,,ii #aadth ,,congress #b;d ,session ,s4 #caia ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #ac1 #bjaf ,mr4 ,franken 7for himself and ,ms4 ,heitkamp7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend titles ,,xviii and ,,xix of the ,social ,security ,act to improve the quality of health care furnished in rural areas1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,rural ,health ,care ,quality ,improvement ,act of #bjaf4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,,title ,i--,rural health care ,sec4 #aja4 ,establishment of core set of rural health care quality measures4 ,sec4 #ajb4 ,revisions to ,medicare rural grants4 ,,title ,,ii--,rural-based payment reforms ,sec4 #bja4 ,integrating core set of rural health care quality measures into certain payment models4 ,sec4 #bjb4 ,center for ,medicare and ,medicaid ,innovation testing of providing financial incentives for rural providers of services and suppliers to submit data on quality measures4 ,sec4 #bjc4 ,center for ,medicare and ,medicaid ,innovation testing of value-based payment models for rural providers of services and suppliers4 ,sec4 #bjd4 ,center for ,medicare and ,medicaid ,innovation testing of hospital readmissions reduction program for rural hospitals4 ,sec4 #bje4 ,participation by rural health clinics and ,federally qualified health centers in ,comprehensive ,primary ,care ,plus model4 ,,title ,,iii--,improving rural representation ,sec4 #cja4 ,inclusion of rural representation on ,,cms ,rural ,health ,council4 ,sec4 #cjb4 ,ensuring rural representation on the ,medicare ,payment ,advisory ,commission and the ,medicaid and ,,chip ,payment and ,access ,commission4 ,i ,rural health care #aja4 ,establishment of core set of rural health care quality measures 7a7 ,in general ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by inserting after section #ahij;,a the following new section3 #ahij;,b4 ,rural health care quality measures 7a7 ,establishment ,not later than ,january #a1 #bjah1 the ,secretary shall1 using the process described in section #ahij7;b77#g71 establish a core set of relevant quality measures that address the following with respect to rural providers of services and suppliers who furnish items and services to individuals in rural areas3 7#a7 ,improving patient outcomes1 such as mortality rates1 hospital acquired infections1 hospital readmissions1 and other patient-reported outcomes4 7#b7 ,improving care coordination1 transitions1 and medicine reconciliation4 7#c7 ,reducing costs4 7#d7 ,improving patient safety4 7#e7 ,use of preventive care services1 including immunizations and screening tests4 7#f7 ,improving care for individuals with chronic disease1 including cardiovascular disease1 diabetes1 behavioral health1 and other chronic conditions4 7#g7 ,other purposes specified by the ,secretary4 7b7 ,aligning measures with existing quality reporting requirements ,in establishing the core set of quality measures under subsection 7a71 the ,secretary shall reduce reporting burdens for small rural providers of services and suppliers 7as determined by the ,secretary7 by1 to the extent practicable1 ensuring that such quality measures are consistent with measures applicable under other quality and value-based payment reporting requirements under this title1 as determined by the ,secretary1 including the ,merit-,based ,incentive ,payment ,system under section #ahdh7q7 and incentive payments for the meaningful use of certified ,,ehr technology under section #ahhf7;b77#c77;,b77ix74 7c7 ,implementation ,the provisions of paragraphs 7#d7 and 7#e7 of section #ahij;,a7a7 shall apply to the establishment of the core set of quality measures under subsection 7a7 in the same manner as such provisions apply to the selection of quality and efficiency measures described in section #ahij7;b77#g77;,b74 7d7 ,annual updating ,the ,secretary shall1 using the process described in section #ahij;,a1 review and update the core set of quality measures established under subsection 7a7 in accordance with section #ahij;,a7c7 to ensure such quality measures remain reliable1 scientifically valid1 and appropriate for quality measurement purposes4 4 7b7 ,conforming amendment ,section #ahij7;b77#e77;,a77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7b77#e77;,a77iv77 is amended by inserting and 7beginning with #bjai7 rural health care quality measures under section #ahij;,b after ,public ,health ,service ,act4 #ajb4 ,revisions to ,medicare rural