<num value="I">TITLE I—</num><heading>SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION</heading> <section id="d354370e500" identifier="/us/pl/114/10/tI/s101" style="-uslm-lc:I658143"><num class="fontsize12" value="101">SEC. 101. </num><heading>REPEALING THE SUSTAINABLE GROWTH RATE (SGR) AND IMPROVING MEDICARE PAYMENT FOR PHYSICIANS’ SERVICES.</heading><subsection class="firstIndent0 fontsize10" id="y584f0f06-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Stabilizing Fee Updates</inline>.—</heading><paragraph class="fontsize10" id="y584f3617-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Repeal of sgr payment methodology</inline>.—</heading><chapeau>Section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y584f3618-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><chapeau>in subsection (d)—</chapeau><clause class="fontsize10" id="y584f3619-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><chapeau>in paragraph (1)(A)—</chapeau><subclause class="fontsize10" id="y584f361a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A/i/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and ending with 2025</quotedText>” after “<quotedText>beginning with 2001</quotedText>”; and</content></subclause> <subclause class="fontsize10" id="y584f361b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A/i/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>or a subsequent paragraph</quotedText>” after “<quotedText>paragraph (4)</quotedText>”; and</content></subclause> </clause> <clause class="fontsize10" id="y584f361c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><chapeau>in paragraph (4)—</chapeau><subclause class="fontsize10" id="y584f361d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A/ii/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>in the heading, by <amendingAction type="insert">inserting</amendingAction> “<quotedText><headingText class="smallCaps">and ending with 2014</headingText></quotedText>” after “<quotedText><headingText class="smallCaps">years beginning with 2001</headingText></quotedText>”; and</content></subclause> <subclause class="fontsize10" id="y584f361e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A/ii/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>in subparagraph (A), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and ending with 2014</quotedText>” after “<quotedText>a year beginning with 2001</quotedText>”; and</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y584f361f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><chapeau>in subsection (f)—</chapeau><clause class="fontsize10" id="y584f3620-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in paragraph (1)(B), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>through 2014</quotedText>” after “<quotedText>of each succeeding year</quotedText>”; and</content></clause> <clause class="fontsize10" id="y584f3621-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in paragraph (2), in the matter preceding subparagraph (A), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and ending with 2014</quotedText>” after “<quotedText>beginning with 2000</quotedText>”.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y584f3622-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/2" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Update of rates for 2015 and subsequent years</inline>.—</heading><chapeau>Subsection (d) of section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y584f3623-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x584f3624-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><content>in paragraph (1)(A), by <amendingAction type="add">adding</amendingAction> at the end the following: “<quotedText>There shall be two separate conversion factors for each year beginning with 2026, one for items and services furnished by a qualifying APM participant (as defined in section 1833(z)(2)) (referred to in this subsection as the ‘qualifying APM conversion factor’) and the other for other items and services (referred to in this subsection as the ‘nonqualifying APM conversion factor’), equal to the respective conversion factor for the previous year (or, in the case of 2026, equal to the single conversion factor for 2025) multiplied by the update established under paragraph (20) for such respective conversion factor for such year.</quotedText>”;</content></subparagraph> <subparagraph class="fontsize10" id="y584f3625-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in paragraph (1)(D), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>(or, beginning with 2026, applicable conversion factor)</quotedText>” after “<quotedText>single conversion factor</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y584f3626-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/2/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>by <amendingAction type="delete">striking</amendingAction> paragraph (16) and <amendingAction type="insert">inserting</amendingAction> the following new paragraphs:<quotedContent><paragraph class="indentDown1 fontsize10" id="y584f5d37-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="16">“(16) </num><heading class="fontsize10"><inline class="smallCaps">Update for january through june of 2015</inline>.—</heading><content>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 June 30, 2015, the update to the single conversion factor shall be 0.0 percent.<page identifier="/us/stat/129/90">129 STAT. 90</page></content></paragraph> <paragraph class="indentDown1 fontsize10" id="y584f5d38-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="17">“(17) </num><heading class="fontsize10"><inline class="smallCaps">Update for july through december of 2015</inline>.—</heading><content>The update to the single conversion factor established in paragraph (1)(C) for the period beginning on July 1, 2015, and ending on December 31, 2015, shall be 0.5 percent.</content></paragraph> <paragraph class="indentDown1 fontsize10" id="y584f5d39-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="18">“(18) </num><heading class="fontsize10"><inline class="smallCaps">Update for 2016 through 2019</inline>.—</heading><content>The update to the single conversion factor established in paragraph (1)(C) for 2016 and each subsequent year through 2019 shall be 0.5 percent.</content></paragraph> <paragraph class="indentDown1 fontsize10" id="y584f5d3a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="19">“(19) </num><heading class="fontsize10"><inline class="smallCaps">Update for 2020 through 2025</inline>.—</heading><content>The update to the single conversion factor established in paragraph (1)(C) for 2020 and each subsequent year through 2025 shall be 0.0 percent.</content></paragraph> <paragraph class="indentDown1 fontsize10" id="y584f5d3b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="20">“(20) </num><heading class="fontsize10"><inline class="smallCaps">Update for 2026 and subsequent years</inline>.—</heading><content>For 2026 and each subsequent year, the update to the qualifying APM conversion factor established under paragraph (1)(A) is 0.75 percent, and the update to the nonqualifying APM conversion factor established under such paragraph is 0.25 percent.”</content></paragraph> </quotedContent>.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y584f5d3c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">MedPAC reports</inline>.—</heading><subparagraph class="fontsize10" id="y584f5d3d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Initial report</inline>.—</heading><chapeau>Not later than July 1, 2017, the Medicare Payment Advisory Commission shall submit to Congress a report on the relationship between—</chapeau><clause class="fontsize10" id="y584f5d3e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>physician and other health professional utilization and expenditures (and the rate of increase of such utilization and expenditures) of items and services for which payment is made under section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>); and</content></clause> <clause class="fontsize10" id="y584f5d3f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>total utilization and expenditures (and the rate of increase of such utilization and expenditures) under parts A, B, and D of title XVIII of such Act.</content></clause> <continuation class="firstIndent1 fontsize10" id="x584f5d40-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124">Such report shall include a methodology to describe such relationship and the impact of changes in such physician and other health professional practice and service ordering patterns on total utilization and expenditures under parts A, B, and D of such title.</continuation></subparagraph> <subparagraph class="fontsize10" id="y584f5d41-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Final report</inline>.—</heading><content>Not later than July 1, 2021, the Medicare Payment Advisory Commission shall submit to Congress a report on the relationship described in subparagraph (A), including the results determined from applying the methodology included in the report submitted under such subparagraph.</content></subparagraph> <subparagraph class="fontsize10" id="y584f5d42-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Report on update to physicians’ services under medicare</inline>.—</heading><chapeau>Not later than July 1, 2019, the Medicare Payment Advisory Commission shall submit to Congress a report on—</chapeau><clause class="fontsize10" id="y584f5d43-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/C/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>the payment update for professional services applied under the Medicare program under title XVIII of the Social Security Act for the period of years 2015 through 2019;</content></clause> <clause class="fontsize10" id="y584f5d44-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/C/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>the effect of such update on the efficiency, economy, and quality of care provided under such program;</content></clause> <clause class="fontsize10" id="y584f5d45-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/C/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>the effect of such update on ensuring a sufficient number of providers to maintain access to care by Medicare beneficiaries; and</content></clause> <clause class="fontsize10" id="y584f5d46-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/C/iv" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">(iv) </num><content>recommendations for any future payment updates for professional services under such program <page identifier="/us/stat/129/91">129 STAT. 91</page> to ensure adequate access to care is maintained for Medicare beneficiaries.</content></clause> </subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y584f5d47-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Consolidation of Certain Current Law Performance Programs With New Merit-Based Incentive Payment System</inline>.—</heading><paragraph class="fontsize10" id="y584f5d48-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">EHR meaningful use incentive program</inline>.—</heading><subparagraph class="fontsize10" id="y584f5d49-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Sunsetting separate meaningful use payment adjustments</inline>.—</heading><chapeau>Section 1848(a)(7)(A) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/a/7/A">42 U.S.C. 1395w–4(a)(7)(A)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><clause class="fontsize10" id="y584f5d4a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015 or any subsequent payment year</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>each of 2015 through 2018</quotedText>”;</content></clause> <clause class="fontsize10" id="y584f5d4b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in clause (ii)(III), by <amendingAction type="delete">striking</amendingAction> “<quotedText>each subsequent year</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2018</quotedText>”; and</content></clause> <clause class="fontsize10" id="y584f5d4c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><chapeau>in clause (iii)—</chapeau><subclause class="fontsize10" id="y584f5d4d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A/iii/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>in the heading, by <amendingAction type="delete">striking</amendingAction> “<quotedText><headingText class="smallCaps">and subsequent years</headingText></quotedText>”;</content></subclause> <subclause class="fontsize10" id="y584f5d4e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A/iii/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>and each subsequent year</quotedText>”; and</content></subclause> <subclause class="fontsize10" id="y584f5d4f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A/iii/III" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">(III) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>, but in no case shall the applicable percent be less than 95 percent</quotedText>”.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y584f5d50-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Continuation of meaningful use determinations for mips</inline>.—</heading><chapeau>Section 1848(o)(2) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/o/2">42 U.S.C. 1395w–4(o)(2)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><clause class="fontsize10" id="y584f5d51-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><chapeau>in subparagraph (A), in the matter preceding clause (i)—</chapeau><subclause class="fontsize10" id="y584f5d52-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/B/i/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>For purposes of paragraph (1), an</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>An</quotedText>”; and</content></subclause> <subclause class="fontsize10" id="y584f5d53-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/B/i/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>, or pursuant to subparagraph (D) for purposes of subsection (q), for a performance period under such subsection for a year</quotedText>” after “<quotedText>under such subsection for a year</quotedText>”; and</content></subclause> </clause> <clause class="fontsize10" id="y584f5d54-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraph:<quotedContent><subparagraph class="indentDown1 fontsize10" id="y584f5d55-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Continued application for purposes of mips</inline>.—</heading><content>With respect to 2019 and each subsequent payment year, the Secretary shall, for purposes of subsection (q) and in accordance with paragraph (1)(F) of such subsection, determine whether an eligible professional who is a MIPS eligible professional (as defined in subsection (q)(1)(C)) for such year is a meaningful EHR user under this paragraph for the performance period under subsection (q) for such year.”</content></subparagraph> </quotedContent>.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y584f5d56-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Quality reporting</inline>.—</heading><subparagraph class="fontsize10" id="y584f5d57-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Sunsetting separate quality reporting incentives</inline>.—</heading><chapeau>Section 1848(a)(8)(A) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/a/8/A">42 U.S.C. 1395w–4(a)(8)(A)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><clause class="fontsize10" id="y584f5d58-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015 or any subsequent year</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>each of 2015 through 2018</quotedText>”; and</content></clause> <clause class="fontsize10" id="y584f5d59-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in clause (ii)(II), by <amendingAction type="delete">striking</amendingAction> “<quotedText>and each subsequent year</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>, 2017, and 2018</quotedText>”.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y584f5d5a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Continuation of quality measures and processes for mips</inline>.—</heading><chapeau>Section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><clause class="fontsize10" id="y584f5d5b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in subsection (k), by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<page identifier="/us/stat/129/92">129 STAT. 92</page> <quotedContent><paragraph class="indentDown2 fontsize10" id="y584f846c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="9">“(9) </num><heading class="fontsize10"><inline class="smallCaps">Continued application for purposes of mips and for certain professionals volunteering to report</inline>.—</heading><chapeau>The Secretary shall, in accordance with subsection (q)(1)(F), carry out the provisions of this subsection—</chapeau><subparagraph class="fontsize10" id="y584f846d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>for purposes of subsection (q); and</content></subparagraph> <subparagraph class="fontsize10" id="y584f846e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>for eligible professionals who are not MIPS eligible professionals (as defined in subsection (q)(1)(C)) for the year involved.”</content></subparagraph> </paragraph> </quotedContent>; and</content></clause> <clause class="fontsize10" id="y584f846f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><chapeau>in subsection (m)—</chapeau><subclause class="fontsize10" id="y584f8470-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/B/ii/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>by <amendingAction type="redesignate">redesignating</amendingAction> paragraph (7) added by <ref href="/us/pl/111/148/s10327/a">section 10327(a) of Public Law 111–148</ref> as paragraph (8); and</content></subclause> <subclause class="fontsize10" id="y584f8471-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/B/ii/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="indentDown3 fontsize10" id="y584f8472-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="9">“(9) </num><heading class="fontsize10"><inline class="smallCaps">Continued application for purposes of mips and for certain professionals volunteering to report</inline>.—</heading><chapeau>The Secretary shall, in accordance with subsection (q)(1)(F), carry out the processes under this subsection—</chapeau><subparagraph class="fontsize10" id="y584f8473-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>for purposes of subsection (q); and</content></subparagraph> <subparagraph class="fontsize10" id="y584f8474-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>for eligible professionals who are not MIPS eligible professionals (as defined in subsection (q)(1)(C)) for the year involved.”</content></subparagraph> </paragraph> </quotedContent>.</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y584f8475-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Value-based payments</inline>.—</heading><subparagraph class="fontsize10" id="y584f8476-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/3/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Sunsetting separate value-based payments</inline>.—</heading><content>Clause (iii) of section 1848(p)(4)(B) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/p/4/B">42 U.S.C. 1395w–4(p)(4)(B)</ref>) <amendingAction type="amend">is amended</amendingAction> to read as follows:<quotedContent><subsection class="indentUp1 fontsize10" id="y584fab87-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii)</num><heading class="fontsize10"><inline class="smallCaps">Application</inline>.—</heading><content>The Secretary shall apply the payment modifier established under this subsection for items and services furnished on or after January 1, 2015, with respect to specific physicians and groups of physicians the Secretary determines appropriate, and for services furnished on or after January 1, 2017, with respect to all physicians and groups of physicians. Such payment modifier shall not be applied for items and services furnished on or after January 1, 2019.”</content></subsection> </quotedContent>.</content></subparagraph> <subparagraph class="fontsize10" id="y584fab88-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/3/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Continuation of value-based payment modifier measures for mips</inline>.—</heading><chapeau>Section 1848(p) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/p">42 U.S.C. 1395w–4(p)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><clause class="fontsize10" id="y584fab89-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/3/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in paragraph (2), by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraph:<quotedContent><subparagraph class="indentDown1 fontsize10" id="y584fab8a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Continued application for purposes of mips</inline>.—</heading><content>The Secretary shall, in accordance with subsection (q)(1)(F), carry out subparagraph (B) for purposes of subsection (q).”</content></subparagraph> </quotedContent>; and</content></clause> <clause class="fontsize10" id="y584fab8b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/3/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in paragraph (3), by <amendingAction type="add">adding</amendingAction> at the end the following: “<quotedText>With respect to 2019 and each subsequent year, the Secretary shall, in accordance with subsection (q)(1)(F), carry out this paragraph for purposes of subsection (q).</quotedText>”.</content></clause> </subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y584fab8c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Merit-Based Incentive Payment System</inline>.—</heading><paragraph class="fontsize10" id="y584fab8d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="indentDown1 firstIndent0 fontsize10" id="y5854b49e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="q">“(q) </num><heading class="fontsize10"><inline class="smallCaps">Merit-Based Incentive Payment System</inline>.—</heading><paragraph class="fontsize10" id="y5854b49f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">Establishment</inline>.—</heading><page identifier="/us/stat/129/93">129 STAT. 93</page> <subparagraph class="fontsize10" id="y5854b4a0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Subject to the succeeding provisions of this subsection, the Secretary shall establish an eligible professional Merit-based Incentive Payment System (in this subsection referred to as the ‘MIPS’) under which the Secretary shall—</chapeau><clause class="fontsize10" id="y5854b4a1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>develop a methodology for assessing the total performance of each MIPS eligible professional according to performance standards under paragraph (3) for a performance period (as established under paragraph (4)) for a year;</content></clause> <clause class="fontsize10" id="y5854b4a2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>using such methodology, provide for a composite performance score in accordance with paragraph (5) for each such professional for each performance period; and</content></clause> <clause class="fontsize10" id="y5854b4a3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>use such composite performance score of the MIPS eligible professional for a performance period for a year to determine and apply a MIPS adjustment factor (and, as applicable, an additional MIPS adjustment factor) under paragraph (6) to the professional for the year.</content></clause> <continuation class="firstIndent1 fontsize10" id="x5854b4a4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124">Notwithstanding subparagraph (C)(ii), under the MIPS, the Secretary shall permit any eligible professional (as defined in subsection (k)(3)(B)) to report on applicable measures and activities described in paragraph (2)(B).</continuation></subparagraph> <subparagraph class="fontsize10" id="y5854b4a5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5854b4a6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p><p class="leftAlign firstIndent0 fontsize8" id="x5854b4a7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Program implementation</inline>.—</heading><content>The MIPS shall apply to payments for items and services furnished on or after January 1, 2019.</content></subparagraph> <subparagraph class="fontsize10" id="y5854b4a8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">MIPS eligible professional defined</inline>.—</heading><clause class="fontsize10" id="y5854b4a9-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>For purposes of this subsection, subject to clauses (ii) and (iv), the term ‘<term>MIPS eligible professional</term>’ means—</chapeau><subclause class="fontsize10" id="y5854b4aa-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>for the first and second years for which the MIPS applies to payments (and for the performance period for such first and second year), a physician (as defined in section 1861(r)), a physician assistant, nurse practitioner, and clinical nurse specialist (as such terms are defined in section 1861(aa)(5)), a certified registered nurse anesthetist (as defined in section 1861(bb)(2)), and a group that includes such professionals; and</content></subclause> <subclause class="fontsize10" id="y5854b4ab-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>for the third year for which the MIPS applies to payments (and for the performance period for such third year) and for each succeeding year (and for the performance period for each such year), the professionals described in subclause (I), such other eligible professionals (as defined in subsection (k)(3)(B)) as specified by the Secretary, and a group that includes such professionals.</content></subclause> </clause> <clause class="fontsize10" id="y5854b4ac-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Exclusions</inline>.—</heading><chapeau>For purposes of clause (i), the term ‘<term>MIPS eligible professional</term>’ does not include, with respect to a year, an eligible professional (as defined in subsection (k)(3)(B)) who—</chapeau><subclause class="fontsize10" id="y5854b4ad-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>is a qualifying APM participant (as defined in section 1833(z)(2));</content></subclause> <subclause class="fontsize10" id="y5854b4ae-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>subject to clause (vii), is a partial qualifying APM participant (as defined in clause (iii)) <page identifier="/us/stat/129/94">129 STAT. 94</page> for the most recent period for which data are available and who, for the performance period with respect to such year, does not report on applicable measures and activities described in paragraph (2)(B) that are required to be reported by such a professional under the MIPS; or</content></subclause> <subclause class="fontsize10" id="y5854b4af-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>for the performance period with respect to such year, does not exceed the low-volume threshold measurement selected under clause (iv).</content></subclause> </clause> <clause class="fontsize10" id="y5854b4b0-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5854b4b1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Definition.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Partial qualifying apm participant</inline>.—</heading><chapeau>For purposes of this subparagraph, the term ‘<term>partial qualifying APM participant</term>’ means, with respect to a year, an eligible professional for whom the Secretary determines the minimum payment percentage (or percentages), as applicable, described in paragraph (2) of section 1833(z) for such year have not been satisfied, but who would be considered a qualifying APM participant (as defined in such paragraph) for such year if—</chapeau><subclause class="fontsize10" id="y5854b4b2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>with respect to 2019 and 2020, the reference in subparagraph (A) of such paragraph to 25 percent was instead a reference to 20 percent;</content></subclause> <subclause class="fontsize10" id="y5854b4b3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><chapeau>with respect to 2021 and 2022—</chapeau><item class="fontsize10" id="y5854b4b4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>the reference in subparagraph (B)(i) of such paragraph to 50 percent was instead a reference to 40 percent; and</content></item> <item class="fontsize10" id="y5854b4b5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>the references in subparagraph (B)(ii) of such paragraph to 50 percent and 25 percent of such paragraph were instead references to 40 percent and 20 percent, respectively; and</content></item> </subclause> <subclause class="fontsize10" id="y5854dbc6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><chapeau>with respect to 2023 and subsequent years—</chapeau><item class="fontsize10" id="y5854dbc7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>the reference in subparagraph (C)(i) of such paragraph to 75 percent was instead a reference to 50 percent; and</content></item> <item class="fontsize10" id="y5854dbc8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>the references in subparagraph (C)(ii) of such paragraph to 75 percent and 25 percent of such paragraph were instead references to 50 percent and 20 percent, respectively.</content></item> </subclause> </clause> <clause class="fontsize10" id="y5854dbc9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Selection of low-volume threshold measurement</inline>.—</heading><chapeau>The Secretary shall select a low-volume threshold to apply for purposes of clause (ii)(III), which may include one or more or a combination of the following:</chapeau><subclause class="fontsize10" id="y5854dbca-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>The minimum number (as determined by the Secretary) of individuals enrolled under this part who are treated by the eligible professional for the performance period involved.</content></subclause> <subclause class="fontsize10" id="y5854dbcb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>The minimum number (as determined by the Secretary) of items and services furnished to individuals enrolled under this part by such professional for such performance period.</content></subclause> <subclause class="fontsize10" id="y5854dbcc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>The minimum amount (as determined by the Secretary) of allowed charges billed by such <page identifier="/us/stat/129/95">129 STAT. 95</page> professional under this part for such performance period.</content></subclause> </clause> <clause class="fontsize10" id="y5854dbcd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><heading class="fontsize10"><inline class="smallCaps">Treatment of new medicare enrolled eligible professionals</inline>.—</heading><content>In the case of a professional who first becomes a Medicare enrolled eligible professional during the performance period for a year (and had not previously submitted claims under this title such as a person, an entity, or a part of a physician group or under a different billing number or tax identifier), such professional shall not be treated under this subsection as a MIPS eligible professional until the subsequent year and performance period for such subsequent year.</content></clause> <clause class="fontsize10" id="y5854dbce-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">“(vi) </num><heading class="fontsize10"><inline class="smallCaps">Clarification</inline>.—</heading><content>In the case of items and services furnished during a year by an individual who is not a MIPS eligible professional (including pursuant to clauses (ii) and (v)) with respect to a year, in no case shall a MIPS adjustment factor (or additional MIPS adjustment factor) under paragraph (6) apply to such individual for such year.</content></clause> <clause class="fontsize10" id="y5854dbcf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vii">“(vii) </num><heading class="fontsize10"><inline class="smallCaps">Partial qualifying apm participant clarifications</inline>.—</heading><subclause class="fontsize10" id="y5854dbd0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">Treatment as mips eligible professional</inline>.—</heading><content>In the case of an eligible professional who is a partial qualifying APM participant, with respect to a year, and who, for the performance period for such year, reports on applicable measures and activities described in paragraph (2)(B) that are required to be reported by such a professional under the MIPS, such eligible professional is considered to be a MIPS eligible professional with respect to such year.</content></subclause> <subclause class="fontsize10" id="y5854dbd1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Not eligible for qualifying apm participant payments</inline>.—</heading><content>In no case shall an eligible professional who is a partial qualifying APM participant, with respect to a year, be considered a qualifying APM participant (as defined in paragraph (2) of section 1833(z)) for such year or be eligible for the additional payment under paragraph (1) of such section for such year.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y5854dbd2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Application to group practices</inline>.—</heading><clause class="fontsize10" id="y5854dbd3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Under the MIPS:</chapeau><subclause class="fontsize10" id="y5854dbd4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">Quality performance category</inline>.—</heading><content>The Secretary shall establish and apply a process that includes features of the provisions of subsection (m)(3)(C) for MIPS eligible professionals in a group practice with respect to assessing performance of such group with respect to the performance category described in clause (i) of paragraph (2)(A).</content></subclause> <subclause class="fontsize10" id="y5854dbd5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Other performance categories</inline>.—</heading><content>The Secretary may establish and apply a process that includes features of the provisions of subsection (m)(3)(C) for MIPS eligible professionals in a group practice with respect to assessing the performance of such group with respect to the performance categories described in clauses (ii) through (iv) of such paragraph.<page identifier="/us/stat/129/96">129 STAT. 96</page></content></subclause> </clause> <clause class="fontsize10" id="y5854dbd6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Ensuring comprehensiveness of group practice assessment</inline>.—</heading><content>The process established under clause (i) shall to the extent practicable reflect the range of items and services furnished by the MIPS eligible professionals in the group practice involved.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5854dbd7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Use of registries</inline>.—</heading><content>Under the MIPS, the Secretary shall encourage the use of qualified clinical data registries pursuant to subsection (m)(3)(E) in carrying out this subsection.</content></subparagraph> <subparagraph class="fontsize10" id="y5854dbd8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><heading class="fontsize10"><inline class="smallCaps">Application of certain provisions</inline>.—</heading><chapeau>In applying a provision of subsection (k), (m), (o), or (p) for purposes of this subsection, the Secretary shall—</chapeau><clause class="fontsize10" id="y5854dbd9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>adjust the application of such provision to ensure the provision is consistent with the provisions of this subsection; and</content></clause> <clause class="fontsize10" id="y5854dbda-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>not apply such provision to the extent that the provision is duplicative with a provision of this subsection.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5854dbdb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="G">“(G) </num><heading class="fontsize10"><inline class="smallCaps">Accounting for risk factors</inline>.—</heading><clause class="fontsize10" id="y5854dbdc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Risk factors</inline>.—</heading><chapeau>Taking into account the relevant studies conducted and recommendations made in reports under section 2(d) of the Improving Medicare Post-Acute Care Transformation Act of 2014, and, as appropriate, other information, including information collected before completion of such studies and recommendations, the Secretary, on an ongoing basis, shall, as the Secretary determines appropriate and based on an individual’s health status and other risk factors—</chapeau><subclause class="fontsize10" id="y5854dbdd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>assess appropriate adjustments to quality measures, resource use measures, and other measures used under the MIPS; and</content></subclause> <subclause class="fontsize10" id="y5854dbde-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>assess and implement appropriate adjustments to payment adjustments, composite performance scores, scores for performance categories, or scores for measures or activities under the MIPS.</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y5854dbdf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">Measures and activities under performance categories</inline>.—</heading><subparagraph class="fontsize10" id="y5854dbe0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Performance categories</inline>.—</heading><chapeau>Under the MIPS, the Secretary shall use the following performance categories (each of which is referred to in this subsection as a performance category) in determining the composite performance score under paragraph (5):</chapeau><clause class="fontsize10" id="y5854dbe1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>Quality.</content></clause> <clause class="fontsize10" id="y5854dbe2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>Resource use.</content></clause> <clause class="fontsize10" id="y5854dbe3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>Clinical practice improvement activities.</content></clause> <clause class="fontsize10" id="y5854dbe4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>Meaningful use of certified EHR technology.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5854dbe5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Measures and activities specified for each category</inline>.—</heading><chapeau>For purposes of paragraph (3)(A) and subject to subparagraph (C), measures and activities specified for a performance period (as established under paragraph (4)) for a year are as follows:</chapeau><clause class="fontsize10" id="y5854dbe6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Quality</inline>.—</heading><content>For the performance category described in subparagraph (A)(i), the quality measures included in the final measures list published under subparagraph (D)(i) for such year and the list of quality measures described in subparagraph (D)(vi) used by <page identifier="/us/stat/129/97">129 STAT. 97</page> qualified clinical data registries under subsection (m)(3)(E).</content></clause> <clause class="fontsize10" id="y5854dbe7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Resource use</inline>.—</heading><content>For the performance category described in subparagraph (A)(ii), the measurement of resource use for such period under subsection (p)(3), using the methodology under subsection (r) as appropriate, and, as feasible and applicable, accounting for the cost of drugs under part D.</content></clause> <clause class="fontsize10" id="y5854dbe8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Clinical practice improvement activities</inline>.—</heading><chapeau>For the performance category described in subparagraph (A)(iii), clinical practice improvement activities (as defined in subparagraph (C)(v)(III)) under subcategories specified by the Secretary for such period, which shall include at least the following:</chapeau><subclause class="fontsize10" id="y5854dbe9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>The subcategory of expanded practice access, such as same day appointments for urgent needs and after hours access to clinician advice.</content></subclause> <subclause class="fontsize10" id="y5854dbea-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>The subcategory of population management, such as monitoring health conditions of individuals to provide timely health care interventions or participation in a qualified clinical data registry.</content></subclause> <subclause class="fontsize10" id="y5854dbeb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>The subcategory of care coordination, such as timely communication of test results, timely exchange of clinical information to patients and other providers, and use of remote monitoring or telehealth.</content></subclause> <subclause class="fontsize10" id="y5854dbec-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="IV">“(IV) </num><content>The subcategory of beneficiary engagement, such as the establishment of care plans for individuals with complex care needs, beneficiary self-management assessment and training, and using shared decision-making mechanisms.</content></subclause> <subclause class="fontsize10" id="y5854dbed-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="V">“(V) </num><content>The subcategory of patient safety and practice assessment, such as through use of clinical or surgical checklists and practice assessments related to maintaining certification.</content></subclause> <subclause class="fontsize10" id="y5854dbee-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="VI">“(VI) </num><content>The subcategory of participation in an alternative payment model (as defined in section 1833(z)(3)(C)).</content></subclause> <continuation class="firstIndent1 fontsize10" id="x5854dbef-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126">In establishing activities under this clause, the Secretary shall give consideration to the circumstances of small practices (consisting of 15 or fewer professionals) and practices located in rural areas and in health professional shortage areas (as designated under section 332(a)(1)(A) of the Public Health Service Act).</continuation></clause> <clause class="fontsize10" id="y5854dbf0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Meaningful ehr use</inline>.—</heading><content>For the performance category described in subparagraph (A)(iv), the requirements established for such period under subsection (o)(2) for determining whether an eligible professional is a meaningful EHR user.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5854dbf1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Additional provisions</inline>.—</heading><clause class="fontsize10" id="y5854dbf2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Emphasizing outcome measures under the quality performance category</inline>.—</heading><content>In<sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5854dbf3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote> applying subparagraph (B)(i), the Secretary shall, as feasible, emphasize the application of outcome measures.<page identifier="/us/stat/129/98">129 STAT. 98</page></content></clause> <clause class="fontsize10" id="y5854dbf4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Application of additional system measures</inline>.—</heading><content>The Secretary may use measures used for a payment system other than for physicians, such as measures for inpatient hospitals, for purposes of the performance categories described in clauses (i) and (ii) of subparagraph (A). For purposes of the previous sentence, the Secretary may not use measures for hospital outpatient departments, except in the case of items and services furnished by emergency physicians, radiologists, and anesthesiologists.</content></clause> <clause class="fontsize10" id="y5854dbf5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Global and population-based measures</inline>.—</heading><content>The Secretary may use global measures, such as global outcome measures, and population-based measures for purposes of the performance category described in subparagraph (A)(i).</content></clause> <clause class="fontsize10" id="y5854dbf6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Application of measures and activities to non-patient-facing professionals</inline>.—</heading><chapeau>In carrying out this paragraph, with respect to measures and activities specified in subparagraph (B) for performance categories described in subparagraph (A), the Secretary—</chapeau><subclause class="fontsize10" id="y5854dbf7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>shall give consideration to the circumstances of professional types (or subcategories of those types determined by practice characteristics) who typically furnish services that do not involve face-to-face interaction with a patient; and</content></subclause> <subclause class="fontsize10" id="y5854dbf8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>may, to the extent feasible and appropriate, take into account such circumstances and apply under this subsection with respect to MIPS eligible professionals of such professional types or subcategories, alternative measures or activities that fulfill the goals of the applicable performance category.</content></subclause> <continuation class="firstIndent1 fontsize10" id="x5854dbf9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126">In<sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5854dbfa-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Consultation.</p></sidenote> carrying out the previous sentence, the Secretary shall consult with professionals of such professional types or subcategories.</continuation></clause> <clause class="fontsize10" id="y5854dbfb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><heading class="fontsize10"><inline class="smallCaps">Clinical practice improvement activities</inline>.—</heading><subclause class="fontsize10" id="y5854dbfc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">Request for information</inline>.—</heading><content>In initially applying subparagraph (B)(iii), the Secretary shall use a request for information to solicit recommendations from stakeholders to identify activities described in such subparagraph and specifying criteria for such activities.</content></subclause> <subclause class="fontsize10" id="y5854dbfd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Contract authority for clinical practice improvement activities performance category</inline>.—</heading><chapeau>In <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5854dbfe-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote>applying subparagraph (B)(iii), the Secretary may contract with entities to assist the Secretary in—</chapeau><item class="fontsize10" id="y5854dbff-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>identifying activities described in subparagraph (B)(iii);</content></item> <item class="fontsize10" id="y5854dc00-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>specifying criteria for such activities; and</content></item> <item class="fontsize10" id="y5854dc01-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="cc">“(cc) </num><content>determining whether a MIPS eligible professional meets such criteria.</content></item> </subclause> <subclause class="fontsize10" id="y5854dc02-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><heading class="fontsize10"><inline class="smallCaps">Clinical practice improvement activities defined</inline>.—</heading><content>For purposes of this subsection, the term ‘<term>clinical practice improvement activity</term>’ <page identifier="/us/stat/129/99">129 STAT. 99</page> means an activity that relevant eligible professional organizations and other relevant stakeholders identify as improving clinical practice or care delivery and that the Secretary determines, when effectively executed, is likely to result in improved outcomes.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y5854dc03-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Annual list of quality measures available for mips assessment</inline>.—</heading><clause class="fontsize10" id="y5854dc04-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5854dc05-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Notice.</p><p class="leftAlign firstIndent0 fontsize8" id="x5854dc06-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Regulations.</p><p class="leftAlign firstIndent0 fontsize8" id="x5854dc07-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadlines.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Under the MIPS, the Secretary, through notice and comment rulemaking and subject to the succeeding clauses of this subparagraph, shall, with respect to the performance period for a year, establish an annual final list of quality measures from which MIPS eligible professionals may choose for purposes of assessment under this subsection for such performance period. Pursuant to the previous sentence, the Secretary shall—</chapeau><subclause class="fontsize10" id="y5854dc08-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>not later than November 1 of the year prior to the first day of the first performance period under the MIPS, establish and publish in the Federal Register a final list of quality measures; and</content></subclause> <subclause class="fontsize10" id="y5854dc09-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><chapeau>not later than November 1 of the year prior to the first day of each subsequent performance period, update the final list of quality measures from the previous year (and publish such updated final list in the Federal Register), by—</chapeau><item class="fontsize10" id="y5854dc0a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>removing from such list, as appropriate, quality measures, which may include the removal of measures that are no longer meaningful (such as measures that are topped out);</content></item> <item class="fontsize10" id="y5854dc0b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>adding to such list, as appropriate, new quality measures; and</content></item> <item class="fontsize10" id="y5855031c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="cc">“(cc) </num><content>determining whether or not quality measures on such list that have undergone substantive changes should be included in the updated list.</content></item> </subclause> </clause> <clause class="fontsize10" id="y5855031d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Call for quality measures</inline>.—</heading><subclause class="fontsize10" id="y5855031e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Eligible professional organizations and other relevant stakeholders shall be requested to identify and submit quality measures to be considered for selection under this subparagraph in the annual list of quality measures published under clause (i) and to identify and submit updates to the measures on such list. For purposes of the previous sentence, measures may be submitted regardless of whether such measures were previously published in a proposed rule or endorsed by an entity with a contract under section 1890(a).</content></subclause> <subclause class="fontsize10" id="y5855031f-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Eligible professional organization defined</inline>.—</heading><content>In this subparagraph, the term ‘<term>eligible professional organization</term>’ means a professional organization as defined by nationally recognized specialty boards of certification or equivalent certification boards.<page identifier="/us/stat/129/100">129 STAT. 100</page></content></subclause> </clause> <clause class="fontsize10" id="y58550320-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Requirements</inline>.—</heading><chapeau>In selecting quality measures for inclusion in the annual final list under clause (i), the Secretary shall—</chapeau><subclause class="fontsize10" id="y58550321-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>provide that, to the extent practicable, all quality domains (as defined in subsection (s)(1)(B)) are addressed by such measures; and</content></subclause> <subclause class="fontsize10" id="y58550322-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>ensure that such selection is consistent with the process for selection of measures under subsections (k), (m), and (p)(2).</content></subclause> </clause> <clause class="fontsize10" id="y58550323-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58550324-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Publication.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Peer review</inline>.—</heading><content>Before including a new measure in the final list of measures published under clause (i) for a year, the Secretary shall submit for publication in applicable specialty-appropriate, peer-reviewed journals such measure and the method for developing and selecting such measure, including clinical and other data supporting such measure.</content></clause> <clause class="fontsize10" id="y58550325-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><heading class="fontsize10"><inline class="smallCaps">Measures for inclusion</inline>.—</heading><chapeau>The final list of quality measures published under clause (i) shall include, as applicable, measures under subsections (k), (m), and (p)(2), including quality measures from among—</chapeau><subclause class="fontsize10" id="y58550326-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>measures endorsed by a consensus-based entity;</content></subclause> <subclause class="fontsize10" id="y58550327-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>measures developed under subsection (s); and</content></subclause> <subclause class="fontsize10" id="y58550328-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>measures submitted under clause (ii)(I).</content></subclause> <continuation class="firstIndent1 fontsize10" id="x58550329-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126">Any measure selected for inclusion in such list that is not endorsed by a consensus-based entity shall have a focus that is evidence-based.</continuation></clause> <clause class="fontsize10" id="y5855032a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">“(vi) </num><heading class="fontsize10"><inline class="smallCaps">Exception for qualified clinical data registry measures</inline>.—</heading><content>Measures used by a qualified clinical data registry under subsection (m)(3)(E) shall not be subject to the requirements under clauses (i), (iv), and (v).<sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5855032b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote> The Secretary shall publish the list of measures used by such qualified clinical data registries on the Internet website of the Centers for Medicare & Medicaid Services.</content></clause> <clause class="fontsize10" id="y5855032c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vii">“(vii) </num><heading class="fontsize10"><inline class="smallCaps">Exception for existing quality measures</inline>.—</heading><chapeau>Any quality measure specified by the Secretary under subsection (k) or (m), including under subsection (m)(3)(E), and any measure of quality of care established under subsection (p)(2) for the reporting period or performance period under the respective subsection beginning before the first performance period under the MIPS—</chapeau><subclause class="fontsize10" id="y5855032d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>shall not be subject to the requirements under clause (i) (except under items (aa) and (cc) of subclause (II) of such clause) or to the requirement under clause (iv); and</content></subclause> <subclause class="fontsize10" id="y5855032e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>shall be included in the final list of quality measures published under clause (i) unless removed under clause (i)(II)(aa).</content></subclause> </clause> <clause class="fontsize10" id="y5855032f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="viii">“(viii) </num><heading class="fontsize10"><inline class="smallCaps">Consultation with relevant eligible professional organizations and other relevant stakeholders</inline>.—</heading><content>Relevant eligible professional organizations and other relevant stakeholders, <page identifier="/us/stat/129/101">129 STAT. 101</page> including State and national medical societies, shall be consulted in carrying out this subparagraph.</content></clause> <clause class="fontsize10" id="y58550330-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ix">“(ix) </num><heading class="fontsize10"><inline class="smallCaps">Optional application</inline>.—</heading><content>The process under section 1890A is not required to apply to the selection of measures under this subparagraph.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y58550331-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Performance standards</inline>.—</heading><subparagraph class="fontsize10" id="y58550332-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Establishment</inline>.—</heading><content>Under the MIPS, the Secretary shall establish performance standards with respect to measures and activities specified under paragraph (2)(B) for a performance period (as established under paragraph (4)) for a year.</content></subparagraph> <subparagraph class="fontsize10" id="y58550333-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Considerations in establishing standards</inline>.—</heading><chapeau>In establishing such performance standards with respect to measures and activities specified under paragraph (2)(B), the Secretary shall consider the following:</chapeau><clause class="fontsize10" id="y58550334-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>Historical performance standards.</content></clause> <clause class="fontsize10" id="y58550335-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>Improvement.</content></clause> <clause class="fontsize10" id="y58550336-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>The opportunity for continued improvement.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y58550337-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Performance period</inline>.—</heading><content>The Secretary shall establish a performance period (or periods) for a year (beginning with 2019). Such performance period (or periods) shall begin and end prior to the beginning of such year and be as close as possible to such year. In this subsection, such performance period (or periods) for a year shall be referred to as the performance period for the year.</content></paragraph> <paragraph class="fontsize10" id="y58550338-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">“(5) </num><heading class="fontsize10"><inline class="smallCaps">Composite performance score</inline>.—</heading><subparagraph class="fontsize10" id="y58550339-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to the succeeding provisions of this paragraph and taking into account, as available and applicable, paragraph (1)(G), the Secretary shall develop a methodology for assessing the total performance of each MIPS eligible professional according to performance standards under paragraph (3) with respect to applicable measures and activities specified in paragraph (2)(B) with respect to each performance category applicable to such professional for a performance period (as established under paragraph (4)) for a year. Using such methodology, the Secretary shall provide for a composite assessment (using a scoring scale of 0 to 100) for each such professional for the performance period for such year. In this subsection such a composite assessment for such a professional with respect to a performance period shall be referred to as the ‘composite performance score’ for such professional for such performance period.</content></subparagraph> <subparagraph class="fontsize10" id="y5855033a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Incentive to report; encouraging use of certified ehr technology for reporting quality measures</inline>.—</heading><clause class="fontsize10" id="y5855033b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Incentive to report</inline>.—</heading><content>Under the methodology established under subparagraph (A), the Secretary shall provide that in the case of a MIPS eligible professional who fails to report on an applicable measure or activity that is required to be reported by the professional, the professional shall be treated as achieving the lowest potential score applicable to such measure or activity.</content></clause> <clause class="fontsize10" id="y5855033c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Encouraging use of certified ehr technology and qualified clinical data registries for </inline><page identifier="/us/stat/129/102">129 STAT. 102</page> reporting quality measures.—</heading><chapeau>Under the methodology established under subparagraph (A), the Secretary shall—</chapeau><subclause class="fontsize10" id="y5855033d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>encourage MIPS eligible professionals to report on applicable measures with respect to the performance category described in paragraph (2)(A)(i) through the use of certified EHR technology and qualified clinical data registries; and</content></subclause> <subclause class="fontsize10" id="y5855033e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>with respect to a performance period, with respect to a year, for which a MIPS eligible professional reports such measures through the use of such EHR technology, treat such professional as satisfying the clinical quality measures reporting requirement described in subsection (o)(2)(A)(iii) for such year.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y5855033f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Clinical practice improvement activities performance score</inline>.—</heading><clause class="fontsize10" id="y58550340-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Rule for certification</inline>.—</heading><content>A MIPS eligible professional who is in a practice that is certified as a patient-centered medical home or comparable specialty practice, as determined by the Secretary, with respect to a performance period shall be given the highest potential score for the performance category described in paragraph (2)(A)(iii) for such period.</content></clause> <clause class="fontsize10" id="y58550341-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">APM participation</inline>.—</heading><content>Participation by a MIPS eligible professional in an alternative payment model (as defined in section 1833(z)(3)(C)) with respect to a performance period shall earn such eligible professional a minimum score of one-half of the highest potential score for the performance category described in paragraph (2)(A)(iii) for such performance period.</content></clause> <clause class="fontsize10" id="y58550342-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Subcategories</inline>.—</heading><content>A MIPS eligible professional shall not be required to perform activities in each subcategory under paragraph (2)(B)(iii) or participate in an alternative payment model in order to achieve the highest potential score for the performance category described in paragraph (2)(A)(iii).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58550343-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Achievement and improvement</inline>.—</heading><clause class="fontsize10" id="y58550344-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Taking into account improvement</inline>.—</heading><chapeau>Beginning with the second year to which the MIPS applies, in addition to the achievement of a MIPS eligible professional, if data sufficient to measure improvement is available, the methodology developed under subparagraph (A)—</chapeau><subclause class="fontsize10" id="y58550345-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>in the case of the performance score for the performance category described in clauses (i) and (ii) of paragraph (2)(A), shall take into account the improvement of the professional; and</content></subclause> <subclause class="fontsize10" id="y58550346-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>in the case of performance scores for other performance categories, may take into account the improvement of the professional.</content></subclause> </clause> <clause class="fontsize10" id="y58550347-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Assigning higher weight for achievement</inline>.—</heading><content>Subject to clause (i), under the methodology developed under subparagraph (A), the Secretary may assign a higher scoring weight under subparagraph (F) with respect to the achievement of a MIPS eligible professional than with respect to any improvement <page identifier="/us/stat/129/103">129 STAT. 103</page> of such professional applied under clause (i) with respect to a measure, activity, or category described in paragraph (2).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58550348-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Weights for the performance categories</inline>.—</heading><clause class="fontsize10" id="y58550349-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Under the methodology developed under subparagraph (A), subject to subparagraph (F)(i) and clause (ii), the composite performance score shall be determined as follows:</chapeau><subclause class="fontsize10" id="y5855034a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">Quality</inline>.—</heading><item class="fontsize10" id="y5855034b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to item (bb), thirty percent of such score shall be based on performance with respect to the category described in clause (i) of paragraph (2)(A). In applying the previous sentence, the Secretary shall, as feasible, encourage the application of outcome measures within such category.</content></item> <item class="fontsize10" id="y5855034c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><heading class="fontsize10"><inline class="smallCaps">First 2 years</inline>.—</heading><content>For the first and second years for which the MIPS applies to payments, the percentage applicable under item (aa) shall be increased in a manner such that the total percentage points of the increase under this item for the respective year equals the total number of percentage points by which the percentage applied under subclause (II)(bb) for the respective year is less than 30 percent.</content></item> </subclause> <subclause class="fontsize10" id="y5855034d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Resource use</inline>.—</heading><item class="fontsize10" id="y5855034e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to item (bb), thirty percent of such score shall be based on performance with respect to the category described in clause (ii) of paragraph (2)(A).</content></item> <item class="fontsize10" id="y5855034f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><heading class="fontsize10"><inline class="smallCaps">First 2 years</inline>.—</heading><content>For the first year for which the MIPS applies to payments, not more than 10 percent of such score shall be based on performance with respect to the category described in clause (ii) of paragraph (2)(A). For the second year for which the MIPS applies to payments, not more than 15 percent of such score shall be based on performance with respect to the category described in clause (ii) of paragraph (2)(A).</content></item> </subclause> <subclause class="fontsize10" id="y58550350-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><heading class="fontsize10"><inline class="smallCaps">Clinical practice improvement activities</inline>.—</heading><content>Fifteen percent of such score shall be based on performance with respect to the category described in clause (iii) of paragraph (2)(A).</content></subclause> <subclause class="fontsize10" id="y58550351-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="IV">“(IV) </num><heading class="fontsize10"><inline class="smallCaps">Meaningful use of certified ehr technology</inline>.—</heading><content>Twenty-five percent of such score shall be based on performance with respect to the category described in clause (iv) of paragraph (2)(A).</content></subclause> </clause> <clause class="fontsize10" id="y58550352-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Authority to adjust percentages in case of high ehr meaningful use adoption</inline>.—</heading><content>In any year in which the Secretary estimates that the proportion of eligible professionals (as defined in subsection (o)(5)) who are meaningful EHR users (as determined under subsection (o)(2)) is 75 percent or greater, the Secretary may reduce the percent applicable under clause (i)(IV), <page identifier="/us/stat/129/104">129 STAT. 104</page> but not below 15 percent. If the Secretary makes such reduction for a year, subject to subclauses (I)(bb) and (II)(bb) of clause (i), the percentages applicable under one or more of subclauses (I), (II), and (III) of clause (i) for such year shall be increased in a manner such that the total percentage points of the increase under this clause for such year equals the total number of percentage points reduced under the preceding sentence for such year.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58550353-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><heading class="fontsize10"><inline class="smallCaps">Certain flexibility for weighting performance categories, measures, and activities</inline>.—</heading><chapeau>Under the methodology under subparagraph (A), if there are not sufficient measures and activities (described in paragraph (2)(B)) applicable and available to each type of eligible professional involved, the Secretary shall assign different scoring weights (including a weight of 0)—</chapeau><clause class="fontsize10" id="y58550354-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>which may vary from the scoring weights specified in subparagraph (E), for each performance category based on the extent to which the category is applicable to the type of eligible professional involved; and</content></clause> <clause class="fontsize10" id="y58550355-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>for each measure and activity specified under paragraph (2)(B) with respect to each such category based on the extent to which the measure or activity is applicable and available to the type of eligible professional involved.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58550356-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="G">“(G) </num><heading class="fontsize10"><inline class="smallCaps">Resource use</inline>.—</heading><content>Analysis of the performance category described in paragraph (2)(A)(ii) shall include results from the methodology described in subsection (r)(5), as appropriate.</content></subparagraph> <subparagraph class="fontsize10" id="y58550357-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="H">“(H) </num><heading class="fontsize10"><inline class="smallCaps">Inclusion of quality measure data from other payers</inline>.—</heading><content>In applying subsections (k), (m), and (p) with respect to measures described in paragraph (2)(B)(i), analysis of the performance category described in paragraph (2)(A)(i) may include data submitted by MIPS eligible professionals with respect to items and services furnished to individuals who are not individuals entitled to benefits under part A or enrolled under part B.</content></subparagraph> <subparagraph class="fontsize10" id="y58552968-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">Use of voluntary virtual groups for certain assessment purposes</inline>.—</heading><clause class="fontsize10" id="y58552969-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>In the case of MIPS eligible professionals electing to be a virtual group under clause (ii) with respect to a performance period for a year, for purposes of applying the methodology under subparagraph (A) with respect to the performance categories described in clauses (i) and (ii) of paragraph (2)(A)—</chapeau><subclause class="fontsize10" id="y5855296a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the assessment of performance provided under such methodology with respect to such performance categories that is to be applied to each such professional in such group for such performance period shall be with respect to the combined performance of all such professionals in such group for such period; and</content></subclause> <subclause class="fontsize10" id="y5855296b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>with respect to the composite performance score provided under this paragraph for such performance period for each such MIPS eligible professional in such virtual group, the components <page identifier="/us/stat/129/105">129 STAT. 105</page> of the composite performance score that assess performance with respect to such performance categories shall be based on the assessment of the combined performance under subclause (I) for such performance categories and performance period.</content></subclause> </clause> <clause class="fontsize10" id="y5855296c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Election of practices to be a virtual group</inline>.—</heading><content>The Secretary shall, in accordance with the requirements under clause (iii), establish and have in place a process to allow an individual MIPS eligible professional or a group practice consisting of not more than 10 MIPS eligible professionals to elect, with respect to a performance period for a year to be a virtual group under this subparagraph with at least one other such individual MIPS eligible professional or group practice. Such a virtual group may be based on appropriate classifications of providers, such as by geographic areas or by provider specialties defined by nationally recognized specialty boards of certification or equivalent certification boards.</content></clause> <clause class="fontsize10" id="y5855296d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Requirements</inline>.—</heading><chapeau>The requirements for the process under clause (ii) shall—</chapeau><subclause class="fontsize10" id="y5855296e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>provide that an election under such clause, with respect to a performance period, shall be made before the beginning of such performance period and may not be changed during such performance period;</content></subclause> <subclause class="fontsize10" id="y5855296f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>provide that an individual MIPS eligible professional and a group practice described in clause (ii) may elect to be in no more than one virtual group for a performance period and that, in the case of such a group practice that elects to be in such virtual group for such performance period, such election applies to all MIPS eligible professionals in such group practice;</content></subclause> <subclause class="fontsize10" id="y58552970-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>provide that a virtual group be a combination of tax identification numbers;</content></subclause> <subclause class="fontsize10" id="y58552971-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="IV">“(IV) </num><content>provide for formal written agreements among MIPS eligible professionals electing to be a virtual group under this subparagraph; and</content></subclause> <subclause class="fontsize10" id="y58552972-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="V">“(V) </num><content>include such other requirements as the Secretary determines appropriate.</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y58552973-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="6">“(6) </num><heading class="fontsize10"><inline class="smallCaps">MIPS payments</inline>.—</heading><subparagraph class="fontsize10" id="y58552974-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">MIPS adjustment factor</inline>.—</heading><chapeau>Taking into account paragraph (1)(G), the Secretary shall specify a MIPS adjustment factor for each MIPS eligible professional for a year. Such MIPS adjustment factor for a MIPS eligible professional for a year shall be in the form of a percent and shall be determined—</chapeau><clause class="fontsize10" id="y58552975-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>by comparing the composite performance score of the eligible professional for such year to the performance threshold established under subparagraph (D)(i) for such year;</content></clause> <clause class="fontsize10" id="y58552976-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><chapeau>in a manner such that the adjustment factors specified under this subparagraph for a year result in differential payments under this paragraph reflecting that—<page identifier="/us/stat/129/106">129 STAT. 106</page></chapeau><subclause class="fontsize10" id="y58552977-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>MIPS eligible professionals with composite performance scores for such year at or above such performance threshold for such year receive zero or positive payment adjustment factors for such year in accordance with clause (iii), with such professionals having higher composite performance scores receiving higher adjustment factors; and</content></subclause> <subclause class="fontsize10" id="y58552978-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>MIPS eligible professionals with composite performance scores for such year below such performance threshold for such year receive negative payment adjustment factors for such year in accordance with clause (iv), with such professionals having lower composite performance scores receiving lower adjustment factors;</content></subclause> </clause> <clause class="fontsize10" id="y58552979-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>in a manner such that MIPS eligible professionals with composite scores described in clause (ii)(I) for such year, subject to clauses (i) and (ii) of subparagraph (F), receive a zero or positive adjustment factor on a linear sliding scale such that an adjustment factor of 0 percent is assigned for a score at the performance threshold and an adjustment factor of the applicable percent specified in subparagraph (B) is assigned for a score of 100; and</content></clause> <clause class="fontsize10" id="y5855297a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><chapeau>in a manner such that—</chapeau><subclause class="fontsize10" id="y5855297b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>subject to subclause (II), MIPS eligible professionals with composite performance scores described in clause (ii)(II) for such year receive a negative payment adjustment factor on a linear sliding scale such that an adjustment factor of 0 percent is assigned for a score at the performance threshold and an adjustment factor of the negative of the applicable percent specified in subparagraph (B) is assigned for a score of 0; and</content></subclause> <subclause class="fontsize10" id="y5855297c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>MIPS eligible professionals with composite performance scores that are equal to or greater than 0, but not greater than ¼ of the performance threshold specified under subparagraph (D)(i) for such year, receive a negative payment adjustment factor that is equal to the negative of the applicable percent specified in subparagraph (B) for such year.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y5855297d-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Applicable percent defined</inline>.—</heading><chapeau>For purposes of this paragraph, the term ‘<term>applicable percent</term>’ means—</chapeau><clause class="fontsize10" id="y5855297e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>for 2019, 4 percent;</content></clause> <clause class="fontsize10" id="y5855297f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>for 2020, 5 percent;</content></clause> <clause class="fontsize10" id="y58552980-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>for 2021, 7 percent; and</content></clause> <clause class="fontsize10" id="y58552981-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>for 2022 and subsequent years, 9 percent.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58552982-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Additional mips adjustment factors for exceptional performance</inline>.—</heading><content>For 2019 and each subsequent year through 2024, in the case of a MIPS eligible professional with a composite performance score for a year at or above the additional performance threshold under subparagraph (D)(ii) for such year, in addition to the MIPS adjustment factor under subparagraph (A) for the eligible professional for such year, subject to subparagraph (F)(iv), the Secretary shall specify an additional positive MIPS adjustment factor for such professional and year. Such additional MIPS <page identifier="/us/stat/129/107">129 STAT. 107</page> adjustment factors shall be in the form of a percent and determined by the Secretary in a manner such that professionals having higher composite performance scores above the additional performance threshold receive higher additional MIPS adjustment factors.</content></subparagraph> <subparagraph class="fontsize10" id="y58552983-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Establishment of performance thresholds</inline>.—</heading><clause class="fontsize10" id="y58552984-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Performance threshold</inline>.—</heading><content>For each year of the MIPS, the Secretary shall compute a performance threshold with respect to which the composite performance score of MIPS eligible professionals shall be compared for purposes of determining adjustment factors under subparagraph (A) that are positive, negative, and zero. Such performance threshold for a year shall be the mean or median (as selected by the Secretary) of the composite performance scores for all MIPS eligible professionals with respect to a prior period specified by the Secretary. The Secretary may reassess the selection of the mean or median under the previous sentence every 3 years.</content></clause> <clause class="fontsize10" id="y58552985-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Additional performance threshold for exceptional performance</inline>.—</heading><chapeau>In addition to the performance threshold under clause (i), for each year of the MIPS, the Secretary shall compute an additional performance threshold for purposes of determining the additional MIPS adjustment factors under subparagraph (C). For each such year, the Secretary shall apply either of the following methods for computing such additional performance threshold for such a year:</chapeau><subclause class="fontsize10" id="y58552986-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>The threshold shall be the score that is equal to the 25th percentile of the range of possible composite performance scores above the performance threshold determined under clause (i).</content></subclause> <subclause class="fontsize10" id="y58552987-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>The threshold shall be the score that is equal to the 25th percentile of the actual composite performance scores for MIPS eligible professionals with composite performance scores at or above the performance threshold with respect to the prior period described in clause (i).</content></subclause> </clause> <clause class="fontsize10" id="y58552988-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Special rule for initial 2 years</inline>.—</heading><chapeau>With respect to each of the first two years to which the MIPS applies, the Secretary shall, prior to the performance period for such years, establish a performance threshold for purposes of determining MIPS adjustment factors under subparagraph (A) and a threshold for purposes of determining additional MIPS adjustment factors under subparagraph (C). Each such performance threshold shall—</chapeau><subclause class="fontsize10" id="y58552989-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>be based on a period prior to such performance periods; and</content></subclause> <subclause class="fontsize10" id="y5855298a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><chapeau>take into account—</chapeau><item class="fontsize10" id="y5855298b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>data available with respect to performance on measures and activities that may be used under the performance categories under subparagraph (2)(B); and</content></item> <item class="fontsize10" id="y5855298c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>other factors determined appropriate by the Secretary.<page identifier="/us/stat/129/108">129 STAT. 108</page></content></item> </subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y5855298d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Application of mips adjustment factors</inline>.—</heading><chapeau>In the case of items and services furnished by a MIPS eligible professional during a year (beginning with 2019), the amount otherwise paid under this part with respect to such items and services and MIPS eligible professional for such year, shall be multiplied by—</chapeau><clause class="fontsize10" id="y5855298e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>1, plus</content></clause> <clause class="fontsize10" id="y5855298f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><chapeau>the sum of—</chapeau><subclause class="fontsize10" id="y58552990-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the MIPS adjustment factor determined under subparagraph (A) divided by 100, and</content></subclause> <subclause class="fontsize10" id="y58552991-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>as applicable, the additional MIPS adjustment factor determined under subparagraph (C) divided by 100.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y58552992-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><heading class="fontsize10"><inline class="smallCaps">Aggregate application of mips adjustment factors</inline>.—</heading><clause class="fontsize10" id="y58552993-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Application of scaling factor</inline>.—</heading><subclause class="fontsize10" id="y58552994-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>With respect to positive MIPS adjustment factors under subparagraph (A)(ii)(I) for eligible professionals whose composite performance score is above the performance threshold under subparagraph (D)(i) for such year, subject to subclause (II), the Secretary shall increase or decrease such adjustment factors by a scaling factor in order to ensure that the budget neutrality requirement of clause (ii) is met.