,,ii  #aad? ,,congress  #b;d ,session   
,s4 #caia  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #ac1 #bjaf ,mr4  
,frank5 7= himself & ,ms4 ,heitkamp7    
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d titles     
,,xviii & ,,xix ( ! ,social ,security   
,act to improve ! quality ( heal? c>e   
furni%$ 9 rural areas1 & = o!r purposes4
  #a4 ,%ort title2 table ( cont5ts  7a7 
,%ort title  ,?is ,act may be cit$ z !  
,rural ,heal? ,c>e ,quality ,improvem5t 
,act ( #bjaf4  7b7 ,table ( cont5ts ,!  
table ( cont5ts ( ?is ,act is z foll[s3 
,sec4 #a4 ,%ort title2 table ( cont5ts4 
,,title ,i--,rural heal? c>e ,sec4 #aja4
 ,e/abli%m5t ( core set ( rural heal?   
c>e quality measures4 ,sec4 #ajb4       
,revisions to ,m$ic>e rural grants4     
,,title ,,ii--,rural-bas$ paym5t re=ms  
,sec4 #bja4 ,integrat+ core set ( rural 
heal? c>e quality measures into c]ta9   
paym5t models4 ,sec4 #bjb4 ,c5t] =      
,m$ic>e & ,m$icaid ,innovation te/+ (   

provid+ f9ancial inc5tives = rural      
provid]s ( s]vices & suppli]s to submit 
data on quality measures4 ,sec4 #bjc4   
,c5t] = ,m$ic>e & ,m$icaid ,innovation  
te/+ ( value-bas$ paym5t models = rural 
provid]s ( s]vices & suppli]s4 ,sec4    
#bjd4 ,c5t] = ,m$ic>e & ,m$icaid        
,innovation te/+ ( hospital readmissions
 r$uction program = rural hospitals4    
,sec4 #bje4 ,p>ticipation by rural heal?
 cl9ics & ,f$]ally qualifi$ heal? c5t]s 
9 ,compreh5sive ,prim>y ,c>e ,plus      
model4 ,,title ,,iii--,improv+ rural    
repres5tation ,sec4 #cja4 ,inclusion (  
rural repres5tation on ,,cms ,rural     
,heal? ,c\ncil4 ,sec4 #cjb4 ,ensur+     
rural repres5tation on ! ,m$ic>e ,paym5t
 ,advisory ,commission & ! ,m$icaid &   
,,*ip ,paym5t & ,access ,commission4  ,i
 ,rural heal? c>e  #aja4 ,e/abli%m5t (  
core set ( rural heal? c>e quality      
measures  7a7 ,9 g5]al ,title ,,xviii ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acie et seq47 is am5d$ by ins]t+ aft]  
section #ahij;,a ! foll[+ new section3  

#ahij;,b4 ,rural heal? c>e quality      
measures  7a7 ,e/abli%m5t ,n lat] ?an   
,janu>y #a1 #bjah1 ! ,secret>y %all1 us+
 ! process describ$ 9 section           
#ahij7;b77#g71 e/abli% a core set (     
relevant quality measures t address !   
foll[+ ) respect to rural provid]s (    
s]vices & suppli]s :o furni% items &    
s]vices to individuals 9 rural areas3   
7#a7 ,improv+ pati5t outcomes1 su* z    
mortality rates1 hospital acquir$       
infections1 hospital readmissions1 & o!r
 pati5t-report$ outcomes4  7#b7 ,improv+
 c>e coord9ation1 transitions1 & m$ic9e 
reconciliation4  7#c7 ,r$uc+ co/s4  7#d7
 ,improv+ pati5t safety4  7#e7 ,use (   
prev5tive c>e s]vices1 includ+          
immunizations & scre5+ te/s4  7#f7      
,improv+ c>e = individuals ) *ronic     
disease1 includ+ c>diovascul> disease1  
diabetes1 behavioral heal?1 & o!r *ronic
 conditions4  7#g7 ,o!r purposes        
specifi$ by ! ,secret>y4  7b7 ,align+   
measures ) exi/+ quality report+        
requirem5ts ,9 e/abli%+ ! core set (    