grants 7a7 ,reauthorization ,section #ahbj7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7;j77 is amended-- 7#a7 by striking ,appropriations4--,there and inserting the following3 ,appropriations4-- 7#a7 ,,hi ,trust fund ,there 2 and 7#b7 by adding at the end the following new paragraph3 7#b7 ,general revenues ,there are authorized to be appropriated1 from amounts in the ,treasury not otherwise appropriated1 for making grants to all ,states under subsection 7g71 #ej1jjj1jjj in each of fiscal years #bjag through #bjba1 to remain available until expended4 4 7b7 ,medicare rural emergency medical services grants ,section #ahbj7;g77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7;g77#b77;,a77 is amended by inserting the following before the period at the end3 1 which may include plans to support emergency medical transportation services1 particularly in rural communities that have lost their rural hospital4 7c7 ,grants ,to provide technical assistance for quality improvement reporting by critical access hospitals ,section #ahbj7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7;g77 is amended by adding at the end the following new paragraph3 7#h7 ,technical assistance for quality improvement reporting by critical access hospitals 7,a7 ,grants ,the ,secretary may award grants to critical access hospitals that have submitted applications in accordance with subparagraph 7,b7 for-- 7i7 assisting such hospitals in establishing or expanding a quality improvement reporting program2 and 7ii7 supporting the provision of technical assistance for quality improvement reporting4 7,b7 ,application ,a critical access hospital seeking a grant under this paragraph shall submit an application to the ,secretary on or before such date and in such form and manner as the ,secretary specifies4 7,c7 ,reporting requirement in order to continue to receive grants after second year ,the ,secretary may not award a grant under this paragraph to a critical access hospital for more than #b years unless the hospital agrees to submit1 for each year after that second year1 such relevant quality data specified by the ,secretary1 including data on rural health care quality measures established under section #ahij;,b1 as appropriate4 7,d7 ,availability to public ,the ,secretary shall establish procedures for making data submitted under subparagraph 7,c7 available to the public4 7,e7 ,opportunity to review ,the procedures established under subparagraph 7,d7 shall ensure that a critical access hospital has the opportunity to review the data that are to be made public with respect to the hospital prior to such data being made public4 7,f7 ,measures ,the ,secretary shall report quality measures of process1 structure1 outcome1 patients' perspective on care1 efficiency1 and costs of care that relate to services furnished in such hospitals on the ,internet website of the ,centers for ,medicare ,medicaid ,services4 4 ,,ii ,rural-based payment reforms #bja4 ,integrating core set of rural health care quality measures into certain payment models ,section #ahij;,b of the ,social ,security ,act1 as added by section #aja1 is amended by adding at the end the following new subsection3 7e7 ,inclusion under alternative payment models and value-,based demonstration projects ,effective beginning with calendar year or fiscal year #bjba1 as applicable1 the ,secretary shall ensure that rural health care quality measures established under this section are included in quality reporting under alternative payment models and value-based payment demonstration projects under this title1 as appropriate1 including the shared savings program under section #ahii and the ,merit-,based ,incentive ,payment ,system under section #ahdh7q74 4 #bjb4 ,center for ,medicare and ,medicaid ,innovation testing of providing financial incentives for rural providers of services and suppliers to submit data on quality measures ,section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 is amended-- 7#a7 in subsection 7b77#b77;,a71 by adding at the end the following new sentence3 ,the models selected under this subparagraph shall include the model described in subsection 7h742 and 7#b7 by adding at the end the following new subsection3 7h7 ,providing financial incentives for rural providers of services and suppliers ,to submit data on quality measures ,the ,secretary shall test a model providing financial incentives to providers of services and suppliers located in rural areas to submit