,,ib ,union ,calendar ,no4 #egd #aafth  
,,congress  #b;d ,session  ,h4 ,r4 #cdag
 ,report ,no4 #aaf-fia1 ,part ,i ,,in   
,,the ,,house ,,of ,,representatives    
,june #ba1 #bjai,mr4 ,neal 7for himself 
and ,mr4 ,brady7 introduced the         
following bill2 which was referred to   
the ,committee on ,ways and ,means1 and 
in addition to the ,committee on ,energy
 and ,commerce1 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 
,december #bd1 #bjbj,reported from the  
,committee on ,ways and ,means with an  
amendment,strike out all after the      
enacting clause and insert the part     
printed in italic  ,december #bd1       
#bjbj;,committee on ,energy and         
,commerce discharged2 committed to the  
,committee of the ,whole ,house on the  
,state of the ,union and ordered to be  
printed,for text of introduced bill1 see
 copy of bill as introduced on ,june    

#ba1 #bjai  ,a ,,bill  ,to amend title  
,,xviii of the ,social ,security ,act to
 provide for patient improvements and   
rural and quality improvements under the
 ,medicare program4  #a4 ,short title2  
table of contents  7a7 ,short title     
,this ,act may be cited as the          
,beneficiary ,education ,tools1         
,telehealth1 and ,extenders             
,reauthorization ,act of #bjai or the   
,,better ,act of #bjai4  7b7 ,table of  
contents ,the table of contents for this
 ,act is as follows3 ,sec4 #a4 ,short   
title2 table of contents4,title         
,i--,patient ,improvements,sec4 #aja4   
,beneficiary enrollment notification and
 eligibility simplification4,sec4 #ajb4 
,extension of funding outreach and      
assistance for low-income programs4,sec4
 #ajc4 ,medicare coverage of certain    
mental health telehealth services4,sec4 
#ajd4 ,requiring prescription drug plan 
sponsors to include real-time benefit   
information as part of such sponsor's   
electronic prescription program under   

the ,medicare program4,sec4 #aje4       
,transitional coverage and retroactive  
,medicare part ,d coverage for certain  
low-income beneficiaries4,title         
,,ii--,rural and ,quality               
,improvements,sec4 #bja4 ,medicare ,,gme
 treatment of hospitals establishing new
 medical residency training programs    
after hosting medical resident rotators 
for short durations4,sec4 #bjb4         
,extension of the work geographic index 
floor under the ,medicare program4,sec4 
#bjc4 ,extension of funding for quality 
measure endorsement1 input1 and         
selection under ,medicare program4,sec4 
#bjd4 ,improving measurements under the 
skilled nursing facility value-based    
purchasing program under the ,medicare  
program4  ,i ,patient ,improvements     
#aja4 ,beneficiary enrollment           
notification and eligibility            
simplification  7a7 ,eligibility and    
enrollment notices  7#a7 ,as part of    
social security account statement for   
individuals attaining ages #fc to #fe   

,section #aadc7;a7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#ac7;a77 is amended by adding at
 the end the following new paragraph3   
7#d7 ,medicare eligibility information  
7,a7 ,in general ,in the case of        
statements provided on or after the date
 that is #b years after the date of the 
enactment of this paragraph to          
individuals who are attaining ages #fc1 
#fd1 and #fe1 the statement shall also  
include a notice containing the         
information described in subparagraph   
7,b74  7,b7 ,contents of notice ,the    
notice required under subparagraph 7,a7 
shall include a clear1 simple           
explanation of-- 7i7 eligibility for    
benefits under the ,medicare program    
under title ,,xviii1 and in particular  
benefits under part ,b of such title2   
7ii7 the reasons a late enrollment      
penalty for failure to timely enroll    
could be assessed and how such late     
enrollment penalty is calculated1 in    
particular for benefits under part ,b2  

7iii7 the availability of relief from   
the late enrollment penalty and         
retroactive enrollment under section    
#ahcg7;h7 7including as such section is 
applied under sections #ahah7;c7 and    
#ahah;,a7c77#c771 with examples of      
circumstances under which such relief   
may be granted and examples of          
circumstances under which such relief   
would not be granted2  7iv7 coordination
 of benefits 7including primary and     
secondary coverage scenarios7 pursuant  
to section #ahfb7;b71 in particular for 
benefits under part ,b of such title2   
and  7v7 information for populations1   
such as residents of ,puerto ,rico and  
veterans1 for whom there are special    
considerations with respect to          
enrollment1 eligibility1 and            
coordination of benefits under title    
,,xviii4  7,c7 ,development of notice   
7i7 ,in general ,the ,secretary1 in     
coordination with the ,commissioner of  
,social ,security1 and taking into      
consideration information collected     