</content></subclause> <subclause class="fontsize10" id="y58552995-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Scaling factor limit</inline>.—</heading><content>In no case may the scaling factor applied under this clause exceed 3.0.</content></subclause> </clause> <clause class="fontsize10" id="y58552996-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Budget neutrality requirement</inline>.—</heading><subclause class="fontsize10" id="y58552997-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to clause (iii), the Secretary shall ensure that the estimated amount described in subclause (II) for a year is equal to the estimated amount described in subclause (III) for such year.</content></subclause> <subclause class="fontsize10" id="y58552998-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Aggregate increases</inline>.—</heading><content>The amount described in this subclause is the estimated increase in the aggregate allowed charges resulting from the application of positive MIPS adjustment factors under subparagraph (A) (after application of the scaling factor described in clause (i)) to MIPS eligible professionals whose composite performance score for a year is above the performance threshold under subparagraph (D)(i) for such year.</content></subclause> <subclause class="fontsize10" id="y58552999-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><heading class="fontsize10"><inline class="smallCaps">Aggregate decreases</inline>.—</heading><content>The amount described in this subclause is the estimated decrease in the aggregate allowed charges resulting from the application of negative MIPS adjustment factors under subparagraph (A) to MIPS eligible professionals whose composite performance score for a year is below the performance threshold under subparagraph (D)(i) for such year.</content></subclause> </clause> <clause class="fontsize10" id="y5855299a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Exceptions</inline>.—</heading><subclause class="fontsize10" id="y5855299b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5855299c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote><content>In the case that all MIPS eligible professionals receive composite performance scores for a year that are below the performance threshold <page identifier="/us/stat/129/109">129 STAT. 109</page> under subparagraph (D)(i) for such year, the negative MIPS adjustment factors under subparagraph (A) shall apply with respect to such MIPS eligible professionals and the budget neutrality requirement of clause (ii) and the additional adjustment factors under clause (iv) shall not apply for such year.</content></subclause> <subclause class="fontsize10" id="y5855299d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>In the case that, with respect to a year, the application of clause (i) results in a scaling factor equal to the maximum scaling factor specified in clause (i)(II), such scaling factor shall apply and the budget neutrality requirement of clause (ii) shall not apply for such year.</content></subclause> </clause> <clause class="fontsize10" id="y5855299e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Additional incentive payment adjustments</inline>.—</heading><subclause class="fontsize10" id="y5855299f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585529a0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to subclause (II), in specifying the MIPS additional adjustment factors under subparagraph (C) for each applicable MIPS eligible professional for a year, the Secretary shall ensure that the estimated aggregate increase in payments under this part resulting from the application of such additional adjustment factors for MIPS eligible professionals in a year shall be equal (as estimated by the Secretary) to $500,000,000 for each year beginning with 2019 and ending with 2024.</content></subclause> <subclause class="fontsize10" id="y585529a1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Limitation on additional incentive payment adjustments</inline>.—</heading><content>The MIPS additional adjustment factor under subparagraph (C) for a year for an applicable MIPS eligible professional whose composite performance score is above the additional performance threshold under subparagraph (D)(ii) for such year shall not exceed 10 percent. The application of the previous sentence may result in an aggregate amount of additional incentive payments that are less than the amount specified in subclause (I).</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585529a2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="7">“(7) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585529a3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Announcement of result of adjustments</inline>.—</heading><content>Under the MIPS, the Secretary shall, not later than 30 days prior to January 1 of the year involved, make available to MIPS eligible professionals the MIPS adjustment factor (and, as applicable, the additional MIPS adjustment factor) under paragraph (6) applicable to the eligible professional for items and services furnished by the professional for such year. The Secretary may include such information in the confidential feedback under paragraph (12).</content></paragraph> <paragraph class="fontsize10" id="y585550b4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="8">“(8) </num><heading class="fontsize10"><inline class="smallCaps">No effect in subsequent years</inline>.—</heading><content>The MIPS adjustment factors and additional MIPS adjustment factors under paragraph (6) shall apply only with respect to the year involved, and the Secretary shall not take into account such adjustment factors in making payments to a MIPS eligible professional under this part in a subsequent year.</content></paragraph> <paragraph class="fontsize10" id="y585550b5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="9">“(9) </num><heading class="fontsize10"><inline class="smallCaps">Public reporting</inline>.—</heading><subparagraph class="fontsize10" id="y585550b6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585550b7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>The Secretary shall, in an easily understandable format, make available on the Physician Compare Internet website of the Centers for Medicare & Medicaid Services the following:</chapeau><page identifier="/us/stat/129/110">129 STAT. 110</page> <clause class="fontsize10" id="y585550b8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><chapeau>Information regarding the performance of MIPS eligible professionals under the MIPS, which—</chapeau><subclause class="fontsize10" id="y585550b9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>shall include the composite score for each such MIPS eligible professional and the performance of each such MIPS eligible professional with respect to each performance category; and</content></subclause> <subclause class="fontsize10" id="y585550ba-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>may include the performance of each such MIPS eligible professional with respect to each measure or activity specified in paragraph (2)(B).</content></subclause> </clause> <clause class="fontsize10" id="y585550bb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>The names of eligible professionals in eligible alternative payment models (as defined in section 1833(z)(3)(D)) and, to the extent feasible, the names of such eligible alternative payment models and performance of such models.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585550bc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Disclosure</inline>.—</heading><content>The information made available under this paragraph shall indicate, where appropriate, that publicized information may not be representative of the eligible professional’s entire patient population, the variety of services furnished by the eligible professional, or the health conditions of individuals treated.</content></subparagraph> <subparagraph class="fontsize10" id="y585550bd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Opportunity to review and submit corrections</inline>.—</heading><content>The Secretary shall provide for an opportunity for a professional described in subparagraph (A) to review, and submit corrections for, the information to be made public with respect to the professional under such subparagraph prior to such information being made public.</content></subparagraph> <subparagraph class="fontsize10" id="y585550be-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585550bf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Aggregate information</inline>.—</heading><content>The Secretary shall periodically post on the Physician Compare Internet website aggregate information on the MIPS, including the range of composite scores for all MIPS eligible professionals and the range of the performance of all MIPS eligible professionals with respect to each performance category.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585550c0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="10">“(10) </num><heading class="fontsize10"><inline class="smallCaps">Consultation</inline>.—</heading><content>The Secretary shall consult with stakeholders in carrying out the MIPS, including for the identification of measures and activities under paragraph (2)(B) and the methodologies developed under paragraphs (5)(A) and (6) and regarding the use of qualified clinical data registries. Such consultation shall include the use of a request for information or other mechanisms determined appropriate.</content></paragraph> <paragraph class="fontsize10" id="y585550c1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="11">“(11) </num><heading class="fontsize10"><inline class="smallCaps">Technical assistance to small practices and practices in health professional shortage areas</inline>.—</heading><subparagraph class="fontsize10" id="y585550c2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585550c3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Contracts.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>The Secretary shall enter into contracts or agreements with appropriate entities (such as quality improvement organizations, regional extension centers (as described in section 3012(c) of the Public Health Service Act), or regional health collaboratives) to offer guidance and assistance to MIPS eligible professionals in practices of 15 or fewer professionals (with priority given to such practices located in rural areas, health professional shortage areas (as designated under in section 332(a)(1)(A) of such Act), and medically underserved areas, and practices with low composite scores) with respect to—</chapeau><clause class="fontsize10" id="y585550c4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>the performance categories described in clauses (i) through (iv) of paragraph (2)(A); or</content></clause> <clause class="fontsize10" id="y585550c5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>how to transition to the implementation of and participation in an alternative payment model as described in section 1833(z)(3)(C).<page identifier="/us/stat/129/111">129 STAT. 111</page></content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585550c6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Funding for technical assistance</inline>.—</heading><content>For purposes of implementing subparagraph (A), the Secretary shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 to the Centers for Medicare & Medicaid Services Program Management Account of $20,000,000 for each of fiscal years 2016 through 2020. Amounts transferred under this subparagraph for a fiscal year shall be available until expended.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585550c7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="12">“(12) </num><heading class="fontsize10"><inline class="smallCaps">Feedback and information to improve performance</inline>.—</heading><subparagraph class="fontsize10" id="y585550c8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Performance feedback</inline>.—</heading><clause class="fontsize10" id="y585550c9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585550ca-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Beginning July 1, 2017, the Secretary—</chapeau><subclause class="fontsize10" id="y585550cb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>shall make available timely (such as quarterly) confidential feedback to MIPS eligible professionals on the performance of such professionals with respect to the performance categories under clauses (i) and (ii) of paragraph (2)(A); and</content></subclause> <subclause class="fontsize10" id="y585550cc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>may make available confidential feedback to such professionals on the performance of such professionals with respect to the performance categories under clauses (iii) and (iv) of such paragraph.</content></subclause> </clause> <clause class="fontsize10" id="y585550cd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Mechanisms</inline>.—</heading><content>The Secretary may use one or more mechanisms to make feedback available under clause (i), which may include use of a web-based portal or other mechanisms determined appropriate by the Secretary. With respect to the performance category described in paragraph (2)(A)(i), feedback under this subparagraph shall, to the extent an eligible professional chooses to participate in a data registry for purposes of this subsection (including registries under subsections (k) and (m)), be provided based on performance on quality measures reported through the use of such registries. With respect to any other performance category described in paragraph (2)(A), the Secretary shall encourage provision of feedback through qualified clinical data registries as described in subsection (m)(3)(E)).</content></clause> <clause class="fontsize10" id="y585550ce-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Use of data</inline>.—</heading><content>For purposes of clause (i), the Secretary may use data, with respect to a MIPS eligible professional, from periods prior to the current performance period and may use rolling periods in order to make illustrative calculations about the performance of such professional.</content></clause> <clause class="fontsize10" id="y585550cf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Disclosure exemption</inline>.—</heading><content>Feedback made available under this subparagraph shall be exempt from disclosure under <ref href="/us/usc/t5/s552">section 552 of title 5, United States Code</ref>.</content></clause> <clause class="fontsize10" id="y585550d0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><heading class="fontsize10"><inline class="smallCaps">Receipt of information</inline>.—</heading><content>The Secretary may use the mechanisms established under clause (ii) to receive information from professionals, such as information with respect to this subsection.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585550d1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Additional information</inline>.—</heading><page identifier="/us/stat/129/112">129 STAT. 112</page> <clause class="fontsize10" id="y585550d2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585550d3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Beginning July 1, 2018, the Secretary shall make available to MIPS eligible professionals information, with respect to individuals who are patients of such MIPS eligible professionals, about items and services for which payment is made under this title that are furnished to such individuals by other suppliers and providers of services, which may include information described in clause (ii). Such information may be made available under the previous sentence to such MIPS eligible professionals by mechanisms determined appropriate by the Secretary, which may include use of a web-based portal. Such information may be made available in accordance with the same or similar terms as data are made available to accountable care organizations participating in the shared savings program under section 1899.</content></clause> <clause class="fontsize10" id="y585550d4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Type of information</inline>.—</heading><chapeau>For purposes of clause (i), the information described in this clause, is the following:</chapeau><subclause class="fontsize10" id="y585550d5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>With respect to selected items and services (as determined appropriate by the Secretary) for which payment is made under this title and that are furnished to individuals, who are patients of a MIPS eligible professional, by another supplier or provider of services during the most recent period for which data are available (such as the most recent three-month period), such as the name of such providers furnishing such items and services to such patients during such period, the types of such items and services so furnished, and the dates such items and services were so furnished.</content></subclause> <subclause class="fontsize10" id="y585550d6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>Historical data, such as averages and other measures of the distribution if appropriate, of the total, and components of, allowed charges (and other figures as determined appropriate by the Secretary).</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585550d7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="13">“(13) </num><heading class="fontsize10"><inline class="smallCaps">Review</inline>.—</heading><subparagraph class="fontsize10" id="y585550d8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Targeted review</inline>.—</heading><content>The Secretary shall establish a process under which a MIPS eligible professional may seek an informal review of the calculation of the MIPS adjustment factor (or factors) applicable to such eligible professional under this subsection for a year. The results of a review conducted pursuant to the previous sentence shall not be taken into account for purposes of paragraph (6) with respect to a year (other than with respect to the calculation of such eligible professional’s MIPS adjustment factor for such year or additional MIPS adjustment factor for such year) after the factors determined in subparagraph (A) and subparagraph (C) of such paragraph have been determined for such year.</content></subparagraph> <subparagraph class="fontsize10" id="y585550d9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Limitation</inline>.—</heading><chapeau>Except as provided for in subparagraph (A), there shall be no administrative or judicial review under section 1869, section 1878, or otherwise of the following:</chapeau><clause class="fontsize10" id="y585550da-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>The methodology used to determine the amount of the MIPS adjustment factor under paragraph (6)(A) and the amount of the additional MIPS adjustment <page identifier="/us/stat/129/113">129 STAT. 113</page> factor under paragraph (6)(C) and the determination of such amounts.</content></clause> <clause class="fontsize10" id="y585550db-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>The establishment of the performance standards under paragraph (3) and the performance period under paragraph (4).</content></clause> <clause class="fontsize10" id="y585550dc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>The identification of measures and activities specified under paragraph (2)(B) and information made public or posted on the Physician Compare Internet website of the Centers for Medicare & Medicaid Services under paragraph (9).</content></clause> <clause class="fontsize10" id="y585550dd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>The methodology developed under paragraph (5) that is used to calculate performance scores and the calculation of such scores, including the weighting of measures and activities under such methodology.”</content></clause> </subparagraph> </paragraph> </subsection> </quotedContent>.</content></paragraph> <paragraph class="fontsize10" id="y585550de-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">GAO reports</inline>.—</heading><subparagraph class="fontsize10" id="y585550df-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Evaluation of eligible professional mips</inline>.—</heading><chapeau>Not later than October 1, 2021, the Comptroller General of the United States shall submit to Congress a report evaluating the eligible professional Merit-based Incentive Payment System under subsection (q) of section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>), as added by paragraph (1). Such report shall—</chapeau><clause class="fontsize10" id="y585550e0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>examine the distribution of the composite performance scores and MIPS adjustment factors (and additional MIPS adjustment factors) for MIPS eligible professionals (as defined in subsection (q)(1)(c) of such section) under such program, and patterns relating to such scores and adjustment factors, including based on type of provider, practice size, geographic location, and patient mix;</content></clause> <clause class="fontsize10" id="y585550e1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>provide recommendations for improving such program;</content></clause> <clause class="fontsize10" id="y585550e2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/A/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>evaluate the impact of technical assistance funding under section 1848(q)(11) of the Social Security Act, as added by paragraph (1), on the ability of professionals to improve within such program or successfully transition to an alternative payment model (as defined in section 1833(z)(3) of the Social Security Act, as added by subsection (e)), with priority for such evaluation given to practices located in rural areas, health professional shortage areas (as designated in section 332(a)(1)(A) of the Public Health Service Act), and medically underserved areas; and</content></clause> <clause class="fontsize10" id="y585577f3-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/A/iv" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">(iv) </num><content>provide recommendations for optimizing the use of such technical assistance funds.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585577f4-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Study to examine alignment of quality measures used in public and private programs</inline>.—</heading><clause class="fontsize10" id="y585577f5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>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—</chapeau><subclause class="fontsize10" id="y585577f6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B/i/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>compares the similarities and differences in the use of quality measures under the original Medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act, the Medicare Advantage program under part C of such title, selected State Medicaid programs <page identifier="/us/stat/129/114">129 STAT. 114</page> under title XIX of such Act, and private payer arrangements; and</content></subclause> <subclause class="fontsize10" id="y585577f7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B/i/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>makes recommendations on how to reduce the administrative burden involved in applying such quality measures.</content></subclause> </clause> <clause class="fontsize10" id="y585577f8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><heading class="fontsize10"><inline class="smallCaps">Requirements</inline>.—</heading><chapeau>The report under clause (i) shall—</chapeau><subclause class="fontsize10" id="y585577f9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B/ii/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>consider those measures applicable to individuals entitled to, or enrolled for, benefits under such part A, or enrolled under such part B and individuals under the age of 65; and</content></subclause> <subclause class="fontsize10" id="y585577fa-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B/ii/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>focus on those measures that comprise the most significant component of the quality performance category of the eligible professional MIPS incentive program under subsection (q) of section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>), as added by paragraph (1).</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y585577fb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Study on role of independent risk managers</inline>.—</heading><content>Not later than January 1, 2017, the Comptroller General of the United States shall submit to Congress a report examining whether entities that pool financial risk for physician practices, such as independent risk managers, can play a role in supporting physician practices, particularly small physician practices, in assuming financial risk for the treatment of patients. Such report shall examine barriers that small physician practices currently face in assuming financial risk for treating patients, the types of risk management entities that could assist physician practices in participating in two-sided risk payment models, and how such entities could assist with risk management and with quality improvement activities. Such report shall also include an analysis of any existing legal barriers to such arrangements.</content></subparagraph> <subparagraph class="fontsize10" id="y585577fc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/D" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><heading class="fontsize10"><inline class="smallCaps">Study to examine rural and health professional shortage area alternative payment models</inline>.—</heading><content>Not later than October 1, 2021, the Comptroller General of the United States shall submit to Congress a report that examines the transition of professionals in rural areas, health professional shortage areas (as designated in section 332(a)(1)(A) of the Public Health Service Act), or medically underserved areas to an alternative payment model (as defined in section 1833(z)(3) of the Social Security Act, as added by subsection (e)). Such report shall make recommendations for removing administrative barriers to practices, including small practices consisting of 15 or fewer professionals, in rural areas, health professional shortage areas, and medically underserved areas to participation in such models.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585577fd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Funding for implementation</inline>.—</heading><content>For purposes of implementing the provisions of and the amendments made by this section, the Secretary of Health and Human Services shall provide for the transfer of $80,000,000 from the Supplementary Medical Insurance Trust Fund established under section 1841 of the Social Security Act (<ref href="/us/usc/t42/s1395t">42 U.S.C. 1395t</ref>) to the Centers for Medicare & Medicaid Program Management Account for each of the fiscal years 2015 through 2019. Amounts transferred under this paragraph shall be available until expended.<page identifier="/us/stat/129/115">129 STAT. 115</page></content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y585577fe-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><heading class="fontsize10"><inline class="smallCaps">Improving Quality Reporting for Composite Scores</inline>.—</heading><paragraph class="fontsize10" id="y585577ff-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Changes for group reporting option</inline>.—</heading><subparagraph class="fontsize10" id="y58557800-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/1/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Section 1848(m)(3)(C)(ii) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/m/3/C/ii">42 U.S.C. 1395w–4(m)(3)(C)(ii)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and, for 2016 and subsequent years, may provide</quotedText>” after “<quotedText>shall provide</quotedText>”.</content></subparagraph> <subparagraph class="fontsize10" id="y58557801-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/1/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Clarification of qualified clinical data registry reporting to group practices</inline>.—</heading><content>Section 1848(m)(3)(D) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/m/3/D">42 U.S.C. 1395w–4(m)(3)(D)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and, for 2016 and subsequent years, subparagraph (A) or (C)</quotedText>” after “<quotedText>subparagraph (A)</quotedText>”.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58557802-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/2" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Changes for multiple reporting periods and alternative criteria for satisfactory reporting</inline>.—</heading><chapeau>Section 1848(m)(5)(F) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/m/5/F">42 U.S.C. 1395w–4(m)(5)(F)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y58557803-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>and subsequent years</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>through reporting periods occurring in 2015</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y58559f14-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and, for reporting periods occurring in 2016 and subsequent years, the Secretary may establish</quotedText>” after “<quotedText>shall establish</quotedText>”.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58559f15-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/3" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Physician feedback program reports succeeded by reports under mips</inline>.—</heading><content>Section 1848(n) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/n">42 U.S.C. 1395w–4(n)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="indentUp0 fontsize10" id="y58559f16-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="11">“(11) </num><heading class="fontsize10"><inline class="smallCaps">Reports ending with 2017</inline>.—</heading><content>Reports under the Program shall not be provided after December 31, 2017. See subsection (q)(12) for reports under the eligible professionals Merit-based Incentive Payment System.”</content></paragraph> </quotedContent>.</content></paragraph> <paragraph class="fontsize10" id="y58559f17-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/4" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><heading class="fontsize10"><inline class="smallCaps">Coordination with satisfying meaningful ehr use clinical quality measure reporting requirement</inline>.—</heading><content>Section 1848(o)(2)(A)(iii) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/o/2/A/iii">42 U.S.C. 1395w–4(o)(2)(A)(iii)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and subsection (q)(5)(B)(ii)(II)</quotedText>” after “<quotedText>Subject to subparagraph (B)(ii)</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y58559f18-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="e">(e) </num><heading class="fontsize10"><inline class="smallCaps">Promoting Alternative Payment Models</inline>.—</heading><paragraph class="fontsize10" id="y58559f19-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Increasing transparency of physician-focused payment models</inline>.—</heading><content>Section 1868 of the Social Security Act (<ref href="/us/usc/t42/s1395ee">42 U.S.C. 1395ee</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="indentDown1 firstIndent0 fontsize10" id="y58563b5a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">“(c) </num><heading class="fontsize10"><inline class="smallCaps">Physician-Focused Payment Models</inline>.—</heading><paragraph class="fontsize10" id="y58563b5b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">Technical advisory committee</inline>.—</heading><subparagraph class="fontsize10" id="y58563b5c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Establishment</inline>.—</heading><content>There is established an ad hoc committee to be known as the ‘Physician-Focused Payment Model Technical Advisory Committee’ (referred to in this subsection as the ‘Committee’).</content></subparagraph> <subparagraph class="fontsize10" id="y58563b5d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Membership</inline>.—</heading><clause class="fontsize10" id="y58563b5e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Number and appointment</inline>.—</heading><content>The Committee shall be composed of 11 members appointed by the Comptroller General of the United States.</content></clause> <clause class="fontsize10" id="y58563b5f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Qualifications</inline>.—</heading><content>The membership of the Committee shall include individuals with national recognition for their expertise in physician-focused payment models and related delivery of care. No more than 5 members of the Committee shall be providers of services or suppliers, or representatives of providers of services or suppliers.<page identifier="/us/stat/129/116">129 STAT. 116</page></content></clause> <clause class="fontsize10" id="y58563b60-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Prohibition on federal employment</inline>.—</heading><content>A member of the Committee shall not be an employee of the Federal Government.</content></clause> <clause class="fontsize10" id="y58563b61-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Ethics disclosure</inline>.—</heading><content>The Comptroller General shall establish a system for public disclosure by members of the Committee of financial and other potential conflicts of interest relating to such members. Members of the Committee shall be treated as employees of Congress for purposes of applying title I of the Ethics in Government Act of 1978 (<ref href="/us/pl/95/521">Public Law 95–521</ref>).</content></clause> <clause class="fontsize10" id="y58563b62-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58563b63-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Date of initial appointments</inline>.—</heading><content>The initial appointments of members of the Committee shall be made by not later than 180 days after the date of enactment of this subsection.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58563b64-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Term; vacancies</inline>.—</heading><clause class="fontsize10" id="y58563b65-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Term</inline>.—</heading><content>The terms of members of the Committee shall be for 3 years except that the Comptroller General shall designate staggered terms for the members first appointed.</content></clause> <clause class="fontsize10" id="y58563b66-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Vacancies</inline>.—</heading><content>Any member appointed to fill a vacancy occurring before the expiration of the term for which the member’s predecessor was appointed shall be appointed only for the remainder of that term. A member may serve after the expiration of that member’s term until a successor has taken office. A vacancy in the Committee shall be filled in the manner in which the original appointment was made.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58563b67-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Duties</inline>.—</heading><content>The Committee shall meet, as needed, to provide comments and recommendations to the Secretary, as described in paragraph (2)(C), on physician-focused payment models.</content></subparagraph> <subparagraph class="fontsize10" id="y58563b68-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Compensation of members</inline>.—</heading><clause class="fontsize10" id="y58563b69-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Except as provided in clause (ii), a member of the Committee shall serve without compensation.</content></clause> <clause class="fontsize10" id="y58563b6a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Travel expenses</inline>.—</heading><content>A member of the Committee shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for an employee of an agency under <ref href="/us/usc/t5/ch57/schI">subchapter I of chapter 57 of title 5, United States Code</ref>, while away from the home or regular place of business of the member in the performance of the duties of the Committee.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58563b6b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><heading class="fontsize10"><inline class="smallCaps">Operational and technical support</inline>.—</heading><clause class="fontsize10" id="y58563b6c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>The Assistant Secretary for Planning and Evaluation shall provide technical and operational support for the Committee, which may be by use of a contractor. The Office of the Actuary of the Centers for Medicare & Medicaid Services shall provide to the Committee actuarial assistance as needed.</content></clause> <clause class="fontsize10" id="y58563b6d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Funding</inline>.—</heading><content>The Secretary shall provide for the transfer, from the Federal Supplementary Medical Insurance Trust Fund under section 1841, such amounts as are necessary to carry out this paragraph (not to exceed $5,000,000) for fiscal year 2015 and each subsequent fiscal year. Any amounts transferred <page identifier="/us/stat/129/117">129 STAT. 117</page> under the preceding sentence for a fiscal year shall remain available until expended.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58563b6e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="G">“(G) </num><heading class="fontsize10"><inline class="smallCaps">Application</inline>.—</heading><content>Section 14 of the Federal Advisory Committee Act (<ref href="/us/usc/t5/app">5 U.S.C. App.</ref>) shall not apply to the Committee.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58563b6f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">Criteria and process for submission and review of physician-focused payment models</inline>.—</heading><subparagraph class="fontsize10" id="y58563b70-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Criteria for assessing physician-focused payment models</inline>.—</heading><clause class="fontsize10" id="y58563b71-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58563b72-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Rulemaking</inline>.—</heading><content>Not later than November 1, 2016, the Secretary shall, through notice and comment rulemaking, following a request for information, establish criteria for physician-focused payment models, including models for specialist physicians, that could be used by the Committee for making comments and recommendations pursuant to paragraph (1)(D).</content></clause> <clause class="fontsize10" id="y58563b73-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">MedPAC submission of comments</inline>.—</heading><content>During the comment period for the proposed rule described in clause (i), the Medicare Payment Advisory Commission may submit comments to the Secretary on the proposed criteria under such clause.</content></clause> <clause class="fontsize10" id="y58563b74-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Updating</inline>.—</heading><content>The Secretary may update the criteria established under this subparagraph through rulemaking.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58563b75-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Stakeholder submission of physician-focused payment models</inline>.—</heading><content>On an ongoing basis, individuals and stakeholder entities may submit to the Committee proposals for physician-focused payment models that such individuals and entities believe meet the criteria described in subparagraph (A).</content></subparagraph> <subparagraph class="fontsize10" id="y58563b76-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Committee review of models submitted</inline>.—</heading><content>The Committee shall, on a periodic basis, review models submitted under subparagraph (B), prepare comments and recommendations regarding whether such models meet the criteria described in subparagraph (A), and submit such comments and recommendations to the Secretary.</content></subparagraph> <subparagraph class="fontsize10" id="y58563b77-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Secretary review and response</inline>.—</heading><content>The Secretary shall review the comments and recommendations submitted by the Committee under subparagraph (C) and post a detailed response to such comments and recommendations on the Internet website of the Centers for Medicare & Medicaid Services.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58563b78-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Rule of construction</inline>.—</heading><content>Nothing in this subsection shall be construed to impact the development or testing of models under this title or titles XI, XIX, or XXI.”</content></paragraph> </subsection> </quotedContent>.</content></paragraph> <paragraph class="fontsize10" id="y58563b79-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/2" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Incentive payments for participation in eligible alternative payment models</inline>.—</heading><content>Section 1833 of the Social Security Act (<ref href="/us/usc/t42/s1395l">42 U.S.C. 1395l</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="indentDown1 firstIndent0 fontsize10" id="y58579b0a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="z">“(z) </num><heading class="fontsize10"><inline class="smallCaps">Incentive Payments for Participation in Eligible Alternative Payment Models</inline>.—</heading><paragraph class="fontsize10" id="y58579b0b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">Payment incentive</inline>.—</heading><subparagraph class="fontsize10" id="y58579b0c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58579b0d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>In the case of covered professional services furnished by an eligible professional during a year that is in the period beginning with 2019 and ending with 2024 and for which the professional is a qualifying APM participant with respect to such year, in addition to the <page identifier="/us/stat/129/118">129 STAT. 118</page> amount of payment that would otherwise be made for such covered professional services under this part for such year, there also shall be paid to such professional an amount equal to 5 percent of the estimated aggregate payment amounts for such covered professional services under this part for the preceding year. For purposes of the previous sentence, the payment amount for the preceding year may be an estimation for the full preceding year based on a period of such preceding year that is less than the full year. The <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58579b0e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Policies.</p></sidenote>Secretary shall establish policies to implement this subparagraph in cases in which payment for covered professional services furnished by a qualifying APM participant in an alternative payment model—</chapeau><clause class="fontsize10" id="y58579b0f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>is made to an eligible alternative payment entity rather than directly to the qualifying APM participant; or</content></clause> <clause class="fontsize10" id="y58579b10-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>is made on a basis other than a fee-for-service basis (such as payment on a capitated basis).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58579b11-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Form of payment</inline>.—</heading><content>Payments under this subsection shall be made in a lump sum, on an annual basis, as soon as practicable.</content></subparagraph> <subparagraph class="fontsize10" id="y58579b12-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Treatment of payment incentive</inline>.—</heading><content>Payments under this subsection shall not be taken into account for purposes of determining actual expenditures under an alternative payment model and for purposes of determining or rebasing any benchmarks used under the alternative payment model.</content></subparagraph> <subparagraph class="fontsize10" id="y58579b13-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Coordination</inline>.—</heading><content>The amount of the additional payment under this subsection or subsection (m) shall be determined without regard to any additional payment under subsection (m) and this subsection, respectively. The amount of the additional payment under this subsection or subsection (x) shall be determined without regard to any additional payment under subsection (x) and this subsection, respectively. The amount of the additional payment under this subsection or subsection (y) shall be determined without regard to any additional payment under subsection (y) and this subsection, respectively.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58579b14-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58579b15-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Definition.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Qualifying apm participant</inline>.—</heading><chapeau>For purposes of this subsection, the term ‘<term>qualifying APM participant</term>’ means the following:</chapeau><subparagraph class="fontsize10" id="y58579b16-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10 smallCaps">2019 and 2020<inline class="noSmallCaps">.—</inline></heading><content>With respect to 2019 and 2020, an eligible professional for whom the Secretary determines that at least 25 percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available (which may be less than a year) were attributable to such services furnished under this part through an eligible alternative payment entity.</content></subparagraph> <subparagraph class="fontsize10" id="y58579b17-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10 smallCaps">2021 and 2022<inline class="noSmallCaps">.—</inline></heading><chapeau>With respect to 2021 and 2022, an eligible professional described in either of the following clauses:</chapeau><clause class="fontsize10" id="y58579b18-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Medicare payment threshold option</inline>.—</heading><content>An eligible professional for whom the Secretary determines that at least 50 percent of payments under this part for covered professional services furnished by such professional during the most recent period for which <page identifier="/us/stat/129/119">129 STAT. 119</page> data are available (which may be less than a year) were attributable to such services furnished under this part through an eligible alternative payment entity.</content></clause> <clause class="fontsize10" id="y58579b19-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Combination all-payer and medicare payment threshold option</inline>.—</heading><chapeau>An eligible professional—</chapeau><subclause class="fontsize10" id="y58579b1a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><chapeau>for whom the Secretary determines, with respect to items and services furnished by such professional during the most recent period for which data are available (which may be less than a year), that at least 50 percent of the sum of—</chapeau><item class="fontsize10" id="y58579b1b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>payments described in clause (i); and</content></item> <item class="fontsize10" id="y58579b1c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>all other payments, regardless of payer (other than payments made by the Secretary of Defense or the Secretary of Veterans Affairs and other than payments made under title XIX in a State in which no medical home or alternative payment model is available under the State program under that title),</content></item> <continuation class="firstIndent1 fontsize10" id="x58579b1d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128">meet the requirement described in clause (iii)(I) with respect to payments described in item (aa) and meet the requirement described in clause (iii)(II) with respect to payments described in item (bb);</continuation></subclause> <subclause class="fontsize10" id="y58579b1e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>for whom the Secretary determines at least 25 percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available (which may be less than a year) were attributable to such services furnished under this part through an eligible alternative payment entity; and</content></subclause> <subclause class="fontsize10" id="y58579b1f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>who provides to the Secretary such information as is necessary for the Secretary to make a determination under subclause (I), with respect to such professional.</content></subclause> </clause> <clause class="fontsize10" id="y58579b20-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Requirement</inline>.—</heading><chapeau>For purposes of clause (ii)(I)—</chapeau><subclause class="fontsize10" id="y58579b21-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the requirement described in this subclause, with respect to payments described in item (aa) of such clause, is that such payments are made to an eligible alternative payment entity; and</content></subclause> <subclause class="fontsize10" id="y58579b22-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><chapeau>the requirement described in this subclause, with respect to payments described in item (bb) of such clause, is that such payments are made under arrangements in which—</chapeau><item class="fontsize10" id="y58579b23-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>quality measures comparable to measures under the performance category described in section 1848(q)(2)(B)(i) apply;</content></item> <item class="fontsize10" id="y58579b24-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>certified EHR technology is used; and</content></item> <item class="fontsize10" id="y58579b25-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="cc">“(cc) </num><chapeau>the eligible professional participates in an entity that—</chapeau><subitem class="fontsize10" id="y58579b26-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658131"><num class="fontsize10" style="-uslm-lc:emspace2" value="AA">“(AA) </num><content>bears more than nominal financial risk if actual aggregate expenditures exceeds expected aggregate expenditures; or<page identifier="/us/stat/129/120">129 STAT. 120</page></content></subitem> <subitem class="fontsize10" id="y58579b27-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658131"><num class="fontsize10" style="-uslm-lc:emspace2" value="BB">“(BB) </num><content>with respect to beneficiaries under title XIX, is a medical home that meets criteria comparable to medical homes expanded under section 1115A(c).</content></subitem> </item> </subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y58579b28-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58579b29-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Beginning in 2023</inline>.—</heading><chapeau>With respect to 2023 and each subsequent year, an eligible professional described in either of the following clauses:</chapeau><clause class="fontsize10" id="y58579b2a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Medicare payment threshold option</inline>.—</heading><content>An eligible professional for whom the Secretary determines that at least 75 percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available (which may be less than a year) were attributable to such services furnished under this part through an eligible alternative payment entity.</content></clause> <clause class="fontsize10" id="y58579b2b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Combination all-payer and medicare payment threshold option</inline>.—</heading><chapeau>An eligible professional—</chapeau><subclause class="fontsize10" id="y58579b2c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><chapeau>for whom the Secretary determines, with respect to items and services furnished by such professional during the most recent period for which data are available (which may be less than a year), that at least 75 percent of the sum of—</chapeau><item class="fontsize10" id="y58579b2d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>payments described in clause (i); and</content></item> <item class="fontsize10" id="y58579b2e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>all other payments, regardless of payer (other than payments made by the Secretary of Defense or the Secretary of Veterans Affairs and other than payments made under title XIX in a State in which no medical home or alternative payment model is available under the State program under that title),</content></item> <continuation class="firstIndent1 fontsize10" id="x58579b2f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128">meet the requirement described in clause (iii)(I) with respect to payments described in item (aa) and meet the requirement described in clause (iii)(II) with respect to payments described in item (bb);</continuation></subclause> <subclause class="fontsize10" id="y58579b30-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>for whom the Secretary determines at least 25 percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available (which may be less than a year) were attributable to such services furnished under this part through an eligible alternative payment entity; and</content></subclause> <subclause class="fontsize10" id="y58579b31-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>who provides to the Secretary such information as is necessary for the Secretary to make a determination under subclause (I), with respect to such professional.</content></subclause> </clause> <clause class="fontsize10" id="y58579b32-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Requirement</inline>.—</heading><chapeau>For purposes of clause (ii)(I)—</chapeau><subclause class="fontsize10" id="y58579b33-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the requirement described in this subclause, with respect to payments described in item (aa) of such clause, is that such payments are made to an eligible alternative payment entity; and</content></subclause> <subclause class="fontsize10" id="y58579b34-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><chapeau>the requirement described in this subclause, with respect to payments described in item <page identifier="/us/stat/129/121">129 STAT. 121</page> (bb) of such clause, is that such payments are made under arrangements in which—</chapeau><item class="fontsize10" id="y58579b35-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58579b36-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote><content>quality measures comparable to measures under the performance category described in section 1848(q)(2)(B)(i) apply;</content></item> <item class="fontsize10" id="y58579b37-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>certified EHR technology is used; and</content></item> <item class="fontsize10" id="y58579b38-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="cc">“(cc) </num><chapeau>the eligible professional participates in an entity that—</chapeau><subitem class="fontsize10" id="y58579b39-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658131"><num class="fontsize10" style="-uslm-lc:emspace2" value="AA">“(AA) </num><content>bears more than nominal financial risk if actual aggregate expenditures exceeds expected aggregate expenditures; or</content></subitem> <subitem class="fontsize10" id="y58579b3a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658131"><num class="fontsize10" style="-uslm-lc:emspace2" value="BB">“(BB) </num><content>with respect to beneficiaries under title XIX, is a medical home that meets criteria comparable to medical homes expanded under section 1115A(c).</content></subitem> </item> </subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y58579b3b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Use of patient approach</inline>.—</heading><content>The Secretary may base the determination of whether an eligible professional is a qualifying APM participant under this subsection and the determination of whether an eligible professional is a partial qualifying APM participant under section 1848(q)(1)(C)(iii) by using counts of patients in lieu of using payments and using the same or similar percentage criteria (as specified in this subsection and such section, respectively), as the Secretary determines appropriate.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58579b3c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Additional definitions</inline>.—</heading><chapeau>In this subsection:</chapeau><subparagraph class="fontsize10" id="y5857c24d-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Covered professional services</inline>.—</heading><content>The term ‘<term>covered professional services</term>’ has the meaning given that term in section 1848(k)(3)(A).</content></subparagraph> <subparagraph class="fontsize10" id="y5857c24e-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Eligible professional</inline>.—</heading><content>The term ‘<term>eligible professional</term>’ has the meaning given that term in section 1848(k)(3)(B) and includes a group that includes such professionals.</content></subparagraph> <subparagraph class="fontsize10" id="y5857c24f-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Alternative payment model (apm)</inline>.—</heading><chapeau>The term ‘<term>alternative payment model</term>’ means, other than for purposes of subparagraphs (B)(ii)(I)(bb) and (C)(ii)(I)(bb) of paragraph (2), any of the following:</chapeau><clause class="fontsize10" id="y5857c250-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>A model under section 1115A (other than a health care innovation award).</content></clause> <clause class="fontsize10" id="y5857c251-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>The shared savings program under section 1899.</content></clause> <clause class="fontsize10" id="y5857c252-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>A demonstration under section 1866C.</content></clause> <clause class="fontsize10" id="y5857c253-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>A demonstration required by Federal law.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5857c254-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Eligible alternative payment entity</inline>.—</heading><chapeau>The term ‘<term>eligible alternative payment entity</term>’ means, with respect to a year, an entity that—</chapeau><clause class="fontsize10" id="y5857c255-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><chapeau>participates in an alternative payment model that—</chapeau><subclause class="fontsize10" id="y5857c256-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>requires participants in such model to use certified EHR technology (as defined in subsection (o)(4)); and</content></subclause> <subclause class="fontsize10" id="y5857c257-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>provides for payment for covered professional services based on quality measures comparable to measures under the performance category described in section 1848(q)(2)(B)(i); and<page identifier="/us/stat/129/122">129 STAT. 122</page></content></subclause> </clause> <clause class="fontsize10" id="y5857c258-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii)</num><subclause class="inline" id="y5857c259-e871-11f0-bc57-ad3ac4b1618c"><num value="I">(I) </num><content>bears financial risk for monetary losses under such alternative payment model that are in excess of a nominal amount; or</content></subclause> <subclause class="indentUp0 fontsize10" id="y5857c25a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>is a medical home expanded under section 1115A(c).</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y5857c25b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Limitation</inline>.—</heading><chapeau>There shall be no administrative or judicial review under section 1869, 1878, or otherwise, of the following:</chapeau><subparagraph class="fontsize10" id="y5857c25c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>The determination that an eligible professional is a qualifying APM participant under paragraph (2) and the determination that an entity is an eligible alternative payment entity under paragraph (3)(D).</content></subparagraph> <subparagraph class="fontsize10" id="y5857c25d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>The determination of the amount of the 5 percent payment incentive under paragraph (1)(A), including any estimation as part of such determination.”</content></subparagraph> </paragraph> </subsection> </quotedContent>.</content></paragraph> <paragraph class="fontsize10" id="y5857c25e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Coordination conforming amendments</inline>.—</heading><chapeau>Section 1833 of the Social Security Act (<ref href="/us/usc/t42/s1395l">42 U.S.C. 1395l</ref>) is further amended—</chapeau><subparagraph class="fontsize10" id="y5857c25f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/3/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in subsection (x)(3), by <amendingAction type="add">adding</amendingAction> at the end the following new sentence: “<quotedText>The amount of the additional payment for a service under this subsection and subsection (z) shall be determined without regard to any additional payment for the service under subsection (z) and this subsection, respectively.</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y5857c260-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/3/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in subsection (y)(3), by <amendingAction type="add">adding</amendingAction> at the end the following new sentence: “<quotedText>The amount of the additional payment for a service under this subsection and subsection (z) shall be determined without regard to any additional payment for the service under subsection (z) and this subsection, respectively.</quotedText>”.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5857c261-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/4" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><heading class="fontsize10"><inline class="smallCaps">Encouraging development and testing of certain models</inline>.—</heading><chapeau>Section 1115A(b)(2) of the Social Security Act (<ref href="/us/usc/t42/s1315a/b/2">42 U.S.C. 1315a(b)(2)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y5857c262-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/4/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in subparagraph (B), by <amendingAction type="add">adding</amendingAction> at the end the following new clauses:<quotedContent><clause class="fontsize10" id="y5857c263-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="xxi">“(xxi) </num><content>Focusing primarily on physicians’ services (as defined in section 1848(j)(3)) furnished by physicians who are not primary care practitioners.</content></clause> <clause class="fontsize10" id="y5857c264-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="xxii">“(xxii) </num><content>Focusing on practices of 15 or fewer professionals.</content></clause> <clause class="fontsize10" id="y5857c265-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="xxiii">“(xxiii) </num><content>Focusing on risk-based models for small physician practices which may involve two-sided risk and prospective patient assignment, and which examine risk-adjusted decreases in mortality rates, hospital readmissions rates, and other relevant and appropriate clinical measures.</content></clause> <clause class="fontsize10" id="y5857c266-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="xxiv">“(xxiv) </num><content>Focusing primarily on title XIX, working in conjunction with the Center for Medicaid and CHIP Services.”</content></clause> </quotedContent>; and</content></subparagraph> <subparagraph class="fontsize10" id="y5857c267-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/4/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in subparagraph (C)(viii), by <amendingAction type="delete">striking</amendingAction> “<quotedText>other public sector or private sector payers</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>other public sector payers, private sector payers, or statewide payment models</quotedText>”.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5857c268-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/5" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">(5) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5857c269-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1315a">42 USC 1315a note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Construction regarding telehealth services</inline>.—</heading><content>Nothing in the provisions of, or amendments made by, this title shall be construed as precluding an alternative payment model or a qualifying APM participant (as those terms are <page identifier="/us/stat/129/123">129 STAT. 123</page> defined in section 1833(z) of the Social Security Act, as added by paragraph (1)) from furnishing a telehealth service for which payment is not made under section 1834(m) of the Social Security Act (<ref href="/us/usc/t42/s1395m/m">42 U.S.C. 1395m(m)</ref>).</content></paragraph> <paragraph class="fontsize10" id="y5857c26a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/6" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="6">(6) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5857c26b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5857c26c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Study.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Integrating medicare advantage alternative payment models</inline>.—</heading><content>Not later than July 1, 2016, the Secretary of Health and Human Services shall submit to Congress a study that examines the feasibility of integrating alternative payment models in the Medicare Advantage payment system. The study shall include the feasibility of including a value-based modifier and whether such modifier should be budget neutral.</content></paragraph> <paragraph class="fontsize10" id="y5857c26d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/7" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="7">(7) </num><heading class="fontsize10"><inline class="smallCaps">Study and report on fraud related to alternative payment models under the medicare program</inline>.—</heading><subparagraph class="fontsize10" id="y5857c26e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/7/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5857c26f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Consultation.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Study</inline>.—</heading><chapeau>The Secretary of Health and Human Services, in consultation with the Inspector General of the Department of Health and Human Services, shall conduct a study that—</chapeau><clause class="fontsize10" id="y5857c270-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/7/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>examines the applicability of the Federal fraud prevention laws to items and services furnished under title XVIII of the Social Security Act for which payment is made under an alternative payment model (as defined in section 1833(z)(3)(C) of such Act (<ref href="/us/usc/t42/s1395l/z/3/C">42 U.S.C. 1395l(z)(3)(C)</ref>));</content></clause> <clause class="fontsize10" id="y5857e881-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/7/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>identifies aspects of such alternative payment models that are vulnerable to fraudulent activity; and</content></clause> <clause class="fontsize10" id="y5857e882-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/7/A/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>examines the implications of waivers to such laws granted in support of such alternative payment models, including under any potential expansion of such models.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5857e883-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/7/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Report</inline>.—</heading><content>Not later than 2 years after the date of the enactment of this Act, the Secretary shall submit to Congress a report containing the results of the study conducted under subparagraph (A). <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5857e884-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Recommenda-</p><p class="leftAlign firstIndent0 fontsize8" id="x5857e885-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">tions.</p></sidenote>Such report shall include recommendations for actions to be taken to reduce the vulnerability of such alternative payment models to fraudulent activity. Such report also shall include, as appropriate, recommendations of the Inspector General for changes in Federal fraud prevention laws to reduce such vulnerability.</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5857e886-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/f" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="f">(f) </num><heading class="fontsize10"><inline class="smallCaps">Collaborating With the Physician, Practitioner, and Other Stakeholder Communities To Improve Resource Use Measurement</inline>.—</heading><content>Section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>), as amended by subsection (c), is further amended by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="firstIndent0 fontsize10" id="y58594817-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="r">“(r) </num><heading class="fontsize10"><inline class="smallCaps">Collaborating With the Physician, Practitioner, and Other Stakeholder Communities To Improve Resource Use Measurement</inline>.—</heading><paragraph class="fontsize10" id="y58594818-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In order to involve the physician, practitioner, and other stakeholder communities in enhancing the infrastructure for resource use measurement, including for purposes of the Merit-based Incentive Payment System under subsection (q) and alternative payment models under section 1833(z), the Secretary shall undertake the steps described in the succeeding provisions of this subsection.</content></paragraph> <paragraph class="fontsize10" id="y58594819-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">Development of care episode and patient condition groups and classification codes</inline>.—</heading><page identifier="/us/stat/129/124">129 STAT. 124</page> <subparagraph class="fontsize10" id="y5859481a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In order to classify similar patients into care episode groups and patient condition groups, the Secretary shall undertake the steps described in the succeeding provisions of this paragraph.</content></subparagraph> <subparagraph class="fontsize10" id="y5859481b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Public availability of existing efforts to design an episode grouper</inline>.—</heading><content>Not <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5859481c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5859481d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote>later than 180 days after the date of the enactment of this subsection, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services a list of the episode groups developed pursuant to subsection (n)(9)(A) and related descriptive information.</content></subparagraph> <subparagraph class="fontsize10" id="y5859481e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5859481f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Comment period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Stakeholder input</inline>.—</heading><chapeau>The Secretary shall accept, through the date that is 120 days after the day the Secretary posts the list pursuant to subparagraph (B), suggestions from physician specialty societies, applicable practitioner organizations, and other stakeholders for episode groups in addition to those posted pursuant to such subparagraph, and specific clinical criteria and patient characteristics to classify patients into—</chapeau><clause class="fontsize10" id="y58594820-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>care episode groups; and</content></clause> <clause class="fontsize10" id="y58594821-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>patient condition groups.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58594822-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Development of proposed classification codes</inline>.—</heading><clause class="fontsize10" id="y58594823-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Taking into account the information described in subparagraph (B) and the information received under subparagraph (C), the Secretary shall—</chapeau><subclause class="fontsize10" id="y58594824-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>establish care episode groups and patient condition groups, which account for a target of an estimated ½ of expenditures under parts A and B (with such target increasing over time as appropriate); and</content></subclause> <subclause class="fontsize10" id="y58594825-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>assign codes to such groups.</content></subclause> </clause> <clause class="fontsize10" id="y58594826-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Care episode groups</inline>.—</heading><chapeau>In establishing the care episode groups under clause (i), the Secretary shall take into account—</chapeau><subclause class="fontsize10" id="y58594827-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the patient’s clinical problems at the time items and services are furnished during an episode of care, such as the clinical conditions or diagnoses, whether or not inpatient hospitalization occurs, and the principal procedures or services furnished; and</content></subclause> <subclause class="fontsize10" id="y58594828-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>other factors determined appropriate by the Secretary.</content></subclause> </clause> <clause class="fontsize10" id="y58594829-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Patient condition groups</inline>.—</heading><chapeau>In establishing the patient condition groups under clause (i), the Secretary shall take into account—</chapeau><subclause class="fontsize10" id="y5859482a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the patient’s clinical history at the time of a medical visit, such as the patient’s combination of chronic conditions, current health status, and recent significant history (such as hospitalization and major surgery during a previous period, such as 3 months); and</content></subclause> <subclause class="fontsize10" id="y5859482b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>other factors determined appropriate by the Secretary, such as eligibility status under this title (including eligibility under section 226(a), 226(b), or 226A, and dual eligibility under this title and title XIX).<page identifier="/us/stat/129/125">129 STAT. 125</page></content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y5859482c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Draft care episode and patient condition groups and classification codes</inline>.—</heading><content>Not <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5859482d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5859482e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote>later than 270 days after the end of the comment period described in subparagraph (C), the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services a draft list of the care episode and patient condition codes established under subparagraph (D) (and the criteria and characteristics assigned to such code).</content></subparagraph> <subparagraph class="fontsize10" id="y5859482f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594830-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Comment period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Solicitation of input</inline>.—</heading><content>The Secretary shall seek, through the date that is 120 days after the Secretary posts the list pursuant to subparagraph (E), comments from physician specialty societies, applicable practitioner organizations, and other stakeholders, including representatives of individuals entitled to benefits under part A or enrolled under this part, regarding the care episode and patient condition groups (and codes) posted under subparagraph (E). In seeking such comments, the Secretary shall use one or more mechanisms (other than notice and comment rulemaking) that may include use of open door forums, town hall meetings, or other appropriate mechanisms.</content></subparagraph> <subparagraph class="fontsize10" id="y58594831-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="G">“(G) </num><heading class="fontsize10"><inline class="smallCaps">Operational list of care episode and patient condition groups and codes</inline>.—</heading><content>Not <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594832-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x58594833-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote>later than 270 days after the end of the comment period described in subparagraph (F), taking into account the comments received under such subparagraph, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services an operational list of care episode and patient condition codes (and the criteria and characteristics assigned to such code).</content></subparagraph> <subparagraph class="fontsize10" id="y58594834-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="H">“(H) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594835-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x58594836-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p><p class="leftAlign firstIndent0 fontsize8" id="x58594837-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Regulations.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Subsequent revisions</inline>.—</heading><content>Not later than November 1 of each year (beginning with 2018), the Secretary shall, through rulemaking, make revisions to the operational lists of care episode and patient condition codes as the Secretary determines may be appropriate. Such revisions may be based on experience, new information developed pursuant to subsection (n)(9)(A), and input from the physician specialty societies, applicable practitioner organizations, and other stakeholders, including representatives of individuals entitled to benefits under part A or enrolled under this part.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58594838-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Attribution of patients to physicians or practitioners</inline>.—</heading><subparagraph class="fontsize10" id="y58594839-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In order to facilitate the attribution of patients and episodes (in whole or in part) to one or more physicians or applicable practitioners furnishing items and services, the Secretary shall undertake the steps described in the succeeding provisions of this paragraph.</content></subparagraph> <subparagraph class="fontsize10" id="y5859483a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Development of patient relationship categories and codes</inline>.—</heading><chapeau>The Secretary shall develop patient relationship categories and codes that define and distinguish the relationship and responsibility of a physician or applicable practitioner with a patient at the time of furnishing an item or service. Such patient relationship categories shall include different relationships of the physician or applicable practitioner to the patient (and the codes <page identifier="/us/stat/129/126">129 STAT. 126</page> may reflect combinations of such categories), such as a physician or applicable practitioner who—</chapeau><clause class="fontsize10" id="y5859483b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>considers themself to have the primary responsibility for the general and ongoing care for the patient over extended periods of time;</content></clause> <clause class="fontsize10" id="y5859483c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>considers themself to be the lead physician or practitioner and who furnishes items and services and coordinates care furnished by other physicians or practitioners for the patient during an acute episode;</content></clause> <clause class="fontsize10" id="y5859483d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>furnishes items and services to the patient on a continuing basis during an acute episode of care, but in a supportive rather than a lead role;</content></clause> <clause class="fontsize10" id="y5859483e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>furnishes items and services to the patient on an occasional basis, usually at the request of another physician or practitioner; or</content></clause> <clause class="fontsize10" id="y5859483f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>furnishes items and services only as ordered by another physician or practitioner.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58594840-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594841-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x58594842-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Draft list of patient relationship categories and codes</inline>.—</heading><content>Not later than one year after the date of the enactment of this subsection, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services a draft list of the patient relationship categories and codes developed under subparagraph (B).</content></subparagraph> <subparagraph class="fontsize10" id="y58594843-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594844-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Comment period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Stakeholder input</inline>.—</heading><content>The Secretary shall seek, through the date that is 120 days after the Secretary posts the list pursuant to subparagraph (C), comments from physician specialty societies, applicable practitioner organizations, and other stakeholders, including representatives of individuals entitled to benefits under part A or enrolled under this part, regarding the patient relationship categories and codes posted under subparagraph (C). In seeking such comments, the Secretary shall use one or more mechanisms (other than notice and comment rulemaking) that may include open door forums, town hall meetings, web-based forums, or other appropriate mechanisms.</content></subparagraph> <subparagraph class="fontsize10" id="y58594845-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Operational list of patient relationship categories and codes</inline>.—</heading><content>Not <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594846-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x58594847-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote>later than 240 days after the end of the comment period described in subparagraph (D), taking into account the comments received under such subparagraph, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services an operational list of patient relationship categories and codes.</content></subparagraph> <subparagraph class="fontsize10" id="y58594848-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594849-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5859484a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p><p class="leftAlign firstIndent0 fontsize8" id="x5859484b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Regulations.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Subsequent revisions</inline>.—</heading><content>Not later than November 1 of each year (beginning with 2018), the Secretary shall, through rulemaking, make revisions to the operational list of patient relationship categories and codes as the Secretary determines appropriate. Such revisions may be based on experience, new information developed pursuant to subsection (n)(9)(A), and input from the physician specialty societies, applicable practitioner organizations, and other stakeholders, including representatives of individuals entitled to benefits under part A or enrolled under this part.<page identifier="/us/stat/129/127">129 STAT. 127</page></content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58596f5c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Reporting of information for resource use measurement</inline>.—</heading><chapeau>Claims <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58596f5d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Claims.</p><p class="leftAlign firstIndent0 fontsize8" id="x58596f5e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote>submitted for items and services furnished by a physician or applicable practitioner on or after January 1, 2018, shall, as determined appropriate by the Secretary, include—</chapeau><subparagraph class="fontsize10" id="y58596f5f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>applicable codes established under paragraphs (2) and (3); and</content></subparagraph> <subparagraph class="fontsize10" id="y58596f60-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>the national provider identifier of the ordering physician or applicable practitioner (if different from the billing physician or applicable practitioner).</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58596f61-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">“(5) </num><heading class="fontsize10"><inline class="smallCaps">Methodology for resource use analysis</inline>.—</heading><subparagraph class="fontsize10" id="y58596f62-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>In order to evaluate the resources used to treat patients (with respect to care episode and patient condition groups), the Secretary shall, as the Secretary determines appropriate—</chapeau><clause class="fontsize10" id="y58596f63-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>use the patient relationship codes reported on claims pursuant to paragraph (4) to attribute patients (in whole or in part) to one or more physicians and applicable practitioners;</content></clause> <clause class="fontsize10" id="y58596f64-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>use the care episode and patient condition codes reported on claims pursuant to paragraph (4) as a basis to compare similar patients and care episodes and patient condition groups; and</content></clause> <clause class="fontsize10" id="y58596f65-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>conduct an analysis of resource use (with respect to care episodes and patient condition groups of such patients).