,i #aaith ,,congress #b;d ,session ,h4 ,r4 #hfbb ,,in ,,the ,,house ,,of ,,representatives ,april #cj1 #bjbf,mrs4 ,miller-,meeks 7for herself and ,mr4 ,conaway7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to transform the ,merit-based ,incentive ,payment ,system into the ,data-driven ,performance ,payment ,system under the ,medicare physician fee schedule1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medicare ,physician ,data-driven ,performance ,payment ,system ,act of #bjbf4 #b4 ,transforming the ,merit-based ,incentive ,payment ,system into the ,data-driven ,performance ,payment ,system 7a7 ,implementation of the ,data-driven ,performance ,payment ,system 7#a7 ,in general ,effective ,january #a1 #bjbg1 there is established the ,data-driven ,performance ,payment ,system1 which shall consist of the payment system under section #ahdh7q7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q771 including as amended by this section4 7#b7 ,references ,subject to paragraph 7#c71 any reference to the payment system under section #ahdh7q7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q771 including the terms ,merit-based ,incentive ,payment ,system and ,,mips1 shall be deemed a reference to the ,data-driven ,performance ,payment ,system and ,,dpps1 respectively4 7#c7 ,transition ,in order to provide for an orderly transition and avoid provider confusion1 the ,secretary of ,health and ,human ,services shall provide for an appropriate transition in the use of the terms ,merit-based ,incentive ,payment ,system 7and ,,mips7 and ,data-driven ,performance ,payment ,system 7and ,,dpps7 in reference to the payment system under section #ahdh7q7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q774 ,before the completion of such transition1 any reference to the ,data-driven ,performance ,payment ,system 7or ,,dpps7 shall be deemed to include a reference to the ,merit-based ,incentive ,payment ,system4 7b7 ,reforming application of adjustment factors 7#a7 ,in general ,section #ahdh7q77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77#f77 is amended-- 7,a7 in subparagraph 7,a7-- 7i7 by inserting for years before #bjbh1 after ,taking into account paragraph 7#a77;,g712 7ii7 in clause 7ii7-- 7,i7 in subclause 7,i71 by striking clause 7iii7 and inserting subclause 7,,iii72 7,,ii7 in subclause 7,,ii71 by striking clause 7iv7 and inserting subclause 7,,iv72 and 7,,iii7 by redesignating subclauses 7,i7 and 7,,ii7 as items 7aa7 and 7bb71 respectively1 and adjusting the margins accordingly2 7iii7 in clause 7iii71 by striking clause 7ii77,i7 and inserting subclause 7,,ii77aa72 7iv7 in clause 7iv7-- 7,i7 by striking subclause 7,,ii7 and inserting item 7bb72 7,,ii7 by striking clause 7ii77,,ii7 and inserting subclause 7,,ii77bb72 and 7,,iii7 by redesignating subclauses 7,i7 and 7,,ii7 as items 7aa7 and 7bb71 respectively1 and adjusting the margins accordingly2 7v7 by redesignating clauses 7i7 through 7iv7 as subclauses 7,i7 through 7,,iv7 and adjusting the margins accordingly2 7vi7 by striking ,taking into account and inserting the following3 7i7 ,adjustment factors for years before #bjbh ,taking into account 2 and 7vii7 by adding at the end the following new clause3 7ii7 ,adjustment factors for #bjbh and subsequent years ,for #bjbh and each subsequent year1 the ,,dpps adjustment factor specified under this subparagraph for a ,,dpps eligible professional for such year shall be equal to-- 7,i7 subject to subparagraph 7,f77v71 in the case of a ,,dpps eligible professional with a composite performance score for such year above the performance threshold established under subparagraph 7,d7 for such year1 #a4be2 7,,ii7 in the case of a ,,dpps eligible professional with a composite performance score for such year equal to such performance threshold1 #a2 7,,iii7 in the case of a ,,dpps eligible professional not described in subclause 7,,iv7 with a composite performance score for such year below such performance threshold1 #j4ge2 and 7,,iv7 in the case of a ,,dpps eligible professional who is treated under paragraph 7#e77;,b77i7 as achieving the lowest potential score applicable to each applicable measure or activity that is required to be reported by the professional for such year1 #j4e4 2 7,b7 in subparagraph 7,b77iv71 by striking and subsequent years and inserting and each subsequent year through #bjbg2 7,c7 in subparagraph 7,d77i71 by striking that are positive1 negative1 and zero2 and 7,d7 in subparagraph 7,e7-- 7i7 by inserting and ending with #bjbg after beginning with #bjai2 7ii7 in clause 7ii7-- 7,i7 by striking subparagraph 7,a7 and inserting subparagraph 7,a77i72 and 7,,ii7 by redesignating subclauses 7,i7 and 7,,ii7 as items 7aa7 and 7bb71 respectively2 7iii7 by