pursuant to clause 7ii71 shall1 not     
later than #ab months after the last day
 of the period for the request of       
information described in clause 7ii71   
develop the notice to be provided       
pursuant to subparagraph 7,a74  7ii7    
,request for information ,not later than
 #f months after the date of the        
enactment of this paragraph1 the        
,secretary shall request written        
information1 including recommendations1 
from stakeholders 7including the groups 
described in subparagraph 7,d77 on the  
information to be included in the       
notice4  7iii7 ,notice improvement      
,beginning #d years after the date of   
enactment of this paragraph1 and not    
less than once every two years          
thereafter1 the ,secretary1 in          
coordination with the ,commissioner of  
,social ,security1 shall-- 7,i7 review  
the content of the notice to be provided
 under subparagraph 7,a72  7,,ii7       
solicit recommendations on the notice   
through a request for information       

process as described in clause 7ii72 and
  7,,iii7 update and revise such notice 
as the ,secretary deems appropriate4    
7,d7 ,groups for consultation ,for      
purposes of subparagraph 7,c77ii71 the  
groups described in this clause include 
the following3 7i7 ,individuals who are 
#fj years of age or older4  7ii7        
,veterans4  7iii7 ,individuals with     
disabilities4  7iv7 ,individuals with   
end stage renal disease4  7v7           
,low-income individuals and families4   
7vi7 ,employers 7including human        
resources professionals74  7vii7 ,states
 7including representatives of          
,state-run ,health ,insurance           
,exchanges1 ,medicaid offices1 and      
,departments of ,insurance74  7viii7    
,state ,health ,insurance ,assistance   
,programs4  7ix7 ,health insurers4  7x7 
,health insurance agents and brokers4   
7xi7 ,such other groups as specified by 
the ,secretary4  7,e7 ,posting of notice
 on websites ,the ,commissioner of      
,social ,security and the ,secretary    

shall post the notice required under    
subparagraph 7,a7 in a prominent        
location on the public ,internet website
 of the ,social ,security               
,administration and on the public       
,internet website of the ,centers for   
,medicare  ,medicaid ,services1         
respectively4  7,f7 ,reimbursement of   
costs  7i7 ,in general ,effective for   
fiscal years beginning in the year in   
which the date of enactment of this     
paragraph occurs1 the ,commissioner of  
,social ,security and the ,secretary    
shall enter into an agreement which     
shall provide funding to cover the      
administrative costs of the             
,commissioner's activities under this   
paragraph4 ,such agreement shall-- 7,i7 
provide funds to the ,commissioner for  
the full cost of the ,social ,security  
,administration's work related to the   
implementation of this paragraph1       
including any costs incurred prior to   
the finalization of such agreement2     
7,,ii7 provide such funding quarterly in

 advance of the applicable quarter based
 on estimating methodology agreed to by 
the ,commissioner and the ,secretary2   
and  7,,iii7 require an annual          
accounting and reconciliation of the    
actual costs incurred and funds provided
 under this paragraph4  7ii7 ,limitation
 ,in no case shall funds from the       
,social ,security ,administration's     
,limitation on ,administrative ,expenses
 be used to carry out activities related
 to the implementation of this          
paragraph1 except as the ,commissioner  
determines is necessary in developing   
the agreement under clause 7i74  7,g7   
,no effect on obligation to mail        
statements ,nothing in this paragraph   
shall be construed to relieve the       
,commissioner of ,social ,security from 
any requirement under subsection 7c71   
including the requirement to mail a     
statement on an annual basis to each    
eligible individual who is not receiving
 benefits under title ,,ii and for whom 
a mailing address can be determined     

through such methods as the             
,commissioner determines to be          
appropriate4  4  7#b7 ,individuals in   
medicare waiting period ,title ,,xi of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #acja et seq47 is amended by  
inserting after section #aadd the       
following new section3  #aadd;,a4       
,medicare enrollment notification and   
eligibility notices for individuals in  
medicare waiting period  7a7 ,notices   
7#a7 ,in general ,the ,commissioner of  
,social ,security shall distribute the  
notice to be provided pursuant to       
section #aadc7;a77#d71 as may be        
modified under paragraph 7#b71 to       
individuals in the #bd-month waiting    
period under section #bbf7;b74  7#b7    
,authority to modify notice ,the        
,secretary1 in coordination with the    
,commissioner of ,social ,security1 may 
modify the notice to be distributed     
under paragraph 7#a7 as necessary to    
take into account the individuals       
described in such paragraph4  7#c7      

,posting of notice on websites ,the     
,commissioner of ,social ,security and  
the ,secretary shall post the notice    
required to be distributed under        
paragraph 7#a7 in a prominent location  
on the public ,internet website of the  
,social ,security ,administration and on
 the public ,internet website of the    
,centers for ,medicare  ,medicaid       
,services1 respectively4  7b7 ,timing   
,beginning not later than #b years after
 the date of the enactment of this      
section1 a notice required under        
subsection 7a77#a7 shall be mailed to an
 individual no less than two times in   
accordance with the following3 7#a7 ,the
 notice shall be provided to such       
individual not later than #c months     
prior to the date on which such         
individual's enrollment period begins as
 provided under section #ahcg4  7#b7    
,the notice shall subsequently be       
provided to such individual not later   
than one month prior to such date4  7c7 
,reimbursement of costs  7#a7 ,in       