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58596f66-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Analysis of patients of physicians and practitioners</inline>.—</heading><chapeau>In conducting the analysis described in subparagraph (A)(iii) with respect to patients attributed to physicians and applicable practitioners, the Secretary shall, as feasible—</chapeau><clause class="fontsize10" id="y58596f67-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58596f68-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time period.</p></sidenote><content>use the claims data experience of such patients by patient condition codes during a common period, such as 12 months; and</content></clause> <clause class="fontsize10" id="y58596f69-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><chapeau>use the claims data experience of such patients by care episode codes—</chapeau><subclause class="fontsize10" id="y58596f6a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>in the case of episodes without a hospitalization, during periods of time (such as the number of days) determined appropriate by the Secretary; and</content></subclause> <subclause class="fontsize10" id="y58596f6b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>in the case of episodes with a hospitalization, during periods of time (such as the number of days) before, during, and after the hospitalization.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y58596f6c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Measurement of resource use</inline>.—</heading><chapeau>In measuring such resource use, the Secretary—</chapeau><clause class="fontsize10" id="y58596f6d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>shall use per patient total allowed charges for all services under part A and this part (and, if the Secretary determines appropriate, part D) for the analysis of patient resource use, by care episode codes and by patient condition codes; and</content></clause> <clause class="fontsize10" id="y58596f6e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>may, as determined appropriate, use other measures of allowed charges (such as subtotals for categories of items and services) and measures of utilization of items and services (such as frequency of specific items and services and the ratio of specific items and services among attributed patients or episodes).<page identifier="/us/stat/129/128">129 STAT. 128</page></content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58596f6f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Stakeholder input</inline>.—</heading><content>The Secretary shall seek comments from the physician specialty societies, applicable practitioner organizations, and other stakeholders, including representatives of individuals entitled to benefits under part A or enrolled under this part, regarding the resource use methodology established pursuant to this paragraph. In seeking comments the Secretary shall use one or more mechanisms (other than notice and comment rulemaking) that may include open door forums, town hall meetings, web-based forums, or other appropriate mechanisms.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58596f70-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="6">“(6) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58596f71-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Contracts.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Implementation</inline>.—</heading><content>To the extent that the Secretary contracts with an entity to carry out any part of the provisions of this subsection, the Secretary may not contract with an entity or an entity with a subcontract if the entity or subcontracting entity currently makes recommendations to the Secretary on relative values for services under the fee schedule for physicians’ services under this section.</content></paragraph> <paragraph class="fontsize10" id="y58596f72-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="7">“(7) </num><heading class="fontsize10"><inline class="smallCaps">Limitation</inline>.—</heading><chapeau>There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of—</chapeau><subparagraph class="fontsize10" id="y58596f73-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>care episode and patient condition groups and codes established under paragraph (2);</content></subparagraph> <subparagraph class="fontsize10" id="y58596f74-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>patient relationship categories and codes established under paragraph (3); and</content></subparagraph> <subparagraph class="fontsize10" id="y58596f75-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><content>measurement of, and analyses of resource use with respect to, care episode and patient condition codes and patient relationship codes pursuant to paragraph (5).</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58596f76-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="8">“(8) </num><heading class="fontsize10"><inline class="smallCaps">Administration</inline>.—</heading><content><ref href="/us/usc/t44/ch35">Chapter 35 of title 44, United States Code</ref>, shall not apply to this section.</content></paragraph> <paragraph class="fontsize10" id="y58596f77-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="9">“(9) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>In this subsection:</chapeau><subparagraph class="fontsize10" id="y58596f78-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Physician</inline>.—</heading><content>The term ‘<term>physician</term>’ has the meaning given such term in section 1861(r)(1).</content></subparagraph> <subparagraph class="fontsize10" id="y58596f79-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Applicable practitioner</inline>.—</heading><chapeau>The term ‘<term>applicable practitioner</term>’ means—</chapeau><clause class="fontsize10" id="y58596f7a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>a physician assistant, nurse practitioner, and clinical nurse specialist (as such terms are defined in section 1861(aa)(5)), and a certified registered nurse anesthetist (as defined in section 1861(bb)(2)); and</content></clause> <clause class="fontsize10" id="y58596f7b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58596f7c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><content>beginning January 1, 2019, such other eligible professionals (as defined in subsection (k)(3)(B)) as specified by the Secretary.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y58596f7d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="10">“(10) </num><heading class="fontsize10"><inline class="smallCaps">Clarification</inline>.—</heading><content>The provisions of sections 1890(b)(7) and 1890A shall not apply to this subsection.”</content></paragraph> </subsection> </quotedContent>.</content></subsection> </section> <section id="d354370e4765" identifier="/us/pl/114/10/tI/s102" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="102">SEC. 102. </num><heading>PRIORITIES AND FUNDING FOR MEASURE DEVELOPMENT.</heading><content class="firstIndent0 fontsize10" id="x5859e4ae-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>), as amended by subsections (c) and (f) of section 101, is further amended by <amendingAction type="insert">inserting</amendingAction> at the end the following new subsection:<quotedContent><subsection class="firstIndent0 fontsize10" id="y585af61f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="s">“(s) </num><heading class="fontsize10"><inline class="smallCaps">Priorities and Funding for Measure Development</inline>.—</heading><paragraph class="fontsize10" id="y585af620-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">Plan identifying measure development priorities and timelines</inline>.—</heading><subparagraph class="fontsize10" id="y585af621-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af622-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x585af623-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Plans.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Draft measure development plan</inline>.—</heading><chapeau>Not later than January 1, 2016, the Secretary shall develop, and post on the Internet website of the Centers for Medicare & Medicaid Services, a draft plan for the development of quality measures for application under the applicable <page identifier="/us/stat/129/129">129 STAT. 129</page> provisions (as defined in paragraph (5)). Under such plan the Secretary shall—</chapeau><clause class="fontsize10" id="y585af624-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>address how measures used by private payers and integrated delivery systems could be incorporated under title XVIII;</content></clause> <clause class="fontsize10" id="y585af625-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>describe how coordination, to the extent possible, will occur across organizations developing such measures; and</content></clause> <clause class="fontsize10" id="y585af626-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>take into account how clinical best practices and clinical practice guidelines should be used in the development of quality measures.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585af627-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af628-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Definitions.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Quality domains</inline>.—</heading><chapeau>For purposes of this subsection, the term ‘<term>quality domains</term>’ means at least the following domains:</chapeau><clause class="fontsize10" id="y585af629-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>Clinical care.</content></clause> <clause class="fontsize10" id="y585af62a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>Safety.</content></clause> <clause class="fontsize10" id="y585af62b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>Care coordination.</content></clause> <clause class="fontsize10" id="y585af62c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>Patient and caregiver experience.</content></clause> <clause class="fontsize10" id="y585af62d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>Population health and prevention.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585af62e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af62f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Plans.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Consideration</inline>.—</heading><chapeau>In developing the draft plan under this paragraph, the Secretary shall consider—</chapeau><clause class="fontsize10" id="y585af630-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>gap analyses conducted by the entity with a contract under section 1890(a) or other contractors or entities;</content></clause> <clause class="fontsize10" id="y585af631-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>whether measures are applicable across health care settings;</content></clause> <clause class="fontsize10" id="y585af632-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>clinical practice improvement activities submitted under subsection (q)(2)(C)(iv) for identifying possible areas for future measure development and identifying existing gaps with respect to such measures; and</content></clause> <clause class="fontsize10" id="y585af633-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>the quality domains applied under this subsection.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585af634-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af635-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Plans.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Priorities</inline>.—</heading><chapeau>In developing the draft plan under this paragraph, the Secretary shall give priority to the following types of measures:</chapeau><clause class="fontsize10" id="y585af636-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>Outcome measures, including patient reported outcome and functional status measures.</content></clause> <clause class="fontsize10" id="y585af637-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>Patient experience measures.</content></clause> <clause class="fontsize10" id="y585af638-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>Care coordination measures.</content></clause> <clause class="fontsize10" id="y585af639-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>Measures of appropriate use of services, including measures of over use.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585af63a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af63b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x585af63c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Comment period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Stakeholder input</inline>.—</heading><content>The Secretary shall accept through March 1, 2016, comments on the draft plan posted under paragraph (1)(A) from the public, including health care providers, payers, consumers, and other stakeholders.</content></subparagraph> <subparagraph class="fontsize10" id="y585af63d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af63e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x585af63f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Final measure development plan</inline>.—</heading><content>Not later than May 1, 2016, taking into account the comments received under this subparagraph, the Secretary shall finalize the plan and post on the Internet website of the Centers for Medicare & Medicaid Services an operational plan for the development of quality measures for use under the applicable provisions. Such plan shall be updated as appropriate.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585af640-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">Contracts and other arrangements for quality measure development</inline>.—</heading><page identifier="/us/stat/129/130">129 STAT. 130</page> <subparagraph class="fontsize10" id="y585af641-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>The Secretary shall enter into contracts or other arrangements with entities for the purpose of developing, improving, updating, or expanding in accordance with the plan under paragraph (1) quality measures for application under the applicable provisions. Such entities shall include organizations with quality measure development expertise.</content></subparagraph> <subparagraph class="fontsize10" id="y585af642-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Prioritization</inline>.—</heading><clause class="fontsize10" id="y585af643-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In entering into contracts or other arrangements under subparagraph (A), the Secretary shall give priority to the development of the types of measures described in paragraph (1)(D).</content></clause> <clause class="fontsize10" id="y585af644-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Consideration</inline>.—</heading><chapeau>In selecting measures for development under this subsection, the Secretary shall consider—</chapeau><subclause class="fontsize10" id="y585af645-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>whether such measures would be electronically specified; and</content></subclause> <subclause class="fontsize10" id="y585af646-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>clinical practice guidelines to the extent that such guidelines exist.</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585af647-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Annual report by the secretary</inline>.—</heading><subparagraph class="fontsize10" id="y585af648-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af649-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Not later than May 1, 2017, and annually thereafter, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services a report on the progress made in developing quality measures for application under the applicable provisions.</content></subparagraph> <subparagraph class="fontsize10" id="y585af64a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Requirements</inline>.—</heading><chapeau>Each report submitted pursuant to subparagraph (A) shall include the following:</chapeau><clause class="fontsize10" id="y585af64b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>A description of the Secretary’s efforts to implement this paragraph.</content></clause> <clause class="fontsize10" id="y585af64c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><chapeau>With respect to the measures developed during the previous year—</chapeau><subclause class="fontsize10" id="y585af64d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>a description of the total number of quality measures developed and the types of such measures, such as an outcome or patient experience measure;</content></subclause> <subclause class="fontsize10" id="y585af64e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>the name of each measure developed;</content></subclause> <subclause class="fontsize10" id="y585af64f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>the name of the developer and steward of each measure;</content></subclause> <subclause class="fontsize10" id="y585af650-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="IV">“(IV) </num><content>with respect to each type of measure, an estimate of the total amount expended under this title to develop all measures of such type; and</content></subclause> <subclause class="fontsize10" id="y585af651-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="V">“(V) </num><content>whether the measure would be electronically specified.</content></subclause> </clause> <clause class="fontsize10" id="y585af652-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><chapeau>With respect to measures in development at the time of the report—</chapeau><subclause class="fontsize10" id="y585af653-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the information described in clause (ii), if available; and</content></subclause> <subclause class="fontsize10" id="y585af654-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>a timeline for completion of the development of such measures.</content></subclause> </clause> <clause class="fontsize10" id="y585af655-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>A description of any updates to the plan under paragraph (1) (including newly identified gaps and the status of previously identified gaps) and the inventory of measures applicable under the applicable provisions.</content></clause> <clause class="fontsize10" id="y585af656-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>Other information the Secretary determines to be appropriate.<page identifier="/us/stat/129/131">129 STAT. 131</page></content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585af657-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Stakeholder input</inline>.—</heading><chapeau>With respect to paragraph (1), the Secretary shall seek stakeholder input with respect to—</chapeau><subparagraph class="fontsize10" id="y585af658-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>the identification of gaps where no quality measures exist, particularly with respect to the types of measures described in paragraph (1)(D);</content></subparagraph> <subparagraph class="fontsize10" id="y585af659-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>prioritizing quality measure development to address such gaps; and</content></subparagraph> <subparagraph class="fontsize10" id="y585af65a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><content>other areas related to quality measure development determined appropriate by the Secretary.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585af65b-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">“(5) </num><heading class="fontsize10"><inline class="smallCaps">Definition of applicable provisions</inline>.—</heading><chapeau>In this subsection, the term ‘<term>applicable provisions</term>’ means the following provisions:</chapeau><subparagraph class="fontsize10" id="y585af65c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>Subsection (q)(2)(B)(i).</content></subparagraph> <subparagraph class="fontsize10" id="y585af65d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>Section 1833(z)(2)(C).</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585af65e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="6">“(6) </num><heading class="fontsize10"><inline class="smallCaps">Funding</inline>.—</heading><content>For purposes of carrying out this subsection, the Secretary shall provide for the transfer, from the Federal Supplementary Medical Insurance Trust Fund under section 1841, of $15,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for each of fiscal years 2015 through 2019. Amounts transferred under this paragraph shall remain available through the end of fiscal year 2022.</content></paragraph> <paragraph class="fontsize10" id="y585b1d6f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="7">“(7) </num><heading class="fontsize10"><inline class="smallCaps">Administration</inline>.—</heading><content><ref href="/us/usc/t44/ch35">Chapter 35 of title 44, United States Code</ref>, shall not apply to the collection of information for the development of quality measures.”</content></paragraph> </subsection> </quotedContent>.</content></section> <section id="d354370e5175" identifier="/us/pl/114/10/tI/s103" style="-uslm-lc:I658143"><num class="fontsize12" value="103">SEC. 103. </num><heading>ENCOURAGING CARE MANAGEMENT FOR INDIVIDUALS WITH CHRONIC CARE NEEDS.</heading><subsection class="firstIndent0 fontsize10" id="y585b6b90-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><content>Section 1848(b) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/b">42 U.S.C. 1395w–4(b)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="fontsize10" id="y585b92a1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="8">“(8) </num><heading class="fontsize10"><inline class="smallCaps">Encouraging care management for individuals with chronic care needs</inline>.—</heading><subparagraph class="fontsize10" id="y585b92a2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585b92a3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In order to encourage the management of care for individuals with chronic care needs the Secretary shall, subject to subparagraph (B), make payment (as the Secretary determines to be appropriate) under this section for chronic care management services furnished on or after January 1, 2015, by a physician (as defined in section 1861(r)(1)), physician assistant or nurse practitioner (as defined in section 1861(aa)(5)(A)), clinical nurse specialist (as defined in section 1861(aa)(5)(B)), or certified nurse midwife (as defined in section 1861(gg)(2)).</content></subparagraph> <subparagraph class="fontsize10" id="y585b92a4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Policies relating to payment</inline>.—</heading><chapeau>In carrying out this paragraph, with respect to chronic care management services, the Secretary shall—</chapeau><clause class="fontsize10" id="y585b92a5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>make payment to only one applicable provider for such services furnished to an individual during a period;</content></clause> <clause class="fontsize10" id="y585b92a6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>not make payment under subparagraph (A) if such payment would be duplicative of payment that is otherwise made under this title for such services; and</content></clause> <clause class="fontsize10" id="y585b92a7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>not require that an annual wellness visit (as defined in section 1861(hhh)) or an initial preventive physical examination (as defined in section <page identifier="/us/stat/129/132">129 STAT. 132</page> 1861(ww)) be furnished as a condition of payment for such management services.”</content></clause> </subparagraph> </paragraph> </quotedContent>.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y585b92a8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Education and Outreach</inline>.—</heading><paragraph class="fontsize10" id="y585b92a9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585b92aa-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395w–4">42 USC 1395w–4 note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Campaign</inline>.—</heading><subparagraph class="fontsize10" id="y585b92ab-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>The Secretary of Health and Human Services (in this subsection referred to as the “Secretary”) shall conduct an education and outreach campaign to inform professionals who furnish items and services under part B of title XVIII of the Social Security Act and individuals enrolled under such part of the benefits of chronic care management services described in section 1848(b)(8) of the Social Security Act, as added by subsection (a), and encourage such individuals with chronic care needs to receive such services.</content></subparagraph> <subparagraph class="fontsize10" id="y585b92ac-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Requirements</inline>.—</heading><chapeau>Such campaign shall—</chapeau><clause class="fontsize10" id="y585b92ad-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/1/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>be directed by the Office of Rural Health Policy of the Department of Health and Human Services and the Office of Minority Health of the Centers for Medicare & Medicaid Services; and</content></clause> <clause class="fontsize10" id="y585b92ae-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/1/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>focus on encouraging participation by underserved rural populations and racial and ethnic minority populations.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585bb9bf-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Report</inline>.—</heading><chapeau>Not later than December 31, 2017, the Secretary shall submit to Congress a report on the use of chronic care management services described in such section 1848(b)(8) by individuals living in rural areas and by racial and ethnic minority populations. Such report shall—</chapeau><subparagraph class="fontsize10" id="y585bb9c0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>identify barriers to receiving chronic care management services; and</content></subparagraph> <subparagraph class="fontsize10" id="y585bb9c1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585bb9c2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Recommenda-</p><p class="leftAlign firstIndent0 fontsize8" id="x585bb9c3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">tions.</p></sidenote><content>make recommendations for increasing the appropriate use of chronic care management services.</content></subparagraph> </paragraph> </subsection> </section> <section id="d354370e5322" identifier="/us/pl/114/10/tI/s104" style="-uslm-lc:I658143"><num class="fontsize12" value="104">SEC. 104. </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585bb9c4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395w–6">42 USC 1395w–6</ref>.</p></sidenote><heading>EMPOWERING BENEFICIARY CHOICES THROUGH CONTINUED ACCESS TO INFORMATION ON PHYSICIANS’ SERVICES.</heading><subsection class="firstIndent0 fontsize10" id="y585c2ef5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585c2ef6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadlines.</p><p class="leftAlign firstIndent0 fontsize8" id="x585c2ef7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p><p class="leftAlign firstIndent0 fontsize8" id="x585c2ef8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Public information.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><content>On an annual basis (beginning with 2015), the Secretary shall make publicly available, in an easily understandable format, information with respect to physicians and, as appropriate, other eligible professionals on items and services furnished to Medicare beneficiaries under title XVIII of the Social Security Act (<ref href="/us/usc/t42/s1395/etseq">42 U.S.C. 1395 et seq.</ref>).</content></subsection> <subsection class="firstIndent0 fontsize10" id="y585c2ef9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Type and Manner of Information</inline>.—</heading><content>The information made available under this section shall be similar to the type of information in the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File released by the Secretary with respect to 2012 and shall be made available in a manner similar to the manner in which the information in such file is made available.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y585c2efa-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Requirements</inline>.—</heading><chapeau>The information made available under this section shall include, at a minimum, the following:</chapeau><paragraph class="fontsize10" id="y585c2efb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>Information on the number of services furnished by the physician or other eligible professional under part B of title XVIII of the Social Security Act (<ref href="/us/usc/t42/s1395j/etseq">42 U.S.C. 1395j et seq.</ref>), which may include information on the most frequent services furnished or groupings of services.</content></paragraph> <paragraph class="fontsize10" id="y585c2efc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>Information on submitted charges and payments for services under such part.<page identifier="/us/stat/129/133">129 STAT. 133</page></content></paragraph> <paragraph class="fontsize10" id="y585c2efd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/c/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>A unique identifier for the physician or other eligible professional that is available to the public, such as a national provider identifier.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y585c2efe-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/d" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><heading class="fontsize10"><inline class="smallCaps">Searchability</inline>.—</heading><chapeau>The information made available under this section shall be searchable by at least the following:</chapeau><paragraph class="fontsize10" id="y585c2eff-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/d/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>The specialty or type of the physician or other eligible professional.</content></paragraph> <paragraph class="fontsize10" id="y585c2f00-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/d/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>Characteristics of the services furnished, such as volume or groupings of services.</content></paragraph> <paragraph class="fontsize10" id="y585c2f01-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/d/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>The location of the physician or other eligible professional.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y585c2f02-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/e" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="e">(e) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585c2f03-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Integration on Physician Compare</inline>.—</heading><content>Beginning with 2016, the Secretary shall integrate the information made available under this section on Physician Compare.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y585c2f04-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/f" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="f">(f) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>In this section:</chapeau><paragraph class="fontsize10" id="y585c2f05-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/f/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Eligible professional; physician; secretary</inline>.—</heading><content>The terms “eligible professional”, “physician”, and “Secretary” have the meaning given such terms in <ref href="/us/pl/111/148/s10331/i">section 10331(i) of Public Law 111–148</ref>.</content></paragraph> <paragraph class="fontsize10" id="y585c2f06-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/f/2" role="definitions" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Physician compare</inline>.—</heading><content>The term “<term>Physician Compare</term>” means the Physician Compare Internet website of the Centers for Medicare & Medicaid Services (or a successor website).</content></paragraph> </subsection> </section> <section id="d354370e5461" identifier="/us/pl/114/10/tI/s105" style="-uslm-lc:I658143"><num class="fontsize12" value="105">SEC. 105. </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585c2f07-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">42 USC</p><p class="leftAlign firstIndent0 fontsize8" id="x585c2f08-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">1395kk–2.</p></sidenote><heading>EXPANDING AVAILABILITY OF MEDICARE DATA.</heading><subsection class="firstIndent0 fontsize10" id="y585e78f9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Expanding Uses of Medicare Data by Qualified Entities</inline>.—</heading><paragraph class="fontsize10" id="y585e78fa-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Additional analyses</inline>.—</heading><subparagraph class="fontsize10" id="y585ea00b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585ea00c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to subparagraph (B), to the extent consistent with applicable information, privacy, security, and disclosure laws (including paragraph (3)), notwithstanding paragraph (4)(B) of section 1874(e) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e">42 U.S.C. 1395kk(e)</ref>) and the second sentence of paragraph (4)(D) of such section, beginning July 1, 2016, a qualified entity may use the combined data described in paragraph (4)(B)(iii) of such section received by such entity under such section, and information derived from the evaluation described in such paragraph (4)(D), to conduct additional non-public analyses (as determined appropriate by the Secretary) and provide or sell such analyses to authorized users for non-public use (including for the purposes of assisting providers of services and suppliers to develop and participate in quality and patient care improvement activities, including developing new models of care).</content></subparagraph> <subparagraph class="fontsize10" id="y585ea00d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Limitations with respect to analyses</inline>.—</heading><clause class="fontsize10" id="y585ea00e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/1/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><heading class="fontsize10"><inline class="smallCaps">Employers</inline>.—</heading><content>Any analyses provided or sold under subparagraph (A) to an employer described in paragraph (9)(A)(iii) may only be used by such employer for purposes of providing health insurance to employees and retirees of the employer.</content></clause> <clause class="fontsize10" id="y585ea00f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/1/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><heading class="fontsize10"><inline class="smallCaps">Health insurance issuers</inline>.—</heading><content>A qualified entity may not provide or sell an analysis to a health insurance issuer described in paragraph (9)(A)(iv) unless the issuer is providing the qualified entity with data under section 1874(e)(4)(B)(iii) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e/4/B/iii">42 U.S.C. 1395kk(e)(4)(B)(iii)</ref>).</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ea010-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Access to certain data</inline>.—</heading><page identifier="/us/stat/129/134">129 STAT. 134</page> <subparagraph class="fontsize10" id="y585ea011-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585ea012-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Access</inline>.—</heading><chapeau>To the extent consistent with applicable information, privacy, security, and disclosure laws (including paragraph (3)), notwithstanding paragraph (4)(B) of section 1874(e) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e">42 U.S.C. 1395kk(e)</ref>) and the second sentence of paragraph (4)(D) of such section, beginning July 1, 2016, a qualified entity may—</chapeau><clause class="fontsize10" id="y585ea013-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/2/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>provide or sell the combined data described in paragraph (4)(B)(iii) of such section to authorized users described in clauses (i), (ii), and (v) of paragraph (9)(A) for non-public use, including for the purposes described in subparagraph (B); or</content></clause> <clause class="fontsize10" id="y585ea014-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/2/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>subject to subparagraph (C), provide Medicare claims data to authorized users described in clauses (i), (ii), and (v), of paragraph (9)(A) for non-public use, including for the purposes described in subparagraph (B).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585ea015-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Purposes described</inline>.—</heading><content>The purposes described in this subparagraph are assisting providers of services and suppliers in developing and participating in quality and patient care improvement activities, including developing new models of care.</content></subparagraph> <subparagraph class="fontsize10" id="y585ea016-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/2/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Medicare claims data must be provided at no cost</inline>.—</heading><content>A qualified entity may not charge a fee for providing the data under subparagraph (A)(ii).</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ea017-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Protection of information</inline>.—</heading><subparagraph class="fontsize10" id="y585ea018-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/3/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Except as provided in subparagraph (B), an analysis or data that is provided or sold under paragraph (1) or (2) shall not contain information that individually identifies a patient.</content></subparagraph> <subparagraph class="fontsize10" id="y585ea019-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/3/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Information on patients of the provider of services or supplier</inline>.—</heading><content>To the extent consistent with applicable information, privacy, security, and disclosure laws, an analysis or data that is provided or sold to a provider of services or supplier under paragraph (1) or (2) may contain information that individually identifies a patient of such provider or supplier, including with respect to items and services furnished to the patient by other providers of services or suppliers.</content></subparagraph> <subparagraph class="fontsize10" id="y585ea01a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/3/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Prohibition on using analyses or data for marketing purposes</inline>.—</heading><content>An authorized user shall not use an analysis or data provided or sold under paragraph (1) or (2) for marketing purposes.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ea01b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/4" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><heading class="fontsize10"><inline class="smallCaps">Data use agreement</inline>.—</heading><content>A qualified entity and an authorized user described in clauses (i), (ii), and (v) of paragraph (9)(A) shall enter into an agreement regarding the use of any data that the qualified entity is providing or selling to the authorized user under paragraph (2). Such agreement shall describe the requirements for privacy and security of the data and, as determined appropriate by the Secretary, any prohibitions on using such data to link to other individually identifiable sources of information. If the authorized user is not a covered entity under the rules promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996, the agreement shall identify the relevant regulations, as determined by the Secretary, that the user shall comply <page identifier="/us/stat/129/135">129 STAT. 135</page> with as if it were acting in the capacity of such a covered entity.</content></paragraph> <paragraph class="fontsize10" id="y585ea01c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/5" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">(5) </num><heading class="fontsize10"><inline class="smallCaps">No redisclosure of analyses or data</inline>.—</heading><subparagraph class="fontsize10" id="y585ea01d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/5/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Except as provided in subparagraph (B), an authorized user that is provided or sold an analysis or data under paragraph (1) or (2) shall not redisclose or make public such analysis or data or any analysis using such data.</content></subparagraph> <subparagraph class="fontsize10" id="y585ea01e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/5/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Permitted redisclosure</inline>.—</heading><content>A provider of services or supplier that is provided or sold an analysis or data under paragraph (1) or (2) may, as determined by the Secretary, redisclose such analysis or data for the purposes of performance improvement and care coordination activities but shall not make public such analysis or data or any analysis using such data.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ea01f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/6" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="6">(6) </num><heading class="fontsize10"><inline class="smallCaps">Opportunity for providers of services and suppliers to review</inline>.—</heading><content>Prior to a qualified entity providing or selling an analysis to an authorized user under paragraph (1), to the extent that such analysis would individually identify a provider of services or supplier who is not being provided or sold such analysis, such qualified entity shall provide such provider or supplier with the opportunity to appeal and correct errors in the manner described in section 1874(e)(4)(C)(ii) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e/4/C/ii">42 U.S.C. 1395kk(e)(4)(C)(ii)</ref>).</content></paragraph> <paragraph class="fontsize10" id="y585ea020-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="7">(7) </num><heading class="fontsize10"><inline class="smallCaps">Assessment for a breach</inline>.—</heading><subparagraph class="fontsize10" id="y585ea021-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>In the case of a breach of a data use agreement under this section or section 1874(e) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e">42 U.S.C. 1395kk(e)</ref>), the Secretary shall impose an assessment on the qualified entity both in the case of—</chapeau><clause class="fontsize10" id="y585ea022-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>an agreement between the Secretary and a qualified entity; and</content></clause> <clause class="fontsize10" id="y585ec733-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>an agreement between a qualified entity and an authorized user.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585ec734-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Assessment</inline>.—</heading><chapeau>The assessment under subparagraph (A) shall be an amount up to $100 for each individual entitled to, or enrolled for, benefits under part A of title XVIII of the Social Security Act or enrolled for benefits under part B of such title—</chapeau><clause class="fontsize10" id="y585ec735-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in the case of an agreement described in subparagraph (A)(i), for whom the Secretary provided data on to the qualified entity under paragraph (2); and</content></clause> <clause class="fontsize10" id="y585ec736-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in the case of an agreement described in subparagraph (A)(ii), for whom the qualified entity provided data on to the authorized user under paragraph (2).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585ec737-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Deposit of amounts collected</inline>.—</heading><content>Any amounts collected pursuant to this paragraph shall be deposited in Federal Supplementary Medical Insurance Trust Fund under section 1841 of the Social Security Act (<ref href="/us/usc/t42/s1395t">42 U.S.C. 1395t</ref>).</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ec738-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/8" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="8">(8) </num><heading class="fontsize10"><inline class="smallCaps">Annual reports</inline>.—</heading><chapeau>Any qualified entity that provides or sells an analysis or data under paragraph (1) or (2) shall annually submit to the Secretary a report that includes—</chapeau><subparagraph class="fontsize10" id="y585ec739-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/8/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>a summary of the analyses provided or sold, including the number of such analyses, the number of <page identifier="/us/stat/129/136">129 STAT. 136</page> purchasers of such analyses, and the total amount of fees received for such analyses;</content></subparagraph> <subparagraph class="fontsize10" id="y585ec73a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/8/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>a description of the topics and purposes of such analyses;</content></subparagraph> <subparagraph class="fontsize10" id="y585ec73b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/8/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>information on the entities who received the data under paragraph (2), the uses of the data, and the total amount of fees received for providing, selling, or sharing the data; and</content></subparagraph> <subparagraph class="fontsize10" id="y585ec73c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/8/D" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><content>other information determined appropriate by the Secretary.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ec73d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="9">(9) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>In this subsection and subsection (b):</chapeau><subparagraph class="fontsize10" id="y585ec73e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Authorized user</inline>.—</heading><chapeau>The term “<term>authorized user</term>” means the following:</chapeau><clause class="fontsize10" id="y585ec73f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>A provider of services.</content></clause> <clause class="fontsize10" id="y585ec740-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>A supplier.</content></clause> <clause class="fontsize10" id="y585ec741-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>An employer (as defined in section 3(5) of the Employee Retirement Insurance Security Act of 1974).</content></clause> <clause class="fontsize10" id="y585ec742-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A/iv" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">(iv) </num><content>A health insurance issuer (as defined in section 2791 of the Public Health Service Act).</content></clause> <clause class="fontsize10" id="y585ec743-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A/v" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">(v) </num><content>A medical society or hospital association.</content></clause> <clause class="fontsize10" id="y585ec744-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A/vi" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">(vi) </num><content>Any entity not described in clauses (i) through (v) that is approved by the Secretary (other than an employer or health insurance issuer not described in clauses (iii) and (iv), respectively, as determined by the Secretary).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585ec745-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/B" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Provider of services</inline>.—</heading><content>The term “<term>provider of services</term>” has the meaning given such term in section 1861(u) of the Social Security Act (<ref href="/us/usc/t42/s1395x/u">42 U.S.C. 1395x(u)</ref>).</content></subparagraph> <subparagraph class="fontsize10" id="y585ec746-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/C" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Qualified entity</inline>.—</heading><content>The term “<term>qualified entity</term>” has the meaning given such term in section 1874(e)(2) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e">42 U.S.C. 1395kk(e)</ref>).</content></subparagraph> <subparagraph class="fontsize10" id="y585ec747-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/D" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><heading class="fontsize10"><inline class="smallCaps">Secretary</inline>.—</heading><content>The term “<term>Secretary</term>” means the Secretary of Health and Human Services.</content></subparagraph> <subparagraph class="fontsize10" id="y585ec748-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/E" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">(E) </num><heading class="fontsize10"><inline class="smallCaps">Supplier</inline>.—</heading><content>The term “<term>supplier</term>” has the meaning given such term in section 1861(d) of the Social Security Act (<ref href="/us/usc/t42/s1395x/d">42 U.S.C. 1395x(d)</ref>).</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y585ec749-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Access to Medicare Data by Qualified Clinical Data Registries To Facilitate Quality Improvement</inline>.—</heading><paragraph class="fontsize10" id="y585ec74a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Access</inline>.—</heading><subparagraph class="fontsize10" id="y585ec74b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585ec74c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>To the extent consistent with applicable information, privacy, security, and disclosure laws, beginning July 1, 2016, the Secretary shall, at the request of a qualified clinical data registry under section 1848(m)(3)(E) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/m/3/E">42 U.S.C. 1395w–4(m)(3)(E)</ref>), provide the data described in subparagraph (B) (in a form and manner determined to be appropriate) to such qualified clinical data registry for purposes of linking such data with clinical outcomes data and performing risk-adjusted, scientifically valid analyses and research to support quality improvement or patient safety, provided that any public reporting of such analyses or research that identifies a provider of services or supplier shall only be conducted with the opportunity of such provider or supplier to appeal and correct errors in the manner described in subsection (a)(6).<page identifier="/us/stat/129/137">129 STAT. 137</page></content></subparagraph> <subparagraph class="fontsize10" id="y585ec74d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Data described</inline>.—</heading><chapeau>The data described in this subparagraph is—</chapeau><clause class="fontsize10" id="y585ec74e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b/1/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>claims data under the Medicare program under title XVIII of the Social Security Act; and</content></clause> <clause class="fontsize10" id="y585ec74f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b/1/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>if the Secretary determines appropriate, claims data under the Medicaid program under title XIX of such Act and the State Children’s Health Insurance Program under title XXI of such Act.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ec750-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Fee</inline>.—</heading><content>Data described in paragraph (1)(B) shall be provided to a qualified clinical data registry under paragraph (1) at a fee equal to the cost of providing such data. Any fee collected pursuant to the preceding sentence shall be deposited in the Centers for Medicare & Medicaid Services Program Management Account.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y585ec751-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/c" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Expansion of Data Available to Qualified Entities</inline>.—</heading><chapeau>Section 1874(e) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e">42 U.S.C. 1395kk(e)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y585ec752-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in the subsection heading, by <amendingAction type="delete">striking</amendingAction> “<quotedText><headingText class="smallCaps">Medicare</headingText></quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y585ec753-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><chapeau>in paragraph (3)—</chapeau><subparagraph class="fontsize10" id="y585ec754-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/c/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585ec755-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><content>by <amendingAction type="insert">inserting</amendingAction> after the first sentence the following new sentence: “<quotedText>Beginning July 1, 2016, if the Secretary determines appropriate, the data described in this paragraph may also include standardized extracts (as determined by the Secretary) of claims data under titles XIX and XXI for assistance provided under such titles for one or more specified geographic areas and time periods requested by a qualified entity.</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y585ec756-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/c/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in the last sentence, by <amendingAction type="insert">inserting</amendingAction> “<quotedText>or under titles XIX or XXI</quotedText>” before the period at the end.</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y585ec757-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/d" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><heading class="fontsize10"><inline class="smallCaps">Revision of Placement of Fees</inline>.—</heading><chapeau>Section 1874(e)(4)(A) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e/4/A">42 U.S.C. 1395kk(e)(4)(A)</ref>) <amendingAction type="amend">is amended</amendingAction>, in the second sentence—</chapeau><paragraph class="fontsize10" id="y585ec758-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/d/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>, for periods prior to July 1, 2016,</quotedText>” after “<quotedText>deposited</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y585ec759-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/d/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="insert">inserting</amendingAction> the following before the period at the end: “<quotedText>, and, beginning July 1, 2016, into the Centers for Medicare & Medicaid Services Program Management Account</quotedText>”.</content></paragraph> </subsection> </section> <section id="d354370e6020" identifier="/us/pl/114/10/tI/s106" style="-uslm-lc:I658143"><num class="fontsize12" value="106">SEC. 106. </num><heading>REDUCING ADMINISTRATIVE BURDEN AND OTHER PROVISIONS.</heading><subsection class="firstIndent0 fontsize10" id="y5861857a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Medicare Physician and Practitioner Opt-Out to Private Contract</inline>.—</heading><paragraph class="fontsize10" id="y5861857b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Indefinite, continuing automatic extension of opt out election</inline>.—</heading><subparagraph class="fontsize10" id="y5861857c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/1/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861857d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time periods.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Section 1802(b)(3) of the Social Security Act (<ref href="/us/usc/t42/s1395a/b/3">42 U.S.C. 1395a(b)(3)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><clause class="fontsize10" id="y5861857e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/1/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in subparagraph (B)(ii), by <amendingAction type="delete">striking</amendingAction> “<quotedText>during the 2-year period beginning on the date the affidavit is signed</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>during the applicable 2-year period (as defined in subparagraph (D))</quotedText>”;</content></clause> <clause class="fontsize10" id="y5861857f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/1/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in subparagraph (C), by <amendingAction type="delete">striking</amendingAction> “<quotedText>during the 2-year period described in subparagraph (B)(ii)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>during the applicable 2-year period</quotedText>”; and</content></clause> <clause class="fontsize10" id="y58618580-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/1/A/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraph:<quotedContent><subparagraph class="indentDown1 fontsize10" id="y58618581-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Applicable 2-year periods for effectiveness of affidavits</inline>.—</heading><content>In <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58618582-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Definition.</p></sidenote>this subsection, the term ‘applicable <page identifier="/us/stat/129/138">129 STAT. 138</page> 2-year period’ means, with respect to an affidavit of a physician or practitioner under subparagraph (B), the 2-year period beginning on the date the affidavit is signed and includes each subsequent 2-year period unless the physician or practitioner involved provides notice to the Secretary (in a form and manner specified by the Secretary), not later than 30 days before the end of the previous 2-year period, that the physician or practitioner does not want to extend the application of the affidavit for such subsequent 2-year period.”</content></subparagraph> </quotedContent>.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58618583-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58618584-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p><p class="leftAlign firstIndent0 fontsize8" id="x58618585-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395a">42 USC 1395a note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Effective date</inline>.—</heading><content>The amendments made by subparagraph (A) shall apply to affidavits entered into on or after the date that is 60 days after the date of the enactment of this Act.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58618586-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/2" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Public availability of information on opt-out physicians and practitioners</inline>.—</heading><chapeau>Section 1802(b) of the Social Security Act (<ref href="/us/usc/t42/s1395a/b">42 U.S.C. 1395a(b)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y58618587-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in paragraph (5), by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraph:<quotedContent><subparagraph class="indentDown1 fontsize10" id="y5861ac98-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861ac99-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Definition.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Opt-out physician or practitioner</inline>.—</heading><content>The term ‘<term>opt-out physician or practitioner</term>’ means a physician or practitioner who has in effect an affidavit under paragraph (3)(B).”</content></subparagraph> </quotedContent>;</content></subparagraph> <subparagraph class="fontsize10" id="y5861ac9a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>by <amendingAction type="redesignate">redesignating</amendingAction> paragraph (5) as paragraph (6); and</content></subparagraph> <subparagraph class="fontsize10" id="y5861ac9b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/2/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>by <amendingAction type="insert">inserting</amendingAction> after paragraph (4) the following new paragraph:<quotedContent><paragraph class="indentDown1 fontsize10" id="y5861d3ac-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">“(5) </num><heading class="fontsize10"><inline class="smallCaps">Posting of information on opt-out physicians and practitioners</inline>.—</heading><subparagraph class="fontsize10" id="y5861d3ad-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861d3ae-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p><p class="leftAlign firstIndent0 fontsize8" id="x5861d3af-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Public information.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Beginning not later than February 1, 2016, the Secretary shall make publicly available through an appropriate publicly accessible website of the Department of Health and Human Services information on the number and characteristics of opt-out physicians and practitioners and shall update such information on such website not less often than annually.</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3b0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Information to be included</inline>.—</heading><chapeau>The information to be made available under subparagraph (A) shall include at least the following with respect to opt-out physicians and practitioners:</chapeau><clause class="fontsize10" id="y5861d3b1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>Their number.</content></clause> <clause class="fontsize10" id="y5861d3b2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>Their physician or professional specialty or other designation.</content></clause> <clause class="fontsize10" id="y5861d3b3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>Their geographic distribution.</content></clause> <clause class="fontsize10" id="y5861d3b4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861d3b5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time period.</p></sidenote><content>The timing of their becoming opt-out physicians and practitioners, relative, to the extent feasible, to when they first enrolled in the program under this title and with respect to applicable 2-year periods.</content></clause> <clause class="fontsize10" id="y5861d3b6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>The proportion of such physicians and practitioners who billed for emergency or urgent care services.”</content></clause> </subparagraph> </paragraph> </quotedContent>.</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5861d3b7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Promoting Interoperability of Electronic Health Record Systems</inline>.—</heading><paragraph class="fontsize10" id="y5861d3b8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Recommendations for achieving widespread ehr interoperability</inline>.—</heading><subparagraph class="fontsize10" id="y5861d3b9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861d3ba-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Objective</inline>.—</heading><content>As a consequence of a significant Federal investment in the implementation of health information technology through the Medicare and Medicaid EHR <page identifier="/us/stat/129/139">129 STAT. 139</page> incentive programs, Congress declares it a national objective to achieve widespread exchange of health information through interoperable certified EHR technology nationwide by December 31, 2018.</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3bb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>In this paragraph:</chapeau><clause class="fontsize10" id="y5861d3bc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/B/i" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><heading class="fontsize10"><inline class="smallCaps">Widespread interoperability</inline>.—</heading><content>The term “<term>widespread interoperability</term>” means interoperability between certified EHR technology systems employed by meaningful EHR users under the Medicare and Medicaid EHR incentive programs and other clinicians and health care providers on a nationwide basis.</content></clause> <clause class="fontsize10" id="y5861d3bd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/B/ii" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><heading class="fontsize10"><inline class="smallCaps">Interoperability</inline>.—</heading><content>The term “<term>interoperability</term>” means the ability of two or more health information systems or components to exchange clinical and other information and to use the information that has been exchanged using common standards as to provide access to longitudinal information for health care providers in order to facilitate coordinated care and improved patient outcomes.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5861d3be-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861d3bf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5861d3c0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Consultation.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Establishment of metrics</inline>.—</heading><content>Not later than July 1, 2016, and in consultation with stakeholders, the Secretary shall establish metrics to be used to determine if and to the extent that the objective described in subparagraph (A) has been achieved.</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3c1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/D" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861d3c2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Determination.</p><p class="leftAlign firstIndent0 fontsize8" id="x5861d3c3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadlines.</p><p class="leftAlign firstIndent0 fontsize8" id="x5861d3c4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Reports.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Recommendations if objective not achieved</inline>.—</heading><chapeau>If the Secretary of Health and Human Services determines that the objective described in subparagraph (A) has not been achieved by December 31, 2018, then the Secretary shall submit to Congress a report, by not later than December 31, 2019, that identifies barriers to such objective and recommends actions that the Federal Government can take to achieve such objective. Such recommended actions may include recommendations—</chapeau><clause class="fontsize10" id="y5861d3c5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/D/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>to adjust payments for not being meaningful EHR users under the Medicare EHR incentive programs; and</content></clause> <clause class="fontsize10" id="y5861d3c6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/D/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>for criteria for decertifying certified EHR technology products.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y5861d3c7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Preventing blocking the sharing of information</inline>.—</heading><subparagraph class="fontsize10" id="y5861d3c8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/2/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">For meaningful use ehr professionals</inline>.—</heading><content>Section 1848(o)(2)(A)(ii) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/o/2/A/ii">42 U.S.C. 1395w–4(o)(2)(A)(ii)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> before the period at the end the following: “<quotedText>, and the professional demonstrates (through a process specified by the Secretary, such as the use of an attestation) that the professional has not knowingly and willfully taken action (such as to disable functionality) to limit or restrict the compatibility or interoperability of the certified EHR technology</quotedText>”.</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3c9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/2/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">For meaningful use ehr hospitals</inline>.—</heading><content>Section 1886(n)(3)(A)(ii) of the Social Security Act (<ref href="/us/usc/t42/s1395ww/n/3/A/ii">42 U.S.C. 1395ww(n)(3)(A)(ii)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> before the period at the end the following: “<quotedText>, and the hospital demonstrates (through a process specified by the Secretary, such as the use of an attestation) that the hospital has not knowingly and willfully taken action (such as to disable functionality) to limit or restrict the compatibility or interoperability of the certified EHR technology</quotedText>”.<page identifier="/us/stat/129/140">129 STAT. 140</page></content></subparagraph> <subparagraph class="fontsize10" id="y5861d3ca-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/2/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861d3cb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p><p class="leftAlign firstIndent0 fontsize8" id="x5861d3cc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395w–4">42 USC 1395w–4 note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Effective date</inline>.—</heading><content>The amendments made by this subsection shall apply to meaningful EHR users as of the date that is one year after the date of the enactment of this Act.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5861d3cd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Study and report on the feasibility of establishing a mechanism to compare certified ehr technology products</inline>.—</heading><subparagraph class="fontsize10" id="y5861d3ce-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/3/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Study</inline>.—</heading><chapeau>The Secretary shall conduct a study to examine the feasibility of establishing one or more mechanisms to assist providers in comparing and selecting certified EHR technology products. Such mechanisms may include—</chapeau><clause class="fontsize10" id="y5861d3cf-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/3/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>a website with aggregated results of surveys of meaningful EHR users on the functionality of certified EHR technology products to enable such users to directly compare the functionality and other features of such products; and</content></clause> <clause class="fontsize10" id="y5861d3d0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/3/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>information from vendors of certified products that is made publicly available in a standardized format.</content></clause> <continuation class="firstIndent1 fontsize10" id="x5861d3d1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124">The aggregated results of the surveys described in clause (i) may be made available through contracts with physicians, hospitals, or other organizations that maintain such comparative information described in such clause.</continuation></subparagraph> <subparagraph class="fontsize10" id="y5861d3d2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/3/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Report</inline>.—</heading><content>Not later than 1 year after the date of the enactment of this Act, the Secretary shall submit to Congress a report on mechanisms that would assist providers in comparing and selecting certified EHR technology products. The report shall include information on the benefits of, and resources needed to develop and maintain, such mechanisms.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5861d3d3-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>In this subsection:</chapeau><subparagraph class="fontsize10" id="y5861d3d4-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4/A" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>The term “<term>certified EHR technology</term>” has the meaning given such term in section 1848(o)(4) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/o/4">42 U.S.C. 1395w–4(o)(4)</ref>).</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3d5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4/B" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>The term “<term>meaningful EHR user</term>” has the meaning given such term under the Medicare EHR incentive programs.</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3d6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4/C" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><chapeau>The term “<term>Medicare and Medicaid EHR incentive programs</term>” means—</chapeau><clause class="fontsize10" id="y5861d3d7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4/C/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in the case of the Medicare program under title XVIII of the Social Security Act, the incentive programs under section 1814(l)(3), section 1848(o), subsections (l) and (m) of section 1853, and section 1886(n) of the Social Security Act (<ref href="/us/usc/t42/s1395f/l/3">42 U.S.C. 1395f(l)(3)</ref>, 1395w–4(o), 1395w–23, 1395ww(n)); and</content></clause> <clause class="fontsize10" id="y5861d3d8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4/C/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in the case of the Medicaid program under title XIX of such Act, the incentive program under subsections (a)(3)(F) and (t) of section 1903 of such Act (<ref href="/us/usc/t42/s1396b">42 U.S.C. 1396b</ref>).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5861d3d9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4/D" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><content>The term “<term>Secretary</term>” means the Secretary of Health and Human Services.</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5861d3da-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">GAO Studies and Reports on the Use of Telehealth Under Federal Programs and on Remote Patient Monitoring Services</inline>.—</heading><page identifier="/us/stat/129/141">129 STAT. 141</page> <paragraph class="fontsize10" id="y5861d3db-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Study on telehealth services</inline>.—</heading><chapeau>The Comptroller General of the United States shall conduct a study on the following:</chapeau><subparagraph class="fontsize10" id="y5861d3dc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>How the definition of telehealth across various Federal programs and Federal efforts can inform the use of telehealth in the Medicare program under title XVIII of the Social Security Act (<ref href="/us/usc/t42/s1395/etseq">42 U.S.C. 1395 et seq.</ref>).</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3dd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>Issues that can facilitate or inhibit the use of telehealth under the Medicare program under such title, including oversight and professional licensure, changing technology, privacy and security, infrastructure requirements, and varying needs across urban and rural areas.</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3de-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/1/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>Potential implications of greater use of telehealth with respect to payment and delivery system transformations under the Medicare program under such title XVIII and the Medicaid program under title XIX of such Act (<ref href="/us/usc/t42/s1396/etseq">42 U.S.C. 1396 et seq.</ref>).</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3df-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/1/D" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><content>How the Centers for Medicare & Medicaid Services monitors payments made under the Medicare program under such title XVIII to providers for telehealth services.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5861d3e0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Study on remote patient monitoring services</inline>.—</heading><subparagraph class="fontsize10" id="y5861d3e1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>The Comptroller General of the United States shall conduct a study—</chapeau><clause class="fontsize10" id="y5861d3e2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>of the dissemination of remote patient monitoring technology in the private health insurance market;</content></clause> <clause class="fontsize10" id="y5861d3e3-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>of the financial incentives in the private health insurance market relating to adoption of such technology;</content></clause> <clause class="fontsize10" id="y5861d3e4-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/A/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>of the barriers to adoption of such services under the Medicare program under title XVIII of the Social Security Act;</content></clause> <clause class="fontsize10" id="y5861faf5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/A/iv" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">(iv) </num><content>that evaluates the patients, conditions, and clinical circumstances that could most benefit from remote patient monitoring services; and</content></clause> <clause class="fontsize10" id="y5861faf6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/A/v" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">(v) </num><content>that evaluates the challenges related to establishing appropriate valuation for remote patient monitoring services under the Medicare physician fee schedule under section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>) in order to accurately reflect the resources involved in furnishing such services.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5861faf7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>For purposes of this paragraph:</chapeau><clause class="fontsize10" id="y5861faf8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/B/i" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><heading class="fontsize10"><inline class="smallCaps">Remote patient monitoring services</inline>.—</heading><content>The term “<term>remote patient monitoring services</term>” means services furnished through remote patient monitoring technology.</content></clause> <clause class="fontsize10" id="y5861faf9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/B/ii" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><heading class="fontsize10"><inline class="smallCaps">Remote patient monitoring technology</inline>.—</heading><content>The term “<term>remote patient monitoring technology</term>” means a coordinated system that uses one or more home-based or mobile monitoring devices that automatically transmit vital sign data or information on activities of daily living and may include responses to assessment questions collected on the devices wirelessly or through a telecommunications connection to a server that complies with the Federal regulations (concerning the privacy of individually identifiable health information) promulgated under section 264(c) <page identifier="/us/stat/129/142">129 STAT. 142</page> of the Health Insurance Portability and Accountability Act of 1996, as part of an established plan of care for that patient that includes the review and interpretation of that data by a health care professional.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y5861fafa-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Reports</inline>.—</heading><chapeau>Not later than 24 months after the date of the enactment of this Act, the Comptroller General shall submit to Congress—</chapeau><subparagraph class="fontsize10" id="y5861fafb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/3/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>a report containing the results of the study conducted under paragraph (1); and</content></subparagraph> <subparagraph class="fontsize10" id="y5861fafc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/3/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>a report containing the results of the study conducted under paragraph (2).</content></subparagraph> <continuation class="firstIndent1 fontsize10" id="x5861fafd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122">A report<sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861fafe-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Recommenda-</p><p class="leftAlign firstIndent0 fontsize8" id="x5861faff-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">tions.</p></sidenote> required under this paragraph shall be submitted together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate. The Comptroller General may submit one report containing the results described in subparagraphs (A) and (B) and the recommendations described in the previous sentence.</continuation></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5861fb00-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861fb01-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s18122">42 USC 18122 note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Rule of Construction Regarding Health Care Providers</inline>.—</heading><paragraph class="fontsize10" id="y5861fb02-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to paragraph (3), the development, recognition, or implementation of any guideline or other standard under any Federal health care provision shall not be construed to establish the standard of care or duty of care owed by a health care provider to a patient in any medical malpractice or medical product liability action or claim.</content></paragraph> <paragraph class="fontsize10" id="y5861fb03-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>For purposes of this subsection:</chapeau><subparagraph class="fontsize10" id="y5861fb04-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2/A" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Federal health care provision</inline>.—</heading><content>The term “<term>Federal health care provision</term>” means any provision of the Patient Protection and Affordable Care Act (<ref href="/us/pl/111/148">Public Law 111–148</ref>), title I or subtitle B of title II of the Health Care and Education Reconciliation Act of 2010 (<ref href="/us/pl/111/152">Public Law 111–152</ref>), or title XVIII or XIX of the Social Security Act (<ref href="/us/usc/t42/s1395/etseq">42 U.S.C. 1395 et seq.</ref>, <ref href="/us/usc/t42/s1396/etseq">42 U.S.C. 1396 et seq.</ref>).</content></subparagraph> <subparagraph class="fontsize10" id="y5861fb05-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2/B" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Health care provider</inline>.—</heading><chapeau>The term “<term>health care provider</term>” means any individual, group practice, corporation of health care professionals, or hospital—</chapeau><clause class="fontsize10" id="y5861fb06-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>licensed, registered, or certified under Federal or State laws or regulations to provide health care services; or</content></clause> <clause class="fontsize10" id="y5861fb07-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>required to be so licensed, registered, or certified but that is exempted by other statute or regulation.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5861fb08-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2/C" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Medical malpractice or medical product liability action or claim</inline>.—</heading><content>The term “<term>medical malpractice or medical product liability action or claim</term>” means a medical malpractice action or claim (as defined in section 431(7) of the Health Care Quality Improvement Act of 1986 (<ref href="/us/usc/t42/s11151/7">42 U.S.C. 11151(7)</ref>)) and includes a liability action or claim relating to a health care provider’s prescription or provision of a drug, device, or biological product (as such terms are defined in section 201 of the Federal Food, Drug, and Cosmetic Act (<ref href="/us/usc/t21/s321">21 U.S.C. 321</ref>) or section 351 of the Public Health Service Act (<ref href="/us/usc/t42/s262">42 U.S.C. 262</ref>)).</content></subparagraph> <subparagraph class="fontsize10" id="y5861fb09-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2/D" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><heading class="fontsize10"><inline class="smallCaps">State</inline>.—</heading><content>The term “<term>State</term>” includes the District of Columbia, Puerto Rico, and any other commonwealth, possession, or territory of the United States.<page identifier="/us/stat/129/143">129 STAT. 143</page></content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5861fb0a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861fb0b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s18122">42 USC 18122 note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">No preemption</inline>.—</heading><content>Nothing in paragraph (1) or any provision of the Patient Protection and Affordable Care Act (<ref href="/us/pl/111/148">Public Law 111–148</ref>), title I or subtitle B of title II of the Health Care and Education Reconciliation Act of 2010 (<ref href="/us/pl/111/152">Public Law 111–152</ref>), or title XVIII or XIX of the Social Security Act (<ref href="/us/usc/t42/s1395/etseq">42 U.S.C. 1395 et seq.</ref>, <ref href="/us/usc/t42/s1396/etseq">42 U.S.C. 1396 et seq.</ref>) shall be construed to preempt any State or common law governing medical professional or medical product liability actions or claims.</content></paragraph> </subsection> </section>

An Act To amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and strengthen Medicare access by improving physician payments and making other improvements, to reauthorize the Children’s Health Insurance Program, and for other purposes.

Apr. 16, 2015

[H.R. 2]

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

Medicare Access and CHIP Reauthorization Act of 2015.

