113 HR 4302 EH: Protecting Access to Medicare Act of 2014
U.S. House of Representatives
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents
(a)This Act may be cited as the Protecting Access to Medicare Act of 2014
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Title I—Medicare Extenders
Sec. 101. Physician payment update.
Sec. 102. Extension of work GPCI floor.
Sec. 103. Extension of therapy cap exceptions process.
Sec. 104. Extension of ambulance add-ons.
Sec. 105. Extension of increased inpatient hospital payment adjustment for certain low-volume hospitals.
Sec. 106. Extension of the Medicare-dependent hospital (MDH) program.
Sec. 107. Extension for specialized Medicare Advantage plans for special needs individuals.
Sec. 108. Extension of Medicare reasonable cost contracts.
Sec. 109. Extension of funding for quality measure endorsement, input, and selection.
Sec. 110. Extension of funding outreach and assistance for low-income programs.
Sec. 111. Extension of two-midnight rule.
Sec. 112. Technical changes to Medicare LTCH amendments.
Title II—Other Health Provisions
Sec. 201. Extension of the qualifying individual (QI) program.
Sec. 202. Temporary extension of transitional medical assistance (TMA).
Sec. 203. Extension of Medicaid and CHIP express lane option.
Sec. 204. Extension of special diabetes program for type I diabetes and for Indians.
Sec. 205. Extension of abstinence education.
Sec. 206. Extension of personal responsibility education program (PREP).
Sec. 207. Extension of funding for family-to-family health information centers.
Sec. 208. Extension of health workforce demonstration project for low-income individuals.
Sec. 209. Extension of maternal, infant, and early childhood home visiting programs.
Sec. 210. Pediatric quality measures.
Sec. 211. Delay of effective date for Medicaid amendments relating to beneficiary liability settlements.
Sec. 212. Delay in transition from ICD–9 TO ICD–10 code sets.
Sec. 213. Elimination of limitation on deductibles for employer-sponsored health plans.
Sec. 214. GAO report on the Children’s Hospital Graduate Medical Education Program.
Sec. 215. Skilled nursing facility value-based purchasing.
Sec. 216. Improving Medicare policies for clinical diagnostic laboratory tests.
Sec. 217. Revisions under the Medicare ESRD prospective payment system.
Sec. 218. Quality incentives for computed tomography diagnostic imaging and promoting evidence-based care.
Sec. 219. Using funding from Transitional Fund for Sustainable Growth Rate (SGR) Reform.
Sec. 220. Ensuring accurate valuation of services under the physician fee schedule.
Sec. 221. Medicaid DSH.
Sec. 222. Realignment of the Medicare sequester for fiscal year 2024.
Sec. 223. Demonstration programs to improve community mental health services.
Sec. 224. Assisted outpatient treatment grant program for individuals with serious mental illness.
Sec. 225. Exclusion from PAYGO scorecards.
<enum>I</enum><header>Medicare Extenders</header>
<section id="HC626A489203D445282B62FBD62BA5EA5"><enum>101.</enum><header>Physician payment update</header> <text display-inline="no-display-inline">Section 1848(d) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(d)</external-xref>) is amended—</text>
<paragraph id="H5CD851B4D1B949B591267E2905767AD1"><enum>(1)</enum><text>in paragraph (15)—</text>
<subparagraph id="HF42F2E1681A742779FCFD7A4ECAE7C61"><enum>(A)</enum><text>in the heading, by striking <quote><header-in-text level="paragraph" style="OLC">January through March of</header-in-text></quote>;</text> </subparagraph>
<subparagraph id="HA583E957ADA74AD7942F5CCE41A7F7B5"><enum>(B)</enum><text>in subparagraph (A), by striking <quote>for the period beginning on January 1, 2014, and ending on March 31, 2014</quote>; and</text> </subparagraph>
<subparagraph id="H8AB385EDA5C44DF2912EEA63C670F7AF"><enum>(C)</enum><text>in subparagraph (B)—</text>
<clause id="H3833D501D8404D709B7DCA9623119015"><enum>(i)</enum><text>in the heading, by striking <quote><header-in-text level="subparagraph" style="OLC">remaining portion of 2014 and</header-in-text></quote>; and</text> </clause>
<clause id="HF432970861F34C8A82023F33AB5277C9"><enum>(ii)</enum><text>by striking <quote>the period beginning on April 1, 2014, and ending on December 31, 2014, and for</quote>; and</text> </clause></subparagraph></paragraph>
<paragraph id="HCF90C9BA100B47368268A31A3F8B6415"><enum>(2)</enum><text>by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HCAFEA1FB0C6B414FA810523C56987900" style="OLC">
<paragraph display-inline="no-display-inline" id="HA8475C871F6548038837A15511397A7E"><enum>(16)</enum><header>Update for January through March of 2015</header>
<subparagraph id="H2842C819E44E4E41B6E97138761A7DCA"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Subject to paragraphs (7)(B), (8)(B), (9)(B), (10)(B), (11)(B), (12)(B), (13)(B), (14)(B), and (15)(B), in lieu of the update to the single conversion factor established in paragraph (1)(C) that would otherwise apply for 2015 for the period beginning on January 1, 2015, and ending on March 31, 2015, the update to the single conversion factor shall be 0.0 percent.</text> </subparagraph>
<subparagraph id="H1D1AA112EBBD40D0929957501BD445DD"><enum>(B)</enum><header>No effect on computation of conversion factor for remaining portion of 2015 and subsequent years</header><text>The conversion factor under this subsection shall be computed under paragraph (1)(A) for the period beginning on April 1, 2015, and ending on December 31, 2015, and for 2016 and subsequent years as if subparagraph (A) had never applied.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></section>
<section id="HF1006C5A9C974C8DB5112A26CCA71455"><enum>102.</enum><header>Extension of work GPCI floor</header><text display-inline="no-display-inline">Section 1848(e)(1)(E) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(e)(1)(E)</external-xref>) is amended by striking <quote>April 1, 2014</quote> and inserting <quote>April 1, 2015</quote>.</text> </section>
<section id="H8A2C6C9E840D4F37A3F6734F715DB2AF"><enum>103.</enum><header>Extension of therapy cap exceptions process</header> <text display-inline="no-display-inline">Section 1833(g) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(g)</external-xref>) is amended—</text>
<paragraph display-inline="no-display-inline" id="HD3FF6773822340BCA7C74F43E86DCAE8"><enum>(1)</enum><text>in paragraph (5)(A), in the first sentence, by striking <quote>March 31, 2014</quote> and inserting <quote>March 31, 2015</quote>; and</text> </paragraph>
<paragraph id="H322681E429954796885EF7E83F9C7672"><enum>(2)</enum><text display-inline="yes-display-inline">in paragraph (6)(A)—</text>
<subparagraph id="H317FA9219F654655B1B7A1ABA1BBC90C"><enum>(A)</enum><text display-inline="yes-display-inline">by striking <quote>March 31, 2014</quote> and inserting <quote>March 31, 2015</quote>; and</text> </subparagraph>
<subparagraph id="H703BA456C92B434689740CA16F0DB3F7"><enum>(B)</enum><text>by striking <quote>2012, 2013, or the first three months of 2014</quote> and inserting <quote>2012, 2013, 2014, or the first three months of 2015</quote>.</text> </subparagraph></paragraph></section>
<section id="H68C52AD184694D37B920523E23EB68B2"><enum>104.</enum><header>Extension of ambulance add-ons</header>
<subsection id="H7A8556CB4E6B4F94AB22B12038999B4D"><enum>(a)</enum><header>Ground Ambulance</header><text>Section 1834(l)(13)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(l)(13)(A)</external-xref>) is amended by striking <quote>April 1, 2014</quote> and inserting <quote>April 1, 2015</quote> each place it appears.</text> </subsection>
<subsection id="H06761AE75FB848EE9D41A0B23B055C04"><enum>(b)</enum><header>Super rural ground ambulance</header><text display-inline="yes-display-inline">Section 1834(l)(12)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(l)(12)(A)</external-xref>) is amended, in the first sentence, by striking <quote>April 1, 2014</quote> and inserting <quote>April 1, 2015</quote>.</text> </subsection></section>
<section commented="no" id="HC32D53E266784F52A5FD9D410F1B275A"><enum>105.</enum><header>Extension of increased inpatient hospital payment adjustment for certain low-volume hospitals</header><text display-inline="no-display-inline">Section 1886(d)(12) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(12)</external-xref>) is amended—</text>
<paragraph commented="no" id="HC2EE5D4A3C42417385B3A2CCFF330604"><enum>(1)</enum><text>in subparagraph (B), in the matter preceding clause (i), by striking <quote>in the portion of fiscal year 2014 beginning on April 1, 2014, fiscal year 2015, and subsequent fiscal years</quote> and inserting <quote>in fiscal year 2015 (beginning on April 1, 2015), fiscal year 2016, and subsequent fiscal years</quote>;</text> </paragraph>
<paragraph commented="no" id="HC63F7938C60046D7929728513494851F"><enum>(2)</enum><text display-inline="yes-display-inline">in subparagraph (C)(i), by striking <quote>fiscal years 2011, 2012, and 2013, and the portion of fiscal year 2014 before</quote> and inserting <quote>fiscal years 2011 through 2014 and fiscal year 2015 (before April 1, 2015),</quote> each place it appears; and</text> </paragraph>
<paragraph commented="no" id="HE14F2608AB2A48898737388C5B16B3AD"><enum>(3)</enum><text display-inline="yes-display-inline">in subparagraph (D), by striking <quote>fiscal years 2011, 2012, and 2013, and the portion of fiscal year 2014 before April 1, 2014,</quote> and inserting <quote>fiscal years 2011 through 2014 and fiscal year 2015 (before April 1, 2015),</quote>.</text> </paragraph></section>
<section commented="no" display-inline="no-display-inline" id="H068DA4F0482F4FE8829EF69D9B2CB579"><enum>106.</enum><header>Extension of the Medicare-dependent hospital (MDH) program</header>
<subsection commented="no" id="H8D1BEA5A648841CD9F00274637C83CEE"><enum>(a)</enum><header>In general</header><text>Section 1886(d)(5)(G) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(5)(G)</external-xref>) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="H4933D0CEBF2D4E788E5C2BEA7946D20C"><enum>(1)</enum><text display-inline="yes-display-inline">in clause (i), by striking <quote>April 1, 2014</quote> and inserting <quote>April 1, 2015</quote>; and</text> </paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HA48D9DA009454519BF1AC4DA87C97671"><enum>(2)</enum><text display-inline="yes-display-inline">in clause (ii)(II), by striking <quote>April 1, 2014</quote> and inserting <quote>April 1, 2015</quote>.</text> </paragraph></subsection>
<subsection commented="no" id="HA8345EA1907E48E3961AD73C1088AF0C"><enum>(b)</enum><header>Conforming amendments</header>
<paragraph commented="no" id="H9DDBEED72DE343CB9728C2A8CBE38B7D"><enum>(1)</enum><header>Extension of target amount</header><text>Section 1886(b)(3)(D) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(b)(3)(D)</external-xref>) is amended—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H9656D05AC71A4F85A82F960A0A59FD9C"><enum>(A)</enum><text display-inline="yes-display-inline">in the matter preceding clause (i), by striking <quote>April 1, 2014</quote> and inserting <quote>April 1, 2015</quote>; and</text> </subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H3FD0B06FBD7240FC97486129A3C5EED3"><enum>(B)</enum><text display-inline="yes-display-inline">in clause (iv), by striking <quote>through fiscal year 2013 and the portion of fiscal year 2014 before April 1, 2014</quote> and inserting <quote>through fiscal year 2014 and the portion of fiscal year 2015 before April 1, 2015</quote>.</text> </subparagraph></paragraph>
<paragraph commented="no" id="H7BEE24EE862245D5AD671E23355F8B2E"><enum>(2)</enum><header>Permitting hospitals to decline reclassification</header><text display-inline="yes-display-inline">Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww</external-xref> note) is amended by striking <quote>through the first 2 quarters of fiscal year 2014</quote> and inserting <quote>through the first 2 quarters of fiscal year 2015</quote>.</text> </paragraph></subsection></section>
<section commented="no" display-inline="no-display-inline" id="H49941A8607BE4525B6A4BC4914D10B0B"><enum>107.</enum><header>Extension for specialized Medicare Advantage plans for special needs individuals</header><text display-inline="no-display-inline">Section 1859(f)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-28">42 U.S.C. 1395w–28(f)(1)</external-xref>) is amended by striking <quote>2016</quote> and inserting <quote>2017</quote>.</text> </section>
<section commented="no" id="H06986B3561E8452A8058A8753B16CC5E"><enum>108.</enum><header>Extension of Medicare reasonable cost contracts</header><text display-inline="no-display-inline">Section 1876(h)(5)(C)(ii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395mm">42 U.S.C. 1395mm(h)(5)(C)(ii)</external-xref>) is amended, in the matter preceding subclause (I), by striking <quote>January 1, 2015</quote> and inserting <quote>January 1, 2016</quote>.</text> </section>
<section commented="no" display-inline="no-display-inline" id="H3767447F7BB0413698458C818F11068E"><enum>109.</enum><header>Extension of funding for quality measure endorsement, input, and selection</header><text display-inline="no-display-inline">Section 1890(d) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395aaa">42 U.S.C. 1395aaa(d)</external-xref>) is amended—</text>
<paragraph id="H6158DC4F91184FBBA9B2D0FB78909485"><enum>(1)</enum><text>by inserting <quote>(1)</quote> before <quote>For purposes</quote>; and</text> </paragraph>
<paragraph id="H30D0E65E17A14DD39A550B8D3920E150"><enum>(2)</enum><text>by adding at the end the following new paragraph:</text>
<quoted-block id="H1EB7CE8CB7F74363894F09A2ECC56F31" style="OLC">
<paragraph id="H8F30B5C5898D40B8B8CAE22DB60CA99B" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">For purposes of carrying out this section and section 1890A (other than subsections (e) and (f)), the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841, in such proportion as the Secretary determines appropriate, to the Centers for Medicare & Medicaid Services Program Management Account of $5,000,000 for fiscal year 2014 and $15,000,000 for the first 6 months of fiscal year 2015. Amounts transferred under the preceding sentence shall remain available until expended.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></section>
<section commented="no" id="HBC7B87B72FA74E7A8969B5E52D95E7E2"><enum>110.</enum><header>Extension of funding outreach and assistance for low-income programs</header>
<subsection id="H0FD1F42BAED24ACDBEE2BF4A10A8957E"><enum>(a)</enum><header>Additional funding for state health insurance programs</header><text display-inline="yes-display-inline">Subsection (a)(1)(B) of section 119 of the Medicare Improvements for Patients and Providers Act of 2008 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395b-3">42 U.S.C. 1395b–3</external-xref> note), as amended by section 3306 of the Patient Protection and Affordable Care Act <external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>), section 610 of the American Taxpayer Relief Act of 2012 (<external-xref legal-doc="public-law" parsable-cite="pl/112/240">Public Law 112–240</external-xref>), and section 1110 of the Pathway for SGR Reform Act of 2013 (<external-xref legal-doc="public-law" parsable-cite="pl/113/67">Public Law 113–67</external-xref>), is amended—</text>
<paragraph id="HCA281922760344038650491F3C38C99B"><enum>(1)</enum><text>in clause (iii), by striking <quote>and</quote> at the end;</text> </paragraph>
<paragraph id="H2F1D33C4C3864002930C0B519119F2A9"><enum>(2)</enum><text>by striking clause (iv); and</text> </paragraph>
<paragraph id="H8F20A06E503040789F1A87733873D5BE"><enum>(3)</enum><text>by adding at the end the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="HE0FCFB1167EF40B0B504F18339D36019" style="OLC">
<clause id="HEAEA1B6897424A5286BF83ED31051E21"><enum>(iv)</enum><text display-inline="yes-display-inline">for fiscal year 2014, of $7,500,000; and</text> </clause>
<clause commented="no" id="H763782505EFB4115A1B5EF5CB52AA9D9"><enum>(v)</enum><text display-inline="yes-display-inline">for the portion of fiscal year 2015 before April 1, 2015, of $3,750,000.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection>
<subsection id="H528D8082915B4B97AE02A2751C3AF7C9"><enum>(b)</enum><header>Additional funding for area agencies on aging</header><text>Subsection (b)(1)(B) of such section 119, as so amended, is amended—</text>
<paragraph id="H0C4CF6F74B7441738631A1C806A97B65"><enum>(1)</enum><text>in clause (iii), by striking <quote>and</quote> at the end;</text> </paragraph>
<paragraph id="H51355315202A4D09B806B8184EE2B989"><enum>(2)</enum><text>by striking clause (iv); and</text> </paragraph>
<paragraph id="H6DEB3C6DEC3C477589514A5A67FB0F8C"><enum>(3)</enum><text>by inserting after clause (iii) the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="H60111016D0EF455D961953ED6044B2AA" style="OLC">
<clause id="H05568BD0127F4D56998C6FE94AD126F4"><enum>(iv)</enum><text display-inline="yes-display-inline">for fiscal year 2014, of $7,500,000; and</text> </clause>
<clause commented="no" id="H908B24089B2B4644A266FBB239902439"><enum>(v)</enum><text display-inline="yes-display-inline">for the portion of fiscal year 2015 before April 1, 2015, of $3,750,000.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection>
<subsection id="H15965AAFBA0F46DA8036183A4A45AA7E"><enum>(c)</enum><header>Additional funding for aging and disability resource centers</header><text>Subsection (c)(1)(B) of such section 119, as so amended, is amended—</text>
<paragraph id="HD0728C467919448CBB1333D000BADC93"><enum>(1)</enum><text>in clause (iii), by striking <quote>and</quote> at the end;</text> </paragraph>
<paragraph id="H9906A7C9CAE44FB08D6407C0E3AB96C3"><enum>(2)</enum><text>by striking clause (iv); and</text> </paragraph>
<paragraph id="H1FD62DE47CA24D8FA7DED8B18B6A3ECB"><enum>(3)</enum><text display-inline="yes-display-inline">by inserting after clause (iii) the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="H376D65580616425EAE407810A8493047" style="OLC">
<clause id="H4832AE041933440898FE19DFB346A293"><enum>(iv)</enum><text display-inline="yes-display-inline">for fiscal year 2014, of $5,000,000; and</text> </clause>
<clause commented="no" id="HC2FD4AF85664433B9F8CA690D66900B3"><enum>(v)</enum><text>for the portion of fiscal year 2015 before April 1, 2015, of $2,500,000.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection>
<subsection commented="no" id="HE3900B7AA28B4A83A7572C877EDA23D6"><enum>(d)</enum><header>Additional funding for contract with the national center for benefits and outreach enrollment</header><text>Subsection (d)(2) of such section 119, as so amended, is amended—</text>
<paragraph id="H43F8070F8C9E43C082A8691A082295CF"><enum>(1)</enum><text>in clause (iii), by striking <quote>and</quote> at the end;</text> </paragraph>
<paragraph id="H8DCE9CE2226F4CB5AD0C2E1B7FF07060"><enum>(2)</enum><text>by striking clause (iv); and</text> </paragraph>
<paragraph id="HD2F7AFE0C77649A08A21C02D46A5ABDC"><enum>(3)</enum><text display-inline="yes-display-inline">by inserting after clause (iii) the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="HC70F1B8B9D0345F7A0CA5FE7EA71BE16" style="OLC">
<clause id="HC4D2E4B1B36D4F19B56181C49D305F69"><enum>(iv)</enum><text display-inline="yes-display-inline">for fiscal year 2014, of $5,000,000; and</text> </clause>
<clause commented="no" id="H09F944C1DF85497C8AA1E56189D5D7FA"><enum>(v)</enum><text>for the portion of fiscal year 2015 before April 1, 2015, of $2,500,000.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection></section>
<section display-inline="no-display-inline" id="HCDD4C1A38E0F4013ACCA9AF234DBB6AD" section-type="subsequent-section"><enum>111.</enum><header>Extension of two-midnight rule</header>
<subsection id="HB75D617B42A042559A6D69A8B5C9636A"><enum>(a)</enum><header>Continuation of certain medical review activities</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services may continue medical review activities described in the notice entitled <quote>Selecting Hospital Claims for Patient Status Reviews: Admissions On or After October 1, 2013</quote>, posted on the Internet website of the Centers for Medicare & Medicaid Services, through the first 6 months of fiscal year 2015 for such additional hospital claims as the Secretary determines appropriate.</text> </subsection>
<subsection id="HAF77361EDA1F4BA59658205F960DB7B3"><enum>(b)</enum><header>Limitation</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services shall not conduct patient status reviews (as described in such notice) on a post-payment review basis through recovery audit contractors under section 1893(h) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ddd">42 U.S.C. 1395ddd(h)</external-xref>) for inpatient claims with dates of admission October 1, 2013, through March 31, 2015, unless there is evidence of systematic gaming, fraud, abuse, or delays in the provision of care by a provider of services (as defined in section 1861(u) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(u)</external-xref>)).</text> </subsection></section>
<section commented="no" id="H190D6914F6EC424587D606DEB49EB8B2" section-type="subsequent-section"><enum>112.</enum><header>Technical changes to Medicare LTCH amendments</header>
<subsection commented="no" id="H7715CA228BBA4CB9868E0C195FC558C8"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subclauses (I) and (II) of section 1886(m)(6)(C)(iv) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(m)(6)(C)(iv)</external-xref>) are each amended by striking <quote>discharges</quote> and inserting <quote>Medicare fee-for-service discharges</quote>.</text> </subsection>
<subsection commented="no" id="HC63B8BDF604846B392E9CFDA149A7EE7"><enum>(b)</enum><header>MMSEA correction</header><text display-inline="yes-display-inline">Section 114(d) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww</external-xref> note), as amended by sections 3106(b) and 10312(b) of <external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref> and by section 1206(b)(2) of the Pathway for SGR Reform Act of 2013 (division B of <external-xref legal-doc="public-law" parsable-cite="pl/113/67">Public Law 113–67</external-xref>), is amended—</text>
<paragraph commented="no" id="H3DDAFAFC69694EABBC582672FB7FF1D9"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (1), in the matter preceding subparagraph (A), by striking <quote>January 1, 2015,</quote> and inserting <quote>on the date of the enactment of paragraph (7) of this subsection</quote>;</text> </paragraph>
<paragraph id="H42CADDCE5AAF40CFA0DD73526E4E8F9D"><enum>(2)</enum><text display-inline="yes-display-inline">in paragraph (6), by striking <quote>January 1, 2015,</quote> and inserting <quote>on the date of the enactment of paragraph (7) of this subsection</quote>; and</text> </paragraph>
<paragraph commented="no" id="HB6F371FA61C745BCB8A1537085C653EA"><enum>(3)</enum><text>by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HB4E80B66AC6F470A9504CE4B5E40BCE9" style="OLC">
<paragraph commented="no" id="H6FC768504BD44D8EB014B6F46BB0D392"><enum>(7)</enum><header>Additional exception for certain long-term care hospitals</header><text display-inline="yes-display-inline">The moratorium under paragraph (1)(A) shall not apply to a long-term care hospital that—</text>
<subparagraph commented="no" id="HBC40C1038B9D4607A01BAA1D573BE6C6"><enum>(A)</enum><text display-inline="yes-display-inline">began its qualifying period for payment as a long-term care hospital under <external-xref legal-doc="regulation" parsable-cite="cfr/42/412.23">section 412.23(e)</external-xref> of title 42, Code of Federal Regulations, on or before the date of enactment of this paragraph;</text> </subparagraph>
<subparagraph commented="no" id="HE46E7C5247D844D2B7929C7CBF452B62"><enum>(B)</enum><text display-inline="yes-display-inline">has a binding written agreement as of the date of the enactment of this paragraph with an outside, unrelated party for the actual construction, renovation, lease, or demolition for a long-term care hospital, and has expended, before such date of enactment, at least 10 percent of the estimated cost of the project (or, if less, $2,500,000); or</text> </subparagraph>
<subparagraph commented="no" id="H49D46C93A9C94074997030F45F3F857C"><enum>(C)</enum><text display-inline="yes-display-inline">has obtained an approved certificate of need in a State where one is required on or before such date of enactment.</text></subparagraph></paragraph><after-quoted-block>. </after-quoted-block></quoted-block> </paragraph></subsection>
<subsection commented="no" id="H839C074FD03144698A1CA9F1B2EA48E3"><enum>(c)</enum><header>Additional amendments</header><text display-inline="yes-display-inline">Section 1206(a) of the Pathway for SGR Reform Act of 2013 (division B of <external-xref legal-doc="public-law" parsable-cite="pl/113/67">Public Law 113–67</external-xref>) is amended—</text>