general ,effective for fiscal years     
beginning in the year in which the date 
of enactment of this section occurs1 the
 ,commissioner of ,social ,security and 
the ,secretary shall enter into an      
agreement which shall provide funding to
 cover the administrative costs of the  
,commissioner's activities under this   
section4 ,such agreement shall-- 7,a7   
provide funds to the ,commissioner for  
the full cost of the ,social ,security  
,administration's work related to the   
implementation of this section1         
including any costs incurred prior to   
the finalization of such agreement2     
7,b7 provide such funding quarterly in  
advance of the applicable quarter based 
on estimating methodology agreed to by  
the ,commissioner and the ,secretary2   
and  7,c7 require an annual accounting  
and reconciliation of the actual costs  
incurred and funds provided under this  
section4  7#b7 ,limitation ,in no case  
shall funds from the ,social ,security  
,administration's ,limitation on        

,administrative ,expenses be used to    
carry out activities related to the     
implementation of this section1 except  
as the ,commissioner determines is      
necessary in developing the agreement   
under paragraph 7#a74  4  7b7           
,beneficiary enrollment simplification  
7#a7 ,effective date of coverage        
,section #ahch7;a7 of the ,social       
,security ,act 7#db ,u4,s4,c4 #acieq7a77
 is amended-- 7,a7 by amending paragraph
 7#b7 to read as follows3  7#b7 7,a7 in 
the case of an individual who enrolls   
pursuant to subsection 7d7 of section   
#ahcg before the month in which he first
 satisfies paragraph 7#a7 or 7#b7 of    
section #ahcf1 the first day of such    
month1  7,b7 in the case of an          
individual who first satisfies such     
paragraph in a month beginning before   
,january #bjba and who enrolls pursuant 
to such subsection 7d7-- 7i7 in such    
month in which he first satisfies such  
paragraph1 the first day of the month   
following the month in which he so      

enrolls1  7ii7 in the month following   
such month in which he first satisfies  
such paragraph1 the first day of the    
second month following the month in     
which he so enrolls1 or  7iii7 more than
 one month following such month in which
 he satisfies such paragraph1 the first 
day of the third month following the    
month in which he so enrolls1  7,c7 in  
the case of an individual who first     
satisfies such paragraph in a month     
beginning on or after ,january #a1      
#bjba1 and who enrolls pursuant to such 
subsection 7d7 in such month in which he
 first satisfies such paragraph or in   
any subsequent month of his initial     
enrollment period1 the first day of the 
month following the month in which he so
 enrolls1 or  7,d7 in the case of an    
individual who enrolls pursuant to      
subsection 7e7 of section #ahcg in a    
month beginning-- 7i7 before ,january   
#a1 #bjba1 the ,july #a following the   
month in which he so enrolls1 or  7ii7  
on or after ,january #a1 #bjba1 the     

first day of the month following the    
month in which he so enrolls1 or  2 and 
7,b7 by amending paragraph 7#c7 to read 
as follows3  7#c7 in the case of an     
individual who is deemed to have        
enrolled-- 7,a7 on or before the last   
day of the third month of his initial   
enrollment period1 the first day of the 
month in which he first meets the       
applicable requirements of section #ahcf
 or ,july #a1 #aigc1 whichever is later1
 or  7,b7 on or after the first day of  
the fourth month of his initial         
enrollment period1 and where such month 
begins-- 7i7 before ,january #a1 #bjba1 
as prescribed under subparagraphs       
7,b77i71 7,b77ii71 7,b77iii71 and 7,d7  
of paragraph 7#b71 or  7ii7 on or after 
,january #a1 #bjba1 as prescribed under 
paragraph 7#b77;,c74  4  7#b7 ,special  
enrollment periods for exceptional      
circumstances  7,a7 ,enrollment ,section
 #ahcg of the ,social ,security ,act    
7#db ,u4,s4,c4 #aciep7 is amended by    
adding at the end the following new     

subsection3  7m7 ,beginning ,january #a1
 #bjba1 the ,secretary may establish    
special enrollment periods in the case  
of individuals who meet such exceptional
 conditions as the ,secretary may       
provide1 such as individuals who reside 
in an area with an emergency or disaster
 as determined by the ,secretary4  4    
7,b7 ,coverage period ,section #ahch of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #acieq7 is amended by adding  
at the end the following new subsection3
  7g7 ,notwithstanding subsection 7a71  
in the case of an individual who enrolls
 during a special enrollment period     
pursuant to section #ahcg7m71 the       
coverage period shall begin on a date   
the ,secretary provides in a manner     
consistent 7to the extent practicable7  
with protecting continuity of health    
benefit coverage4  4  7,c7 ,conforming  
amendment ,section #ahci7;b7 of the     
,social ,security ,act 7#db ,u4,s4,c4   
#acier7b77 is amended1 in the first     
sentence1 by striking or 7l7 and        