42 USC 1305 note.

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.(a) Short Title.—This Act may be cited as the “Medicare Access and CHIP Reauthorization Act of 2015”. (b) Table of Contents.—The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. TITLE I— SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION Sec. 101. Repealing the sustainable growth rate (SGR) and improving Medicare payment for physicians’ services. Sec. 102. Priorities and funding for measure development. Sec. 103. Encouraging care management for individuals with chronic care needs. Sec. 104. Empowering beneficiary choices through continued access to information on physicians’ services. Sec. 105. Expanding availability of Medicare data. Sec. 106. Reducing administrative burden and other provisions. TITLE II— MEDICARE AND OTHER HEALTH EXTENDERS Subtitle A— Medicare Extenders Sec. 201. Extension of work GPCI floor. Sec. 202. Extension of therapy cap exceptions process. Sec. 203. Extension of ambulance add-ons. Sec. 204. Extension of increased inpatient hospital payment adjustment for certain low-volume hospitals. Sec. 205. Extension of the Medicare-dependent hospital (MDH) program. Sec. 206. Extension for specialized Medicare Advantage plans for special needs individuals. Sec. 207. Extension of funding for quality measure endorsement, input, and selection. Sec. 208. Extension of funding outreach and assistance for low-income programs. Sec. 209. Extension and transition of reasonable cost reimbursement contracts. Sec. 210. Extension of home health rural add-on. Subtitle B— Other Health Extenders Sec. 211. Permanent extension of the qualifying individual (QI) program. Sec. 212. Permanent extension of transitional medical assistance (TMA). Sec. 213. Extension of special diabetes program for type I diabetes and for Indians. Sec. 214. Extension of abstinence education. Sec. 215. Extension of personal responsibility education program (PREP). Sec. 216. Extension of funding for family-to-family health information centers. Sec. 217. Extension of health workforce demonstration project for low-income individuals.129 STAT. 88 Sec. 218. Extension of maternal, infant, and early childhood home visiting programs. Sec. 219. Tennessee DSH allotment for fiscal years 2015 through 2025. Sec. 220. Delay in effective date for Medicaid amendments relating to beneficiary liability settlements. Sec. 221. Extension of funding for community health centers, the National Health Service Corps, and teaching health centers. TITLE III— CHIP Sec. 301. 2-year extension of the Children’s Health Insurance Program. Sec. 302. Extension of express lane eligibility. Sec. 303. Extension of outreach and enrollment program. Sec. 304. Extension of certain programs and demonstration projects. Sec. 305. Report of Inspector General of HHS on use of express lane option under Medicaid and CHIP. TITLE IV— OFFSETS Subtitle A— Medicare Beneficiary Reforms Sec. 401. Limitation on certain medigap policies for newly eligible Medicare beneficiaries. Sec. 402. Income-related premium adjustment for parts B and D. Subtitle B— Other Offsets Sec. 411. Medicare payment updates for post-acute providers. Sec. 412. Delay of reduction to Medicaid DSH allotments. Sec. 413. Levy on delinquent providers. Sec. 414. Adjustments to inpatient hospital payment rates. TITLE V— MISCELLANEOUS Subtitle A— Protecting the Integrity of Medicare Sec. 501. Prohibition of inclusion of Social Security account numbers on Medicare cards. Sec. 502. Preventing wrongful Medicare payments for items and services furnished to incarcerated individuals, individuals not lawfully present, and deceased individuals. Sec. 503. Consideration of measures regarding Medicare beneficiary smart cards. Sec. 504. Modifying Medicare durable medical equipment face-to-face encounter documentation requirement. Sec. 505. Reducing improper Medicare payments. Sec. 506. Improving senior Medicare patrol and fraud reporting rewards. Sec. 507. Requiring valid prescriber National Provider Identifiers on pharmacy claims. Sec. 508. Option to receive Medicare Summary Notice electronically. Sec. 509. Renewal of MAC contracts. Sec. 510. Study on pathway for incentives to States for State participation in medicaid data match program. Sec. 511. Guidance on application of Common Rule to clinical data registries. Sec. 512. Eliminating certain civil money penalties; gainsharing study and report. Sec. 513. Modification of Medicare home health surety bond condition of participation requirement. Sec. 514. Oversight of Medicare coverage of manual manipulation of the spine to correct subluxation. Sec. 515. National expansion of prior authorization model for repetitive scheduled non-emergent ambulance transport. Sec. 516. Repealing duplicative Medicare secondary payor provision. Sec. 517. Plan for expanding data in annual CERT report. Sec. 518. Removing funds for Medicare Improvement Fund added by IMPACT Act of 2014. Sec. 519. Rule of construction. Subtitle B— Other Provisions Sec. 521. Extension of two-midnight PAMA rules on certain medical review activities. Sec. 522. Requiring bid surety bonds and State licensure for entities submitting bids under the Medicare DMEPOS competitive acquisition program. Sec. 523. Payment for global surgical packages. Sec. 524. Extension of Secure Rural Schools and Community Self-Determination Act of 2000. Sec. 525. Exclusion from PAYGO scorecards. 129 STAT. 89

<num value="I">TITLE I—</num><heading>SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION</heading> <section id="d354370e500" identifier="/us/pl/114/10/tI/s101" style="-uslm-lc:I658143"><num class="fontsize12" value="101">SEC. 101. </num><heading>REPEALING THE SUSTAINABLE GROWTH RATE (SGR) AND IMPROVING MEDICARE PAYMENT FOR PHYSICIANS’ SERVICES.</heading><subsection class="firstIndent0 fontsize10" id="y584f0f06-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Stabilizing Fee Updates</inline>.—</heading><paragraph class="fontsize10" id="y584f3617-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Repeal of sgr payment methodology</inline>.—</heading><chapeau>Section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y584f3618-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><chapeau>in subsection (d)—</chapeau><clause class="fontsize10" id="y584f3619-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><chapeau>in paragraph (1)(A)—</chapeau><subclause class="fontsize10" id="y584f361a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A/i/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and ending with 2025</quotedText>” after “<quotedText>beginning with 2001</quotedText>”; and</content></subclause> <subclause class="fontsize10" id="y584f361b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A/i/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>or a subsequent paragraph</quotedText>” after “<quotedText>paragraph (4)</quotedText>”; and</content></subclause> </clause> <clause class="fontsize10" id="y584f361c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><chapeau>in paragraph (4)—</chapeau><subclause class="fontsize10" id="y584f361d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A/ii/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>in the heading, by <amendingAction type="insert">inserting</amendingAction> “<quotedText><headingText class="smallCaps">and ending with 2014</headingText></quotedText>” after “<quotedText><headingText class="smallCaps">years beginning with 2001</headingText></quotedText>”; and</content></subclause> <subclause class="fontsize10" id="y584f361e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/A/ii/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>in subparagraph (A), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and ending with 2014</quotedText>” after “<quotedText>a year beginning with 2001</quotedText>”; and</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y584f361f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><chapeau>in subsection (f)—</chapeau><clause class="fontsize10" id="y584f3620-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in paragraph (1)(B), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>through 2014</quotedText>” after “<quotedText>of each succeeding year</quotedText>”; and</content></clause> <clause class="fontsize10" id="y584f3621-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/1/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in paragraph (2), in the matter preceding subparagraph (A), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and ending with 2014</quotedText>” after “<quotedText>beginning with 2000</quotedText>”.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y584f3622-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/2" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Update of rates for 2015 and subsequent years</inline>.—</heading><chapeau>Subsection (d) of section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y584f3623-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x584f3624-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><content>in paragraph (1)(A), by <amendingAction type="add">adding</amendingAction> at the end the following: “<quotedText>There shall be two separate conversion factors for each year beginning with 2026, one for items and services furnished by a qualifying APM participant (as defined in section 1833(z)(2)) (referred to in this subsection as the ‘qualifying APM conversion factor’) and the other for other items and services (referred to in this subsection as the ‘nonqualifying APM conversion factor’), equal to the respective conversion factor for the previous year (or, in the case of 2026, equal to the single conversion factor for 2025) multiplied by the update established under paragraph (20) for such respective conversion factor for such year.</quotedText>”;</content></subparagraph> <subparagraph class="fontsize10" id="y584f3625-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in paragraph (1)(D), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>(or, beginning with 2026, applicable conversion factor)</quotedText>” after “<quotedText>single conversion factor</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y584f3626-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/2/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>by <amendingAction type="delete">striking</amendingAction> paragraph (16) and <amendingAction type="insert">inserting</amendingAction> the following new paragraphs:<quotedContent><paragraph class="indentDown1 fontsize10" id="y584f5d37-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="16">“(16) </num><heading class="fontsize10"><inline class="smallCaps">Update for january through june of 2015</inline>.—</heading><content>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 June 30, 2015, the update to the single conversion factor shall be 0.0 percent.<page identifier="/us/stat/129/90">129 STAT. 90</page></content></paragraph> <paragraph class="indentDown1 fontsize10" id="y584f5d38-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="17">“(17) </num><heading class="fontsize10"><inline class="smallCaps">Update for july through december of 2015</inline>.—</heading><content>The update to the single conversion factor established in paragraph (1)(C) for the period beginning on July 1, 2015, and ending on December 31, 2015, shall be 0.5 percent.</content></paragraph> <paragraph class="indentDown1 fontsize10" id="y584f5d39-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="18">“(18) </num><heading class="fontsize10"><inline class="smallCaps">Update for 2016 through 2019</inline>.—</heading><content>The update to the single conversion factor established in paragraph (1)(C) for 2016 and each subsequent year through 2019 shall be 0.5 percent.</content></paragraph> <paragraph class="indentDown1 fontsize10" id="y584f5d3a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="19">“(19) </num><heading class="fontsize10"><inline class="smallCaps">Update for 2020 through 2025</inline>.—</heading><content>The update to the single conversion factor established in paragraph (1)(C) for 2020 and each subsequent year through 2025 shall be 0.0 percent.</content></paragraph> <paragraph class="indentDown1 fontsize10" id="y584f5d3b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="20">“(20) </num><heading class="fontsize10"><inline class="smallCaps">Update for 2026 and subsequent years</inline>.—</heading><content>For 2026 and each subsequent year, the update to the qualifying APM conversion factor established under paragraph (1)(A) is 0.75 percent, and the update to the nonqualifying APM conversion factor established under such paragraph is 0.25 percent.”</content></paragraph> </quotedContent>.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y584f5d3c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">MedPAC reports</inline>.—</heading><subparagraph class="fontsize10" id="y584f5d3d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Initial report</inline>.—</heading><chapeau>Not later than July 1, 2017, the Medicare Payment Advisory Commission shall submit to Congress a report on the relationship between—</chapeau><clause class="fontsize10" id="y584f5d3e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>physician and other health professional utilization and expenditures (and the rate of increase of such utilization and expenditures) of items and services for which payment is made under section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>); and</content></clause> <clause class="fontsize10" id="y584f5d3f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>total utilization and expenditures (and the rate of increase of such utilization and expenditures) under parts A, B, and D of title XVIII of such Act.</content></clause> <continuation class="firstIndent1 fontsize10" id="x584f5d40-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124">Such report shall include a methodology to describe such relationship and the impact of changes in such physician and other health professional practice and service ordering patterns on total utilization and expenditures under parts A, B, and D of such title.</continuation></subparagraph> <subparagraph class="fontsize10" id="y584f5d41-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Final report</inline>.—</heading><content>Not later than July 1, 2021, the Medicare Payment Advisory Commission shall submit to Congress a report on the relationship described in subparagraph (A), including the results determined from applying the methodology included in the report submitted under such subparagraph.</content></subparagraph> <subparagraph class="fontsize10" id="y584f5d42-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Report on update to physicians’ services under medicare</inline>.—</heading><chapeau>Not later than July 1, 2019, the Medicare Payment Advisory Commission shall submit to Congress a report on—</chapeau><clause class="fontsize10" id="y584f5d43-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/C/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>the payment update for professional services applied under the Medicare program under title XVIII of the Social Security Act for the period of years 2015 through 2019;</content></clause> <clause class="fontsize10" id="y584f5d44-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/C/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>the effect of such update on the efficiency, economy, and quality of care provided under such program;</content></clause> <clause class="fontsize10" id="y584f5d45-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/C/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>the effect of such update on ensuring a sufficient number of providers to maintain access to care by Medicare beneficiaries; and</content></clause> <clause class="fontsize10" id="y584f5d46-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/a/3/C/iv" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">(iv) </num><content>recommendations for any future payment updates for professional services under such program <page identifier="/us/stat/129/91">129 STAT. 91</page> to ensure adequate access to care is maintained for Medicare beneficiaries.</content></clause> </subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y584f5d47-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Consolidation of Certain Current Law Performance Programs With New Merit-Based Incentive Payment System</inline>.—</heading><paragraph class="fontsize10" id="y584f5d48-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">EHR meaningful use incentive program</inline>.—</heading><subparagraph class="fontsize10" id="y584f5d49-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Sunsetting separate meaningful use payment adjustments</inline>.—</heading><chapeau>Section 1848(a)(7)(A) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/a/7/A">42 U.S.C. 1395w–4(a)(7)(A)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><clause class="fontsize10" id="y584f5d4a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015 or any subsequent payment year</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>each of 2015 through 2018</quotedText>”;</content></clause> <clause class="fontsize10" id="y584f5d4b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in clause (ii)(III), by <amendingAction type="delete">striking</amendingAction> “<quotedText>each subsequent year</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2018</quotedText>”; and</content></clause> <clause class="fontsize10" id="y584f5d4c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><chapeau>in clause (iii)—</chapeau><subclause class="fontsize10" id="y584f5d4d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A/iii/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>in the heading, by <amendingAction type="delete">striking</amendingAction> “<quotedText><headingText class="smallCaps">and subsequent years</headingText></quotedText>”;</content></subclause> <subclause class="fontsize10" id="y584f5d4e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A/iii/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>and each subsequent year</quotedText>”; and</content></subclause> <subclause class="fontsize10" id="y584f5d4f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/A/iii/III" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">(III) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>, but in no case shall the applicable percent be less than 95 percent</quotedText>”.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y584f5d50-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Continuation of meaningful use determinations for mips</inline>.—</heading><chapeau>Section 1848(o)(2) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/o/2">42 U.S.C. 1395w–4(o)(2)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><clause class="fontsize10" id="y584f5d51-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><chapeau>in subparagraph (A), in the matter preceding clause (i)—</chapeau><subclause class="fontsize10" id="y584f5d52-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/B/i/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>For purposes of paragraph (1), an</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>An</quotedText>”; and</content></subclause> <subclause class="fontsize10" id="y584f5d53-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/B/i/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>, or pursuant to subparagraph (D) for purposes of subsection (q), for a performance period under such subsection for a year</quotedText>” after “<quotedText>under such subsection for a year</quotedText>”; and</content></subclause> </clause> <clause class="fontsize10" id="y584f5d54-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/1/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraph:<quotedContent><subparagraph class="indentDown1 fontsize10" id="y584f5d55-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Continued application for purposes of mips</inline>.—</heading><content>With respect to 2019 and each subsequent payment year, the Secretary shall, for purposes of subsection (q) and in accordance with paragraph (1)(F) of such subsection, determine whether an eligible professional who is a MIPS eligible professional (as defined in subsection (q)(1)(C)) for such year is a meaningful EHR user under this paragraph for the performance period under subsection (q) for such year.”</content></subparagraph> </quotedContent>.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y584f5d56-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Quality reporting</inline>.—</heading><subparagraph class="fontsize10" id="y584f5d57-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Sunsetting separate quality reporting incentives</inline>.—</heading><chapeau>Section 1848(a)(8)(A) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/a/8/A">42 U.S.C. 1395w–4(a)(8)(A)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><clause class="fontsize10" id="y584f5d58-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015 or any subsequent year</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>each of 2015 through 2018</quotedText>”; and</content></clause> <clause class="fontsize10" id="y584f5d59-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in clause (ii)(II), by <amendingAction type="delete">striking</amendingAction> “<quotedText>and each subsequent year</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>, 2017, and 2018</quotedText>”.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y584f5d5a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Continuation of quality measures and processes for mips</inline>.—</heading><chapeau>Section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><clause class="fontsize10" id="y584f5d5b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in subsection (k), by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<page identifier="/us/stat/129/92">129 STAT. 92</page> <quotedContent><paragraph class="indentDown2 fontsize10" id="y584f846c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="9">“(9) </num><heading class="fontsize10"><inline class="smallCaps">Continued application for purposes of mips and for certain professionals volunteering to report</inline>.—</heading><chapeau>The Secretary shall, in accordance with subsection (q)(1)(F), carry out the provisions of this subsection—</chapeau><subparagraph class="fontsize10" id="y584f846d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>for purposes of subsection (q); and</content></subparagraph> <subparagraph class="fontsize10" id="y584f846e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>for eligible professionals who are not MIPS eligible professionals (as defined in subsection (q)(1)(C)) for the year involved.”</content></subparagraph> </paragraph> </quotedContent>; and</content></clause> <clause class="fontsize10" id="y584f846f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><chapeau>in subsection (m)—</chapeau><subclause class="fontsize10" id="y584f8470-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/B/ii/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>by <amendingAction type="redesignate">redesignating</amendingAction> paragraph (7) added by <ref href="/us/pl/111/148/s10327/a">section 10327(a) of Public Law 111–148</ref> as paragraph (8); and</content></subclause> <subclause class="fontsize10" id="y584f8471-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/2/B/ii/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="indentDown3 fontsize10" id="y584f8472-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="9">“(9) </num><heading class="fontsize10"><inline class="smallCaps">Continued application for purposes of mips and for certain professionals volunteering to report</inline>.—</heading><chapeau>The Secretary shall, in accordance with subsection (q)(1)(F), carry out the processes under this subsection—</chapeau><subparagraph class="fontsize10" id="y584f8473-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>for purposes of subsection (q); and</content></subparagraph> <subparagraph class="fontsize10" id="y584f8474-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>for eligible professionals who are not MIPS eligible professionals (as defined in subsection (q)(1)(C)) for the year involved.”</content></subparagraph> </paragraph> </quotedContent>.</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y584f8475-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Value-based payments</inline>.—</heading><subparagraph class="fontsize10" id="y584f8476-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/3/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Sunsetting separate value-based payments</inline>.—</heading><content>Clause (iii) of section 1848(p)(4)(B) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/p/4/B">42 U.S.C. 1395w–4(p)(4)(B)</ref>) <amendingAction type="amend">is amended</amendingAction> to read as follows:<quotedContent><subsection class="indentUp1 fontsize10" id="y584fab87-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii)</num><heading class="fontsize10"><inline class="smallCaps">Application</inline>.—</heading><content>The Secretary shall apply the payment modifier established under this subsection for items and services furnished on or after January 1, 2015, with respect to specific physicians and groups of physicians the Secretary determines appropriate, and for services furnished on or after January 1, 2017, with respect to all physicians and groups of physicians. Such payment modifier shall not be applied for items and services furnished on or after January 1, 2019.”</content></subsection> </quotedContent>.</content></subparagraph> <subparagraph class="fontsize10" id="y584fab88-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/3/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Continuation of value-based payment modifier measures for mips</inline>.—</heading><chapeau>Section 1848(p) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/p">42 U.S.C. 1395w–4(p)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><clause class="fontsize10" id="y584fab89-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/3/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in paragraph (2), by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraph:<quotedContent><subparagraph class="indentDown1 fontsize10" id="y584fab8a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Continued application for purposes of mips</inline>.—</heading><content>The Secretary shall, in accordance with subsection (q)(1)(F), carry out subparagraph (B) for purposes of subsection (q).”</content></subparagraph> </quotedContent>; and</content></clause> <clause class="fontsize10" id="y584fab8b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/b/3/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in paragraph (3), by <amendingAction type="add">adding</amendingAction> at the end the following: “<quotedText>With respect to 2019 and each subsequent year, the Secretary shall, in accordance with subsection (q)(1)(F), carry out this paragraph for purposes of subsection (q).</quotedText>”.</content></clause> </subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y584fab8c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Merit-Based Incentive Payment System</inline>.—</heading><paragraph class="fontsize10" id="y584fab8d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="indentDown1 firstIndent0 fontsize10" id="y5854b49e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="q">“(q) </num><heading class="fontsize10"><inline class="smallCaps">Merit-Based Incentive Payment System</inline>.—</heading><paragraph class="fontsize10" id="y5854b49f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">Establishment</inline>.—</heading><page identifier="/us/stat/129/93">129 STAT. 93</page> <subparagraph class="fontsize10" id="y5854b4a0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Subject to the succeeding provisions of this subsection, the Secretary shall establish an eligible professional Merit-based Incentive Payment System (in this subsection referred to as the ‘MIPS’) under which the Secretary shall—</chapeau><clause class="fontsize10" id="y5854b4a1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>develop a methodology for assessing the total performance of each MIPS eligible professional according to performance standards under paragraph (3) for a performance period (as established under paragraph (4)) for a year;</content></clause> <clause class="fontsize10" id="y5854b4a2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>using such methodology, provide for a composite performance score in accordance with paragraph (5) for each such professional for each performance period; and</content></clause> <clause class="fontsize10" id="y5854b4a3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>use such composite performance score of the MIPS eligible professional for a performance period for a year to determine and apply a MIPS adjustment factor (and, as applicable, an additional MIPS adjustment factor) under paragraph (6) to the professional for the year.</content></clause> <continuation class="firstIndent1 fontsize10" id="x5854b4a4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124">Notwithstanding subparagraph (C)(ii), under the MIPS, the Secretary shall permit any eligible professional (as defined in subsection (k)(3)(B)) to report on applicable measures and activities described in paragraph (2)(B).</continuation></subparagraph> <subparagraph class="fontsize10" id="y5854b4a5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5854b4a6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p><p class="leftAlign firstIndent0 fontsize8" id="x5854b4a7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Program implementation</inline>.—</heading><content>The MIPS shall apply to payments for items and services furnished on or after January 1, 2019.</content></subparagraph> <subparagraph class="fontsize10" id="y5854b4a8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">MIPS eligible professional defined</inline>.—</heading><clause class="fontsize10" id="y5854b4a9-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>For purposes of this subsection, subject to clauses (ii) and (iv), the term ‘<term>MIPS eligible professional</term>’ means—</chapeau><subclause class="fontsize10" id="y5854b4aa-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>for the first and second years for which the MIPS applies to payments (and for the performance period for such first and second year), a physician (as defined in section 1861(r)), a physician assistant, nurse practitioner, and clinical nurse specialist (as such terms are defined in section 1861(aa)(5)), a certified registered nurse anesthetist (as defined in section 1861(bb)(2)), and a group that includes such professionals; and</content></subclause> <subclause class="fontsize10" id="y5854b4ab-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>for the third year for which the MIPS applies to payments (and for the performance period for such third year) and for each succeeding year (and for the performance period for each such year), the professionals described in subclause (I), such other eligible professionals (as defined in subsection (k)(3)(B)) as specified by the Secretary, and a group that includes such professionals.</content></subclause> </clause> <clause class="fontsize10" id="y5854b4ac-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Exclusions</inline>.—</heading><chapeau>For purposes of clause (i), the term ‘<term>MIPS eligible professional</term>’ does not include, with respect to a year, an eligible professional (as defined in subsection (k)(3)(B)) who—</chapeau><subclause class="fontsize10" id="y5854b4ad-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>is a qualifying APM participant (as defined in section 1833(z)(2));</content></subclause> <subclause class="fontsize10" id="y5854b4ae-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>subject to clause (vii), is a partial qualifying APM participant (as defined in clause (iii)) <page identifier="/us/stat/129/94">129 STAT. 94</page> for the most recent period for which data are available and who, for the performance period with respect to such year, does not report on applicable measures and activities described in paragraph (2)(B) that are required to be reported by such a professional under the MIPS; or</content></subclause> <subclause class="fontsize10" id="y5854b4af-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>for the performance period with respect to such year, does not exceed the low-volume threshold measurement selected under clause (iv).</content></subclause> </clause> <clause class="fontsize10" id="y5854b4b0-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5854b4b1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Definition.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Partial qualifying apm participant</inline>.—</heading><chapeau>For purposes of this subparagraph, the term ‘<term>partial qualifying APM participant</term>’ means, with respect to a year, an eligible professional for whom the Secretary determines the minimum payment percentage (or percentages), as applicable, described in paragraph (2) of section 1833(z) for such year have not been satisfied, but who would be considered a qualifying APM participant (as defined in such paragraph) for such year if—</chapeau><subclause class="fontsize10" id="y5854b4b2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>with respect to 2019 and 2020, the reference in subparagraph (A) of such paragraph to 25 percent was instead a reference to 20 percent;</content></subclause> <subclause class="fontsize10" id="y5854b4b3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><chapeau>with respect to 2021 and 2022—</chapeau><item class="fontsize10" id="y5854b4b4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>the reference in subparagraph (B)(i) of such paragraph to 50 percent was instead a reference to 40 percent; and</content></item> <item class="fontsize10" id="y5854b4b5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>the references in subparagraph (B)(ii) of such paragraph to 50 percent and 25 percent of such paragraph were instead references to 40 percent and 20 percent, respectively; and</content></item> </subclause> <subclause class="fontsize10" id="y5854dbc6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><chapeau>with respect to 2023 and subsequent years—</chapeau><item class="fontsize10" id="y5854dbc7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>the reference in subparagraph (C)(i) of such paragraph to 75 percent was instead a reference to 50 percent; and</content></item> <item class="fontsize10" id="y5854dbc8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>the references in subparagraph (C)(ii) of such paragraph to 75 percent and 25 percent of such paragraph were instead references to 50 percent and 20 percent, respectively.</content></item> </subclause> </clause> <clause class="fontsize10" id="y5854dbc9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Selection of low-volume threshold measurement</inline>.—</heading><chapeau>The Secretary shall select a low-volume threshold to apply for purposes of clause (ii)(III), which may include one or more or a combination of the following:</chapeau><subclause class="fontsize10" id="y5854dbca-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>The minimum number (as determined by the Secretary) of individuals enrolled under this part who are treated by the eligible professional for the performance period involved.</content></subclause> <subclause class="fontsize10" id="y5854dbcb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>The minimum number (as determined by the Secretary) of items and services furnished to individuals enrolled under this part by such professional for such performance period.</content></subclause> <subclause class="fontsize10" id="y5854dbcc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>The minimum amount (as determined by the Secretary) of allowed charges billed by such <page identifier="/us/stat/129/95">129 STAT. 95</page> professional under this part for such performance period.</content></subclause> </clause> <clause class="fontsize10" id="y5854dbcd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><heading class="fontsize10"><inline class="smallCaps">Treatment of new medicare enrolled eligible professionals</inline>.—</heading><content>In the case of a professional who first becomes a Medicare enrolled eligible professional during the performance period for a year (and had not previously submitted claims under this title such as a person, an entity, or a part of a physician group or under a different billing number or tax identifier), such professional shall not be treated under this subsection as a MIPS eligible professional until the subsequent year and performance period for such subsequent year.</content></clause> <clause class="fontsize10" id="y5854dbce-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">“(vi) </num><heading class="fontsize10"><inline class="smallCaps">Clarification</inline>.—</heading><content>In the case of items and services furnished during a year by an individual who is not a MIPS eligible professional (including pursuant to clauses (ii) and (v)) with respect to a year, in no case shall a MIPS adjustment factor (or additional MIPS adjustment factor) under paragraph (6) apply to such individual for such year.</content></clause> <clause class="fontsize10" id="y5854dbcf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vii">“(vii) </num><heading class="fontsize10"><inline class="smallCaps">Partial qualifying apm participant clarifications</inline>.—</heading><subclause class="fontsize10" id="y5854dbd0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">Treatment as mips eligible professional</inline>.—</heading><content>In the case of an eligible professional who is a partial qualifying APM participant, with respect to a year, and who, for the performance period for such year, reports on applicable measures and activities described in paragraph (2)(B) that are required to be reported by such a professional under the MIPS, such eligible professional is considered to be a MIPS eligible professional with respect to such year.</content></subclause> <subclause class="fontsize10" id="y5854dbd1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Not eligible for qualifying apm participant payments</inline>.—</heading><content>In no case shall an eligible professional who is a partial qualifying APM participant, with respect to a year, be considered a qualifying APM participant (as defined in paragraph (2) of section 1833(z)) for such year or be eligible for the additional payment under paragraph (1) of such section for such year.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y5854dbd2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Application to group practices</inline>.—</heading><clause class="fontsize10" id="y5854dbd3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Under the MIPS:</chapeau><subclause class="fontsize10" id="y5854dbd4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">Quality performance category</inline>.—</heading><content>The Secretary shall establish and apply a process that includes features of the provisions of subsection (m)(3)(C) for MIPS eligible professionals in a group practice with respect to assessing performance of such group with respect to the performance category described in clause (i) of paragraph (2)(A).</content></subclause> <subclause class="fontsize10" id="y5854dbd5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Other performance categories</inline>.—</heading><content>The Secretary may establish and apply a process that includes features of the provisions of subsection (m)(3)(C) for MIPS eligible professionals in a group practice with respect to assessing the performance of such group with respect to the performance categories described in clauses (ii) through (iv) of such paragraph.<page identifier="/us/stat/129/96">129 STAT. 96</page></content></subclause> </clause> <clause class="fontsize10" id="y5854dbd6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Ensuring comprehensiveness of group practice assessment</inline>.—</heading><content>The process established under clause (i) shall to the extent practicable reflect the range of items and services furnished by the MIPS eligible professionals in the group practice involved.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5854dbd7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Use of registries</inline>.—</heading><content>Under the MIPS, the Secretary shall encourage the use of qualified clinical data registries pursuant to subsection (m)(3)(E) in carrying out this subsection.</content></subparagraph> <subparagraph class="fontsize10" id="y5854dbd8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><heading class="fontsize10"><inline class="smallCaps">Application of certain provisions</inline>.—</heading><chapeau>In applying a provision of subsection (k), (m), (o), or (p) for purposes of this subsection, the Secretary shall—</chapeau><clause class="fontsize10" id="y5854dbd9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>adjust the application of such provision to ensure the provision is consistent with the provisions of this subsection; and</content></clause> <clause class="fontsize10" id="y5854dbda-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>not apply such provision to the extent that the provision is duplicative with a provision of this subsection.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5854dbdb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="G">“(G) </num><heading class="fontsize10"><inline class="smallCaps">Accounting for risk factors</inline>.—</heading><clause class="fontsize10" id="y5854dbdc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Risk factors</inline>.—</heading><chapeau>Taking into account the relevant studies conducted and recommendations made in reports under section 2(d) of the Improving Medicare Post-Acute Care Transformation Act of 2014, and, as appropriate, other information, including information collected before completion of such studies and recommendations, the Secretary, on an ongoing basis, shall, as the Secretary determines appropriate and based on an individual’s health status and other risk factors—</chapeau><subclause class="fontsize10" id="y5854dbdd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>assess appropriate adjustments to quality measures, resource use measures, and other measures used under the MIPS; and</content></subclause> <subclause class="fontsize10" id="y5854dbde-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>assess and implement appropriate adjustments to payment adjustments, composite performance scores, scores for performance categories, or scores for measures or activities under the MIPS.</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y5854dbdf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">Measures and activities under performance categories</inline>.—</heading><subparagraph class="fontsize10" id="y5854dbe0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Performance categories</inline>.—</heading><chapeau>Under the MIPS, the Secretary shall use the following performance categories (each of which is referred to in this subsection as a performance category) in determining the composite performance score under paragraph (5):</chapeau><clause class="fontsize10" id="y5854dbe1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>Quality.</content></clause> <clause class="fontsize10" id="y5854dbe2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>Resource use.</content></clause> <clause class="fontsize10" id="y5854dbe3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>Clinical practice improvement activities.</content></clause> <clause class="fontsize10" id="y5854dbe4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>Meaningful use of certified EHR technology.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5854dbe5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Measures and activities specified for each category</inline>.—</heading><chapeau>For purposes of paragraph (3)(A) and subject to subparagraph (C), measures and activities specified for a performance period (as established under paragraph (4)) for a year are as follows:</chapeau><clause class="fontsize10" id="y5854dbe6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Quality</inline>.—</heading><content>For the performance category described in subparagraph (A)(i), the quality measures included in the final measures list published under subparagraph (D)(i) for such year and the list of quality measures described in subparagraph (D)(vi) used by <page identifier="/us/stat/129/97">129 STAT. 97</page> qualified clinical data registries under subsection (m)(3)(E).</content></clause> <clause class="fontsize10" id="y5854dbe7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Resource use</inline>.—</heading><content>For the performance category described in subparagraph (A)(ii), the measurement of resource use for such period under subsection (p)(3), using the methodology under subsection (r) as appropriate, and, as feasible and applicable, accounting for the cost of drugs under part D.</content></clause> <clause class="fontsize10" id="y5854dbe8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Clinical practice improvement activities</inline>.—</heading><chapeau>For the performance category described in subparagraph (A)(iii), clinical practice improvement activities (as defined in subparagraph (C)(v)(III)) under subcategories specified by the Secretary for such period, which shall include at least the following:</chapeau><subclause class="fontsize10" id="y5854dbe9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>The subcategory of expanded practice access, such as same day appointments for urgent needs and after hours access to clinician advice.</content></subclause> <subclause class="fontsize10" id="y5854dbea-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>The subcategory of population management, such as monitoring health conditions of individuals to provide timely health care interventions or participation in a qualified clinical data registry.</content></subclause> <subclause class="fontsize10" id="y5854dbeb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>The subcategory of care coordination, such as timely communication of test results, timely exchange of clinical information to patients and other providers, and use of remote monitoring or telehealth.</content></subclause> <subclause class="fontsize10" id="y5854dbec-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="IV">“(IV) </num><content>The subcategory of beneficiary engagement, such as the establishment of care plans for individuals with complex care needs, beneficiary self-management assessment and training, and using shared decision-making mechanisms.</content></subclause> <subclause class="fontsize10" id="y5854dbed-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="V">“(V) </num><content>The subcategory of patient safety and practice assessment, such as through use of clinical or surgical checklists and practice assessments related to maintaining certification.</content></subclause> <subclause class="fontsize10" id="y5854dbee-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="VI">“(VI) </num><content>The subcategory of participation in an alternative payment model (as defined in section 1833(z)(3)(C)).</content></subclause> <continuation class="firstIndent1 fontsize10" id="x5854dbef-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126">In establishing activities under this clause, the Secretary shall give consideration to the circumstances of small practices (consisting of 15 or fewer professionals) and practices located in rural areas and in health professional shortage areas (as designated under section 332(a)(1)(A) of the Public Health Service Act).</continuation></clause> <clause class="fontsize10" id="y5854dbf0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Meaningful ehr use</inline>.—</heading><content>For the performance category described in subparagraph (A)(iv), the requirements established for such period under subsection (o)(2) for determining whether an eligible professional is a meaningful EHR user.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5854dbf1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Additional provisions</inline>.—</heading><clause class="fontsize10" id="y5854dbf2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Emphasizing outcome measures under the quality performance category</inline>.—</heading><content>In<sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5854dbf3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote> applying subparagraph (B)(i), the Secretary shall, as feasible, emphasize the application of outcome measures.<page identifier="/us/stat/129/98">129 STAT. 98</page></content></clause> <clause class="fontsize10" id="y5854dbf4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Application of additional system measures</inline>.—</heading><content>The Secretary may use measures used for a payment system other than for physicians, such as measures for inpatient hospitals, for purposes of the performance categories described in clauses (i) and (ii) of subparagraph (A). For purposes of the previous sentence, the Secretary may not use measures for hospital outpatient departments, except in the case of items and services furnished by emergency physicians, radiologists, and anesthesiologists.</content></clause> <clause class="fontsize10" id="y5854dbf5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Global and population-based measures</inline>.—</heading><content>The Secretary may use global measures, such as global outcome measures, and population-based measures for purposes of the performance category described in subparagraph (A)(i).</content></clause> <clause class="fontsize10" id="y5854dbf6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Application of measures and activities to non-patient-facing professionals</inline>.—</heading><chapeau>In carrying out this paragraph, with respect to measures and activities specified in subparagraph (B) for performance categories described in subparagraph (A), the Secretary—</chapeau><subclause class="fontsize10" id="y5854dbf7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>shall give consideration to the circumstances of professional types (or subcategories of those types determined by practice characteristics) who typically furnish services that do not involve face-to-face interaction with a patient; and</content></subclause> <subclause class="fontsize10" id="y5854dbf8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>may, to the extent feasible and appropriate, take into account such circumstances and apply under this subsection with respect to MIPS eligible professionals of such professional types or subcategories, alternative measures or activities that fulfill the goals of the applicable performance category.</content></subclause> <continuation class="firstIndent1 fontsize10" id="x5854dbf9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126">In<sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5854dbfa-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Consultation.</p></sidenote> carrying out the previous sentence, the Secretary shall consult with professionals of such professional types or subcategories.</continuation></clause> <clause class="fontsize10" id="y5854dbfb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><heading class="fontsize10"><inline class="smallCaps">Clinical practice improvement activities</inline>.—</heading><subclause class="fontsize10" id="y5854dbfc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">Request for information</inline>.—</heading><content>In initially applying subparagraph (B)(iii), the Secretary shall use a request for information to solicit recommendations from stakeholders to identify activities described in such subparagraph and specifying criteria for such activities.</content></subclause> <subclause class="fontsize10" id="y5854dbfd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Contract authority for clinical practice improvement activities performance category</inline>.—</heading><chapeau>In <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5854dbfe-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote>applying subparagraph (B)(iii), the Secretary may contract with entities to assist the Secretary in—</chapeau><item class="fontsize10" id="y5854dbff-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>identifying activities described in subparagraph (B)(iii);</content></item> <item class="fontsize10" id="y5854dc00-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>specifying criteria for such activities; and</content></item> <item class="fontsize10" id="y5854dc01-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="cc">“(cc) </num><content>determining whether a MIPS eligible professional meets such criteria.</content></item> </subclause> <subclause class="fontsize10" id="y5854dc02-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><heading class="fontsize10"><inline class="smallCaps">Clinical practice improvement activities defined</inline>.—</heading><content>For purposes of this subsection, the term ‘<term>clinical practice improvement activity</term>’ <page identifier="/us/stat/129/99">129 STAT. 99</page> means an activity that relevant eligible professional organizations and other relevant stakeholders identify as improving clinical practice or care delivery and that the Secretary determines, when effectively executed, is likely to result in improved outcomes.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y5854dc03-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Annual list of quality measures available for mips assessment</inline>.—</heading><clause class="fontsize10" id="y5854dc04-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5854dc05-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Notice.</p><p class="leftAlign firstIndent0 fontsize8" id="x5854dc06-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Regulations.</p><p class="leftAlign firstIndent0 fontsize8" id="x5854dc07-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadlines.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Under the MIPS, the Secretary, through notice and comment rulemaking and subject to the succeeding clauses of this subparagraph, shall, with respect to the performance period for a year, establish an annual final list of quality measures from which MIPS eligible professionals may choose for purposes of assessment under this subsection for such performance period. Pursuant to the previous sentence, the Secretary shall—</chapeau><subclause class="fontsize10" id="y5854dc08-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>not later than November 1 of the year prior to the first day of the first performance period under the MIPS, establish and publish in the Federal Register a final list of quality measures; and</content></subclause> <subclause class="fontsize10" id="y5854dc09-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><chapeau>not later than November 1 of the year prior to the first day of each subsequent performance period, update the final list of quality measures from the previous year (and publish such updated final list in the Federal Register), by—</chapeau><item class="fontsize10" id="y5854dc0a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>removing from such list, as appropriate, quality measures, which may include the removal of measures that are no longer meaningful (such as measures that are topped out);</content></item> <item class="fontsize10" id="y5854dc0b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>adding to such list, as appropriate, new quality measures; and</content></item> <item class="fontsize10" id="y5855031c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="cc">“(cc) </num><content>determining whether or not quality measures on such list that have undergone substantive changes should be included in the updated list.</content></item> </subclause> </clause> <clause class="fontsize10" id="y5855031d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Call for quality measures</inline>.—</heading><subclause class="fontsize10" id="y5855031e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Eligible professional organizations and other relevant stakeholders shall be requested to identify and submit quality measures to be considered for selection under this subparagraph in the annual list of quality measures published under clause (i) and to identify and submit updates to the measures on such list. For purposes of the previous sentence, measures may be submitted regardless of whether such measures were previously published in a proposed rule or endorsed by an entity with a contract under section 1890(a).</content></subclause> <subclause class="fontsize10" id="y5855031f-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Eligible professional organization defined</inline>.—</heading><content>In this subparagraph, the term ‘<term>eligible professional organization</term>’ means a professional organization as defined by nationally recognized specialty boards of certification or equivalent certification boards.<page identifier="/us/stat/129/100">129 STAT. 100</page></content></subclause> </clause> <clause class="fontsize10" id="y58550320-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Requirements</inline>.—</heading><chapeau>In selecting quality measures for inclusion in the annual final list under clause (i), the Secretary shall—</chapeau><subclause class="fontsize10" id="y58550321-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>provide that, to the extent practicable, all quality domains (as defined in subsection (s)(1)(B)) are addressed by such measures; and</content></subclause> <subclause class="fontsize10" id="y58550322-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>ensure that such selection is consistent with the process for selection of measures under subsections (k), (m), and (p)(2).</content></subclause> </clause> <clause class="fontsize10" id="y58550323-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58550324-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Publication.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Peer review</inline>.—</heading><content>Before including a new measure in the final list of measures published under clause (i) for a year, the Secretary shall submit for publication in applicable specialty-appropriate, peer-reviewed journals such measure and the method for developing and selecting such measure, including clinical and other data supporting such measure.</content></clause> <clause class="fontsize10" id="y58550325-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><heading class="fontsize10"><inline class="smallCaps">Measures for inclusion</inline>.—</heading><chapeau>The final list of quality measures published under clause (i) shall include, as applicable, measures under subsections (k), (m), and (p)(2), including quality measures from among—</chapeau><subclause class="fontsize10" id="y58550326-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>measures endorsed by a consensus-based entity;</content></subclause> <subclause class="fontsize10" id="y58550327-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>measures developed under subsection (s); and</content></subclause> <subclause class="fontsize10" id="y58550328-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>measures submitted under clause (ii)(I).</content></subclause> <continuation class="firstIndent1 fontsize10" id="x58550329-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126">Any measure selected for inclusion in such list that is not endorsed by a consensus-based entity shall have a focus that is evidence-based.</continuation></clause> <clause class="fontsize10" id="y5855032a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">“(vi) </num><heading class="fontsize10"><inline class="smallCaps">Exception for qualified clinical data registry measures</inline>.—</heading><content>Measures used by a qualified clinical data registry under subsection (m)(3)(E) shall not be subject to the requirements under clauses (i), (iv), and (v).<sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5855032b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote> The Secretary shall publish the list of measures used by such qualified clinical data registries on the Internet website of the Centers for Medicare & Medicaid Services.</content></clause> <clause class="fontsize10" id="y5855032c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vii">“(vii) </num><heading class="fontsize10"><inline class="smallCaps">Exception for existing quality measures</inline>.—</heading><chapeau>Any quality measure specified by the Secretary under subsection (k) or (m), including under subsection (m)(3)(E), and any measure of quality of care established under subsection (p)(2) for the reporting period or performance period under the respective subsection beginning before the first performance period under the MIPS—</chapeau><subclause class="fontsize10" id="y5855032d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>shall not be subject to the requirements under clause (i) (except under items (aa) and (cc) of subclause (II) of such clause) or to the requirement under clause (iv); and</content></subclause> <subclause class="fontsize10" id="y5855032e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>shall be included in the final list of quality measures published under clause (i) unless removed under clause (i)(II)(aa).</content></subclause> </clause> <clause class="fontsize10" id="y5855032f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="viii">“(viii) </num><heading class="fontsize10"><inline class="smallCaps">Consultation with relevant eligible professional organizations and other relevant stakeholders</inline>.—</heading><content>Relevant eligible professional organizations and other relevant stakeholders, <page identifier="/us/stat/129/101">129 STAT. 101</page> including State and national medical societies, shall be consulted in carrying out this subparagraph.</content></clause> <clause class="fontsize10" id="y58550330-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ix">“(ix) </num><heading class="fontsize10"><inline class="smallCaps">Optional application</inline>.—</heading><content>The process under section 1890A is not required to apply to the selection of measures under this subparagraph.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y58550331-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Performance standards</inline>.—</heading><subparagraph class="fontsize10" id="y58550332-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Establishment</inline>.—</heading><content>Under the MIPS, the Secretary shall establish performance standards with respect to measures and activities specified under paragraph (2)(B) for a performance period (as established under paragraph (4)) for a year.</content></subparagraph> <subparagraph class="fontsize10" id="y58550333-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Considerations in establishing standards</inline>.—</heading><chapeau>In establishing such performance standards with respect to measures and activities specified under paragraph (2)(B), the Secretary shall consider the following:</chapeau><clause class="fontsize10" id="y58550334-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>Historical performance standards.</content></clause> <clause class="fontsize10" id="y58550335-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>Improvement.</content></clause> <clause class="fontsize10" id="y58550336-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>The opportunity for continued improvement.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y58550337-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Performance period</inline>.—</heading><content>The Secretary shall establish a performance period (or periods) for a year (beginning with 2019). Such performance period (or periods) shall begin and end prior to the beginning of such year and be as close as possible to such year. In this subsection, such performance period (or periods) for a year shall be referred to as the performance period for the year.</content></paragraph> <paragraph class="fontsize10" id="y58550338-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">“(5) </num><heading class="fontsize10"><inline class="smallCaps">Composite performance score</inline>.—</heading><subparagraph class="fontsize10" id="y58550339-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to the succeeding provisions of this paragraph and taking into account, as available and applicable, paragraph (1)(G), the Secretary shall develop a methodology for assessing the total performance of each MIPS eligible professional according to performance standards under paragraph (3) with respect to applicable measures and activities specified in paragraph (2)(B) with respect to each performance category applicable to such professional for a performance period (as established under paragraph (4)) for a year. Using such methodology, the Secretary shall provide for a composite assessment (using a scoring scale of 0 to 100) for each such professional for the performance period for such year. In this subsection such a composite assessment for such a professional with respect to a performance period shall be referred to as the ‘composite performance score’ for such professional for such performance period.</content></subparagraph> <subparagraph class="fontsize10" id="y5855033a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Incentive to report; encouraging use of certified ehr technology for reporting quality measures</inline>.—</heading><clause class="fontsize10" id="y5855033b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Incentive to report</inline>.—</heading><content>Under the methodology established under subparagraph (A), the Secretary shall provide that in the case of a MIPS eligible professional who fails to report on an applicable measure or activity that is required to be reported by the professional, the professional shall be treated as achieving the lowest potential score applicable to such measure or activity.</content></clause> <clause class="fontsize10" id="y5855033c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Encouraging use of certified ehr technology and qualified clinical data registries for </inline><page identifier="/us/stat/129/102">129 STAT. 102</page> reporting quality measures.—</heading><chapeau>Under the methodology established under subparagraph (A), the Secretary shall—</chapeau><subclause class="fontsize10" id="y5855033d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>encourage MIPS eligible professionals to report on applicable measures with respect to the performance category described in paragraph (2)(A)(i) through the use of certified EHR technology and qualified clinical data registries; and</content></subclause> <subclause class="fontsize10" id="y5855033e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>with respect to a performance period, with respect to a year, for which a MIPS eligible professional reports such measures through the use of such EHR technology, treat such professional as satisfying the clinical quality measures reporting requirement described in subsection (o)(2)(A)(iii) for such year.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y5855033f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Clinical practice improvement activities performance score</inline>.—</heading><clause class="fontsize10" id="y58550340-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Rule for certification</inline>.—</heading><content>A MIPS eligible professional who is in a practice that is certified as a patient-centered medical home or comparable specialty practice, as determined by the Secretary, with respect to a performance period shall be given the highest potential score for the performance category described in paragraph (2)(A)(iii) for such period.</content></clause> <clause class="fontsize10" id="y58550341-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">APM participation</inline>.—</heading><content>Participation by a MIPS eligible professional in an alternative payment model (as defined in section 1833(z)(3)(C)) with respect to a performance period shall earn such eligible professional a minimum score of one-half of the highest potential score for the performance category described in paragraph (2)(A)(iii) for such performance period.</content></clause> <clause class="fontsize10" id="y58550342-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Subcategories</inline>.—</heading><content>A MIPS eligible professional shall not be required to perform activities in each subcategory under paragraph (2)(B)(iii) or participate in an alternative payment model in order to achieve the highest potential score for the performance category described in paragraph (2)(A)(iii).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58550343-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Achievement and improvement</inline>.—</heading><clause class="fontsize10" id="y58550344-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Taking into account improvement</inline>.—</heading><chapeau>Beginning with the second year to which the MIPS applies, in addition to the achievement of a MIPS eligible professional, if data sufficient to measure improvement is available, the methodology developed under subparagraph (A)—</chapeau><subclause class="fontsize10" id="y58550345-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>in the case of the performance score for the performance category described in clauses (i) and (ii) of paragraph (2)(A), shall take into account the improvement of the professional; and</content></subclause> <subclause class="fontsize10" id="y58550346-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>in the case of performance scores for other performance categories, may take into account the improvement of the professional.</content></subclause> </clause> <clause class="fontsize10" id="y58550347-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Assigning higher weight for achievement</inline>.—</heading><content>Subject to clause (i), under the methodology developed under subparagraph (A), the Secretary may assign a higher scoring weight under subparagraph (F) with respect to the achievement of a MIPS eligible professional than with respect to any improvement <page identifier="/us/stat/129/103">129 STAT. 103</page> of such professional applied under clause (i) with respect to a measure, activity, or category described in paragraph (2).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58550348-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Weights for the performance categories</inline>.—</heading><clause class="fontsize10" id="y58550349-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Under the methodology developed under subparagraph (A), subject to subparagraph (F)(i) and clause (ii), the composite performance score shall be determined as follows:</chapeau><subclause class="fontsize10" id="y5855034a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">Quality</inline>.—</heading><item class="fontsize10" id="y5855034b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to item (bb), thirty percent of such score shall be based on performance with respect to the category described in clause (i) of paragraph (2)(A). In applying the previous sentence, the Secretary shall, as feasible, encourage the application of outcome measures within such category.</content></item> <item class="fontsize10" id="y5855034c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><heading class="fontsize10"><inline class="smallCaps">First 2 years</inline>.—</heading><content>For the first and second years for which the MIPS applies to payments, the percentage applicable under item (aa) shall be increased in a manner such that the total percentage points of the increase under this item for the respective year equals the total number of percentage points by which the percentage applied under subclause (II)(bb) for the respective year is less than 30 percent.</content></item> </subclause> <subclause class="fontsize10" id="y5855034d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Resource use</inline>.—</heading><item class="fontsize10" id="y5855034e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to item (bb), thirty percent of such score shall be based on performance with respect to the category described in clause (ii) of paragraph (2)(A).</content></item> <item class="fontsize10" id="y5855034f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><heading class="fontsize10"><inline class="smallCaps">First 2 years</inline>.—</heading><content>For the first year for which the MIPS applies to payments, not more than 10 percent of such score shall be based on performance with respect to the category described in clause (ii) of paragraph (2)(A). For the second year for which the MIPS applies to payments, not more than 15 percent of such score shall be based on performance with respect to the category described in clause (ii) of paragraph (2)(A).</content></item> </subclause> <subclause class="fontsize10" id="y58550350-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><heading class="fontsize10"><inline class="smallCaps">Clinical practice improvement activities</inline>.—</heading><content>Fifteen percent of such score shall be based on performance with respect to the category described in clause (iii) of paragraph (2)(A).</content></subclause> <subclause class="fontsize10" id="y58550351-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="IV">“(IV) </num><heading class="fontsize10"><inline class="smallCaps">Meaningful use of certified ehr technology</inline>.—</heading><content>Twenty-five percent of such score shall be based on performance with respect to the category described in clause (iv) of paragraph (2)(A).</content></subclause> </clause> <clause class="fontsize10" id="y58550352-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Authority to adjust percentages in case of high ehr meaningful use adoption</inline>.—</heading><content>In any year in which the Secretary estimates that the proportion of eligible professionals (as defined in subsection (o)(5)) who are meaningful EHR users (as determined under subsection (o)(2)) is 75 percent or greater, the Secretary may reduce the percent applicable under clause (i)(IV), <page identifier="/us/stat/129/104">129 STAT. 104</page> but not below 15 percent. If the Secretary makes such reduction for a year, subject to subclauses (I)(bb) and (II)(bb) of clause (i), the percentages applicable under one or more of subclauses (I), (II), and (III) of clause (i) for such year shall be increased in a manner such that the total percentage points of the increase under this clause for such year equals the total number of percentage points reduced under the preceding sentence for such year.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58550353-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><heading class="fontsize10"><inline class="smallCaps">Certain flexibility for weighting performance categories, measures, and activities</inline>.—</heading><chapeau>Under the methodology under subparagraph (A), if there are not sufficient measures and activities (described in paragraph (2)(B)) applicable and available to each type of eligible professional involved, the Secretary shall assign different scoring weights (including a weight of 0)—</chapeau><clause class="fontsize10" id="y58550354-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>which may vary from the scoring weights specified in subparagraph (E), for each performance category based on the extent to which the category is applicable to the type of eligible professional involved; and</content></clause> <clause class="fontsize10" id="y58550355-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>for each measure and activity specified under paragraph (2)(B) with respect to each such category based on the extent to which the measure or activity is applicable and available to the type of eligible professional involved.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58550356-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="G">“(G) </num><heading class="fontsize10"><inline class="smallCaps">Resource use</inline>.—</heading><content>Analysis of the performance category described in paragraph (2)(A)(ii) shall include results from the methodology described in subsection (r)(5), as appropriate.</content></subparagraph> <subparagraph class="fontsize10" id="y58550357-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="H">“(H) </num><heading class="fontsize10"><inline class="smallCaps">Inclusion of quality measure data from other payers</inline>.—</heading><content>In applying subsections (k), (m), and (p) with respect to measures described in paragraph (2)(B)(i), analysis of the performance category described in paragraph (2)(A)(i) may include data submitted by MIPS eligible professionals with respect to items and services furnished to individuals who are not individuals entitled to benefits under part A or enrolled under part B.</content></subparagraph> <subparagraph class="fontsize10" id="y58552968-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">Use of voluntary virtual groups for certain assessment purposes</inline>.—</heading><clause class="fontsize10" id="y58552969-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>In the case of MIPS eligible professionals electing to be a virtual group under clause (ii) with respect to a performance period for a year, for purposes of applying the methodology under subparagraph (A) with respect to the performance categories described in clauses (i) and (ii) of paragraph (2)(A)—</chapeau><subclause class="fontsize10" id="y5855296a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the assessment of performance provided under such methodology with respect to such performance categories that is to be applied to each such professional in such group for such performance period shall be with respect to the combined performance of all such professionals in such group for such period; and</content></subclause> <subclause class="fontsize10" id="y5855296b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>with respect to the composite performance score provided under this paragraph for such performance period for each such MIPS eligible professional in such virtual group, the components <page identifier="/us/stat/129/105">129 STAT. 105</page> of the composite performance score that assess performance with respect to such performance categories shall be based on the assessment of the combined performance under subclause (I) for such performance categories and performance period.</content></subclause> </clause> <clause class="fontsize10" id="y5855296c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Election of practices to be a virtual group</inline>.—</heading><content>The Secretary shall, in accordance with the requirements under clause (iii), establish and have in place a process to allow an individual MIPS eligible professional or a group practice consisting of not more than 10 MIPS eligible professionals to elect, with respect to a performance period for a year to be a virtual group under this subparagraph with at least one other such individual MIPS eligible professional or group practice. Such a virtual group may be based on appropriate classifications of providers, such as by geographic areas or by provider specialties defined by nationally recognized specialty boards of certification or equivalent certification boards.</content></clause> <clause class="fontsize10" id="y5855296d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Requirements</inline>.—</heading><chapeau>The requirements for the process under clause (ii) shall—</chapeau><subclause class="fontsize10" id="y5855296e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>provide that an election under such clause, with respect to a performance period, shall be made before the beginning of such performance period and may not be changed during such performance period;</content></subclause> <subclause class="fontsize10" id="y5855296f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>provide that an individual MIPS eligible professional and a group practice described in clause (ii) may elect to be in no more than one virtual group for a performance period and that, in the case of such a group practice that elects to be in such virtual group for such performance period, such election applies to all MIPS eligible professionals in such group practice;</content></subclause> <subclause class="fontsize10" id="y58552970-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>provide that a virtual group be a combination of tax identification numbers;</content></subclause> <subclause class="fontsize10" id="y58552971-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="IV">“(IV) </num><content>provide for formal written agreements among MIPS eligible professionals electing to be a virtual group under this subparagraph; and</content></subclause> <subclause class="fontsize10" id="y58552972-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="V">“(V) </num><content>include such other requirements as the Secretary determines appropriate.</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y58552973-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="6">“(6) </num><heading class="fontsize10"><inline class="smallCaps">MIPS payments</inline>.—</heading><subparagraph class="fontsize10" id="y58552974-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">MIPS adjustment factor</inline>.—</heading><chapeau>Taking into account paragraph (1)(G), the Secretary shall specify a MIPS adjustment factor for each MIPS eligible professional for a year. Such MIPS adjustment factor for a MIPS eligible professional for a year shall be in the form of a percent and shall be determined—</chapeau><clause class="fontsize10" id="y58552975-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>by comparing the composite performance score of the eligible professional for such year to the performance threshold established under subparagraph (D)(i) for such year;</content></clause> <clause class="fontsize10" id="y58552976-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><chapeau>in a manner such that the adjustment factors specified under this subparagraph for a year result in differential payments under this paragraph reflecting that—<page identifier="/us/stat/129/106">129 STAT. 106</page></chapeau><subclause class="fontsize10" id="y58552977-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>MIPS eligible professionals with composite performance scores for such year at or above such performance threshold for such year receive zero or positive payment adjustment factors for such year in accordance with clause (iii), with such professionals having higher composite performance scores receiving higher adjustment factors; and</content></subclause> <subclause class="fontsize10" id="y58552978-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>MIPS eligible professionals with composite performance scores for such year below such performance threshold for such year receive negative payment adjustment factors for such year in accordance with clause (iv), with such professionals having lower composite performance scores receiving lower adjustment factors;</content></subclause> </clause> <clause class="fontsize10" id="y58552979-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>in a manner such that MIPS eligible professionals with composite scores described in clause (ii)(I) for such year, subject to clauses (i) and (ii) of subparagraph (F), receive a zero or positive adjustment factor on a linear sliding scale such that an adjustment factor of 0 percent is assigned for a score at the performance threshold and an adjustment factor of the applicable percent specified in subparagraph (B) is assigned for a score of 100; and</content></clause> <clause class="fontsize10" id="y5855297a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><chapeau>in a manner such that—</chapeau><subclause class="fontsize10" id="y5855297b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>subject to subclause (II), MIPS eligible professionals with composite performance scores described in clause (ii)(II) for such year receive a negative payment adjustment factor on a linear sliding scale such that an adjustment factor of 0 percent is assigned for a score at the performance threshold and an adjustment factor of the negative of the applicable percent specified in subparagraph (B) is assigned for a score of 0; and</content></subclause> <subclause class="fontsize10" id="y5855297c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>MIPS eligible professionals with composite performance scores that are equal to or greater than 0, but not greater than ¼ of the performance threshold specified under subparagraph (D)(i) for such year, receive a negative payment adjustment factor that is equal to the negative of the applicable percent specified in subparagraph (B) for such year.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y5855297d-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Applicable percent defined</inline>.—</heading><chapeau>For purposes of this paragraph, the term ‘<term>applicable percent</term>’ means—</chapeau><clause class="fontsize10" id="y5855297e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>for 2019, 4 percent;</content></clause> <clause class="fontsize10" id="y5855297f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>for 2020, 5 percent;</content></clause> <clause class="fontsize10" id="y58552980-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>for 2021, 7 percent; and</content></clause> <clause class="fontsize10" id="y58552981-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>for 2022 and subsequent years, 9 percent.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58552982-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Additional mips adjustment factors for exceptional performance</inline>.—</heading><content>For 2019 and each subsequent year through 2024, in the case of a MIPS eligible professional with a composite performance score for a year at or above the additional performance threshold under subparagraph (D)(ii) for such year, in addition to the MIPS adjustment factor under subparagraph (A) for the eligible professional for such year, subject to subparagraph (F)(iv), the Secretary shall specify an additional positive MIPS adjustment factor for such professional and year. Such additional MIPS <page identifier="/us/stat/129/107">129 STAT. 107</page> adjustment factors shall be in the form of a percent and determined by the Secretary in a manner such that professionals having higher composite performance scores above the additional performance threshold receive higher additional MIPS adjustment factors.</content></subparagraph> <subparagraph class="fontsize10" id="y58552983-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Establishment of performance thresholds</inline>.—</heading><clause class="fontsize10" id="y58552984-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Performance threshold</inline>.—</heading><content>For each year of the MIPS, the Secretary shall compute a performance threshold with respect to which the composite performance score of MIPS eligible professionals shall be compared for purposes of determining adjustment factors under subparagraph (A) that are positive, negative, and zero. Such performance threshold for a year shall be the mean or median (as selected by the Secretary) of the composite performance scores for all MIPS eligible professionals with respect to a prior period specified by the Secretary. The Secretary may reassess the selection of the mean or median under the previous sentence every 3 years.</content></clause> <clause class="fontsize10" id="y58552985-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Additional performance threshold for exceptional performance</inline>.—</heading><chapeau>In addition to the performance threshold under clause (i), for each year of the MIPS, the Secretary shall compute an additional performance threshold for purposes of determining the additional MIPS adjustment factors under subparagraph (C). For each such year, the Secretary shall apply either of the following methods for computing such additional performance threshold for such a year:</chapeau><subclause class="fontsize10" id="y58552986-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>The threshold shall be the score that is equal to the 25th percentile of the range of possible composite performance scores above the performance threshold determined under clause (i).</content></subclause> <subclause class="fontsize10" id="y58552987-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>The threshold shall be the score that is equal to the 25th percentile of the actual composite performance scores for MIPS eligible professionals with composite performance scores at or above the performance threshold with respect to the prior period described in clause (i).</content></subclause> </clause> <clause class="fontsize10" id="y58552988-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Special rule for initial 2 years</inline>.—</heading><chapeau>With respect to each of the first two years to which the MIPS applies, the Secretary shall, prior to the performance period for such years, establish a performance threshold for purposes of determining MIPS adjustment factors under subparagraph (A) and a threshold for purposes of determining additional MIPS adjustment factors under subparagraph (C). Each such performance threshold shall—</chapeau><subclause class="fontsize10" id="y58552989-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>be based on a period prior to such performance periods; and</content></subclause> <subclause class="fontsize10" id="y5855298a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><chapeau>take into account—</chapeau><item class="fontsize10" id="y5855298b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>data available with respect to performance on measures and activities that may be used under the performance categories under subparagraph (2)(B); and</content></item> <item class="fontsize10" id="y5855298c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>other factors determined appropriate by the Secretary.<page identifier="/us/stat/129/108">129 STAT. 108</page></content></item> </subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y5855298d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Application of mips adjustment factors</inline>.—</heading><chapeau>In the case of items and services furnished by a MIPS eligible professional during a year (beginning with 2019), the amount otherwise paid under this part with respect to such items and services and MIPS eligible professional for such year, shall be multiplied by—</chapeau><clause class="fontsize10" id="y5855298e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>1, plus</content></clause> <clause class="fontsize10" id="y5855298f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><chapeau>the sum of—</chapeau><subclause class="fontsize10" id="y58552990-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the MIPS adjustment factor determined under subparagraph (A) divided by 100, and</content></subclause> <subclause class="fontsize10" id="y58552991-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>as applicable, the additional MIPS adjustment factor determined under subparagraph (C) divided by 100.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y58552992-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><heading class="fontsize10"><inline class="smallCaps">Aggregate application of mips adjustment factors</inline>.—</heading><clause class="fontsize10" id="y58552993-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Application of scaling factor</inline>.—</heading><subclause class="fontsize10" id="y58552994-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>With respect to positive MIPS adjustment factors under subparagraph (A)(ii)(I) for eligible professionals whose composite performance score is above the performance threshold under subparagraph (D)(i) for such year, subject to subclause (II), the Secretary shall increase or decrease such adjustment factors by a scaling factor in order to ensure that the budget neutrality requirement of clause (ii) is met.</content></subclause> <subclause class="fontsize10" id="y58552995-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Scaling factor limit</inline>.—</heading><content>In no case may the scaling factor applied under this clause exceed 3.0.</content></subclause> </clause> <clause class="fontsize10" id="y58552996-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Budget neutrality requirement</inline>.—</heading><subclause class="fontsize10" id="y58552997-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to clause (iii), the Secretary shall ensure that the estimated amount described in subclause (II) for a year is equal to the estimated amount described in subclause (III) for such year.</content></subclause> <subclause class="fontsize10" id="y58552998-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Aggregate increases</inline>.—</heading><content>The amount described in this subclause is the estimated increase in the aggregate allowed charges resulting from the application of positive MIPS adjustment factors under subparagraph (A) (after application of the scaling factor described in clause (i)) to MIPS eligible professionals whose composite performance score for a year is above the performance threshold under subparagraph (D)(i) for such year.</content></subclause> <subclause class="fontsize10" id="y58552999-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><heading class="fontsize10"><inline class="smallCaps">Aggregate decreases</inline>.—</heading><content>The amount described in this subclause is the estimated decrease in the aggregate allowed charges resulting from the application of negative MIPS adjustment factors under subparagraph (A) to MIPS eligible professionals whose composite performance score for a year is below the performance threshold under subparagraph (D)(i) for such year.</content></subclause> </clause> <clause class="fontsize10" id="y5855299a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Exceptions</inline>.—</heading><subclause class="fontsize10" id="y5855299b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5855299c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote><content>In the case that all MIPS eligible professionals receive composite performance scores for a year that are below the performance threshold <page identifier="/us/stat/129/109">129 STAT. 109</page> under subparagraph (D)(i) for such year, the negative MIPS adjustment factors under subparagraph (A) shall apply with respect to such MIPS eligible professionals and the budget neutrality requirement of clause (ii) and the additional adjustment factors under clause (iv) shall not apply for such year.</content></subclause> <subclause class="fontsize10" id="y5855299d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>In the case that, with respect to a year, the application of clause (i) results in a scaling factor equal to the maximum scaling factor specified in clause (i)(II), such scaling factor shall apply and the budget neutrality requirement of clause (ii) shall not apply for such year.</content></subclause> </clause> <clause class="fontsize10" id="y5855299e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Additional incentive payment adjustments</inline>.—</heading><subclause class="fontsize10" id="y5855299f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585529a0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to subclause (II), in specifying the MIPS additional adjustment factors under subparagraph (C) for each applicable MIPS eligible professional for a year, the Secretary shall ensure that the estimated aggregate increase in payments under this part resulting from the application of such additional adjustment factors for MIPS eligible professionals in a year shall be equal (as estimated by the Secretary) to $500,000,000 for each year beginning with 2019 and ending with 2024.