<paragraph commented="no" id="HB9DC4235C38C468CAB662EB01A1B7E43"><enum>(1)</enum><text>in paragraph (2)(A), by striking <quote>Assessment</quote> and inserting <quote>Advisory</quote>; and</text> </paragraph>
<paragraph commented="no" id="H6B18185D0269401DA98043E0C09591B5"><enum>(2)</enum><text>in paragraph (3)(B), by striking <quote>shall not apply to a hospital that is classified as of December 10, 2013, as a subsection (d) hospital (as defined in section 1886(d)(1)(B) of the Social Security Act, <external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(1)(B)</external-xref>)</quote> and inserting <quote>shall only apply to a hospital that is classified as of December 10, 2013, as a long-term care hospital (as defined in section 1861(ccc) of the Social Security Act, <external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(ccc)</external-xref>)</quote>.</text> </paragraph></subsection>
<subsection commented="no" id="H7011661D2E5940AB9AA01287278BF949"><enum>(d)</enum><header>Effective date</header><text>The amendments made by this section are effective as of the date of the enactment of this Act.</text> </subsection></section>
<enum>II</enum><header>Other Health Provisions</header>
<section id="H175F55AE431C46FA85B23D38A703F3CC"><enum>201.</enum><header>Extension of the qualifying individual (QI) program</header>
<subsection id="HF55BAB9451F94618883090CBE9DAC954"><enum>(a)</enum><header>Extension</header><text display-inline="yes-display-inline">Section 1902(a)(10)(E)(iv) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(10)(E)(iv)</external-xref>) is amended by striking <quote>March 2014</quote> and inserting <quote>March 2015</quote>.</text> </subsection>
<subsection id="HBDCE21C25A3B4D6B90A674684845817D"><enum>(b)</enum><header>Extending total amount available for allocation</header><text>Section 1933(g) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396u-3">42 U.S.C. 1396u–3(g)</external-xref>) is amended—</text>
<paragraph id="H1CC698693657402CA2AD29752674827B"><enum>(1)</enum><text>in paragraph (2)—</text>
<subparagraph id="HC8851E2312BF4CF3B0175A252C52DC22"><enum>(A)</enum><text>in subparagraph (T), by striking <quote>and</quote> at the end;</text> </subparagraph>
<subparagraph id="H3B91A9D477FF4410A009478778948B95"><enum>(B)</enum><text>in subparagraph (U)—</text>
<clause id="HBC6785D4A245407E85547D6B5D77C684"><enum>(i)</enum><text>by striking <quote>March 31, 2014</quote> and inserting <quote>September 30, 2014</quote>; and</text> </clause>
<clause id="H7F89143DF7ED415B87E218708FCAAA3F"><enum>(ii)</enum><text>by striking <quote>$200,000,000.</quote> and inserting <quote>$485,000,000;</quote>; and</text> </clause></subparagraph>
<subparagraph id="H4B84B82721CD4BE88DCD5D61D7F4D2CF"><enum>(C)</enum><text>by adding at the end the following new subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="HE049F97D4D4B483BAA8911FC9ACCE327" style="OLC">
<subparagraph id="H26112BB63466477D83563D4EAF55FB4D"><enum>(V)</enum><text display-inline="yes-display-inline">for the period that begins on October 1, 2014, and ends on December 31, 2014, the total allocation amount is $300,000,000; and</text> </subparagraph>
<subparagraph id="H4191E4DE0E764C76930168A06EAC1164"><enum>(W)</enum><text display-inline="yes-display-inline">for the period that begins on January 1, 2015, and ends on March 31, 2015, the total allocation amount is $250,000,000.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block> </subparagraph></paragraph>
<paragraph id="H1C2FCA5331E94D60BA5FDE5EAB764B84"><enum>(2)</enum><text>in paragraph (3), in the matter preceding subparagraph (A), by striking <quote>or (T)</quote> and inserting <quote>(T), or (V)</quote>.</text> </paragraph></subsection></section>
<section commented="no" id="H920FE63CC3094282AB63216D00986B37" section-type="subsequent-section"><enum>202.</enum><header>Temporary extension of transitional medical assistance (TMA)</header><text display-inline="no-display-inline">Sections 1902(e)(1)(B) and 1925(f) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(e)(1)(B)</external-xref>, 1396r–6(f)) are each amended by striking <quote>March 31, 2014</quote> and inserting <quote>March 31, 2015</quote>.</text> </section>
<section id="H2BAD872FD4A642749BEA38FE471B305B"><enum>203.</enum><header>Extension of Medicaid and CHIP express lane option</header><text display-inline="no-display-inline">Section 1902(e)(13)(I) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(e)(13)(I)</external-xref>) is amended by striking <quote>September 30, 2014</quote> and inserting <quote>September 30, 2015</quote>.</text> </section>
<section display-inline="no-display-inline" id="HD41811A52D04406C91A52B44CE98653F"> <enum>204.</enum> <header>Extension of special diabetes program for type I diabetes and for Indians</header>
<subsection id="H42F647F7900442EC96E8E594A4697022"> <enum>(a)</enum> <header>Special Diabetes Programs for Type I Diabetes</header> <text>Section 330B(b)(2)(C) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254c-2">42 U.S.C. 254c–2(b)(2)(C)</external-xref>) is amended by striking <quote>2014</quote> and inserting <quote>2015</quote>.</text> </subsection>
<subsection id="HAFA3967F791C44479B301EFB0B3CB3CB"> <enum>(b)</enum> <header>Special Diabetes Programs for Indians</header> <text display-inline="yes-display-inline">Section 330C(c)(2)(C) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254c-3">42 U.S.C. 254c–3(c)(2)(C)</external-xref>) is amended by striking <quote>2014</quote> and inserting <quote>2015</quote>.</text> </subsection></section>
<section display-inline="no-display-inline" id="H5F6784084D994E7291ADBAA799FF0D1D"> <enum>205.</enum> <header>Extension of abstinence education</header>
<subsection id="HD28D6EFEC4C94C21928F41C856BAB764"> <enum></enum><text display-inline="yes-display-inline">Subsections (a) and (d) of section 510 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/710">42 U.S.C. 710</external-xref>) are each amended by striking <quote>2014</quote> and inserting <quote>2015</quote>.</text> </subsection></section>
<section display-inline="no-display-inline" id="HF3199ADDD19C498190F3C31428DACFDA"><enum>206.</enum><header>Extension of personal responsibility education program (PREP)</header><text display-inline="no-display-inline">Section 513 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/713">42 U.S.C. 713</external-xref>) is amended—</text>
<paragraph id="H9FA4BB2DF61F40DEB6AD024D9B340CB3"><enum>(1)</enum><text>in paragraphs (1)(A) and (4)(A) of subsection (a), by striking <quote>2014</quote> and inserting <quote>2015</quote> each place it appears;</text> </paragraph>
<paragraph id="H09D8E6D9B9DE46D38BF2C7AAFDA6A2B7"><enum>(2)</enum><text display-inline="yes-display-inline">in subsection (a)(4)(B)(i), by striking <quote>and 2014</quote> and inserting <quote>2014, and 2015</quote>; and</text> </paragraph>
<paragraph id="HAF3D652FB73E41DF879A151717BF0529"><enum>(3)</enum><text>in subsection (f), by striking <quote>2014</quote> and inserting <quote>2015</quote>.</text> </paragraph></section>
<section commented="no" id="H40D40BC87C36491EBBAD2F0ED0245278"><enum>207.</enum><header>Extension of funding for family-to-family health information centers</header><text display-inline="no-display-inline"><italic></italic><italic></italic>Section 501(c)(1)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/701">42 U.S.C. 701(c)(1)(A)</external-xref>) is amended—</text>
<paragraph commented="no" id="H883E920B8EA64EE586B9E670B867C768"><enum>(1)</enum><text>in clause (iii), by striking at the end <quote>and</quote>;</text> </paragraph>
<paragraph commented="no" id="H69737145A81C44C787C981607C99A36E"><enum>(2)</enum><text>in clause (iv), by striking the period at the end and inserting a semicolon and by moving the margin to align with the margin for clause (iii); and</text> </paragraph>
<paragraph commented="no" id="H343BDD928D0349F0B583D8389C8890E4"><enum>(3)</enum><text>by adding at the end the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="H37575D15034F47C8B47487D11EC5424D" style="OLC">
<clause commented="no" id="H4A7E80C1CCEB4B91A56394BE2594070A" indent="up2"><enum>(v)</enum><text display-inline="yes-display-inline">$2,500,000 for the portion of fiscal year 2014 on or after April 1, 2014; and</text> </clause>
<clause id="HBC11377B968540A7A2D0C273E465AEA5" indent="up2"><enum>(vi)</enum><text display-inline="yes-display-inline">$2,500,000 for the portion of fiscal year 2015 before April 1, 2015.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></section>
<section id="H6EC552D28E1B4A5D962375D4A5A090AF"><enum>208.</enum><header>Extension of health workforce demonstration project for low-income individuals</header><text display-inline="no-display-inline">Section 2008(c)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397g">42 U.S.C. 1397g(c)(1)</external-xref>) is amended by striking <quote>2014</quote> and inserting <quote>2015</quote>.</text> </section>
<section id="HC786ADC3B4EB475980B1AB4E501876BD"><enum>209.</enum><header>Extension of maternal, infant, and early childhood home visiting programs</header><text display-inline="no-display-inline">Section 511(j) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/711">42 U.S.C. 711(j)</external-xref>) is amended—</text>
<paragraph id="H1B300EF9C78142B3A115600EB710E6B4"><enum>(1)</enum><text>in paragraph (1)—</text>
<subparagraph id="HEF6902BCAEBD409D8316C8F6164A889B"><enum>(A)</enum><text>by striking <quote>and</quote> at the end of subparagraph (D);</text> </subparagraph>
<subparagraph id="H40596FB5F8BC4859BF7D1FEA276AFB51"><enum>(B)</enum><text>by striking the period at the end of subparagraph (E) and inserting <quote>; and</quote>; and</text> </subparagraph>
<subparagraph id="H5A551FA4F6C644E8818476590DE12CD8"><enum>(C)</enum><text>by adding at the end the following new subparagraph:</text>
<quoted-block id="H37D1CA381AF74CAFAF4593EDFE4A4770" style="OLC">
<subparagraph id="HE4E5D3281E23498CAE1CB5D91B37DF24"><enum>(F)</enum><text>for the period beginning on October 1, 2014, and ending on March 31, 2015, an amount equal to the amount provided in subparagraph (E).</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block> </subparagraph></paragraph>
<paragraph id="H4C9EA08FD8414EFCB481EFD6B6033476"><enum>(2)</enum><text>in paragraphs (2) and (3), by inserting <quote>(or portion of a fiscal year)</quote> after <quote>for a fiscal year</quote> each place it appears.</text> </paragraph></section>
<section id="H754FC1885ED342388DFDFF21C1334193"><enum>210.</enum><header>Pediatric quality measures</header>
<subsection id="H1200EAFDDC844DCF876A58F1A6AEFAA9"><enum>(a)</enum><header>Continuation of funding for pediatric quality measures for improving the quality of children’s health care</header><text display-inline="yes-display-inline">Section 1139B(e) of the Social Security Act (42 U.S.C. 1320b–9b(e)) is amended by adding at the end the following: <quote>Of the funds appropriated under this subsection, not less than $15,000,000 shall be used to carry out section 1139A(b).</quote>.</text> </subsection>
<subsection id="HC7E64B3D9DB94BA7A44E385371E67C2D"><enum>(b)</enum><header>Elimination of restriction on Medicaid quality measurement program</header><text display-inline="yes-display-inline">Section 1139B(b)(5)(A) of the Social Security Act (42 U.S.C. 1320b–9b(b)(5)(A)) is amended by striking <quote>The aggregate amount awarded by the Secretary for grants and contracts for the development, testing, and validation of emerging and innovative evidence-based measures under such program shall equal the aggregate amount awarded by the Secretary for grants under section 1139A(b)(4)(A)</quote>.</text> </subsection></section>
<section id="H9823E2FF9FEE4B438231E0EFA503CD4C"><enum>211.</enum><header>Delay of effective date for Medicaid amendments relating to beneficiary liability settlements</header><text display-inline="no-display-inline">Effective as if included in the enactment of the Bipartisan Budget Act of 2013 (<external-xref legal-doc="public-law" parsable-cite="pl/113/67">Public Law 113–67</external-xref>), section 202(c) of such Act is amended by striking <quote>October 1, 2014</quote> and inserting <quote>October 1, 2016</quote>.</text> </section>
<section id="H2B66A34293144071B10C8D6636CA87BF"><enum>212.</enum><header>Delay in transition from ICD–9 TO ICD–10 code sets</header><text display-inline="no-display-inline">The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1320d-2">42 U.S.C. 1320d–2(c)</external-xref>) and <external-xref legal-doc="regulation" parsable-cite="cfr/45/162.1002">section 162.1002</external-xref> of title 45, Code of Federal Regulations.</text> </section>
<section id="H5BC8F6BB80B64B43BBF0213ABC867DD0"><enum>213.</enum><header>Elimination of limitation on deductibles for employer-sponsored health plans</header>
<subsection id="H1096350059B945E583ADD759858451C8"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1302(c) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/42/18022">42 U.S.C. 18022(c)</external-xref>) is amended—</text>
<paragraph id="HD7507FEDA9664466BA4C6BAB5D33262F"><enum>(1)</enum><text>by striking paragraph (2); and</text> </paragraph>
<paragraph id="H373720DADE3E4F96BDF558D4BAB9927E"><enum>(2)</enum><text display-inline="yes-display-inline">in paragraph (4)(A), by striking <quote>paragraphs (1)(B)(i) and (2)(B)(i)</quote> and inserting <quote>paragraph (1)(B)(i)</quote>.</text> </paragraph></subsection>
<subsection id="H74F44278F7124BF7A67AD42BD90EF993"><enum>(b)</enum><header>Conforming amendment</header><text display-inline="yes-display-inline">Section 2707(b) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-6">42 U.S.C. 300gg–6(b)</external-xref>) is amended by striking <quote>paragraphs (1) and (2)</quote> and inserting <quote>paragraph (1)</quote>.</text> </subsection>
<subsection id="H41EE41B98F264EB4A7373B9B49E4C340"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this Act shall be effective as if included in the enactment of the Patient Protection and Affordable Care Act (<external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>).</text> </subsection></section>
<section commented="no" id="H6A1ABBD2DE1644E29AE0DEE975489CED" section-type="subsequent-section"><enum>214.</enum><header>GAO report on the Children’s Hospital Graduate Medical Education Program</header>
<subsection commented="no" id="H4427DC9D9A03451FB82F846E76C832A9"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">In the case that the Children’s Hospital GME Support Reauthorization Act of 2013 is enacted into law, the Comptroller General of the United States shall, not later than November 30, 2017, conduct an independent evaluation, and submit to the appropriate committees of Congress a report, concerning the implementation of section 340E(h) of the Public Health Service Act, as added by section 3 of the Children’s Hospital GME Support Reauthorization Act of 2013.</text> </subsection>
<subsection commented="no" id="HA7B8630D0D4C476DAF86FB48F65FD17E"><enum>(b)</enum><header>Content</header><text>The report described in subsection (a) shall review and assess each of the following, with respect to hospitals receiving payments under such section 340E(h) during the period of fiscal years 2015 through 2017:</text>
<paragraph commented="no" id="H2DC49579A14C465D9F44AF85358F2DFE"><enum>(1)</enum><text>The number and type of such hospitals that applied for such payments.</text> </paragraph>
<paragraph commented="no" id="H053BB5BEEE194CD2B6A4581C874A741E"><enum>(2)</enum><text>The number and type of such hospitals receiving such payments.</text> </paragraph>
<paragraph commented="no" id="HFA2B49120ECA41E9B9FCFE1FD3C40A13"><enum>(3)</enum><text>The amount of such payments awarded to such hospitals.</text> </paragraph>
<paragraph commented="no" id="H7491B4F4902147D4B3FBF173D1E645B1"><enum>(4)</enum><text>How such hospitals used such payments.</text> </paragraph>
<paragraph commented="no" id="H099D687FCD0C44B39B740AA7E8C27A19"><enum>(5)</enum><text>The impact of such payments on—</text>
<subparagraph commented="no" id="HFB366A5FC4EB4718A85DAD3FB9F56148"><enum>(A)</enum><text>the number of pediatric providers; and</text> </subparagraph>
<subparagraph commented="no" id="HDE52A3B648B24EBBA0BFFE9933B947B0"><enum>(B)</enum><text>health care needs of children.</text> </subparagraph></paragraph></subsection></section>
<section id="H80C0CE9753E241C2B84F9141D931FA6F" section-type="subsequent-section"><enum>215.</enum><header>Skilled nursing facility value-based purchasing</header>
<subsection id="H77F0E089948D48C8A638611B926D2ABF"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1888 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395yy">42 U.S.C. 1395yy</external-xref>) is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H0E526774BF2D4AA293C0EBBD6D4E0F60" style="OLC">
<subsection id="HA5C5864F5F9B4168AF7D23B84BBFA981"><enum>(g)</enum><header>Skilled nursing facility readmission measure</header>
<paragraph id="H26E3CB24AB804199A6D9148B8A3DF9FF"><enum>(1)</enum><header>Readmission measure</header><text display-inline="yes-display-inline">Not later than October 1, 2015, the Secretary shall specify a skilled nursing facility all-cause all-condition hospital readmission measure (or any successor to such a measure).</text> </paragraph>
<paragraph id="HEF7C4A8240804AB0997315C05D4D1AEE"><enum>(2)</enum><header>Resource use measure</header><text display-inline="yes-display-inline">Not later than October 1, 2016, the Secretary shall specify a measure to reflect an all-condition risk-adjusted potentially preventable hospital readmission rate for skilled nursing facilities.</text> </paragraph>
<paragraph id="H3A959E02383045B99D71DB9D21DA6AE1"><enum>(3)</enum><header>Measure adjustments</header><text display-inline="yes-display-inline">When specifying the measures under paragraphs (1) and (2), the Secretary shall devise a methodology to achieve a high level of reliability and validity, especially for skilled nursing facilities with a low volume of readmissions.</text> </paragraph>
<paragraph id="H80EE0ABCA8954FF28B13F3234F20DFBA"><enum>(4)</enum><header>Pre-rulemaking process (measure application partnership process)</header><text>The application of the provisions of section 1890A shall be optional in the case of a measure specified under paragraph (1) and a measure specified under paragraph (2).</text> </paragraph>
<paragraph id="HDFDA218E8E684C99B0CDC7A2A8F8B93C"><enum>(5)</enum><header> Feedback reports to skilled nursing facilities</header><text display-inline="yes-display-inline">Beginning October 1, 2016, and every quarter thereafter, the Secretary shall provide confidential feedback reports to skilled nursing facilities on the performance of such facilities with respect to a measure specified under paragraph (1) or (2).</text> </paragraph>
<paragraph id="H0C21C4E579B9450C9CCB7DB9A427911F"><enum>(6)</enum><header>Public reporting of skilled nursing facilities</header>
<subparagraph id="HD33A1734DD23422080D650D4087C37BF"><enum>(A)</enum><header>In general</header><text>Subject to subparagraphs (B) and (C), the Secretary shall establish procedures for making available to the public by posting on the Nursing Home Compare Medicare website (or a successor website) described in section 1819(i) information on the performance of skilled nursing facilities with respect to a measure specified under paragraph (1) and a measure specified under paragraph (2).</text> </subparagraph>
<subparagraph id="HDB7B43B9812447CC9853AF245E648F8C"><enum>(B)</enum><header>Opportunity to review</header><text>The procedures under subparagraph (A) shall ensure that a skilled nursing facility has the opportunity to review and submit corrections to the information that is to be made public with respect to the facility prior to such information being made public.</text> </subparagraph>
<subparagraph id="H5830E234FCEC47D59B41214685F3775D"><enum>(C)</enum><header>Timing</header><text>Such procedures shall provide that the information described in subparagraph (A) is made publicly available beginning not later than October 1, 2017.</text> </subparagraph></paragraph>
<paragraph id="H53DDCE333514489090A1DC2649361C07"><enum>(7)</enum><header>Non-application of Paperwork Reduction Act</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/44/35">Chapter 35</external-xref> of title 44, United States Code (commonly referred to as the ‘Paperwork Reduction Act of 1995’) shall not apply to this subsection.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block> </subsection>
<subsection id="H9F7C6BFF9B2E42F8BB971CF78E6B194B"><enum>(b)</enum><header>Value-Based purchasing program for skilled nursing facilities</header><text>Section 1888 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395yy">42 U.S.C. 1395yy</external-xref>), as amended by subsection (a), is further amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H687E965EA3C743589080B118BFE5B2EB" style="OLC">
<subsection id="H655CB6A2E25445908A02CCF9810C1BD0"><enum>(h)</enum><header>Skilled nursing facility value-Based purchasing program</header>
<paragraph id="H2D030A3B6A15491CAB84E170B77BB0A9"><enum>(1)</enum><header>Establishment</header>
<subparagraph id="H7887F68C7084469DBDF52083AE36AC29"><enum>(A)</enum><header>In general</header><text>Subject to the succeeding provisions of this subsection, the Secretary shall establish a skilled nursing facility value-based purchasing program (in this subsection referred to as the <quote>SNF VBP Program</quote>) under which value-based incentive payments are made in a fiscal year to skilled nursing facilities.</text> </subparagraph>
<subparagraph id="HC4E815A02EC04E0593461635D6BA77DE"><enum>(B)</enum><header>Program to begin in fiscal year 2019</header><text>The SNF VBP Program shall apply to payments for services furnished on or after October 1, 2018.</text> </subparagraph></paragraph>
<paragraph id="H3C5B26DABC164C8D88FED7A24CDAF01C"><enum>(2)</enum><header>Application of measures</header>
<subparagraph id="H683923E9AD4E465ABB7E87324EB58D69"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall apply the measure specified under subsection (g)(1) for purposes of the SNF VBP Program.</text> </subparagraph>
<subparagraph id="HC6359571D6BB4323A9EC832294A91175"><enum>(B)</enum><header>Replacement</header><text display-inline="yes-display-inline">For purposes of the SNF VBP Program, the Secretary shall apply the measure specified under (g)(2) instead of the measure specified under (g)(1) as soon as practicable.</text> </subparagraph></paragraph>
<paragraph id="HAA16A9CC56FE4FBBA699D4BBEA9B1243"><enum>(3)</enum><header>Performance standards</header>
<subparagraph id="HD50BFE902A484800BAD0DEAAD9BCD40B"><enum>(A)</enum><header>Establishment</header><text display-inline="yes-display-inline">The Secretary shall establish performance standards with respect to the measure applied under paragraph (2) for a performance period for a fiscal year.</text> </subparagraph>
<subparagraph id="HA0DB0E9690C44C8CAB9FD25B088D1B24"><enum>(B)</enum><header>Higher of achievement and improvement</header><text display-inline="yes-display-inline">The performance standards established under subparagraph (A) shall include levels of achievement and improvement. In calculating the SNF performance score under paragraph (4), the Secretary shall use the higher of either improvement or achievement.</text> </subparagraph>
<subparagraph id="HECBED96A4FD044BC8753CEF92616A7BF"><enum>(C)</enum><header>Timing</header><text display-inline="yes-display-inline">The Secretary shall establish and announce the performance standards established under subparagraph (A) not later than 60 days prior to the beginning of the performance period for the fiscal year involved.</text> </subparagraph></paragraph>
<paragraph id="H02D2C27258814EEA880CF09441FC67FE"><enum>(4)</enum><header>SNF performance score</header>
<subparagraph id="H0642ABEE80114A319AC7F086F08C3911"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall develop a methodology for assessing the total performance of each skilled nursing facility based on performance standards established under paragraph (3) with respect to the measure applied under paragraph (2). Using such methodology, the Secretary shall provide for an assessment (in this subsection referred to as the <quote>SNF performance score</quote>) for each skilled nursing facility for each such performance period.</text> </subparagraph>
<subparagraph id="H893ED499C5C340F58A0B4AF35D92D02F"><enum>(B)</enum><header>Ranking of SNF performance scores</header><text display-inline="yes-display-inline">The Secretary shall, for the performance period for each fiscal year, rank the SNF performance scores determined under subparagraph (A) from low to high.</text> </subparagraph></paragraph>
