret>y %all n take into acc\nt ! r$uc$ exp5ditures t result f ! application ( ?is subp>agraph4 4 7c7 ,effective date ,! am5dm5ts made by ?is section %all be effective z if includ$ 9 ! enactm5t ( section #fjc ( ! ,bip>tisan ,budget ,act ( #bjae 7,public ,law #aad-gd74 #bjc4 ,treatm5t ( eligible pr(essionals 9 ambulatory surgical c5t]s = mean+ful use & ,,mips 7a7 ,9 g5]al ,section #ahdh7;a77#g77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g77;,d77 is am5d$-- 7#a7 by /rik+ hospital-bas$ eligible pr(essionals & all t foll[s ?r\gh ,no paym5t & ins]t+ ! foll[+3 hospital-bas$ & ambulatory surgical c5t]-bas$ eligible pr(essionals4-- 7i7 ,hospital-bas$ ,no paym5t 2 & 7#b7 by add+ at ! end ! foll[+ new clauses3 7ii7 ,ambulatory surgical c5t]-bas$ ,subject to clause 7iv71 no paym5t adju/m5t may be made "u subp>agraph 7,a7 = #bjag & #bjah 9 ! case ( an eligible pr(essional ) respect to :om sub/antially all ( ! cov]$ pr(essional s]vices furni%$ by su* pr(essional are furni%$ 9 an ambulatory surgical c5t]4 7iii7 ,det]m9ation ,! det]m9ation ( :e!r an eligible pr(essional is an eligible pr(essional describ$ 9 clause 7ii7 may be made on ! basis (-- 7,i7 ! site ( s]vice 7z def9$ by ! ,secret>y72 or 7,,ii7 an atte/ation submitt$ by ! eligible pr(essional4 ,det]m9ations made "u subclauses 7,i7 & 7,,ii7 %all be made )\t reg>d to any employm5t or bill+ arrangem5t betwe5 ! eligible pr(essional & any o!r suppli] or provid] ( s]vices4 7iv7 ,sunset ,clause 7ii7 %all no long] apply z ( ! fir/ ye> t beg9s m ?an #c ye>s aft] ! date on :i* ! ,secret>y det]m9es1 ?r\gh notice & comm5t rulemak+1 t c]tifi$ ,,ehr te*nology applicable to ! ambulatory surgical c5t] sett+ is available4 4 7b7 ,cont9u$ application ( c]ta9 provisions "u ,,mips ,section #ahdh7o77#b77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#b77;,d77 is am5d$ by add+ at ! end ! foll[+ new s5t5ce3 ,! provisions ( subp>agraphs 7,b7 & 7,d7 ( subsection 7a77#g71 includ+ ! application ( clause 7iv7 ( su* subp>agraph 7,d71 %all apply to assessm5ts ( ,,mips eligible pr(essionals "u subsection 7q7 ) respect to ! p]=mance category describ$ 9 subsection 7q77#b77;,a77iv7 9 a mann] simil> to ! mann] 9 :i* su* provisions apply ) respect to paym5t adju/m5ts made "u subsection 7a77#g77;,a744 ,,iii ,o!r ,m$ic>e ,provisions #cja4 ,delay 9 au?ority to t]m9ate contracts = ,m$ic>e ,advantage plans fail+ to a*ieve m9imum quality rat+s 7a7 ,f9d+s ,consi/5t ) ! /udies provid$ "u ! ,,impact ,act ( #bjad 7,public ,law #aac-ahe71 x is ! int5t ( ,congress-- 7#a7 to cont9ue to /udy & reque/ input on ! effects ( socioeconomic /atus & dual-eligible populations on ! ,m$ic>e ,advantage ,,/>s rat+ sy/em be=e re=m+ su* sy/em ) ! input ( /akehold]s2 & 7#b7 p5d+ ! results ( su* /udies & input1 to provide = a tempor>y delay 9 au?ority ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7,,cms7 to t]m9ate ,m$ic>e ,advantage plan contracts solely on ! basis ( p]=mance ( plans "u ! ,,/>s rat+ sy/em4 7b7 ,delay 9 ,,ma contract t]m9ation au?ority = plans fail+ ,to a*ieve m9imum quality rat+s ,section #aheg7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;h77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#c7 ,delay 9 contract t]m9ation au?ority = plans fail+ to a*ieve m9imum quality rat+ ,dur+ ! p]iod beg9n+ on ! date ( ! enactm5t ( ?is p>agraph & ?r\gh ! end ( plan ye> #bjah1 ! ,secret>y may n t]m9ate a contract "u ?is section ) respect to ! (f]+ ( an ,,ma plan by a ,m$ic>e ,advantage organization solely because ! ,,ma plan has fail$ to a*ieve a m9imum quality rat+ "u ! #e-/> rat+ sy/em "u section #ahec7o77#d74 4 #cjb4 ,requirem5t = enrollm5t data report+ = ,m$ic>e ,section #ahgd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7g7 ,requirem5t = enrollm5t data report+ 7#a7 ,9 g5]al ,ea* ye> 7beg9n+ ) #bjaf71 ! ,secret>y %all submit to ! ,committees on ,ways & ,means & ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate a report on ,m$ic>e enrollm5t data 7&1 9 ! case ( "p ,a1 on data on individuals receiv+ b5efits "u su* "p7 z ( a date 9 su* ye> specifi$ by ! ,secret>y4 ,su* data %all be pres5t$-- 7,a7 by ,congressional di/rict & ,/ate2 & 7,b7 9 a mann] t provides = su* data bas$ on-- 7i7 fee-=-s]vice enrollm5t 7z def9$ 9 p>agraph 7#b772 7ii7 enrollm5t "u "p ,c 7includ+ sep>ate = aggregate enrollm5t 9 ,,ma-,,pd plans & aggregate enrollm5t 9 ,,ma plans t are n ,,ma-,,pd plans72 & 7iii7 enrollm5t "u "p ,d4 7#b7 ,fee-=-s]vice enrollm5t def9$ ,= purpose ( p>agraph 7#a77;,b77i71 ! t]m fee-=-s]vice enrollm5t means aggregate enrollm5t 7includ+ receipt ( b5efits o!r ?an ?r\gh enrollm5t7 "u-- 7,a7 "p ,a only2 7,b7 "p ,b only2 & 7,c7 bo? "p ,a & "p ,b4 4 #cjc4 ,updat+ ! ,welcome to ,m$ic>e package 7a7 ,9 g5]al ,n lat] ?an #ab mon?s aft] ! la/ day ( ! p]iod = ! reque/ ( in=mation describ$ 9 subsection 7b71 ! ,secret>y ( ,heal? & ,human ,s]vices %all1 tak+ into consid]ation in=mation collect$ pursuant to subsection 7b71 update ! in=mation includ$ 9 ! ,welcome to ,m$ic>e package to include in=mation1 pres5t$ 9 a cle> & simple mann]1 ab\t options = receiv+ b5efits "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 includ+ ?r\gh ! orig9al m$ic>e fee-=-s]vice program "u p>ts ,a & ,b ( su* title 7#db ,u4,s4,c4 #acie;c et seq41 #db ,u4,s4,c4 #acie;j et seq471 ,m$ic>e ,advantage plans "u "p ,c ( su* title 7#db ,u4,s4,c4 #aciew-#ba et seq471 & prescription drug plans "u "p ,d ( su* title 7#db ,u4,s4,c4 #aciew-#aja et seq4774 ,! ,secret>y %all make subsequ5t updates to ! in=mation includ$ 9 ! ,welcome to ,m$ic>e package z appropriate4 7b7 ,reque/ = in=mation ,n lat] ?an six mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all reque/ in=mation1 includ+ recomm5dations1 f /akehold]s 7includ+ pati5t advocates1 issu]s1 & employ]s7 on in=mation includ$ 9 ! ,welcome to ,m$ic>e package1 includ+ p]t95t data & in=mation reg>d+ enrollm5t & cov]age = ,m$ic>e eligible individuals4 ,june #g1 #bjaf ,report$ f ! ,committee on ,ways & ,means ) an amendment,june #g1 #bjaf,! ,committee on ,en]gy & ,comm]ce dis*>g$2 committ$ to ! ,committee ( ! ,:ole ,h\se on ! ,/ate ( ! ,union & ord]$ to be pr9t$