</content></subclause> <subclause class="fontsize10" id="y585529a1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><heading class="fontsize10"><inline class="smallCaps">Limitation on additional incentive payment adjustments</inline>.—</heading><content>The MIPS additional adjustment factor under subparagraph (C) for a year for an applicable MIPS eligible professional whose composite performance score is above the additional performance threshold under subparagraph (D)(ii) for such year shall not exceed 10 percent. The application of the previous sentence may result in an aggregate amount of additional incentive payments that are less than the amount specified in subclause (I).</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585529a2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="7">“(7) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585529a3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Announcement of result of adjustments</inline>.—</heading><content>Under the MIPS, the Secretary shall, not later than 30 days prior to January 1 of the year involved, make available to MIPS eligible professionals the MIPS adjustment factor (and, as applicable, the additional MIPS adjustment factor) under paragraph (6) applicable to the eligible professional for items and services furnished by the professional for such year. The Secretary may include such information in the confidential feedback under paragraph (12).</content></paragraph> <paragraph class="fontsize10" id="y585550b4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="8">“(8) </num><heading class="fontsize10"><inline class="smallCaps">No effect in subsequent years</inline>.—</heading><content>The MIPS adjustment factors and additional MIPS adjustment factors under paragraph (6) shall apply only with respect to the year involved, and the Secretary shall not take into account such adjustment factors in making payments to a MIPS eligible professional under this part in a subsequent year.</content></paragraph> <paragraph class="fontsize10" id="y585550b5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="9">“(9) </num><heading class="fontsize10"><inline class="smallCaps">Public reporting</inline>.—</heading><subparagraph class="fontsize10" id="y585550b6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585550b7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>The Secretary shall, in an easily understandable format, make available on the Physician Compare Internet website of the Centers for Medicare & Medicaid Services the following:</chapeau><page identifier="/us/stat/129/110">129 STAT. 110</page> <clause class="fontsize10" id="y585550b8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><chapeau>Information regarding the performance of MIPS eligible professionals under the MIPS, which—</chapeau><subclause class="fontsize10" id="y585550b9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>shall include the composite score for each such MIPS eligible professional and the performance of each such MIPS eligible professional with respect to each performance category; and</content></subclause> <subclause class="fontsize10" id="y585550ba-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>may include the performance of each such MIPS eligible professional with respect to each measure or activity specified in paragraph (2)(B).</content></subclause> </clause> <clause class="fontsize10" id="y585550bb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>The names of eligible professionals in eligible alternative payment models (as defined in section 1833(z)(3)(D)) and, to the extent feasible, the names of such eligible alternative payment models and performance of such models.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585550bc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Disclosure</inline>.—</heading><content>The information made available under this paragraph shall indicate, where appropriate, that publicized information may not be representative of the eligible professional’s entire patient population, the variety of services furnished by the eligible professional, or the health conditions of individuals treated.</content></subparagraph> <subparagraph class="fontsize10" id="y585550bd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Opportunity to review and submit corrections</inline>.—</heading><content>The Secretary shall provide for an opportunity for a professional described in subparagraph (A) to review, and submit corrections for, the information to be made public with respect to the professional under such subparagraph prior to such information being made public.</content></subparagraph> <subparagraph class="fontsize10" id="y585550be-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585550bf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Aggregate information</inline>.—</heading><content>The Secretary shall periodically post on the Physician Compare Internet website aggregate information on the MIPS, including the range of composite scores for all MIPS eligible professionals and the range of the performance of all MIPS eligible professionals with respect to each performance category.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585550c0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="10">“(10) </num><heading class="fontsize10"><inline class="smallCaps">Consultation</inline>.—</heading><content>The Secretary shall consult with stakeholders in carrying out the MIPS, including for the identification of measures and activities under paragraph (2)(B) and the methodologies developed under paragraphs (5)(A) and (6) and regarding the use of qualified clinical data registries. Such consultation shall include the use of a request for information or other mechanisms determined appropriate.</content></paragraph> <paragraph class="fontsize10" id="y585550c1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="11">“(11) </num><heading class="fontsize10"><inline class="smallCaps">Technical assistance to small practices and practices in health professional shortage areas</inline>.—</heading><subparagraph class="fontsize10" id="y585550c2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585550c3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Contracts.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>The Secretary shall enter into contracts or agreements with appropriate entities (such as quality improvement organizations, regional extension centers (as described in section 3012(c) of the Public Health Service Act), or regional health collaboratives) to offer guidance and assistance to MIPS eligible professionals in practices of 15 or fewer professionals (with priority given to such practices located in rural areas, health professional shortage areas (as designated under in section 332(a)(1)(A) of such Act), and medically underserved areas, and practices with low composite scores) with respect to—</chapeau><clause class="fontsize10" id="y585550c4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>the performance categories described in clauses (i) through (iv) of paragraph (2)(A); or</content></clause> <clause class="fontsize10" id="y585550c5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>how to transition to the implementation of and participation in an alternative payment model as described in section 1833(z)(3)(C).<page identifier="/us/stat/129/111">129 STAT. 111</page></content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585550c6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Funding for technical assistance</inline>.—</heading><content>For purposes of implementing subparagraph (A), the Secretary shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 to the Centers for Medicare & Medicaid Services Program Management Account of $20,000,000 for each of fiscal years 2016 through 2020. Amounts transferred under this subparagraph for a fiscal year shall be available until expended.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585550c7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="12">“(12) </num><heading class="fontsize10"><inline class="smallCaps">Feedback and information to improve performance</inline>.—</heading><subparagraph class="fontsize10" id="y585550c8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Performance feedback</inline>.—</heading><clause class="fontsize10" id="y585550c9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585550ca-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Beginning July 1, 2017, the Secretary—</chapeau><subclause class="fontsize10" id="y585550cb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>shall make available timely (such as quarterly) confidential feedback to MIPS eligible professionals on the performance of such professionals with respect to the performance categories under clauses (i) and (ii) of paragraph (2)(A); and</content></subclause> <subclause class="fontsize10" id="y585550cc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>may make available confidential feedback to such professionals on the performance of such professionals with respect to the performance categories under clauses (iii) and (iv) of such paragraph.</content></subclause> </clause> <clause class="fontsize10" id="y585550cd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Mechanisms</inline>.—</heading><content>The Secretary may use one or more mechanisms to make feedback available under clause (i), which may include use of a web-based portal or other mechanisms determined appropriate by the Secretary. With respect to the performance category described in paragraph (2)(A)(i), feedback under this subparagraph shall, to the extent an eligible professional chooses to participate in a data registry for purposes of this subsection (including registries under subsections (k) and (m)), be provided based on performance on quality measures reported through the use of such registries. With respect to any other performance category described in paragraph (2)(A), the Secretary shall encourage provision of feedback through qualified clinical data registries as described in subsection (m)(3)(E)).</content></clause> <clause class="fontsize10" id="y585550ce-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Use of data</inline>.—</heading><content>For purposes of clause (i), the Secretary may use data, with respect to a MIPS eligible professional, from periods prior to the current performance period and may use rolling periods in order to make illustrative calculations about the performance of such professional.</content></clause> <clause class="fontsize10" id="y585550cf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Disclosure exemption</inline>.—</heading><content>Feedback made available under this subparagraph shall be exempt from disclosure under <ref href="/us/usc/t5/s552">section 552 of title 5, United States Code</ref>.</content></clause> <clause class="fontsize10" id="y585550d0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><heading class="fontsize10"><inline class="smallCaps">Receipt of information</inline>.—</heading><content>The Secretary may use the mechanisms established under clause (ii) to receive information from professionals, such as information with respect to this subsection.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585550d1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Additional information</inline>.—</heading><page identifier="/us/stat/129/112">129 STAT. 112</page> <clause class="fontsize10" id="y585550d2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585550d3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Beginning July 1, 2018, the Secretary shall make available to MIPS eligible professionals information, with respect to individuals who are patients of such MIPS eligible professionals, about items and services for which payment is made under this title that are furnished to such individuals by other suppliers and providers of services, which may include information described in clause (ii). Such information may be made available under the previous sentence to such MIPS eligible professionals by mechanisms determined appropriate by the Secretary, which may include use of a web-based portal. Such information may be made available in accordance with the same or similar terms as data are made available to accountable care organizations participating in the shared savings program under section 1899.</content></clause> <clause class="fontsize10" id="y585550d4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Type of information</inline>.—</heading><chapeau>For purposes of clause (i), the information described in this clause, is the following:</chapeau><subclause class="fontsize10" id="y585550d5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>With respect to selected items and services (as determined appropriate by the Secretary) for which payment is made under this title and that are furnished to individuals, who are patients of a MIPS eligible professional, by another supplier or provider of services during the most recent period for which data are available (such as the most recent three-month period), such as the name of such providers furnishing such items and services to such patients during such period, the types of such items and services so furnished, and the dates such items and services were so furnished.</content></subclause> <subclause class="fontsize10" id="y585550d6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>Historical data, such as averages and other measures of the distribution if appropriate, of the total, and components of, allowed charges (and other figures as determined appropriate by the Secretary).</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585550d7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="13">“(13) </num><heading class="fontsize10"><inline class="smallCaps">Review</inline>.—</heading><subparagraph class="fontsize10" id="y585550d8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Targeted review</inline>.—</heading><content>The Secretary shall establish a process under which a MIPS eligible professional may seek an informal review of the calculation of the MIPS adjustment factor (or factors) applicable to such eligible professional under this subsection for a year. The results of a review conducted pursuant to the previous sentence shall not be taken into account for purposes of paragraph (6) with respect to a year (other than with respect to the calculation of such eligible professional’s MIPS adjustment factor for such year or additional MIPS adjustment factor for such year) after the factors determined in subparagraph (A) and subparagraph (C) of such paragraph have been determined for such year.</content></subparagraph> <subparagraph class="fontsize10" id="y585550d9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Limitation</inline>.—</heading><chapeau>Except as provided for in subparagraph (A), there shall be no administrative or judicial review under section 1869, section 1878, or otherwise of the following:</chapeau><clause class="fontsize10" id="y585550da-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>The methodology used to determine the amount of the MIPS adjustment factor under paragraph (6)(A) and the amount of the additional MIPS adjustment <page identifier="/us/stat/129/113">129 STAT. 113</page> factor under paragraph (6)(C) and the determination of such amounts.</content></clause> <clause class="fontsize10" id="y585550db-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>The establishment of the performance standards under paragraph (3) and the performance period under paragraph (4).</content></clause> <clause class="fontsize10" id="y585550dc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>The identification of measures and activities specified under paragraph (2)(B) and information made public or posted on the Physician Compare Internet website of the Centers for Medicare & Medicaid Services under paragraph (9).</content></clause> <clause class="fontsize10" id="y585550dd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>The methodology developed under paragraph (5) that is used to calculate performance scores and the calculation of such scores, including the weighting of measures and activities under such methodology.”</content></clause> </subparagraph> </paragraph> </subsection> </quotedContent>.</content></paragraph> <paragraph class="fontsize10" id="y585550de-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">GAO reports</inline>.—</heading><subparagraph class="fontsize10" id="y585550df-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Evaluation of eligible professional mips</inline>.—</heading><chapeau>Not later than October 1, 2021, the Comptroller General of the United States shall submit to Congress a report evaluating the eligible professional Merit-based Incentive Payment System under subsection (q) of section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>), as added by paragraph (1). Such report shall—</chapeau><clause class="fontsize10" id="y585550e0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>examine the distribution of the composite performance scores and MIPS adjustment factors (and additional MIPS adjustment factors) for MIPS eligible professionals (as defined in subsection (q)(1)(c) of such section) under such program, and patterns relating to such scores and adjustment factors, including based on type of provider, practice size, geographic location, and patient mix;</content></clause> <clause class="fontsize10" id="y585550e1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>provide recommendations for improving such program;</content></clause> <clause class="fontsize10" id="y585550e2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/A/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>evaluate the impact of technical assistance funding under section 1848(q)(11) of the Social Security Act, as added by paragraph (1), on the ability of professionals to improve within such program or successfully transition to an alternative payment model (as defined in section 1833(z)(3) of the Social Security Act, as added by subsection (e)), with priority for such evaluation given to practices located in rural areas, health professional shortage areas (as designated in section 332(a)(1)(A) of the Public Health Service Act), and medically underserved areas; and</content></clause> <clause class="fontsize10" id="y585577f3-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/A/iv" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">(iv) </num><content>provide recommendations for optimizing the use of such technical assistance funds.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585577f4-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Study to examine alignment of quality measures used in public and private programs</inline>.—</heading><clause class="fontsize10" id="y585577f5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>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—</chapeau><subclause class="fontsize10" id="y585577f6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B/i/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>compares the similarities and differences in the use of quality measures under the original Medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act, the Medicare Advantage program under part C of such title, selected State Medicaid programs <page identifier="/us/stat/129/114">129 STAT. 114</page> under title XIX of such Act, and private payer arrangements; and</content></subclause> <subclause class="fontsize10" id="y585577f7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B/i/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>makes recommendations on how to reduce the administrative burden involved in applying such quality measures.</content></subclause> </clause> <clause class="fontsize10" id="y585577f8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><heading class="fontsize10"><inline class="smallCaps">Requirements</inline>.—</heading><chapeau>The report under clause (i) shall—</chapeau><subclause class="fontsize10" id="y585577f9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B/ii/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>consider those measures applicable to individuals entitled to, or enrolled for, benefits under such part A, or enrolled under such part B and individuals under the age of 65; and</content></subclause> <subclause class="fontsize10" id="y585577fa-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/B/ii/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>focus on those measures that comprise the most significant component of the quality performance category of the eligible professional MIPS incentive program under subsection (q) of section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>), as added by paragraph (1).</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y585577fb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Study on role of independent risk managers</inline>.—</heading><content>Not later than January 1, 2017, the Comptroller General of the United States shall submit to Congress a report examining whether entities that pool financial risk for physician practices, such as independent risk managers, can play a role in supporting physician practices, particularly small physician practices, in assuming financial risk for the treatment of patients. Such report shall examine barriers that small physician practices currently face in assuming financial risk for treating patients, the types of risk management entities that could assist physician practices in participating in two-sided risk payment models, and how such entities could assist with risk management and with quality improvement activities. Such report shall also include an analysis of any existing legal barriers to such arrangements.</content></subparagraph> <subparagraph class="fontsize10" id="y585577fc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/2/D" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><heading class="fontsize10"><inline class="smallCaps">Study to examine rural and health professional shortage area alternative payment models</inline>.—</heading><content>Not later than October 1, 2021, the Comptroller General of the United States shall submit to Congress a report that examines the transition of professionals in rural areas, health professional shortage areas (as designated in section 332(a)(1)(A) of the Public Health Service Act), or medically underserved areas to an alternative payment model (as defined in section 1833(z)(3) of the Social Security Act, as added by subsection (e)). Such report shall make recommendations for removing administrative barriers to practices, including small practices consisting of 15 or fewer professionals, in rural areas, health professional shortage areas, and medically underserved areas to participation in such models.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585577fd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/c/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Funding for implementation</inline>.—</heading><content>For purposes of implementing the provisions of and the amendments made by this section, the Secretary of Health and Human Services shall provide for the transfer of $80,000,000 from the Supplementary Medical Insurance Trust Fund established under section 1841 of the Social Security Act (<ref href="/us/usc/t42/s1395t">42 U.S.C. 1395t</ref>) to the Centers for Medicare & Medicaid Program Management Account for each of the fiscal years 2015 through 2019. Amounts transferred under this paragraph shall be available until expended.<page identifier="/us/stat/129/115">129 STAT. 115</page></content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y585577fe-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><heading class="fontsize10"><inline class="smallCaps">Improving Quality Reporting for Composite Scores</inline>.—</heading><paragraph class="fontsize10" id="y585577ff-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Changes for group reporting option</inline>.—</heading><subparagraph class="fontsize10" id="y58557800-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/1/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Section 1848(m)(3)(C)(ii) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/m/3/C/ii">42 U.S.C. 1395w–4(m)(3)(C)(ii)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and, for 2016 and subsequent years, may provide</quotedText>” after “<quotedText>shall provide</quotedText>”.</content></subparagraph> <subparagraph class="fontsize10" id="y58557801-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/1/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Clarification of qualified clinical data registry reporting to group practices</inline>.—</heading><content>Section 1848(m)(3)(D) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/m/3/D">42 U.S.C. 1395w–4(m)(3)(D)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and, for 2016 and subsequent years, subparagraph (A) or (C)</quotedText>” after “<quotedText>subparagraph (A)</quotedText>”.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58557802-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/2" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Changes for multiple reporting periods and alternative criteria for satisfactory reporting</inline>.—</heading><chapeau>Section 1848(m)(5)(F) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/m/5/F">42 U.S.C. 1395w–4(m)(5)(F)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y58557803-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>and subsequent years</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>through reporting periods occurring in 2015</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y58559f14-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and, for reporting periods occurring in 2016 and subsequent years, the Secretary may establish</quotedText>” after “<quotedText>shall establish</quotedText>”.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58559f15-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/3" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Physician feedback program reports succeeded by reports under mips</inline>.—</heading><content>Section 1848(n) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/n">42 U.S.C. 1395w–4(n)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="indentUp0 fontsize10" id="y58559f16-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="11">“(11) </num><heading class="fontsize10"><inline class="smallCaps">Reports ending with 2017</inline>.—</heading><content>Reports under the Program shall not be provided after December 31, 2017. See subsection (q)(12) for reports under the eligible professionals Merit-based Incentive Payment System.”</content></paragraph> </quotedContent>.</content></paragraph> <paragraph class="fontsize10" id="y58559f17-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/d/4" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><heading class="fontsize10"><inline class="smallCaps">Coordination with satisfying meaningful ehr use clinical quality measure reporting requirement</inline>.—</heading><content>Section 1848(o)(2)(A)(iii) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/o/2/A/iii">42 U.S.C. 1395w–4(o)(2)(A)(iii)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and subsection (q)(5)(B)(ii)(II)</quotedText>” after “<quotedText>Subject to subparagraph (B)(ii)</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y58559f18-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="e">(e) </num><heading class="fontsize10"><inline class="smallCaps">Promoting Alternative Payment Models</inline>.—</heading><paragraph class="fontsize10" id="y58559f19-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Increasing transparency of physician-focused payment models</inline>.—</heading><content>Section 1868 of the Social Security Act (<ref href="/us/usc/t42/s1395ee">42 U.S.C. 1395ee</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="indentDown1 firstIndent0 fontsize10" id="y58563b5a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">“(c) </num><heading class="fontsize10"><inline class="smallCaps">Physician-Focused Payment Models</inline>.—</heading><paragraph class="fontsize10" id="y58563b5b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">Technical advisory committee</inline>.—</heading><subparagraph class="fontsize10" id="y58563b5c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Establishment</inline>.—</heading><content>There is established an ad hoc committee to be known as the ‘Physician-Focused Payment Model Technical Advisory Committee’ (referred to in this subsection as the ‘Committee’).</content></subparagraph> <subparagraph class="fontsize10" id="y58563b5d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Membership</inline>.—</heading><clause class="fontsize10" id="y58563b5e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Number and appointment</inline>.—</heading><content>The Committee shall be composed of 11 members appointed by the Comptroller General of the United States.</content></clause> <clause class="fontsize10" id="y58563b5f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Qualifications</inline>.—</heading><content>The membership of the Committee shall include individuals with national recognition for their expertise in physician-focused payment models and related delivery of care. No more than 5 members of the Committee shall be providers of services or suppliers, or representatives of providers of services or suppliers.<page identifier="/us/stat/129/116">129 STAT. 116</page></content></clause> <clause class="fontsize10" id="y58563b60-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Prohibition on federal employment</inline>.—</heading><content>A member of the Committee shall not be an employee of the Federal Government.</content></clause> <clause class="fontsize10" id="y58563b61-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Ethics disclosure</inline>.—</heading><content>The Comptroller General shall establish a system for public disclosure by members of the Committee of financial and other potential conflicts of interest relating to such members. Members of the Committee shall be treated as employees of Congress for purposes of applying title I of the Ethics in Government Act of 1978 (<ref href="/us/pl/95/521">Public Law 95–521</ref>).</content></clause> <clause class="fontsize10" id="y58563b62-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58563b63-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Date of initial appointments</inline>.—</heading><content>The initial appointments of members of the Committee shall be made by not later than 180 days after the date of enactment of this subsection.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58563b64-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Term; vacancies</inline>.—</heading><clause class="fontsize10" id="y58563b65-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Term</inline>.—</heading><content>The terms of members of the Committee shall be for 3 years except that the Comptroller General shall designate staggered terms for the members first appointed.</content></clause> <clause class="fontsize10" id="y58563b66-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Vacancies</inline>.—</heading><content>Any member appointed to fill a vacancy occurring before the expiration of the term for which the member’s predecessor was appointed shall be appointed only for the remainder of that term. A member may serve after the expiration of that member’s term until a successor has taken office. A vacancy in the Committee shall be filled in the manner in which the original appointment was made.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58563b67-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Duties</inline>.—</heading><content>The Committee shall meet, as needed, to provide comments and recommendations to the Secretary, as described in paragraph (2)(C), on physician-focused payment models.</content></subparagraph> <subparagraph class="fontsize10" id="y58563b68-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Compensation of members</inline>.—</heading><clause class="fontsize10" id="y58563b69-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Except as provided in clause (ii), a member of the Committee shall serve without compensation.</content></clause> <clause class="fontsize10" id="y58563b6a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Travel expenses</inline>.—</heading><content>A member of the Committee shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for an employee of an agency under <ref href="/us/usc/t5/ch57/schI">subchapter I of chapter 57 of title 5, United States Code</ref>, while away from the home or regular place of business of the member in the performance of the duties of the Committee.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58563b6b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><heading class="fontsize10"><inline class="smallCaps">Operational and technical support</inline>.—</heading><clause class="fontsize10" id="y58563b6c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>The Assistant Secretary for Planning and Evaluation shall provide technical and operational support for the Committee, which may be by use of a contractor. The Office of the Actuary of the Centers for Medicare & Medicaid Services shall provide to the Committee actuarial assistance as needed.</content></clause> <clause class="fontsize10" id="y58563b6d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Funding</inline>.—</heading><content>The Secretary shall provide for the transfer, from the Federal Supplementary Medical Insurance Trust Fund under section 1841, such amounts as are necessary to carry out this paragraph (not to exceed $5,000,000) for fiscal year 2015 and each subsequent fiscal year. Any amounts transferred <page identifier="/us/stat/129/117">129 STAT. 117</page> under the preceding sentence for a fiscal year shall remain available until expended.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58563b6e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="G">“(G) </num><heading class="fontsize10"><inline class="smallCaps">Application</inline>.—</heading><content>Section 14 of the Federal Advisory Committee Act (<ref href="/us/usc/t5/app">5 U.S.C. App.</ref>) shall not apply to the Committee.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58563b6f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">Criteria and process for submission and review of physician-focused payment models</inline>.—</heading><subparagraph class="fontsize10" id="y58563b70-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Criteria for assessing physician-focused payment models</inline>.—</heading><clause class="fontsize10" id="y58563b71-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58563b72-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Rulemaking</inline>.—</heading><content>Not later than November 1, 2016, the Secretary shall, through notice and comment rulemaking, following a request for information, establish criteria for physician-focused payment models, including models for specialist physicians, that could be used by the Committee for making comments and recommendations pursuant to paragraph (1)(D).</content></clause> <clause class="fontsize10" id="y58563b73-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">MedPAC submission of comments</inline>.—</heading><content>During the comment period for the proposed rule described in clause (i), the Medicare Payment Advisory Commission may submit comments to the Secretary on the proposed criteria under such clause.</content></clause> <clause class="fontsize10" id="y58563b74-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Updating</inline>.—</heading><content>The Secretary may update the criteria established under this subparagraph through rulemaking.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58563b75-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Stakeholder submission of physician-focused payment models</inline>.—</heading><content>On an ongoing basis, individuals and stakeholder entities may submit to the Committee proposals for physician-focused payment models that such individuals and entities believe meet the criteria described in subparagraph (A).</content></subparagraph> <subparagraph class="fontsize10" id="y58563b76-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Committee review of models submitted</inline>.—</heading><content>The Committee shall, on a periodic basis, review models submitted under subparagraph (B), prepare comments and recommendations regarding whether such models meet the criteria described in subparagraph (A), and submit such comments and recommendations to the Secretary.</content></subparagraph> <subparagraph class="fontsize10" id="y58563b77-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Secretary review and response</inline>.—</heading><content>The Secretary shall review the comments and recommendations submitted by the Committee under subparagraph (C) and post a detailed response to such comments and recommendations on the Internet website of the Centers for Medicare & Medicaid Services.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58563b78-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Rule of construction</inline>.—</heading><content>Nothing in this subsection shall be construed to impact the development or testing of models under this title or titles XI, XIX, or XXI.”</content></paragraph> </subsection> </quotedContent>.</content></paragraph> <paragraph class="fontsize10" id="y58563b79-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/2" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Incentive payments for participation in eligible alternative payment models</inline>.—</heading><content>Section 1833 of the Social Security Act (<ref href="/us/usc/t42/s1395l">42 U.S.C. 1395l</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="indentDown1 firstIndent0 fontsize10" id="y58579b0a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="z">“(z) </num><heading class="fontsize10"><inline class="smallCaps">Incentive Payments for Participation in Eligible Alternative Payment Models</inline>.—</heading><paragraph class="fontsize10" id="y58579b0b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">Payment incentive</inline>.—</heading><subparagraph class="fontsize10" id="y58579b0c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58579b0d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>In the case of covered professional services furnished by an eligible professional during a year that is in the period beginning with 2019 and ending with 2024 and for which the professional is a qualifying APM participant with respect to such year, in addition to the <page identifier="/us/stat/129/118">129 STAT. 118</page> amount of payment that would otherwise be made for such covered professional services under this part for such year, there also shall be paid to such professional an amount equal to 5 percent of the estimated aggregate payment amounts for such covered professional services under this part for the preceding year. For purposes of the previous sentence, the payment amount for the preceding year may be an estimation for the full preceding year based on a period of such preceding year that is less than the full year. The <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58579b0e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Policies.</p></sidenote>Secretary shall establish policies to implement this subparagraph in cases in which payment for covered professional services furnished by a qualifying APM participant in an alternative payment model—</chapeau><clause class="fontsize10" id="y58579b0f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>is made to an eligible alternative payment entity rather than directly to the qualifying APM participant; or</content></clause> <clause class="fontsize10" id="y58579b10-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>is made on a basis other than a fee-for-service basis (such as payment on a capitated basis).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58579b11-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Form of payment</inline>.—</heading><content>Payments under this subsection shall be made in a lump sum, on an annual basis, as soon as practicable.</content></subparagraph> <subparagraph class="fontsize10" id="y58579b12-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Treatment of payment incentive</inline>.—</heading><content>Payments under this subsection shall not be taken into account for purposes of determining actual expenditures under an alternative payment model and for purposes of determining or rebasing any benchmarks used under the alternative payment model.</content></subparagraph> <subparagraph class="fontsize10" id="y58579b13-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Coordination</inline>.—</heading><content>The amount of the additional payment under this subsection or subsection (m) shall be determined without regard to any additional payment under subsection (m) and this subsection, respectively. The amount of the additional payment under this subsection or subsection (x) shall be determined without regard to any additional payment under subsection (x) and this subsection, respectively. The amount of the additional payment under this subsection or subsection (y) shall be determined without regard to any additional payment under subsection (y) and this subsection, respectively.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58579b14-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58579b15-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Definition.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Qualifying apm participant</inline>.—</heading><chapeau>For purposes of this subsection, the term ‘<term>qualifying APM participant</term>’ means the following:</chapeau><subparagraph class="fontsize10" id="y58579b16-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10 smallCaps">2019 and 2020<inline class="noSmallCaps">.—</inline></heading><content>With respect to 2019 and 2020, an eligible professional for whom the Secretary determines that at least 25 percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available (which may be less than a year) were attributable to such services furnished under this part through an eligible alternative payment entity.</content></subparagraph> <subparagraph class="fontsize10" id="y58579b17-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10 smallCaps">2021 and 2022<inline class="noSmallCaps">.—</inline></heading><chapeau>With respect to 2021 and 2022, an eligible professional described in either of the following clauses:</chapeau><clause class="fontsize10" id="y58579b18-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Medicare payment threshold option</inline>.—</heading><content>An eligible professional for whom the Secretary determines that at least 50 percent of payments under this part for covered professional services furnished by such professional during the most recent period for which <page identifier="/us/stat/129/119">129 STAT. 119</page> data are available (which may be less than a year) were attributable to such services furnished under this part through an eligible alternative payment entity.</content></clause> <clause class="fontsize10" id="y58579b19-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Combination all-payer and medicare payment threshold option</inline>.—</heading><chapeau>An eligible professional—</chapeau><subclause class="fontsize10" id="y58579b1a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><chapeau>for whom the Secretary determines, with respect to items and services furnished by such professional during the most recent period for which data are available (which may be less than a year), that at least 50 percent of the sum of—</chapeau><item class="fontsize10" id="y58579b1b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>payments described in clause (i); and</content></item> <item class="fontsize10" id="y58579b1c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>all other payments, regardless of payer (other than payments made by the Secretary of Defense or the Secretary of Veterans Affairs and other than payments made under title XIX in a State in which no medical home or alternative payment model is available under the State program under that title),</content></item> <continuation class="firstIndent1 fontsize10" id="x58579b1d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128">meet the requirement described in clause (iii)(I) with respect to payments described in item (aa) and meet the requirement described in clause (iii)(II) with respect to payments described in item (bb);</continuation></subclause> <subclause class="fontsize10" id="y58579b1e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>for whom the Secretary determines at least 25 percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available (which may be less than a year) were attributable to such services furnished under this part through an eligible alternative payment entity; and</content></subclause> <subclause class="fontsize10" id="y58579b1f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>who provides to the Secretary such information as is necessary for the Secretary to make a determination under subclause (I), with respect to such professional.</content></subclause> </clause> <clause class="fontsize10" id="y58579b20-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Requirement</inline>.—</heading><chapeau>For purposes of clause (ii)(I)—</chapeau><subclause class="fontsize10" id="y58579b21-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the requirement described in this subclause, with respect to payments described in item (aa) of such clause, is that such payments are made to an eligible alternative payment entity; and</content></subclause> <subclause class="fontsize10" id="y58579b22-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><chapeau>the requirement described in this subclause, with respect to payments described in item (bb) of such clause, is that such payments are made under arrangements in which—</chapeau><item class="fontsize10" id="y58579b23-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>quality measures comparable to measures under the performance category described in section 1848(q)(2)(B)(i) apply;</content></item> <item class="fontsize10" id="y58579b24-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>certified EHR technology is used; and</content></item> <item class="fontsize10" id="y58579b25-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="cc">“(cc) </num><chapeau>the eligible professional participates in an entity that—</chapeau><subitem class="fontsize10" id="y58579b26-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658131"><num class="fontsize10" style="-uslm-lc:emspace2" value="AA">“(AA) </num><content>bears more than nominal financial risk if actual aggregate expenditures exceeds expected aggregate expenditures; or<page identifier="/us/stat/129/120">129 STAT. 120</page></content></subitem> <subitem class="fontsize10" id="y58579b27-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658131"><num class="fontsize10" style="-uslm-lc:emspace2" value="BB">“(BB) </num><content>with respect to beneficiaries under title XIX, is a medical home that meets criteria comparable to medical homes expanded under section 1115A(c).</content></subitem> </item> </subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y58579b28-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58579b29-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Beginning in 2023</inline>.—</heading><chapeau>With respect to 2023 and each subsequent year, an eligible professional described in either of the following clauses:</chapeau><clause class="fontsize10" id="y58579b2a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Medicare payment threshold option</inline>.—</heading><content>An eligible professional for whom the Secretary determines that at least 75 percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available (which may be less than a year) were attributable to such services furnished under this part through an eligible alternative payment entity.</content></clause> <clause class="fontsize10" id="y58579b2b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Combination all-payer and medicare payment threshold option</inline>.—</heading><chapeau>An eligible professional—</chapeau><subclause class="fontsize10" id="y58579b2c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><chapeau>for whom the Secretary determines, with respect to items and services furnished by such professional during the most recent period for which data are available (which may be less than a year), that at least 75 percent of the sum of—</chapeau><item class="fontsize10" id="y58579b2d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>payments described in clause (i); and</content></item> <item class="fontsize10" id="y58579b2e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>all other payments, regardless of payer (other than payments made by the Secretary of Defense or the Secretary of Veterans Affairs and other than payments made under title XIX in a State in which no medical home or alternative payment model is available under the State program under that title),</content></item> <continuation class="firstIndent1 fontsize10" id="x58579b2f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128">meet the requirement described in clause (iii)(I) with respect to payments described in item (aa) and meet the requirement described in clause (iii)(II) with respect to payments described in item (bb);</continuation></subclause> <subclause class="fontsize10" id="y58579b30-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>for whom the Secretary determines at least 25 percent of payments under this part for covered professional services furnished by such professional during the most recent period for which data are available (which may be less than a year) were attributable to such services furnished under this part through an eligible alternative payment entity; and</content></subclause> <subclause class="fontsize10" id="y58579b31-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>who provides to the Secretary such information as is necessary for the Secretary to make a determination under subclause (I), with respect to such professional.</content></subclause> </clause> <clause class="fontsize10" id="y58579b32-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Requirement</inline>.—</heading><chapeau>For purposes of clause (ii)(I)—</chapeau><subclause class="fontsize10" id="y58579b33-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the requirement described in this subclause, with respect to payments described in item (aa) of such clause, is that such payments are made to an eligible alternative payment entity; and</content></subclause> <subclause class="fontsize10" id="y58579b34-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><chapeau>the requirement described in this subclause, with respect to payments described in item <page identifier="/us/stat/129/121">129 STAT. 121</page> (bb) of such clause, is that such payments are made under arrangements in which—</chapeau><item class="fontsize10" id="y58579b35-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58579b36-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote><content>quality measures comparable to measures under the performance category described in section 1848(q)(2)(B)(i) apply;</content></item> <item class="fontsize10" id="y58579b37-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>certified EHR technology is used; and</content></item> <item class="fontsize10" id="y58579b38-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658130"><num class="fontsize10" style="-uslm-lc:emspace2" value="cc">“(cc) </num><chapeau>the eligible professional participates in an entity that—</chapeau><subitem class="fontsize10" id="y58579b39-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658131"><num class="fontsize10" style="-uslm-lc:emspace2" value="AA">“(AA) </num><content>bears more than nominal financial risk if actual aggregate expenditures exceeds expected aggregate expenditures; or</content></subitem> <subitem class="fontsize10" id="y58579b3a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658131"><num class="fontsize10" style="-uslm-lc:emspace2" value="BB">“(BB) </num><content>with respect to beneficiaries under title XIX, is a medical home that meets criteria comparable to medical homes expanded under section 1115A(c).</content></subitem> </item> </subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y58579b3b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Use of patient approach</inline>.—</heading><content>The Secretary may base the determination of whether an eligible professional is a qualifying APM participant under this subsection and the determination of whether an eligible professional is a partial qualifying APM participant under section 1848(q)(1)(C)(iii) by using counts of patients in lieu of using payments and using the same or similar percentage criteria (as specified in this subsection and such section, respectively), as the Secretary determines appropriate.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58579b3c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Additional definitions</inline>.—</heading><chapeau>In this subsection:</chapeau><subparagraph class="fontsize10" id="y5857c24d-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Covered professional services</inline>.—</heading><content>The term ‘<term>covered professional services</term>’ has the meaning given that term in section 1848(k)(3)(A).</content></subparagraph> <subparagraph class="fontsize10" id="y5857c24e-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Eligible professional</inline>.—</heading><content>The term ‘<term>eligible professional</term>’ has the meaning given that term in section 1848(k)(3)(B) and includes a group that includes such professionals.</content></subparagraph> <subparagraph class="fontsize10" id="y5857c24f-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Alternative payment model (apm)</inline>.—</heading><chapeau>The term ‘<term>alternative payment model</term>’ means, other than for purposes of subparagraphs (B)(ii)(I)(bb) and (C)(ii)(I)(bb) of paragraph (2), any of the following:</chapeau><clause class="fontsize10" id="y5857c250-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>A model under section 1115A (other than a health care innovation award).</content></clause> <clause class="fontsize10" id="y5857c251-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>The shared savings program under section 1899.</content></clause> <clause class="fontsize10" id="y5857c252-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>A demonstration under section 1866C.</content></clause> <clause class="fontsize10" id="y5857c253-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>A demonstration required by Federal law.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5857c254-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Eligible alternative payment entity</inline>.—</heading><chapeau>The term ‘<term>eligible alternative payment entity</term>’ means, with respect to a year, an entity that—</chapeau><clause class="fontsize10" id="y5857c255-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><chapeau>participates in an alternative payment model that—</chapeau><subclause class="fontsize10" id="y5857c256-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>requires participants in such model to use certified EHR technology (as defined in subsection (o)(4)); and</content></subclause> <subclause class="fontsize10" id="y5857c257-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>provides for payment for covered professional services based on quality measures comparable to measures under the performance category described in section 1848(q)(2)(B)(i); and<page identifier="/us/stat/129/122">129 STAT. 122</page></content></subclause> </clause> <clause class="fontsize10" id="y5857c258-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii)</num><subclause class="inline" id="y5857c259-e871-11f0-bc57-ad3ac4b1618c"><num value="I">(I) </num><content>bears financial risk for monetary losses under such alternative payment model that are in excess of a nominal amount; or</content></subclause> <subclause class="indentUp0 fontsize10" id="y5857c25a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>is a medical home expanded under section 1115A(c).</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y5857c25b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Limitation</inline>.—</heading><chapeau>There shall be no administrative or judicial review under section 1869, 1878, or otherwise, of the following:</chapeau><subparagraph class="fontsize10" id="y5857c25c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>The determination that an eligible professional is a qualifying APM participant under paragraph (2) and the determination that an entity is an eligible alternative payment entity under paragraph (3)(D).</content></subparagraph> <subparagraph class="fontsize10" id="y5857c25d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>The determination of the amount of the 5 percent payment incentive under paragraph (1)(A), including any estimation as part of such determination.”</content></subparagraph> </paragraph> </subsection> </quotedContent>.</content></paragraph> <paragraph class="fontsize10" id="y5857c25e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Coordination conforming amendments</inline>.—</heading><chapeau>Section 1833 of the Social Security Act (<ref href="/us/usc/t42/s1395l">42 U.S.C. 1395l</ref>) is further amended—</chapeau><subparagraph class="fontsize10" id="y5857c25f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/3/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in subsection (x)(3), by <amendingAction type="add">adding</amendingAction> at the end the following new sentence: “<quotedText>The amount of the additional payment for a service under this subsection and subsection (z) shall be determined without regard to any additional payment for the service under subsection (z) and this subsection, respectively.</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y5857c260-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/3/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in subsection (y)(3), by <amendingAction type="add">adding</amendingAction> at the end the following new sentence: “<quotedText>The amount of the additional payment for a service under this subsection and subsection (z) shall be determined without regard to any additional payment for the service under subsection (z) and this subsection, respectively.</quotedText>”.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5857c261-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/4" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><heading class="fontsize10"><inline class="smallCaps">Encouraging development and testing of certain models</inline>.—</heading><chapeau>Section 1115A(b)(2) of the Social Security Act (<ref href="/us/usc/t42/s1315a/b/2">42 U.S.C. 1315a(b)(2)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y5857c262-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/4/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in subparagraph (B), by <amendingAction type="add">adding</amendingAction> at the end the following new clauses:<quotedContent><clause class="fontsize10" id="y5857c263-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="xxi">“(xxi) </num><content>Focusing primarily on physicians’ services (as defined in section 1848(j)(3)) furnished by physicians who are not primary care practitioners.</content></clause> <clause class="fontsize10" id="y5857c264-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="xxii">“(xxii) </num><content>Focusing on practices of 15 or fewer professionals.</content></clause> <clause class="fontsize10" id="y5857c265-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="xxiii">“(xxiii) </num><content>Focusing on risk-based models for small physician practices which may involve two-sided risk and prospective patient assignment, and which examine risk-adjusted decreases in mortality rates, hospital readmissions rates, and other relevant and appropriate clinical measures.</content></clause> <clause class="fontsize10" id="y5857c266-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="xxiv">“(xxiv) </num><content>Focusing primarily on title XIX, working in conjunction with the Center for Medicaid and CHIP Services.”</content></clause> </quotedContent>; and</content></subparagraph> <subparagraph class="fontsize10" id="y5857c267-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/4/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in subparagraph (C)(viii), by <amendingAction type="delete">striking</amendingAction> “<quotedText>other public sector or private sector payers</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>other public sector payers, private sector payers, or statewide payment models</quotedText>”.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5857c268-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/5" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">(5) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5857c269-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1315a">42 USC 1315a note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Construction regarding telehealth services</inline>.—</heading><content>Nothing in the provisions of, or amendments made by, this title shall be construed as precluding an alternative payment model or a qualifying APM participant (as those terms are <page identifier="/us/stat/129/123">129 STAT. 123</page> defined in section 1833(z) of the Social Security Act, as added by paragraph (1)) from furnishing a telehealth service for which payment is not made under section 1834(m) of the Social Security Act (<ref href="/us/usc/t42/s1395m/m">42 U.S.C. 1395m(m)</ref>).</content></paragraph> <paragraph class="fontsize10" id="y5857c26a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/6" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="6">(6) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5857c26b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5857c26c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Study.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Integrating medicare advantage alternative payment models</inline>.—</heading><content>Not later than July 1, 2016, the Secretary of Health and Human Services shall submit to Congress a study that examines the feasibility of integrating alternative payment models in the Medicare Advantage payment system. The study shall include the feasibility of including a value-based modifier and whether such modifier should be budget neutral.</content></paragraph> <paragraph class="fontsize10" id="y5857c26d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/7" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="7">(7) </num><heading class="fontsize10"><inline class="smallCaps">Study and report on fraud related to alternative payment models under the medicare program</inline>.—</heading><subparagraph class="fontsize10" id="y5857c26e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/7/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5857c26f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Consultation.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Study</inline>.—</heading><chapeau>The Secretary of Health and Human Services, in consultation with the Inspector General of the Department of Health and Human Services, shall conduct a study that—</chapeau><clause class="fontsize10" id="y5857c270-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/7/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>examines the applicability of the Federal fraud prevention laws to items and services furnished under title XVIII of the Social Security Act for which payment is made under an alternative payment model (as defined in section 1833(z)(3)(C) of such Act (<ref href="/us/usc/t42/s1395l/z/3/C">42 U.S.C. 1395l(z)(3)(C)</ref>));</content></clause> <clause class="fontsize10" id="y5857e881-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/7/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>identifies aspects of such alternative payment models that are vulnerable to fraudulent activity; and</content></clause> <clause class="fontsize10" id="y5857e882-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/7/A/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>examines the implications of waivers to such laws granted in support of such alternative payment models, including under any potential expansion of such models.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5857e883-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/e/7/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Report</inline>.—</heading><content>Not later than 2 years after the date of the enactment of this Act, the Secretary shall submit to Congress a report containing the results of the study conducted under subparagraph (A). <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5857e884-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Recommenda-</p><p class="leftAlign firstIndent0 fontsize8" id="x5857e885-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">tions.</p></sidenote>Such report shall include recommendations for actions to be taken to reduce the vulnerability of such alternative payment models to fraudulent activity. Such report also shall include, as appropriate, recommendations of the Inspector General for changes in Federal fraud prevention laws to reduce such vulnerability.</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5857e886-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s101/f" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="f">(f) </num><heading class="fontsize10"><inline class="smallCaps">Collaborating With the Physician, Practitioner, and Other Stakeholder Communities To Improve Resource Use Measurement</inline>.—</heading><content>Section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>), as amended by subsection (c), is further amended by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="firstIndent0 fontsize10" id="y58594817-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="r">“(r) </num><heading class="fontsize10"><inline class="smallCaps">Collaborating With the Physician, Practitioner, and Other Stakeholder Communities To Improve Resource Use Measurement</inline>.—</heading><paragraph class="fontsize10" id="y58594818-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In order to involve the physician, practitioner, and other stakeholder communities in enhancing the infrastructure for resource use measurement, including for purposes of the Merit-based Incentive Payment System under subsection (q) and alternative payment models under section 1833(z), the Secretary shall undertake the steps described in the succeeding provisions of this subsection.</content></paragraph> <paragraph class="fontsize10" id="y58594819-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">Development of care episode and patient condition groups and classification codes</inline>.—</heading><page identifier="/us/stat/129/124">129 STAT. 124</page> <subparagraph class="fontsize10" id="y5859481a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In order to classify similar patients into care episode groups and patient condition groups, the Secretary shall undertake the steps described in the succeeding provisions of this paragraph.</content></subparagraph> <subparagraph class="fontsize10" id="y5859481b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Public availability of existing efforts to design an episode grouper</inline>.—</heading><content>Not <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5859481c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5859481d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote>later than 180 days after the date of the enactment of this subsection, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services a list of the episode groups developed pursuant to subsection (n)(9)(A) and related descriptive information.</content></subparagraph> <subparagraph class="fontsize10" id="y5859481e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5859481f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Comment period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Stakeholder input</inline>.—</heading><chapeau>The Secretary shall accept, through the date that is 120 days after the day the Secretary posts the list pursuant to subparagraph (B), suggestions from physician specialty societies, applicable practitioner organizations, and other stakeholders for episode groups in addition to those posted pursuant to such subparagraph, and specific clinical criteria and patient characteristics to classify patients into—</chapeau><clause class="fontsize10" id="y58594820-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>care episode groups; and</content></clause> <clause class="fontsize10" id="y58594821-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>patient condition groups.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58594822-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Development of proposed classification codes</inline>.—</heading><clause class="fontsize10" id="y58594823-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Taking into account the information described in subparagraph (B) and the information received under subparagraph (C), the Secretary shall—</chapeau><subclause class="fontsize10" id="y58594824-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>establish care episode groups and patient condition groups, which account for a target of an estimated ½ of expenditures under parts A and B (with such target increasing over time as appropriate); and</content></subclause> <subclause class="fontsize10" id="y58594825-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>assign codes to such groups.</content></subclause> </clause> <clause class="fontsize10" id="y58594826-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Care episode groups</inline>.—</heading><chapeau>In establishing the care episode groups under clause (i), the Secretary shall take into account—</chapeau><subclause class="fontsize10" id="y58594827-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the patient’s clinical problems at the time items and services are furnished during an episode of care, such as the clinical conditions or diagnoses, whether or not inpatient hospitalization occurs, and the principal procedures or services furnished; and</content></subclause> <subclause class="fontsize10" id="y58594828-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>other factors determined appropriate by the Secretary.</content></subclause> </clause> <clause class="fontsize10" id="y58594829-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Patient condition groups</inline>.—</heading><chapeau>In establishing the patient condition groups under clause (i), the Secretary shall take into account—</chapeau><subclause class="fontsize10" id="y5859482a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the patient’s clinical history at the time of a medical visit, such as the patient’s combination of chronic conditions, current health status, and recent significant history (such as hospitalization and major surgery during a previous period, such as 3 months); and</content></subclause> <subclause class="fontsize10" id="y5859482b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>other factors determined appropriate by the Secretary, such as eligibility status under this title (including eligibility under section 226(a), 226(b), or 226A, and dual eligibility under this title and title XIX).<page identifier="/us/stat/129/125">129 STAT. 125</page></content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y5859482c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Draft care episode and patient condition groups and classification codes</inline>.—</heading><content>Not <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5859482d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5859482e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote>later than 270 days after the end of the comment period described in subparagraph (C), the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services a draft list of the care episode and patient condition codes established under subparagraph (D) (and the criteria and characteristics assigned to such code).</content></subparagraph> <subparagraph class="fontsize10" id="y5859482f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594830-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Comment period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Solicitation of input</inline>.—</heading><content>The Secretary shall seek, through the date that is 120 days after the Secretary posts the list pursuant to subparagraph (E), comments from physician specialty societies, applicable practitioner organizations, and other stakeholders, including representatives of individuals entitled to benefits under part A or enrolled under this part, regarding the care episode and patient condition groups (and codes) posted under subparagraph (E). In seeking such comments, the Secretary shall use one or more mechanisms (other than notice and comment rulemaking) that may include use of open door forums, town hall meetings, or other appropriate mechanisms.</content></subparagraph> <subparagraph class="fontsize10" id="y58594831-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="G">“(G) </num><heading class="fontsize10"><inline class="smallCaps">Operational list of care episode and patient condition groups and codes</inline>.—</heading><content>Not <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594832-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x58594833-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote>later than 270 days after the end of the comment period described in subparagraph (F), taking into account the comments received under such subparagraph, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services an operational list of care episode and patient condition codes (and the criteria and characteristics assigned to such code).</content></subparagraph> <subparagraph class="fontsize10" id="y58594834-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="H">“(H) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594835-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x58594836-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p><p class="leftAlign firstIndent0 fontsize8" id="x58594837-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Regulations.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Subsequent revisions</inline>.—</heading><content>Not later than November 1 of each year (beginning with 2018), the Secretary shall, through rulemaking, make revisions to the operational lists of care episode and patient condition codes as the Secretary determines may be appropriate. Such revisions may be based on experience, new information developed pursuant to subsection (n)(9)(A), and input from the physician specialty societies, applicable practitioner organizations, and other stakeholders, including representatives of individuals entitled to benefits under part A or enrolled under this part.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58594838-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Attribution of patients to physicians or practitioners</inline>.—</heading><subparagraph class="fontsize10" id="y58594839-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In order to facilitate the attribution of patients and episodes (in whole or in part) to one or more physicians or applicable practitioners furnishing items and services, the Secretary shall undertake the steps described in the succeeding provisions of this paragraph.</content></subparagraph> <subparagraph class="fontsize10" id="y5859483a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Development of patient relationship categories and codes</inline>.—</heading><chapeau>The Secretary shall develop patient relationship categories and codes that define and distinguish the relationship and responsibility of a physician or applicable practitioner with a patient at the time of furnishing an item or service. Such patient relationship categories shall include different relationships of the physician or applicable practitioner to the patient (and the codes <page identifier="/us/stat/129/126">129 STAT. 126</page> may reflect combinations of such categories), such as a physician or applicable practitioner who—</chapeau><clause class="fontsize10" id="y5859483b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>considers themself to have the primary responsibility for the general and ongoing care for the patient over extended periods of time;</content></clause> <clause class="fontsize10" id="y5859483c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>considers themself to be the lead physician or practitioner and who furnishes items and services and coordinates care furnished by other physicians or practitioners for the patient during an acute episode;</content></clause> <clause class="fontsize10" id="y5859483d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>furnishes items and services to the patient on a continuing basis during an acute episode of care, but in a supportive rather than a lead role;</content></clause> <clause class="fontsize10" id="y5859483e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>furnishes items and services to the patient on an occasional basis, usually at the request of another physician or practitioner; or</content></clause> <clause class="fontsize10" id="y5859483f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>furnishes items and services only as ordered by another physician or practitioner.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58594840-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594841-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x58594842-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Draft list of patient relationship categories and codes</inline>.—</heading><content>Not later than one year after the date of the enactment of this subsection, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services a draft list of the patient relationship categories and codes developed under subparagraph (B).</content></subparagraph> <subparagraph class="fontsize10" id="y58594843-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594844-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Comment period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Stakeholder input</inline>.—</heading><content>The Secretary shall seek, through the date that is 120 days after the Secretary posts the list pursuant to subparagraph (C), comments from physician specialty societies, applicable practitioner organizations, and other stakeholders, including representatives of individuals entitled to benefits under part A or enrolled under this part, regarding the patient relationship categories and codes posted under subparagraph (C). In seeking such comments, the Secretary shall use one or more mechanisms (other than notice and comment rulemaking) that may include open door forums, town hall meetings, web-based forums, or other appropriate mechanisms.</content></subparagraph> <subparagraph class="fontsize10" id="y58594845-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Operational list of patient relationship categories and codes</inline>.—</heading><content>Not <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594846-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x58594847-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote>later than 240 days after the end of the comment period described in subparagraph (D), taking into account the comments received under such subparagraph, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services an operational list of patient relationship categories and codes.</content></subparagraph> <subparagraph class="fontsize10" id="y58594848-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58594849-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5859484a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p><p class="leftAlign firstIndent0 fontsize8" id="x5859484b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Regulations.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Subsequent revisions</inline>.—</heading><content>Not later than November 1 of each year (beginning with 2018), the Secretary shall, through rulemaking, make revisions to the operational list of patient relationship categories and codes as the Secretary determines appropriate. Such revisions may be based on experience, new information developed pursuant to subsection (n)(9)(A), and input from the physician specialty societies, applicable practitioner organizations, and other stakeholders, including representatives of individuals entitled to benefits under part A or enrolled under this part.<page identifier="/us/stat/129/127">129 STAT. 127</page></content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58596f5c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Reporting of information for resource use measurement</inline>.—</heading><chapeau>Claims <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58596f5d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Claims.</p><p class="leftAlign firstIndent0 fontsize8" id="x58596f5e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote>submitted for items and services furnished by a physician or applicable practitioner on or after January 1, 2018, shall, as determined appropriate by the Secretary, include—</chapeau><subparagraph class="fontsize10" id="y58596f5f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>applicable codes established under paragraphs (2) and (3); and</content></subparagraph> <subparagraph class="fontsize10" id="y58596f60-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>the national provider identifier of the ordering physician or applicable practitioner (if different from the billing physician or applicable practitioner).</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58596f61-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">“(5) </num><heading class="fontsize10"><inline class="smallCaps">Methodology for resource use analysis</inline>.—</heading><subparagraph class="fontsize10" id="y58596f62-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>In order to evaluate the resources used to treat patients (with respect to care episode and patient condition groups), the Secretary shall, as the Secretary determines appropriate—</chapeau><clause class="fontsize10" id="y58596f63-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>use the patient relationship codes reported on claims pursuant to paragraph (4) to attribute patients (in whole or in part) to one or more physicians and applicable practitioners;</content></clause> <clause class="fontsize10" id="y58596f64-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>use the care episode and patient condition codes reported on claims pursuant to paragraph (4) as a basis to compare similar patients and care episodes and patient condition groups; and</content></clause> <clause class="fontsize10" id="y58596f65-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>conduct an analysis of resource use (with respect to care episodes and patient condition groups of such patients).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58596f66-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Analysis of patients of physicians and practitioners</inline>.—</heading><chapeau>In conducting the analysis described in subparagraph (A)(iii) with respect to patients attributed to physicians and applicable practitioners, the Secretary shall, as feasible—</chapeau><clause class="fontsize10" id="y58596f67-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58596f68-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time period.</p></sidenote><content>use the claims data experience of such patients by patient condition codes during a common period, such as 12 months; and</content></clause> <clause class="fontsize10" id="y58596f69-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><chapeau>use the claims data experience of such patients by care episode codes—</chapeau><subclause class="fontsize10" id="y58596f6a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>in the case of episodes without a hospitalization, during periods of time (such as the number of days) determined appropriate by the Secretary; and</content></subclause> <subclause class="fontsize10" id="y58596f6b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>in the case of episodes with a hospitalization, during periods of time (such as the number of days) before, during, and after the hospitalization.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y58596f6c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Measurement of resource use</inline>.—</heading><chapeau>In measuring such resource use, the Secretary—</chapeau><clause class="fontsize10" id="y58596f6d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>shall use per patient total allowed charges for all services under part A and this part (and, if the Secretary determines appropriate, part D) for the analysis of patient resource use, by care episode codes and by patient condition codes; and</content></clause> <clause class="fontsize10" id="y58596f6e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>may, as determined appropriate, use other measures of allowed charges (such as subtotals for categories of items and services) and measures of utilization of items and services (such as frequency of specific items and services and the ratio of specific items and services among attributed patients or episodes).<page identifier="/us/stat/129/128">129 STAT. 128</page></content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58596f6f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Stakeholder input</inline>.—</heading><content>The Secretary shall seek comments from the physician specialty societies, applicable practitioner organizations, and other stakeholders, including representatives of individuals entitled to benefits under part A or enrolled under this part, regarding the resource use methodology established pursuant to this paragraph. In seeking comments the Secretary shall use one or more mechanisms (other than notice and comment rulemaking) that may include open door forums, town hall meetings, web-based forums, or other appropriate mechanisms.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58596f70-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="6">“(6) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58596f71-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Contracts.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Implementation</inline>.—</heading><content>To the extent that the Secretary contracts with an entity to carry out any part of the provisions of this subsection, the Secretary may not contract with an entity or an entity with a subcontract if the entity or subcontracting entity currently makes recommendations to the Secretary on relative values for services under the fee schedule for physicians’ services under this section.</content></paragraph> <paragraph class="fontsize10" id="y58596f72-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="7">“(7) </num><heading class="fontsize10"><inline class="smallCaps">Limitation</inline>.—</heading><chapeau>There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of—</chapeau><subparagraph class="fontsize10" id="y58596f73-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>care episode and patient condition groups and codes established under paragraph (2);</content></subparagraph> <subparagraph class="fontsize10" id="y58596f74-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>patient relationship categories and codes established under paragraph (3); and</content></subparagraph> <subparagraph class="fontsize10" id="y58596f75-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><content>measurement of, and analyses of resource use with respect to, care episode and patient condition codes and patient relationship codes pursuant to paragraph (5).</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58596f76-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="8">“(8) </num><heading class="fontsize10"><inline class="smallCaps">Administration</inline>.—</heading><content><ref href="/us/usc/t44/ch35">Chapter 35 of title 44, United States Code</ref>, shall not apply to this section.</content></paragraph> <paragraph class="fontsize10" id="y58596f77-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="9">“(9) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>In this subsection:</chapeau><subparagraph class="fontsize10" id="y58596f78-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Physician</inline>.—</heading><content>The term ‘<term>physician</term>’ has the meaning given such term in section 1861(r)(1).</content></subparagraph> <subparagraph class="fontsize10" id="y58596f79-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Applicable practitioner</inline>.—</heading><chapeau>The term ‘<term>applicable practitioner</term>’ means—</chapeau><clause class="fontsize10" id="y58596f7a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>a physician assistant, nurse practitioner, and clinical nurse specialist (as such terms are defined in section 1861(aa)(5)), and a certified registered nurse anesthetist (as defined in section 1861(bb)(2)); and</content></clause> <clause class="fontsize10" id="y58596f7b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58596f7c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><content>beginning January 1, 2019, such other eligible professionals (as defined in subsection (k)(3)(B)) as specified by the Secretary.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y58596f7d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="10">“(10) </num><heading class="fontsize10"><inline class="smallCaps">Clarification</inline>.—</heading><content>The provisions of sections 1890(b)(7) and 1890A shall not apply to this subsection.”</content></paragraph> </subsection> </quotedContent>.</content></subsection> </section> <section id="d354370e4765" identifier="/us/pl/114/10/tI/s102" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="102">SEC. 102. </num><heading>PRIORITIES AND FUNDING FOR MEASURE DEVELOPMENT.</heading><content class="firstIndent0 fontsize10" id="x5859e4ae-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>), as amended by subsections (c) and (f) of section 101, is further amended by <amendingAction type="insert">inserting</amendingAction> at the end the following new subsection:<quotedContent><subsection class="firstIndent0 fontsize10" id="y585af61f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="s">“(s) </num><heading class="fontsize10"><inline class="smallCaps">Priorities and Funding for Measure Development</inline>.—</heading><paragraph class="fontsize10" id="y585af620-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">Plan identifying measure development priorities and timelines</inline>.—</heading><subparagraph class="fontsize10" id="y585af621-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af622-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x585af623-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Plans.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Draft measure development plan</inline>.—</heading><chapeau>Not later than January 1, 2016, the Secretary shall develop, and post on the Internet website of the Centers for Medicare & Medicaid Services, a draft plan for the development of quality measures for application under the applicable <page identifier="/us/stat/129/129">129 STAT. 129</page> provisions (as defined in paragraph (5)). Under such plan the Secretary shall—</chapeau><clause class="fontsize10" id="y585af624-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>address how measures used by private payers and integrated delivery systems could be incorporated under title XVIII;</content></clause> <clause class="fontsize10" id="y585af625-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>describe how coordination, to the extent possible, will occur across organizations developing such measures; and</content></clause> <clause class="fontsize10" id="y585af626-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>take into account how clinical best practices and clinical practice guidelines should be used in the development of quality measures.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585af627-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af628-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Definitions.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Quality domains</inline>.—</heading><chapeau>For purposes of this subsection, the term ‘<term>quality domains</term>’ means at least the following domains:</chapeau><clause class="fontsize10" id="y585af629-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>Clinical care.</content></clause> <clause class="fontsize10" id="y585af62a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>Safety.</content></clause> <clause class="fontsize10" id="y585af62b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>Care coordination.</content></clause> <clause class="fontsize10" id="y585af62c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>Patient and caregiver experience.</content></clause> <clause class="fontsize10" id="y585af62d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>Population health and prevention.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585af62e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af62f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Plans.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Consideration</inline>.—</heading><chapeau>In developing the draft plan under this paragraph, the Secretary shall consider—</chapeau><clause class="fontsize10" id="y585af630-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>gap analyses conducted by the entity with a contract under section 1890(a) or other contractors or entities;</content></clause> <clause class="fontsize10" id="y585af631-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>whether measures are applicable across health care settings;</content></clause> <clause class="fontsize10" id="y585af632-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>clinical practice improvement activities submitted under subsection (q)(2)(C)(iv) for identifying possible areas for future measure development and identifying existing gaps with respect to such measures; and</content></clause> <clause class="fontsize10" id="y585af633-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>the quality domains applied under this subsection.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585af634-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af635-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Plans.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Priorities</inline>.—</heading><chapeau>In developing the draft plan under this paragraph, the Secretary shall give priority to the following types of measures:</chapeau><clause class="fontsize10" id="y585af636-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>Outcome measures, including patient reported outcome and functional status measures.</content></clause> <clause class="fontsize10" id="y585af637-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>Patient experience measures.</content></clause> <clause class="fontsize10" id="y585af638-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>Care coordination measures.</content></clause> <clause class="fontsize10" id="y585af639-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>Measures of appropriate use of services, including measures of over use.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585af63a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af63b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x585af63c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Comment period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Stakeholder input</inline>.