quality measures "u subsection 7a71 !   
,secret>y %all r$uce report+ burd5s =   
small rural provid]s ( s]vices &        
suppli]s 7z det]m9$ by ! ,secret>y7 by1 
to ! ext5t practicable1 ensur+ t su*    
quality measures are consi/5t ) measures
 applicable "u o!r quality & value-bas$ 
paym5t report+ requirem5ts "u ?is title1
 z det]m9$ by ! ,secret>y1 includ+ !    
,m]it-,bas$ ,inc5tive ,paym5t ,sy/em "u 
section #ahdh7q7 & inc5tive paym5ts = ! 
mean+ful use ( c]tifi$ ,,ehr te*nology  
"u section #ahhf7;b77#c77;,b77ix74  7c7 
,implem5tation ,! provisions ( p>agraphs
 7#d7 & 7#e7 ( section #ahij;,a7a7 %all 
apply to ! e/abli%m5t ( ! core set (    
quality measures "u subsection 7a7 9 !  
same mann] z su* provisions apply to !  
selection ( quality & effici5cy measures
 describ$ 9 section #ahij7;b77#g77;,b74 
7d7 ,annual updat+ ,! ,secret>y %all1   
us+ ! process describ$ 9 section        
#ahij;,a1 review & update ! core set (  
quality measures e/abli%$ "u subsection 
7a7 9 accordance ) section #ahij;,a7c7  

to ensure su* quality measures rema9    
reliable1 sci5tifically valid1 &        
appropriate = quality measurem5t        
purposes4  4  7b7 ,con=m+ am5dm5t       
,section #ahij7;b77#e77;,a77iv7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acie;aaa7b77#e77;,a77iv77 is am5d$ by  
ins]t+ & 7beg9n+ ) #bjai7 rural heal?   
c>e quality measures "u section #ahij;,b
 aft] ,public ,heal? ,s]vice ,act4      
#ajb4 ,revisions to ,m$ic>e rural grants
  7a7 ,reau?orization ,section #ahbj7;j7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;i-#d7;j77 is am5d$--    
7#a7 by /rik+ ,appropriations4--,!re &  
ins]t+ ! foll[+3  ,appropriations4--    
7#a7 ,,hi ,tru/ fund ,!re  2 &  7#b7 by 
add+ at ! end ! foll[+ new p>agraph3    
7#b7 ,g5]al rev5ues ,!re are au?oriz$ to
 be appropriat$1 f am\nts 9 ! ,treasury 
n o!rwise appropriat$1 = mak+ grants to 
all ,/ates "u subsection 7g71           
#ej1jjj1jjj 9 ea* ( fiscal ye>s #bjag   
?r\gh #bjba1 to rema9 available until   
exp5d$4  4  7b7 ,m$ic>e rural em]g5cy   

m$ical s]vices grants ,section          
#ahbj7;g77#b77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acie;i-#d7;g77#b77;,a77 is am5d$ by    
ins]t+ ! foll[+ be=e ! p]iod at ! end3 1
 :i* may include plans to support       
em]g5cy m$ical transportation s]vices1  
p>ticul>ly 9 rural communities t h lo/  
_! rural hospital4  7c7 ,grants ,to     
provide te*nical assi/ance = quality    
improvem5t report+ by critical access   
hospitals ,section #ahbj7;g7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acie;i-#d7;g77 is am5d$ by add+ at !   
end ! foll[+ new p>agraph3  7#h7        
,te*nical assi/ance = quality improvem5t
 report+ by critical access hospitals   
7,a7 ,grants ,! ,secret>y may aw>d      
grants to critical access hospitals t h 
submitt$ applications 9 accordance )    
subp>agraph 7,b7 =--  7i7 assi/+ su*    
hospitals 9 e/abli%+ or exp&+ a quality 
improvem5t report+ program2 &  7ii7     
support+ ! provision ( te*nical         
assi/ance = quality improvem5t report+4 

7,b7 ,application ,a critical access    
hospital seek+ a grant "u ?is p>agraph  
%all submit an application to !         
,secret>y on or be=e su* date & 9 su* =m
 & mann] z ! ,secret>y specifies4  7,c7 
,report+ requirem5t 9 ord] to cont9ue to
 receive grants aft] second ye> ,!      
,secret>y may n aw>d a grant "u ?is     
p>agraph to a critical access hospital =
 m ?an #b ye>s unless ! hospital agrees 
to submit1 = ea* ye> aft] t second ye>1 
su* relevant quality data specifi$ by ! 
,secret>y1 includ+ data on rural heal?  
c>e quality measures e/abli%$ "u section
 #ahij;,b1 z appropriate4  7,d7         
,availability to public ,! ,secret>y    
%all e/abli% proc$ures = mak+ data      
submitt$ "u subp>agraph 7,c7 available  
to ! public4  7,e7 ,opportunity to      
review ,! proc$ures e/abli%$ "u         
subp>agraph 7,d7 %all ensure t a        
critical access hospital has !          
opportunity to review ! data t are to be
 made public ) respect to ! hospital    
prior to su* data be+ made public4  7,f7