<paragraph id="H01D4A169E51F4ED5AF1FE3D31DD54ED6"><enum>(5)</enum><header>Calculation of value-based incentive payments</header>
<subparagraph id="H4E838B57BCB04ED69909CD82012A2F0B"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">With respect to a skilled nursing facility, based on the ranking under paragraph (4)(B) for a performance period for a fiscal year, the Secretary shall increase the adjusted Federal per diem rate determined under subsection (e)(4)(G) otherwise applicable to such skilled nursing facility (and after application of paragraph (6)) for services furnished by such facility during such fiscal year by the value-based incentive payment amount under subparagraph (B).</text> </subparagraph>
<subparagraph id="H621ABBF168D842DAB51D10C7592008F6"><enum>(B)</enum><header>Value-based incentive payment amount</header><text>The value-based incentive payment amount for services furnished by a skilled nursing facility in a fiscal year shall be equal to the product of—</text>
<clause id="H362DFB4C89FB4605BDC77E7F2F5C1C37"><enum>(i)</enum><text display-inline="yes-display-inline">the adjusted Federal per diem rate determined under subsection (e)(4)(G) otherwise applicable to such skilled nursing facility for such services furnished by the skilled nursing facility during such fiscal year; and</text> </clause>
<clause id="H7919C6F8450E4AF885BD37EC350D01BC"><enum>(ii)</enum><text>the value-based incentive payment percentage specified under subparagraph (C) for the skilled nursing facility for such fiscal year.</text> </clause></subparagraph>
<subparagraph id="H868BECDA45A64981A9AE770247E825CA"><enum>(C)</enum><header>Value-based incentive payment percentage</header>
<clause id="H5D5A3B68F2C04ABDBF489CB0797B8F94"><enum>(i)</enum><header>In general</header><text>The Secretary shall specify a value-based incentive payment percentage for a skilled nursing facility for a fiscal year which may include a zero percentage.</text> </clause>
<clause id="H6975A2627579484388F472053D8B328A"><enum>(ii)</enum><header>Requirements</header><text>In specifying the value-based incentive payment percentage for each skilled nursing facility for a fiscal year under clause (i), the Secretary shall ensure that—</text>
<subclause id="H4F1613DE28284A01954024DD1F47D5E2"><enum>(I)</enum><text>such percentage is based on the SNF performance score of the skilled nursing facility provided under paragraph (4) for the performance period for such fiscal year;</text> </subclause>
<subclause id="H54042C48B6F64DBCA5513A43A960F6A0"><enum>(II)</enum><text>the application of all such percentages in such fiscal year results in an appropriate distribution of value-based incentive payments under subparagraph (B) such that—</text>
<item id="HFC3E0EA63032466C979F2EF132796F43"><enum>(aa)</enum><text display-inline="yes-display-inline">skilled nursing facilities with the highest rankings under paragraph (4)(B) receive the highest value-based incentive payment amounts under subparagraph (B);</text> </item>
<item id="HF6C5EA7E28574544B1008EC1C770E39B"><enum>(bb)</enum><text display-inline="yes-display-inline">skilled nursing facilities with the lowest rankings under paragraph (4)(B) receive the lowest value-based incentive payment amounts under subparagraph (B); and</text> </item>
<item commented="no" id="H33A7C9CB58B44DEAB7EC9893FEEAA5C0"><enum>(cc)</enum><text display-inline="yes-display-inline">in the case of skilled nursing facilities in the lowest 40 percent of the ranking under paragraph (4)(B), the payment rate under subparagraph (A) for services furnished by such facility during such fiscal year shall be less than the payment rate for such services for such fiscal year that would otherwise apply under subsection (e)(4)(G) without application of this subsection; and</text> </item></subclause>
<subclause id="H75D99545EBEE4FE780C767F5E05821BF"><enum>(III)</enum><text display-inline="yes-display-inline">the total amount of value-based incentive payments under this paragraph for all skilled nursing facilities in such fiscal year shall be greater than or equal to 50 percent, but not greater than 70 percent, of the total amount of the reductions to payments for such fiscal year under paragraph (6), as estimated by the Secretary.</text> </subclause></clause></subparagraph></paragraph>
<paragraph id="H808E3C57610A4ABCB79489FED5BAE9CC"><enum>(6)</enum><header>Funding for value-based incentive payments</header>
<subparagraph id="H9A21D380AFA74D078912AEF323DCF3D2"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall reduce the adjusted Federal per diem rate determined under subsection (e)(4)(G) otherwise applicable to a skilled nursing facility for services furnished by such facility during a fiscal year (beginning with fiscal year 2019) by the applicable percent (as defined in subparagraph (B)). The Secretary shall make such reductions for all skilled nursing facilities in the fiscal year involved, regardless of whether or not the skilled nursing facility has been determined by the Secretary to have earned a value-based incentive payment under paragraph (5) for such fiscal year.</text> </subparagraph>
<subparagraph id="H73C65C28A9D34B56A187025C41A3AD27"><enum>(B)</enum><header>Applicable percent</header><text display-inline="yes-display-inline">For purposes of subparagraph (A), the term <term>applicable percent</term> means, with respect to fiscal year 2019 and succeeding fiscal years, 2 percent.</text> </subparagraph></paragraph>
<paragraph id="HB00B195FDC734AEF95DF93B0205A25E0"><enum>(7)</enum><header>Announcement of net result of adjustments</header><text display-inline="yes-display-inline">Under the SNF VBP Program, the Secretary shall, not later than 60 days prior to the fiscal year involved, inform each skilled nursing facility of the adjustments to payments to the skilled nursing facility for services furnished by such facility during the fiscal year under paragraphs (5) and (6).</text> </paragraph>
<paragraph id="HAADA390306974E659ED6358906CC7A4A"><enum>(8)</enum><header>No effect in subsequent fiscal years</header><text>The value-based incentive payment under paragraph (5) and the payment reduction under paragraph (6) shall each apply only with respect to the fiscal year involved, and the Secretary shall not take into account such value-based incentive payment or payment reduction in making payments to a skilled nursing facility under this section in a subsequent fiscal year.</text> </paragraph>
<paragraph id="HCDB6BF6EB4774E3D874B926FB209021F"><enum>(9)</enum><header>Public reporting</header>
<subparagraph id="HA1554F31BA2648C1B121A5E773E1DC33"><enum>(A)</enum><header>SNF specific information</header><text display-inline="yes-display-inline">The Secretary shall make available to the public, by posting on the Nursing Home Compare Medicare website (or a successor website) described in section 1819(i) in an easily understandable format, information regarding the performance of individual skilled nursing facilities under the SNF VBP Program, with respect to a fiscal year, including—</text>
<clause id="HD1606B5BEC16419E9C06F3E95DE363F4"><enum>(i)</enum><text>the SNF performance score of the skilled nursing facility for such fiscal year; and</text> </clause>
<clause id="H7893C1642916467C964DB85084A9E022"><enum>(ii)</enum><text display-inline="yes-display-inline">the ranking of the skilled nursing facility under paragraph (4)(B) for the performance period for such fiscal year.</text> </clause></subparagraph>
<subparagraph id="HC299A561D87041A5BEA2D9E3EFC617D0"><enum>(B)</enum><header> Aggregate information</header><text display-inline="yes-display-inline">The Secretary shall periodically post on the Nursing Home Compare Medicare website (or a successor website) described in section 1819(i) aggregate information on the SNF VBP Program, including—</text>
<clause id="H8477CA9E7461471FA8829E9B901768AD"><enum>(i)</enum><text display-inline="yes-display-inline">the range of SNF performance scores provided under paragraph (4)(A); and</text> </clause>
<clause id="H29A815E3BEC9473995469B69BEE517B0"><enum>(ii)</enum><text>the number of skilled nursing facilities receiving value-based incentive payments under paragraph (5) and the range and total amount of such value-based incentive payments.</text> </clause></subparagraph></paragraph>
<paragraph id="HDFA9563C6ECD444F8369AF5194B5CF5F"><enum>(10)</enum><header>Limitation on review</header><text>There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of the following:</text>
<subparagraph id="H91DD565ED93E4B7CBE0AD254E90E2874"><enum>(A)</enum><text display-inline="yes-display-inline">The methodology used to determine the value-based incentive payment percentage and the amount of the value-based incentive payment under paragraph (5).</text> </subparagraph>
<subparagraph id="H0F060D662E494E21B387FC9CDEE8F009"><enum>(B)</enum><text>The determination of the amount of funding available for such value-based incentive payments under paragraph (5)(C)(ii)(III) and the payment reduction under paragraph (6).</text> </subparagraph>
<subparagraph id="H03275418749947F0B22E7EF2539ECD93"><enum>(C)</enum><text>The establishment of the performance standards under paragraph (3) and the performance period.</text> </subparagraph>
<subparagraph id="HAC7CC982CBAC472C944F4C3BE15CDF9D"><enum>(D)</enum><text>The methodology developed under paragraph (4) that is used to calculate SNF performance scores and the calculation of such scores.</text> </subparagraph>
<subparagraph id="H98C33D2227F642CB84109A41BB40368D"><enum>(E)</enum><text>The ranking determinations under paragraph (4)(B).</text> </subparagraph></paragraph>
<paragraph id="H0E58383BC5104F3F8AC70E6EF561AB6A"><enum>(11)</enum><header>Funding for program management</header><text display-inline="yes-display-inline">The Secretary shall provide for the one time transfer from the Federal Hospital Insurance Trust Fund established under section 1817 to the Centers for Medicare & Medicaid Services Program Management Account of—</text>
<subparagraph id="H424DD305DDCB4A198CA54B878ED823B4"><enum>(A)</enum><text display-inline="yes-display-inline">for purposes of subsection (g)(2), $2,000,000; and</text> </subparagraph>
<subparagraph id="H9823D36BAAE543809E7ADD328E2AF532"><enum>(B)</enum><text display-inline="yes-display-inline">for purposes of implementing this subsection, $10,000,000.</text></subparagraph><continuation-text continuation-text-level="paragraph">Such funds shall remain available until expended.</continuation-text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block> </subsection>
<subsection id="HBCA3E1A9A09B4DFA942252BB0B4E2B7D"><enum>(c)</enum><header>MedPAC study</header><text display-inline="yes-display-inline">Not later than June 30, 2021, the Medicare Payment Advisory Commission shall submit to Congress a report that reviews the progress of the skilled nursing facility value-based purchasing program established under section 1888(h) of the Social Security Act, as added by subsection (b), and makes recommendations, as appropriate, on any improvements that should be made to such program. For purposes of the previous sentence, the Medicare Payment Advisory Commission shall consider any unintended consequences with respect to such skilled nursing facility value-based purchasing program and any potential adjustments to the readmission measure specified under section 1888(g)(1) of such Act, as added by subsection (a), for purposes of determining the effect of the socio-economic status of a beneficiary under the Medicare program under title XVIII of the Social Security Act for the SNF performance score of a skilled nursing facility provided under section 1888(h)(4) of such Act, as added by subsection (b).</text> </subsection></section>
<section id="HD722BDF8A6FD49D6AEBB5446A6253F11"><enum>216.</enum><header>Improving Medicare policies for clinical diagnostic laboratory tests</header>
<subsection id="HE7E8034618B9444E8F2059CAC8AE0476"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Title XVIII of the Social Security Act is amended by inserting after section 1834 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m</external-xref>) the following new section:</text>
<quoted-block display-inline="no-display-inline" id="HC229E41CFDBD4AE0BD4D972AB7E19360" style="OLC">
<section id="H0AD4CB7E85DF41B0ABAF7C35168F9D71"><enum>1834A.</enum><header>Improving policies for clinical diagnostic laboratory tests</header>
<subsection id="HA51E19F24F254F91B1AF5A218C5FD791"><enum>(a)</enum><header>Reporting of private sector payment rates for establishment of Medicare payment rates</header>
<paragraph id="H7C6BA5EB631848C3B49092AAB3AB20F7"><enum>(1)</enum><header>In general</header><text>Beginning January 1, 2016, and every 3 years thereafter (or, annually, in the case of reporting with respect to an advanced diagnostic laboratory test, as defined in subsection (d)(5)), an applicable laboratory (as defined in paragraph (2)) shall report to the Secretary, at a time specified by the Secretary, applicable information (as defined in paragraph (3)) for a data collection period (as defined in paragraph (4)) for each clinical diagnostic laboratory test that the laboratory furnishes during such period for which payment is made under this part.</text> </paragraph>
<paragraph id="HDDFEB0A8CD4D4F68A9987A021E163A29"><enum>(2)</enum><header>Definition of applicable laboratory</header><text>In this section, the term <term>applicable laboratory</term> means a laboratory that, with respect to its revenues under this title, a majority of such revenues are from this section, section 1833(h), or section 1848. The Secretary may establish a low volume or low expenditure threshold for excluding a laboratory from the definition of applicable laboratory under this paragraph, as the Secretary determines appropriate.</text> </paragraph>
<paragraph id="HB018221C825D4AA3B5DC3F4648BCFF0B"><enum>(3)</enum><header>Applicable information defined</header>
<subparagraph id="H389C63CB85024B3B99FEDFBB2E6F2F6B"><enum>(A)</enum><header>In general</header><text>In this section, subject to subparagraph (B), the term <term>applicable information</term> means, with respect to a laboratory test for a data collection period, the following:</text>
<clause id="H29586A386BB44AFDAB1D1A4A778B85D5"><enum>(i)</enum><text>The payment rate (as determined in accordance with paragraph (5)) that was paid by each private payor for the test during the period.</text> </clause>
<clause id="H71D1972A030C49AABE4AB685268D4BF9"><enum>(ii)</enum><text>The volume of such tests for each such payor for the period.</text> </clause></subparagraph>
<subparagraph id="H519D7127D7DA447D95BBD628CDDB2BDF"><enum>(B)</enum><header>Exception for certain contractual arrangements</header><text>Such term shall not include information with respect to a laboratory test for which payment is made on a capitated basis or other similar payment basis during the data collection period.</text> </subparagraph></paragraph>
<paragraph id="H29856BB86B094163965E382A4E4DD3D4"><enum>(4)</enum><header>Data collection period defined</header><text>In this section, the term <term>data collection period</term> means a period of time, such as a previous 12 month period, specified by the Secretary.</text> </paragraph>
<paragraph id="HD9A86D143B704B5D9E1B3E984BE282F1"><enum>(5)</enum><header>Treatment of discounts</header><text>The payment rate reported by a laboratory under this subsection shall reflect all discounts, rebates, coupons, and other price concessions, including those described in section 1847A(c)(3).</text> </paragraph>
<paragraph id="H4CF89ACB00B94E46BCCE8BFFE4CE84C8"><enum>(6)</enum><header>Ensuring complete reporting</header><text>In the case where an applicable laboratory has more than one payment rate for the same payor for the same test or more than one payment rate for different payors for the same test, the applicable laboratory shall report each such payment rate and the volume for the test at each such rate under this subsection. Beginning with January 1, 2019, the Secretary may establish rules to aggregate reporting with respect to the situations described in the preceding sentence.</text> </paragraph>
<paragraph id="HD481F7CA7760499F9969A2FB78881605"><enum>(7)</enum><header>Certification</header><text>An officer of the laboratory shall certify the accuracy and completeness of the information reported under this subsection.</text> </paragraph>
<paragraph id="H8688EC0377B1462B90D12B0D0CD44AB6"><enum>(8)</enum><header>Private payor defined</header><text>In this section, the term <term>private payor</term> means the following:</text>
<subparagraph id="H424C3A9B5F4C42E1ADF819E5F46D52D3"><enum>(A)</enum><text>A health insurance issuer and a group health plan (as such terms are defined in section 2791 of the Public Health Service Act).</text> </subparagraph>
<subparagraph id="HBA1416DEC24F48DDB3A7866845D045EE"><enum>(B)</enum><text>A Medicare Advantage plan under part C.</text> </subparagraph>
<subparagraph id="H5437370AA0084BBF92548FFB08A6E44B"><enum>(C)</enum><text>A medicaid managed care organization (as defined in section 1903(m)).</text> </subparagraph></paragraph>
<paragraph id="H2E82A1ED549B4400864151246FA102C2"><enum>(9)</enum><header>Civil money penalty</header>
<subparagraph id="HC01CBEBCA6904025A0143533E6629930"><enum>(A)</enum><header>In general</header><text>If the Secretary determines that an applicable laboratory has failed to report or made a misrepresentation or omission in reporting information under this subsection with respect to a clinical diagnostic laboratory test, the Secretary may apply a civil money penalty in an amount of up to $10,000 per day for each failure to report or each such misrepresentation or omission.</text> </subparagraph>
<subparagraph commented="no" id="HD8666665AEFF4B229C5B066C3DA4FFC1"><enum>(B)</enum><header>Application</header><text>The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under this paragraph in the same manner as they apply to a civil money penalty or proceeding under section 1128A(a).</text> </subparagraph></paragraph>
<paragraph id="HDFF1F5FD171B48108A162D930F9E24E9"><enum>(10)</enum><header>Confidentiality of information</header><text>Notwithstanding any other provision of law, information disclosed by a laboratory under this subsection is confidential and shall not be disclosed by the Secretary or a Medicare contractor in a form that discloses the identity of a specific payor or laboratory, or prices charged or payments made to any such laboratory, except—</text>
<subparagraph id="H8E98A8D3DA26477B9B48CD41BB6F7049"><enum>(A)</enum><text>as the Secretary determines to be necessary to carry out this section;</text> </subparagraph>
<subparagraph id="H79AD22C96B714F6FB154E9BEB91E6544"><enum>(B)</enum><text>to permit the Comptroller General to review the information provided;</text> </subparagraph>
<subparagraph id="H0CBF4D85563A4FD3B4B1896793B655AA"><enum>(C)</enum><text>to permit the Director of the Congressional Budget Office to review the information provided; and</text> </subparagraph>
<subparagraph id="HC10F09BFBD244B02B7EC279958C543E5"><enum>(D)</enum><text>to permit the Medicare Payment Advisory Commission to review the information provided.</text> </subparagraph></paragraph>
<paragraph id="HD94D688979F0488FA51B513061685112"><enum>(11)</enum><header>Protection from public disclosure</header><text>A payor shall not be identified on information reported under this subsection. The name of an applicable laboratory under this subsection shall be exempt from disclosure under <external-xref legal-doc="usc" parsable-cite="usc/5/552">section 552(b)(3)</external-xref> of title 5, United States Code.</text> </paragraph>
<paragraph id="HE3BB2A2B924E46419C64DF2E1790CBEF"><enum>(12)</enum><header>Regulations</header><text>Not later than June 30, 2015, the Secretary shall establish through notice and comment rulemaking parameters for data collection under this subsection.</text> </paragraph></subsection>
<subsection id="HD45DF5B89DC74B4686553A6AE772BD4F"><enum>(b)</enum><header>Payment for clinical diagnostic laboratory tests</header>
<paragraph id="H10E1E99A995D457BBAAF210A22A6E8F5"><enum>(1)</enum><header>Use of private payor rate information to determine Medicare payment rates</header>
<subparagraph id="HA7C3410D6D9D48C1A9F6277CEDC472AE"><enum>(A)</enum><header>In general</header><text>Subject to paragraph (3) and subsections (c) and (d), in the case of a clinical diagnostic laboratory test furnished on or after January 1, 2017, the payment amount under this section shall be equal to the weighted median determined for the test under paragraph (2) for the most recent data collection period.</text> </subparagraph>
<subparagraph id="H191EE92270F4474695854E1F0829061F"><enum>(B)</enum><header>Application of payment amounts to hospital laboratories</header><text>The payment amounts established under this section shall apply to a clinical diagnostic laboratory test furnished by a hospital laboratory if such test is paid for separately, and not as part of a bundled payment under section 1833(t).</text> </subparagraph></paragraph>
<paragraph id="HAB9D8882517145A199E49A414FE5F476"><enum>(2)</enum><header>Calculation of weighted median</header><text>For each laboratory test with respect to which information is reported under subsection (a) for a data collection period, the Secretary shall calculate a weighted median for the test for the period, by arraying the distribution of all payment rates reported for the period for each test weighted by volume for each payor and each laboratory.</text> </paragraph>
<paragraph id="H36D842549CC240608D2D753D1DFDF334"><enum>(3)</enum><header>Phase-in of reductions from private payor rate implementation</header>
<subparagraph id="H883D563B83D94B3BB7570ABA72571B42"><enum>(A)</enum><header>In general</header><text>Payment amounts determined under this subsection for a clinical diagnostic laboratory test for each of 2017 through 2022 shall not result in a reduction in payments for a clinical diagnostic laboratory test for the year of greater than the applicable percent (as defined in subparagraph (B)) of the amount of payment for the test for the preceding year.</text> </subparagraph>
<subparagraph id="H44F5D0A5C4EC4682BF7B273D861129A3"><enum>(B)</enum><header>Applicable percent defined</header><text>In this paragraph, the term <term>applicable percent</term> means—</text>
<clause id="HE4DF5E0C51F1499492CC5558F3E34DAD"><enum>(i)</enum><text>for each of 2017 through 2019, 10 percent; and</text> </clause>
<clause id="H4DD1BA97903044D9898D33CEDB561879"><enum>(ii)</enum><text>for each of 2020 through 2022, 15 percent.</text> </clause></subparagraph>
<subparagraph id="H0DB6F13A07B746D1B995A6602EC34B85"><enum>(C)</enum><header>No application to new tests</header><text>This paragraph shall not apply to payment amounts determined under this section for either of the following.</text>
<clause id="H00C56D544E144FE9BDFD8790323772A1"><enum>(i)</enum><text>A new test under subsection (c).</text> </clause>
<clause id="HC89BCC81C6014520B9D2D986EF8E0DCC"><enum>(ii)</enum><text>A new advanced diagnostic test (as defined in subsection (d)(5)) under subsection (d).</text> </clause></subparagraph></paragraph>
<paragraph id="HE96DF42948D64A9180F4D6232C3B5A0F"><enum>(4)</enum><header>Application of market rates</header>
<subparagraph id="HDD48861D4E1045A6826D59F3158CCD35"><enum>(A)</enum><header>In general</header><text>Subject to paragraph (3), once established for a year following a data collection period, the payment amounts under this subsection shall continue to apply until the year following the next data collection period.</text> </subparagraph>
<subparagraph id="H1FE4B66B3C6F403F9B26BC3C44998F56"><enum>(B)</enum><header>Other adjustments not applicable</header><text>The payment amounts under this section shall not be subject to any adjustment (including any geographic adjustment, budget neutrality adjustment, annual update, or other adjustment).</text> </subparagraph></paragraph>
<paragraph id="H5D52594E57F54439B06B3002BB5E7B61"><enum>(5)</enum><header>Sample collection fee</header><text>In the case of a sample collected from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, the nominal fee that would otherwise apply under section 1833(h)(3)(A) shall be increased by $2.</text> </paragraph></subsection>
<subsection id="H86BF4DEAFCE44FA5949ABAD2748D2FD9"><enum>(c)</enum><header>Payment for new tests that are not advanced diagnostic laboratory tests</header>
<paragraph id="H7A8C65DFB07C45D89FF2920F100F0806"><enum>(1)</enum><header>Payment during initial period</header><text>In the case of a clinical diagnostic laboratory test that is assigned a new or substantially revised HCPCS code on or after the date of enactment of this section, and which is not an advanced diagnostic laboratory test (as defined in subsection (d)(5)), during an initial period until payment rates under subsection (b) are established for the test, payment for the test shall be determined—</text>