inserting 1 7l71 or 7m74  7#c7          
,technical correction ,section #ahci7;b7
 of the ,social ,security ,act 7#db     
,u4,s4,c4 #acier7b77 is amended by      
adding at the end the following new     
sentence3 ,for purposes of determining  
any increase under this subsection for  
individuals whose enrollment occurs on  
or after ,january #a1 #bjba1 the second 
sentence of this subsection shall be    
applied by substituting close of the    
month for close of the enrollment period
 each place it appears44  7#d7 ,report  
,not later than ,january #a1 #bjba1 the 
,secretary of ,health and ,human        
,services shall submit to the ,committee
 on ,ways and ,means and ,committee on  
,energy and ,commerce of the ,house of  
,representatives and the ,committee on  
,finance and ,special ,committee on     
,aging of the ,senate a report including
 recommendations on how to align        
existing ,medicare enrollment periods   
under title ,,xviii of the ,social      
,security ,act1 including the general   

enrollment period under part ,b of such 
title and the annual election period    
under the ,medicare ,advantage program  
under part ,c of such title and under   
the prescription drug program under part
 ,d of such title4 ,such recommendations
 shall be consistent with the goals of  
maximizing coverage continuity and      
choice and easing beneficiary           
transition4  #ajb4 ,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   
section #aaj of the ,protecting ,access 

to ,medicare ,act of #bjad 7,public ,law
 #aac-ic71 section #bjh of the ,medicare
 ,access and ,,chip ,reauthorization    
,act of #bjae 7,public ,law #aad-aj71   
and section #ejbjg of the ,bipartisan   
,budget ,act of #bjah 7,public ,law     
#aae-abc71 is amended-- 7#a7 in clause  
7vii71 by striking and at the end2  7#b7
 in clause 7viii71 by striking and at   
the end2  7#c7 in clause 7ix71 by       
striking the period at the end and      
inserting 2 and2 and  7#d7 by inserting 
after clause 7ix7 the following new     
clause3  7x7 for each of fiscal years   
#bjbj through #bjbb1 of #ae1jjj1jjj4  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   
7vii71 by striking and at the end2  7#b7
 in clause 7viii71 by striking and at   
the end2  7#c7 in clause 7ix71 by       
striking the period at the end and      
inserting 2 and2 and  7#d7 by inserting 
after clause 7ix7 the following new     

clause3  7x7 for each of fiscal years   
#bjbj through #bjbb1 of #ae1jjj1jjj4  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   
7vii71 by striking and at the end2  7#b7
 in clause 7viii71 by striking and at   
the end2  7#c7 in clause 7ix71 by       
striking the period at the end and      
inserting 2 and2 and  7#d7 by inserting 
after clause 7ix7 the following new     
clause3  7x7 for each of fiscal years   
#bjbj through #bjbb1 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    
7vii71 by striking and at the end2  7#b7
 in clause 7viii71 by striking and at   
the end2  7#c7 in clause 7ix71 by       
striking the period at the end and      
inserting 2 and2 and  7#d7 by inserting 
after clause 7ix7 the following new     

clause3  7x7 for each of fiscal years   
#bjbj through #bjbb1 of #ae1jjj1jjj4  4 
#ajc4 ,medicare coverage of certain     
mental health telehealth services       
,section #ahcd7m7 of the ,social        
,security ,act 7#db ,u4,s4,c4 #aciem7m77
 is amended-- 7#a7 in paragraph         
7#b77;,b77i71 by striking and paragraph 
7#f77;,c7 and inserting 1 paragraph     
7#f77;,c71 and paragraph 7#h77;,c72     
7#b7 in paragraph 7#d77;,c77i71 by      
striking and 7#g7 and inserting 7#g71   
and 7#h72  7#c7 in paragraph            
7#d77;,f77i71 by inserting services     
identified by ,,cpt codes #ijhcb1       
#ijhcd1 and #ijhcg 7and as subsequently 
modified by the ,secretary71 before and 
any additional service2  7#d7 in        
paragraph 7#f77;,a71 by striking        
paragraph 7#d77;,c7 and inserting       
paragraph 7#d77;,c77i72  7#e7 in        
paragraph 7#g71 by striking ,the        
geographic requirements and inserting   
,subject to paragraph 7#h77;,d71 the    
geographic requirements2 and  7#f7 by   

adding at the end the following new     
paragraph3  7#h7 ,treatment of mental   
health telehealth services  7,a7        
,non-application of originating site    
requirements ,the requirements described
 in paragraph 7#d77;,c77i7 shall not    
apply with respect to telehealth        
services furnished on or after ,january 
#a1 #bjba1 that are mental health       
telehealth services4 ,nothing in the    
previous sentence shall waive any       
applicable ,state law requirements4     
7,b7 ,inclusion of certain sites ,with  
respect to telehealth services described
 in subparagraph 7,a71 the term         
originating site shall include the home 
of the eligible telehealth individual at
 which the individual is located at the 
time the service is furnished via a     
telecommunications system4  7,c7 ,no    
originating site facility fee ,no       
facility fee shall be paid under        
paragraph 7#b77;,b7 to an originating   
site with respect to a telehealth       
service described in subparagraph 7,a7  