 ,measures ,! ,secret>y %all report     
quality measures ( process1 /ructure1   
outcome1 pati5ts' p]spective on c>e1    
effici5cy1 & co/s ( c>e t relate to     
s]vices furni%$ 9 su* hospitals on !    
,int]net website ( ! ,c5t]s = ,m$ic>e   
,m$icaid ,s]vices4  4  ,,ii ,rural-bas$ 
paym5t re=ms  #bja4 ,integrat+ core set 
( rural heal? c>e quality measures into 
c]ta9 paym5t models ,section #ahij;,b ( 
! ,social ,security ,act1 z add$ by     
section #aja1 is am5d$ by add+ at ! end 
! foll[+ new subsection3  7e7 ,inclusion
 "u alt]native paym5t models &          
value-,bas$ demon/ration projects       
,effective beg9n+ ) cal5d> ye> or fiscal
 ye> #bjba1 z applicable1 ! ,secret>y   
%all ensure t rural heal? c>e quality   
measures e/abli%$ "u ?is section are    
includ$ 9 quality report+ "u alt]native 
paym5t models & value-bas$ paym5t       
demon/ration projects "u ?is title1 z   
appropriate1 includ+ ! %>$ sav+s program
 "u section #ahii & ! ,m]it-,bas$       
,inc5tive ,paym5t ,sy/em "u section     

#ahdh7q74  4  #bjb4 ,c5t] = ,m$ic>e &   
,m$icaid ,innovation te/+ ( provid+     
f9ancial inc5tives = rural provid]s (   
s]vices & suppli]s to submit data on    
quality measures ,section #aaae;,a ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acae;a7 is am5d$-- 7#a7 9 subsection   
7b77#b77;,a71 by add+ at ! end ! foll[+ 
new s5t5ce3 ,! models select$ "u ?is    
subp>agraph %all include ! model        
describ$ 9 subsection 7h742 &  7#b7 by  
add+ at ! end ! foll[+ new subsection3  
7h7 ,provid+ f9ancial inc5tives = rural 
provid]s ( s]vices & suppli]s ,to submit
 data on quality measures ,! ,secret>y  
%all te/ a model provid+ f9ancial       
inc5tives to provid]s ( s]vices &       
suppli]s locat$ 9 rural areas to submit 
data on applicable quality measures "u  
title ,,xviii1 includ+ rural heal? c>e  
quality measures e/abli%$ "u section    
#ahij;,b4  4  #bjc4 ,c5t] = ,m$ic>e &   
,m$icaid ,innovation te/+ ( value-bas$  
paym5t models = rural provid]s ( s]vices
 & suppli]s ,section #aaae;,a ( !       

,social ,security ,act 7#db ,u4,s4,c4   
#acae;a71 z am5d$ by section #bjb1 is   
am5d$-- 7#a7 9 subsection 7b77#b77;,a71 
by /rik+ model describ$ 9 subsection 7h7
 & ins]t+ models describ$ 9 subsections 
7h7 & 7i72 &  7#b7 by add+ at ! end !   
foll[+ new subsection3  7i7 ,value-,bas$
 paym5t models = rural provid]s (       
s]vices & suppli]s ,! ,secret>y %all te/
 value-bas$ paym5t models1 includ+      
value-bas$ pur*as+1 = items & s]vices   
furni%$ by provid]s ( s]vices & suppli]s
 locat$ 9 rural areas "u title ,,xviii1 
includ+ critical access hospitals4  4   
#bjd4 ,c5t] = ,m$ic>e & ,m$icaid        
,innovation te/+ ( hospital readmissions
 r$uction program = rural hospitals     
,section #aaae;,a ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acae;a71 z am5d$ by
 sections #bjb & #bjc1 is am5d$--  7#a7 
9 subsection 7b77#b77;,a71 by /rik+ &   
7i7 & ins]t+ 1 7i71 & 7j72 &  7#b7 by   
add+ at ! end ! foll[+ new subsection3  
7j7 ,hospital readmissions r$uction     
program = rural hospitals ,! ,secret>y  