<subparagraph id="HAAE641AFDD9443AB9D7805B7829FF567"><enum>(A)</enum><text>using cross-walking (as described in <external-xref legal-doc="regulation" parsable-cite="cfr/42/414.508">section 414.508(a)</external-xref> of title 42, Code of Federal Regulations, or any successor regulation) to the most appropriate existing test under the fee schedule under this section during that period; or</text> </subparagraph>
<subparagraph id="HA89A6BC9F1CC4FE4908869BDF4B210DE"><enum>(B)</enum><text>if no existing test is comparable to the new test, according to the gapfilling process described in paragraph (2).</text> </subparagraph></paragraph>
<paragraph id="HBA36521D63A64476B59B0C0F45A04A25"><enum>(2)</enum><header>Gapfilling process described</header><text>The gapfilling process described in this paragraph shall take into account the following sources of information to determine gapfill amounts, if available:</text>
<subparagraph id="HE991459EA75544EF9328766AFF620284"><enum>(A)</enum><text>Charges for the test and routine discounts to charges.</text> </subparagraph>
<subparagraph id="HEFFAA651D56545938D1EB5C9FD958172"><enum>(B)</enum><text>Resources required to perform the test.</text> </subparagraph>
<subparagraph id="H2E61CB69A03D4B9F95154498753B37D4"><enum>(C)</enum><text>Payment amounts determined by other payors.</text> </subparagraph>
<subparagraph id="H217708D5167D471A88DDC80DAE661099"><enum>(D)</enum><text>Charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant.</text> </subparagraph>
<subparagraph id="H7B78BA1B40BC4F63BE3C979805CD5EF8"><enum>(E)</enum><text>Other criteria the Secretary determines appropriate.</text> </subparagraph></paragraph>
<paragraph id="H2223E01DA52A4ED0BC1451193B2F4A87"><enum>(3)</enum><header>Additional consideration</header><text>In determining the payment amount under crosswalking or gapfilling processes under this subsection, the Secretary shall consider recommendations from the panel established under subsection (f)(1).</text> </paragraph>
<paragraph id="H9C7287C3E00540E69A8E8181524FF9CE"><enum>(4)</enum><header>Explanation of payment rates</header><text>In the case of a clinical diagnostic laboratory test for which payment is made under this subsection, the Secretary shall make available to the public an explanation of the payment rate for the test, including an explanation of how the criteria described in paragraph (2) and paragraph (3) are applied.</text> </paragraph></subsection>
<subsection id="H53B380EA7A5F4A4C8CF526B0896E6357"><enum>(d)</enum><header>Payment for new advanced diagnostic laboratory tests</header>
<paragraph id="HEACEB763969144AE97C0F43CE08E9A53"><enum>(1)</enum><header>Payment during initial period</header>
<subparagraph id="H93C925630B4747E7956386B03E3976B0"><enum>(A)</enum><header>In general</header><text>In the case of an advanced diagnostic laboratory test for which payment has not been made under the fee schedule under section 1833(h) prior to the date of enactment of this section, during an initial period of three quarters, the payment amount for the test for such period shall be based on the actual list charge for the laboratory test.</text> </subparagraph>
<subparagraph id="H1FA55BB32E724DB28A8CBB6C905B528B"><enum>(B)</enum><header>Actual list charge</header><text>For purposes of subparagraph (A), the term <term>actual list charge</term>, with respect to a laboratory test furnished during such period, means the publicly available rate on the first day at which the test is available for purchase by a private payor.</text> </subparagraph></paragraph>
<paragraph id="HAC5BF192A0034329AD19B4BE606AA534"><enum>(2)</enum><header>Special rule for timing of initial reporting</header><text>With respect to an advanced diagnostic laboratory test described in paragraph (1)(A), an applicable laboratory shall initially be required to report under subsection (a) not later than the last day of the second quarter of the initial period under such paragraph.</text> </paragraph>
<paragraph id="H30441DB38C6F4690BD4689A7C4CB965B"><enum>(3)</enum><header>Application of market rates after initial period</header><text>Subject to paragraph (4), data reported under paragraph (2) shall be used to establish the payment amount for an advanced diagnostic laboratory test after the initial period under paragraph (1)(A) using the methodology described in subsection (b). Such payment amount shall continue to apply until the year following the next data collection period.</text> </paragraph>
<paragraph id="H38B14095360C4DE4858042F251314472"><enum>(4)</enum><header>Recoupment if actual list charge exceeds market rate</header><text>With respect to the initial period described in paragraph (1)(A), if, after such period, the Secretary determines that the payment amount for an advanced diagnostic laboratory test under paragraph (1)(A) that was applicable during the period was greater than 130 percent of the payment amount for the test established using the methodology described in subsection (b) that is applicable after such period, the Secretary shall recoup the difference between such payment amounts for tests furnished during such period.</text> </paragraph>
<paragraph id="H9CEE47E29F2D41B1B7F8A13E04478E51"><enum>(5)</enum><header>Advanced diagnostic laboratory test defined</header><text>In this subsection, the term <term>advanced diagnostic laboratory test</term> means a clinical diagnostic laboratory test covered under this part that is offered and furnished only by a single laboratory and not sold for use by a laboratory other than the original developing laboratory (or a successor owner) and meets one of the following criteria:</text>
<subparagraph commented="no" id="H78D69AF0E8184E7B80F240AFA23124FB"><enum>(A)</enum><text>The test is an analysis of multiple biomarkers of DNA, RNA, or proteins combined with a unique algorithm to yield a single patient-specific result.</text> </subparagraph>
<subparagraph id="HF0D39A578973428F98FCBDB8288EDDEF"><enum>(B)</enum><text>The test is cleared or approved by the Food and Drug Administration.</text> </subparagraph>
<subparagraph id="HD13B8FB2CF0949748AAB1878A6A3EB29"><enum>(C)</enum><text>The test meets other similar criteria established by the Secretary.</text> </subparagraph></paragraph></subsection>
<subsection id="HD207E31FCCC64DDE8BB87E232AA110B1"><enum>(e)</enum><header>Coding</header>
<paragraph id="HCFDBE5C8DA7B4AC898049FC03B38114F"><enum>(1)</enum><header>Temporary codes for certain new tests</header>
<subparagraph id="HA25DD2AE8AF24BFB898051ABAB413616"><enum>(A)</enum><header>In general</header><text>The Secretary shall adopt temporary HCPCS codes to identify new advanced diagnostic laboratory tests (as defined in subsection (d)(5)) and new laboratory tests that are cleared or approved by the Food and Drug Administration.</text> </subparagraph>
<subparagraph id="H63AFBCF2FE6A430FB5838E9BBD623DD4"><enum>(B)</enum><header>Duration</header>
<clause id="H8A5F072A6498423CBEB9DBCD804FB4A2"><enum>(i)</enum><header>In general</header><text>Subject to clause (ii), the temporary code shall be effective until a permanent HCPCS code is established (but not to exceed 2 years).</text> </clause>
<clause id="H6DA27C4BFE6F4A17B3A58C1EF4AE2800"><enum>(ii)</enum><header>Exception</header><text>The Secretary may extend the temporary code or establish a permanent HCPCS code, as the Secretary determines appropriate.</text> </clause></subparagraph></paragraph>
<paragraph id="HA6D6A0816DF9452BBF1AFB7C1CD9C8A6"><enum>(2)</enum><header>Existing tests</header><text>Not later than January 1, 2016, for each existing advanced diagnostic laboratory test (as so defined) and each existing clinical diagnostic laboratory test that is cleared or approved by the Food and Drug Administration for which payment is made under this part as of the date of enactment of this section, if such test has not already been assigned a unique HCPCS code, the Secretary shall—</text>
<subparagraph id="H908EB8E8C38C42CA94C65BA8F30BD4CC"><enum>(A)</enum><text>assign a unique HCPCS code for the test; and</text> </subparagraph>
<subparagraph id="H3A9909704A59411CB02DB4249160C561"><enum>(B)</enum><text>publicly report the payment rate for the test.</text> </subparagraph></paragraph>
<paragraph id="HB9ED480AD01443D4A656C7B5BE5B99BF"><enum>(3)</enum><header>Establishment of unique identifier for certain tests</header><text>For purposes of tracking and monitoring, if a laboratory or a manufacturer requests a unique identifier for an advanced diagnostic laboratory test (as so defined) or a laboratory test that is cleared or approved by the Food and Drug Administration, the Secretary shall utilize a means to uniquely track such test through a mechanism such as a HCPCS code or modifier.</text> </paragraph></subsection>
<subsection id="H8BBA40D79BB844EA8C725220B860096D"><enum>(f)</enum><header>Input from clinicians and technical experts</header>
<paragraph id="H37A977130C7F4443AC06464BBDB18B63"><enum>(1)</enum><header>In general</header><text>The Secretary shall consult with an expert outside advisory panel, established by the Secretary not later than July 1, 2015, composed of an appropriate selection of individuals with expertise, which may include molecular pathologists, researchers, and individuals with expertise in laboratory science or health economics, in issues related to clinical diagnostic laboratory tests, which may include the development, validation, performance, and application of such tests, to provide—</text>
<subparagraph id="HAFE0D07A8E6446788D6948A0A6407CF5"><enum>(A)</enum><text>input on—</text>
<clause id="H18BF203DF696432EB1CA395648573999"><enum>(i)</enum><text>the establishment of payment rates under this section for new clinical diagnostic laboratory tests, including whether to use crosswalking or gapfilling processes to determine payment for a specific new test; and</text> </clause>
<clause id="HF1CCDFE644094D3FB054E99179FBF98E"><enum>(ii)</enum><text>the factors used in determining coverage and payment processes for new clinical diagnostic laboratory tests; and</text> </clause></subparagraph>
<subparagraph id="H50C50DFC3B4C4D5AAFC0F77E089DCE2F"><enum>(B)</enum><text>recommendations to the Secretary under this section.</text> </subparagraph></paragraph>
<paragraph id="H8359F685E9D942F3BF03A9A1492865C5"><enum>(2)</enum><header>Compliance with FACA</header><text>The panel shall be subject to the Federal Advisory Committee Act (5 U.S.C. App.).</text> </paragraph>
<paragraph id="H28A90573248841908CAA5B4E2113D55F"><enum>(3)</enum><header>Continuation of annual meeting</header><text>The Secretary shall continue to convene the annual meeting described in section 1833(h)(8)(B)(iii) after the implementation of this section for purposes of receiving comments and recommendations (and data on which the recommendations are based) as described in such section on the establishment of payment amounts under this section.</text> </paragraph></subsection>
<subsection id="H90E22B288F18489C984F89361552746E"><enum>(g)</enum><header>Coverage</header>
<paragraph id="H8441D0D799A345ABA1AD3FD1A2608E51"><enum>(1)</enum><header>Issuance of coverage policies</header>
<subparagraph id="H03595EE76AC44BC89A3CB69B4D8111FE"><enum>(A)</enum><header>In general</header><text>A medicare administrative contractor shall only issue a coverage policy with respect to a clinical diagnostic laboratory test in accordance with the process for making a local coverage determination (as defined in section 1869(f)(2)(B)), including the appeals and review process for local coverage determinations under part 426 of title 42, Code of Federal Regulations (or successor regulations).</text> </subparagraph>
<subparagraph id="H542210C7CBF34CDFB2F48884A4580B6A"><enum>(B)</enum><header>No effect on national coverage determination process</header><text>This paragraph shall not apply to the national coverage determination process (as defined in section 1869(f)(1)(B)).</text> </subparagraph>
<subparagraph id="HD56A7A802C69462981FEA88C69D8B4A9"><enum>(C)</enum><header>Effective date</header><text>This paragraph shall apply to coverage policies issued on or after January 1, 2015.</text> </subparagraph></paragraph>
<paragraph id="HF7E7421ECF6A4E21853528369C75BEA1"><enum>(2)</enum><header>Designation of one or more medicare administrative contractors for clinical diagnostic laboratory tests</header><text>The Secretary may designate one or more (not to exceed 4) medicare administrative contractors to either establish coverage policies or establish coverage policies and process claims for payment for clinical diagnostic laboratory tests, as determined appropriate by the Secretary.</text> </paragraph></subsection>
<subsection id="H134424375E144B0BB21F9433227FD016"><enum>(h)</enum><header>Implementation</header>
<paragraph id="HA1C5A308F6954E7B82AF4698FB6BE74F"><enum>(1)</enum><header>Implementation</header><text>There shall be no administrative or judicial review under section 1869, section 1878, or otherwise, of the establishment of payment amounts under this section.</text> </paragraph>
<paragraph id="H451FB65930DE4D26B6A4BAB501288C9D"><enum>(2)</enum><header>Administration</header><text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/44/35">Chapter 35</external-xref> of title 44, United States Code, shall not apply to information collected under this section.</text> </paragraph>
<paragraph id="H0BB6E120A4B94FA48C3096AEB15A74AA"><enum>(3)</enum><header>Funding</header><text>For purposes of implementing this section, the Secretary shall provide for the transfer, from the Federal Supplementary Medical Insurance Trust Fund under section 1841, to the Centers for Medicare & Medicaid Services Program Management Account, for each of fiscal years 2014 through 2018, $4,000,000, and for each of fiscal years 2019 through 2023, $3,000,000. Amounts transferred under the preceding sentence shall remain available until expended.</text> </paragraph></subsection>
<subsection id="HA2C07DED96A04E4AAB3FAD0B5C4FCD25"><enum>(i)</enum><header>Transitional rule</header><text>During the period beginning on the date of enactment of this section and ending on December 31, 2016, with respect to advanced diagnostic laboratory tests under this part, the Secretary shall use the methodologies for pricing, coding, and coverage in effect on the day before such date of enactment, which may include cross-walking or gapfilling methods.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block> </subsection>
<subsection id="H6B74FDA058194115B570CFC061C6F612"><enum>(b)</enum><header>Conforming amendments</header>
<paragraph id="H07C94BBE77E540D099074269865698EE"><enum>(1)</enum><text>Section 1833(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(a)</external-xref>) is amended—</text>
<subparagraph id="H213789CB649A4AA0B21FFD8D9F044CE5"><enum>(A)</enum><text>in paragraph (1)(D)—</text>
<clause id="H977E7F2502D14898994AABBCEDD96761"><enum>(i)</enum><text>by striking <quote>(i) on the basis</quote> and inserting <quote>(i)(I) on the basis</quote>;</text> </clause>
<clause id="H81C6009371864E4E9708CA0512A6FBD0"><enum>(ii)</enum><text>in subclause (I), as added by clause (i), by striking <quote>subsection (h)(1)</quote> and inserting <quote>subsection (h)(1) (for tests furnished before January 1, 2017)</quote>;</text> </clause>
<clause id="H72E11FF0C51047289B689DEBED921C5D"><enum>(iii)</enum><text>by striking <quote>or (ii)</quote> and inserting <quote>or (II) under section 1834A (for tests furnished on or after January 1, 2017), the amount paid shall be equal to 80 percent (or 100 percent, in the case of such tests for which payment is made on an assignment-related basis) of the lesser of the amount determined under such section or the amount of the charges billed for the tests, or (ii)</quote>; and</text> </clause>
<clause id="H993D2C4585204B2F91C1BEA8597D6087"><enum>(iv)</enum><text>in clause (ii), by striking <quote>on the basis</quote> and inserting <quote>for tests furnished before January 1, 2017, on the basis</quote>;</text> </clause></subparagraph>
<subparagraph id="H3B2401E61A374CF49AF64E91D2495124"><enum>(B)</enum><text>in paragraph (2)(D)—</text>
<clause id="H6EA8902A34AD41C6A65170F39D2C10EB"><enum>(i)</enum><text>by striking <quote>(i) on the basis</quote> and inserting <quote>(i)(I) on the basis</quote>;</text> </clause>
<clause id="HEBFD7BAE23E9437C90F7162A9DC34FA1"><enum>(ii)</enum><text>in subclause (I), as added by clause (i), by striking <quote>subsection (h)(1)</quote> and inserting <quote>subsection (h)(1) (for tests furnished before January 1, 2017)</quote>;</text> </clause>
<clause id="H4D7172CECABD4DC3AF103CD9B5266ECD"><enum>(iii)</enum><text>by striking <quote>or (ii)</quote> and inserting <quote>or (II) under section 1834A (for tests furnished on or after January 1, 2017), the amount paid shall be equal to 80 percent (or 100 percent, in the case of such tests for which payment is made on an assignment-related basis or to a provider having an agreement under section 1866) of the lesser of the amount determined under such section or the amount of the charges billed for the tests, or (ii)</quote>; and</text> </clause>
<clause id="H5692B5A54E1A47B18A42971C43B2B456"><enum>(iv)</enum><text>in clause (ii), by striking <quote>on the basis</quote> and inserting <quote>for tests furnished before January 1, 2017, on the basis</quote>;</text> </clause></subparagraph>
<subparagraph id="H0D53E92EED104E8DA65C5B192AFC1E41"><enum>(C)</enum><text>in subsection (b)(3)(B), by striking <quote>on the basis</quote> and inserting <quote>for tests furnished before January 1, 2017, on the basis</quote>;</text> </subparagraph>
<subparagraph id="H1EDD313DA3D24A7E964741C75C33A042"><enum>(D)</enum><text>in subsection (h)(2)(A)(i), by striking <quote>and subject to</quote> and inserting <quote>and, for tests furnished before the date of enactment of section 1834A, subject to</quote>;</text> </subparagraph>
<subparagraph id="H5A0F6F37A6044350A15C71E2A67A6DF6"><enum>(E)</enum><text>in subsection (h)(3), in the matter preceding subparagraph (A), by striking <quote>fee schedules</quote> and inserting <quote>fee schedules (for tests furnished before January 1, 2017) or under section 1834A (for tests furnished on or after January 1, 2017), subject to subsection (b)(5) of such section</quote>;</text> </subparagraph>
<subparagraph id="H60E61D4689FD43EFB0DD852CF61FD86C"><enum>(F)</enum><text>in subsection (h)(6), by striking <quote>In the case</quote> and inserting <quote>For tests furnished before January 1, 2017, in the case</quote>; and</text> </subparagraph>
<subparagraph id="HFE3DA314718E4251B11D9E44F2330040"><enum>(G)</enum><text>in subsection (h)(7), in the first sentence—</text>
<clause id="H8BC40EE0365E4CED8745AEA88CC020AE"><enum>(i)</enum><text>by striking <quote>and (4)</quote> and inserting <quote>and (4) and section 1834A</quote>; and</text> </clause>
<clause id="H58766D4784A741FA8E06AF2BF669C409"><enum>(ii)</enum><text>by striking <quote>under this subsection</quote> and inserting <quote>under this part</quote>.</text> </clause></subparagraph></paragraph>
<paragraph id="H87F863ACF7A74FA4A6D6679A41C12F60"><enum>(2)</enum><text>Section 1869(f)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ff">42 U.S.C. 1395ff(f)(2)</external-xref>) is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H23BB1B674B924A779BF12A95BE88520E" style="OLC">
<subparagraph id="H892B2960D7C240F9AD4A57396E006D0F"><enum>(C)</enum><header>Local coverage determinations for clinical diagnostic laboratory tests</header><text>For provisions relating to local coverage determinations for clinical diagnostic laboratory tests, see section 1834A(g).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection>
<subsection id="H9C66E6658F924E3D881B1DB539EAD765"><enum>(c)</enum><header>GAO study and report; Monitoring of Medicare expenditures and implementation of new payment system for laboratory tests</header>
<paragraph id="H674805C6F3D4437E8255D090DA602CB8"><enum>(1)</enum><header>GAO study and report on implementation of new payment rates for clinical diagnostic laboratory tests</header>
<subparagraph id="H1E2B6FE1FFFB4C3285851E7DEABC0153"><enum>(A)</enum><header>Study</header><text>The Comptroller General of the United States (in this subsection referred to as the <quote>Comptroller General</quote>) shall conduct a study on the implementation of section 1834A of the Social Security Act, as added by subsection (a). The study shall include an analysis of—</text>
<clause id="H2D51BB2048824B0DBCD22A484980F4A1"><enum>(i)</enum><text>payment rates paid by private payors for laboratory tests furnished in various settings, including—</text>
<subclause id="H4BEBDB4F766749608610F2D79E4EB294"><enum>(I)</enum><text>how such payment rates compare across settings;</text> </subclause>
<subclause id="H0D147D4E1C284E1FA2D10062A79DB3A1"><enum>(II)</enum><text>the trend in payment rates over time; and</text> </subclause>
<subclause id="HABB9A24EE7434FCA8F904E2E820FE9E3"><enum>(III)</enum><text>trends by private payors to move to alternative payment methodologies for laboratory tests;</text> </subclause></clause>
<clause id="H4C685CF588214C5D837CFBDAF270A7C0"><enum>(ii)</enum><text>the conversion to the new payment rate for laboratory tests under such section;</text> </clause>
<clause id="HDA575DC43F754FE9804F29047E81EC6E"><enum>(iii)</enum><text>the impact of such implementation on beneficiary access under title XVIII of the Social Security Act;</text> </clause>
<clause id="H9AD046090BD14B48A09DBBC5BF562474"><enum>(iv)</enum><text>the impact of the new payment system on laboratories that furnish a low volume of services and laboratories that specialize in a small number of tests;</text> </clause>
<clause id="H2349178F1AB8457FBDF84DB8CE87BB03"><enum>(v)</enum><text>the number of new Healthcare Common Procedure Coding System (HCPCS) codes issued for laboratory tests;</text> </clause>
<clause id="H36C421CAB0D14349A370F10CC71DD424"><enum>(vi)</enum><text>the spending trend for laboratory tests under such title;</text> </clause>
<clause id="H5A825BC4332644BF8CBDC12248E6631D"><enum>(vii)</enum><text>whether the information reported by laboratories and the new payment rates for laboratory tests under such section accurately reflect market prices;</text> </clause>
<clause id="H72C7E21FA6714279967F0A29ADFFF327"><enum>(viii)</enum><text>the initial list price for new laboratory tests and the subsequent reported rates for such tests under such section;</text> </clause>
<clause id="H553C302FDEA946E2AE3A712A314DFFEA"><enum>(ix)</enum><text>changes in the number of advanced diagnostic laboratory tests and laboratory tests cleared or approved by the Food and Drug Administration for which payment is made under such section; and</text> </clause>
<clause id="H1814AB869826499981CA9FCB817F1CFF"><enum>(x)</enum><text>healthcare economic information on downstream cost impacts for such tests and decision making based on accepted methodologies.</text> </clause></subparagraph>
<subparagraph id="H2AD3B54927934E9D87A4E917C29628EF"><enum>(B)</enum><header>Report</header><text>Not later than October 1, 2018, the Comptroller General shall submit to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report on the study under subparagraph (A), including recommendations for such legislation and administrative action as the Comptroller General determines appropriate.</text> </subparagraph></paragraph>
<paragraph id="HD60FB0D5EFBB4AC2B3290D298E1277C4"><enum>(2)</enum><header>Monitoring of Medicare expenditures and implementation of new payment system for laboratory tests</header><text>The Inspector General of the Department of Health and Human Services shall—</text>
<subparagraph id="HF37F6CC2EA0540B79F1ED8E34CF1B577"><enum>(A)</enum><text>publicly release an annual analysis of the top 25 laboratory tests by expenditures under title XVIII of the Social Security Act; and</text> </subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H97A52FEAF8974A02BB21E14B77F95083"><enum>(B)</enum><text>conduct analyses the Inspector General determines appropriate with respect to the implementation and effect of the new payment system for laboratory tests under section 1834A of the Social Security Act, as added by subsection (a).</text> </subparagraph></paragraph></subsection></section>
<section commented="no" display-inline="no-display-inline" id="H5657FF3EC5B94F68A89A87E3EF180A99"><enum>217.</enum><header>Revisions under the Medicare ESRD prospective payment system</header>