if the originating site does not        
otherwise meet the requirements for an  
originating site under paragraph        
7#d77;,c74  7,d7 ,face-to-face initial  
assessment2 reassessments ,payment may  
not be made for mental health telehealth
 services under this paragraph 7if such 
payment would not otherwise be allowed  
under this subsection without           
application of this paragraph or        
paragraph 7#g77 furnished to an eligible
 telehealth individual unless-- 7i7     
within the #f-month period prior to the 
provision of such mental health         
telehealth services1 the individual     
receives a face-to-face clinical        
assessment1 without the use of          
telehealth1 by a physician described in 
subparagraph 7,f77i7 or a practitioner  
described in subparagraph 7,f77ii7 of   
the needs of such individual for such   
services2 and  7ii7 the individual      
receives a reassessment 7at a frequency 
specified by the ,secretary7 by a       
physician so described or a practitioner

 so described of the needs of such      
individual for such services4  7,e7     
,mental health telehealth services      
defined ,for purposes of this paragraph1
 the term mental health telehealth      
service means services identified by    
,,cpt codes #ijhcb1 #ijhcd1 and #ijhcg  
7and as subsequently modified by the    
,secretary74  7,f7 ,physician and       
practitioner described ,for purposes of 
subparagraph 7,d73 7i7 ,physician ,a    
physician described in this clause is a 
physician1 as defined in section        
#ahfa7r77#a74  7ii7 ,practitioner ,a    
practitioner described in this clause is
 a practitioner described in any of     
clauses 7i71 7iv71 or 7v7 of section    
#ahdb7;b77#ah77;,c74  4  #ajd4          
,requiring prescription drug plan       
sponsors to include real-time benefit   
information as part of such sponsor's   
electronic prescription program under   
the ,medicare program ,section          
#ahfj;,d-#d7;e77#b7 of the ,social      
,security ,act 7#db ,u4,s4,c4           

#aciew-#ajd7;e77#b77 is amended-- 7#a7  
in subparagraph 7,d71 by striking ,to   
the extent and inserting ,except as     
provided in subparagraph 7,f71 to the   
extent2 and  7#b7 by adding at the end  
the following new subparagraph3  7,f7   
,real-time benefit information  7i7 ,in 
general ,not later than ,january #a1    
#bjba1 the program shall implement      
real-time benefit tools that are capable
 of integrating with a prescribing      
health care professional's electronic   
prescribing or electronic health record 
system for the transmission of formulary
 and benefit information in real time to
 prescribing health care professionals4 
,with respect to a covered part ,d drug1
 such tools shall be capable of         
transmitting such information specific  
to an individual enrolled in a          
prescription drug plan4 ,such           
information shall include the following3
 7,i7 ,a list of any                    
clinically-appropriate alternatives to  
such drug included in the formulary of  

such plan4  7,,ii7 ,cost-sharing        
information for such drug and such      
alternatives1 including a description of
 any variance in cost sharing based on  
the pharmacy dispensing such drug or    
such alternatives4  7,,iii7 ,information
 relating to whether such drug is       
included in the formulary of such plan  
and any prior authorization or other    
utilization management requirements     
applicable to such drug and such        
alternatives so included4  7ii7         
,electronic transmission ,the provisions
 of subclauses 7,i7 and 7,,ii7 of clause
 7ii7 of subparagraph 7,e7 shall apply  
to an electronic transmission described 
in clause 7i7 in the same manner as such
 provisions apply with respect to an    
electronic transmission described in    
clause 7i7 of such subparagraph4  7iii7 
,special rule for #bjba ,the program    
shall be deemed to be in compliance with
 clause 7i7 for #bjba if the program    
complies with the provisions of section 
#dbc4afj7;b77#g7 of title #db1 ,code of 

,federal ,regulations 7or a successor   
regulation71 for such year4  4  #aje4   
,transitional coverage and retroactive  
,medicare part ,d coverage for certain  
low-income beneficiaries ,section       
#ahfj;,d-#ad of the ,social ,security   
,act 7#db ,u4,s4,c4 #aciew-#aad7 is     
amended-- 7#a7 by redesignating         
subsection 7e7 as subsection 7f72 and   
7#b7 by adding after subsection 7d7 the 
following new subsection3  7e7 ,limited 
income newly eligible transition program
  7#a7 ,in general ,beginning not later 
than ,january #a1 #bjba1 the ,secretary 
shall carry out a program to provide    
transitional coverage for covered part  
,d drugs for ,,li ,,net eligible        
individuals in accordance with this     
subsection4  7#b7 ,,li net eligible     
individual defined ,for purposes of this
 subsection1 the term ,,li ,,net        
eligible individual means a part ,d     
eligible individual who-- 7,a7 meets the
 requirements of clauses 7ii7 and 7iii7 
of subsection 7a77#c77;,a72 and  7,b7   