redesignating clauses 7i7 and 7ii7 as subclauses 7,i7 and 7,,ii71 respectively2 7iv7 by striking ,in the case of and inserting the following3 7i7 ,application of adjustment factors for years before #bjbh ,in the case of 2 and 7v7 by adding at the end the following new clause3 7ii7 ,application of adjustment factors for #bjbh and subsequent years 7,i7 ,in general ,in the case of covered professional services 7as defined in subsection 7k77#c77;,a77 furnished by a ,,dpps eligible professional during a year 7beginning with #bjbh71 subject to subclauses 7,,ii7 and 7,,iii71 for purposes of determining the amount paid under this part with respect to such covered professional services and ,,dpps eligible professional for such year1 the update to the nonqualifying ,,apm conversion factor established under subsection 7d7 applicable to such services and such professional for such year shall be multiplied by the adjustment factor specified under subparagraph 7,a77ii7 with respect to such professional and such year4 7,,ii7 ,nonapplication to certain updates ,subclause 7,i7 shall not apply with respect to covered professional services furnished during a year in the case that the update to the conversion factor described in such subclause for such year is less than #j percent4 7,,iii7 ,nonapplication of certain adjustment factors for lack of timely feedback reports 7aa7 ,in general ,subclause 7,i7 shall not apply with respect to covered professional services furnished by a ,,dpps eligible professional during a year if the ,,dpps eligible professional does not receive timely feedback in accordance with item 7bb7 with respect to each quarter of the performance period for such year and would1 without application of this item1 otherwise be subject to the ,,dpps adjustment factor described in subparagraph 7,a77ii77,,iii7 for such year4 7bb7 ,timely feedback described ,for purposes of item 7aa71 a ,,dpps eligible professional receives timely feedback in accordance with this item with respect to a quarter of a performance period if1 not later than the date that is #fj days after the last day of such quarter1 such professional receives the confidential feedback required under paragraph 7#ab7 on the performance of such professional during such quarter with respect to administrative claims-based measures included in the performance categories described in subparagraph 7,a77i77,,ii7 of such paragraph1 including-- 7,,aa7 a description of the patients and episodes attributed with respect to such measures for purposes of assessing the performance of such professional during such quarter2 7,,bb7 an identification of the items and services furnished by such professional or another individual that will contribute to the assessment of the performance of such professional during such quarter with respect to such measures2 and 7,,cc7 an identification of whether each item or service identified under subitem 7,,bb7 for the quarter was furnished by such professional or another individual 7and1 in the case that the performance of such professional for such quarter with respect to such measures is assessed based on participation in a group practice or other group1 whether each such item or service was furnished by such professional1 another individual in such group1 or another individual outside of such group74 7,,iv7 ,hold harmless ,in computing the amount of any coinsurance under section #ahcc7;a77#a7 and the expenses incurred for applying the deductible under section #ahcc7;b7 with respect to covered professional services furnished by a ,,dpps eligible professional for a year1 such coinsurance and incurred expenses shall be computed as if the update to the conversion factor applicable to such services and professional for such year were not subject to the adjustment factor under subclause 7,i74 4 7#b7 ,conforming amendment ,section #ahdh7;d77#bj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;d77#bj77 is amended by inserting 1 subject to subsection 7q77#f77;,e77ii71 before the update to the nonqualifying ,,apm conversion factor4 7c7 ,reforming performance thresholds ,section #ahdh7q77#f77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77#f77;,d77 is amended-- 7#a7 in clause 7i71 by striking clauses 7iii7 and 7iv7 and inserting clauses 7iii7 through 7vi72 and 7#b7 by adding at the end the following new clauses3 7v7 ,temporary extension of special rules 7,i7 ,in general ,with respect to each of #bjbh through #bjcc 7or such later year as determined by the ,secretary pursuant to subclause 7,,ii771 the ,secretary shall establish a performance threshold for purposes of determining ,,dpps adjustment factors under subparagraph 7,a7 for such year in accordance with the requirements described in clause 