<subsection commented="no" display-inline="no-display-inline" id="H2AE702D5ECFC40C486D31E5382DF6C78"><enum>(a)</enum><header>Delay of implementation of oral-Only policy</header><text>Section 632(b)(1) of the American Taxpayer Relief Act of 2012 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr</external-xref> note) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="H9BCD6FE665BD46A78FB118137872C582"><enum>(1)</enum><text>by striking <quote>2016</quote> and inserting <quote>2024</quote>; and</text> </paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HD923F2D6F66A40CAA407D44AB93A356A"><enum>(2)</enum><text>by adding at the end the following new sentence: <quote>Notwithstanding section 1881(b)(14)(A)(ii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)(14)(A)(ii)</external-xref>), implementation of the policy described in the previous sentence shall be based on data from the most recent year available.</quote>.</text> </paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H03B1AE76D38B4A13A78D3098C2C23A8B"><enum>(b)</enum><header>Mitigation of the application of adjustment to ESRD bundled payment rate To account for changes in the utilization of certain drugs and biologicals</header>
<paragraph commented="no" display-inline="no-display-inline" id="H7E18AE86A26B4011B0152AEAED1C4FF1"><enum>(1)</enum><header>In general</header><text>Section 1881(b)(14)(I) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)(14)(I)</external-xref>) is amended by inserting <quote>and before January 1, 2015,</quote> after <quote>January 1, 2014,</quote>.</text> </paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H3CF128503D624CCF8FDB6C01AD409351"><enum>(2)</enum><header>Market basket</header><text>Section 1881(b)(14)(F)(i) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)(14)(F)(i)</external-xref>) is amended—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H15CF4FA8F3CD4ED3AE96D28E51A2FFF9"><enum>(A)</enum><text>in subclause (I)—</text>
<clause commented="no" display-inline="no-display-inline" id="H21D925FE2F1B4515909A81C074D6D47A"><enum>(i)</enum><text>by striking <quote>subclause (II)</quote> and inserting <quote>subclauses (II) and (III)</quote>; and</text> </clause>
<clause commented="no" display-inline="no-display-inline" id="HA5F6F2253FFF412C9E1C92277DAFB747"><enum>(ii)</enum><text>by adding at the end the following new sentence: <quote>In order to accomplish the purposes of subparagraph (I) with respect to 2016, 2017, and 2018, after determining the increase factor described in the preceding sentence for each of 2016, 2017, and 2018, the Secretary shall reduce such increase factor by 1.25 percentage points for each of 2016 and 2017 and by 1 percentage point for 2018.</quote>;</text> </clause></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HE3B5F71BE8A547339204B037C7225EF9"><enum>(B)</enum><text>in subclause (II), by striking <quote>For 2012</quote> and inserting <quote>Subject to subclause (III), for 2012</quote>; and</text> </subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H714A8DB4A74F43FDA93A7E262DDCE628"><enum>(C)</enum><text>by adding at the end the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="H517A8EE972B3429DAB45B70ACC936FEC" style="OLC">
<subclause commented="no" display-inline="no-display-inline" id="H104B8609072A485384A91564E7995E48" indent="up3"><enum>(III)</enum><text>Notwithstanding subclauses (I) and (II), in order to accomplish the purposes of subparagraph (I) with respect to 2015, the increase factor described in subclause (I) for 2015 shall be 0.0 percent pursuant to the regulation issued by the Secretary on December 2, 2013, entitled <quote>Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies; Final Rule</quote> (78 Fed. Reg. 72156).</text></subclause><after-quoted-block>.</after-quoted-block></quoted-block> </subparagraph></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H4927747691AD41F086514798A896CF37"><enum>(c)</enum><header>Drug designations</header><text>As part of the promulgation of annual rule for the Medicare end stage renal disease prospective payment system under section 1881(b)(14) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)(14)</external-xref>) for calendar year 2016, the Secretary of Health and Human Services (in this subsection referred to as the <quote>Secretary</quote>) shall establish a process for—</text>
<paragraph commented="no" display-inline="no-display-inline" id="H0D7BD6FBA50B4CB99D9FBEF886407B93"><enum>(1)</enum><text>determining when a product is no longer an oral-only drug; and</text> </paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H6DB71A60F4DA44019C183A3612CEAEAA"><enum>(2)</enum><text>including new injectable and intravenous products into the bundled payment under such system.</text> </paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HBBD986ED01104D1ABF4A084BA44CD980"><enum>(d)</enum><header>Quality measures related to conditions treated by oral-Only drugs under the ESRD quality incentive program</header><text>Section 1881(h)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(h)(2)</external-xref>) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="H4554B14A64934370982FD660C60112FE"><enum>(1)</enum><text>in subparagraph (A)—</text>
<subparagraph id="HB7B27A56AAA84F20BF25E4A8B4AB0737"><enum>(A)</enum><text>in clause (ii), by striking <quote>and</quote> at the end;</text> </subparagraph>
<subparagraph id="HDE404F0C97EA497093F4995719119B62"><enum>(B)</enum><text>by redesignating clause (iii) as clause (iv); and</text> </subparagraph>
<subparagraph id="HF152F2F12DAC49CA8E5AD67D308738FC"><enum>(C)</enum><text>by inserting after clause (ii) the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="HAC73EBAC763243678D078D09E3564F1E" style="OLC">
<clause id="H92B2DD0682BF408DA26857961A539382"><enum>(iii)</enum><text>for 2016 and subsequent years, measures described in subparagraph (E)(i); and</text></clause><after-quoted-block>; </after-quoted-block></quoted-block> </subparagraph></paragraph>
<paragraph id="HA6348CEC35B34A91915B36DA73CF14BE"><enum>(2)</enum><text>in subparagraph (B)(i), by striking <quote>(A)(iii)</quote> and inserting <quote>(A)(iv)</quote>; and</text> </paragraph>
<paragraph id="HEB5E21C798DC4C49945294D33BC7A6BA"><enum>(3)</enum><text>by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H366FA46720DA4A33B4787A3C4201CD9E" style="OLC">
<subparagraph id="H585E18BE75204F918B1D47B17598C33F"><enum>(E)</enum><header>Measures specific to the conditions treated with oral-only drugs</header>
<clause id="HD3D9B046710A4A64BA9984C17DEEFCD8"><enum>(i)</enum><header>In general</header><text>The measures described in this subparagraph are measures specified by the Secretary that are specific to the conditions treated with oral-only drugs. To the extent feasible, such measures shall be outcomes-based measures.</text> </clause>
<clause id="H87DAC326B2744E828D1F55E324B00080"><enum>(ii)</enum><header>Consultation</header><text>In specifying the measures under clause (i), the Secretary shall consult with interested stakeholders.</text> </clause>
<clause id="H6205F2C0C52B47C2AD44BA1433EED27A"><enum>(iii)</enum><header>Use of endorsed measures</header>
<subclause id="H88C5E4A672BD44C4B233E3791F4D9B37"><enum>(I)</enum><header>In general</header><text>Subject to subclause (I), any measures specified under clause (i) must have been endorsed by the entity with a contract under section 1890(a).</text> </subclause>
<subclause id="H715EF34A931B4B2A9BEAD86C85EDFE0F"><enum>(II)</enum><header>Exception</header><text>If the entity with a contract under section 1890(a) has not endorsed a measure for a specified area or topic related to measures described in clause (i) that the Secretary determines appropriate, the Secretary may specify a measure that is endorsed or adopted by a consensus organization recognized by the Secretary that has expertise in clinical guidelines for kidney disease.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection>
<subsection id="HF2B8B3FECEAC43E69EC42D0FA40D597F"><enum>(e)</enum><header>Audits of cost reports of ESRD providers as recommended by MedPAC</header>
<paragraph id="H18D3B6AD44C444F4BEB4B1B849F477C8"><enum>(1)</enum><header>In general</header><text>The Secretary of Health and Human Services shall conduct audits of Medicare cost reports beginning during 2012 for a representative sample of providers of services and renal dialysis facilities furnishing renal dialysis services.</text> </paragraph>
<paragraph id="H0019A85477A04DBEB7880E8B8E989E6B"><enum>(2)</enum><header>Funding</header><text>For purposes of carrying out paragraph (1), the Secretary of Health and Human Services shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395t">42 U.S.C. 1395t</external-xref>) to the Centers for Medicare & Medicaid Services Program Management Account of $18,000,000 for fiscal year 2014. Amounts transferred under this paragraph for a fiscal year shall be available until expended.</text> </paragraph></subsection></section>
<section id="HC0993A87D24C44F79B50C65436661694"><enum>218.</enum><header>Quality incentives for computed tomography diagnostic imaging and promoting evidence-based care</header>
<subsection id="H9FF924EA0DBC466C99DD4FD9BDEC88FF"><enum>(a)</enum><header>Quality incentives To promote patient safety and public health in computed tomography diagnostic imaging</header>
<paragraph id="H77192622F6D14C1F846978F9CA105E7D"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1834 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m</external-xref>) is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H715563077DF84B4580D1667386D5661C" style="OLC">
<subsection id="H7A69E9D5D7464C19A3F57EA57BDFF0A2"><enum>(p)</enum><header>Quality incentives To promote patient safety and public health in computed tomography</header>
<paragraph id="H71C56BB2618441D3B00609B3A95CABB1"><enum>(1)</enum><header>Quality incentives</header><text>In the case of an applicable computed tomography service (as defined in paragraph (2)) for which payment is made under an applicable payment system (as defined in paragraph (3)) and that is furnished on or after January 1, 2016, using equipment that is not consistent with the CT equipment standard (described in paragraph (4)), the payment amount for such service shall be reduced by the applicable percentage (as defined in paragraph (5)).</text> </paragraph>
<paragraph id="HB2B2E99E794B49CC9CE9D1AD8684093E"><enum>(2)</enum><header>Applicable computed tomography services defined</header><text>In this subsection, the term <term>applicable computed tomography service</term> means a service billed using diagnostic radiological imaging codes for computed tomography (identified as of January 1, 2014, by HCPCS codes 70450–70498, 71250–71275, 72125–72133, 72191–72194, 73200–73206, 73700–73706, 74150–74178, 74261–74263, and 75571–75574 (and any succeeding codes).</text> </paragraph>
<paragraph id="H92BB221A2CBF4FADA6E590CF7DC45CCA"><enum>(3)</enum><header>Applicable payment system defined</header><text>In this subsection, the term <term>applicable payment system</term> means the following:</text>
<subparagraph id="H745BA10422B0421AADF5CE19F0BDB5BF"><enum>(A)</enum><text>The technical component and the technical component of the global fee under the fee schedule established under section 1848(b).</text> </subparagraph>
<subparagraph id="HE6DA223A5EC44A0C9435B822B2FD4D3E"><enum>(B)</enum><text>The prospective payment system for hospital outpatient department services under section 1833(t).</text> </subparagraph></paragraph>
<paragraph id="HB4D9C84B597E4595B826FC9B72F94A1A"><enum>(4)</enum><header>Consistency with CT equipment standard</header><text>In this subsection, the term <term>not consistent with the CT equipment standard</term> means, with respect to an applicable computed tomography service, that the service was furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association (NEMA) Standard XR–29–2013, entitled <quote>Standard Attributes on CT Equipment Related to Dose Optimization and Management</quote>. Through rulemaking, the Secretary may apply successor standards.</text> </paragraph>
<paragraph id="H55A378B272E24EE58F79E2B3D2ADF3D7"><enum>(5)</enum><header>Applicable percentage defined</header><text>In this subsection, the term <term>applicable percentage</term> means—</text>
<subparagraph id="HA4C18F2E32DC48D5BF6353BF5DB2BD7E"><enum>(A)</enum><text>for 2016, 5 percent; and</text> </subparagraph>
<subparagraph id="HAC792175A976411DB9B75766BABF4842"><enum>(B)</enum><text>for 2017 and subsequent years, 15 percent.</text> </subparagraph></paragraph>
<paragraph id="H302D1A69C2A345869F2436E77915C5E5"><enum>(6)</enum><header>Implementation</header>
<subparagraph id="HE4C9B9C2FCDE433B9E7D3431741A5F5E"><enum>(A)</enum><header>Information</header><text>The Secretary shall require that information be provided and attested to by a supplier and a hospital outpatient department that indicates whether an applicable computed tomography service was furnished that was not consistent with the CT equipment standard (described in paragraph (4)). Such information may be included on a claim and may be a modifier. Such information shall be verified, as appropriate, as part of the periodic accreditation of suppliers under section 1834(e) and hospitals under section 1865(a).</text> </subparagraph>
<subparagraph id="HB5ECC946355547AD9BF4A88066D66A51"><enum>(B)</enum><header>Administration</header><text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/44/35">Chapter 35</external-xref> of title 44, United States Code, shall not apply to information described in subparagraph (A).</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph>
<paragraph id="H49E6F1903D7B457FBBE9E76EA3C0DD94"><enum>(2)</enum><header>Conforming amendments</header>
<subparagraph id="HBBB1E4DE1D0C468683D7AB5DC71917FA"><enum>(A)</enum><header>Prospective payment system for hospital outpatient department services</header><text>Section 1833(t) of the Social Security Act (42 1395l(t)) is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HF51FE0A0A46E46319C40F8168A8097F7" style="OLC">
<paragraph id="HA61622C85340471EBE87EE680D5F6649"><enum>(20)</enum><header>Not budget neutral application of reduced expenditures resulting from quality incentives for computed tomography</header><text>The Secretary shall not take into account the reduced expenditures that result from the application of section 1834(p) in making any budget neutrality adjustments this subsection.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block> </subparagraph>
<subparagraph id="H10A7FF95E326442CBE06448A2670E005"><enum>(B)</enum><header>Physician fee schedule</header><text>Section 1848(c)(2)(B)(v) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(B)(v)</external-xref>) is amended by adding at the end the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="H171D42F9191D4E5B96E80BCC2B409991" style="OLC">
<subclause id="HEA67568B0CCE4FD5974907C03A48405F"><enum>(VIII)</enum><header>Reduced expenditures attributable to application of quality incentives for computed tomography</header><text>Effective for fee schedules established beginning with 2016, reduced expenditures attributable to the application of the quality incentives for computed tomography under section 1834(p)</text></subclause><after-quoted-block>.</after-quoted-block></quoted-block> </subparagraph></paragraph></subsection>
<subsection id="HEE8FA2B63BBA4DB88BD8BDA71AFEDB3F"> <enum>(b)</enum> <header>Promoting evidence-Based care</header>
<paragraph id="H2571B16AFC5F4B7C8CCA37FA8B8FB99B"> <enum>(1)</enum> <header>In general</header> <text>Section 1834 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m</external-xref>), as amended by subsection (a), is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HFA2DB9876C0B42ADA93AAF4173106A6A" style="OLC">
<subsection id="H3CDAAF0A3CE74011BAA5B118C33BA978"> <enum>(q)</enum> <header>Recognizing appropriate use criteria for certain imaging services</header>
<paragraph id="HFC2EDD828DC34F0B9FF9A62A27A79F5B"> <enum>(1)</enum> <header>Program established</header>
<subparagraph id="H8D5D148AA7B844E79EAD400BF782110F"> <enum>(A)</enum> <header>In general</header> <text>The Secretary shall establish a program to promote the use of appropriate use criteria (as defined in subparagraph (B)) for applicable imaging services (as defined in subparagraph (C)) furnished in an applicable setting (as defined in subparagraph (D)) by ordering professionals and furnishing professionals (as defined in subparagraphs (E) and (F), respectively).</text> </subparagraph>
<subparagraph id="HB0B255EBD1A34F2CB79719C23EECD848"> <enum>(B)</enum> <header>Appropriate use criteria defined</header> <text>In this subsection, the term <term>appropriate use criteria</term> means criteria, only developed or endorsed by national professional medical specialty societies or other provider-led entities, to assist ordering professionals and furnishing professionals in making the most appropriate treatment decision for a specific clinical condition for an individual. To the extent feasible, such criteria shall be evidence-based.</text> </subparagraph>
<subparagraph id="HA424C411F017497186B4901C3ED9D330"> <enum>(C)</enum> <header>Applicable imaging service defined</header> <text>In this subsection, the term <term>applicable imaging service</term> means an advanced diagnostic imaging service (as defined in subsection (e)(1)(B)) for which the Secretary determines—</text>
<clause id="HEA935C04B74E4AAC9A07ED827900107C"> <enum>(i)</enum> <text>one or more applicable appropriate use criteria specified under paragraph (2) apply;</text> </clause>
<clause id="H331B2F7CC0FB46BDB62383010327F0D8"> <enum>(ii)</enum> <text>there are one or more qualified clinical decision support mechanisms listed under paragraph (3)(C); and</text> </clause>
<clause id="HF31C05BBB82E40FFAD4F9BD8205EF6A1"> <enum>(iii)</enum> <text>one or more of such mechanisms is available free of charge.</text> </clause></subparagraph>
<subparagraph id="HCB4BCB12BF304F2DAD21BD9CD3ADBAEE"> <enum>(D)</enum> <header>Applicable setting defined</header> <text>In this subsection, the term <term>applicable setting</term> means a physician’s office, a hospital outpatient department (including an emergency department), an ambulatory surgical center, and any other provider-led outpatient setting determined appropriate by the Secretary.</text> </subparagraph>
<subparagraph id="HDBBED2686AEE4486B903E5EBE3AD1661"> <enum>(E)</enum> <header>Ordering professional defined</header> <text>In this subsection, the term <term>ordering professional</term> means a physician (as defined in section 1861(r)) or a practitioner described in section 1842(b)(18)(C) who orders an applicable imaging service.</text> </subparagraph>
<subparagraph id="H1E3CC78132DE48C6AB8CB1C9A094F1A9"> <enum>(F)</enum> <header>Furnishing professional defined</header> <text>In this subsection, the term <term>furnishing professional</term> means a physician (as defined in section 1861(r)) or a practitioner described in section 1842(b)(18)(C) who furnishes an applicable imaging service.</text> </subparagraph></paragraph>
<paragraph id="H42CA6BE15029411493E00AD92353472B"> <enum>(2)</enum> <header>Establishment of applicable appropriate use criteria</header>
<subparagraph id="H3CFEA1F32DA648EB8233668A070D458A"> <enum>(A)</enum> <header>In general</header> <text>Not later than November 15, 2015, the Secretary shall through rulemaking, and in consultation with physicians, practitioners, and other stakeholders, specify applicable appropriate use criteria for applicable imaging services only from among appropriate use criteria developed or endorsed by national professional medical specialty societies or other provider-led entities.</text> </subparagraph>
<subparagraph id="H7F239E23CBC64303B4683C1548C84571"> <enum>(B)</enum> <header>Considerations</header> <text>In specifying applicable appropriate use criteria under subparagraph (A), the Secretary shall take into account whether the criteria—</text>
<clause id="H24287DC4D8D0475F9CDAA237C5A8A054"> <enum>(i)</enum> <text>have stakeholder consensus;</text> </clause>
<clause id="HE764328ABDBA4A48A84AEB85D3693B67"> <enum>(ii)</enum> <text>are scientifically valid and evidence based; and</text> </clause>
<clause id="HB644F95B4DA24D7EAC0B39ED03970AF0"> <enum>(iii)</enum> <text>are based on studies that are published and reviewable by stakeholders.</text> </clause></subparagraph>
<subparagraph id="H0EE6BE90A595457C8FC30B2530A3CED7"> <enum>(C)</enum> <header>Revisions</header> <text>The Secretary shall review, on an annual basis, the specified applicable appropriate use criteria to determine if there is a need to update or revise (as appropriate) such specification of applicable appropriate use criteria and make such updates or revisions through rulemaking.</text> </subparagraph>
<subparagraph id="H80CB23C9B38C44EFBA31B6BA2A727B4F"> <enum>(D)</enum> <header>Treatment of multiple applicable appropriate use criteria</header> <text>In the case where the Secretary determines that more than one appropriate use criterion applies with respect to an applicable imaging service, the Secretary shall apply one or more applicable appropriate use criteria under this paragraph for the service.</text> </subparagraph></paragraph>
<paragraph id="H882B872D0BCD4BD29A98B45F7848410F"> <enum>(3)</enum> <header>Mechanisms for consultation with applicable appropriate use criteria</header>
<subparagraph id="H40D2F662F2FF4D409C3D95B8EEFA7BBF"> <enum>(A)</enum> <header>Identification of mechanisms to consult with applicable appropriate use criteria</header>
<clause id="H34B615050DED46DA9A7DDD926D486892"> <enum>(i)</enum> <header>In general</header> <text>The Secretary shall specify qualified clinical decision support mechanisms that could be used by ordering professionals to consult with applicable appropriate use criteria for applicable imaging services.</text> </clause>
<clause id="HE79B11F1BC314A72BD84EED175344D29"> <enum>(ii)</enum> <header>Consultation</header> <text>The Secretary shall consult with physicians, practitioners, health care technology experts, and other stakeholders in specifying mechanisms under this paragraph.</text> </clause>
<clause id="HAA75D81007F0461188DFC1EAE1CB22F2"> <enum>(iii)</enum> <header>Inclusion of certain mechanisms</header> <text>Mechanisms specified under this paragraph may include any or all of the following that meet the requirements described in subparagraph (B)(ii):</text>
<subclause id="HB08B6377C9854AE1B66946C9828E95AD"> <enum>(I)</enum> <text>Use of clinical decision support modules in certified EHR technology (as defined in section 1848(o)(4)).</text> </subclause>
<subclause id="HDD594B93397146B8887BAB81BCDC2A8C"> <enum>(II)</enum> <text>Use of private sector clinical decision support mechanisms that are independent from certified EHR technology, which may include use of clinical decision support mechanisms available from medical specialty organizations.</text> </subclause>
<subclause id="H3C61A625F66C4532BC935629E750ED0B"> <enum>(III)</enum> <text>Use of a clinical decision support mechanism established by the Secretary.</text> </subclause></clause></subparagraph>
<subparagraph id="HA611BF86D8E94F0DA0258339AF56F6B4"> <enum>(B)</enum> <header>Qualified clinical decision support mechanisms</header>
<clause id="H28A0140F9EAD49A68DFB827ABA288914"> <enum>(i)</enum> <header>In general</header> <text>For purposes of this subsection, a qualified clinical decision support mechanism is a mechanism that the Secretary determines meets the requirements described in clause (ii).</text> </clause>
<clause id="HBFAF015E1D1645C38AF6DAEBDDEA1E67"> <enum>(ii)</enum> <header>Requirements</header> <text>The requirements described in this clause are the following:</text>
<subclause id="H9E0E16B76CA9410CA4CF679548D71FC0"> <enum>(I)</enum> <text>The mechanism makes available to the ordering professional applicable appropriate use criteria specified under paragraph (2) and the supporting documentation for the applicable imaging service ordered.</text> </subclause>
<subclause id="H6C404D00E6A444339574E36073428B3A"> <enum>(II)</enum> <text>In the case where there is more than one applicable appropriate use criterion specified under such paragraph for an applicable imaging service, the mechanism indicates the criteria that it uses for the service.</text> </subclause>
<subclause id="H7B1450C4BA584CCF88C5B4E336A3FF42"> <enum>(III)</enum> <text>The mechanism determines the extent to which an applicable imaging service ordered is consistent with the applicable appropriate use criteria so specified.</text> </subclause>
<subclause id="H9A4137DA13BF464AB3B2BD3D63AC1CA0"> <enum>(IV)</enum> <text>The mechanism generates and provides to the ordering professional a certification or documentation that documents that the qualified clinical decision support mechanism was consulted by the ordering professional.</text> </subclause>
<subclause id="HB742C83A621D49C8BAC059F33CBB3151"> <enum>(V)</enum> <text>The mechanism is updated on a timely basis to reflect revisions to the specification of applicable appropriate use criteria under such paragraph.</text> </subclause>
<subclause id="HF358D773D38C46F0867F04AC33177A6B"> <enum>(VI)</enum> <text>The mechanism meets privacy and security standards under applicable provisions of law.</text> </subclause>