has not yet enrolled in a prescription  
drug plan or an ,,ma-,,pd plan1 or1 who 
has so enrolled1 but with respect to    
whom coverage under such plan has not   
yet taken effect4  7#c7 ,transitional   
coverage ,for purposes of this          
subsection1 the term transitional       
coverage means with respect to an ,,li  
,,net eligible individual-- 7,a7        
immediate access to covered part ,d     
drugs at the point of sale during the   
period that begins on the first day of  
the month such individual is determined 
to meet the requirements of clauses 7ii7
 and 7iii7 of subsection 7a77#c77;,a7   
and ends on the date that coverage under
 a prescription drug plan or ,,ma-,,pd  
plan takes effect with respect to such  
individual2 and  7,b7 in the case of an 
,,li ,,net eligible individual who is a 
full-benefit dual eligible individual   
7as defined in section #aice7;c77#f77 or
 a recipient of supplemental security   
income benefits under title ,,xvi1      
retroactive coverage 7in the form of    

reimbursement of the amounts that would 
have been paid under this part had such 
individual been enrolled in a           
prescription drug plan or ,,ma-,,pd     
plan7 of covered part ,d drugs purchased
 by such individual during the period   
that begins on the date that is the     
later of-- 7i7 the date that such       
individual was first eligible for a     
low-income subsidy under this part2 or  
7ii7 the date that is #cf months prior  
to the date such individual enrolls in a
 prescription drug plan or ,,ma-,,pd    
plan1  and ends on the date that        
coverage under such plan takes effect4  
7#d7 ,program administration  7,a7      
,single point of contact ,the ,secretary
 shall1 to the extent feasible1         
administer the program under this       
subsection through a contract with a    
single program administrator4  7,b7     
,benefit design ,the ,secretary shall   
ensure that the transitional coverage   
provided to ,,li ,,net eligible         
individuals under this subsection-- 7i7 

provides access to all covered part ,d  
drugs under an open formulary2  7ii7    
permits all pharmacies determined by the
 ,secretary to be in good standing to   
process claims under the program2  7iii7
 is consistent with such requirements as
 the ,secretary considers necessary to  
improve patient safety and ensure       
appropriate dispensing of medication2   
and  7iv7 meets such other requirements 
as the ,secretary may establish4  7#e7  
,relationship to other provisions of    
this title2 waiver authority  7,a7 ,in  
general ,the following provisions shall 
not apply with respect to the program   
under this subsection3 7i7 ,paragraphs  
7#a7 and 7#c77;,b7 of section           
#ahfj;,d-#d7;a7 7relating to            
dissemination of general information2   
availability of information on changes  
in formulary through the internet74     
7ii7 ,subparagraphs 7,a7 and 7,b7 of    
section #ahfj;,d-#d7;b77#c7 7relating to
 requirements on development and        
application of formularies2 formulary   

development74  7iii7 ,paragraphs        
7#a77;,c7 and 7#b7 of section           
#ahfj;,d-#d7;c7 7relating to medication 
therapy management program74  7,b7      
,waiver authority ,the ,secretary may   
waive such other requirements of title  
,,xi and this title as may be necessary 
to carry out the purposes of the program
 established under this subsection4  4  
,,ii ,rural and ,quality ,improvements  
#bja4 ,medicare ,,gme treatment of      
hospitals establishing new medical      
residency training programs after       
hosting medical resident rotators for   
short durations  7a7 ,redetermination of
 approved ,,fte resident amount ,section
 #ahhf7;h77#b77;,f7 of the ,social      
,security ,act 7#db ,u4,s4,c4           
#acieww7h77#b77;,f77 is amended-- 7#a7  
by inserting 7i7 before ,in the case of2
 and  7#b7 by adding at the end the     
following3  7ii7 ,in applying this      
subparagraph in the case of a hospital  
that trains residents and has not       
entered into a ,,gme affiliation        

agreement 7as defined by the ,secretary 
for purposes of paragraph               
7#d77;,h77ii771 on or after the date of 
the enactment of this clause1 the       
,secretary shall not establish an ,,fte 
resident amount until such time as the  
,secretary determines that the hospital 
has trained at least #a4j               
full-time-equivalent resident in an     
approved medical residency training     
program in a cost reporting period4     
7iii7 ,in applying this subparagraph for
 cost reporting periods beginning on or 
after the date of enactment of this     
clause1 in the case of a hospital that1 
as of such date of enactment1 has an    
approved ,,fte resident amount based on 
the training in an approved medical     
residency program or programs of-- 7,i7 
less than #a4j full-time-equivalent     
resident in any cost reporting period   
beginning before ,october #a1 #aiig1 as 
determined by the ,secretary2 or  7,,ii7
 no more than #c4j full-time-equivalent 
residents in any cost reporting period  

beginning on or after ,october #a1      
#aiig1 and before the date of the       
enactment of this clause1 as determined 
by the ,secretary1  in lieu of such     
,,fte resident amount the ,secretary    
shall1 in accordance with the           
methodology described in section        
#dac4gg7;e7 of title #db of the ,code of
 ,federal ,regulations 7or any successor
 regulation71 establish a new ,,fte     
resident amount if the hospital trains  
at least #a4j full-time-equivalent      
resident 7in the case of a hospital     
described in subclause 7,i77 or more    
than #c4j full-time-equivalent residents
 7in the case of a hospital described in
 subclause 7,,ii77 in a cost reporting  
period beginning on or after such date  
of enactment and before the date that is
 #e years after such date of enactment4 
7iv7 ,for purposes of carrying out this 
subparagraph for cost reporting periods 
beginning on or after the date of the   
enactment of this clause1 a hospital    
shall report full-time-equivalent       