data on applicable quality measures under title ,,xviii1 including rural health care quality measures established under section #ahij;,b4 4 #bjc4 ,center for ,medicare and ,medicaid ,innovation testing of value-based payment models for rural providers of services and suppliers ,section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a71 as amended by section #bjb1 is amended-- 7#a7 in subsection 7b77#b77;,a71 by striking model described in subsection 7h7 and inserting models described in subsections 7h7 and 7i72 and 7#b7 by adding at the end the following new subsection3 7i7 ,value-,based payment models for rural providers of services and suppliers ,the ,secretary shall test value-based payment models1 including value-based purchasing1 for items and services furnished by providers of services and suppliers located in rural areas under title ,,xviii1 including critical access hospitals4 4 #bjd4 ,center for ,medicare and ,medicaid ,innovation testing of hospital readmissions reduction program for rural hospitals ,section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a71 as amended by sections #bjb and #bjc1 is amended-- 7#a7 in subsection 7b77#b77;,a71 by striking and 7i7 and inserting 1 7i71 and 7j72 and 7#b7 by adding at the end the following new subsection3 7j7 ,hospital readmissions reduction program for rural hospitals ,the ,secretary shall test a hospital readmissions reduction program under title ,,xviii for hospitals located in rural areas that are not otherwise subject to the program under section #ahhf7q74 4 #bje4 ,participation by rural health clinics and ,federally qualified health centers in ,comprehensive ,primary ,care ,plus model ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services shall permit a rural health clinic 7as defined in section #ahfa7;aa77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#b777 or a ,federally qualified health center 7as defined in section #ahfa7;aa77#d7 of such ,act 7#db ,u4,s4,c4 #aciex7aa77#d777 to participate in the ,comprehensive ,primary ,care ,plus model tested under section #aaae;,a of such ,act 7#db ,u4,s4,c4 #acae;a74 ,,iii ,improving rural representation #cja4 ,inclusion of rural representation on ,,cms ,rural ,health ,council 7a7 ,in general ,to the extent the ,administrator of the ,centers for ,medicare ,medicaid ,services 7in this section referred to as the ,administrator7 establishes a ,,cms ,rural ,health ,council1 the ,administrator shall ensure that such ,council includes external stakeholders who have objective rural health expertise1 such as representatives of rural health research centers1 quality improvement organizations1 and ,state offices of rural health1 who shall serve in an ex officio capacity as nonvoting members4 7b7 ,collaboration with ,health ,care ,payment ,learning and ,action ,network ,the ,council described in subsection 7a7 shall1 to the extent practicable1 work in collaboration with the ,health ,care ,payment ,learning and ,action ,network within the ,department of ,health and ,human ,services4 #cjb4 ,ensuring rural representation on the ,medicare ,payment ,advisory ,commission and the ,medicaid and ,,chip ,payment and ,access ,commission 7a7 ,medicare ,payment ,advisory ,commission 7#a7 ,in general ,section #ahje7;c77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#f7;c77#b77;,a77 is amended by inserting the following before the period at the end3 1 including at least two members who represent a rural area4 7#b7 ,applicable to future appointments ,any appointment to the ,medicare ,payment ,advisory ,commission made by the ,comptroller ,general of the ,united ,states after the date of enactment of this ,act shall be made in a manner that complies with the requirements of section #ahje7;c77#b77;,a7 of the ,social ,security ,act1 as amended by paragraph 7#a74 7b7 ,medicaid and ,,chip ,payment and ,access ,commission 7#a7 ,in general ,section #aijj7;c77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif7;c77#b77;,a77 is amended by inserting the following before the period at the end3 1 including at least two members who represent a rural area4 7#b7 ,applicable to future appointments ,any appointment to the ,medicaid and ,,chip ,payment and ,access ,commission made by the ,comptroller ,general of the ,united ,states after the date of enactment of this ,act shall be made in a manner that complies with the requirements of section #aijj7;c77#b77;,a7 of the ,social ,security ,act1 as amended by paragraph 7#a74