<subclause id="H9160A339ACB04B10A46C1525F33177E5"> <enum>(VII)</enum> <text>The mechanism performs such other functions as specified by the Secretary, which may include a requirement to provide aggregate feedback to the ordering professional.</text> </subclause></clause></subparagraph>
<subparagraph id="H2711248F98CF4831BFBE0D5ADE836C56"> <enum>(C)</enum> <header>List of mechanisms for consultation with applicable appropriate use criteria</header>
<clause id="HA96E190F526C414B91464A01B67D6AD0"> <enum>(i)</enum> <header>Initial list</header> <text>Not later than April 1, 2016, the Secretary shall publish a list of mechanisms specified under this paragraph.</text> </clause>
<clause id="H7E8B75E254614E5FA9E9BA83CCFF6AEC"> <enum>(ii)</enum> <header>Periodic updating of list</header> <text>The Secretary shall identify on an annual basis the list of qualified clinical decision support mechanisms specified under this paragraph.</text> </clause></subparagraph></paragraph>
<paragraph id="HBAAA116DE08E46588A0A37870772F928"> <enum>(4)</enum> <header>Consultation with applicable appropriate use criteria</header>
<subparagraph id="H68286E7D634E4DEB93A2249108AE0A5F"> <enum>(A)</enum> <header>Consultation by ordering professional</header> <text>Beginning with January 1, 2017, subject to subparagraph (C), with respect to an applicable imaging service ordered by an ordering professional that would be furnished in an applicable setting and paid for under an applicable payment system (as defined in subparagraph (D)), an ordering professional shall—</text>
<clause id="HB3ADB945AD50422892F24C195D4125ED"> <enum>(i)</enum> <text>consult with a qualified decision support mechanism listed under paragraph (3)(C); and</text> </clause>
<clause id="H1CD0E3F0DCB348B1857C5634486AD6E5"> <enum>(ii)</enum> <text>provide to the furnishing professional the information described in clauses (i) through (iii) of subparagraph (B).</text> </clause></subparagraph>
<subparagraph id="H5C9E9B01D45444C8A7E8D066CB8B161D"> <enum>(B)</enum> <header>Reporting by furnishing professional</header> <text>Beginning with January 1, 2017, subject to subparagraph (C), with respect to an applicable imaging service furnished in an applicable setting and paid for under an applicable payment system (as defined in subparagraph (D)), payment for such service may only be made if the claim for the service includes the following:</text>
<clause id="HB3CA94CFC59444C4852D99B1739C6234"> <enum>(i)</enum> <text>Information about which qualified clinical decision support mechanism was consulted by the ordering professional for the service.</text> </clause>
<clause id="H19506F49238C4388AE91F82059FCAB1E"> <enum>(ii)</enum> <text>Information regarding—</text>
<subclause id="H69324C3751264ED4B8D14F41D41F2646"> <enum>(I)</enum> <text>whether the service ordered would adhere to the applicable appropriate use criteria specified under paragraph (2);</text> </subclause>
<subclause id="H5F4AAF498D344D51A4153F4FA5A37A64"> <enum>(II)</enum> <text>whether the service ordered would not adhere to such criteria; or</text> </subclause>
<subclause id="H5983BAFDD16C47B1AA063914E93C32C8"> <enum>(III)</enum> <text>whether such criteria was not applicable to the service ordered.</text> </subclause></clause>
<clause id="H81D682B8B0FB4A1581B82F6F1619FE74"> <enum>(iii)</enum> <text>The national provider identifier of the ordering professional (if different from the furnishing professional).</text> </clause></subparagraph>
<subparagraph id="H954A6AE82B7647328DA4DB3879185051"> <enum>(C)</enum> <header>Exceptions</header> <text>The provisions of subparagraphs (A) and (B) and paragraph (6)(A) shall not apply to the following:</text>
<clause id="HD02F161893FF4957B480FEEBD83323C8"> <enum>(i)</enum> <header>Emergency services</header> <text>An applicable imaging service ordered for an individual with an emergency medical condition (as defined in section 1867(e)(1)).</text> </clause>
<clause id="HC330359DBE22434C9BB8197F6A9C0673"> <enum>(ii)</enum> <header>Inpatient services</header> <text>An applicable imaging service ordered for an inpatient and for which payment is made under part A.</text> </clause>
<clause id="HB13E453FFE0D4449926519ECB890CF57"> <enum>(iii)</enum> <header>Significant hardship</header> <text>An applicable imaging service ordered by an ordering professional who the Secretary may, on a case-by-case basis, exempt from the application of such provisions if the Secretary determines, subject to annual renewal, that consultation with applicable appropriate use criteria would result in a significant hardship, such as in the case of a professional who practices in a rural area without sufficient Internet access.</text> </clause></subparagraph>
<subparagraph id="HC64A07266E074E1BBED56B7FCC5F8A04"> <enum>(D)</enum> <header>Applicable payment system defined</header> <text>In this subsection, the term <term>applicable payment system</term> means the following:</text>
<clause id="HFA1F3675383E4997A666EE29FBE8584B"> <enum>(i)</enum> <text>The physician fee schedule established under section 1848(b).</text> </clause>
<clause id="H6D5AD52ECAAE4CC993BFB4D218E5B51F"> <enum>(ii)</enum> <text>The prospective payment system for hospital outpatient department services under section 1833(t).</text> </clause>
<clause id="HE655D7970D4A46A29B1AD350B1A4F73F"> <enum>(iii)</enum> <text>The ambulatory surgical center payment systems under section 1833(i).</text> </clause></subparagraph></paragraph>
<paragraph id="H510D3839C2ED4CDA9A0BAE14F32857D2"> <enum>(5)</enum> <header>Identification of outlier ordering professionals</header>
<subparagraph id="H80870C5562A04A139F1414313C41AD78"> <enum>(A)</enum> <header>In general</header> <text>With respect to applicable imaging services furnished beginning with 2017, the Secretary shall determine, on an annual basis, no more than five percent of the total number of ordering professionals who are outlier ordering professionals.</text> </subparagraph>
<subparagraph id="HC6B1397DF7C34EEF842A0791F291CFFD"> <enum>(B)</enum> <header>Outlier ordering professionals</header> <text>The determination of an outlier ordering professional shall—</text>
<clause id="H900D8586E9B947449E727A8B25E38767"> <enum>(i)</enum> <text>be based on low adherence to applicable appropriate use criteria specified under paragraph (2), which may be based on comparison to other ordering professionals; and</text> </clause>
<clause id="H74F47E7D399C46E9BB2260B45E8596C8"> <enum>(ii)</enum> <text>include data for ordering professionals for whom prior authorization under paragraph (6)(A) applies.</text> </clause></subparagraph>
<subparagraph id="H776CC3FD37C04FC787B48B29590E8236"> <enum>(C)</enum> <header>Use of two years of data</header> <text>The Secretary shall use two years of data to identify outlier ordering professionals under this paragraph.</text> </subparagraph>
<subparagraph id="H79C632508F524EBA92B66121FBDD3512"> <enum>(D)</enum> <header>Process</header> <text>The Secretary shall establish a process for determining when an outlier ordering professional is no longer an outlier ordering professional.</text> </subparagraph>
<subparagraph id="HB65F263643D44C45AB47A40E2C05290D"> <enum>(E)</enum> <header>Consultation with stakeholders</header> <text>The Secretary shall consult with physicians, practitioners and other stakeholders in developing methods to identify outlier ordering professionals under this paragraph.</text> </subparagraph></paragraph>
<paragraph id="HFAC3D061997547A1B06438E0103B88A8"> <enum>(6)</enum> <header>Prior authorization for ordering professionals who are outliers</header>
<subparagraph id="H8C0889285FB14DCBB9136F1BC5FBF246"> <enum>(A)</enum> <header>In general</header> <text>Beginning January 1, 2020, subject to paragraph (4)(C), with respect to services furnished during a year, the Secretary shall, for a period determined appropriate by the Secretary, apply prior authorization for applicable imaging services that are ordered by an outlier ordering professional identified under paragraph (5).</text> </subparagraph>
<subparagraph id="HC7E20D8202D241D6ABDA6737E21BF9C9"> <enum>(B)</enum> <header>Appropriate use criteria in prior authorization</header> <text>In applying prior authorization under subparagraph (A), the Secretary shall utilize only the applicable appropriate use criteria specified under this subsection.</text> </subparagraph>
<subparagraph id="HBADE5BFCE12B40069D5F7B6179C3A55D"> <enum>(C)</enum> <header>Funding</header> <text>For purposes of carrying out this paragraph, the Secretary shall provide for the transfer, from the Federal Supplementary Medical Insurance Trust Fund under section 1841, of $5,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for each of fiscal years 2019 through 2021. Amounts transferred under the preceding sentence shall remain available until expended.</text> </subparagraph></paragraph>
<paragraph id="H5814D9AA24F3422FB107DC46FE111934"><enum>(7)</enum><header>Construction</header><text>Nothing in this subsection shall be construed as granting the Secretary the authority to develop or initiate the development of clinical practice guidelines or appropriate use criteria.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph>
<paragraph id="H229E2A31404E45F5AEB55E7FFB820F2B"> <enum>(2)</enum> <header>Conforming amendment</header> <text>Section 1833(t)(16) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(t)(16)</external-xref>) is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H68CE859621A548BC97F170EB431335DC" style="OLC">
<subparagraph id="H9B86390E94FA4093A760C27E9A4C476D"> <enum>(E)</enum> <header>Application of appropriate use criteria for certain imaging services</header> <text>For provisions relating to the application of appropriate use criteria for certain imaging services, see section 1834(q).</text> </subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HF430491AFD3445DB85865CC230348611"><enum>(3)</enum><header>Report on experience of imaging appropriate use criteria program</header><text>Not later than 18 months after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report that includes a description of the extent to which appropriate use criteria could be used for other services under part B of title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395j">42 U.S.C. 1395j et seq.</external-xref>), such as radiation therapy and clinical diagnostic laboratory services.</text> </paragraph></subsection></section>
<section id="H64CC67104B694A6CB59092D9A0239A98" section-type="subsequent-section"><enum>219.</enum><header>Using funding from Transitional Fund for Sustainable Growth Rate (SGR) Reform</header><text display-inline="no-display-inline">Section 1898(b)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395iii">42 U.S.C. 1395iii(b)(1)</external-xref>) is amended by striking <quote>$2,300,000,000</quote> and inserting <quote>$0</quote>.</text> </section>
<section display-inline="no-display-inline" id="H239A8D3717B94625BC107E13D3FDFC97"> <enum>220.</enum> <header>Ensuring accurate valuation of services under the physician fee schedule</header>
<subsection id="H2E99216BD62F41BB9855B7BDBBD2E5CB"> <enum>(a)</enum> <header>Authority To collect and use information on physicians’ services in the determination of relative values</header>
<paragraph id="H64C3116100524D0AB87D0609902E36D5"> <enum>(1)</enum> <header>In general</header> <text>Section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>) is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H8AFC3968CCF443AD87C550FC6024A89C" style="OLC">
<subparagraph id="HEDBA2EFAB9454FB8AFC087F28D8BFB36"> <enum>(M)</enum> <header>Authority to collect and use information on physicians’ services in the determination of relative values</header>
<clause id="H6E9BB12B914D4804AC2CE375D853112B"> <enum>(i)</enum> <header>Collection of information</header> <text>Notwithstanding any other provision of law, the Secretary may collect or obtain information on the resources directly or indirectly related to furnishing services for which payment is made under the fee schedule established under subsection (b). Such information may be collected or obtained from any eligible professional or any other source.</text> </clause>
<clause id="H52AF5F84D78043DB957587EC1CCCB050"> <enum>(ii)</enum> <header>Use of information</header> <text>Notwithstanding any other provision of law, subject to clause (v), the Secretary may (as the Secretary determines appropriate) use information collected or obtained pursuant to clause (i) in the determination of relative values for services under this section.</text> </clause>
<clause id="H79137E450E154DDDBAC2249EAD4FBC1E"> <enum>(iii)</enum> <header>Types of information</header> <text>The types of information described in clauses (i) and (ii) may, at the Secretary’s discretion, include any or all of the following:</text>
<subclause id="H7A54B50710F24A7EA98EDD1C851B5B6E"> <enum>(I)</enum> <text>Time involved in furnishing services.</text> </subclause>
<subclause id="HC40D6902CFA14974B8ED6CB99E9729C2"> <enum>(II)</enum> <text>Amounts and types of practice expense inputs involved with furnishing services.</text> </subclause>
<subclause id="H37DEDF13B6894B399CA2622127DB6326"> <enum>(III)</enum> <text>Prices (net of any discounts) for practice expense inputs, which may include paid invoice prices or other documentation or records.</text> </subclause>
<subclause id="HE956B1C8F7A64A3EA6ED12ACC5D18C7A"> <enum>(IV)</enum> <text>Overhead and accounting information for practices of physicians and other suppliers.</text> </subclause>
<subclause id="HC41621A60615456B83EA62039BA1F2F0"> <enum>(V)</enum> <text>Any other element that would improve the valuation of services under this section.</text> </subclause></clause>
<clause id="HB63629DE3BDE4C4C82A20F266F850EF5"> <enum>(iv)</enum> <header>Information collection mechanisms</header> <text>Information may be collected or obtained pursuant to this subparagraph from any or all of the following:</text>
<subclause id="HB69A830F9D0B4F4384C46718ABE70C42"> <enum>(I)</enum> <text>Surveys of physicians, other suppliers, providers of services, manufacturers, and vendors.</text> </subclause>
<subclause id="HF7C64716E4E44D4A92BA484517189CC8"> <enum>(II)</enum> <text>Surgical logs, billing systems, or other practice or facility records.</text> </subclause>
<subclause id="H2C4FF7699A9A43E48B0A5E3BA9E6DF86"> <enum>(III)</enum> <text>Electronic health records.</text> </subclause>
<subclause id="H79E31867B6424FF79536325C2E8CE428"> <enum>(IV)</enum> <text>Any other mechanism determined appropriate by the Secretary.</text> </subclause></clause>
<clause id="H97DB1DFE4F64414B8CA8B235538B56FC"> <enum>(v)</enum> <header>Transparency of use of information</header>
<subclause id="H4349C9768C84414F84A847BDC69650F0"> <enum>(I)</enum> <header>In general</header> <text>Subject to subclauses (II) and (III), if the Secretary uses information collected or obtained under this subparagraph in the determination of relative values under this subsection, the Secretary shall disclose the information source and discuss the use of such information in such determination of relative values through notice and comment rulemaking.</text> </subclause>
<subclause id="H6DA58934CB11447687BFD3C152E4CF22"> <enum>(II)</enum> <header>Thresholds for use</header> <text>The Secretary may establish thresholds in order to use such information, including the exclusion of information collected or obtained from eligible professionals who use very high resources (as determined by the Secretary) in furnishing a service.</text> </subclause>
<subclause id="HF8B2E2A88AF3486EB48EF6F3D6818D2A"> <enum>(III)</enum> <header>Disclosure of information</header> <text>The Secretary shall make aggregate information available under this subparagraph but shall not disclose information in a form or manner that identifies an eligible professional or a group practice, or information collected or obtained pursuant to a nondisclosure agreement.</text> </subclause></clause>
<clause id="HFA2A8925160B47898A6A814CDEDBB50B"> <enum>(vi)</enum> <header>Incentive to participate</header> <text>The Secretary may provide for such payments under this part to an eligible professional that submits such solicited information under this subparagraph as the Secretary determines appropriate in order to compensate such eligible professional for such submission. Such payments shall be provided in a form and manner specified by the Secretary.</text> </clause>
<clause id="H3B2965877CEB41E694FA7175451E6108"> <enum>(vii)</enum> <header>Administration</header> <text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/44/35">Chapter 35</external-xref> of title 44, United States Code, shall not apply to information collected or obtained under this subparagraph.</text> </clause>
<clause id="HF6327F3F48B741B790D5A94F42DF157F"> <enum>(viii)</enum> <header>Definition of eligible professional</header> <text>In this subparagraph, the term <term>eligible professional</term> has the meaning given such term in subsection (k)(3)(B).</text> </clause>
<clause commented="no" id="H88ED5FAD8CF946328C1D79C3F8D06D23"> <enum>(ix)</enum> <header>Funding</header> <text>For purposes of carrying out this subparagraph, in addition to funds otherwise appropriated, the Secretary shall provide for the transfer, from the Federal Supplementary Medical Insurance Trust Fund under section 1841, of $2,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for each fiscal year beginning with fiscal year 2014. Amounts transferred under the preceding sentence for a fiscal year shall be available until expended.</text> </clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph>
<paragraph commented="no" id="H8646F893B5534D239FBA54248E1A4E06"> <enum>(2)</enum> <header>Limitation on review</header> <text>Section 1848(i)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(i)(1)</external-xref>) is amended—</text>
<subparagraph commented="no" id="H16CF021907B043BBA22E50EEB311AC7C"> <enum>(A)</enum> <text>in subparagraph (D), by striking <quote>and</quote> at the end;</text> </subparagraph>
<subparagraph commented="no" id="H2A8369A4AAAF4013808BBA7BA1FECC08"> <enum>(B)</enum> <text>in subparagraph (E), by striking the period at the end and inserting <quote>, and</quote>; and</text> </subparagraph>
<subparagraph commented="no" id="HD832FB79C48E4D8BBFE785ED917531CA"> <enum>(C)</enum> <text>by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HCDC74DB1F63B44A29C0A8905C989F488" style="OLC">
<subparagraph commented="no" id="HA4D7A5CA768F4A4386B16D945F91A230"> <enum>(F)</enum> <text>the collection and use of information in the determination of relative values under subsection (c)(2)(M).</text> </subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </subparagraph></paragraph></subsection>
<subsection commented="no" id="H422CF7E42DB845AA8E066594AB9AB17B"> <enum>(b)</enum> <header>Authority for alternative approaches To establishing practice expense relative values</header> <text>Section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>), as amended by subsection (a), is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HDB39C171816147449D15B6C951B1E15B" style="OLC">
<subparagraph commented="no" id="H83706CF141004AAA973A6168D1F60B1E"> <enum>(N)</enum> <header>Authority for alternative approaches to establishing practice expense relative values</header> <text>The Secretary may establish or adjust practice expense relative values under this subsection using cost, charge, or other data from suppliers or providers of services, including information collected or obtained under subparagraph (M).</text> </subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </subsection>
<subsection id="HD5688CA20A1E4A4EBFB8EC009953738C"> <enum>(c)</enum> <header>Revised and expanded identification of potentially misvalued codes</header> <text>Section 1848(c)(2)(K)(ii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(K)(ii)</external-xref>) is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="HC52FF4784C16428BA19F3043D0110763" style="OLC">
<clause id="H38E73866B02A49E8A1F0BDCD5D6AB948"> <enum>(ii)</enum> <header>Identification of potentially misvalued codes</header> <text>For purposes of identifying potentially misvalued codes pursuant to clause (i)(I), the Secretary shall examine codes (and families of codes as appropriate) based on any or all of the following criteria:</text>
<subclause id="H5309679AF0E34D5B88AEEEAACAAC2F01"> <enum>(I)</enum> <text>Codes that have experienced the fastest growth.</text> </subclause>
<subclause id="H0D91107E78D94AED9E19B014F90C1BF7"> <enum>(II)</enum> <text>Codes that have experienced substantial changes in practice expenses.</text> </subclause>
<subclause id="HC5BC083BC8AA43298DD08194124CBD7F"> <enum>(III)</enum> <text>Codes that describe new technologies or services within an appropriate time period (such as 3 years) after the relative values are initially established for such codes.</text> </subclause>
<subclause id="H439BD5C5B75B4091B8366B70FCFDD0CA"> <enum>(IV)</enum> <text>Codes which are multiple codes that are frequently billed in conjunction with furnishing a single service.</text> </subclause>
<subclause id="H0B0C1ED42E03444EBB354AEEF5A0B449"> <enum>(V)</enum> <text>Codes with low relative values, particularly those that are often billed multiple times for a single treatment.</text> </subclause>
<subclause id="HF479F27576A5408286F7D96DEE0B9CC3"> <enum>(VI)</enum> <text>Codes that have not been subject to review since implementation of the fee schedule.</text> </subclause>
<subclause id="HCECB848B800D4E53AF015F00E91E3CB7"> <enum>(VII)</enum> <text>Codes that account for the majority of spending under the physician fee schedule.</text> </subclause>
<subclause id="H82961B90290D4FD389117D2E89FBEB4D"> <enum>(VIII)</enum> <text>Codes for services that have experienced a substantial change in the hospital length of stay or procedure time.</text> </subclause>
<subclause id="HF149851A8EBB4481AE06FDCFDB654C47"> <enum>(IX)</enum> <text>Codes for which there may be a change in the typical site of service since the code was last valued.</text> </subclause>
<subclause commented="no" id="H32F83702642C4CF293BB31AEBB94BD9B"> <enum>(X)</enum> <text>Codes for which there is a significant difference in payment for the same service between different sites of service.</text> </subclause>
<subclause id="H9810BD847F314DD0A071C08C50A4F81D"> <enum>(XI)</enum> <text>Codes for which there may be anomalies in relative values within a family of codes.</text> </subclause>
<subclause id="H5E13FF01767E46B2B68EC481DB8A4DF1"> <enum>(XII)</enum> <text>Codes for services where there may be efficiencies when a service is furnished at the same time as other services.</text> </subclause>
<subclause id="HC34752E85AF640E7AB58EA9EEC9C3028"> <enum>(XIII)</enum> <text>Codes with high intra-service work per unit of time.</text> </subclause>
<subclause id="H91D1863A0D5C4FD6B238F5D363CDAFA8"> <enum>(XIV)</enum> <text>Codes with high practice expense relative value units.</text> </subclause>
<subclause id="H58A3BD148B7346169B9D44F348EC7C2A"> <enum>(XV)</enum> <text>Codes with high cost supplies.</text> </subclause>
<subclause id="H1D0ABA5DF6FD443AABD9687D45223ADD"> <enum>(XVI)</enum> <text>Codes as determined appropriate by the Secretary.</text> </subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block> </subsection>
<subsection id="H878EAA04912B47E69EAD6ABC9E39FEC0"> <enum>(d)</enum> <header>Target for relative value adjustments for misvalued services</header>
<paragraph id="H68AAD29A89F846188DD186409F093E5A"> <enum>(1)</enum> <header>In general</header> <text>Section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>), as amended by subsections (a) and (b), is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H57CE7A6D884A4D118781721968F06F7A" style="OLC">
<subparagraph id="H63F1D485D38349B0A08883B4979DFE88"> <enum>(O)</enum> <header>Target for relative value adjustments for misvalued services</header> <text>With respect to fee schedules established for each of 2017 through 2020, the following shall apply:</text>
<clause id="H2D807FA4B50E46FB97430A25367E961D"> <enum>(i)</enum> <header>Determination of net reduction in expenditures</header> <text>For each year, the Secretary shall determine the estimated net reduction in expenditures under the fee schedule under this section with respect to the year as a result of adjustments to the relative values established under this paragraph for misvalued codes.</text> </clause>
<clause id="H37FE3EB34E0D470DAA2D838DDB018E99"> <enum>(ii)</enum> <header>Budget neutral redistribution of funds if target met and counting overages towards the target for the succeeding year</header> <text>If the estimated net reduction in expenditures determined under clause (i) for the year is equal to or greater than the target for the year—</text>