residents on its cost report for a cost 
reporting period if the hospital trains 
at least #a4j full-time-equivalent      
residents in an approved medical        
residency training program or programs  
in such period4  7v7 ,as appropriate1   
the ,secretary may consider information 
from any cost reporting period necessary
 to establish a new ,,fte resident      
amount as described in clause 7iii74  4 
7b7 ,redetermination of ,,fte resident  
limitation ,section                     
#ahhf7;h77#d77;,h77i7 of the ,social    
,security ,act 7#db ,u4,s4,c4           
#acieww7h77#d77;,h77i77 is amended--    
7#a7 by inserting 7,i7 before ,the      
,secretary2 and  7#b7 by adding at the  
end the following3  7,,ii7 ,in applying 
this clause in the case of a hospital   
that1 on or after the date of the       
enactment of this subclause1 begins     
training residents in a new approved    
medical residency training program or   
programs 7as defined by the ,secretary71
 the ,secretary shall not determine a   

limitation applicable to the hospital   
under subparagraph 7,f7 until such time 
as the ,secretary determines that the   
hospital has trained at least #a4j      
full-time-equivalent resident in such   
new approved medical residency training 
program or programs in a cost reporting 
period4  7,,iii7 ,in applying this      
clause in the case of a hospital that1  
as of the date of the enactment of this 
subclause1 has a limitation under       
subparagraph 7,f71 based on a cost      
reporting period beginning before       
,october #a1 #aiig1 of less than #a4j   
full-time-equivalent resident1 the      
,secretary shall adjust the limitation  
in the manner applicable to a new       
approved medical residency training     
program if the ,secretary determines the
 hospital begins training at least #a4j 
full-time-equivalent residents in a     
program year beginning on or after such 
date of enactment and before the date   
that is #e years after such date of     
enactment4  7,,iv7 ,in applying this    

clause in the case of a hospital that1  
as of the date of the enactment of this 
subclause1 has a limitation under       
subparagraph 7,f71 based on a cost      
reporting period beginning on or after  
,october #a1 #aiig1 and before such date
 of enactment1 of no more than #c4j     
full-time-equivalent residents1 the     
,secretary shall adjust the limitation  
in the manner applicable to a new       
approved medical residency training     
program if the ,secretary determines the
 hospital begins training more than #c4j
 full-time-equivalent residents in a    
program year beginning on or after such 
date of enactment and before the date   
that is #e years after such date of     
enactment4  7,v7 ,an adjustment to the  
limitation applicable to a hospital made
 pursuant to subclause 7,,iii7 or 7,,iv7
 shall be made in a manner consistent   
with the methodology1 as appropriate1 in
 section #dac4gi7;e7 of title #db1 ,code
 of ,federal ,regulations 7or any       
successor regulation74 ,as appropriate1 

the ,secretary may consider information 
from any cost reporting periods         
necessary to make such an adjustment to 
the limitation4  4  7c7 ,technical and  
conforming amendments ,section #ahhf of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #acieww7 is amended-- 7#a7 in 
subsection 7d77#e77;,b77viii71 by       
striking subsection 7h77#d77;,h7 and    
inserting paragraphs 7#b77;,f77iv7 and  
7#d77;,h7 of subsection 7h72 and  7#b7  
in subsection 7h7-- 7,a7 in paragraph   
7#d77;,h77iv71 by striking an rural area
 and inserting a rural area2 and  7,b7  
in paragraph 7#g77;,e71 by striking     
under this and all that follows through 
the period at the end and inserting the 
following3 under this paragraph1        
paragraph 7#h71 clause 7i71 7ii71 7iii71
 or 7v7 of paragraph 7#b77;,f71 or      
clause 7i7 or 7vi7 of paragraph         
7#d77;,h744  7d7 ,effective date ,the   
amendments made by this section shall   
apply to payment under section #ahhf of 
the ,social ,security ,act 7#db         

,u4,s4,c4 #acieww7 for cost reporting   
periods beginning on or after the date  
of the enactment of this ,act4  #bjb4   
,extension of the work geographic index 
floor under the ,medicare program       
,section #ahdh7;e77#a77;,e7 of the      
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#d7;e77#a77;,e77 is amended by   
striking #bjbj and inserting #bjbc4     
#bjc4 ,extension of funding for quality 
measure endorsement1 input1 and         
selection under ,medicare program  7a7  
,in general ,section #ahij7;d77#b7 of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #acie;aaa7d77#b77 is amended--
 7#a7 by striking and #g1ejj1jjj and    
inserting #g1ejj1jjj2 and  7#b7 by      
striking and #bjai4 and inserting and   
#bjai1 and #cj1jjj1jjj for each of      
fiscal years #bjbj through #bjbb44  7b7 
,input for removal of measures ,section 
#ahij7;b7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acie;aaa7b77 is amended 
by inserting after paragraph 7#c7 the   
following3  7#d7 ,removal of ,measures  