7iii71 except that such performance threshold may not be greater than #ge points4 7,,ii7 ,flexibility to extend special rule ,in the case that extraordinary circumstances1 including a natural disaster1 a public health emergency1 or cybersecurity incident1 affect reporting1 data collection1 or the assessment of performance under this subsection for #bjcd1 the ,secretary may extend the application of subclause 7,i7 until the first year for which such extraordinary circumstances do not affect reporting1 data collection1 or assessment of performance under this subsection 7as determined by the ,secretary74 7,,iii7 ,optional transition period ,with respect to the year immediately following the last year with respect to which subclause 7,i7 applies 7after application of subclause 7,,ii71 if applicable71 the ,secretary may1 pursuant to notice and comment rulemaking1 establish a performance threshold for purposes of determining ,,dpps adjustment factors under subparagraph 7,a7 for such year and such subsequent consecutive years as specified by the ,secretary in a manner that provides for a gradual and incremental transition from the performance threshold established under subclause 7,i7 to the performance threshold established under clause 7vi74 7vi7 ,replacement performance threshold 7,i7 ,in general ,with respect to the year immediately following the last year with respect to which clause 7v7 applies and each subsequent year1 the performance threshold established under this subparagraph for purposes of determining ,,dpps adjustment factors under subparagraph 7,a7 shall be computed in accordance with the replacement performance threshold methodology established by the ,secretary under in subclause 7,,ii74 7,,ii7 ,replacement performance threshold methodology ,for purposes of subclause 7,i71 the ,secretary shall1 pursuant to notice and comment rulemaking and based on the recommendations submitted under subclause 7,,iii71 establish a methodology 7referred to in this clause as the replacement performance threshold methodology7 to be used instead of the mean or median described in clause 7i7 for computing the performance threshold applied under this subparagraph4 7,,iii7 ,recommendations for replacement performance threshold methodology ,not later than ,december #ca1 #bjbi1 the ,comptroller ,general of the ,united ,states shall1 in accordance with subclause 7,,iv71 submit to ,congress and the ,secretary a report including detailed recommendations on a methodology to be used instead of the mean or median described in clause 7i7 for computing the performance threshold described in subclause 7,i7 and that is based on data that are accurate and reliable4 7,,iv7 ,recommendation requirements ,in making the recommendations required under subclause 7,,iii71 the ,comptroller ,general of the ,united ,states shall-- 7aa7 seek to prevent unintended consequences that may result from weighing quality and cost performance categories2 7bb7 consider the impact of such recommendations on different types of ,,dpps eligible professionals1 including such professionals in a small group practice and such professionals that serve rural or underserved communities2 and 7cc7 consult with stakeholders1 including organizations representing physicians4 4 7d7 ,maintaining budget neutrality ,section #ahdh7q77#f77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77#f77;,f77 is amended-- 7#a7 in clause 7i7-- 7,a7 in the clause heading1 by inserting for years before #bjbh after factor2 and 7,b7 in subclause 7,i7-- 7i7 by striking ,with respect and inserting ,for years before #bjbh1 with respect2 and 7ii7 by striking subparagraph 7,a77ii77,i7 and inserting subparagraph 7,a77i77,,ii77aa72 7#b7 in clause 7ii7-- 7,a7 in the clause heading1 by inserting for years before #bjbh after requirement2 and 7,b7 in subclause 7,i71 by striking ,subject to and inserting ,for years before #bjbh1 subject to2 7#c7 in clause 7iii7-- 7,a7 in subclause 7,i71 by inserting before #bjbh before that are below2 and 7,b7 in subclause 7,,ii71 by inserting before #bjbh after with respect to a year2 and 7#d7 by adding at the end the following new clause3 7v7 ,budget neutrality for #bjbh and subsequent years ,for #bjbh and each subsequent year1 the ,secretary shall decrease ,,dpps adjustment factors under subparagraph 7,a77ii77,i7 for ,,dpps eligible professionals whose composite performance score for such year is above the performance threshold established under subparagraph 7,d7 for such year in order to ensure that the estimated increase in the aggregate allowed charges resulting from the application of such adjustment factors 7after application of this clause7 to such professionals for such year is not more than the estimated decrease in