<subclause id="HCF14F848658B4933B5F14D5606169B45"> <enum>(I)</enum> <text>reduced expenditures attributable to such adjustments shall be redistributed for the year in a budget neutral manner in accordance with subparagraph (B)(ii)(II); and</text> </subclause>
<subclause id="H571F7FFD11B84FA2A45521DF64E57A1B"> <enum>(II)</enum> <text>the amount by which such reduced expenditures exceeds the target for the year shall be treated as a reduction in expenditures described in clause (i) for the succeeding year, for purposes of determining whether the target has or has not been met under this subparagraph with respect to that year.</text> </subclause></clause>
<clause id="H2CB75D016A8F462DB8242A93984827AD"> <enum>(iii)</enum> <header>Exemption from budget neutrality if target not met</header> <text>If the estimated net reduction in expenditures determined under clause (i) for the year is less than the target for the year, reduced expenditures in an amount equal to the target recapture amount shall not be taken into account in applying subparagraph (B)(ii)(II) with respect to fee schedules beginning with 2017.</text> </clause>
<clause id="H2A5B8EDDD69C44A28070EBFBBC9C2587"> <enum>(iv)</enum> <header>Target recapture amount</header> <text>For purposes of clause (iii), the target recapture amount is, with respect to a year, an amount equal to the difference between—</text>
<subclause id="H65EC93F826FB475FAA218FB7AB3AED46"> <enum>(I)</enum> <text>the target for the year; and</text> </subclause>
<subclause id="H8183E8E576C04660830EAECE4912F4D9"> <enum>(II)</enum> <text>the estimated net reduction in expenditures determined under clause (i) for the year.</text> </subclause></clause>
<clause id="HB5AD7162145A41C099B7516A69CA808D"> <enum>(v)</enum> <header>Target</header> <text>For purposes of this subparagraph, with respect to a year, the target is calculated as 0.5 percent of the estimated amount of expenditures under the fee schedule under this section for the year.</text> </clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph>
<paragraph id="H8F4FF53179D147F09F3832F698AF3C2E"> <enum>(2)</enum> <header>Conforming amendment</header> <text>Section 1848(c)(2)(B)(v) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(B)(v)</external-xref>) is amended by adding at the end the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="H610D77B84A654FD9895E5795BE28560B" style="OLC">
<subclause id="HB16970F690EA4D26AD0794FABCCAE622"> <enum>(VIII)</enum> <header>Reductions for misvalued services if target not met</header> <text>Effective for fee schedules beginning with 2017, reduced expenditures attributable to the application of the target recapture amount described in subparagraph (O)(iii).</text> </subclause><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection>
<subsection id="HE25718E4B7884E0B9A1C8EAD91747ED6"> <enum>(e)</enum> <header>Phase-In of significant relative value unit (RVU) reductions</header>
<paragraph id="H44E48830F7D742879C16A4544046B075"> <enum>(1)</enum> <header>In general</header> <text>Section 1848(c) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)</external-xref>) is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H1C68D98B48CD4B23B6B5791C553FB351" style="OLC">
<paragraph id="HF6980DFEA3054D5C85A1FBB4B883F098"> <enum>(7)</enum> <header>Phase-in of significant relative value unit (RVU) reductions</header> <text>Effective for fee schedules established beginning with 2017, for services that are not new or revised codes, if the total relative value units for a service for a year would otherwise be decreased by an estimated amount equal to or greater than 20 percent as compared to the total relative value units for the previous year, the applicable adjustments in work, practice expense, and malpractice relative value units shall be phased-in over a 2-year period.</text> </paragraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph>
<paragraph id="H3B82542281A64918A8D31A92C835B610"> <enum>(2)</enum> <header>Conforming amendments</header> <text>Section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>) is amended—</text>
<subparagraph id="H67D4FF232FEB48B6A318567C97371683"> <enum>(A)</enum> <text>in subparagraph (B)(ii)(I), by striking <quote>subclause (II)</quote> and inserting <quote>subclause (II) and paragraph (7)</quote>; and</text> </subparagraph>
<subparagraph id="HD9923B2AF2E14E8D9FEC2C43529CB07D"> <enum>(B)</enum> <text>in subparagraph (K)(iii)(VI)—</text>
<clause id="HC313B669252848E5BD687A0E5CB00ED4"> <enum>(i)</enum> <text>by striking <quote>provisions of subparagraph (B)(ii)(II)</quote> and inserting <quote>provisions of subparagraph (B)(ii)(II) and paragraph (7)</quote>; and</text> </clause>
<clause id="HBB08C64D72604AC9861149AFE5905E4E"> <enum>(ii)</enum> <text>by striking <quote>under subparagraph (B)(ii)(II)</quote> and inserting <quote>under subparagraph (B)(ii)(I)</quote>.</text> </clause></subparagraph></paragraph></subsection>
<subsection id="HB8C73CF8A20D488D8C58225057C7F4CA"> <enum>(f)</enum> <header>Authority To smooth relative values within groups of services</header> <text>Section 1848(c)(2)(C) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(C)</external-xref>) is amended—</text>
<paragraph id="H4CDAC39544724DAAA12C6E42B945C746"> <enum>(1)</enum> <text>in each of clauses (i) and (iii), by striking <quote>the service</quote> and inserting <quote>the service or group of services</quote> each place it appears; and</text> </paragraph>
<paragraph id="H747D9D49CF79494390060CB335420969"> <enum>(2)</enum> <text>in the first sentence of clause (ii), by inserting <quote>or group of services</quote> before the period.</text> </paragraph></subsection>
<subsection commented="no" id="H3C34BBA509BD48638FFC60C122F27FDD"> <enum>(g)</enum> <header>GAO study and report on Relative Value Scale Update Committee</header>
<paragraph commented="no" id="HD4AA2C73B63B4F3CBA4401744D4E4988"> <enum>(1)</enum> <header>Study</header> <text>The Comptroller General of the United States (in this subsection referred to as the <quote>Comptroller General</quote>) shall conduct a study of the processes used by the Relative Value Scale Update Committee (RUC) to provide recommendations to the Secretary of Health and Human Services regarding relative values for specific services under the Medicare physician fee schedule under section 1848 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4</external-xref>).</text> </paragraph>
<paragraph commented="no" id="HF3A5404150AC43759046A73154C2538F"> <enum>(2)</enum> <header>Report</header> <text>Not later than 1 year after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1).</text> </paragraph></subsection>
<subsection id="H4B5F9D8D297A4D2CA03764DDC132E27A"> <enum>(h)</enum> <header>Adjustment to Medicare payment localities</header>
<paragraph id="H284F123634334C02B01679E01899FB31"> <enum>(1)</enum> <header>In general</header> <text>Section 1848(e) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(e)</external-xref>) is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H73DAFA46742644D183273D25E4915C08" style="OLC">
<paragraph id="HE130C22467304D3982DFB0E13DE59EA4"> <enum>(6)</enum> <header>Use of MSAs as fee schedule areas in California</header>
<subparagraph id="HACBF84C6676D4F83837877C9098835AF"> <enum>(A)</enum> <header>In general</header> <text display-inline="yes-display-inline">Subject to the succeeding provisions of this paragraph and notwithstanding the previous provisions of this subsection, for services furnished on or after January 1, 2017, the fee schedule areas used for payment under this section applicable to California shall be the following:</text>
<clause id="H2780DBB842024B7F8F5C7708EE99FAC1"> <enum>(i)</enum> <text>Each Metropolitan Statistical Area (each in this paragraph referred to as an <quote>MSA</quote>), as defined by the Director of the Office of Management and Budget as of December 31 of the previous year, shall be a fee schedule area.</text> </clause>
<clause id="H76D955A015D4453EA1F062F9F9AD132D"> <enum>(ii)</enum> <text>All areas not included in an MSA shall be treated as a single rest-of-State fee schedule area.</text> </clause></subparagraph>
<subparagraph display-inline="no-display-inline" id="HC381211780094627AED223FC2ADFFA31"> <enum>(B)</enum> <header>Transition for MSAs previously in rest-of-State payment locality or in locality 3</header>
<clause id="H6D21D696B41B4EDEB0B7A4E22F7CA7F6"> <enum>(i)</enum> <header>In general</header> <text display-inline="yes-display-inline">For services furnished in California during a year beginning with 2017 and ending with 2021 in an MSA in a transition area (as defined in subparagraph (D)), subject to subparagraph (C), the geographic index values to be applied under this subsection for such year shall be equal to the sum of the following:</text>
<subclause id="HC1041F726B7E4355A3016918F9CA1D05"> <enum>(I)</enum> <header>Current law component</header> <text display-inline="yes-display-inline">The old weighting factor (described in clause (ii)) for such year multiplied by the geographic index values under this subsection for the fee schedule area that included such MSA that would have applied in such area (as estimated by the Secretary) if this paragraph did not apply.</text> </subclause>
<subclause id="H2C7A4C00551449C9AB930C6352BAE6B3"> <enum>(II)</enum> <header>MSA-based component</header> <text>The MSA-based weighting factor (described in clause (iii)) for such year multiplied by the geographic index values computed for the fee schedule area under subparagraph (A) for the year (determined without regard to this subparagraph).</text> </subclause></clause>
<clause display-inline="no-display-inline" id="HD038D343D1E840938D40EEC9A287BE68"> <enum>(ii)</enum> <header>Old weighting factor</header> <text>The old weighting factor described in this clause—</text>
<subclause id="HE7CB84C957E646DA8AE57CDC0FA31EB9"> <enum>(I)</enum> <text>for 2017, is <fraction>5/6</fraction>; and</text> </subclause>
<subclause id="HDF3E5D6D2D6946A6AF9C3DC5771D5AB5"> <enum>(II)</enum> <text display-inline="yes-display-inline">for each succeeding year, is the old weighting factor described in this clause for the previous year minus <fraction>1/6</fraction>.</text> </subclause></clause>
<clause id="HDF763D48ECB04D62A0B73F7E78BF2613"> <enum>(iii)</enum> <header>MSA-based weighting factor</header> <text>The MSA-based weighting factor described in this clause for a year is 1 minus the old weighting factor under clause (ii) for that year.</text> </clause></subparagraph>
<subparagraph id="HE68DFB1D05A946BDB2D60AEE3FF4DB4A"> <enum>(C)</enum> <header>Hold harmless</header> <text display-inline="yes-display-inline">For services furnished in a transition area in California during a year beginning with 2017, the geographic index values to be applied under this subsection for such year shall not be less than the corresponding geographic index values that would have applied in such transition area (as estimated by the Secretary) if this paragraph did not apply.</text> </subparagraph>
<subparagraph id="H9ED26E522FA14193B1AAFB2D4AE71F66"> <enum>(D)</enum> <header>Transition area defined</header> <text display-inline="yes-display-inline">In this paragraph, the term <term>transition area</term> means each of the following fee schedule areas for 2013:</text>
<clause id="HF9DE944D14C34525808BEEDA69F6282F"> <enum>(i)</enum> <text>The rest-of-State payment locality.</text> </clause>
<clause id="HBE416639E462494181AE4EE2670F5258"> <enum>(ii)</enum> <text>Payment locality 3.</text> </clause></subparagraph>
<subparagraph id="H857A178FFFA048B1AA85C55E44B6B1A3"> <enum>(E)</enum> <header>References to fee schedule areas</header> <text display-inline="yes-display-inline">Effective for services furnished on or after January 1, 2017, for California, any reference in this section to a fee schedule area shall be deemed a reference to a fee schedule area established in accordance with this paragraph.</text> </subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph>
<paragraph id="H1C165F4FCFEE459EB66D946036066BC5"> <enum>(2)</enum> <header>Conforming amendment to definition of fee schedule area</header> <text>Section 1848(j)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(j)(2)</external-xref>) is amended by striking <quote>The term</quote> and inserting <quote>Except as provided in subsection (e)(6)(D), the term</quote>.</text> </paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HF259531722334E6E93B2B0374581199E"><enum>(i)</enum><header>Disclosure of data used To establish multiple procedure payment reduction policy</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services shall make publicly available the information used to establish the multiple procedure payment reduction policy to the professional component of imaging services in the final rule published in the Federal Register, v. 77, n. 222, November 16, 2012, pages 68891–69380 under the physician fee schedule under section 1848 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4</external-xref>).</text> </subsection></section>
<section display-inline="no-display-inline" id="HEED071E39240466D8CB65865953F6F57"> <enum>221.</enum> <header>Medicaid DSH</header>
<subsection id="H86E1E6A2A6254040B40563B6E9B87F4C"><enum>(a)</enum><header>Modifications of reductions to allotments</header><text>Section 1923(f) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-4">42 U.S.C. 1396r–4(f)</external-xref>) is amended—</text>
<paragraph id="H5ACF87C742DB4FBB9D75BD401119DC0A"><enum>(1)</enum><text>in paragraph (7)(A)—</text>
<subparagraph id="HA2448A40D5C74E8998F4A9C5599C26DE"><enum>(A)</enum><text>in clause (i), by striking <quote>2016 through 2020</quote> and inserting <quote>2017 through 2024</quote>; and</text> </subparagraph>
<subparagraph id="H2896EF7C52FB42258DCB67A550ABB438"><enum>(B)</enum><text>in clause (ii), by striking subclauses (I) through (IV), and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="H09789FCA212541429EA1A0673BFED9D9" style="OLC">
<subclause id="HDCA35DAC7BCE468590AF897858B3662E"><enum>(I)</enum><text>$1,800,000,000 for fiscal year 2017;</text> </subclause>
<subclause id="H46710DCB4E1E49F6A4306164BF7EED76"><enum>(II)</enum><text>$4,700,000,000 for fiscal year 2018;</text> </subclause>
<subclause id="H2842AE769D0646BF9812FB9497FA4770"><enum>(III)</enum><text>$4,700,000,000 for fiscal year 2019;</text> </subclause>
<subclause id="HDCD8756F7FAB4EED8458B874952C7FE6"><enum>(IV)</enum><text>$4,700,000,000 for fiscal year 2020;</text> </subclause>
<subclause id="H1BBFF0ABA4F74D7984B248227267BF21"><enum>(V)</enum><text>$4,800,000,000 for fiscal year 2021;</text> </subclause>
<subclause id="H34443BDA7D3E4EC8841D6ED0C47F3A38"><enum>(VI)</enum><text>$5,000,000,000 for fiscal year 2022;</text> </subclause>
<subclause id="H9144B6DD501D41F38623060A53BB83C8"><enum>(VII)</enum><text>$5,000,000,000 for fiscal year 2023; and</text> </subclause>
<subclause id="HBB8CE34BD72642D4977737421B01168D"><enum>(VIII)</enum><text>$4,400,000,000 for fiscal year 2024.</text></subclause><after-quoted-block>; and</after-quoted-block></quoted-block> </subparagraph></paragraph>
<paragraph id="HA3602557BEAF4FCAA8373E01D53FA001"><enum>(2)</enum><text>by striking paragraph (8) and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="HBB96536EBA194D56AD45272312AA8023" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="HBFA86607D501487A80DD81FB717E5739"><enum>(8)</enum><header display-inline="yes-display-inline">Calculation of <enum-in-header>DSH</enum-in-header> allotments after reductions period</header><text>The DSH allotment for a State for fiscal years after fiscal year 2024 shall be calculated under paragraph (3) without regard to paragraph (7).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection>
<subsection id="H0F6E8DD075424618ACB4D083514CE8AA"><enum>(b)</enum><header>MACPAC review and report</header> <text display-inline="yes-display-inline">Section 1900(b)(6) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396(b)(6)</external-xref>) is amended—</text>
<paragraph id="H9DAD2D0B6DAE405AA5DCF8A1A40FFBB7"><enum>(1)</enum><text display-inline="yes-display-inline">by striking <quote>MACPAC shall consult</quote> and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="HFFA907D825734F2F9089CB26BD9F921E" style="OLC">
<subparagraph id="HC1AB9F03B2CD457F9B6275C50BEDF466"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">MACPAC shall consult</text> </subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block> </paragraph>
<paragraph id="HB06EDD42A97A4A18A49E8ACCA43D702F"><enum>(2)</enum><text>by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H722162106825463A818C51711B9A5A34" style="OLC">
<subparagraph id="H9C1C5521FA704D1EBF4C945C35850F36"><enum>(B)</enum><header>Review and reports regarding Medicaid DSH</header>
<clause id="HE23EB8AEFD99467A893F5E7AE1AF1D0A"> <enum>(i)</enum> <header>In general</header> <text>MACPAC shall review and submit an annual report to Congress on disproportionate share hospital payments under section 1923. Each report shall include the information specified in clause (ii).</text> </clause>
<clause id="H7C4B9F00FD29440B8DCF976BAAC173F5"> <enum>(ii)</enum> <header>Required report information</header> <text>Each report required under this subparagraph shall include the following:</text>
<subclause id="H2A1D7E3FC5564F43AC79E7E022CF43BB"> <enum>(I)</enum> <text>Data relating to changes in the number of uninsured individuals.</text> </subclause>
<subclause id="H5770A97FA90E49D5B9F0945449F9A985"> <enum>(II)</enum> <text>Data relating to the amount and sources of hospitals' uncompensated care costs, including the amount of such costs that are the result of providing unreimbursed or under-reimbursed services, charity care, or bad debt.</text> </subclause>
<subclause id="HEC1F44C3079F4E10B58C633270BFEAA7"> <enum>(III)</enum> <text>Data identifying hospitals with high levels of uncompensated care that also provide access to essential community services for low-income, uninsured, and vulnerable populations, such as graduate medical education, and the continuum of primary through quarternary care, including the provision of trauma care and public health services.</text> </subclause>
<subclause id="HE3A910E704234192906493B9E1E51A44"><enum>(IV)</enum><text>State-specific analyses regarding the relationship between the most recent State DSH allotment and the projected State DSH allotment for the succeeding year and the data reported under subclauses (I), (II), and (III) for the State.</text> </subclause></clause>
<clause id="H788F25D07E0948B9AE59B09F438C2C69"><enum>(iii)</enum><header>Data</header><text>Notwithstanding any other provision of law, the Secretary regularly shall provide MACPAC with the most recent State reports and most recent independent certified audits submitted under section 1923(j), cost reports submitted under title XVIII, and such other data as MACPAC may request for purposes of conducting the reviews and preparing and submitting the annual reports required under this subparagraph.</text> </clause>
<clause id="H97B39B8FAEB54CF19DDDE05C75E34771"><enum>(iv)</enum><header>Submission deadlines</header><text>The first report required under this subparagraph shall be submitted to Congress not later than February 1, 2016. Subsequent reports shall be submitted as part of, or with, each annual report required under paragraph (1)(C) during the period of fiscal years 2017 through 2024.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection></section>
<section id="HC543CDFDB4AE492EA2B970BD2A1DFFC0" section-type="subsequent-section"><enum>222.</enum><header>Realignment of the Medicare sequester for fiscal year 2024</header><text display-inline="no-display-inline">Paragraph (6) (relating to implementing direct spending reductions) of section 251A of the Balanced Budget and Emergency Deficit Control Act of 1985 (<external-xref legal-doc="usc" parsable-cite="usc/2/901a">2 U.S.C. 901a</external-xref>) is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H15F3273973074F689407C8D62713E24F" style="OLC">
<subparagraph id="H13D2F0D0A1F14F69A30441A1C98D6869" indent="up1"><enum>(D)</enum><text display-inline="yes-display-inline">Notwithstanding the 2 percent limit specified in subparagraph (A) for payments for the Medicare programs specified in section 256(d), the sequestration order of the President under such subparagraph for fiscal year 2024 shall be applied to such payments so that—</text>
<clause id="H7B330AECC1244DA6A52F321FA5553209"><enum>(i)</enum><text display-inline="yes-display-inline">with respect to the first 6 months in which such order is effective for such fiscal year, the payment reduction shall be 4.0 percent; and</text> </clause>
<clause id="H771E98D8DD114DDABBE1F782C42C6390"><enum>(ii)</enum><text display-inline="yes-display-inline">with respect to the second 6 months in which such order is so effective for such fiscal year, the payment reduction shall be 0.0 percent.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </section>
<section id="H1DCB12A737DC4561AE47B55A9B915A71"><enum>223.</enum><header>Demonstration programs to improve community mental health services</header>
<subsection id="H58DEEE3FEDEB43B89F1D46CEB518D958"><enum>(a)</enum><header>Criteria for certified community behavioral health clinics To participate in demonstration programs</header>
<paragraph id="HF8CDCFE469B447B59D5F46FD736C923B"><enum>(1)</enum><header>Publication</header><text>Not later than September 1, 2015, the Secretary shall publish criteria for a clinic to be certified by a State as a certified community behavioral health clinic for purposes of participating in a demonstration program conducted under subsection (d).</text> </paragraph>
<paragraph id="H4D331CD190EC4F94BABFF0B1056D2385"><enum>(2)</enum><header>Requirements</header><text>The criteria published under this subsection shall include criteria with respect to the following:</text>
<subparagraph id="HE914CADFF2D9438CBBD51A3F7AC0FB60"><enum>(A)</enum><header>Staffing</header><text>Staffing requirements, including criteria that staff have diverse disciplinary backgrounds, have necessary State-required license and accreditation, and are culturally and linguistically trained to serve the needs of the clinic's patient population.</text> </subparagraph>
<subparagraph id="H5D06B4E31CBB47BD80B48A877C449336"><enum>(B)</enum><header>Availability and accessibility of services</header><text>Availability and accessibility of services, including crisis management services that are available and accessible 24 hours a day, the use of a sliding scale for payment, and no rejection for services or limiting of services on the basis of a patient's ability to pay or a place of residence.</text> </subparagraph>
<subparagraph id="H69B46E503EC947A680C2A01721C2E1A2"><enum>(C)</enum><header>Care coordination</header><text>Care coordination, including requirements to coordinate care across settings and providers to ensure seamless transitions for patients across the full spectrum of health services including acute, chronic, and behavioral health needs. Care coordination requirements shall include partnerships or formal contracts with the following:</text>
<clause id="HA4336156E0A2473B825409B17217266C"><enum>(i)</enum><text>Federally-qualified health centers (and as applicable, rural health clinics) to provide Federally-qualified health center services (and as applicable, rural health clinic services) to the extent such services are not provided directly through the certified community behavioral health clinic.</text> </clause>
<clause id="H3AB234F81BEA4AF680AB535DC75155DE"><enum>(ii)</enum><text>Inpatient psychiatric facilities and substance use detoxification, post-detoxification step-down services, and residential programs.</text> </clause>
<clause id="H86880AA70F994322B9BE9C43B107B6F1"><enum>(iii)</enum><text>Other community or regional services, supports, and providers, including schools, child welfare agencies, juvenile and criminal justice agencies and facilities, Indian Health Service youth regional treatment centers, State licensed and nationally accredited child placing agencies for therapeutic foster care service, and other social and human services.</text> </clause>
<clause id="H991C7894BF424D8DA81033BF935CB2FF"><enum>(iv)</enum><text>Department of Veterans Affairs medical centers, independent outpatient clinics, drop-in centers, and other facilities of the Department as defined in <external-xref legal-doc="usc" parsable-cite="usc/38/1801">section 1801</external-xref> of title 38, United States Code.</text> </clause>
<clause id="H1A9B6CA0B42E43A78E6BD30DCE365914"><enum>(v)</enum><text>Inpatient acute care hospitals and hospital outpatient clinics.</text> </clause></subparagraph>
<subparagraph id="H7040AD0E5C4F439C86308F4FFBD806BB"><enum>(D)</enum><header>Scope of services</header><text>Provision (in a manner reflecting person-centered care) of the following services which, if not available directly through the certified community behavioral health clinic, are provided or referred through formal relationships with other providers:</text>