%all te/ a hospital readmissions        
r$uction program "u title ,,xviii =     
hospitals locat$ 9 rural areas t are n  
o!rwise subject to ! program "u section 
#ahhf7q74  4  #bje4 ,p>ticipation by    
rural heal? cl9ics & ,f$]ally qualifi$  
heal? c5t]s 9 ,compreh5sive ,prim>y ,c>e
 ,plus model ,not)/&+ any o!r provision 
( law1 ! ,secret>y ( ,heal? & ,human    
,s]vices %all p]mit a rural heal? cl9ic 
7z def9$ 9 section #ahfa7;aa77#b7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7aa77#b777 or a ,f$]ally qualifi$ 
heal? c5t] 7z def9$ 9 section           
#ahfa7;aa77#d7 ( su* ,act 7#db ,u4,s4,c4
 #aciex7aa77#d777 to p>ticipate 9 !     
,compreh5sive ,prim>y ,c>e ,plus model  
te/$ "u section #aaae;,a ( su* ,act 7#db
 ,u4,s4,c4 #acae;a74  ,,iii ,improv+    
rural repres5tation  #cja4 ,inclusion ( 
rural repres5tation on ,,cms ,rural     
,heal? ,c\ncil  7a7 ,9 g5]al ,to ! ext5t
 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices 79 ?is section ref]r$ 
to z ! ,adm9i/rator7 e/abli%es a ,,cms  

,rural ,heal? ,c\ncil1 ! ,adm9i/rator   
%all ensure t su* ,c\ncil includes      
ext]nal /akehold]s :o h objective rural 
heal? exp]tise1 su* z repres5tatives (  
rural heal? rese>* c5t]s1 quality       
improvem5t organizations1 & ,/ate (fices
 ( rural heal?1 :o %all s]ve 9 an ex    
(ficio capacity z nonvot+ memb]s4  7b7  
,collaboration ) ,heal? ,c>e ,paym5t    
,le>n+ & ,action ,network ,! ,c\ncil    
describ$ 9 subsection 7a7 %all1 to !    
ext5t practicable1 "w 9 collaboration ) 
! ,heal? ,c>e ,paym5t ,le>n+ & ,action  
,network )9 ! ,dep>tm5t ( ,heal? &      
,human ,s]vices4  #cjb4 ,ensur+ rural   
repres5tation on ! ,m$ic>e ,paym5t      
,advisory ,commission & ! ,m$icaid &    
,,*ip ,paym5t & ,access ,commission  7a7
 ,m$ic>e ,paym5t ,advisory ,commission  
7#a7 ,9 g5]al ,section                  
#ahje7;c77#b77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acie;b-#f7;c77#b77;,a77 is am5d$ by    
ins]t+ ! foll[+ be=e ! p]iod at ! end3 1
 includ+ at lea/ two memb]s :o repres5t 

a rural area4  7#b7 ,applicable to      
future appo9tm5ts ,any appo9tm5t to !   
,m$ic>e ,paym5t ,advisory ,commission   
made by ! ,comptroll] ,g5]al ( ! ,unit$ 
,/ates aft] ! date ( enactm5t ( ?is ,act
 %all be made 9 a mann] t complies ) !  
requirem5ts ( section #ahje7;c77#b77;,a7
 ( ! ,social ,security ,act1 z am5d$ by 
p>agraph 7#a74  7b7 ,m$icaid & ,,*ip    
,paym5t & ,access ,commission  7#a7 ,9  
g5]al ,section #aijj7;c77#b77;,a7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acif7;c77#b77;,a77 is am5d$ by ins]t+ !
 foll[+ be=e ! p]iod at ! end3 1 includ+
 at lea/ two memb]s :o repres5t a rural 
area4  7#b7 ,applicable to future       
appo9tm5ts ,any appo9tm5t to ! ,m$icaid 
& ,,*ip ,paym5t & ,access ,commission   
made by ! ,comptroll] ,g5]al ( ! ,unit$ 
,/ates aft] ! date ( enactm5t ( ?is ,act
 %all be made 9 a mann] t complies ) !  
requirem5ts ( section #aijj7;c77#b77;,a7
 ( ! ,social ,security ,act1 z am5d$ by 
p>agraph 7#a74