,the entity may provide input to the    
,secretary on quality and efficiency    
measures described in paragraph         
7#g77;,b7 that could be considered for  
removal4  4  7c7 ,prioritization of     
measure endorsement ,section #ahij7;b7  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acie;aaa7b77 is amended by   
adding at the end the following3  7#i7  
,prioritization of measure endorsement  
,the entity-- 7,a7 during the period    
beginning on the date of the enactment  
of this paragraph and ending on         
,december #ca1 #bjbc1 shall prioritize  
the endorsement of measures relating to 
maternal morbidity and mortality by the 
entity with a contract under subsection 
7a7 in connection with endorsement of   
measures described in paragraph 7#b72   
and  7,b7 on and after ,january #a1     
#bjbd1 may prioritize the endorsement of
 such measures by such entity4  4  #bjd4
 ,improving measurements under the      
skilled nursing facility value-based    
purchasing program under the ,medicare  

program  7a7 ,in general ,section       
#ahhh7;h7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acieyy7h77 is amended-- 
7#a7 in paragraph 7#a71 by adding at the
 end the following new subparagraph3    
7,c7 ,exclusions ,with respect to       
payments for services furnished on or   
after ,october #a1 #bjba1 this          
subsection shall not apply to a facility
 for which there are not a minimum      
number 7as determined by the ,secretary7
 of-- 7i7 cases for the measures that   
apply to the facility for the           
performance period for the applicable   
fiscal year2 or  7ii7 measures that     
apply to the facility for the           
performance period for the applicable   
fiscal year4  2  7#b7 in paragraph      
7#b77;,a7-- 7,a7 by striking ,the       
,secretary shall apply and inserting    
,the ,secretary-- 7i7 shall apply  2    
7,b7 by striking the period at the end  
and inserting 2 and2 and  7,c7 by adding
 at the end the following3  7ii7 may1   
with respect to payments for services   

furnished on or after ,october #a1      
#bjbb1 apply additional measures        
determined appropriate by the           
,secretary1 which may include measures  
of functional status1 patient safety1   
care coordination1 or patient           
experience4 ,subject to the succeeding  
sentence1 in the case that the          
,secretary applies additional measures  
under clause 7ii71 the ,secretary shall 
consider and apply1 as appropriate1     
quality measures specified under section
 #ahii;,b7c77#a74 ,in no case may the   
,secretary apply more than #aj measures 
under this subparagraph4 2  7#c7 in     
subparagraph 7,a7 of each of paragraphs 
7#c7 and 7#d71 by striking measure and  
inserting measures2 and  7#d7 by adding 
at the end the following new paragraph3 
7#ab7 ,validation  7,a7 ,in general ,the
 ,secretary shall apply to the measures 
applied under this subsection and the   
data submitted under subsection 7e77#f7 
a process to validate such measures and 
data1 as appropriate1 which may be      

similar to the process specified in     
section #ahhf7;b77#c77;,b77viii77,,xi7  
for validating inpatient hospital       
measures4  7,b7 ,funding ,for purposes  
of carrying out this paragraph1 the     
,secretary shall provide for the        
transfer1 from the ,federal ,hospital   
,insurance ,trust ,fund established     
under section #ahag1 of #e1jjj1jjj to   
the ,centers for ,medicare  ,medicaid   
,services ,program ,management ,account 
for each of fiscal years #bjbb through  
#bjbd4  4  7b7 ,report by ,med,p,a,c    
,not later than ,march #ae1 #bjba1 the  
,medicare ,payment ,advisory ,commission
 shall submit to ,congress a report on  
establishing a prototype value-based    
payment program under a unified         
prospective payment system for          
post-acute care services under the      
,medicare program under title ,,xviii of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acie et seq474 ,such report--
 7#a7 shall-- 7,a7 consider design      
elements such as-- 7i7 measures that are

 important to the ,medicare program and 
to beneficiaries under such program2    
7ii7 methodologies for scoring provider 
performance and effects on payment2 and 
7iii7 other elements determined         
appropriate by the ,commission2 and     
7,b7 analyze the effects of implementing
 such prototype program2 and  7#b7 may--
 7,a7 discuss the possible effects1 with
 respect to the ,medicare program1 on   
program spending1 post-acute care       
providers1 patient outcomes1 and other  
effects determined appropriate by the   
,commission2 and  7,b7 include          
recommendations with respect to such    
prototype program1 as determined        
appropriate by the ,commission1 to      
,congress and the ,secretary of ,health 
and ,human ,services4  ,december #bd1   
#bjbj,reported from the ,committee on   
,ways and ,means with an                
amendment,december #bd1 #bjbj;,committee
 on ,energy and ,commerce discharged2   
committed to the ,committee of the      
,whole ,house on the ,state of the      

,union and ordered to be printed