<clause id="H9E08F41B2DAF4F89B5FDE5677C5D6E1E"><enum>(i)</enum><text>Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization.</text> </clause>
<clause id="H247B5A828ACA46978A96914D7BC145AA"><enum>(ii)</enum><text>Screening, assessment, and diagnosis, including risk assessment.</text> </clause>
<clause id="HCD489A66E27040D3BBE63E831B85EEC1"><enum>(iii)</enum><text>Patient-centered treatment planning or similar processes, including risk assessment and crisis planning.</text> </clause>
<clause id="H08025BDC93DB4701A75677B43C8546CE"><enum>(iv)</enum><text>Outpatient mental health and substance use services.</text> </clause>
<clause id="HCD0CD6D4B93045CDA62ED91FF63C88F4"><enum>(v)</enum><text>Outpatient clinic primary care screening and monitoring of key health indicators and health risk.</text> </clause>
<clause id="H017AB1BAD7C043ABAA46585939055E31"><enum>(vi)</enum><text>Targeted case management.</text> </clause>
<clause id="H457098FD3EA34B10AC00888FDF4C8A05"><enum>(vii)</enum><text>Psychiatric rehabilitation services.</text> </clause>
<clause id="H11304811E08E4D449AD7BB1A9C43A4B1"><enum>(viii)</enum><text>Peer support and counselor services and family supports.</text> </clause>
<clause id="HFD2AAB758616434496EFB9AE96341488"><enum>(ix)</enum><text>Intensive, community-based mental health care for members of the armed forces and veterans, particularly those members and veterans located in rural areas, provided the care is consistent with minimum clinical mental health guidelines promulgated by the Veterans Health Administration including clinical guidelines contained in the Uniform Mental Health Services Handbook of such Administration.</text> </clause></subparagraph>
<subparagraph id="HC52A25FCDF9943B8B2AAA54C71910EE8"><enum>(E)</enum><header>Quality and other reporting</header><text>Reporting of encounter data, clinical outcomes data, quality data, and such other data as the Secretary requires.</text> </subparagraph>
<subparagraph id="HF3A8906E42FC48A1AA1D42AD3FD8BDF0"><enum>(F)</enum><header>Organizational authority</header><text>Criteria that a clinic be a non-profit or part of a local government behavioral health authority or operated under the authority of the Indian Health Service, an Indian tribe or tribal organization pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination Act (<external-xref legal-doc="usc" parsable-cite="usc/25/450">25 U.S.C. 450 et seq.</external-xref>), or an urban Indian organization pursuant to a grant or contract with the Indian Health Service under title V of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1601">25 U.S.C. 1601 et seq.</external-xref>).</text> </subparagraph></paragraph></subsection>
<subsection id="H2714DD425292404BBEB01D39A0F748CA"><enum>(b)</enum><header>Guidance on development of prospective payment system for testing under demonstration programs</header>
<paragraph id="HE18F1E4FFAF3468AB173D241A0456C64"><enum>(1)</enum><header>In general</header><text>Not later than September 1, 2015, the Secretary, through the Administrator of the Centers for Medicare & Medicaid Services, shall issue guidance for the establishment of a prospective payment system that shall only apply to medical assistance for mental health services furnished by a certified community behavioral health clinic participating in a demonstration program under subsection (d).</text> </paragraph>
<paragraph id="H7EE82EF309EE4040BEB6DA433C666D31"><enum>(2)</enum><header>Requirements</header><text>The guidance issued by the Secretary under paragraph (1) shall provide that—</text>
<subparagraph id="HC879121BBB0B4F2EAA817330A1E69E8F"><enum>(A)</enum><text>no payment shall be made for inpatient care, residential treatment, room and board expenses, or any other non-ambulatory services, as determined by the Secretary; and</text> </subparagraph>
<subparagraph id="HC8922633BCC248CD8979DDAEBDB02514"><enum>(B)</enum><text>no payment shall be made to satellite facilities of certified community behavioral health clinics if such facilities are established after the date of enactment of this Act.</text> </subparagraph></paragraph></subsection>
<subsection id="H2635496C9D4F470295ACCC6E0DE89058"><enum>(c)</enum><header>Planning grants</header>
<paragraph id="H9221B24C2D694FA99DDF890B75E8C621"><enum>(1)</enum><header>In general</header><text>Not later than January 1, 2016, the Secretary shall award planning grants to States for the purpose of developing proposals to participate in time-limited demonstration programs described in subsection (d).</text> </paragraph>
<paragraph id="H0FD10F51EF994EBCA86C622D48ECF33C"><enum>(2)</enum><header>Use of funds</header><text>A State awarded a planning grant under this subsection shall—</text>
<subparagraph id="H5459D1F415424A539B41988F406588A4"><enum>(A)</enum><text>solicit input with respect to the development of such a demonstration program from patients, providers, and other stakeholders;</text> </subparagraph>
<subparagraph id="HA8DDDCFB2FAE4521858E2AE4CD13B1C0"><enum>(B)</enum><text>certify clinics as certified community behavioral health clinics for purposes of participating in a demonstration program conducted under subsection (d); and</text> </subparagraph>
<subparagraph id="H0957CB33EA9F4862B6C7F926E10F9577"><enum>(C)</enum><text>establish a prospective payment system for mental health services furnished by a certified community behavioral health clinic participating in a demonstration program under subsection (d) in accordance with the guidance issued under subsection (b).</text> </subparagraph></paragraph></subsection>
<subsection id="H9947E79C139341B4996385853A5DAC1D"><enum>(d)</enum><header>Demonstration programs</header>
<paragraph id="HA1D204E1927546D081F4B37E21D3C2C2"><enum>(1)</enum><header>In general</header><text>Not later than September 1, 2017, the Secretary shall select States to participate in demonstration programs that are developed through planning grants awarded under subsection (c), meet the requirements of this subsection, and represent a diverse selection of geographic areas, including rural and underserved areas.</text> </paragraph>
<paragraph id="H410E6FF7DDB741FC8CB9A41805F2164A"><enum>(2)</enum><header>Application requirements</header>
<subparagraph id="H879D4B7A384445DCA31FCAA7453C5BD2"><enum>(A)</enum><header>In general</header><text>The Secretary shall solicit applications to participate in demonstration programs under this subsection solely from States awarded planning grants under subsection (c).</text> </subparagraph>
<subparagraph id="H0B76BC1DF17A48F4B67A8B176CBC7C91"><enum>(B)</enum><header>Required information</header><text>An application for a demonstration program under this subsection shall include the following:</text>
<clause id="H1E7B8A7D69E849889277666C128D79D1"><enum>(i)</enum><text>The target Medicaid population to be served under the demonstration program.</text> </clause>
<clause id="H86BD9D506D8D412FB6AB4151B5CAFFB2"><enum>(ii)</enum><text>A list of participating certified community behavioral health clinics.</text> </clause>
<clause id="H9D5476CF9EAB4BB7894F04CBD8D0F57D"><enum>(iii)</enum><text>Verification that the State has certified a participating clinic as a certified community behavioral health clinic in accordance with the requirements of subsection (b).</text> </clause>
<clause id="H767F5EF80EA94DD59F891EFCE4855656"><enum>(iv)</enum><text>A description of the scope of the mental health services available under the State Medicaid program that will be paid for under the prospective payment system tested in the demonstration program.</text> </clause>
<clause id="H19351BD9BF874CFBB973780D395F9DCD"><enum>(v)</enum><text>Verification that the State has agreed to pay for such services at the rate established under the prospective payment system.</text> </clause>
<clause id="HDD0FE160D6EF4B18889A9197767570CB"><enum>(vi)</enum><text>Such other information as the Secretary may require relating to the demonstration program including with respect to determining the soundness of the proposed prospective payment system.</text> </clause></subparagraph></paragraph>
<paragraph id="H2F596F88EA2C429A9C8D51D58D7FCCD5"><enum>(3)</enum><header>Number and length of demonstration programs</header><text>Not more than 8 States shall be selected for 2-year demonstration programs under this subsection.</text> </paragraph>
<paragraph commented="no" id="HFD12037DDF2F4622B49F543D124854F3"><enum>(4)</enum><header>Requirements for selecting demonstration programs</header>
<subparagraph id="H372814A347E4423D9187B28EB43D0A57"><enum>(A)</enum><header>In general</header><text>The Secretary shall give preference to selecting demonstration programs where participating certified community behavioral health clinics—</text>
<clause id="H374570012E6C4F43BC37CB01F2D6F9B7"><enum>(i)</enum><text>provide the most complete scope of services described in subsection (a)(2)(D) to individuals eligible for medical assistance under the State Medicaid program;</text> </clause>
<clause id="HEC514C8C229C425FAF9B87D854E8F57C"><enum>(ii)</enum><text>will improve availability of, access to, and participation in, services described in subsection (a)(2)(D) to individuals eligible for medical assistance under the State Medicaid program;</text> </clause>
<clause id="H3B75C36456E24A79BBE0D8022122EF7F"><enum>(iii)</enum><text>will improve availability of, access to, and participation in assisted outpatient mental health treatment in the State; or</text> </clause>
<clause id="H3B3AE50A78164D9FBF6D6290F5ECDFA8"><enum>(iv)</enum><text>demonstrate the potential to expand available mental health services in a demonstration area and increase the quality of such services without increasing net Federal spending.</text> </clause></subparagraph></paragraph>
<paragraph id="H7E2E0282772B48AAAE0D9AD2B3751869"><enum>(5)</enum><header>Payment for medical assistance for mental health services provided by certified community behavioral health clinics</header>
<subparagraph id="H2B1969FE6B6149CCACF8D53000106E36"><enum>(A)</enum><header>In general</header><text>The Secretary shall pay a State participating in a demonstration program under this subsection the Federal matching percentage specified in subparagraph (B) for amounts expended by the State to provide medical assistance for mental health services described in the demonstration program application in accordance with paragraph (2)(B)(iv) that are provided by certified community behavioral health clinics to individuals who are enrolled in the State Medicaid program. Payments to States made under this paragraph shall be considered to have been under, and are subject to the requirements of, section 1903 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b</external-xref>).</text> </subparagraph>
<subparagraph id="HE872BBD6F3024D3F8220ED172943EDA7"><enum>(B)</enum><header>Federal matching percentage</header><text>The Federal matching percentage specified in this subparagraph is with respect to medical assistance described in subparagraph (A) that is furnished—</text>
<clause id="H5764192912474C4E8CE72AA084379126"><enum>(i)</enum><text>to a newly eligible individual described in paragraph (2) of section 1905(y) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(y)</external-xref>), the matching rate applicable under paragraph (1) of that section; and</text> </clause>
<clause id="HE865E194FCE5491D987632B0D16A9019"><enum>(ii)</enum><text>to an individual who is not a newly eligible individual (as so described) but who is eligible for medical assistance under the State Medicaid program, the enhanced FMAP applicable to the State.</text> </clause></subparagraph>
<subparagraph id="HE6496D16FFCA4F36B8ACB21ED9211333"><enum>(C)</enum><header>Limitations</header>
<clause id="H2B246EB01B0D4379BF5C42E145CFE5B3"><enum>(i)</enum><header>In general</header><text>Payments shall be made under this paragraph to a State only for mental health services—</text>
<subclause id="H7F87D3B171D14BEF87217F4C7FB6A35F"><enum>(I)</enum><text>that are described in the demonstration program application in accordance with paragraph (2)(iv);</text> </subclause>
<subclause id="H3C56DB88EE6245099627E1B4CCF362CB"><enum>(II)</enum><text>for which payment is available under the State Medicaid program; and</text> </subclause>
<subclause id="HE1741D5DA6B64B50B9DB3A381F926C05"><enum>(III)</enum><text>that are provided to an individual who is eligible for medical assistance under the State Medicaid program.</text> </subclause></clause>
<clause id="HB40437F9B8DA414BAC561BD84B4F7D53"><enum>(ii)</enum><header>Prohibited payments</header><text>No payment shall be made under this paragraph—</text>
<subclause id="H33F67189316B45929EB5C656A9371A32"><enum>(I)</enum><text>for inpatient care, residential treatment, room and board expenses, or any other non-ambulatory services, as determined by the Secretary; or</text> </subclause>
<subclause id="H6725D8170E3046DEBA982F9D2B770393"><enum>(II)</enum><text>with respect to payments made to satellite facilities of certified community behavioral health clinics if such facilities are established after the date of enactment of this Act.</text> </subclause></clause></subparagraph></paragraph>
<paragraph id="HE6E0928A4E0446298D5DD01F1AC66732"><enum>(6)</enum><header>Waiver of statewideness requirement</header><text>The Secretary shall waive section 1902(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(1)</external-xref>) (relating to statewideness) as may be necessary to conduct demonstration programs in accordance with the requirements of this subsection.</text> </paragraph>
<paragraph id="HA6E8EA319B2D4CF98BB7ABAC41AB9A7D"><enum>(7)</enum><header>Annual reports</header>
<subparagraph id="H06366D542FD042418B2C3BE711B9259B"><enum>(A)</enum><header>In general</header><text>Not later than 1 year after the date on which the first State is selected for a demonstration program under this subsection, and annually thereafter, the Secretary shall submit to Congress an annual report on the use of funds provided under all demonstration programs conducted under this subsection. Each such report shall include—</text>
<clause id="H974F9345DAAD42F3B8F6B80A0C9DB917"><enum>(i)</enum><text>an assessment of access to community-based mental health services under the Medicaid program in the area or areas of a State targeted by a demonstration program compared to other areas of the State;</text> </clause>
<clause id="H80BF3C788F6D45D1B5D3871F9A52E2C3"><enum>(ii)</enum><text>an assessment of the quality and scope of services provided by certified community behavioral health clinics compared to community-based mental health services provided in States not participating in a demonstration program under this subsection and in areas of a demonstration State that are not participating in the demonstration program; and</text> </clause>
<clause id="H2743FEB99B66450FBB616D35B291DB1D"><enum>(iii)</enum><text>an assessment of the impact of the demonstration programs on the Federal and State costs of a full range of mental health services (including inpatient, emergency and ambulatory services).</text> </clause></subparagraph>
<subparagraph id="H909FB0A7A2CD48359653DA4A08BC52C0"><enum>(B)</enum><header>Recommendations</header><text>Not later than December 31, 2021, the Secretary shall submit to Congress recommendations concerning whether the demonstration programs under this section should be continued, expanded, modified, or terminated.</text> </subparagraph></paragraph></subsection>
<subsection id="H7B044C26502F4198BB3884CAF0ED9A4D"><enum>(e)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H000257A76256463C94E4C9552FAF9DE1"><enum>(1)</enum><header>Federally-qualified health center services; Federally-qualified health center; rural health clinic services; rural health clinic</header><text>The terms <term>Federally-qualified health center services</term>, <term>Federally-qualified health center</term>, <term>rural health clinic services</term>, and <term>rural health clinic</term> have the meanings given those terms in section 1905(l) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(l)</external-xref>).</text> </paragraph>
<paragraph id="H4B68F774D10A4AC1ABDAAE51606B83E0"><enum>(2)</enum><header>Enhanced FMAP</header><text>The term <term>enhanced FMAP</term> has the meaning given that term in section 2105(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397dd">42 U.S.C. 1397dd(b)</external-xref>) but without regard to the second and third sentences of that section.</text> </paragraph>
<paragraph id="H36C7CCD15BC24F23B23C59DAE8292461"><enum>(3)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Health and Human Services.</text> </paragraph>
<paragraph id="HE3B23CF64CC747C58D239CF06467C505"><enum>(4)</enum><header>State</header><text>The term <term>State</term> has the meaning given such term for purposes of title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>).</text> </paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H08C1FC4C7D3F4B7BB64772BBC5C6368B"><enum>(f)</enum><header>Funding</header>
<paragraph commented="no" display-inline="no-display-inline" id="HAA87CC0DCA864A53926BFF043B0D115F"><enum>(1)</enum><header>In general</header><text>Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary—</text>
<subparagraph id="H79946FA5EAAE479990DEA14AE2EFAE12"><enum>(A)</enum><text>for purposes of carrying out subsections (a), (b), and (d)(7), $2,000,000 for fiscal year 2014; and</text> </subparagraph>
<subparagraph id="H118EF92BF50449BF84C1FFFA18CDE0A4"><enum>(B)</enum><text>for purposes of awarding planning grants under subsection (c), $25,000,000 for fiscal year 2016.</text> </subparagraph></paragraph>
<paragraph commented="no" id="H93269F8AE1A34B4EB4E20432B4CB1565"><enum>(2)</enum><header>Availability</header><text>Funds appropriated under paragraph (1) shall remain available until expended.</text> </paragraph></subsection></section>
<section id="HC8B9CBD0AFAE40238F633D90DA44ACAA"><enum>224.</enum><header>Assisted outpatient treatment grant program for individuals with serious mental illness</header>
<subsection id="H6190329097E648D796E113ED6F6F48A2"><enum>(a)</enum><header>In general</header><text>The Secretary shall establish a 4-year pilot program to award not more than 50 grants each year to eligible entities for assisted outpatient treatment programs for individuals with serious mental illness.</text> </subsection>
<subsection id="HFAEED2F5F66043D498826A34AC574019"><enum>(b)</enum><header>Consultation</header><text display-inline="yes-display-inline">The Secretary shall carry out this section in consultation with the Director of the National Institute of Mental Health, the Attorney General of the United States, the Administrator of the Administration for Community Living, and the Administrator of the Substance Abuse and Mental Health Services Administration.</text> </subsection>
<subsection id="HB3A4B45FD979479681F56D13F0ACF02E"><enum>(c)</enum><header>Selecting among applicants</header><text>The Secretary—</text>
<paragraph id="HB3D5AB3BF62C418A9C0B31F87FE04085"><enum>(1)</enum><text>may only award grants under this section to applicants that have not previously implemented an assisted outpatient treatment program; and</text> </paragraph>
<paragraph id="H4D2D5A83BEC940899E803AB08411D6F2"><enum>(2)</enum><text>shall evaluate applicants based on their potential to reduce hospitalization, homelessness, incarceration, and interaction with the criminal justice system while improving the health and social outcomes of the patient.</text> </paragraph></subsection>
<subsection id="H279AAFC4457A4F74A3322C5DD5D8C423"><enum>(d)</enum><header>Use of grant</header><text>An assisted outpatient treatment program funded with a grant awarded under this section shall include—</text>
<paragraph id="H15C96B814BC54948BF77733935566659"><enum>(1)</enum><text>evaluating the medical and social needs of the patients who are participating in the program;</text> </paragraph>
<paragraph id="H3E2682594BFD40EE8DAF7495D4CD7D44"><enum>(2)</enum><text>preparing and executing treatment plans for such patients that—</text>
<subparagraph id="H97792ACED30345D3AF108B3EA6EE3F8B"><enum>(A)</enum><text>include criteria for completion of court-ordered treatment; and</text> </subparagraph>
<subparagraph id="HEFF0356311F14143A2D12420B46DE819"><enum>(B)</enum><text>provide for monitoring of the patient’s compliance with the treatment plan, including compliance with medication and other treatment regimens;</text> </subparagraph></paragraph>
<paragraph id="HD9DB62D233A548BEA2E52C4C0027CB33"><enum>(3)</enum><text>providing for such patients case management services that support the treatment plan;</text> </paragraph>
<paragraph id="H5422A24BE72C417EB0CAD0E8C4E1A78F"><enum>(4)</enum><text>ensuring appropriate referrals to medical and social service providers;</text> </paragraph>
<paragraph id="H64187073B7604A52AFC80B2CB1D74BD7"><enum>(5)</enum><text>evaluating the process for implementing the program to ensure consistency with the patient’s needs and State law; and</text> </paragraph>
<paragraph id="H21ADA4F4C8AB41C099A43F5EA8938366"><enum>(6)</enum><text display-inline="yes-display-inline">measuring treatment outcomes, including health and social outcomes such as rates of incarceration, health care utilization, and homelessness.</text> </paragraph></subsection>
<subsection id="HFF4CAF2E9C4D438486BC7DF0DFF9E89B"><enum>(e)</enum><header>Report</header><text>Not later than the end of each of fiscal years 2016, 2017, and 2018, the Secretary shall submit a report to the appropriate congressional committees on the grant program under this section. Each such report shall include an evaluation of the following:</text>
<paragraph id="HAAF663398C624385B95330D6DA8D89F9"><enum>(1)</enum><text>Cost savings and public health outcomes such as mortality, suicide, substance abuse, hospitalization, and use of services.</text> </paragraph>
<paragraph id="HA52B23A85D6148E9ACD2AA91C949D224"><enum>(2)</enum><text>Rates of incarceration by patients.</text> </paragraph>
<paragraph id="H3F793B3321FD43029D5EA60F3AE99E2C"><enum>(3)</enum><text>Rates of homelessness among patients.</text> </paragraph>
<paragraph id="H52690FDE02654C26B2D048EAB57EA3B9"><enum>(4)</enum><text>Patient and family satisfaction with program participation.</text> </paragraph></subsection>
<subsection id="H9A70B87FE4AC476783D4883B7EAFDE94"><enum>(f)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H1FCDBFD1AADE4A50B8133130A72EB9F4"><enum>(1)</enum><text>The term <term>assisted outpatient treatment</term> means medically prescribed mental health treatment that a patient receives while living in a community under the terms of a law authorizing a State or local court to order such treatment.</text> </paragraph>
<paragraph id="H482B6100B6A64271833B7F6864CE52B6"><enum>(2)</enum><text display-inline="yes-display-inline">The term <term>eligible entity</term> means a county, city, mental health system, mental health court, or any other entity with authority under the law of the State in which the grantee is located to implement, monitor, and oversee assisted outpatient treatment programs.</text> </paragraph>
<paragraph id="H68FFF9731BA841F5AF6F8FD038CBD96A"><enum>(3)</enum><text>The term <term>Secretary</term> means the Secretary of Health and Human Services.</text> </paragraph></subsection>
<subsection id="HF213D85EB5E94BFD841E7A5A6562AA26"><enum>(g)</enum><header>Funding</header>
<paragraph id="HCFF3AF93716B442592D74EC453B976A4"><enum>(1)</enum><header>Amount of grants</header><text display-inline="yes-display-inline">A grant under this section shall be in an amount that is not more than $1,000,000 for each of fiscal years 2015 through 2018. Subject to the preceding sentence, the Secretary shall determine the amount of each grant based on the population of the area, including estimated patients, to be served under the grant.</text> </paragraph>
<paragraph id="H7B3309CD304F4324A44D1D7A8A0E17E1"><enum>(2)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section $15,000,000 for each of fiscal years 2015 through 2018.</text> </paragraph></subsection></section>
<section id="HD8D952F62D6C4C37A68DA2A21C20FD2E"><enum>225.</enum><header>Exclusion from PAYGO scorecards</header>
<subsection id="H98049D3944FB470B9437F4B92B22EC87"><enum>(a)</enum><header>Statutory Pay-As-You-Go scorecards</header><text display-inline="yes-display-inline">The budgetary effects of this Act shall not be entered on either PAYGO scorecard maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.</text> </subsection>
<subsection id="H5096D79A7DAD42F883FF57C56C96D9CE"><enum>(b)</enum><header>Senate PAYGO scorecards</header><text>The budgetary effects of this Act shall not be entered on any PAYGO scorecard maintained for purposes of section 201 of S. Con. Res. 21 (110th Congress).</text> </subsection></section>
Passed the House of Representatives March 27, 2014.Karen L. Haas,Clerk.