such charges resulting from the application for such year of ,,dpps adjustment factors under subclauses 7,,iii7 and 7,,iv7 of subparagraph 7,a77ii7 to ,,dpps eligible professionals whose composite performance score for such year is below such performance threshold4 4 7e7 ,investing in under-resourced practices to assist in value-based care and quality improvement ,section #ahdh7q77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77#f77 is amended by adding at the end the following new subparagraph3 7,g7 ,investing in under-resourced practices to assist in value-based care and quality improvement 7i7 ,in general ,in the case of a ,,dpps eligible professional who furnishes covered professional services during a year that is a ,,dpps savings year 7as defined in clause 7v77 and for which the professional meets the criteria specified in clause 7ii71 in addition to the amount of payment that would otherwise be made for such services under this part for such year1 there also shall be paid to such professional1 from the amount specified in clause 7iv77,i7 for such ,,dpps savings year1 a lump-sum incentive payment 7in such amount as specified by the ,secretary7 which shall be used by such professional to improve care management1 address health-related social needs1 implement and further the use of certified ,,ehr technology 7as defined in subsection 7o77#d771 improve performance with respect to the performance categories described in paragraph 7#b77;,a71 or implement and participate in value-based care models4 7ii7 ,criteria 7,i7 ,attestation ,a ,,dpps eligible professional meets the criteria specified in this clause for a year if1 with respect to such year and professional1 data was submitted under this subsection and1 for purposes of this subparagraph1 it is demonstrated through an attestation that the professional is in a small practice described in subclause 7,,ii74 7,,ii7 ,small practices ,subject to clause 7iii71 a small practice described in this subclause is a practice of #ae or fewer professionals4 7iii7 ,secretarial authority to give priority to certain small practices ,the ,secretary may1 with respect to a ,,dpps savings year and based on the amount specified in clause 7iv77,i7 with respect to such year1 for purposes of this subparagraph give priority to ,,dpps eligible professionals in certain small practices by applying clause 7ii77,,ii7 for such year as if instead of describing a practice of #ae or fewer professionals1 such clause described any one or more of the following3 7,i7 ,a practice of #ae or fewer professionals located in a rural area4 7,,ii7 ,a practice of #ae or fewer professionals located in a health professional shortage area 7as designated under in section #ccb7;a77#a77;,a7 of such ,act74 7,,iii7 ,a practice of #ae or fewer professionals located in a medically underserved area4 7,,iv7 ,a practice of #ae or fewer professionals with a low composite score4 7iv7 ,funding for incentive payments 7,i7 ,amount available ,the amount specified in this subclause1 with respect to a ,,dpps savings year1 is the amount by which the amount described in subclause 7,,ii7 for such year exceeds the amount described in subclause 7,,iii7 for such year4 7,,ii7 ,aggregate decrease ,the amount described in this subclause is the estimated decrease in the aggregate allowed charges resulting from the application of ,,dpps adjustment factors under subclauses 7,,iii7 and 7,,iv7 of subparagraph 7,a77ii7 to ,,dpps eligible professionals whose composite performance score for a year is below the performance threshold under subparagraph 7,d7 for such year4 7,,iii7 ,aggregate increase ,the amount described in this subclause is the estimated increase in the aggregate allowed charges resulting from the application of ,,dpps adjustment factors under subparagraph 7,a77ii77,i7 7after application of subparagraph 7,f77v77 to ,,dpps eligible professionals whose composite performance score for a year is above the performance threshold under subparagraph 7,d7 for such year4 7,,iv7 ,funding limitation ,in no case may the amounts used to carry out this subparagraph with respect to a year exceed the amount specified for such year under subclause 7,i74 7v7 ,,dpps savings year ,for purposes of this subparagraph1 the term ,,dpps savings year means a year 7beginning with #bjbh7 for which the amount described in clause 7iv77,,ii7 exceeds the amount described in clause 7iv77,,iii74 7vi7 ,coordination with other incentive payments ,the amount of any additional payment under this subparagraph and any other provision under this section or section #ahcc1 including section #ahcc7m7 shall be determined without regard to any additional payment under such other provision and this subparagraph1 respectively4 4