—</heading><content>The Secretary shall accept through March 1, 2016, comments on the draft plan posted under paragraph (1)(A) from the public, including health care providers, payers, consumers, and other stakeholders.</content></subparagraph> <subparagraph class="fontsize10" id="y585af63d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af63e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x585af63f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Final measure development plan</inline>.—</heading><content>Not later than May 1, 2016, taking into account the comments received under this subparagraph, the Secretary shall finalize the plan and post on the Internet website of the Centers for Medicare & Medicaid Services an operational plan for the development of quality measures for use under the applicable provisions. Such plan shall be updated as appropriate.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585af640-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">Contracts and other arrangements for quality measure development</inline>.—</heading><page identifier="/us/stat/129/130">129 STAT. 130</page> <subparagraph class="fontsize10" id="y585af641-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>The Secretary shall enter into contracts or other arrangements with entities for the purpose of developing, improving, updating, or expanding in accordance with the plan under paragraph (1) quality measures for application under the applicable provisions. Such entities shall include organizations with quality measure development expertise.</content></subparagraph> <subparagraph class="fontsize10" id="y585af642-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Prioritization</inline>.—</heading><clause class="fontsize10" id="y585af643-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In entering into contracts or other arrangements under subparagraph (A), the Secretary shall give priority to the development of the types of measures described in paragraph (1)(D).</content></clause> <clause class="fontsize10" id="y585af644-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Consideration</inline>.—</heading><chapeau>In selecting measures for development under this subsection, the Secretary shall consider—</chapeau><subclause class="fontsize10" id="y585af645-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>whether such measures would be electronically specified; and</content></subclause> <subclause class="fontsize10" id="y585af646-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>clinical practice guidelines to the extent that such guidelines exist.</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585af647-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Annual report by the secretary</inline>.—</heading><subparagraph class="fontsize10" id="y585af648-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585af649-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Web posting.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Not later than May 1, 2017, and annually thereafter, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services a report on the progress made in developing quality measures for application under the applicable provisions.</content></subparagraph> <subparagraph class="fontsize10" id="y585af64a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Requirements</inline>.—</heading><chapeau>Each report submitted pursuant to subparagraph (A) shall include the following:</chapeau><clause class="fontsize10" id="y585af64b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>A description of the Secretary’s efforts to implement this paragraph.</content></clause> <clause class="fontsize10" id="y585af64c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><chapeau>With respect to the measures developed during the previous year—</chapeau><subclause class="fontsize10" id="y585af64d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>a description of the total number of quality measures developed and the types of such measures, such as an outcome or patient experience measure;</content></subclause> <subclause class="fontsize10" id="y585af64e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>the name of each measure developed;</content></subclause> <subclause class="fontsize10" id="y585af64f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>the name of the developer and steward of each measure;</content></subclause> <subclause class="fontsize10" id="y585af650-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="IV">“(IV) </num><content>with respect to each type of measure, an estimate of the total amount expended under this title to develop all measures of such type; and</content></subclause> <subclause class="fontsize10" id="y585af651-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="V">“(V) </num><content>whether the measure would be electronically specified.</content></subclause> </clause> <clause class="fontsize10" id="y585af652-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><chapeau>With respect to measures in development at the time of the report—</chapeau><subclause class="fontsize10" id="y585af653-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the information described in clause (ii), if available; and</content></subclause> <subclause class="fontsize10" id="y585af654-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>a timeline for completion of the development of such measures.</content></subclause> </clause> <clause class="fontsize10" id="y585af655-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>A description of any updates to the plan under paragraph (1) (including newly identified gaps and the status of previously identified gaps) and the inventory of measures applicable under the applicable provisions.</content></clause> <clause class="fontsize10" id="y585af656-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>Other information the Secretary determines to be appropriate.<page identifier="/us/stat/129/131">129 STAT. 131</page></content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585af657-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Stakeholder input</inline>.—</heading><chapeau>With respect to paragraph (1), the Secretary shall seek stakeholder input with respect to—</chapeau><subparagraph class="fontsize10" id="y585af658-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>the identification of gaps where no quality measures exist, particularly with respect to the types of measures described in paragraph (1)(D);</content></subparagraph> <subparagraph class="fontsize10" id="y585af659-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>prioritizing quality measure development to address such gaps; and</content></subparagraph> <subparagraph class="fontsize10" id="y585af65a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><content>other areas related to quality measure development determined appropriate by the Secretary.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585af65b-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">“(5) </num><heading class="fontsize10"><inline class="smallCaps">Definition of applicable provisions</inline>.—</heading><chapeau>In this subsection, the term ‘<term>applicable provisions</term>’ means the following provisions:</chapeau><subparagraph class="fontsize10" id="y585af65c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>Subsection (q)(2)(B)(i).</content></subparagraph> <subparagraph class="fontsize10" id="y585af65d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>Section 1833(z)(2)(C).</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585af65e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="6">“(6) </num><heading class="fontsize10"><inline class="smallCaps">Funding</inline>.—</heading><content>For purposes of carrying out this subsection, the Secretary shall provide for the transfer, from the Federal Supplementary Medical Insurance Trust Fund under section 1841, of $15,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for each of fiscal years 2015 through 2019. Amounts transferred under this paragraph shall remain available through the end of fiscal year 2022.</content></paragraph> <paragraph class="fontsize10" id="y585b1d6f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="7">“(7) </num><heading class="fontsize10"><inline class="smallCaps">Administration</inline>.—</heading><content><ref href="/us/usc/t44/ch35">Chapter 35 of title 44, United States Code</ref>, shall not apply to the collection of information for the development of quality measures.”</content></paragraph> </subsection> </quotedContent>.</content></section> <section id="d354370e5175" identifier="/us/pl/114/10/tI/s103" style="-uslm-lc:I658143"><num class="fontsize12" value="103">SEC. 103. </num><heading>ENCOURAGING CARE MANAGEMENT FOR INDIVIDUALS WITH CHRONIC CARE NEEDS.</heading><subsection class="firstIndent0 fontsize10" id="y585b6b90-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><content>Section 1848(b) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/b">42 U.S.C. 1395w–4(b)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="fontsize10" id="y585b92a1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="8">“(8) </num><heading class="fontsize10"><inline class="smallCaps">Encouraging care management for individuals with chronic care needs</inline>.—</heading><subparagraph class="fontsize10" id="y585b92a2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585b92a3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In order to encourage the management of care for individuals with chronic care needs the Secretary shall, subject to subparagraph (B), make payment (as the Secretary determines to be appropriate) under this section for chronic care management services furnished on or after January 1, 2015, by a physician (as defined in section 1861(r)(1)), physician assistant or nurse practitioner (as defined in section 1861(aa)(5)(A)), clinical nurse specialist (as defined in section 1861(aa)(5)(B)), or certified nurse midwife (as defined in section 1861(gg)(2)).</content></subparagraph> <subparagraph class="fontsize10" id="y585b92a4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Policies relating to payment</inline>.—</heading><chapeau>In carrying out this paragraph, with respect to chronic care management services, the Secretary shall—</chapeau><clause class="fontsize10" id="y585b92a5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>make payment to only one applicable provider for such services furnished to an individual during a period;</content></clause> <clause class="fontsize10" id="y585b92a6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>not make payment under subparagraph (A) if such payment would be duplicative of payment that is otherwise made under this title for such services; and</content></clause> <clause class="fontsize10" id="y585b92a7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>not require that an annual wellness visit (as defined in section 1861(hhh)) or an initial preventive physical examination (as defined in section <page identifier="/us/stat/129/132">129 STAT. 132</page> 1861(ww)) be furnished as a condition of payment for such management services.”</content></clause> </subparagraph> </paragraph> </quotedContent>.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y585b92a8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Education and Outreach</inline>.—</heading><paragraph class="fontsize10" id="y585b92a9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585b92aa-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395w–4">42 USC 1395w–4 note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Campaign</inline>.—</heading><subparagraph class="fontsize10" id="y585b92ab-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>The Secretary of Health and Human Services (in this subsection referred to as the “Secretary”) shall conduct an education and outreach campaign to inform professionals who furnish items and services under part B of title XVIII of the Social Security Act and individuals enrolled under such part of the benefits of chronic care management services described in section 1848(b)(8) of the Social Security Act, as added by subsection (a), and encourage such individuals with chronic care needs to receive such services.</content></subparagraph> <subparagraph class="fontsize10" id="y585b92ac-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Requirements</inline>.—</heading><chapeau>Such campaign shall—</chapeau><clause class="fontsize10" id="y585b92ad-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/1/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>be directed by the Office of Rural Health Policy of the Department of Health and Human Services and the Office of Minority Health of the Centers for Medicare & Medicaid Services; and</content></clause> <clause class="fontsize10" id="y585b92ae-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/1/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>focus on encouraging participation by underserved rural populations and racial and ethnic minority populations.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585bb9bf-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Report</inline>.—</heading><chapeau>Not later than December 31, 2017, the Secretary shall submit to Congress a report on the use of chronic care management services described in such section 1848(b)(8) by individuals living in rural areas and by racial and ethnic minority populations. Such report shall—</chapeau><subparagraph class="fontsize10" id="y585bb9c0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>identify barriers to receiving chronic care management services; and</content></subparagraph> <subparagraph class="fontsize10" id="y585bb9c1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s103/b/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585bb9c2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Recommenda-</p><p class="leftAlign firstIndent0 fontsize8" id="x585bb9c3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">tions.</p></sidenote><content>make recommendations for increasing the appropriate use of chronic care management services.</content></subparagraph> </paragraph> </subsection> </section> <section id="d354370e5322" identifier="/us/pl/114/10/tI/s104" style="-uslm-lc:I658143"><num class="fontsize12" value="104">SEC. 104. </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585bb9c4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395w–6">42 USC 1395w–6</ref>.</p></sidenote><heading>EMPOWERING BENEFICIARY CHOICES THROUGH CONTINUED ACCESS TO INFORMATION ON PHYSICIANS’ SERVICES.</heading><subsection class="firstIndent0 fontsize10" id="y585c2ef5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585c2ef6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadlines.</p><p class="leftAlign firstIndent0 fontsize8" id="x585c2ef7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p><p class="leftAlign firstIndent0 fontsize8" id="x585c2ef8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Public information.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><content>On an annual basis (beginning with 2015), the Secretary shall make publicly available, in an easily understandable format, information with respect to physicians and, as appropriate, other eligible professionals on items and services furnished to Medicare beneficiaries under title XVIII of the Social Security Act (<ref href="/us/usc/t42/s1395/etseq">42 U.S.C. 1395 et seq.</ref>).</content></subsection> <subsection class="firstIndent0 fontsize10" id="y585c2ef9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Type and Manner of Information</inline>.—</heading><content>The information made available under this section shall be similar to the type of information in the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File released by the Secretary with respect to 2012 and shall be made available in a manner similar to the manner in which the information in such file is made available.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y585c2efa-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Requirements</inline>.—</heading><chapeau>The information made available under this section shall include, at a minimum, the following:</chapeau><paragraph class="fontsize10" id="y585c2efb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>Information on the number of services furnished by the physician or other eligible professional under part B of title XVIII of the Social Security Act (<ref href="/us/usc/t42/s1395j/etseq">42 U.S.C. 1395j et seq.</ref>), which may include information on the most frequent services furnished or groupings of services.</content></paragraph> <paragraph class="fontsize10" id="y585c2efc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>Information on submitted charges and payments for services under such part.<page identifier="/us/stat/129/133">129 STAT. 133</page></content></paragraph> <paragraph class="fontsize10" id="y585c2efd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/c/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>A unique identifier for the physician or other eligible professional that is available to the public, such as a national provider identifier.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y585c2efe-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/d" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><heading class="fontsize10"><inline class="smallCaps">Searchability</inline>.—</heading><chapeau>The information made available under this section shall be searchable by at least the following:</chapeau><paragraph class="fontsize10" id="y585c2eff-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/d/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>The specialty or type of the physician or other eligible professional.</content></paragraph> <paragraph class="fontsize10" id="y585c2f00-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/d/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>Characteristics of the services furnished, such as volume or groupings of services.</content></paragraph> <paragraph class="fontsize10" id="y585c2f01-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/d/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>The location of the physician or other eligible professional.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y585c2f02-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/e" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="e">(e) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585c2f03-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Integration on Physician Compare</inline>.—</heading><content>Beginning with 2016, the Secretary shall integrate the information made available under this section on Physician Compare.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y585c2f04-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/f" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="f">(f) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>In this section:</chapeau><paragraph class="fontsize10" id="y585c2f05-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/f/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Eligible professional; physician; secretary</inline>.—</heading><content>The terms “eligible professional”, “physician”, and “Secretary” have the meaning given such terms in <ref href="/us/pl/111/148/s10331/i">section 10331(i) of Public Law 111–148</ref>.</content></paragraph> <paragraph class="fontsize10" id="y585c2f06-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s104/f/2" role="definitions" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Physician compare</inline>.—</heading><content>The term “<term>Physician Compare</term>” means the Physician Compare Internet website of the Centers for Medicare & Medicaid Services (or a successor website).</content></paragraph> </subsection> </section> <section id="d354370e5461" identifier="/us/pl/114/10/tI/s105" style="-uslm-lc:I658143"><num class="fontsize12" value="105">SEC. 105. </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585c2f07-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">42 USC</p><p class="leftAlign firstIndent0 fontsize8" id="x585c2f08-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">1395kk–2.</p></sidenote><heading>EXPANDING AVAILABILITY OF MEDICARE DATA.</heading><subsection class="firstIndent0 fontsize10" id="y585e78f9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Expanding Uses of Medicare Data by Qualified Entities</inline>.—</heading><paragraph class="fontsize10" id="y585e78fa-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Additional analyses</inline>.—</heading><subparagraph class="fontsize10" id="y585ea00b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585ea00c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to subparagraph (B), to the extent consistent with applicable information, privacy, security, and disclosure laws (including paragraph (3)), notwithstanding paragraph (4)(B) of section 1874(e) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e">42 U.S.C. 1395kk(e)</ref>) and the second sentence of paragraph (4)(D) of such section, beginning July 1, 2016, a qualified entity may use the combined data described in paragraph (4)(B)(iii) of such section received by such entity under such section, and information derived from the evaluation described in such paragraph (4)(D), to conduct additional non-public analyses (as determined appropriate by the Secretary) and provide or sell such analyses to authorized users for non-public use (including for the purposes of assisting providers of services and suppliers to develop and participate in quality and patient care improvement activities, including developing new models of care).</content></subparagraph> <subparagraph class="fontsize10" id="y585ea00d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Limitations with respect to analyses</inline>.—</heading><clause class="fontsize10" id="y585ea00e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/1/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><heading class="fontsize10"><inline class="smallCaps">Employers</inline>.—</heading><content>Any analyses provided or sold under subparagraph (A) to an employer described in paragraph (9)(A)(iii) may only be used by such employer for purposes of providing health insurance to employees and retirees of the employer.</content></clause> <clause class="fontsize10" id="y585ea00f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/1/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><heading class="fontsize10"><inline class="smallCaps">Health insurance issuers</inline>.—</heading><content>A qualified entity may not provide or sell an analysis to a health insurance issuer described in paragraph (9)(A)(iv) unless the issuer is providing the qualified entity with data under section 1874(e)(4)(B)(iii) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e/4/B/iii">42 U.S.C. 1395kk(e)(4)(B)(iii)</ref>).</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ea010-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Access to certain data</inline>.—</heading><page identifier="/us/stat/129/134">129 STAT. 134</page> <subparagraph class="fontsize10" id="y585ea011-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585ea012-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Access</inline>.—</heading><chapeau>To the extent consistent with applicable information, privacy, security, and disclosure laws (including paragraph (3)), notwithstanding paragraph (4)(B) of section 1874(e) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e">42 U.S.C. 1395kk(e)</ref>) and the second sentence of paragraph (4)(D) of such section, beginning July 1, 2016, a qualified entity may—</chapeau><clause class="fontsize10" id="y585ea013-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/2/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>provide or sell the combined data described in paragraph (4)(B)(iii) of such section to authorized users described in clauses (i), (ii), and (v) of paragraph (9)(A) for non-public use, including for the purposes described in subparagraph (B); or</content></clause> <clause class="fontsize10" id="y585ea014-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/2/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>subject to subparagraph (C), provide Medicare claims data to authorized users described in clauses (i), (ii), and (v), of paragraph (9)(A) for non-public use, including for the purposes described in subparagraph (B).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585ea015-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Purposes described</inline>.—</heading><content>The purposes described in this subparagraph are assisting providers of services and suppliers in developing and participating in quality and patient care improvement activities, including developing new models of care.</content></subparagraph> <subparagraph class="fontsize10" id="y585ea016-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/2/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Medicare claims data must be provided at no cost</inline>.—</heading><content>A qualified entity may not charge a fee for providing the data under subparagraph (A)(ii).</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ea017-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Protection of information</inline>.—</heading><subparagraph class="fontsize10" id="y585ea018-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/3/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Except as provided in subparagraph (B), an analysis or data that is provided or sold under paragraph (1) or (2) shall not contain information that individually identifies a patient.</content></subparagraph> <subparagraph class="fontsize10" id="y585ea019-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/3/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Information on patients of the provider of services or supplier</inline>.—</heading><content>To the extent consistent with applicable information, privacy, security, and disclosure laws, an analysis or data that is provided or sold to a provider of services or supplier under paragraph (1) or (2) may contain information that individually identifies a patient of such provider or supplier, including with respect to items and services furnished to the patient by other providers of services or suppliers.</content></subparagraph> <subparagraph class="fontsize10" id="y585ea01a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/3/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Prohibition on using analyses or data for marketing purposes</inline>.—</heading><content>An authorized user shall not use an analysis or data provided or sold under paragraph (1) or (2) for marketing purposes.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ea01b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/4" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><heading class="fontsize10"><inline class="smallCaps">Data use agreement</inline>.—</heading><content>A qualified entity and an authorized user described in clauses (i), (ii), and (v) of paragraph (9)(A) shall enter into an agreement regarding the use of any data that the qualified entity is providing or selling to the authorized user under paragraph (2). Such agreement shall describe the requirements for privacy and security of the data and, as determined appropriate by the Secretary, any prohibitions on using such data to link to other individually identifiable sources of information. If the authorized user is not a covered entity under the rules promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996, the agreement shall identify the relevant regulations, as determined by the Secretary, that the user shall comply <page identifier="/us/stat/129/135">129 STAT. 135</page> with as if it were acting in the capacity of such a covered entity.</content></paragraph> <paragraph class="fontsize10" id="y585ea01c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/5" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">(5) </num><heading class="fontsize10"><inline class="smallCaps">No redisclosure of analyses or data</inline>.—</heading><subparagraph class="fontsize10" id="y585ea01d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/5/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Except as provided in subparagraph (B), an authorized user that is provided or sold an analysis or data under paragraph (1) or (2) shall not redisclose or make public such analysis or data or any analysis using such data.</content></subparagraph> <subparagraph class="fontsize10" id="y585ea01e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/5/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Permitted redisclosure</inline>.—</heading><content>A provider of services or supplier that is provided or sold an analysis or data under paragraph (1) or (2) may, as determined by the Secretary, redisclose such analysis or data for the purposes of performance improvement and care coordination activities but shall not make public such analysis or data or any analysis using such data.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ea01f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/6" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="6">(6) </num><heading class="fontsize10"><inline class="smallCaps">Opportunity for providers of services and suppliers to review</inline>.—</heading><content>Prior to a qualified entity providing or selling an analysis to an authorized user under paragraph (1), to the extent that such analysis would individually identify a provider of services or supplier who is not being provided or sold such analysis, such qualified entity shall provide such provider or supplier with the opportunity to appeal and correct errors in the manner described in section 1874(e)(4)(C)(ii) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e/4/C/ii">42 U.S.C. 1395kk(e)(4)(C)(ii)</ref>).</content></paragraph> <paragraph class="fontsize10" id="y585ea020-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="7">(7) </num><heading class="fontsize10"><inline class="smallCaps">Assessment for a breach</inline>.—</heading><subparagraph class="fontsize10" id="y585ea021-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>In the case of a breach of a data use agreement under this section or section 1874(e) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e">42 U.S.C. 1395kk(e)</ref>), the Secretary shall impose an assessment on the qualified entity both in the case of—</chapeau><clause class="fontsize10" id="y585ea022-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>an agreement between the Secretary and a qualified entity; and</content></clause> <clause class="fontsize10" id="y585ec733-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>an agreement between a qualified entity and an authorized user.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585ec734-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Assessment</inline>.—</heading><chapeau>The assessment under subparagraph (A) shall be an amount up to $100 for each individual entitled to, or enrolled for, benefits under part A of title XVIII of the Social Security Act or enrolled for benefits under part B of such title—</chapeau><clause class="fontsize10" id="y585ec735-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in the case of an agreement described in subparagraph (A)(i), for whom the Secretary provided data on to the qualified entity under paragraph (2); and</content></clause> <clause class="fontsize10" id="y585ec736-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in the case of an agreement described in subparagraph (A)(ii), for whom the qualified entity provided data on to the authorized user under paragraph (2).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585ec737-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/7/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Deposit of amounts collected</inline>.—</heading><content>Any amounts collected pursuant to this paragraph shall be deposited in Federal Supplementary Medical Insurance Trust Fund under section 1841 of the Social Security Act (<ref href="/us/usc/t42/s1395t">42 U.S.C. 1395t</ref>).</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ec738-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/8" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="8">(8) </num><heading class="fontsize10"><inline class="smallCaps">Annual reports</inline>.—</heading><chapeau>Any qualified entity that provides or sells an analysis or data under paragraph (1) or (2) shall annually submit to the Secretary a report that includes—</chapeau><subparagraph class="fontsize10" id="y585ec739-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/8/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>a summary of the analyses provided or sold, including the number of such analyses, the number of <page identifier="/us/stat/129/136">129 STAT. 136</page> purchasers of such analyses, and the total amount of fees received for such analyses;</content></subparagraph> <subparagraph class="fontsize10" id="y585ec73a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/8/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>a description of the topics and purposes of such analyses;</content></subparagraph> <subparagraph class="fontsize10" id="y585ec73b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/8/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>information on the entities who received the data under paragraph (2), the uses of the data, and the total amount of fees received for providing, selling, or sharing the data; and</content></subparagraph> <subparagraph class="fontsize10" id="y585ec73c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/8/D" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><content>other information determined appropriate by the Secretary.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ec73d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="9">(9) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>In this subsection and subsection (b):</chapeau><subparagraph class="fontsize10" id="y585ec73e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Authorized user</inline>.—</heading><chapeau>The term “<term>authorized user</term>” means the following:</chapeau><clause class="fontsize10" id="y585ec73f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>A provider of services.</content></clause> <clause class="fontsize10" id="y585ec740-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>A supplier.</content></clause> <clause class="fontsize10" id="y585ec741-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>An employer (as defined in section 3(5) of the Employee Retirement Insurance Security Act of 1974).</content></clause> <clause class="fontsize10" id="y585ec742-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A/iv" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">(iv) </num><content>A health insurance issuer (as defined in section 2791 of the Public Health Service Act).</content></clause> <clause class="fontsize10" id="y585ec743-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A/v" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">(v) </num><content>A medical society or hospital association.</content></clause> <clause class="fontsize10" id="y585ec744-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/A/vi" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">(vi) </num><content>Any entity not described in clauses (i) through (v) that is approved by the Secretary (other than an employer or health insurance issuer not described in clauses (iii) and (iv), respectively, as determined by the Secretary).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y585ec745-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/B" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Provider of services</inline>.—</heading><content>The term “<term>provider of services</term>” has the meaning given such term in section 1861(u) of the Social Security Act (<ref href="/us/usc/t42/s1395x/u">42 U.S.C. 1395x(u)</ref>).</content></subparagraph> <subparagraph class="fontsize10" id="y585ec746-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/C" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Qualified entity</inline>.—</heading><content>The term “<term>qualified entity</term>” has the meaning given such term in section 1874(e)(2) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e">42 U.S.C. 1395kk(e)</ref>).</content></subparagraph> <subparagraph class="fontsize10" id="y585ec747-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/D" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><heading class="fontsize10"><inline class="smallCaps">Secretary</inline>.—</heading><content>The term “<term>Secretary</term>” means the Secretary of Health and Human Services.</content></subparagraph> <subparagraph class="fontsize10" id="y585ec748-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/a/9/E" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">(E) </num><heading class="fontsize10"><inline class="smallCaps">Supplier</inline>.—</heading><content>The term “<term>supplier</term>” has the meaning given such term in section 1861(d) of the Social Security Act (<ref href="/us/usc/t42/s1395x/d">42 U.S.C. 1395x(d)</ref>).</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y585ec749-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Access to Medicare Data by Qualified Clinical Data Registries To Facilitate Quality Improvement</inline>.—</heading><paragraph class="fontsize10" id="y585ec74a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Access</inline>.—</heading><subparagraph class="fontsize10" id="y585ec74b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585ec74c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>To the extent consistent with applicable information, privacy, security, and disclosure laws, beginning July 1, 2016, the Secretary shall, at the request of a qualified clinical data registry under section 1848(m)(3)(E) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/m/3/E">42 U.S.C. 1395w–4(m)(3)(E)</ref>), provide the data described in subparagraph (B) (in a form and manner determined to be appropriate) to such qualified clinical data registry for purposes of linking such data with clinical outcomes data and performing risk-adjusted, scientifically valid analyses and research to support quality improvement or patient safety, provided that any public reporting of such analyses or research that identifies a provider of services or supplier shall only be conducted with the opportunity of such provider or supplier to appeal and correct errors in the manner described in subsection (a)(6).<page identifier="/us/stat/129/137">129 STAT. 137</page></content></subparagraph> <subparagraph class="fontsize10" id="y585ec74d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Data described</inline>.—</heading><chapeau>The data described in this subparagraph is—</chapeau><clause class="fontsize10" id="y585ec74e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b/1/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>claims data under the Medicare program under title XVIII of the Social Security Act; and</content></clause> <clause class="fontsize10" id="y585ec74f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b/1/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>if the Secretary determines appropriate, claims data under the Medicaid program under title XIX of such Act and the State Children’s Health Insurance Program under title XXI of such Act.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y585ec750-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Fee</inline>.—</heading><content>Data described in paragraph (1)(B) shall be provided to a qualified clinical data registry under paragraph (1) at a fee equal to the cost of providing such data. Any fee collected pursuant to the preceding sentence shall be deposited in the Centers for Medicare & Medicaid Services Program Management Account.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y585ec751-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/c" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Expansion of Data Available to Qualified Entities</inline>.—</heading><chapeau>Section 1874(e) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e">42 U.S.C. 1395kk(e)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y585ec752-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in the subsection heading, by <amendingAction type="delete">striking</amendingAction> “<quotedText><headingText class="smallCaps">Medicare</headingText></quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y585ec753-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><chapeau>in paragraph (3)—</chapeau><subparagraph class="fontsize10" id="y585ec754-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/c/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x585ec755-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><content>by <amendingAction type="insert">inserting</amendingAction> after the first sentence the following new sentence: “<quotedText>Beginning July 1, 2016, if the Secretary determines appropriate, the data described in this paragraph may also include standardized extracts (as determined by the Secretary) of claims data under titles XIX and XXI for assistance provided under such titles for one or more specified geographic areas and time periods requested by a qualified entity.</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y585ec756-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/c/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in the last sentence, by <amendingAction type="insert">inserting</amendingAction> “<quotedText>or under titles XIX or XXI</quotedText>” before the period at the end.</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y585ec757-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/d" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><heading class="fontsize10"><inline class="smallCaps">Revision of Placement of Fees</inline>.—</heading><chapeau>Section 1874(e)(4)(A) of the Social Security Act (<ref href="/us/usc/t42/s1395kk/e/4/A">42 U.S.C. 1395kk(e)(4)(A)</ref>) <amendingAction type="amend">is amended</amendingAction>, in the second sentence—</chapeau><paragraph class="fontsize10" id="y585ec758-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/d/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>, for periods prior to July 1, 2016,</quotedText>” after “<quotedText>deposited</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y585ec759-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s105/d/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="insert">inserting</amendingAction> the following before the period at the end: “<quotedText>, and, beginning July 1, 2016, into the Centers for Medicare & Medicaid Services Program Management Account</quotedText>”.</content></paragraph> </subsection> </section> <section id="d354370e6020" identifier="/us/pl/114/10/tI/s106" style="-uslm-lc:I658143"><num class="fontsize12" value="106">SEC. 106. </num><heading>REDUCING ADMINISTRATIVE BURDEN AND OTHER PROVISIONS.</heading><subsection class="firstIndent0 fontsize10" id="y5861857a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Medicare Physician and Practitioner Opt-Out to Private Contract</inline>.—</heading><paragraph class="fontsize10" id="y5861857b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Indefinite, continuing automatic extension of opt out election</inline>.—</heading><subparagraph class="fontsize10" id="y5861857c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/1/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861857d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time periods.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Section 1802(b)(3) of the Social Security Act (<ref href="/us/usc/t42/s1395a/b/3">42 U.S.C. 1395a(b)(3)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><clause class="fontsize10" id="y5861857e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/1/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in subparagraph (B)(ii), by <amendingAction type="delete">striking</amendingAction> “<quotedText>during the 2-year period beginning on the date the affidavit is signed</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>during the applicable 2-year period (as defined in subparagraph (D))</quotedText>”;</content></clause> <clause class="fontsize10" id="y5861857f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/1/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in subparagraph (C), by <amendingAction type="delete">striking</amendingAction> “<quotedText>during the 2-year period described in subparagraph (B)(ii)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>during the applicable 2-year period</quotedText>”; and</content></clause> <clause class="fontsize10" id="y58618580-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/1/A/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraph:<quotedContent><subparagraph class="indentDown1 fontsize10" id="y58618581-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Applicable 2-year periods for effectiveness of affidavits</inline>.—</heading><content>In <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58618582-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Definition.</p></sidenote>this subsection, the term ‘applicable <page identifier="/us/stat/129/138">129 STAT. 138</page> 2-year period’ means, with respect to an affidavit of a physician or practitioner under subparagraph (B), the 2-year period beginning on the date the affidavit is signed and includes each subsequent 2-year period unless the physician or practitioner involved provides notice to the Secretary (in a form and manner specified by the Secretary), not later than 30 days before the end of the previous 2-year period, that the physician or practitioner does not want to extend the application of the affidavit for such subsequent 2-year period.”</content></subparagraph> </quotedContent>.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58618583-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58618584-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p><p class="leftAlign firstIndent0 fontsize8" id="x58618585-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395a">42 USC 1395a note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Effective date</inline>.—</heading><content>The amendments made by subparagraph (A) shall apply to affidavits entered into on or after the date that is 60 days after the date of the enactment of this Act.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58618586-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/2" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Public availability of information on opt-out physicians and practitioners</inline>.—</heading><chapeau>Section 1802(b) of the Social Security Act (<ref href="/us/usc/t42/s1395a/b">42 U.S.C. 1395a(b)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y58618587-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in paragraph (5), by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraph:<quotedContent><subparagraph class="indentDown1 fontsize10" id="y5861ac98-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861ac99-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Definition.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Opt-out physician or practitioner</inline>.—</heading><content>The term ‘<term>opt-out physician or practitioner</term>’ means a physician or practitioner who has in effect an affidavit under paragraph (3)(B).”</content></subparagraph> </quotedContent>;</content></subparagraph> <subparagraph class="fontsize10" id="y5861ac9a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>by <amendingAction type="redesignate">redesignating</amendingAction> paragraph (5) as paragraph (6); and</content></subparagraph> <subparagraph class="fontsize10" id="y5861ac9b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/a/2/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>by <amendingAction type="insert">inserting</amendingAction> after paragraph (4) the following new paragraph:<quotedContent><paragraph class="indentDown1 fontsize10" id="y5861d3ac-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">“(5) </num><heading class="fontsize10"><inline class="smallCaps">Posting of information on opt-out physicians and practitioners</inline>.—</heading><subparagraph class="fontsize10" id="y5861d3ad-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861d3ae-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p><p class="leftAlign firstIndent0 fontsize8" id="x5861d3af-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Public information.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Beginning not later than February 1, 2016, the Secretary shall make publicly available through an appropriate publicly accessible website of the Department of Health and Human Services information on the number and characteristics of opt-out physicians and practitioners and shall update such information on such website not less often than annually.</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3b0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Information to be included</inline>.—</heading><chapeau>The information to be made available under subparagraph (A) shall include at least the following with respect to opt-out physicians and practitioners:</chapeau><clause class="fontsize10" id="y5861d3b1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>Their number.</content></clause> <clause class="fontsize10" id="y5861d3b2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>Their physician or professional specialty or other designation.</content></clause> <clause class="fontsize10" id="y5861d3b3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>Their geographic distribution.</content></clause> <clause class="fontsize10" id="y5861d3b4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861d3b5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time period.</p></sidenote><content>The timing of their becoming opt-out physicians and practitioners, relative, to the extent feasible, to when they first enrolled in the program under this title and with respect to applicable 2-year periods.</content></clause> <clause class="fontsize10" id="y5861d3b6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>The proportion of such physicians and practitioners who billed for emergency or urgent care services.”</content></clause> </subparagraph> </paragraph> </quotedContent>.</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5861d3b7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Promoting Interoperability of Electronic Health Record Systems</inline>.—</heading><paragraph class="fontsize10" id="y5861d3b8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Recommendations for achieving widespread ehr interoperability</inline>.—</heading><subparagraph class="fontsize10" id="y5861d3b9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861d3ba-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Objective</inline>.—</heading><content>As a consequence of a significant Federal investment in the implementation of health information technology through the Medicare and Medicaid EHR <page identifier="/us/stat/129/139">129 STAT. 139</page> incentive programs, Congress declares it a national objective to achieve widespread exchange of health information through interoperable certified EHR technology nationwide by December 31, 2018.</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3bb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>In this paragraph:</chapeau><clause class="fontsize10" id="y5861d3bc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/B/i" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><heading class="fontsize10"><inline class="smallCaps">Widespread interoperability</inline>.—</heading><content>The term “<term>widespread interoperability</term>” means interoperability between certified EHR technology systems employed by meaningful EHR users under the Medicare and Medicaid EHR incentive programs and other clinicians and health care providers on a nationwide basis.</content></clause> <clause class="fontsize10" id="y5861d3bd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/B/ii" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><heading class="fontsize10"><inline class="smallCaps">Interoperability</inline>.—</heading><content>The term “<term>interoperability</term>” means the ability of two or more health information systems or components to exchange clinical and other information and to use the information that has been exchanged using common standards as to provide access to longitudinal information for health care providers in order to facilitate coordinated care and improved patient outcomes.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5861d3be-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861d3bf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5861d3c0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Consultation.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Establishment of metrics</inline>.—</heading><content>Not later than July 1, 2016, and in consultation with stakeholders, the Secretary shall establish metrics to be used to determine if and to the extent that the objective described in subparagraph (A) has been achieved.</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3c1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/D" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861d3c2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Determination.</p><p class="leftAlign firstIndent0 fontsize8" id="x5861d3c3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadlines.</p><p class="leftAlign firstIndent0 fontsize8" id="x5861d3c4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Reports.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Recommendations if objective not achieved</inline>.—</heading><chapeau>If the Secretary of Health and Human Services determines that the objective described in subparagraph (A) has not been achieved by December 31, 2018, then the Secretary shall submit to Congress a report, by not later than December 31, 2019, that identifies barriers to such objective and recommends actions that the Federal Government can take to achieve such objective. Such recommended actions may include recommendations—</chapeau><clause class="fontsize10" id="y5861d3c5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/D/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>to adjust payments for not being meaningful EHR users under the Medicare EHR incentive programs; and</content></clause> <clause class="fontsize10" id="y5861d3c6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/1/D/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>for criteria for decertifying certified EHR technology products.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y5861d3c7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Preventing blocking the sharing of information</inline>.—</heading><subparagraph class="fontsize10" id="y5861d3c8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/2/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">For meaningful use ehr professionals</inline>.—</heading><content>Section 1848(o)(2)(A)(ii) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/o/2/A/ii">42 U.S.C. 1395w–4(o)(2)(A)(ii)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> before the period at the end the following: “<quotedText>, and the professional demonstrates (through a process specified by the Secretary, such as the use of an attestation) that the professional has not knowingly and willfully taken action (such as to disable functionality) to limit or restrict the compatibility or interoperability of the certified EHR technology</quotedText>”.</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3c9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/2/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">For meaningful use ehr hospitals</inline>.—</heading><content>Section 1886(n)(3)(A)(ii) of the Social Security Act (<ref href="/us/usc/t42/s1395ww/n/3/A/ii">42 U.S.C. 1395ww(n)(3)(A)(ii)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> before the period at the end the following: “<quotedText>, and the hospital demonstrates (through a process specified by the Secretary, such as the use of an attestation) that the hospital has not knowingly and willfully taken action (such as to disable functionality) to limit or restrict the compatibility or interoperability of the certified EHR technology</quotedText>”.<page identifier="/us/stat/129/140">129 STAT. 140</page></content></subparagraph> <subparagraph class="fontsize10" id="y5861d3ca-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/2/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861d3cb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p><p class="leftAlign firstIndent0 fontsize8" id="x5861d3cc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395w–4">42 USC 1395w–4 note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Effective date</inline>.—</heading><content>The amendments made by this subsection shall apply to meaningful EHR users as of the date that is one year after the date of the enactment of this Act.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5861d3cd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Study and report on the feasibility of establishing a mechanism to compare certified ehr technology products</inline>.—</heading><subparagraph class="fontsize10" id="y5861d3ce-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/3/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Study</inline>.—</heading><chapeau>The Secretary shall conduct a study to examine the feasibility of establishing one or more mechanisms to assist providers in comparing and selecting certified EHR technology products. Such mechanisms may include—</chapeau><clause class="fontsize10" id="y5861d3cf-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/3/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>a website with aggregated results of surveys of meaningful EHR users on the functionality of certified EHR technology products to enable such users to directly compare the functionality and other features of such products; and</content></clause> <clause class="fontsize10" id="y5861d3d0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/3/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>information from vendors of certified products that is made publicly available in a standardized format.</content></clause> <continuation class="firstIndent1 fontsize10" id="x5861d3d1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124">The aggregated results of the surveys described in clause (i) may be made available through contracts with physicians, hospitals, or other organizations that maintain such comparative information described in such clause.</continuation></subparagraph> <subparagraph class="fontsize10" id="y5861d3d2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/3/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Report</inline>.—</heading><content>Not later than 1 year after the date of the enactment of this Act, the Secretary shall submit to Congress a report on mechanisms that would assist providers in comparing and selecting certified EHR technology products. The report shall include information on the benefits of, and resources needed to develop and maintain, such mechanisms.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5861d3d3-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>In this subsection:</chapeau><subparagraph class="fontsize10" id="y5861d3d4-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4/A" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>The term “<term>certified EHR technology</term>” has the meaning given such term in section 1848(o)(4) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/o/4">42 U.S.C. 1395w–4(o)(4)</ref>).</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3d5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4/B" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>The term “<term>meaningful EHR user</term>” has the meaning given such term under the Medicare EHR incentive programs.</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3d6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4/C" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><chapeau>The term “<term>Medicare and Medicaid EHR incentive programs</term>” means—</chapeau><clause class="fontsize10" id="y5861d3d7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4/C/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in the case of the Medicare program under title XVIII of the Social Security Act, the incentive programs under section 1814(l)(3), section 1848(o), subsections (l) and (m) of section 1853, and section 1886(n) of the Social Security Act (<ref href="/us/usc/t42/s1395f/l/3">42 U.S.C. 1395f(l)(3)</ref>, 1395w–4(o), 1395w–23, 1395ww(n)); and</content></clause> <clause class="fontsize10" id="y5861d3d8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4/C/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in the case of the Medicaid program under title XIX of such Act, the incentive program under subsections (a)(3)(F) and (t) of section 1903 of such Act (<ref href="/us/usc/t42/s1396b">42 U.S.C. 1396b</ref>).</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5861d3d9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/b/4/D" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><content>The term “<term>Secretary</term>” means the Secretary of Health and Human Services.</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5861d3da-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">GAO Studies and Reports on the Use of Telehealth Under Federal Programs and on Remote Patient Monitoring Services</inline>.—</heading><page identifier="/us/stat/129/141">129 STAT. 141</page> <paragraph class="fontsize10" id="y5861d3db-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Study on telehealth services</inline>.—</heading><chapeau>The Comptroller General of the United States shall conduct a study on the following:</chapeau><subparagraph class="fontsize10" id="y5861d3dc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>How the definition of telehealth across various Federal programs and Federal efforts can inform the use of telehealth in the Medicare program under title XVIII of the Social Security Act (<ref href="/us/usc/t42/s1395/etseq">42 U.S.C. 1395 et seq.</ref>).</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3dd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>Issues that can facilitate or inhibit the use of telehealth under the Medicare program under such title, including oversight and professional licensure, changing technology, privacy and security, infrastructure requirements, and varying needs across urban and rural areas.</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3de-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/1/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>Potential implications of greater use of telehealth with respect to payment and delivery system transformations under the Medicare program under such title XVIII and the Medicaid program under title XIX of such Act (<ref href="/us/usc/t42/s1396/etseq">42 U.S.C. 1396 et seq.</ref>).</content></subparagraph> <subparagraph class="fontsize10" id="y5861d3df-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/1/D" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><content>How the Centers for Medicare & Medicaid Services monitors payments made under the Medicare program under such title XVIII to providers for telehealth services.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5861d3e0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Study on remote patient monitoring services</inline>.—</heading><subparagraph class="fontsize10" id="y5861d3e1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>The Comptroller General of the United States shall conduct a study—</chapeau><clause class="fontsize10" id="y5861d3e2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>of the dissemination of remote patient monitoring technology in the private health insurance market;</content></clause> <clause class="fontsize10" id="y5861d3e3-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>of the financial incentives in the private health insurance market relating to adoption of such technology;</content></clause> <clause class="fontsize10" id="y5861d3e4-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/A/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>of the barriers to adoption of such services under the Medicare program under title XVIII of the Social Security Act;</content></clause> <clause class="fontsize10" id="y5861faf5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/A/iv" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">(iv) </num><content>that evaluates the patients, conditions, and clinical circumstances that could most benefit from remote patient monitoring services; and</content></clause> <clause class="fontsize10" id="y5861faf6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/A/v" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">(v) </num><content>that evaluates the challenges related to establishing appropriate valuation for remote patient monitoring services under the Medicare physician fee schedule under section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>) in order to accurately reflect the resources involved in furnishing such services.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5861faf7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>For purposes of this paragraph:</chapeau><clause class="fontsize10" id="y5861faf8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/B/i" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><heading class="fontsize10"><inline class="smallCaps">Remote patient monitoring services</inline>.—</heading><content>The term “<term>remote patient monitoring services</term>” means services furnished through remote patient monitoring technology.</content></clause> <clause class="fontsize10" id="y5861faf9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/2/B/ii" role="definitions" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><heading class="fontsize10"><inline class="smallCaps">Remote patient monitoring technology</inline>.—</heading><content>The term “<term>remote patient monitoring technology</term>” means a coordinated system that uses one or more home-based or mobile monitoring devices that automatically transmit vital sign data or information on activities of daily living and may include responses to assessment questions collected on the devices wirelessly or through a telecommunications connection to a server that complies with the Federal regulations (concerning the privacy of individually identifiable health information) promulgated under section 264(c) <page identifier="/us/stat/129/142">129 STAT. 142</page> of the Health Insurance Portability and Accountability Act of 1996, as part of an established plan of care for that patient that includes the review and interpretation of that data by a health care professional.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y5861fafa-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Reports</inline>.—</heading><chapeau>Not later than 24 months after the date of the enactment of this Act, the Comptroller General shall submit to Congress—</chapeau><subparagraph class="fontsize10" id="y5861fafb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/3/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>a report containing the results of the study conducted under paragraph (1); and</content></subparagraph> <subparagraph class="fontsize10" id="y5861fafc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/c/3/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>a report containing the results of the study conducted under paragraph (2).</content></subparagraph> <continuation class="firstIndent1 fontsize10" id="x5861fafd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122">A report<sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861fafe-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Recommenda-</p><p class="leftAlign firstIndent0 fontsize8" id="x5861faff-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">tions.</p></sidenote> required under this paragraph shall be submitted together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate. The Comptroller General may submit one report containing the results described in subparagraphs (A) and (B) and the recommendations described in the previous sentence.</continuation></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5861fb00-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861fb01-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s18122">42 USC 18122 note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Rule of Construction Regarding Health Care Providers</inline>.—</heading><paragraph class="fontsize10" id="y5861fb02-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to paragraph (3), the development, recognition, or implementation of any guideline or other standard under any Federal health care provision shall not be construed to establish the standard of care or duty of care owed by a health care provider to a patient in any medical malpractice or medical product liability action or claim.</content></paragraph> <paragraph class="fontsize10" id="y5861fb03-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Definitions</inline>.—</heading><chapeau>For purposes of this subsection:</chapeau><subparagraph class="fontsize10" id="y5861fb04-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2/A" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">Federal health care provision</inline>.—</heading><content>The term “<term>Federal health care provision</term>” means any provision of the Patient Protection and Affordable Care Act (<ref href="/us/pl/111/148">Public Law 111–148</ref>), title I or subtitle B of title II of the Health Care and Education Reconciliation Act of 2010 (<ref href="/us/pl/111/152">Public Law 111–152</ref>), or title XVIII or XIX of the Social Security Act (<ref href="/us/usc/t42/s1395/etseq">42 U.S.C. 1395 et seq.</ref>, <ref href="/us/usc/t42/s1396/etseq">42 U.S.C. 1396 et seq.</ref>).</content></subparagraph> <subparagraph class="fontsize10" id="y5861fb05-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2/B" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Health care provider</inline>.—</heading><chapeau>The term “<term>health care provider</term>” means any individual, group practice, corporation of health care professionals, or hospital—</chapeau><clause class="fontsize10" id="y5861fb06-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>licensed, registered, or certified under Federal or State laws or regulations to provide health care services; or</content></clause> <clause class="fontsize10" id="y5861fb07-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>required to be so licensed, registered, or certified but that is exempted by other statute or regulation.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5861fb08-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2/C" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><heading class="fontsize10"><inline class="smallCaps">Medical malpractice or medical product liability action or claim</inline>.—</heading><content>The term “<term>medical malpractice or medical product liability action or claim</term>” means a medical malpractice action or claim (as defined in section 431(7) of the Health Care Quality Improvement Act of 1986 (<ref href="/us/usc/t42/s11151/7">42 U.S.C. 11151(7)</ref>)) and includes a liability action or claim relating to a health care provider’s prescription or provision of a drug, device, or biological product (as such terms are defined in section 201 of the Federal Food, Drug, and Cosmetic Act (<ref href="/us/usc/t21/s321">21 U.S.C. 321</ref>) or section 351 of the Public Health Service Act (<ref href="/us/usc/t42/s262">42 U.S.C. 262</ref>)).</content></subparagraph> <subparagraph class="fontsize10" id="y5861fb09-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/2/D" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><heading class="fontsize10"><inline class="smallCaps">State</inline>.—</heading><content>The term “<term>State</term>” includes the District of Columbia, Puerto Rico, and any other commonwealth, possession, or territory of the United States.<page identifier="/us/stat/129/143">129 STAT. 143</page></content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5861fb0a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tI/s106/d/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5861fb0b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s18122">42 USC 18122 note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">No preemption</inline>.—</heading><content>Nothing in paragraph (1) or any provision of the Patient Protection and Affordable Care Act (<ref href="/us/pl/111/148">Public Law 111–148</ref>), title I or subtitle B of title II of the Health Care and Education Reconciliation Act of 2010 (<ref href="/us/pl/111/152">Public Law 111–152</ref>), or title XVIII or XIX of the Social Security Act (<ref href="/us/usc/t42/s1395/etseq">42 U.S.C. 1395 et seq.</ref>, <ref href="/us/usc/t42/s1396/etseq">42 U.S.C. 1396 et seq.</ref>) shall be construed to preempt any State or common law governing medical professional or medical product liability actions or claims.</content></paragraph> </subsection> </section> <num value="II">TITLE II—</num><heading>MEDICARE AND OTHER HEALTH EXTENDERS</heading> <subtitle id="d354370e6788" identifier="/us/pl/114/10/tII/stA" style="-uslm-lc:I658178"><num value="A">Subtitle A—</num><heading>Medicare Extenders</heading> <section id="d354370e6793" identifier="/us/pl/114/10/tII/stA/s201" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="201">SEC. 201. </num><heading>EXTENSION OF WORK GPCI FLOOR.</heading><content style="-uslm-lc:I658120"> Section 1848(e)(1)(E) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/e/1/E">42 U.S.C. 1395w–4(e)(1)(E)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>April 1, 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>January 1, 2018</quotedText>”.</content></section> <section id="d354370e6812" identifier="/us/pl/114/10/tII/stA/s202" style="-uslm-lc:I658143"><num class="fontsize12" value="202">SEC. 202. </num><heading>EXTENSION OF THERAPY CAP EXCEPTIONS PROCESS.</heading><subsection class="firstIndent0 fontsize10" id="y5862703c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s202/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><chapeau>Section 1833(g) of the Social Security Act (<ref href="/us/usc/t42/s1395l/g">42 U.S.C. 1395l(g)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y5862703d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s202/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in paragraph (5)(A), in the first sentence, by <amendingAction type="delete">striking</amendingAction> “<quotedText>March 31, 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>December 31, 2017</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y5862703e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s202/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><chapeau>in paragraph (6)(A)—</chapeau><subparagraph class="fontsize10" id="y5862703f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s202/a/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>March 31, 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>December 31, 2017</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y58627040-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s202/a/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>2012, 2013, 2014, or the first three months of 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2012 through 2017</quotedText>”.</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y58627041-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s202/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Targeted Reviews Under Manual Medical Review Process for Outpatient Therapy Services</inline>.—</heading><paragraph class="fontsize10" id="y58627042-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s202/b/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Section 1833(g)(5) of the Social Security Act (<ref href="/us/usc/t42/s1395l/g/5">42 U.S.C. 1395l(g)(5)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y58627043-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s202/b/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in subparagraph (C)(i), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>, subject to subparagraph (E),</quotedText>” after “<quotedText>manual medical review process that</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y58629754-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s202/b/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraph:<quotedContent><subparagraph class="indentDown2 firstIndent0 fontsize10" id="y5862be65-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E)</num><clause class="inline" id="y5862be66-e871-11f0-bc57-ad3ac4b1618c"><num value="i">(i) </num><content>In place of the manual medical review process under subparagraph (C)(i), the Secretary shall implement a process for medical review under this subparagraph under which the Secretary shall identify and conduct medical review for services described in subparagraph (C)(i) furnished by a provider of services or supplier (in this subparagraph referred to as a ‘therapy provider’) using such factors as the Secretary determines to be appropriate.</content></clause> <clause class="indentUp0 firstIndent0 fontsize10" id="y5862be67-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><chapeau>Such factors may include the following:</chapeau><subclause class="fontsize10" id="y5862be68-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>The therapy provider has had a high claims denial percentage for therapy services under this part or is less compliant with applicable requirements under this title.</content></subclause> <subclause class="fontsize10" id="y5862be69-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>The therapy provider has a pattern of billing for therapy services under this part that is aberrant compared to peers or otherwise has questionable billing practices for such services, such as billing medically unlikely units of services in a day.<page identifier="/us/stat/129/144">129 STAT. 144</page></content></subclause> <subclause class="fontsize10" id="y5862be6a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>The therapy provider is newly enrolled under this title or has not previously furnished therapy services under this part.</content></subclause> <subclause class="fontsize10" id="y5862be6b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="IV">“(IV) </num><content>The services are furnished to treat a type of medical condition.</content></subclause> <subclause class="fontsize10" id="y5862be6c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="V">“(V) </num><content>The therapy provider is part of group that includes another therapy provider identified using the factors determined under this subparagraph.</content></subclause> </clause> <clause class="indentUp0 firstIndent0 fontsize10" id="y5862be6d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>For purposes of carrying out this subparagraph, 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 fiscal years 2015 and 2016, to remain available until expended. Such funds may not be used by a contractor under section 1893(h) for medical reviews under this subparagraph.</content></clause> <clause class="indentUp0 firstIndent0 fontsize10" id="y5862be6e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>The targeted review process under this subparagraph shall not apply to services for which expenses are incurred beyond the period for which the exceptions process under subparagraph (A) is implemented.”</content></clause> </subparagraph> </quotedContent>.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5862be6f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s202/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5862be70-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p><p class="leftAlign firstIndent0 fontsize8" id="x5862be71-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5862be72-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395">42 USC 1395</ref><i>l</i> note.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Effective date</inline>.—</heading><content>The amendments made by this subsection shall apply with respect to requests described in section 1833(g)(5)(C)(i) of the Social Security Act (<ref href="/us/usc/t42/s1395l/g/5/C/i">42 U.S.C. 1395l(g)(5)(C)(i)</ref>) with respect to which the Secretary of Health and Human Services has not conducted medical review under such section by a date (not later than 90 days after the date of the enactment of this Act) specified by the Secretary.</content></paragraph> </subsection> </section> <section id="d354370e6993" identifier="/us/pl/114/10/tII/stA/s203" style="-uslm-lc:I658143"><num class="fontsize12" value="203">SEC. 203. </num><heading>EXTENSION OF AMBULANCE ADD-ONS.</heading><subsection class="firstIndent0 fontsize10" id="y5862e583-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s203/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Ground Ambulance</inline>.—</heading><content>Section 1834(l)(13)(A) of the Social Security Act (<ref href="/us/usc/t42/s1395m/l/13/A">42 U.S.C. 1395m(l)(13)(A)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>April 1, 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>January 1, 2018</quotedText>” each place it appears.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y5862e584-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s203/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Super Rural Ground Ambulance</inline>.—</heading><content>Section 1834(l)(12)(A) of the Social Security Act (<ref href="/us/usc/t42/s1395m/l/12/A">42 U.S.C. 1395m(l)(12)(A)</ref>) <amendingAction type="amend">is amended</amendingAction>, in the first sentence, by <amendingAction type="delete">striking</amendingAction> “<quotedText>April 1, 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>January 1, 2018</quotedText>”.</content></subsection> </section> <section id="d354370e7042" identifier="/us/pl/114/10/tII/stA/s204" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="204">SEC. 204. </num><heading>EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT ADJUSTMENT FOR CERTAIN LOW-VOLUME HOSPITALS.</heading><chapeau class="indentUp0 firstIndent0 fontsize10" id="x58630c95-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 1886(d)(12) of the Social Security Act (<ref href="/us/usc/t42/s1395ww/d/12">42 U.S.C. 1395ww(d)(12)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y58630c96-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s204/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in subparagraph (B), in the matter preceding clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>in fiscal year 2015 (beginning on April 1, 2015), fiscal year 2016, and subsequent fiscal years</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>in fiscal year 2018 and subsequent fiscal years</quotedText>”;</content></paragraph> <paragraph class="fontsize10" id="y58630c97-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s204/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in subparagraph (C)(i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>fiscal years 2011 through 2014 and fiscal year 2015 (before April 1, 2015),</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>fiscal years 2011 through 2017,</quotedText>” each place it appears; and</content></paragraph> <paragraph class="fontsize10" id="y58630c98-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s204/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>in subparagraph (D), by <amendingAction type="delete">striking</amendingAction> “<quotedText>fiscal years 2011 through 2014 and fiscal year 2015 (before April 1, 2015),</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>fiscal years 2011 through 2017,</quotedText>”.</content></paragraph> </section> <section id="d354370e7092" identifier="/us/pl/114/10/tII/stA/s205" style="-uslm-lc:I658143"><num class="fontsize12" value="205">SEC. 205. </num><heading>EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL (MDH) PROGRAM.</heading><subsection class="firstIndent0 fontsize10" id="y58635ab9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s205/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><chapeau>Section 1886(d)(5)(G) of the Social Security Act (<ref href="/us/usc/t42/s1395ww/d/5/G">42 U.S.C. 1395ww(d)(5)(G)</ref>) <amendingAction type="amend">is amended</amendingAction>—<page identifier="/us/stat/129/145">129 STAT. 145</page></chapeau><paragraph class="fontsize10" id="y58635aba-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s205/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>April 1, 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>October 1, 2017</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y58635abb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s205/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in clause (ii)(II), by <amendingAction type="delete">striking</amendingAction> “<quotedText>April 1, 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>October 1, 2017</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y58635abc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s205/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Conforming Amendments</inline>.—</heading><paragraph class="fontsize10" id="y58635abd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s205/b/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Extension of target amount</inline>.—</heading><chapeau>Section 1886(b)(3)(D) of the Social Security Act (<ref href="/us/usc/t42/s1395ww/b/3/D">42 U.S.C. 1395ww(b)(3)(D)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y58635abe-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s205/b/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in the matter preceding clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>April 1, 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>October 1, 2017</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y58635abf-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s205/b/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in clause (iv), by <amendingAction type="delete">striking</amendingAction> “<quotedText>through fiscal year 2014 and the portion of fiscal year 2015 before April 1, 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>through fiscal year 2017</quotedText>”.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58635ac0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s205/b/2" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Permitting hospitals to decline reclassification</inline>.—</heading><content>Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 (<ref href="/us/usc/t42/s1395ww">42 U.S.C. 1395ww note</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>through the first 2 quarters of fiscal year 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>through fiscal year 2017</quotedText>”.</content></paragraph> </subsection> </section> <section id="d354370e7209" identifier="/us/pl/114/10/tII/stA/s206" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="206">SEC. 206. </num><heading>EXTENSION FOR SPECIALIZED MEDICARE ADVANTAGE PLANS FOR SPECIAL NEEDS INDIVIDUALS.</heading><content style="-uslm-lc:I658120"> Section 1859(f)(1) of the Social Security Act (<ref href="/us/usc/t42/s1395w–28/f/1">42 U.S.C. 1395w–28(f)(1)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>2017</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2019</quotedText>”.</content></section> <section id="d354370e7228" identifier="/us/pl/114/10/tII/stA/s207" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="207">SEC. 207. </num><heading>EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSEMENT, INPUT, AND SELECTION.</heading><content style="-uslm-lc:I658120"> Section 1890(d)(2) of the Social Security Act (<ref href="/us/usc/t42/s1395aaa/d/2">42 U.S.C. 1395aaa(d)(2)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>and $15,000,000 for the first 6 months of fiscal year 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>and $30,000,000 for each of fiscal years 2015 through 2017</quotedText>”.</content></section> <section id="d354370e7247" identifier="/us/pl/114/10/tII/stA/s208" style="-uslm-lc:I658143"><num class="fontsize12" value="208">SEC. 208. </num><heading>EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR LOW-INCOME PROGRAMS.</heading><subsection class="firstIndent0 fontsize10" id="y58641e11-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Additional Funding for State Health Insurance Programs</inline>.—</heading><chapeau>Subsection (a)(1)(B) of section 119 of the Medicare Improvements for Patients and Providers Act of 2008 (<ref href="/us/usc/t42/s1395b–3">42 U.S.C. 1395b–3 note</ref>), as amended by section 3306 of the Patient Protection and Affordable Care Act (<ref href="/us/pl/111/148">Public Law 111–148</ref>), section 610 of the American Taxpayer Relief Act of 2012 (<ref href="/us/pl/112/240">Public Law 112–240</ref>), section 1110 of the Pathway for SGR Reform Act of 2013 (<ref href="/us/pl/113/67">Public Law 113–67</ref>), and section 110 of the Protecting Access to Medicare Act of 2014 (<ref href="/us/pl/113/93">Public Law 113–93</ref>), <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y58641e12-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in clause (iv), by <amendingAction type="delete">striking</amendingAction> “<quotedText>and</quotedText>” at the end;</content></paragraph> <paragraph class="fontsize10" id="y58641e13-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="delete">striking</amendingAction> clause (v); and</content></paragraph> <paragraph class="fontsize10" id="y58641e14-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/a/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new clauses:<quotedContent><clause class="indentUp2 fontsize10" id="y58641e15-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>for fiscal year 2015, of $7,500,000;</content></clause> <clause class="indentUp2 fontsize10" id="y58641e16-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">“(vi) </num><content>for fiscal year 2016, of $13,000,000; and</content></clause> <clause class="indentUp2 fontsize10" id="y58641e17-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vii">“(vii) </num><content>for fiscal year 2017, of $13,000,000.”</content></clause> </quotedContent>.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y58641e18-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Additional Funding for Area Agencies on Aging</inline>.—</heading><chapeau>Subsection (b)(1)(B) of such section 119, as so amended, <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y58641e19-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in clause (iv), by <amendingAction type="delete">striking</amendingAction> “<quotedText>and</quotedText>” at the end;</content></paragraph> <paragraph class="fontsize10" id="y58641e1a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="delete">striking</amendingAction> clause (v); and</content></paragraph> <paragraph class="fontsize10" id="y58641e1b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/b/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>by <amendingAction type="insert">inserting</amendingAction> after clause (iv) the following new clauses:<quotedContent><clause class="indentUp2 fontsize10" id="y5864452c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>for fiscal year 2015, of $7,500,000;</content></clause> <clause class="indentUp2 fontsize10" id="y5864452d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">“(vi) </num><content>for fiscal year 2016, of $7,500,000; and</content></clause> <clause class="indentUp2 fontsize10" id="y5864452e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vii">“(vii) </num><content>for fiscal year 2017, of $7,500,000.”</content></clause> </quotedContent>.<page identifier="/us/stat/129/146">129 STAT. 146</page></content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5864452f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/c" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Additional Funding for Aging and Disability Resource Centers</inline>.—</heading><chapeau>Subsection (c)(1)(B) of such section 119, as so amended, <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y58644530-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in clause (iv), by <amendingAction type="delete">striking</amendingAction> “<quotedText>and</quotedText>” at the end;</content></paragraph> <paragraph class="fontsize10" id="y58644531-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="delete">striking</amendingAction> clause (v); and</content></paragraph> <paragraph class="fontsize10" id="y58644532-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/c/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>by <amendingAction type="insert">inserting</amendingAction> after clause (iv) the following new clauses:<quotedContent><clause class="indentUp2 fontsize10" id="y58644533-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>for fiscal year 2015, of $5,000,000;</content></clause> <clause class="indentUp2 fontsize10" id="y58644534-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">“(vi) </num><content>for fiscal year 2016, of $5,000,000; and</content></clause> <clause class="indentUp2 fontsize10" id="y58644535-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vii">“(vii) </num><content>for fiscal year 2017, of $5,000,000.”</content></clause> </quotedContent>.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y58644536-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/d" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><heading class="fontsize10"><inline class="smallCaps">Additional Funding for Contract With the National Center for Benefits and Outreach Enrollment</inline>.—</heading><chapeau>Subsection (d)(2) of such section 119, as so amended, <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y58644537-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/d/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in clause (iv), by <amendingAction type="delete">striking</amendingAction> “<quotedText>and</quotedText>” at the end;</content></paragraph> <paragraph class="fontsize10" id="y58644538-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/d/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="delete">striking</amendingAction> clause (v); and</content></paragraph> <paragraph class="fontsize10" id="y58644539-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s208/d/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>by <amendingAction type="insert">inserting</amendingAction> after clause (iv) the following new clauses:<quotedContent><clause class="indentUp2 fontsize10" id="y5864453a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>for fiscal year 2015, of $5,000,000;</content></clause> <clause class="indentUp2 fontsize10" id="y5864453b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">“(vi) </num><content>for fiscal year 2016, of $12,000,000; and</content></clause> <clause class="indentUp2 fontsize10" id="y5864453c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vii">“(vii) </num><content>for fiscal year 2017, of $12,000,000.”</content></clause> </quotedContent>.</content></paragraph> </subsection> </section> <section id="d354370e7498" identifier="/us/pl/114/10/tII/stA/s209" style="-uslm-lc:I658143"><num class="fontsize12" value="209">SEC. 209. </num><heading>EXTENSION AND TRANSITION OF REASONABLE COST REIMBURSEMENT CONTRACTS.</heading><subsection class="firstIndent0 fontsize10" id="y58668f2d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">One-Year Transition and Notice Regarding Transition</inline>.—</heading><chapeau>Section 1876(h)(5)(C) of the Social Security Act (<ref href="/us/usc/t42/s1395mm/h/5/C">42 U.S.C. 1395mm(h)(5)(C)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y58668f2e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in clause (ii), in the matter preceding subclause (I), by <amendingAction type="delete">striking</amendingAction> “<quotedText>For any</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>Subject to clause (iv), for any</quotedText>”;</content></paragraph> <paragraph class="fontsize10" id="y58668f2f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in clause (iii)(I), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>cost plan service</quotedText>” after “<quotedText>With respect to any portion of the</quotedText>”;</content></paragraph> <paragraph class="fontsize10" id="y58668f30-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/a/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>in clause (iii)(II), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>cost plan service</quotedText>” after “<quotedText>With respect to any other portion of such</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y58668f31-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/a/4" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new clauses:<quotedContent><clause class="indentDown1 firstIndent0 fontsize10" id="y5866dd52-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5866dd53-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5866dd54-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote><chapeau>In the case of an eligible organization that is offering a reasonable cost reimbursement contract that may no longer be extended or renewed because of the application of clause (ii), or where such contract has been extended or renewed but the eligible organization has informed the Secretary in writing not later than a date determined appropriate by the Secretary that such organization voluntarily plans not to seek renewal of the reasonable cost reimbursement contract, the following shall apply:</chapeau><subclause class="fontsize10" id="y5866dd55-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>Notwithstanding such clause, such contract may be extended or renewed for the two years subsequent to 2016. The final year in which such contract is extended or renewed is referred to in this subsection as the ‘last reasonable cost reimbursement contract year for the contract’.</content></subclause> <subclause class="fontsize10" id="y5866dd56-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><chapeau>The organization may not enroll a new enrollee under such contract during the last reasonable cost reimbursement contract year for the contract (but may continue to enroll new enrollees through the end of the year immediately preceding such year) unless such enrollee is any of the following:</chapeau><item class="fontsize10" id="y5866dd57-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="aa">“(aa) </num><content>An individual who chooses enrollment in the reasonable cost contract during the annual election period with respect to such last year.</content></item> <item class="fontsize10" id="y5866dd58-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="bb">“(bb) </num><content>An individual whose spouse, at the time of the individual’s enrollment is an enrollee under the reasonable cost reimbursement contract.<page identifier="/us/stat/129/147">129 STAT. 147</page></content></item> <item class="fontsize10" id="y5866dd59-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="cc">“(cc) </num><content>An individual who is covered under an employer group health plan that offers coverage through the reasonable cost reimbursement contract.</content></item> <item class="fontsize10" id="y5866dd5a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="dd">“(dd) </num><content>An individual who becomes entitled to benefits under part A, or enrolled under part B, and was enrolled in a plan offered by the eligible organization immediately prior to the individual’s enrollment under the reasonable cost reimbursement contract.</content></item> </subclause> <subclause class="fontsize10" id="y5866dd5b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5866dd5c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x5866dd5d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Notification.</p></sidenote><content>Not later than a date determined appropriate by the Secretary prior to the beginning of the last reasonable cost reimbursement contract year for the contract, the organization shall provide notice to the Secretary as to whether the organization will apply to have the contract converted over, in whole or in part, and offered as a Medicare Advantage plan under part C for the year following the last reasonable cost reimbursement contract year for the contract.</content></subclause> <subclause class="fontsize10" id="y5866dd5e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="IV">“(IV) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5866dd5f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><content>If the organization provides the notice described in subclause (III) that the contract will be converted, in whole or in part, the organization shall, not later than a date determined appropriate by the Secretary, provide the Secretary with such information as the Secretary determines appropriate in order to carry out section 1851(c)(4) and to carry out section 1854(a)(5), including subparagraph (C)(ii) of such section.</content></subclause> <subclause class="fontsize10" id="y5866dd60-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="V">“(V) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5866dd61-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Notification.</p></sidenote><content>In the case that the organization enrolls a new enrollee under such contract during the last reasonable cost reimbursement contract year for the contract, the organization shall provide the individual with a notification that such year is the last year for such contract.</content></subclause> </clause> <clause class="indentDown1 firstIndent0 fontsize10" id="y5866dd62-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5866dd63-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote><chapeau>If an eligible organization that is offering a reasonable cost reimbursement contract that is extended or renewed pursuant to clause (iv) provides the notice described in clause (iv)(III) that the contract will be converted, in whole or in part, the following shall apply:</chapeau><subclause class="fontsize10" id="y58670474-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>The deemed enrollment under section 1851(c)(4).</content></subclause> <subclause class="fontsize10" id="y58670475-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>The special rule for quality increase under section 1853(o)(4)(C).</content></subclause> <subclause class="fontsize10" id="y58670476-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>During the last reasonable cost reimbursement contract year for the contract and the year immediately preceding such year, the eligible organization, or the corporate parent organization of the eligible organization, shall be permitted to offer an MA plan in the area that such contract is being offered and enroll Medicare Advantage eligible individuals in such MA plan and such cost plan.”</content></subclause> </clause> </quotedContent>.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y58670477-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Deemed Enrollment From Reasonable Cost Reimbursement Contracts Converted to Medicare Advantage Plans</inline>.—</heading><paragraph class="fontsize10" id="y58670478-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/b/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Section 1851(c) of the Social Security Act (<ref href="/us/usc/t42/s1395w–21/c">42 U.S.C. 1395w–21(c)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y58670479-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/b/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in paragraph (1), by <amendingAction type="delete">striking</amendingAction> “<quotedText>Such elections</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>Subject to paragraph (4), such elections</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y5867047a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/b/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following:<quotedContent><paragraph class="indentDown1 fontsize10" id="y586779ab-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Deemed enrollment relating to converted reasonable cost reimbursement contracts</inline>.—</heading><subparagraph class="fontsize10" id="y586779ac-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x586779ad-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>On the first day of the annual, coordinated election period under subsection (e)(3) for plan years beginning on or after January 1, 2017, an MA eligible individual described in clause (i) or (ii) of subparagraph (B) is deemed, unless the individual elects otherwise, to <page identifier="/us/stat/129/148">129 STAT. 148</page> have elected to receive benefits under this title through an applicable MA plan (and shall be enrolled in such plan) beginning with such plan year, if—</chapeau><clause class="fontsize10" id="y586779ae-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>the individual is enrolled in a reasonable cost reimbursement contract under section 1876(h) in the previous plan year;</content></clause> <clause class="fontsize10" id="y586779af-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>such reasonable cost reimbursement contract was extended or renewed for the last reasonable cost reimbursement contract year of the contract (as described in subclause (I) of section 1876(h)(5)(C)(iv)) pursuant to such section;</content></clause> <clause class="fontsize10" id="y586779b0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>the eligible organization that is offering such reasonable cost reimbursement contract provided the notice described in subclause (III) of such section that the contract was to be converted;</content></clause> <clause class="fontsize10" id="y586779b1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><chapeau>the applicable MA plan—</chapeau><subclause class="fontsize10" id="y586779b2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>is the plan that was converted from the reasonable cost reimbursement contract described in clause (iii);</content></subclause> <subclause class="fontsize10" id="y586779b3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>is offered by the same entity (or an organization affiliated with such entity that has a common ownership interest of control) that entered into such contract; and</content></subclause> <subclause class="fontsize10" id="y586779b4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>is offered in the service area where the individual resides;</content></subclause> </clause> <clause class="fontsize10" id="y586779b5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>in the case of reasonable cost reimbursement contracts that provide coverage under parts A and B (and, to the extent the Secretary determines it to be feasible, contracts that provide only part B coverage), the difference between the estimated individual costs (as determined applicable by the Secretary) for the applicable MA plan and such costs for the predecessor cost plan does not exceed a threshold established by the Secretary; and</content></clause> <clause class="fontsize10" id="y586779b6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">“(vi) </num><chapeau>the applicable MA plan—</chapeau><subclause class="fontsize10" id="y586779b7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x586779b8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time period.</p></sidenote><content>provides coverage for enrollees transitioning from the converted reasonable cost reimbursement contract to such plan to maintain current providers of services and suppliers and course of treatment at the time of enrollment for a period of at least 90 days after enrollment; and</content></subclause> <subclause class="fontsize10" id="y586779b9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>during such period, pays such providers of services and suppliers for items and services furnished to the enrollee an amount that is not less than the amount of payment applicable for such items and services under the original Medicare fee-for-service program under parts A and B.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y586779ba-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">MA eligible individuals described</inline>.—</heading><clause class="fontsize10" id="y586779bb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Without prescription drug coverage</inline>.—</heading><content>An MA eligible individual described in this clause, with respect to a plan year, is an MA eligible individual who is enrolled in a reasonable cost reimbursement contract under section 1876(h) in the previous plan year and who is not, for such previous plan year, enrolled in a prescription drug plan under part D, including coverage under section 1860D–22.<page identifier="/us/stat/129/149">129 STAT. 149</page></content></clause> <clause class="fontsize10" id="y586779bc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">With prescription drug coverage</inline>.—</heading><chapeau>An MA eligible individual described in this clause, with respect to a plan year, is an MA eligible individual who is enrolled in a reasonable cost reimbursement contract under section 1876(h) in the previous plan year and who, for such previous plan year, is enrolled in a prescription drug plan under part D—</chapeau><subclause class="fontsize10" id="y586779bd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>through such contract; or</content></subclause> <subclause class="fontsize10" id="y586779be-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>through a prescription drug plan, if the sponsor of such plan is the same entity (or an organization affiliated with such entity) that entered into such contract.</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y586779bf-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Applicable ma plan defined</inline>.—</heading><chapeau>In this paragraph, the term ‘<term>applicable MA plan</term>’ means, in the case of an individual described in—</chapeau><clause class="fontsize10" id="y586779c0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>subparagraph (B)(i), an MA plan that is not an MA–PD plan; and</content></clause> <clause class="fontsize10" id="y586779c1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>subparagraph (B)(ii), an MA–PD plan.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y586779c2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">Identification and notification of deemed individuals</inline>.—</heading><content>Not <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x586779c3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x586779c4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote>later than 45 days before the first day of the annual, coordinated election period under subsection (e)(3) for plan years beginning on or after January 1, 2017, the Secretary shall identify and notify the individuals who will be subject to deemed elections under subparagraph (A) on the first day of such period.”</content></subparagraph> </paragraph> </quotedContent>.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y586779c5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Beneficiary option to discontinue or change ma plan or ma–pd plan after deemed enrollment</inline>.—</heading><subparagraph class="fontsize10" id="y586779c6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/b/2/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Section 1851(e)(2) of the Social Security Act (<ref href="/us/usc/t42/s1395w–21/e/4">42 U.S.C. 1395w–21(e)(4)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following:<quotedContent><subparagraph class="indentUp0 fontsize10" id="y5867a0d7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">“(F) </num><heading class="fontsize10"><inline class="smallCaps">Special period for certain deemed elections</inline>.—</heading><clause class="fontsize10" id="y5867a0d8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>At any time during the period beginning after the last day of the annual, coordinated election period under paragraph (3) in which an individual is deemed to have elected to enroll in an MA plan or MA–PD plan under subsection (c)(4) and ending on the last day of February of the first plan year for which the individual is enrolled in such plan, such individual may change the election under subsection (a)(1) (including changing the MA plan or MA–PD plan in which the individual is enrolled).</content></clause> <clause class="fontsize10" id="y5867a0d9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Limitation of one change</inline>.—</heading><content>An individual may exercise the right under clause (i) only once during the applicable period described in such clause. The limitation under this clause shall not apply to changes in elections effected during an annual, coordinated election period under paragraph (3) or during a special enrollment period under paragraph (4).”</content></clause> </subparagraph> </quotedContent>.</content></subparagraph> <subparagraph class="fontsize10" id="y5867a0da-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/b/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><heading class="fontsize10"><inline class="smallCaps">Conforming amendments</inline>.—</heading><clause class="fontsize10" id="y5867a0db-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/b/2/B/i" role="instruction" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><heading class="fontsize10"><inline class="smallCaps">Plan requirement for open enrollment</inline>.—</heading><content>Section 1851(e)(6)(A) of the Social Security Act (<ref href="/us/usc/t42/s1395w–21/e/6/A">42 U.S.C. 1395w–21(e)(6)(A)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>paragraph (1),</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>paragraph (1), during the period described in paragraph (2)(F),</quotedText>”.</content></clause> <clause class="fontsize10" id="y5867a0dc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/b/2/B/ii" role="instruction" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><heading class="fontsize10"><inline class="smallCaps">Part d</inline>.—</heading><chapeau>Section 1860D–1(b)(1)(B) of such Act (<ref href="/us/usc/t42/s1395w–101/b/1/B">42 U.S.C. 1395w–101(b)(1)(B)</ref>) <amendingAction type="amend">is amended</amendingAction>—<page identifier="/us/stat/129/150">129 STAT. 150</page></chapeau><subclause class="fontsize10" id="y5867a0dd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/b/2/B/ii/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>in clause (ii), by <amendingAction type="add">adding</amendingAction> “<quotedText>and paragraph (4)</quotedText>” after “<quotedText>paragraph (3)(A)</quotedText>”; and</content></subclause> <subclause class="fontsize10" id="y5867a0de-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/b/2/B/ii/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>in clause (iii) by <amendingAction type="delete">striking</amendingAction> “<quotedText>and (E)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>(E), and (F)</quotedText>”.</content></subclause> </clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y5867a0df-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/b/3" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5867a0e0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Treatment of esrd for deemed enrollment</inline>.—</heading><content>Section 1851(a)(3)(B) of the Social Security Act (<ref href="/us/usc/t42/s1395w–21/a/3/B">42 U.S.C. 1395w–21(a)(3)(B)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following flush sentence: “<quotedText>An individual who develops end-stage renal disease while enrolled in a reasonable cost reimbursement contract under section 1876(h) shall be treated as an MA eligible individual for purposes of applying the deemed enrollment under subsection (c)(4).</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5867a0e1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/c" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Information Requirements</inline>.—</heading><chapeau>Section 1851(d)(2)(B) of the Social Security Act (<ref href="/us/usc/t42/s1395w–21/d/2/B">42 U.S.C. 1395w–21(d)(2)(B)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y5867a0e2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in the heading, by <amendingAction type="delete">striking</amendingAction> “<quotedText><headingText class="smallCaps">Notification to newly eligible medicare advantage eligible individuals</headingText></quotedText>” and <amendingAction type="insert">inserting</amendingAction> the following: <quotedContent>“<headingText class="smallCaps">Notifications required.—</headingText><clause class="indentUp2 fontsize10" id="y5867a0e3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Notification to newly eligible medicare advantage eligible individuals</inline>.—</heading><content>”</content></clause> </quotedContent>; and</content></paragraph> <paragraph class="fontsize10" id="y5867a0e4-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new clause:<quotedContent><clause class="indentUp2 fontsize10" id="y5867c6f5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Notification related to certain deemed elections</inline>.—</heading><chapeau>The <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5867c6f6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote>Secretary shall require a Medicare Advantage organization that is offering a Medicare Advantage plan that has been converted from a reasonable cost reimbursement contract pursuant to section 1876(h)(5)(C)(iv) to mail, not later than 30 days prior to the first day of the annual, coordinated election period under subsection (e)(3) of a year, to any individual enrolled under such contract and identified by the Secretary under subsection (c)(4)(D) for such year—</chapeau><subclause class="fontsize10" id="y5867c6f7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>a notification that such individual will, on such day, be deemed to have made an election with respect to such plan to receive benefits under this title through an MA plan or MA–PD plan (and shall be enrolled in such plan) for the next plan year under subsection (c)(4)(A), but that the individual may make a different election during the annual, coordinated election period for such year;</content></subclause> <subclause class="fontsize10" id="y5867c6f8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>the information described in subparagraph (A);</content></subclause> <subclause class="fontsize10" id="y5867c6f9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>a description of the differences between such MA plan or MA–PD plan and the reasonable cost reimbursement contract in which the individual was most recently enrolled with respect to benefits covered under such plans, including cost-sharing, premiums, drug coverage, and provider networks;</content></subclause> <subclause class="fontsize10" id="y5867c6fa-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="IV">“(IV) </num><content>information about the special period for elections under subsection (e)(2)(F); and</content></subclause> <subclause class="fontsize10" id="y5867c6fb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="V">“(V) </num><content>other information the Secretary may specify.”</content></subclause> </clause> </quotedContent>.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5867c6fc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stA/s209/d" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><heading class="fontsize10"><inline class="smallCaps">Treatment of Transition Plan for Quality Rating for Payment Purposes</inline>.—</heading><content>Section 1853(o)(4) of the Social Security Act (<ref href="/us/usc/t42/s1395w–23/o/4">42 U.S.C. 1395w–23(o)(4)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraph:<page identifier="/us/stat/129/151">129 STAT. 151</page> <quotedContent><subparagraph class="indentUp2 fontsize10" id="y5867ee0d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Special rule for first 3 plan years for plans that were converted from a reasonable cost reimbursement contract</inline>.—</heading><chapeau>For <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5867ee0e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote>purposes of applying paragraph (1) and section 1854(b)(1)(C) for the first 3 plan years under this part in the case of an MA plan to which deemed enrollment applies under section 1851(c)(4)—</chapeau><clause class="fontsize10" id="y5867ee0f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>such plan shall not be treated as a new MA plan (as defined in paragraph (3)(A)(iii)(II)); and</content></clause> <clause class="fontsize10" id="y5867ee10-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>in determining the star rating of the plan under subparagraph (A), to the extent that Medicare Advantage data for such plan is not available for a measure used to determine such star rating, the Secretary shall use data from the period in which such plan was a reasonable cost reimbursement contract.”</content></clause> </subparagraph> </quotedContent>.</content></subsection> </section> <section id="d354370e8147" identifier="/us/pl/114/10/tII/stA/s210" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="210">SEC. 210. </num><heading>EXTENSION OF HOME HEALTH RURAL ADD-ON.</heading><content style="-uslm-lc:I658120"> Section 421(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (<ref href="/us/pl/108/173">Public Law 108–173</ref>; <ref href="/us/stat/117/2283">117 Stat. 2283</ref>; <ref href="/us/usc/t42/s1395fff">42 U.S.C. 1395fff note</ref>), as amended by section 5201(b) of the Deficit Reduction Act of 2005 (<ref href="/us/pl/109/171">Public Law 109–171</ref>; <ref href="/us/stat/120/46">120 Stat. 46</ref>) and by section 3131(c) of the Patient Protection and Affordable Care Act (<ref href="/us/pl/111/148">Public Law 111–148</ref>; <ref href="/us/stat/124/428">124 Stat. 428</ref>), <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>January 1, 2016</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>January 1, 2018</quotedText>” each place it appears.</content></section> </subtitle> <subtitle id="d354370e8186" identifier="/us/pl/114/10/tII/stB" style="-uslm-lc:I658178"><num value="B">Subtitle B—</num><heading>Other Health Extenders</heading> <section id="d354370e8191" identifier="/us/pl/114/10/tII/stB/s211" style="-uslm-lc:I658143"><num class="fontsize12" value="211">SEC. 211. </num><heading>PERMANENT EXTENSION OF THE QUALIFYING INDIVIDUAL (QI) PROGRAM.</heading><subsection class="firstIndent0 fontsize10" id="y58683c31-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s211/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Permanent Extension</inline>.—</heading><content>Section 1902(a)(10)(E)(iv) of the Social Security Act (<ref href="/us/usc/t42/s1396a/a/10/E/iv">42 U.S.C. 1396a(a)(10)(E)(iv)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>(but only for premiums payable with respect to months during the period beginning with January 1998, and ending with March 2015)</quotedText>”.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y58686342-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s211/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Allocations</inline>.—</heading><chapeau>Section 1933(g) of the Social Security Act (<ref href="/us/usc/t42/s1396u–3/g">42 U.S.C. 1396u–3(g)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y58686343-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s211/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><chapeau>in paragraph (2)—</chapeau><subparagraph class="fontsize10" id="y58686344-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s211/b/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>by <amendingAction type="delete">striking</amendingAction> subparagraphs (A) through (H);</content></subparagraph> <subparagraph class="fontsize10" id="y58686345-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s211/b/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in subparagraph (V), by <amendingAction type="delete">striking</amendingAction> “<quotedText>and</quotedText>” at the end;</content></subparagraph> <subparagraph class="fontsize10" id="y58686346-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s211/b/1/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>in subparagraph (W), by <amendingAction type="delete">striking</amendingAction> the period at the end and <amendingAction type="insert">inserting</amendingAction> a semicolon;</content></subparagraph> <subparagraph class="fontsize10" id="y58686347-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s211/b/1/D" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><content>by <amendingAction type="redesignate">redesignating</amendingAction> subparagraphs (I) through (W) as subparagraphs (A) through (O), respectively; and</content></subparagraph> <subparagraph class="fontsize10" id="y58686348-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s211/b/1/E" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">(E) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraphs:<quotedContent><subparagraph class="indentUp0 fontsize10" id="y58686349-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="P">“(P) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5868634a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time period.</p></sidenote><content>for the period that begins on April 1, 2015, and ends on December 31, 2015, the total allocation amount is $535,000,000; and</content></subparagraph> <subparagraph class="indentUp0 fontsize10" id="y5868634b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="Q">“(Q) </num><content>for 2016 and, subject to paragraph (4), for each subsequent year, the total allocation amount is $980,000,000.”</content></subparagraph> </quotedContent>;</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5868634c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s211/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in paragraph (3), by <amendingAction type="delete">striking</amendingAction> “<quotedText>(P), (R), (T), or (V)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>or (P)</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y5868634d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s211/b/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="indentUp0 fontsize10" id="y58688a5e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Adjustment to allocations</inline>.—</heading><chapeau>The Secretary may increase the allocation amount under paragraph (2)(Q) for a <page identifier="/us/stat/129/152">129 STAT. 152</page> year (beginning with 2017) up to an amount that does not exceed the product of the following:</chapeau><subparagraph class="fontsize10" id="y58688a5f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Maximum allocation amount for previous year</inline>.—</heading><content>In the case of 2017, the allocation amount for 2016, or in the case of a subsequent year, the maximum allocation amount allowed under this paragraph for the previous year.</content></subparagraph> <subparagraph class="fontsize10" id="y58688a60-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Increase in part b premium</inline>.—</heading><content>The monthly premium rate determined under section 1839 for the year divided by the monthly premium rate determined under such section for the previous year.</content></subparagraph> <subparagraph class="fontsize10" id="y58688a61-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Increase in part b enrollment</inline>.—</heading><content>The average number of individuals (as estimated by the Chief Actuary of the Centers for Medicare & Medicaid Services in September of the previous year) to be enrolled under part B of title XVIII for months in the year divided by the average number of such individuals (as so estimated) under this subparagraph with respect to enrollments in months in the previous year.”</content></subparagraph> </paragraph> </quotedContent>.</content></paragraph> </subsection> </section> <section id="d354370e8362" identifier="/us/pl/114/10/tII/stB/s212" style="-uslm-lc:I658143"><num class="fontsize12" value="212">SEC. 212. </num><heading>PERMANENT EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA).</heading><subsection class="firstIndent0 fontsize10" id="y5868b172-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s212/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><chapeau>Section 1925 of the Social Security Act (<ref href="/us/usc/t42/s1396r–6">42 U.S.C. 1396r–6</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y5868b173-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s212/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>by <amendingAction type="delete">striking</amendingAction> subsection (f); and</content></paragraph> <paragraph class="fontsize10" id="y5868b174-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s212/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="redesignate">redesignating</amendingAction> subsection (g) as subsection (f).</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5868b175-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s212/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Conforming Amendment</inline>.—</heading><content>Section 1902(e)(1) of the Social Security Act (<ref href="/us/usc/t42/s1396a/e/1">42 U.S.C. 1396a(e)(1)</ref>) <amendingAction type="amend">is amended</amendingAction> to read as follows:<quotedContent><paragraph class="indentUp0 firstIndent0 fontsize10" id="y5868b176-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5868b177-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><content>Beginning April 1, 1990, for provisions relating to the extension of eligibility for medical assistance for certain families who have received aid pursuant to a State plan approved under part A of title IV and have earned income, see section 1925.”</content></paragraph> </quotedContent>.</content></subsection> </section> <section id="d354370e8427" identifier="/us/pl/114/10/tII/stB/s213" style="-uslm-lc:I658143"><num class="fontsize12" value="213">SEC. 213. </num><heading>EXTENSION OF SPECIAL DIABETES PROGRAM FOR TYPE I DIABETES AND FOR INDIANS.</heading><subsection class="firstIndent0 fontsize10" id="y5868b178-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s213/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Special Diabetes Programs for Type I Diabetes</inline>.—</heading><content>Section 330B(b)(2)(C) of the Public Health Service Act (<ref href="/us/usc/t42/s254c–2/b/2/C">42 U.S.C. 254c–2(b)(2)(C)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>”.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y5868b179-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s213/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Special Diabetes Programs for Indians</inline>.—</heading><content>Section 330C(c)(2)(C) of the Public Health Service Act (<ref href="/us/usc/t42/s254c–3/c/2/C">42 U.S.C. 254c–3(c)(2)(C)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>”.</content></subsection> </section> <section id="d354370e8476" identifier="/us/pl/114/10/tII/stB/s214" style="-uslm-lc:I658143"><num class="fontsize12" value="214">SEC. 214. </num><heading>EXTENSION OF ABSTINENCE EDUCATION.</heading><subsection class="firstIndent0 fontsize10" id="y5868ff9a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s214/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><chapeau>Section 510 of the Social Security Act (<ref href="/us/usc/t42/s710">42 U.S.C. 710</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y5868ff9b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s214/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in subsection (a), <amendingAction type="delete">striking</amendingAction> “<quotedText>2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y5868ff9c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s214/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in subsection (d), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and an additional $75,000,000 for each of fiscal years 2016 and 2017</quotedText>” after “<quotedText>2015</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5868ff9d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s214/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Budget Scoring</inline>.—</heading><content>Notwithstanding section 257(b)(2) of the Balanced Budget and Emergency Deficit Control Act of 1985, the baseline shall be calculated assuming that no grant shall be made under section 510 of the Social Security Act (<ref href="/us/usc/t42/s710">42 U.S.C. 710</ref>) after fiscal year 2017.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y5868ff9e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s214/c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Reallocation of Unused Funding</inline>.—</heading><content>The remaining unobligated balances of the amount appropriated for fiscal years 2016 and 2017 by section 510(d) of the Social Security Act (<ref href="/us/usc/t42/s710/d">42 U.S.C. 710(d)</ref>) for which no application has been received by the <page identifier="/us/stat/129/153">129 STAT. 153</page> Funding Opportunity Announcement deadline, shall be made available to States that require the implementation of each element described in subparagraphs (A) through (H) of the definition of abstinence education in section 510(b)(2). The remaining unobligated balances shall be reallocated to such States that submit a valid application consistent with the original formula for this funding.</content></subsection> </section> <section id="d354370e8548" identifier="/us/pl/114/10/tII/stB/s215" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="215">SEC. 215. </num><heading>EXTENSION OF PERSONAL RESPONSIBILITY EDUCATION PROGRAM (PREP).</heading><chapeau class="indentUp0 firstIndent0 fontsize10" id="x586926af-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 513 of the Social Security Act (<ref href="/us/usc/t42/s713">42 U.S.C. 713</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586926b0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s215/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in paragraphs (1)(A) and (4)(A) of subsection (a), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>” each place it appears;</content></paragraph> <paragraph class="fontsize10" id="y586926b1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s215/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in subsection (a)(4)(B)(i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>, 2013, 2014, and 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>through 2017</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y586926b2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s215/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>in subsection (f), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>”.</content></paragraph> </section> <section id="d354370e8597" identifier="/us/pl/114/10/tII/stB/s216" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="216">SEC. 216. </num><heading>EXTENSION OF FUNDING FOR FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS.</heading><chapeau class="indentUp0 firstIndent0 fontsize10" id="x586926b3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 501(c)(1)(A) of the Social Security Act (<ref href="/us/usc/t42/s701/c/1/A">42 U.S.C. 701(c)(1)(A)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586926b4-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s216/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>by <amendingAction type="delete">striking</amendingAction> clause (vi); and</content></paragraph> <paragraph class="fontsize10" id="y586926b5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s216/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="add">adding</amendingAction> after clause (v) the following new clause:<quotedContent><clause class="indentUp0 fontsize10" id="y58694dc6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">“(vi) </num><content>$5,000,000 for each of fiscal years 2015 through 2017.”</content></clause> </quotedContent>.</content></paragraph> </section> <section id="d354370e8635" identifier="/us/pl/114/10/tII/stB/s217" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="217">SEC. 217. </num><heading>EXTENSION OF HEALTH WORKFORCE DEMONSTRATION PROJECT FOR LOW-INCOME INDIVIDUALS.</heading><content style="-uslm-lc:I658120"> Section 2008(c)(1) of the Social Security Act (<ref href="/us/usc/t42/s1397g/c/1">42 U.S.C. 1397g(c)(1)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>”.</content></section> <section id="d354370e8654" identifier="/us/pl/114/10/tII/stB/s218" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="218">SEC. 218. </num><heading>EXTENSION OF MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAMS.</heading><chapeau class="indentUp0 firstIndent0 fontsize10" id="x586974d7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 511(j)(1) of the Social Security Act (<ref href="/us/usc/t42/s711/j">42 U.S.C. 711(j)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586974d8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s218/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>and</quotedText>” at the end of subparagraph (E);</content></paragraph> <paragraph class="fontsize10" id="y586974d9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s218/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><chapeau>in subparagraph (F)—</chapeau><subparagraph class="fontsize10" id="y586974da-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s218/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>for the period beginning on October 1, 2014, and ending on March 31, 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>for fiscal year 2015</quotedText>”;</content></subparagraph> <subparagraph class="fontsize10" id="y586974db-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s218/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>an amount equal to the amount provided in subparagraph (E)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>$400,000,000</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y586974dc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s218/2/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>by <amendingAction type="delete">striking</amendingAction> the period at the end and <amendingAction type="insert">inserting</amendingAction> a semicolon; and</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y586974dd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s218/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraphs:<quotedContent><subparagraph class="fontsize10" id="y58699bee-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="G">“(G) </num><content>for fiscal year 2016, $400,000,000; and</content></subparagraph> <subparagraph class="fontsize10" id="y58699bef-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="H">“(H) </num><content>for fiscal year 2017, $400,000,000.”</content></subparagraph> </quotedContent>.</content></paragraph> </section> <section id="d354370e8738" identifier="/us/pl/114/10/tII/stB/s219" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="219">SEC. 219. </num><heading>TENNESSEE DSH ALLOTMENT FOR FISCAL YEARS 2015 THROUGH 2025.</heading><content class="firstIndent0 fontsize10" id="x58699bf0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 1923(f)(6)(A) of the Social Security Act (<ref href="/us/usc/t42/s1396r–4/f/6/A">42 U.S.C. 1396r–4(f)(6)(A)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following:<quotedContent><clause class="indentUp3 fontsize10" id="y58699bf1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">“(vi) </num><heading class="fontsize10"><inline class="smallCaps">Allotment for fiscal years 2015 through 2025</inline>.—</heading><content>Notwithstanding any other provision of this subsection, any other provision of law, or the terms of the TennCare Demonstration Project in effect for the State, the DSH allotment for Tennessee for fiscal year <page identifier="/us/stat/129/154">129 STAT. 154</page> 2015, and for each fiscal year thereafter through fiscal year 2025, shall be $53,100,000 for each such fiscal year.”</content></clause> </quotedContent>.</content></section> <section id="d354370e8770" identifier="/us/pl/114/10/tII/stB/s220" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="220">SEC. 220. </num><heading>DELAY IN EFFECTIVE DATE FOR MEDICAID AMENDMENTS RELATING TO BENEFICIARY LIABILITY SETTLEMENTS.</heading><content style="-uslm-lc:I658120"> Section 202(c) of the Bipartisan Budget Act of 2013 (<ref href="/us/pl/113/67/dA">division A of Public Law 113–67</ref>; <ref href="/us/usc/t42/s1396a">42 U.S.C. 1396a note</ref>), as amended by section 211 of the Protecting Access to Medicare Act of 2014 (<ref href="/us/pl/113/93">Public Law 113–93</ref>; <ref href="/us/stat/128/1047">128 Stat. 1047</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>October 1, 2016</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>October 1, 2017</quotedText>”.</content></section> <section id="d354370e8800" identifier="/us/pl/114/10/tII/stB/s221" style="-uslm-lc:I658143"><num class="fontsize12" value="221">SEC. 221. </num><heading>EXTENSION OF FUNDING FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH SERVICE CORPS, AND TEACHING HEALTH CENTERS.</heading><subsection class="firstIndent0 fontsize10" id="y5869ea12-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s221/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Funding for Community Health Centers and the National Health Service Corps</inline>.—</heading><paragraph class="fontsize10" id="y5869ea13-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s221/a/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Community health centers</inline>.—</heading><content>Section 10503(b)(1)(E) of the Patient Protection and Affordable Care Act (<ref href="/us/usc/t42/s254b–2/b/1/E">42 U.S.C. 254b–2(b)(1)(E)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>for fiscal year 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>for each of fiscal years 2015 through 2017</quotedText>”.</content></paragraph> <paragraph class="fontsize10" id="y5869ea14-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s221/a/2" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">National health service corps</inline>.—</heading><content>Section 10503(b)(2)(E) of the Patient Protection and Affordable Care Act (<ref href="/us/usc/t42/s254b–2/b/2/E">42 U.S.C. 254b–2(b)(2)(E)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>for fiscal year 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>for each of fiscal years 2015 through 2017</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5869ea15-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s221/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Extension of Teaching Health Centers Program</inline>.—</heading><content>Section 340H(g) of the Public Health Service Act (<ref href="/us/usc/t42/s256h/g">42 U.S.C. 256h(g)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and $60,000,000 for each of fiscal years 2016 and 2017</quotedText>” before the period at the end.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y5869ea16-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tII/stB/s221/c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Application</inline>.—</heading><content>Amounts appropriated pursuant to this section for fiscal year 2016 and fiscal year 2017 are subject to the requirements contained in <ref href="/us/pl/113/235">Public Law 113–235</ref> for funds for programs authorized under sections 330 through 340 of the Public Health Service Act (<ref href="/us/usc/t42/s254b–256">42 U.S.C. 254b–256</ref>).</content></subsection> </section> </subtitle> <num value="III">TITLE III—</num><heading>CHIP</heading> <section id="d354370e8900" identifier="/us/pl/114/10/tIII/s301" style="-uslm-lc:I658143"><num class="fontsize12" value="301">SEC. 301. </num><heading>2-YEAR EXTENSION OF THE CHILDREN’S HEALTH INSURANCE PROGRAM.</heading><subsection class="firstIndent0 fontsize10" id="y586b97c7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Funding</inline>.—</heading><chapeau>Section 2104(a) of the Social Security Act (<ref href="/us/usc/t42/s1397dd/a">42 U.S.C. 1397dd(a)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586b97c8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in paragraph (17), by <amendingAction type="delete">striking</amendingAction> “<quotedText>and</quotedText>” at the end;</content></paragraph> <paragraph class="fontsize10" id="y586b97c9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in paragraph (18)(B), by <amendingAction type="delete">striking</amendingAction> the period at the end and <amendingAction type="insert">inserting</amendingAction> a semicolon; and</content></paragraph> <paragraph class="fontsize10" id="y586b97ca-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/a/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new paragraphs:<quotedContent><paragraph class="indentUp0 fontsize10" id="y586bbedb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="19">“(19) </num><content>for fiscal year 2016, $19,300,000,000; and</content></paragraph> <paragraph class="indentUp0 fontsize10" id="y586bbedc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="20">“(20) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x586bbedd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time periods.</p></sidenote><chapeau>for fiscal year 2017, for purposes of making 2 semi-annual allotments—</chapeau><subparagraph class="fontsize10" id="y586bbede-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>$2,850,000,000 for the period beginning on October 1, 2016, and ending on March 31, 2017; and</content></subparagraph> <subparagraph class="fontsize10" id="y586bbedf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>$2,850,000,000 for the period beginning on April 1, 2017, and ending on September 30, 2017.”</content></subparagraph> </paragraph> </quotedContent>.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y586bbee0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Allotments</inline>.—</heading><paragraph class="fontsize10" id="y586bbee1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Section 2104(m) of the Social Security Act (<ref href="/us/usc/t42/s1397dd/m">42 U.S.C. 1397dd(m)</ref>) <amendingAction type="amend">is amended</amendingAction>—<page identifier="/us/stat/129/155">129 STAT. 155</page></chapeau><subparagraph class="fontsize10" id="y586bbee2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in the subsection heading, by <amendingAction type="delete">striking</amendingAction> “<quotedText><headingText class="smallCaps">Through 2015</headingText></quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText><headingText class="smallCaps">and Thereafter</headingText></quotedText>”;</content></subparagraph> <subparagraph class="fontsize10" id="y586bbee3-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><chapeau>in paragraph (2)—</chapeau><clause class="fontsize10" id="y586bbee4-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in the paragraph heading, by <amendingAction type="delete">striking</amendingAction> “<quotedText><headingText class="smallCaps">2014</headingText></quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText><headingText class="smallCaps">2016</headingText></quotedText>”; and</content></clause> <clause class="fontsize10" id="y586bbee5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>by <amendingAction type="delete">striking</amendingAction> subparagraph (B) and <amendingAction type="insert">inserting</amendingAction> the following new subparagraph:<quotedContent><subparagraph class="indentDown1 fontsize10" id="y586be5f6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Fiscal year 2013 and each succeeding fiscal year</inline>.—</heading><chapeau>Subject to paragraphs (5) and (7), from the amount made available under paragraphs (16) through (19) of subsection (a) for fiscal year 2013 and each succeeding fiscal year, respectively, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for each such fiscal year as follows:</chapeau><clause class="fontsize10" id="y586be5f7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Rebasing in fiscal year 2013 and each succeeding odd-numbered fiscal year</inline>.—</heading><content>For fiscal year 2013 and each succeeding odd-numbered fiscal year (other than fiscal years 2015 and 2017), the allotment of the State is equal to the Federal payments to the State that are attributable to (and countable toward) the total amount of allotments available under this section to the State in the preceding fiscal year (including payments made to the State under subsection (n) for such preceding fiscal year as well as amounts redistributed to the State in such preceding fiscal year), multiplied by the allotment increase factor under paragraph (6) for such odd-numbered fiscal year.</content></clause> <clause class="fontsize10" id="y586be5f8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Growth factor update for fiscal year 2014 and each succeeding even-numbered fiscal year</inline>.—</heading><chapeau>Except as provided in clauses (iii) and (iv), for fiscal year 2014 and each succeeding even-numbered fiscal year, the allotment of the State is equal to the sum of—</chapeau><subclause class="fontsize10" id="y586be5f9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the amount of the State allotment under clause (i) for the preceding fiscal year; and</content></subclause> <subclause class="fontsize10" id="y586be5fa-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>the amount of any payments made to the State under subsection (n) for such preceding fiscal year,</content></subclause> <continuation class="firstIndent1 fontsize10" id="x586be5fb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126">multiplied by the allotment increase factor under paragraph (6) for such even-numbered fiscal year.</continuation></clause> <clause class="fontsize10" id="y586be5fc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Special rule for 2016</inline>.—</heading><content>For fiscal year 2016, the allotment of the State is equal to the Federal payments to the State that are attributable to (and countable toward) the total amount of allotments available under this section to the State in the preceding fiscal year (including payments made to the State under subsection (n) for such preceding fiscal year as well as amounts redistributed to the State in such preceding fiscal year), but determined as if the last two sentences of section 2105(b) were in effect in such preceding fiscal year and then multiplying the result by the allotment increase factor under paragraph (6) for fiscal year 2016.</content></clause> <clause class="fontsize10" id="y586be5fd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><heading class="fontsize10"><inline class="smallCaps">Reduction in 2018</inline>.—</heading><content>For fiscal year 2018, with respect to the allotment of the State for fiscal year 2017, any amounts of such allotment that remain <page identifier="/us/stat/129/156">129 STAT. 156</page> available for expenditure by the State in fiscal year 2018 shall be reduced by one-third.”</content></clause> </subparagraph> </quotedContent>;</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y586be5fe-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>in paragraph (4), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>or 2017</quotedText>” after “<quotedText>2015</quotedText>”;</content></subparagraph> <subparagraph class="fontsize10" id="y586be5ff-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/D" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><chapeau>in paragraph (6)—</chapeau><clause class="fontsize10" id="y586be600-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/D/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in subparagraph (A), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>”; and</content></clause> <clause class="fontsize10" id="y586be601-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/D/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in the second sentence, by <amendingAction type="delete">striking</amendingAction> “<quotedText>or fiscal year 2014</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>fiscal year 2014, or fiscal year 2016</quotedText>”;</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y586be602-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/E" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">(E) </num><chapeau>in paragraph (8)—</chapeau><clause class="fontsize10" id="y586be603-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/E/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in the paragraph heading, by <amendingAction type="delete">striking</amendingAction> “<quotedText><headingText class="smallCaps">fiscal year 2015</headingText></quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText><headingText class="smallCaps">fiscal years 2015 and 2017</headingText></quotedText>”; and</content></clause> <clause class="fontsize10" id="y586be604-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/E/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>or fiscal year 2017</quotedText>” after “<quotedText>2015</quotedText>”;</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y586be605-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/F" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="F">(F) </num><content>by <amendingAction type="redesignate">redesignating</amendingAction> paragraphs (4) through (8) as paragraphs (5) through (9), respectively; and</content></subparagraph> <subparagraph class="fontsize10" id="y586be606-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/1/G" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="G">(G) </num><content>by <amendingAction type="insert">inserting</amendingAction> after paragraph (3) the following new paragraph:<quotedContent><paragraph class="indentDown1 fontsize10" id="y586c3427-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">For fiscal year 2017</inline>.—</heading><subparagraph class="fontsize10" id="y586c3428-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">First half</inline>.—</heading><content>Subject to paragraphs (5) and (7), from the amount made available under subparagraph (A) of paragraph (20) of subsection (a) for the semi-annual period described in such paragraph, increased by the amount of the appropriation for such period under section 301(b)(3) of the Medicare Access and CHIP Reauthorization Act of 2015, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the first half ratio (described in subparagraph (D)) of the amount described in subparagraph (C).</content></subparagraph> <subparagraph class="fontsize10" id="y586c3429-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Second half</inline>.—</heading><chapeau>Subject to paragraphs (5) and (7), from the amount made available under subparagraph (B) of paragraph (20) of subsection (a) for the semi-annual period described in such paragraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made available under such subparagraph, multiplied by the ratio of—</chapeau><clause class="fontsize10" id="y586c342a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>the amount of the allotment to such State under subparagraph (A); to</content></clause> <clause class="fontsize10" id="y586c342b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>the total of the amount of all of the allotments made available under such subparagraph.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y586c342c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Full year amount based on rebased amount</inline>.—</heading><content>The amount described in this subparagraph for a State is equal to the Federal payments to the State that are attributable to (and countable towards) the total amount of allotments available under this section to the State in fiscal year 2016 (including payments made to the State under subsection (n) for fiscal year 2016 as well as amounts redistributed to the State in fiscal year 2016), multiplied by the allotment increase factor under paragraph (6) for fiscal year 2017.</content></subparagraph> <subparagraph class="fontsize10" id="y586c342d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><heading class="fontsize10"><inline class="smallCaps">First half ratio</inline>.—</heading><chapeau>The first half ratio described in this subparagraph is the ratio of—<page identifier="/us/stat/129/157">129 STAT. 157</page></chapeau><clause class="fontsize10" id="y586c342e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><chapeau>the sum of—</chapeau><subclause class="fontsize10" id="y586c342f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the amount made available under subsection (a)(20)(A); and</content></subclause> <subclause class="fontsize10" id="y586c3430-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>the amount of the appropriation for such period under section 301(b)(3) of the Medicare Access and CHIP Reauthorization Act of 2015; to</content></subclause> </clause> <clause class="fontsize10" id="y586c3431-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><chapeau>the sum of the—</chapeau><subclause class="fontsize10" id="y586c3432-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>amount described in clause (i); and</content></subclause> <subclause class="fontsize10" id="y586c3433-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>the amount made available under subsection (a)(20)(B).”</content></subclause> </clause> </subparagraph> </paragraph> </quotedContent>.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y586c3434-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Conforming amendments</inline>.—</heading><subparagraph class="fontsize10" id="y586c3435-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>Section 2104(c)(1) of the Social Security Act (<ref href="/us/usc/t42/s1397dd/c/1">42 U.S.C. 1397dd(c)(1)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>(m)(4)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>(m)(5)</quotedText>”.</content></subparagraph> <subparagraph class="fontsize10" id="y586c3436-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><chapeau>Section 2104(m) of such Act (<ref href="/us/usc/t42/s1397dd/m">42 U.S.C. 1397dd(m)</ref>), as amended by paragraph (1), is further amended—</chapeau><clause class="fontsize10" id="y586c3437-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><chapeau>in paragraph (1)—</chapeau><subclause class="fontsize10" id="y586c3438-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/B/i/I" role="instruction" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>paragraph (4)</quotedText>” each place it appears in subparagraphs (A) and (B) and <amendingAction type="insert">inserting</amendingAction> “<quotedText>paragraph (5)</quotedText>”; and</content></subclause> <subclause class="fontsize10" id="y586c3439-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/B/i/II" role="instruction" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>the allotment increase factor determined under paragraph (5)</quotedText>” each place it appears and <amendingAction type="insert">inserting</amendingAction> “<quotedText>the allotment increase factor determined under paragraph (6)</quotedText>”;</content></subclause> </clause> <clause class="fontsize10" id="y586c343a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/B/ii" role="instruction" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in paragraph (2)(A), by <amendingAction type="delete">striking</amendingAction> “<quotedText>the allotment increase factor under paragraph (5)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>the allotment increase factor under paragraph (6)</quotedText>”;</content></clause> <clause class="fontsize10" id="y586c343b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/B/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><chapeau>in paragraph (3)—</chapeau><subclause class="fontsize10" id="y586c343c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/B/iii/I" role="instruction" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>paragraphs (4) and (6)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>paragraphs (5) and (7)</quotedText>” each place it appears; and</content></subclause> <subclause class="fontsize10" id="y586c343d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/B/iii/II" role="instruction" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>the allotment increase factor under paragraph (5)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>the allotment increase factor under paragraph (6)</quotedText>”;</content></subclause> </clause> <clause class="fontsize10" id="y586c343e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/B/iv" role="instruction" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">(iv) </num><content>in paragraph (5) (as redesignated by paragraph (1)(F)), by <amendingAction type="delete">striking</amendingAction> “<quotedText>paragraph (1), (2), or (3)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>paragraph (1), (2), (3), or (4)</quotedText>”;</content></clause> <clause class="fontsize10" id="y586c5b4f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/B/v" role="instruction" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">(v) </num><content>in paragraph (7) (as redesignated by paragraph (1)(F)), by <amendingAction type="delete">striking</amendingAction> “<quotedText>subject to paragraph (4)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>subject to paragraph (5)</quotedText>”; and</content></clause> <clause class="fontsize10" id="y586c5b50-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/B/vi" role="instruction" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">(vi) </num><content>in paragraph (9), (as redesignated by paragraph (1)(F)), by <amendingAction type="delete">striking</amendingAction> “<quotedText>paragraph (3)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>paragraph (3) or (4)</quotedText>”.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y586c5b51-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/C" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>Section 2104(n)(3)(B)(ii) of such Act (<ref href="/us/usc/t42/s1397dd/n/3/B/ii">42 U.S.C. 1397dd(n)(3)(B)(ii)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>subsection (m)(5)(B)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>subsection (m)(6)(B)</quotedText>”.</content></subparagraph> <subparagraph class="fontsize10" id="y586c5b52-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/2/D" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><content>Section 2111(b)(2)(B)(i) of such Act (<ref href="/us/usc/t42/s1397kk/b/2/B/i">42 U.S.C. 1397kk(b)(2)(B)(i)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>section 2104(m)(4)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>section 2104(m)(5)</quotedText>”.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y586c5b53-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/b/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">One-time appropriation for fiscal year 2017</inline>.—</heading><content>There is appropriated to the Secretary of Health and Human Services, out of any money in the Treasury not otherwise appropriated, $14,700,000,000 to accompany the allotment made for the period beginning on October 1, 2016, and ending on March 31, 2017, under paragraph (20)(A) of section 2104(a) of the Social Security Act (<ref href="/us/usc/t42/s1397dd/a">42 U.S.C. 1397dd(a)</ref>) (as added by subsection (a)(1)), to remain available until expended. Such amount <page identifier="/us/stat/129/158">129 STAT. 158</page> shall be used to provide allotments to States under paragraph (4) of section 2104(m) of such Act (<ref href="/us/usc/t42/s1397dd/m">42 U.S.C. 1397dd(m)</ref>) (as amended by paragraph(1)(G)) for the first 6 months of fiscal year 2017 in the same manner as allotments are provided under subsection (a)(20)(A) of such section 2104 and subject to the same terms and conditions as apply to the allotments provided from such subsection (a)(20)(A).</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y586c5b54-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/c" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Extension of Qualifying States Option</inline>.—</heading><chapeau>Section 2105(g)(4) of the Social Security Act (<ref href="/us/usc/t42/s1397ee/g/4">42 U.S.C. 1397ee(g)(4)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586c5b55-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in the paragraph heading, by <amendingAction type="delete">striking</amendingAction> “<quotedText><headingText class="smallCaps">2015</headingText></quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText><headingText class="smallCaps">2017</headingText></quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y586c5b56-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in subparagraph (A), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y586c5b57-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/d" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><heading class="fontsize10"><inline class="smallCaps">Extension of the Child Enrollment Contingency Fund</inline>.—</heading><paragraph class="fontsize10" id="y586c5b58-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/d/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>Section 2104(n) of the Social Security Act (<ref href="/us/usc/t42/s1397dd/n">42 U.S.C. 1397dd(n)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><subparagraph class="fontsize10" id="y586c5b59-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/d/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><chapeau>in paragraph (2)—</chapeau><clause class="fontsize10" id="y586c5b5a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/d/1/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><chapeau>in subparagraph (A)(ii)—</chapeau><subclause class="fontsize10" id="y586c5b5b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/d/1/A/i/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>2010 through 2014</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2010, 2011, 2012, 2013, 2014, and 2016</quotedText>”; and</content></subclause> <subclause class="fontsize10" id="y586c5b5c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/d/1/A/i/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and fiscal year 2017</quotedText>” after “<quotedText>2015</quotedText>”; and</content></subclause> </clause> <clause class="fontsize10" id="y586c5b5d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/d/1/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><chapeau>in subparagraph (B)—</chapeau><subclause class="fontsize10" id="y586c5b5e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/d/1/A/ii/I" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">(I) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>2010 through 2014</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2010, 2011, 2012, 2013, 2014, and 2016</quotedText>”; and</content></subclause> <subclause class="fontsize10" id="y586c5b5f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/d/1/A/ii/II" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">(II) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and fiscal year 2017</quotedText>” after “<quotedText>2015</quotedText>”; and</content></subclause> </clause> </subparagraph> <subparagraph class="fontsize10" id="y586c5b60-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s301/d/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in paragraph (3)(A), in the matter preceding clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>fiscal year 2009, fiscal year 2010, fiscal year 2011, fiscal year 2012, fiscal year 2013, fiscal year 2014, or a semi-annual allotment period for fiscal year 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>any of fiscal years 2009 through 2014, fiscal year 2016, or a semi-annual allotment period for fiscal year 2015 or 2017</quotedText>”.</content></subparagraph> </paragraph> </subsection> </section> <section id="d354370e9632" identifier="/us/pl/114/10/tIII/s302" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="302">SEC. 302. </num><heading>EXTENSION OF EXPRESS LANE ELIGIBILITY.</heading><content style="-uslm-lc:I658120"> Section 1902(e)(13)(I) of the Social Security Act (<ref href="/us/usc/t42/s1396a/e/13/I">42 U.S.C. 1396a(e)(13)(I)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>”.</content></section> <section id="d354370e9651" identifier="/us/pl/114/10/tIII/s303" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="303">SEC. 303. </num><heading>EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM.</heading><chapeau class="indentUp0 firstIndent0 fontsize10" id="x586c8271-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 2113 of the Social Security Act (<ref href="/us/usc/t42/s1397mm">42 U.S.C. 1397mm</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586c8272-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s303/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in subsection (a)(1), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y586c8273-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s303/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in subsection (g), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and $40,000,000 for the period of fiscal years 2016 and 2017</quotedText>” after “<quotedText>2015</quotedText>”.</content></paragraph> </section> <section id="d354370e9685" identifier="/us/pl/114/10/tIII/s304" style="-uslm-lc:I658143"><num class="fontsize12" value="304">SEC. 304. </num><heading>EXTENSION OF CERTAIN PROGRAMS AND DEMONSTRATION PROJECTS.</heading><subsection class="firstIndent0 fontsize10" id="y586c8274-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s304/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Childhood Obesity Demonstration Project</inline>.—</heading><content>Section 1139A(e)(8) of the Social Security Act (<ref href="/us/usc/t42/s1320b–9a/e/8">42 U.S.C. 1320b–9a(e)(8)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> “<quotedText>, and $10,000,000 for the period of fiscal years 2016 and 2017</quotedText>” after “<quotedText>2014</quotedText>”.<page identifier="/us/stat/129/159">129 STAT. 159</page></content></subsection> <subsection class="firstIndent0 fontsize10" id="y586c8275-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s304/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Pediatric Quality Measures Program</inline>.—</heading><content>Section 1139A(i) of the Social Security Act (<ref href="/us/usc/t42/s1320b–9a/i">42 U.S.C. 1320b–9a(i)</ref>) <amendingAction type="amend">is amended</amendingAction> in the first sentence by <amendingAction type="insert">inserting</amendingAction> before the period at the end the following: “<quotedText>, and there is appropriated for the period of fiscal years 2016 and 2017, $20,000,000 for the purpose of carrying out this section (other than subsections (e), (f), and (g))</quotedText>”.</content></subsection> </section> <section id="d354370e9731" identifier="/us/pl/114/10/tIII/s305" style="-uslm-lc:I658143"><num class="fontsize12" value="305">SEC. 305. </num><heading>REPORT OF INSPECTOR GENERAL OF HHS ON USE OF EXPRESS LANE OPTION UNDER MEDICAID AND CHIP.</heading><chapeau class="indentUp0 firstIndent0 fontsize10" id="x586cd096-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Not later than 18 months after the date of the enactment of this Act, the Inspector General of the Department of Health and Human Services shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report that—</chapeau><paragraph class="fontsize10" id="y586cd097-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s305/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>provides data on the number of individuals enrolled in the Medicaid program under title XIX of the Social Security Act (referred to in this section as “Medicaid”) and the Children’s Health Insurance Program under title XXI of such Act (referred to in this section as “CHIP”) through the use of the Express Lane option under section 1902(e)(13) of the Social Security Act (<ref href="/us/usc/t42/s1396a/e/13">42 U.S.C. 1396a(e)(13)</ref>);</content></paragraph> <paragraph class="fontsize10" id="y586cd098-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s305/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>assesses the extent to which individuals so enrolled meet the eligibility requirements under Medicaid or CHIP (as applicable); and</content></paragraph> <paragraph class="fontsize10" id="y586cd099-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIII/s305/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>provides data on Federal and State expenditures under Medicaid and CHIP for individuals so enrolled and disaggregates such data between expenditures made for individuals who meet the eligibility requirements under Medicaid or CHIP (as applicable) and expenditures made for individuals who do not meet such requirements.</content></paragraph> </section> <num value="IV">TITLE IV—</num><heading>OFFSETS</heading> <subtitle id="d354370e9763" identifier="/us/pl/114/10/tIV/stA" style="-uslm-lc:I658178"><num value="A">Subtitle A—</num><heading>Medicare Beneficiary Reforms</heading> <section id="d354370e9768" identifier="/us/pl/114/10/tIV/stA/s401" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="401">SEC. 401. </num><heading>LIMITATION ON CERTAIN MEDIGAP POLICIES FOR NEWLY ELIGIBLE MEDICARE BENEFICIARIES.</heading><content class="firstIndent0 fontsize10" id="x586cf7aa-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 1882 of the Social Security Act (<ref href="/us/usc/t42/s1395ss">42 U.S.C. 1395ss</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="firstIndent0 fontsize10" id="y586d1ebb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="z">“(z) </num><heading class="fontsize10"><inline class="smallCaps">Limitation on Certain Medigap Policies for Newly Eligible Medicare Beneficiaries</inline>.—</heading><paragraph class="fontsize10" id="y586d1ebc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x586d1ebd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Notwithstanding any other provision of this section, on or after January 1, 2020, a medicare supplemental policy that provides coverage of the part B deductible, including any such policy (or rider to such a policy) issued under a waiver granted under subsection (p)(6), may not be sold or issued to a newly eligible Medicare beneficiary.</content></paragraph> <paragraph class="fontsize10" id="y586d1ebe-e871-11f0-bc57-ad3ac4b1618c" role="definitions" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">Newly eligible medicare beneficiary defined</inline>.—</heading><chapeau>In this subsection, the term ‘<term>newly eligible Medicare beneficiary</term>’ means an individual who is neither of the following:</chapeau><subparagraph class="fontsize10" id="y586d1ebf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>An individual who has attained age 65 before January 1, 2020.</content></subparagraph> <subparagraph class="fontsize10" id="y586d1ec0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>An individual who was entitled to benefits under part A pursuant to section 226(b) or 226A, or deemed to be eligible for benefits under section 226(a), before January 1, 2020.<page identifier="/us/stat/129/160">129 STAT. 160</page></content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y586d1ec1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Treatment of waivered states</inline>.—</heading><content>In the case of a State described in subsection (p)(6), nothing in this section shall be construed as preventing the State from modifying its alternative simplification program under such subsection so as to eliminate the coverage of the part B deductible for any medical supplemental policy sold or issued under such program to a newly eligible Medicare beneficiary on or after January 1, 2020.</content></paragraph> <paragraph class="fontsize10" id="y586d1ec2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Treatment of references to certain policies</inline>.—</heading><content>In the case of a newly eligible Medicare beneficiary, except as the Secretary may otherwise provide, any reference in this section to a medicare supplemental policy which has a benefit package classified as ‘C’ or ‘F’ shall be deemed, as of January 1, 2020, to be a reference to a medicare supplemental policy which has a benefit package classified as ‘D’ or ‘G’, respectively.</content></paragraph> <paragraph class="fontsize10" id="y586d1ec3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">“(5) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x586d1ec4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Enforcement</inline>.—</heading><content>The penalties described in clause (ii) of subsection (d)(3)(A) shall apply with respect to a violation of paragraph (1) in the same manner as it applies to a violation of clause (i) of such subsection.”</content></paragraph> </subsection> </quotedContent>.</content></section> <section id="d354370e9859" identifier="/us/pl/114/10/tIV/stA/s402" style="-uslm-lc:I658143"><num class="fontsize12" value="402">SEC. 402. </num><heading>INCOME-RELATED PREMIUM ADJUSTMENT FOR PARTS B AND D.</heading><subsection class="firstIndent0 fontsize10" id="y586d93f5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stA/s402/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><chapeau>Section 1839(i)(3)(C)(i) of the Social Security Act (<ref href="/us/usc/t42/s1395r/i/3/C/i">42 U.S.C. 1395r(i)(3)(C)(i)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586d93f6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stA/s402/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>by <amendingAction type="insert">inserting</amendingAction> after “<quotedText><headingText class="smallCaps">In general.—</headingText></quotedText>” the following:<quotedContent><subclause class="indentUp3 fontsize10" id="y586d93f7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>Subject to paragraphs (5) and (6), for years before 2018:”</content></subclause> </quotedContent>; and</content></paragraph> <paragraph class="fontsize10" id="y586d93f8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stA/s402/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following:<quotedContent><subparagraph class="indentUp3 fontsize10" id="y586d93f9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>Subject to paragraph (5), for years beginning with 2018:<xhtml:table xmlns:xhtml="http://www.w3.org/1999/xhtml" class="Quoted fullWidth" style="border-collapse:collapse; border=0; -uslm-lc: 'c2,L0,nc,tp0,p0,10/12,s200n,16n'; "><xhtml:colgroup><xhtml:col role="stub" style="min-width: 341pt;"/> <xhtml:col role="figure" style="width:84pt ; max-width:84pt;"/> </xhtml:colgroup><xhtml:thead><xhtml:tr class="header" style="font-size:8pt;-uslm-lc:h1"> <xhtml:td/> </xhtml:tr> </xhtml:thead><xhtml:tbody style="line-height:12pt; font-size:10pt;"><xhtml:tr style="-uslm-lc:I01"><xhtml:td leaderAlign="bottomLine" leaders="no" stubHierarchy="1" style="min-width: 341.0pt; text-align:left; vertical-align:top;"><b>“If the modified adjusted gross income is:</b></xhtml:td><xhtml:td leaders="no" style="width:84.0pt ; max-width:84.0pt; text-align:right; vertical-align:bottom;"><b>The applicable percentage is:</b> </xhtml:td></xhtml:tr> <xhtml:tr style="-uslm-lc:I02"><xhtml:td leaderAlign="bottomLine" leaders="yes" stubHierarchy="2" style=" text-align:left; vertical-align:top;"><inline>More than $85,000 but not more than $107,000</inline></xhtml:td><xhtml:td leaders="no" style=" text-align:right; vertical-align:bottom;">35 percent </xhtml:td></xhtml:tr> <xhtml:tr style="-uslm-lc:I02"><xhtml:td leaderAlign="bottomLine" leaders="yes" stubHierarchy="2" style=" text-align:left; vertical-align:top;"><inline>More than $107,000 but not more than $133,500</inline></xhtml:td><xhtml:td leaders="no" style=" text-align:right; vertical-align:bottom;">50 percent </xhtml:td></xhtml:tr> <xhtml:tr style="-uslm-lc:I02"><xhtml:td leaderAlign="bottomLine" leaders="yes" stubHierarchy="2" style=" text-align:left; vertical-align:top;"><inline>More than $133,500 but not more than $160,000</inline></xhtml:td><xhtml:td leaders="no" style=" text-align:right; vertical-align:bottom;"> 65 percent </xhtml:td></xhtml:tr> <xhtml:tr style="-uslm-lc:I02"><xhtml:td leaderAlign="bottomLine" leaders="yes" stubHierarchy="2" style=" text-align:left; vertical-align:top;"><inline>More than $160,000</inline></xhtml:td><xhtml:td leaders="no" style=" text-align:right; vertical-align:bottom;">80 percent.”.</xhtml:td></xhtml:tr> </xhtml:tbody></xhtml:table></content></subparagraph> </quotedContent><?GPOvSpace 04?></content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y586d93fa-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stA/s402/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Conforming Amendments</inline>.—</heading><chapeau>Section 1839(i) of the Social Security Act (<ref href="/us/usc/t42/s1395r/i">42 U.S.C. 1395r(i)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586d93fb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stA/s402/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in paragraph (2)(A), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>(or, beginning with 2018, $85,000)</quotedText>” after “<quotedText>$80,000</quotedText>”;</content></paragraph> <paragraph class="fontsize10" id="y586d93fc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stA/s402/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in paragraph (3)(A)(i), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>applicable</quotedText>” before “<quotedText>table</quotedText>”;</content></paragraph> <paragraph class="fontsize10" id="y586d93fd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stA/s402/b/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><chapeau>in paragraph (5)(A)—</chapeau><subparagraph class="fontsize10" id="y586d93fe-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stA/s402/b/3/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in the matter before clause (i), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>(other than 2018 and 2019)</quotedText>” after “<quotedText>2007</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y586d93ff-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stA/s402/b/3/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in clause (ii), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>(or, in the case of a calendar year beginning with 2020, August 2018)</quotedText>” after “<quotedText>August 2006</quotedText>”; and</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y586d9400-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stA/s402/b/4" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><content>in paragraph (6), in the matter before subparagraph (A), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2019</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>”.<page identifier="/us/stat/129/161">129 STAT. 161</page></content></paragraph> </subsection> </section> </subtitle> <subtitle id="d354370e10038" identifier="/us/pl/114/10/tIV/stB" style="-uslm-lc:I658178"><num value="B">Subtitle B—</num><heading>Other Offsets</heading> <section id="d354370e10043" identifier="/us/pl/114/10/tIV/stB/s411" style="-uslm-lc:I658143"><num class="fontsize12" value="411">SEC. 411. </num><heading>MEDICARE PAYMENT UPDATES FOR POST-ACUTE PROVIDERS.</heading><subsection class="firstIndent0 fontsize10" id="y586e5751-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">SNFs</inline>.—</heading><chapeau>Section 1888(e) of the Social Security Act (<ref href="/us/usc/t42/s1395yy/e">42 U.S.C. 1395yy(e)</ref>)—</chapeau><paragraph class="fontsize10" id="y586e5752-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><chapeau>in paragraph (5)(B)—</chapeau><subparagraph class="fontsize10" id="y586e5753-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/a/1/A" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>clause (ii)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>clauses (ii) and (iii)</quotedText>”;</content></subparagraph> <subparagraph class="fontsize10" id="y586e5754-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/a/1/B" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in clause (ii), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>subject to clause (iii),</quotedText>” after “<quotedText>each subsequent fiscal year,</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y586e5755-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/a/1/C" role="instruction" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new clause:<quotedContent><clause class="fontsize10" id="y586e7e66-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Special rule for fiscal year 2018</inline>.—</heading><content>For fiscal year 2018 (or other similar annual period specified in clause (i)), the skilled nursing facility market basket percentage, after application of clause (ii), is equal to 1 percent.”</content></clause> </quotedContent>; and</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y586e7e67-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/a/2" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in paragraph (6)(A), by <amendingAction type="delete">striking</amendingAction> “<quotedText>paragraph (5)(B)(ii)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>clauses (ii) and (iii) of paragraph (5)(B)</quotedText>” each place it appears.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y586e7e68-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">IRFs</inline>.—</heading><chapeau>Section 1886(j) of the Social Security Act (<ref href="/us/usc/t42/s1395ww/j">42 U.S.C. 1395ww(j)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586e7e69-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><chapeau>in paragraph (3)(C)—</chapeau><subparagraph class="fontsize10" id="y586e7e6a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/b/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>clause (ii)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>clauses (ii) and (iii)</quotedText>”;</content></subparagraph> <subparagraph class="fontsize10" id="y586e7e6b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/b/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in clause (ii), by <amendingAction type="delete">striking</amendingAction> “<quotedText>After</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>Subject to clause (iii), after</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y586e7e6c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/b/1/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new clause:<quotedContent><clause class="fontsize10" id="y586e7e6d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x586e7e6e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Special rule for fiscal year 2018</inline>.—</heading><content>The increase factor to be applied under this subparagraph for fiscal year 2018, after the application of clause (ii), shall be 1 percent.”</content></clause> </quotedContent>; and</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y586e7e6f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in paragraph (7)(A)(i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>paragraph (3)(D)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>subparagraphs (C)(iii) and (D) of paragraph (3)</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y586e7e70-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/c" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">HHAs</inline>.—</heading><chapeau>Section 1895(b)(3)(B) of the Social Security Act (<ref href="/us/usc/t42/s1395fff/b/3/B">42 U.S.C. 1395fff(b)(3)(B)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586e7e71-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in clause (iii), by <amendingAction type="add">adding</amendingAction> at the end the following: “<quotedText>Notwithstanding the previous sentence, the home health market basket percentage increase for 2018 shall be 1 percent.</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y586e7e72-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in clause (vi)(I), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>(except 2018)</quotedText>” after “<quotedText>each subsequent year</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y586e7e73-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/d" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><heading class="fontsize10"><inline class="smallCaps">Hospice</inline>.—</heading><chapeau>Section 1814(i) of the Social Security Act (<ref href="/us/usc/t42/s1395f/i">42 U.S.C. 1395f(i)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586e7e74-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/d/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><chapeau>in paragraph (1)(C)—</chapeau><subparagraph class="fontsize10" id="y586e7e75-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/d/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in clause (ii)(VII), by <amendingAction type="delete">striking</amendingAction> “<quotedText>clause (iv),,</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>clauses (iv) and (vi),</quotedText>”;</content></subparagraph> <subparagraph class="fontsize10" id="y586e7e76-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/d/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in clause (iii), by <amendingAction type="delete">striking</amendingAction> “<quotedText>clause (iv),</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>clauses (iv) and (vi),</quotedText>”;</content></subparagraph> <subparagraph class="fontsize10" id="y586e7e77-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/d/1/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>in clause (iv), by <amendingAction type="delete">striking</amendingAction> “<quotedText>After determining</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>Subject to clause (vi), after determining</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y586e7e78-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/d/1/D" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">(D) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new clause:<quotedContent><clause class="indentDown2 firstIndent0 fontsize10" id="y586e7e79-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="vi">“(vi) </num><content>For fiscal year 2018, the market basket percentage increase under clause (ii)(VII) or (iii), as applicable, after application of clause (iv), shall be 1 percent.”</content></clause> </quotedContent>; and<page identifier="/us/stat/129/162">129 STAT. 162</page></content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y586e7e7a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/d/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in paragraph (5)(A)(i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>paragraph (1)(C)(iv)</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>clauses (iv) and (vi) of paragraph (1)(C)</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y586e7e7b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/e" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="e">(e) </num><heading class="fontsize10"><inline class="smallCaps">LTCHs</inline>.—</heading><chapeau>Section 1886(m)(3) of the Social Security Act (<ref href="/us/usc/t42/s1395ww/m/3">42 U.S.C. 1395ww(m)(3)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586e7e7c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/e/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in subparagraph (A), in the matter preceding clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>In implementing</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>Subject to subparagraph (C), in implementing</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y586e7e7d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s411/e/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraph:<quotedContent><subparagraph class="fontsize10" id="y586e7e7e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Additional special rule</inline>.—</heading><content>For fiscal year 2018, the annual update under subparagraph (A) for the fiscal year, after application of clauses (i) and (ii) of subparagraph (A), shall be 1 percent.”</content></subparagraph> </quotedContent>.</content></paragraph> </subsection> </section> <section id="d354370e10368" identifier="/us/pl/114/10/tIV/stB/s412" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="412">SEC. 412. </num><heading>DELAY OF REDUCTION TO MEDICAID DSH ALLOTMENTS.</heading><chapeau class="indentUp0 firstIndent0 fontsize10" id="x586ecc9f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 1923(f) of the Social Security Act (<ref href="/us/usc/t42/s1396r–4/f">42 U.S.C. 1396r–4(f)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586ecca0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s412/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><chapeau>in paragraph (7)(A)—</chapeau><subparagraph class="fontsize10" id="y586ecca1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s412/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2017 through 2024</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2018 through 2025</quotedText>”;</content></subparagraph> <subparagraph class="fontsize10" id="y586ecca2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s412/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>by <amendingAction type="delete">striking</amendingAction> clause (ii) and <amendingAction type="insert">inserting</amendingAction> the following new clause:<quotedContent><clause class="fontsize10" id="y586ef3b3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Aggregate reductions</inline>.—</heading><chapeau>The aggregate reductions in DSH allotments for all States under clause (i)(I) shall be equal to—</chapeau><subclause class="fontsize10" id="y586ef3b4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>$2,000,000,000 for fiscal year 2018;</content></subclause> <subclause class="fontsize10" id="y586ef3b5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>$3,000,000,000 for fiscal year 2019;</content></subclause> <subclause class="fontsize10" id="y586ef3b6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="III">“(III) </num><content>$4,000,000,000 for fiscal year 2020;</content></subclause> <subclause class="fontsize10" id="y586ef3b7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="IV">“(IV) </num><content>$5,000,000,000 for fiscal year 2021;</content></subclause> <subclause class="fontsize10" id="y586ef3b8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="V">“(V) </num><content>$6,000,000,000 for fiscal year 2022;</content></subclause> <subclause class="fontsize10" id="y586ef3b9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="VI">“(VI) </num><content>$7,000,000,000 for fiscal year 2023;</content></subclause> <subclause class="fontsize10" id="y586ef3ba-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="VII">“(VII) </num><content>$8,000,000,000 for fiscal year 2024; and</content></subclause> <subclause class="fontsize10" id="y586ef3bb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="VIII">“(VIII) </num><content>$8,000,000,000 for fiscal year 2025.”</content></subclause> </clause> </quotedContent>; and</content></subparagraph> <subparagraph class="fontsize10" id="y586ef3bc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s412/1/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new clause:<quotedContent><clause class="fontsize10" id="y586ef3bd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><heading class="fontsize10"><inline class="smallCaps">Distribution of aggregate reductions</inline>.—</heading><content>The Secretary shall distribute the aggregate reductions under clause (ii) among States in accordance with subparagraph (B).”</content></clause> </quotedContent>; and</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y586ef3be-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s412/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in paragraph (8), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2024</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2025</quotedText>”.</content></paragraph> </section> <section id="d354370e10494" identifier="/us/pl/114/10/tIV/stB/s413" style="-uslm-lc:I658143"><num class="fontsize12" value="413">SEC. 413. </num><heading>LEVY ON DELINQUENT PROVIDERS.</heading><subsection class="firstIndent0 fontsize10" id="y586f1acf-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s413/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><content>Paragraph (3) of section 6331(h) of the Internal Revenue Code of 1986<sidenote><p class="leftAlign firstIndent0 fontsize8" id="x586f1ad0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t26/s6331">26 USC 6331</ref>.</p></sidenote> <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>30 percent</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>100 percent</quotedText>”.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y586f1ad1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s413/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x586f1ad2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p><p class="leftAlign firstIndent0 fontsize8" id="x586f1ad3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t26/s6331">26 USC 6331 note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Effective Date</inline>.—</heading><content>The amendment made by this section shall apply to payments made after 180 days after the date of the enactment of this Act.</content></subsection> </section> <section id="d354370e10540" identifier="/us/pl/114/10/tIV/stB/s414" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="414">SEC. 414. </num><heading>ADJUSTMENTS TO INPATIENT HOSPITAL PAYMENT RATES.</heading><chapeau class="indentUp0 firstIndent0 fontsize10" id="x586f68f4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 7(b) of the TMA, Abstinence Education, and QI Programs Extension Act of 2007 (<ref href="/us/pl/110/90">Public Law 110–90</ref>), as amended by section 631(b) of the American Taxpayer Relief Act of 2012 (<ref href="/us/pl/112/240">Public Law 112–240</ref>), <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x586f68f5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/stat/121/986">121 Stat. 986</ref>.</p></sidenote><amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y586f68f6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s414/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><chapeau>in paragraph (1)—</chapeau><subparagraph class="fontsize10" id="y586f68f7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s414/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in the matter preceding subparagraph (A), by <amendingAction type="delete">striking</amendingAction> “<quotedText>, 2009, or 2010</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>or 2009</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y586f68f8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s414/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><chapeau>in subparagraph (B)—<page identifier="/us/stat/129/163">129 STAT. 163</page></chapeau><clause class="fontsize10" id="y586f68f9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s414/1/B/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>in clause (i), by <amendingAction type="delete">striking</amendingAction> “<quotedText>and</quotedText>” at the end;</content></clause> <clause class="fontsize10" id="y586f68fa-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s414/1/B/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>in clause (ii), by <amendingAction type="delete">striking</amendingAction> the period at the end and <amendingAction type="insert">inserting</amendingAction> “<quotedText>; and</quotedText>”; and</content></clause> <clause class="fontsize10" id="y586f68fb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s414/1/B/iii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">(iii) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new clause:<quotedContent><clause class="indentDown1 fontsize10" id="y586f900c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>make an additional adjustment to the standardized amounts under such section 1886(d) of an increase of 0.5 percentage points for discharges occurring during each of fiscal years 2018 through 2023 and not make the adjustment (estimated to be an increase of 3.2 percent) that would otherwise apply for discharges occurring during fiscal year 2018 by reason of the completion of the adjustments required under clause (ii).”</content></clause> </quotedContent>;</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y586f900d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s414/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><chapeau>in paragraph (3)—</chapeau><subparagraph class="fontsize10" id="y586f900e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s414/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>shall be construed</quotedText>” and all that follows through “<quotedText>providing authority</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>shall be construed as providing authority</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y586f900f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s414/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>by <amendingAction type="insert">inserting</amendingAction> “<quotedText>and each succeeding fiscal year through fiscal year 2023</quotedText>” after “<quotedText>2017</quotedText>”;</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y586f9010-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s414/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>by <amendingAction type="redesignate">redesignating</amendingAction> paragraphs (3) and (4) as paragraphs (4) and (5), respectively; and</content></paragraph> <paragraph class="fontsize10" id="y586f9011-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tIV/stB/s414/4" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><content>by <amendingAction type="insert">inserting</amendingAction> after paragraph (2) the following new paragraph:<quotedContent><paragraph class="indentUp0 fontsize10" id="y586f9012-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Prohibition</inline>.—</heading><content>The Secretary shall not make an additional prospective adjustment (estimated to be a decrease of 0.55 percent) to the standardized amounts under such section 1886(d) to offset the amount of the increase in aggregate payments related to documentation and coding changes for discharges occurring during fiscal year 2010.”</content></paragraph> </quotedContent>.</content></paragraph> </section> </subtitle> <num value="V">TITLE V—</num><heading>MISCELLANEOUS</heading> <subtitle id="d354370e10685" identifier="/us/pl/114/10/tV/stA" style="-uslm-lc:I658178"><num value="A">Subtitle A—</num><heading>Protecting the Integrity of Medicare</heading> <section id="d354370e10690" identifier="/us/pl/114/10/tV/stA/s501" style="-uslm-lc:I658143"><num class="fontsize12" value="501">SEC. 501. </num><heading>PROHIBITION OF INCLUSION OF SOCIAL SECURITY ACCOUNT NUMBERS ON MEDICARE CARDS.</heading><subsection class="firstIndent0 fontsize10" id="y58705363-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><chapeau>Section 205(c)(2)(C) of the Social Security Act (<ref href="/us/usc/t42/s405/c/2/C">42 U.S.C. 405(c)(2)(C)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y58705364-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>by moving clause (x), as added by section 1414(a)(2) of the Patient Protection and Affordable Care Act, 6 ems to the left;</content></paragraph> <paragraph class="fontsize10" id="y58705365-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="redesignate">redesignating</amendingAction> clause (x), as added by section 2(a)(1) of the Social Security Number Protection Act of 2010, and clause (xi) as clauses (xi) and (xii), respectively; and</content></paragraph> <paragraph class="fontsize10" id="y58705366-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/a/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new clause:<quotedContent><clause class="indentDown1 firstIndent0 fontsize10" id="y58705367-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="xiii">“(xiii) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58705368-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Consultation.</p><p class="leftAlign firstIndent0 fontsize8" id="x58705369-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Procedures.</p></sidenote><content>The Secretary of Health and Human Services, in consultation with the Commissioner of Social Security, shall establish cost-effective procedures to ensure that a Social Security account number (or derivative thereof) is not displayed, coded, or embedded on the Medicare card issued to an individual who is entitled to benefits under part A of title XVIII or enrolled under part B of title XVIII and that any other identifier displayed on such card is not identifiable as a Social Security account number (or derivative thereof).”</content></clause> </quotedContent>.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5870536a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5870536b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s405">42 USC 405 note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Implementation</inline>.—</heading><chapeau>In implementing clause (xiii) of section 205(c)(2)(C) of the Social Security Act (<ref href="/us/usc/t42/s405/c/2/C">42 U.S.C. 405(c)(2)(C)</ref>), as <page identifier="/us/stat/129/164">129 STAT. 164</page> added by subsection (a)(3), the Secretary of Health and Human Services shall do the following:</chapeau><paragraph class="fontsize10" id="y5870536c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Establish a cost-effective process that involves the least amount of disruption to, as well as necessary assistance for, Medicare beneficiaries and health care providers, such as a process that provides such beneficiaries with access to assistance through a toll-free telephone number and provides outreach to providers.</content></paragraph> <paragraph class="fontsize10" id="y5870536d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Consideration of medicare beneficiary identified</inline>.—</heading><content>Consider implementing a process, similar to the process involving Railroad Retirement Board beneficiaries, under which a Medicare beneficiary identifier which is not a Social Security account number (or derivative thereof) is used external to the Department of Health and Human Services and is convertible over to a Social Security account number (or derivative thereof) for use internal to such Department and the Social Security Administration.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5870536e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Funding for Implementation</inline>.—</heading><chapeau>For purposes of implementing the provisions of and the amendments made by this section, the Secretary of Health and Human Services shall provide for the following transfers from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (<ref href="/us/usc/t42/s1395i">42 U.S.C. 1395i</ref>) and from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of such Act (<ref href="/us/usc/t42/s1395t">42 U.S.C. 1395t</ref>), in such proportions as the Secretary determines appropriate:</chapeau><paragraph class="fontsize10" id="y5870536f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><chapeau>To the Centers for Medicare & Medicaid Program Management Account, transfers of the following amounts:</chapeau><subparagraph class="fontsize10" id="y58705370-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/c/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>For fiscal year 2015, $65,000,000, to be made available through fiscal year 2018.</content></subparagraph> <subparagraph class="fontsize10" id="y58705371-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/c/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>For each of fiscal years 2016 and 2017, $53,000,000, to be made available through fiscal year 2018.</content></subparagraph> <subparagraph class="fontsize10" id="y58705372-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/c/1/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>For fiscal year 2018, $48,000,000, to be made available until expended.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58705373-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><chapeau>To the Social Security Administration Limitation on Administration Account, transfers of the following amounts:</chapeau><subparagraph class="fontsize10" id="y58705374-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/c/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>For fiscal year 2015, $27,000,000, to be made available through fiscal year 2018.</content></subparagraph> <subparagraph class="fontsize10" id="y58705375-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/c/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>For each of fiscal years 2016 and 2017, $22,000,000, to be made available through fiscal year 2018.</content></subparagraph> <subparagraph class="fontsize10" id="y58705376-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/c/2/C" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">(C) </num><content>For fiscal year 2018, $27,000,000, to be made available until expended.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58705377-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/c/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><chapeau>To the Railroad Retirement Board Limitation on Administration Account, the following amount:</chapeau><subparagraph class="fontsize10" id="y58705378-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/c/3/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>For fiscal year 2015, $3,000,000, to be made available until expended.</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y58707989-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/d" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5870798a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadlines.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Effective Date</inline>.—</heading><paragraph class="fontsize10" id="y5870798b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/d/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Clause (xiii) of section 205(c)(2)(C) of the Social Security Act (<ref href="/us/usc/t42/s405/c/2/C">42 U.S.C. 405(c)(2)(C)</ref>), as added by subsection (a)(3), shall apply with respect to Medicare cards issued on and after an effective date specified by the Secretary of Health and Human Services, but in no case shall such effective date be later than the date that is four years after the date of the enactment of this Act.</content></paragraph> <paragraph class="fontsize10" id="y5870798c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s501/d/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Reissuance</inline>.—</heading><content>The Secretary shall provide for the reissuance of Medicare cards that comply with the requirements of such clause not later than four years after the effective date specified by the Secretary under paragraph (1).<page identifier="/us/stat/129/165">129 STAT. 165</page></content></paragraph> </subsection> </section> <section id="d354370e10887" identifier="/us/pl/114/10/tV/stA/s502" style="-uslm-lc:I658143"><num class="fontsize12" value="502">SEC. 502. </num><heading>PREVENTING WRONGFUL MEDICARE PAYMENTS FOR ITEMS AND SERVICES FURNISHED TO INCARCERATED INDIVIDUALS, INDIVIDUALS NOT LAWFULLY PRESENT, AND DECEASED INDIVIDUALS.</heading><subsection class="firstIndent0 fontsize10" id="y5870a09d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s502/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Requirement for the Secretary To Establish Policies and Claims Edits Relating to Incarcerated Individuals, Individuals Not Lawfully Present, and Deceased Individuals</inline>.—</heading><content>Section 1874 of the Social Security Act (<ref href="/us/usc/t42/s1395kk">42 U.S.C. 1395kk</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="firstIndent0 fontsize10" id="y5870a09e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="f">“(f) </num><heading class="fontsize10"><inline class="smallCaps">Requirement for the Secretary To Establish Policies and Claims Edits Relating to Incarcerated Individuals, Individuals Not Lawfully Present, and Deceased Individuals</inline>.—</heading><chapeau>The <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5870a09f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Procedures.</p><p class="leftAlign firstIndent0 fontsize8" id="x5870a0a0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Audits.</p></sidenote>Secretary shall establish and maintain procedures, including procedures for using claims processing edits, updating eligibility information to improve provider accessibility, and conducting recoupment activities such as through recovery audit contractors, in order to ensure that payment is not made under this title for items and services furnished to an individual who is one of the following:</chapeau><paragraph class="fontsize10" id="y5870a0a1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><content>An individual who is incarcerated.</content></paragraph> <paragraph class="fontsize10" id="y5870a0a2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><content>An individual who is not lawfully present in the United States and who is not eligible for coverage under this title.</content></paragraph> <paragraph class="fontsize10" id="y5870a0a3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><content>A deceased individual.”</content></paragraph> </subsection> </quotedContent>.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y5870a0a4-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s502/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5870a0a5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395kk">42 USC 1395kk note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Report</inline>.—</heading><content>Not later than 18 months after the date of the enactment of this section, and periodically thereafter as determined necessary by the Office of Inspector General of the Department of Health and Human Services, such Office shall submit to Congress a report on the activities described in subsection (f) of section 1874 of the Social Security Act (<ref href="/us/usc/t42/s1395kk">42 U.S.C. 1395kk</ref>), as added by subsection (a), that have been conducted since such date of enactment.</content></subsection> </section> <section id="d354370e10962" identifier="/us/pl/114/10/tV/stA/s503" style="-uslm-lc:I658143"><num class="fontsize12" value="503">SEC. 503. </num><heading>CONSIDERATION OF MEASURES REGARDING MEDICARE BENEFICIARY SMART CARDS.</heading><content style="-uslm-lc:I658120"> To the extent the Secretary of Health and Human Services determines that it is cost effective and technologically viable to use electronic Medicare beneficiary and provider cards (such as cards that use smart card technology, including an embedded and secure integrated circuit chip), as presented in the Government Accountability Office report required by the conference report accompanying the Consolidated Appropriations Act, 2014 (<ref href="/us/pl/113/76">Public Law 113–76</ref>), the Secretary shall consider such measures as determined appropriate by the Secretary to implement such use of such cards for beneficiary and provider use under title XVIII of the Social Security Act (<ref href="/us/usc/t42/s1395/etseq">42 U.S.C. 1395 et seq.</ref>). <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5870c7b6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Reports.</p></sidenote>In the case that the Secretary considers measures under the preceding sentence, the Secretary shall submit to the Committees on Ways and Means and Energy and Commerce of the House of Representatives, and to the Committee on Finance of the Senate, a report outlining the considerations undertaken by the Secretary under such sentence.</content></section> <section id="d354370e10979" identifier="/us/pl/114/10/tV/stA/s504" style="-uslm-lc:I658143"><num class="fontsize12" value="504">SEC. 504. </num><heading>MODIFYING MEDICARE DURABLE MEDICAL EQUIPMENT FACE-TO-FACE ENCOUNTER DOCUMENTATION REQUIREMENT.</heading><subsection class="firstIndent0 fontsize10" id="y5870eec7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s504/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><chapeau>Section 1834(a)(11)(B)(ii) of the Social Security Act (<ref href="/us/usc/t42/s1395m/a/11/B/ii">42 U.S.C. 1395m(a)(11)(B)(ii)</ref>) <amendingAction type="amend">is amended</amendingAction>—<page identifier="/us/stat/129/166">129 STAT. 166</page></chapeau><paragraph class="fontsize10" id="y5870eec8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s504/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>the physician documenting that</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y5870eec9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s504/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="delete">striking</amendingAction> “<quotedText>has had a face-to-face encounter</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>documenting such physician, physician assistant, practitioner, or specialist has had a face-to-face encounter</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5870eeca-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s504/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Implementation</inline>.—</heading><content>Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the amendments made by subsection (a) by program instruction or otherwise.</content></subsection> </section> <section id="d354370e11033" identifier="/us/pl/114/10/tV/stA/s505" style="-uslm-lc:I658143"><num class="fontsize12" value="505">SEC. 505. </num><heading>REDUCING IMPROPER MEDICARE PAYMENTS.</heading><subsection class="firstIndent0 fontsize10" id="y587163fb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s505/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Medicare Administrative Contractor Improper Payment Outreach and Education Program</inline>.—</heading><chapeau>Section 1874A of the Social Security Act (<ref href="/us/usc/t42/s1395kk–1">42 U.S.C. 1395kk–1</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y587163fc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s505/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><chapeau>in subsection (a)(4)—</chapeau><subparagraph class="fontsize10" id="y587163fd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s505/a/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>by <amendingAction type="redesignate">redesignating</amendingAction> subparagraph (G) as subparagraph (H); and</content></subparagraph> <subparagraph class="fontsize10" id="y587163fe-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s505/a/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>by <amendingAction type="insert">inserting</amendingAction> after subparagraph (F) the following new subparagraph:<quotedContent><subparagraph class="indentUp0 fontsize10" id="y587163ff-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="G">“(G) </num><heading class="fontsize10"><inline class="smallCaps">Improper payment outreach and education program</inline>.—</heading><content>Having in place an improper payment outreach and education program described in subsection (h).”</content></subparagraph> </quotedContent>; and</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58716400-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s505/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="indentDown1 firstIndent0 fontsize10" id="y5871d931-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="h">“(h) </num><heading class="fontsize10"><inline class="smallCaps">Improper Payment Outreach and Education Program</inline>.—</heading><paragraph class="fontsize10" id="y5871d932-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In order to reduce improper payments under this title, each medicare administrative contractor shall establish and have in place an improper payment outreach and education program under which the contractor, through outreach, education, training, and technical assistance or other activities, shall provide providers of services and suppliers located in the region covered by the contract under this section with the information described in paragraph (2). The activities described in the preceding sentence shall be conducted on a regular basis.</content></paragraph> <paragraph class="fontsize10" id="y5871d933-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">Information to be provided through activities</inline>.—</heading><chapeau>The information to be provided under such payment outreach and education program shall include information the Secretary determines to be appropriate, which may include the following information:</chapeau><subparagraph class="fontsize10" id="y5871d934-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>A list of the providers’ or suppliers’ most frequent and expensive payment errors over the last quarter.</content></subparagraph> <subparagraph class="fontsize10" id="y58720045-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>Specific instructions regarding how to correct or avoid such errors in the future.</content></subparagraph> <subparagraph class="fontsize10" id="y58720046-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><content>A notice of new topics that have been approved by the Secretary for audits conducted by recovery audit contractors under section 1893(h).</content></subparagraph> <subparagraph class="fontsize10" id="y58720047-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><content>Specific instructions to prevent future issues related to such new audits.</content></subparagraph> <subparagraph class="fontsize10" id="y58720048-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><content>Other information determined appropriate by the Secretary.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58720049-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Priority</inline>.—</heading><chapeau>A medicare administrative contractor shall give priority to activities under such program that will reduce improper payments that are one or more of the following:</chapeau><subparagraph class="fontsize10" id="y5872004a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>Are for items and services that have the highest rate of improper payment.</content></subparagraph> <subparagraph class="fontsize10" id="y5872004b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>Are for items and service that have the greatest total dollar amount of improper payments.<page identifier="/us/stat/129/167">129 STAT. 167</page></content></subparagraph> <subparagraph class="fontsize10" id="y5872004c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><content>Are due to clear misapplication or misinterpretation of Medicare policies.</content></subparagraph> <subparagraph class="fontsize10" id="y5872004d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="D">“(D) </num><content>Are clearly due to common and inadvertent clerical or administrative errors.</content></subparagraph> <subparagraph class="fontsize10" id="y5872004e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><content>Are due to other types of errors that the Secretary determines could be prevented through activities under the program.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5872004f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Information on improper payments from recovery audit contractors</inline>.—</heading><subparagraph class="fontsize10" id="y58720050-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In order to assist medicare administrative contractors in carrying out improper payment outreach and education programs, the Secretary shall provide each contractor with a complete list of the types of improper payments identified by recovery audit contractors under section 1893(h) with respect to providers of services and suppliers located in the region covered by the contract under this section. Such information shall be provided on a time frame the Secretary determines appropriate which may be on a quarterly basis.</content></subparagraph> <subparagraph class="fontsize10" id="y58720051-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Information</inline>.—</heading><chapeau>The information described in subparagraph (A) shall include information such as the following:</chapeau><clause class="fontsize10" id="y58720052-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><content>Providers of services and suppliers that have the highest rate of improper payments.</content></clause> <clause class="fontsize10" id="y58720053-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><content>Providers of services and suppliers that have the greatest total dollar amounts of improper payments.</content></clause> <clause class="fontsize10" id="y58720054-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><content>Items and services furnished in the region that have the highest rates of improper payments.</content></clause> <clause class="fontsize10" id="y58720055-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><content>Items and services furnished in the region that are responsible for the greatest total dollar amount of improper payments.</content></clause> <clause class="fontsize10" id="y58720056-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>Other information the Secretary determines would assist the contractor in carrying out the program.</content></clause> </subparagraph> </paragraph> <paragraph class="fontsize10" id="y58720057-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">“(5) </num><heading class="fontsize10"><inline class="smallCaps">Communications</inline>.—</heading><content>Communications with providers of services and suppliers under an improper payment outreach and education program are subject to the standards and requirements of subsection (g).”</content></paragraph> </subsection> </quotedContent>.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y58720058-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s505/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Use of Certain Funds Recovered by RACs</inline>.—</heading><chapeau>Section 1893(h) of the Social Security Act (<ref href="/us/usc/t42/s1395ddd/h">42 U.S.C. 1395ddd(h)</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y58720059-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s505/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in paragraph (2), by <amendingAction type="insert">inserting</amendingAction> “<quotedText>or paragraph (10)</quotedText>” after “<quotedText>paragraph (1)(C)</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y5872005a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s505/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="indentUp0 fontsize10" id="y5872005b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="10">“(10) </num><heading class="fontsize10"><inline class="smallCaps">Use of certain recovered funds</inline>.—</heading><subparagraph class="fontsize10" id="y5872005c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>After application of paragraph (1)(C), the Secretary shall retain a portion of the amounts recovered by recovery audit contractors for each year under this section which shall be available to the program management account of the Centers for Medicare & Medicaid Services for purposes of, subject to subparagraph (B), carrying out sections 1833(z), 1834(l)(16), and 1874A(a)(4)(G), carrying out section 514(b) of the Medicare Access and CHIP Reauthorization Act of 2015, and implementing strategies (such as claims processing edits) to help reduce the error rate of payments under this title. <page identifier="/us/stat/129/168">129 STAT. 168</page> The amounts retained under the preceding sentence shall not exceed an amount equal to 15 percent of the amounts recovered under this subsection, and shall remain available until expended.</content></subparagraph> <subparagraph class="fontsize10" id="y5872005d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Limitation</inline>.—</heading><content>Except for uses that support claims processing (including edits) or system functionality for detecting fraud, amounts retained under subparagraph (A) may not be used for technological-related infrastructure, capital investments, or information systems.</content></subparagraph> <subparagraph class="fontsize10" id="y5872276e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">No reduction in payments to recovery audit contractors</inline>.—</heading><content>Nothing in subparagraph (A) shall reduce amounts available for payments to recovery audit contractors under this subsection.”</content></subparagraph> </paragraph> </quotedContent>.</content></paragraph> </subsection> </section> <section id="d354370e11325" identifier="/us/pl/114/10/tV/stA/s506" style="-uslm-lc:I658143"><num class="fontsize12" value="506">SEC. 506. </num><heading>IMPROVING SENIOR MEDICARE PATROL AND FRAUD REPORTING REWARDS.</heading><subsection class="firstIndent0 fontsize10" id="y58724e7f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s506/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58724e80-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Plans.</p><p class="leftAlign firstIndent0 fontsize8" id="x58724e81-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Recommenda-</p><p class="leftAlign firstIndent0 fontsize8" id="x58724e82-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">tions.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><chapeau>The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall develop a plan to revise the incentive program under section 203(b) of the Health Insurance Portability and Accountability Act of 1996 (<ref href="/us/usc/t42/s1395b–5/b">42 U.S.C. 1395b–5(b)</ref>) to encourage greater participation by individuals to report fraud and abuse in the Medicare program. Such plan shall include recommendations for—</chapeau><paragraph class="fontsize10" id="y58724e83-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s506/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>ways to enhance rewards for individuals reporting under the incentive program, including rewards based on information that leads to an administrative action; and</content></paragraph> <paragraph class="fontsize10" id="y58724e84-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s506/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>extending the incentive program to the Medicaid program.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y58724e85-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s506/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Public Awareness and Education Campaign</inline>.—</heading><content>The plan developed under subsection (a) shall also include recommendations for the use of the Senior Medicare Patrols authorized under section 411 of the Older Americans Act of 1965 (<ref href="/us/usc/t42/s3032">42 U.S.C. 3032</ref>) to conduct a public awareness and education campaign to encourage participation in the revised incentive program under subsection (a).</content></subsection> <subsection class="firstIndent0 fontsize10" id="y58724e86-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s506/c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58724e87-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Submission of Plan</inline>.—</heading><content>Not later than 180 days after the date of enactment of this Act, the Secretary shall submit to Congress the plan developed under subsection (a).</content></subsection> </section> <section id="d354370e11385" identifier="/us/pl/114/10/tV/stA/s507" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="507">SEC. 507. </num><heading>REQUIRING VALID PRESCRIBER NATIONAL PROVIDER IDENTIFIERS ON PHARMACY CLAIMS.</heading><content class="firstIndent0 fontsize10" id="x58727598-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 1860D–4(c) of the Social Security Act (<ref href="/us/usc/t42/s1395w–104/c">42 U.S.C. 1395w–104(c)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="fontsize10" id="y58729ca9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Requiring valid prescriber national provider identifiers on pharmacy claims</inline>.—</heading><subparagraph class="fontsize10" id="y58729caa-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>For plan year 2016 and subsequent plan years, the Secretary shall require a claim for a covered part D drug for a part D eligible individual enrolled in a prescription drug plan under this part or an MA–PD plan under part C to include a prescriber National Provider Identifier that is determined to be valid under the procedures established under subparagraph (B)(i).</content></subparagraph> <subparagraph class="fontsize10" id="y58729cab-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Procedures</inline>.—</heading><clause class="fontsize10" id="y58729cac-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">Validity of prescriber national provider identifiers</inline>.—</heading><content>The <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58729cad-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Consultation.</p></sidenote>Secretary, in consultation with appropriate stakeholders, shall establish procedures for determining the validity of prescriber National Provider Identifiers under subparagraph (A).<page identifier="/us/stat/129/169">129 STAT. 169</page></content></clause> <clause class="fontsize10" id="y58729cae-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Informing beneficiaries of reason for denial</inline>.—</heading><content>The Secretary shall establish procedures to ensure that, in the case that a claim for a covered part D drug of an individual described in subparagraph (A) is denied because the claim does not meet the requirements of this paragraph, the individual is properly informed at the point of service of the reason for the denial.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58729caf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Report</inline>.—</heading><content>Not later than January 1, 2018, the Inspector General of the Department of Health and Human Services shall submit to Congress a report on the effectiveness of the procedures established under subparagraph (B)(i).”</content></subparagraph> </paragraph> </quotedContent>.</content></section> <section id="d354370e11463" identifier="/us/pl/114/10/tV/stA/s508" style="-uslm-lc:I658143"><num class="fontsize12" value="508">SEC. 508. </num><heading>OPTION TO RECEIVE MEDICARE SUMMARY NOTICE ELECTRONICALLY.</heading><subsection class="firstIndent0 fontsize10" id="y5872c3c0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s508/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><content>Section 1806 of the Social Security Act (<ref href="/us/usc/t42/s1395b–7">42 U.S.C. 1395b–7</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="firstIndent0 fontsize10" id="y5872ead1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">“(c) </num><heading class="fontsize10"><inline class="smallCaps">Format of Statements From Secretary</inline>.—</heading><paragraph class="fontsize10" id="y5872ead2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">Electronic option beginning in 2016</inline>.—</heading><content>Subject to paragraph (2), for statements described in subsection (a) that are furnished for a period in 2016 or a subsequent year, in the case that an individual described in subsection (a) elects, in accordance with such form, manner, and time specified by the Secretary, to receive such statement in an electronic format, such statement shall be furnished to such individual for each period subsequent to such election in such a format and shall not be mailed to the individual.</content></paragraph> <paragraph class="fontsize10" id="y5872ead3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">Limitation on revocation option</inline>.—</heading><subparagraph class="fontsize10" id="y5872ead4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to subparagraph (B), the Secretary may determine a maximum number of elections described in paragraph (1) by an individual that may be revoked by the individual.</content></subparagraph> <subparagraph class="fontsize10" id="y5872ead5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Minimum of one revocation option</inline>.—</heading><content>In no case may the Secretary determine a maximum number under subparagraph (A) that is less than one.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y5872ead6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5872ead7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Notification</inline>.—</heading><content>The Secretary shall ensure that, in the most cost effective manner and beginning January 1, 2017, a clear notification of the option to elect to receive statements described in subsection (a) in an electronic format is made available, such as through the notices distributed under section 1804, to individuals described in subsection (a).”</content></paragraph> </subsection> </quotedContent>.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y5872ead8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s508/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5872ead9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t7/s1395b–7">7 USC 1395b–7 note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Encouraged Expansion of Electronic Statements</inline>.—</heading><chapeau>To the extent to which the Secretary of Health and Human Services determines appropriate, the Secretary shall—</chapeau><paragraph class="fontsize10" id="y5872eada-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s508/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5872eadb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote><content>apply an option similar to the option described in subsection (c)(1) of section 1806 of the Social Security Act (<ref href="/us/usc/t42/s1395b–7">42 U.S.C. 1395b–7</ref>) (relating to the provision of the Medicare Summary Notice in an electronic format), as added by subsection (a), to other statements and notifications under title XVIII of such Act (<ref href="/us/usc/t42/s1395/etseq">42 U.S.C. 1395 et seq.</ref>); and</content></paragraph> <paragraph class="fontsize10" id="y587311ec-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s508/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>provide such Medicare Summary Notice and any such other statements and notifications on a more frequent basis than is otherwise required under such title.<page identifier="/us/stat/129/170">129 STAT. 170</page></content></paragraph> </subsection> </section> <section id="d354370e11581" identifier="/us/pl/114/10/tV/stA/s509" style="-uslm-lc:I658143"><num class="fontsize12" value="509">SEC. 509. </num><heading>RENEWAL OF MAC CONTRACTS.</heading><subsection class="firstIndent0 fontsize10" id="y587338fd-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s509/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><content>Section 1874A(b)(1)(B) of the Social Security Act (<ref href="/us/usc/t42/s1395kk–1/b/1/B">42 U.S.C. 1395kk–1(b)(1)(B)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>5 years</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>10 years</quotedText>”.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y587338fe-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s509/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x587338ff-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">42 USC</p><p class="leftAlign firstIndent0 fontsize8" id="x58733900-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">1395kk–1 note.</p></sidenote><inline class="smallCaps">Application</inline>.—</heading><content>The amendments made by subsection (a) shall apply to contracts entered into on or after, and to contracts in effect as of, the date of the enactment of this Act.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y58733901-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s509/c" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Contractor Performance Transparency</inline>.—</heading><content>Section 1874A(b)(3)(A) of the Social Security Act (<ref href="/us/usc/t42/s1395kk–1/b/3/A">42 U.S.C. 1395kk–1(b)(3)(A)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new clause:<quotedContent><clause class="indentUp3 fontsize10" id="y58733902-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iv">“(iv) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58733903-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Public information.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Contractor performance transparency</inline>.—</heading><content>To the extent possible without compromising the process for entering into and renewing contracts with medicare administrative contractors under this section, the Secretary shall make available to the public the performance of each medicare administrative contractor with respect to such performance requirements and measurement standards.”</content></clause> </quotedContent>.</content></subsection> </section> <section id="d354370e11655" identifier="/us/pl/114/10/tV/stA/s510" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="510">SEC. 510. </num><heading>STUDY ON PATHWAY FOR INCENTIVES TO STATES FOR STATE PARTICIPATION IN MEDICAID DATA MATCH PROGRAM.</heading><content class="firstIndent0 fontsize10" id="x58733904-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 1893(g) of the Social Security Act (<ref href="/us/usc/t42/s1395ddd/g">42 U.S.C. 1395ddd(g)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="fontsize10" id="y58733905-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><heading class="fontsize10"><inline class="smallCaps">Incentives for states</inline>.—</heading><content>The Secretary shall study and, as appropriate, may specify incentives for States to work with the Secretary for the purposes described in paragraph (1)(A)(ii). The application of the previous sentence may include use of the waiver authority described in paragraph (2).”</content></paragraph> </quotedContent>.</content></section> <section id="d354370e11684" identifier="/us/pl/114/10/tV/stA/s511" style="-uslm-lc:I658143"><num class="fontsize12" value="511">SEC. 511. </num><heading>GUIDANCE ON APPLICATION OF COMMON RULE TO CLINICAL DATA REGISTRIES.</heading><content style="-uslm-lc:I658120"> Not<sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58736016-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote> later than one year after the date of the enactment of this section, the Secretary of Health and Human Services shall issue a clarification or modification with respect to the application of <ref href="/us/cfr/t45/pt46/sptA">subpart A of part 46 of title 45, Code of Federal Regulations</ref>, governing the protection of human subjects in research (and commonly known as the “Common Rule”), to activities, including quality improvement activities, involving clinical data registries, including entities that are qualified clinical data registries pursuant to section 1848(m)(3)(E) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/m/3/E">42 U.S.C. 1395w–4(m)(3)(E)</ref>).</content></section> <section id="d354370e11701" identifier="/us/pl/114/10/tV/stA/s512" style="-uslm-lc:I658143"><num class="fontsize12" value="512">SEC. 512. </num><heading>ELIMINATING CERTAIN CIVIL MONEY PENALTIES; GAINSHARING STUDY AND REPORT.</heading><subsection class="firstIndent0 fontsize10" id="y5873ae37-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s512/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Eliminating Civil Money Penalties for Inducements to Physicians To Limit Services That Are Not Medically Necessary</inline>.—</heading><paragraph class="fontsize10" id="y5873ae38-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s512/a/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Section 1128A(b)(1) of the Social Security Act (<ref href="/us/usc/t42/s1320a–7a/b/1">42 U.S.C. 1320a–7a(b)(1)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> “<quotedText>medically necessary</quotedText>” after “<quotedText>reduce or limit</quotedText>”.</content></paragraph> <paragraph class="fontsize10" id="y5873ae39-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s512/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5873ae3a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p><p class="leftAlign firstIndent0 fontsize8" id="x5873ae3b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">42 USC</p><p class="leftAlign firstIndent0 fontsize8" id="x5873ae3c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">1320a–7a note.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Effective date</inline>.—</heading><content>The amendment made by paragraph (1) shall apply to payments made on or after the date of the enactment of this Act.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5873ae3d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s512/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5873ae3e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Consultation.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Gainsharing Study and Report</inline>.—</heading><chapeau>Not later than 12 months after the date of the enactment of this Act, the Secretary of Health and Human Services, in consultation with the Inspector General of the Department of Health and Human Services, shall <page identifier="/us/stat/129/171">129 STAT. 171</page> submit to Congress a report with options for <amendingAction type="amend">amending</amendingAction> existing fraud and abuse laws in, and regulations related to, titles XI and XVIII of the Social Security Act (<ref href="/us/usc/t42/s301/etseq">42 U.S.C. 301 et seq.</ref>), through exceptions, safe harbors, or other narrowly targeted provisions, to permit gainsharing arrangements that otherwise would be subject to the civil money penalties described in paragraphs (1) and (2) of section 1128A(b) of such Act (<ref href="/us/usc/t42/s1320a–7a/b">42 U.S.C. 1320a–7a(b)</ref>), or similar arrangements between physicians and hospitals, and that improve care while reducing waste and increasing efficiency. The report shall—</chapeau><paragraph class="fontsize10" id="y5873ae3f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s512/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>consider whether such provisions should apply to ownership interests, compensation arrangements, or other relationships;</content></paragraph> <paragraph class="fontsize10" id="y5873ae40-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s512/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>describe how the recommendations address accountability, transparency, and quality, including how best to limit inducements to stint on care, discharge patients prematurely, or otherwise reduce or limit medically necessary care; and</content></paragraph> <paragraph class="fontsize10" id="y5873ae41-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s512/b/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>consider whether a portion of any savings generated by such arrangements (as compared to an historical benchmark or other metric specified by the Secretary to determine the impact of delivery and payment system changes under such title XVIII on expenditures made under such title) should accrue to the Medicare program under title XVIII of the Social Security Act.</content></paragraph> </subsection> </section> <section id="d354370e11789" identifier="/us/pl/114/10/tV/stA/s513" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="513">SEC. 513. </num><heading>MODIFICATION OF MEDICARE HOME HEALTH SURETY BOND CONDITION OF PARTICIPATION REQUIREMENT.</heading><content class="firstIndent0 fontsize10" id="x5873ae42-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 1861(o)(7) of the Social Security Act (<ref href="/us/usc/t42/s1395x/o/7">42 U.S.C. 1395x(o)(7)</ref>) <amendingAction type="amend">is amended</amendingAction> to read as follows:<quotedContent><paragraph class="fontsize10" id="y5873d553-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="7">“(7) </num><chapeau>provides the Secretary with a surety bond—</chapeau><subparagraph class="fontsize10" id="y5873d554-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>in a form specified by the Secretary and in an amount that is not less than the minimum of $50,000; and</content></subparagraph> <subparagraph class="fontsize10" id="y5873d555-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>that the Secretary determines is commensurate with the volume of payments to the home health agency; and”</content></subparagraph> </paragraph> </quotedContent>.</content></section> <section id="d354370e11820" identifier="/us/pl/114/10/tV/stA/s514" style="-uslm-lc:I658143"><num class="fontsize12" value="514">SEC. 514. </num><heading>OVERSIGHT OF MEDICARE COVERAGE OF MANUAL MANIPULATION OF THE SPINE TO CORRECT SUBLUXATION.</heading><subsection class="firstIndent0 fontsize10" id="y58747196-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s514/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><content>Section 1833 of the Social Security Act (<ref href="/us/usc/t42/s1395l">42 U.S.C. 1395l</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="firstIndent0 fontsize10" id="y58750dd7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="z">“(z) </num><heading class="fontsize10"><inline class="smallCaps">Medical Review of Spinal Subluxation Services</inline>.—</heading><paragraph class="fontsize10" id="y58750dd8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58750dd9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p><p class="leftAlign firstIndent0 fontsize8" id="x58750dda-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><chapeau>The Secretary shall implement a process for the medical review (as described in paragraph (2)) of treatment by a chiropractor described in section 1861(r)(5) by means of manual manipulation of the spine to correct a subluxation (as described in such section) of an individual who is enrolled under this part and apply such process to such services furnished on or after January 1, 2017, focusing on services such as—</chapeau><subparagraph class="fontsize10" id="y58750ddb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><content>services furnished by a such a chiropractor whose pattern of billing is aberrant compared to peers; and</content></subparagraph> <subparagraph class="fontsize10" id="y58750ddc-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><content>services furnished by such a chiropractor who, in a prior period, has a services denial percentage in the 85th percentile or greater, taking into consideration the extent that service denials are overturned on appeal.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58750ddd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">Medical review</inline>.—</heading><page identifier="/us/stat/129/172">129 STAT. 172</page> <subparagraph class="fontsize10" id="y58750dde-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Prior authorization medical review</inline>.—</heading><clause class="fontsize10" id="y58750ddf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to clause (ii), the Secretary shall use prior authorization medical review for services described in paragraph (1) that are furnished to an individual by a chiropractor described in section 1861(r)(5) that are part of an episode of treatment that includes more than 12 services. For purposes of the preceding sentence, an episode of treatment shall be determined by the underlying cause that justifies the need for services, such as a diagnosis code.</content></clause> <clause class="fontsize10" id="y58750de0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Ending application of prior authorization medical review</inline>.—</heading><content>The <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58750de1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Determination.</p></sidenote>Secretary shall end the application of prior authorization medical review under clause (i) to services described in paragraph (1) by such a chiropractor if the Secretary determines that the chiropractor has a low denial rate under such prior authorization medical review. The Secretary may subsequently reapply prior authorization medical review to such chiropractor if the Secretary determines it to be appropriate and the chiropractor has, in the time period subsequent to the determination by the Secretary of a low denial rate with respect to the chiropractor, furnished such services described in paragraph (1).</content></clause> <clause class="fontsize10" id="y58750de2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Early request for prior authorization review permitted</inline>.—</heading><content>Nothing in this subsection shall be construed to prevent such a chiropractor from requesting prior authorization for services described in paragraph (1) that are to be furnished to an individual before the chiropractor furnishes the twelfth such service to such individual for an episode of treatment.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58750de3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Type of review</inline>.—</heading><content>The Secretary may use pre-payment review or post-payment review of services described in section 1861(r)(5) that are not subject to prior authorization medical review under subparagraph (A).</content></subparagraph> <subparagraph class="fontsize10" id="y58750de4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Relationship to law enforcement activities</inline>.—</heading><content>The Secretary may determine that medical review under this subsection does not apply in the case where potential fraud may be involved.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58750de5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">“(3) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58750de6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">No payment without prior authorization</inline>.—</heading><chapeau>With respect to a service described in paragraph (1) for which prior authorization medical review under this subsection applies, the following shall apply:</chapeau><subparagraph class="fontsize10" id="y58750de7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Prior authorization determination</inline>.—</heading><content>The Secretary shall make a determination, prior to the service being furnished, of whether the service would or would not meet the applicable requirements of section 1862(a)(1)(A).</content></subparagraph> <subparagraph class="fontsize10" id="y58750de8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Denial of payment</inline>.—</heading><content>Subject to paragraph (5), no payment may be made under this part for the service unless the Secretary determines pursuant to subparagraph (A) that the service would meet the applicable requirements of such section 1862(a)(1)(A).</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58750de9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">“(4) </num><heading class="fontsize10"><inline class="smallCaps">Submission of information</inline>.—</heading><content>A chiropractor described in section 1861(r)(5) may submit the information <page identifier="/us/stat/129/173">129 STAT. 173</page> necessary for medical review by fax, by mail, or by electronic means. The Secretary shall make available the electronic means described in the preceding sentence as soon as practicable.</content></paragraph> <paragraph class="fontsize10" id="y58750dea-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="5">“(5) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58750deb-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Timeliness</inline>.—</heading><content>If the Secretary does not make a prior authorization determination under paragraph (3)(A) within 14 business days of the date of the receipt of medical documentation needed to make such determination, paragraph (3)(B) shall not apply.</content></paragraph> <paragraph class="fontsize10" id="y58750dec-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="6">“(6) </num><heading class="fontsize10"><inline class="smallCaps">Application of limitation on beneficiary liability</inline>.—</heading><content>Where payment may not be made as a result of the application of paragraph (2)(B), section 1879 shall apply in the same manner as such section applies to a denial that is made by reason of section 1862(a)(1).</content></paragraph> <paragraph class="fontsize10" id="y58750ded-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="7">“(7) </num><heading class="fontsize10"><inline class="smallCaps">Review by contractors</inline>.—</heading><content>The medical review described in paragraph (2) may be conducted by medicare administrative contractors pursuant to section 1874A(a)(4)(G) or by any other contractor determined appropriate by the Secretary that is not a recovery audit contractor.</content></paragraph> <paragraph class="fontsize10" id="y58750dee-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="8">“(8) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58750def-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Multiple services</inline>.—</heading><content>The Secretary shall, where practicable, apply the medical review under this subsection in a manner so as to allow an individual described in paragraph (1) to obtain, at a single time rather than on a service-by-service basis, an authorization in accordance with paragraph (3)(A) for multiple services.</content></paragraph> <paragraph class="fontsize10" id="y58750df0-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="9">“(9) </num><heading class="fontsize10"><inline class="smallCaps">Construction</inline>.—</heading><content>With respect to a service described in paragraph (1) that has been affirmed by medical review under this subsection, nothing in this subsection shall be construed to preclude the subsequent denial of a claim for such service that does not meet other applicable requirements under this Act.</content></paragraph> <paragraph class="fontsize10" id="y58750df1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="10">“(10) </num><heading class="fontsize10"><inline class="smallCaps">Implementation</inline>.—</heading><subparagraph class="fontsize10" id="y58750df2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58750df3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Regulations.</p><p class="leftAlign firstIndent0 fontsize8" id="x58750df4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Comment period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Authority</inline>.—</heading><content>The Secretary may implement the provisions of this subsection by interim final rule with comment period.</content></subparagraph> <subparagraph class="fontsize10" id="y58750df5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Administration</inline>.—</heading><content><ref href="/us/usc/t44/ch35">Chapter 35 of title 44, United States Code</ref>, shall not apply to medical review under this subsection.”</content></subparagraph> </paragraph> </subsection> </quotedContent>.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y58750df6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s514/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58750df7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395">42 USC 1395</ref><i>l</i> note.Consultation.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Improving Documentation of Services</inline>.—</heading><paragraph class="fontsize10" id="y58750df8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s514/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>The Secretary of Health and Human Services shall, in consultation with stakeholders (including the American Chiropractic Association) and representatives of medicare administrative contractors (as defined in section 1874A(a)(3)(A) of the Social Security Act (<ref href="/us/usc/t42/s1395kk–1/a/3/A">42 U.S.C. 1395kk–1(a)(3)(A)</ref>)), develop educational and training programs to improve the ability of chiropractors to provide documentation to the Secretary of services described in section 1861(r)(5) in a manner that demonstrates that such services are, in accordance with section 1862(a)(1) of such Act (<ref href="/us/usc/t42/s1395y/a/1">42 U.S.C. 1395y(a)(1)</ref>), reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.</content></paragraph> <paragraph class="fontsize10" id="y58753509-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s514/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5875350a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Public information.</p><p class="leftAlign firstIndent0 fontsize8" id="x5875350b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Timing</inline>.—</heading><content>The Secretary shall make the educational and training programs described in paragraph (1) publicly available not later than January 1, 2016.</content></paragraph> <paragraph class="fontsize10" id="y5875350c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s514/b/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Funding</inline>.—</heading><content>The Secretary shall use funds made available under paragraph (10) of section 1893(h) of the Social <page identifier="/us/stat/129/174">129 STAT. 174</page> Security Act (<ref href="/us/usc/t42/s1395ddd/h">42 U.S.C. 1395ddd(h)</ref>), as added by section 505, to carry out this subsection.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5875350d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s514/c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">GAO Study and Report</inline>.—</heading><paragraph class="fontsize10" id="y5875350e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s514/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Study</inline>.—</heading><chapeau>The Comptroller General of the United States shall conduct a study on the effectiveness of the process for medical review of services furnished as part of a treatment by means of manual manipulation of the spine to correct a subluxation implemented under subsection (z) of section 1833 of the Social Security Act (<ref href="/us/usc/t42/s1395l">42 U.S.C. 1395l</ref>), as added by subsection (a). Such study shall include an analysis of—</chapeau><subparagraph class="fontsize10" id="y5875350f-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s514/c/1/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><chapeau>aggregate data on—</chapeau><clause class="fontsize10" id="y58753510-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s514/c/1/A/i" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">(i) </num><content>the number of individuals, chiropractors, and claims for services subject to such review; and</content></clause> <clause class="fontsize10" id="y58753511-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s514/c/1/A/ii" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">(ii) </num><content>the number of reviews conducted under such section; and</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58753512-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s514/c/1/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>the outcomes of such reviews.</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y58753513-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s514/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58753514-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Recommenda-</p><p class="leftAlign firstIndent0 fontsize8" id="x58753515-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">tions.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Report</inline>.—</heading><content>Not later than four years after the date of enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1), including recommendations for such legislation and administrative action with respect to the process for medical review implemented under subsection (z) of section 1833 of the Social Security Act (<ref href="/us/usc/t42/s1395l">42 U.S.C. 1395l</ref>) as the Comptroller General determines appropriate.</content></paragraph> </subsection> </section> <section id="d354370e12195" identifier="/us/pl/114/10/tV/stA/s515" style="-uslm-lc:I658143"><num class="fontsize12" value="515">SEC. 515. </num><heading>NATIONAL EXPANSION OF PRIOR AUTHORIZATION MODEL FOR REPETITIVE SCHEDULED NON-EMERGENT AMBULANCE TRANSPORT.</heading><subsection class="firstIndent0 fontsize10" id="y58755c26-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s515/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58755c27-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">State listing.</p></sidenote><inline class="smallCaps">Initial Expansion</inline>.—</heading><paragraph class="fontsize10" id="y58755c28-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s515/a/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58755c29-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>In implementing the model described in paragraph (2) proposed to be tested under subsection (b) of section 1115A of the Social Security Act (<ref href="/us/usc/t42/s1315a">42 U.S.C. 1315a</ref>), the Secretary of Health and Human Services shall revise the testing under subsection (b) of such section to cover, effective not later than January 1, 2016, States located in medicare administrative contractor (MAC) regions L and 11 (consisting of Delaware, the District of Columbia, Maryland, New Jersey, Pennsylvania, North Carolina, South Carolina, West Virginia, and Virginia).</content></paragraph> <paragraph class="fontsize10" id="y58755c2a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s515/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Model described</inline>.—</heading><content>The model described in this paragraph is the testing of a model of prior authorization for repetitive scheduled non-emergent ambulance transport proposed to be carried out in New Jersey, Pennsylvania, and South Carolina.</content></paragraph> <paragraph class="fontsize10" id="y58755c2b-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s515/a/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Funding</inline>.—</heading><content>The Secretary shall allocate funds made available under section 1115A(f)(1)(B) of the Social Security Act (<ref href="/us/usc/t42/s1315a/f/1/B">42 U.S.C. 1315a(f)(1)(B)</ref>) to carry out this subsection.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5875833c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s515/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">National Expansion</inline>.—</heading><content>Section 1834(l) of the Social Security Act (<ref href="/us/usc/t42/s1395m/l">42 U.S.C. 1395m(l)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="fontsize10" id="y5875833d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="16">“(16) </num><heading class="fontsize10"><inline class="smallCaps">Prior authorization for repetitive scheduled non-emergent ambulance transports</inline>.—</heading><subparagraph class="fontsize10" id="y5875833e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5875833f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Beginning January 1, 2017, if the expansion to all States of the model of prior authorization described in paragraph (2) of section 515(a) of the Medicare Access and CHIP Reauthorization Act of 2015 meets the requirements described in paragraphs (1) through (3) of <page identifier="/us/stat/129/175">129 STAT. 175</page> section 1115A(c), then the Secretary shall expand such model to all States.</content></subparagraph> <subparagraph class="fontsize10" id="y58758340-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Funding</inline>.—</heading><content>The Secretary shall use funds made available under section 1893(h)(10) to carry out this paragraph.</content></subparagraph> <subparagraph class="fontsize10" id="y58758341-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Clarification regarding budget neutrality</inline>.—</heading><content>Nothing in this paragraph may be construed to limit or modify the application of section 1115A(b)(3)(B) to models described in such section, including with respect to the model described in subparagraph (A) and expanded beginning on January 1, 2017, under such subparagraph.”</content></subparagraph> </paragraph> </quotedContent>.</content></subsection> </section> <section id="d354370e12312" identifier="/us/pl/114/10/tV/stA/s516" style="-uslm-lc:I658143"><num class="fontsize12" value="516">SEC. 516. </num><heading>REPEALING DUPLICATIVE MEDICARE SECONDARY PAYOR PROVISION.</heading><subsection class="firstIndent0 fontsize10" id="y5875aa52-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s516/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><content>Section 1862(b)(5) of the Social Security Act (<ref href="/us/usc/t42/s1395y/b/5">42 U.S.C. 1395y(b)(5)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="insert">inserting</amendingAction> at the end the following new subparagraph:<quotedContent><subparagraph class="indentUp2 fontsize10" id="y5875aa53-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">End date</inline>.—</heading><content>The provisions of this paragraph shall not apply to information required to be provided on or after July 1, 2016.”</content></subparagraph> </quotedContent>.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y5875aa54-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s516/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5875aa55-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Applicability.</p><p class="leftAlign firstIndent0 fontsize8" id="x5875aa56-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395y">42 USC 1395y note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Effective Date</inline>.—</heading><content>The amendment made by subsection (a) shall take effect on the date of the enactment of this Act and shall apply to information required to be provided on or after January 1, 2016.</content></subsection> </section> <section id="d354370e12364" identifier="/us/pl/114/10/tV/stA/s517" style="-uslm-lc:I658143"><num class="fontsize12" value="517">SEC. 517. </num><heading>PLAN FOR EXPANDING DATA IN ANNUAL CERT REPORT.</heading><chapeau class="indentUp0 firstIndent0 fontsize10" id="x5875d167-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Not later than June 30, 2015, the Secretary of Health and Human Services shall submit to the Committee on Finance of the Senate, and to the Committees on Energy and Commerce and Ways and Means of the House of Representatives—</chapeau><paragraph class="fontsize10" id="y5875d168-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s517/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>a plan for including, in the annual report of the Comprehensive Error Rate Testing (CERT) program, data on services (or groupings of services) (other than medical visits) paid under the physician fee schedule under section 1848 of the Social Security Act (<ref href="/us/usc/t42/s1395w–4">42 U.S.C. 1395w–4</ref>) where the fee schedule amount is in excess of $250 and where the error rate is in excess of 20 percent; and</content></paragraph> <paragraph class="fontsize10" id="y5875d169-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stA/s517/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>to the extent practicable by such date, specific examples of services described in paragraph (1).</content></paragraph> </section> <section id="d354370e12385" identifier="/us/pl/114/10/tV/stA/s518" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="518">SEC. 518. </num><heading>REMOVING FUNDS FOR MEDICARE IMPROVEMENT FUND ADDED BY IMPACT ACT OF 2014.</heading><content style="-uslm-lc:I658120"> Section 1898(b)(1) of the Social Security Act (<ref href="/us/usc/t42/s1395iii/b/1">42 U.S.C. 1395iii(b)(1)</ref>), as amended by section 3(e)(3) of the IMPACT Act of 2014 (<ref href="/us/pl/113/185">Public Law 113–185</ref>), <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>$195,000,000</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>$0</quotedText>”.</content></section> <section id="d354370e12407" identifier="/us/pl/114/10/tV/stA/s519" style="-uslm-lc:I658143"><num class="fontsize12" value="519">SEC. 519. </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5875d16a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s405">42 USC 405 note</ref>.</p></sidenote><heading>RULE OF CONSTRUCTION.</heading><content style="-uslm-lc:I658120"> Except as explicitly provided in this subtitle, nothing in this subtitle, including the amendments made by this subtitle, shall be construed as preventing the use of notice and comment rulemaking in the implementation of the provisions of, and the amendments made by, this subtitle.<page identifier="/us/stat/129/176">129 STAT. 176</page></content></section> </subtitle> <subtitle id="d354370e12422" identifier="/us/pl/114/10/tV/stB" style="-uslm-lc:I658178"><num value="B">Subtitle B—</num><heading>Other Provisions</heading> <section id="d354370e12427" identifier="/us/pl/114/10/tV/stB/s521" role="instruction" style="-uslm-lc:I658143"><num class="fontsize12" value="521">SEC. 521. </num><heading>EXTENSION OF TWO-MIDNIGHT PAMA RULES ON CERTAIN MEDICAL REVIEW ACTIVITIES.</heading><chapeau class="indentUp0 firstIndent0 fontsize10" id="x5875f87b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"> Section 111 of the Protecting Access to Medicare Act of 2014 (<ref href="/us/pl/113/93">Public Law 113–93</ref>; <ref href="/us/usc/t42/s1395ddd">42 U.S.C. 1395ddd note</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y5875f87c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s521/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in subsection (a), by <amendingAction type="delete">striking</amendingAction> “<quotedText>the first 6 months of fiscal year 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>through the end of fiscal year 2015</quotedText>”;</content></paragraph> <paragraph class="fontsize10" id="y5875f87d-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s521/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in subsection (b), by <amendingAction type="delete">striking</amendingAction> “<quotedText>March 31, 2015</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>September 30, 2015</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y5875f87e-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s521/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="indentDown1 firstIndent0 fontsize10" id="y58761f8f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">“(c) </num><heading class="fontsize10"><inline class="smallCaps">Construction</inline>.—</heading><content>Except as provided in subsections (a) and (b), nothing in this section shall be construed as limiting the Secretary’s authority to pursue fraud and abuse activities under such section 1893(h) or otherwise.”</content></subsection> </quotedContent>.</content></paragraph> </section> <section id="d354370e12487" identifier="/us/pl/114/10/tV/stB/s522" style="-uslm-lc:I658143"><num class="fontsize12" value="522">SEC. 522. </num><heading>REQUIRING BID SURETY BONDS AND STATE LICENSURE FOR ENTITIES SUBMITTING BIDS UNDER THE MEDICARE DMEPOS COMPETITIVE ACQUISITION PROGRAM.</heading><subsection class="firstIndent0 fontsize10" id="y58766db0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s522/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Bid Surety Bonds</inline>.—</heading><content>Section 1847(a)(1) of the Social Security Act (<ref href="/us/usc/t42/s1395w–3/a/1">42 U.S.C. 1395w–3(a)(1)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraphs:<quotedContent><subparagraph class="indentUp2 fontsize10" id="y587694c1-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="G">“(G) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x587694c2-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Time period.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Requiring bid bonds for bidding entities</inline>.—</heading><content>With respect to rounds of competitions beginning under this subsection for contracts beginning not earlier than January 1, 2017, and not later than January 1, 2019, an entity may not submit a bid for a competitive acquisition area unless, as of the deadline for bid submission, the entity has obtained (and provided the Secretary with proof of having obtained) a bid surety bond (in this paragraph referred to as a ‘bid bond’) in a form specified by the Secretary consistent with subparagraph (H) and in an amount that is not less than $50,000 and not more than $100,000 for each competitive acquisition area in which the entity submits the bid.</content></subparagraph> <subparagraph class="indentUp2 fontsize10" id="y587694c3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="H">“(H) </num><heading class="fontsize10"><inline class="smallCaps">Treatment of bid bonds submitted</inline>.—</heading><clause class="fontsize10" id="y587694c4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">For bidders that submit bids at or below the median and are offered but do not accept the contract</inline>.—</heading><chapeau>In the case of a bidding entity that is offered a contract for any product category for a competitive acquisition area, if—</chapeau><subclause class="fontsize10" id="y587694c5-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="I">“(I) </num><content>the entity’s composite bid for such product category and area was at or below the median composite bid rate for all bidding entities included in the calculation of the single payment amounts for such product category and area; and</content></subclause> <subclause class="fontsize10" id="y587694c6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658128"><num class="fontsize10" style="-uslm-lc:emspace2" value="II">“(II) </num><content>the entity does not accept the contract offered for such product category and area,</content></subclause> <continuation class="firstIndent1 fontsize10" id="x587694c7-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126">the bid bond submitted by such entity for such area shall be forfeited by the entity and the Secretary shall collect on it.</continuation></clause> <clause class="fontsize10" id="y587694c8-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x587694c9-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x587694ca-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Public information.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Treatment of other bidders</inline>.—</heading><content>In the case of a bidding entity for any product category for a competitive acquisition area, if the entity does not meet the bid forfeiture conditions in subclauses (I) <page identifier="/us/stat/129/177">129 STAT. 177</page> and (II) of clause (i) for any product category for such area, the bid bond submitted by such entity for such area shall be returned within 90 days of the public announcement of the contract suppliers for such area.”</content></clause> </subparagraph> </quotedContent>.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y587694cb-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s522/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">State Licensure</inline>.—</heading><paragraph class="fontsize10" id="y587694cc-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s522/b/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Section 1847(b)(2)(A) of the Social Security Act (<ref href="/us/usc/t42/s1395w–3/b/2/A">42 U.S.C. 1395w–3(b)(2)(A)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new clause:<quotedContent><clause class="indentUp2 fontsize10" id="y587694cd-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="v">“(v) </num><content>The entity meets applicable State licensure requirements.”</content></clause> </quotedContent>.</content></paragraph> <paragraph class="fontsize10" id="y587694ce-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s522/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5876bbdf-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180"><ref href="/us/usc/t42/s1395w–3">42 USC 1395w–3 note</ref>.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Construction</inline>.—</heading><content>Nothing in the amendment made by paragraph (1) shall be construed as affecting the authority of the Secretary of Health and Human Services to require State licensure of an entity under the Medicare competitive acquisition program under section 1847 of the Social Security Act (<ref href="/us/usc/t42/s1395w–3">42 U.S.C. 1395w–3</ref>) before the date of the enactment of this Act.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y5876bbe0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s522/c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">GAO Report on Bid Bond Impact on Small Suppliers</inline>.—</heading><paragraph class="fontsize10" id="y5876bbe1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s522/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Study</inline>.—</heading><content>The Comptroller General of the United States shall conduct a study that evaluates the effect of the bid surety bond requirement under the amendment made by subsection (a) on the participation of small suppliers in the Medicare DMEPOS competitive acquisition program under section 1847 of the Social Security Act (<ref href="/us/usc/t42/s1395w–3">42 U.S.C. 1395w–3</ref>).</content></paragraph> <paragraph class="fontsize10" id="y5876bbe2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s522/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><heading class="fontsize10"><inline class="smallCaps">Report</inline>.—</heading><content>Not later than 6 months after the date contracts are first awarded subject to such bid surety bond requirement, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1). <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5876bbe3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Recommenda-</p><p class="leftAlign firstIndent0 fontsize8" id="x5876bbe4-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">tions.</p></sidenote>Such report shall include recommendations for changes in such requirement in order to ensure robust participation by legitimate small suppliers in the Medicare DMEPOS competition acquisition program.</content></paragraph> </subsection> </section> <section id="d354370e12661" identifier="/us/pl/114/10/tV/stB/s523" style="-uslm-lc:I658143"><num class="fontsize12" value="523">SEC. 523. </num><heading>PAYMENT FOR GLOBAL SURGICAL PACKAGES.</heading><subsection class="firstIndent0 fontsize10" id="y5876e2f5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s523/a" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">In General</inline>.—</heading><content>Section 1848(c) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/c">42 U.S.C. 1395w–4(c)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="fontsize10" id="y58773116-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="8">“(8) </num><heading class="fontsize10"><inline class="smallCaps">Global surgical packages</inline>.—</heading><subparagraph class="fontsize10" id="y58773117-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">“(A) </num><heading class="fontsize10"><inline class="smallCaps">Prohibition of implementation of rule regarding global surgical packages</inline>.—</heading><clause class="fontsize10" id="y58773118-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>The Secretary shall not implement the policy established in the final rule published on November 13, 2014 (<ref href="/us/fr/79/67548/etseq">79 Fed. Reg. 67548 et seq.</ref>), that requires the transition of all 10-day and 90-day global surgery packages to 0-day global periods.</content></clause> <clause class="fontsize10" id="y58773119-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Construction</inline>.—</heading><content>Nothing in clause (i) shall be construed to prevent the Secretary from revaluing misvalued codes for specific surgical services or assigning values to new or revised codes for surgical services.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y5877311a-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">“(B) </num><heading class="fontsize10"><inline class="smallCaps">Collection of data on services included in global surgical packages</inline>.—</heading><clause class="fontsize10" id="y5877311b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="i">“(i) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5877311c-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Regulations.</p><p class="leftAlign firstIndent0 fontsize8" id="x5877311d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">In general</inline>.—</heading><content>Subject to clause (ii), the Secretary shall through rulemaking develop and implement a process to gather, from a representative sample of physicians, beginning not later than January 1, 2017, information needed to value surgical services. <page identifier="/us/stat/129/178">129 STAT. 178</page> Such information shall include the number and level of medical visits furnished during the global period and other items and services related to the surgery and furnished during the global period, as appropriate. Such information shall be reported on claims at the end of the global period or in another manner specified by the Secretary. For purposes of carrying out this paragraph (other than clause (iii)), the Secretary shall transfer from the Federal Supplemental Medical Insurance Trust Fund under section 1841 $2,000,000 to the Center for Medicare & Medicaid Services Program Management Account for fiscal year 2015. Amounts transferred under the previous sentence shall remain available until expended.</content></clause> <clause class="fontsize10" id="y5877311e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="ii">“(ii) </num><heading class="fontsize10"><inline class="smallCaps">Reassessment and potential sunset</inline>.—</heading><content>Every 4 <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x5877311f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p><p class="leftAlign firstIndent0 fontsize8" id="x58773120-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Regulation.</p><p class="leftAlign firstIndent0 fontsize8" id="x58773121-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Determination.</p></sidenote>years, the Secretary shall reassess the value of the information collected pursuant to clause (i). Based on such a reassessment and by regulation, the Secretary may discontinue the requirement for collection of information under such clause if the Secretary determines that the Secretary has adequate information from other sources, such as qualified clinical data registries, surgical logs, billing systems or other practice or facility records, and electronic health records, in order to accurately value global surgical services under this section.</content></clause> <clause class="fontsize10" id="y58773122-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658126"><num class="fontsize10" style="-uslm-lc:emspace2" value="iii">“(iii) </num><heading class="fontsize10"><inline class="smallCaps">Inspector general audit</inline>.—</heading><content>The Inspector General of the Department of Health and Human Services shall audit a sample of the information reported under clause (i) to verify the accuracy of the information so reported.</content></clause> </subparagraph> <subparagraph class="fontsize10" id="y58773123-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Improving accuracy of pricing for surgical services</inline>.—</heading><content>For <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58773124-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote>years beginning with 2019, the Secretary shall use the information reported under subparagraph (B)(i) as appropriate and other available data for the purpose of improving the accuracy of valuation of surgical services under the physician fee schedule under this section.”</content></subparagraph> </paragraph> </quotedContent>.</content></subsection> <subsection class="firstIndent0 fontsize10" id="y58773125-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s523/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Incentive for Reporting Information on Global Surgical Services</inline>.—</heading><content>Section 1848(a) of the Social Security Act (<ref href="/us/usc/t42/s1395w–4/a">42 U.S.C. 1395w–4(a)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new paragraph:<quotedContent><paragraph class="fontsize10" id="y58773126-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="9">“(9) </num><heading class="fontsize10"><inline class="smallCaps">Information reporting on services included in global surgical packages</inline>.—</heading><content>With <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58773127-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Regulations.</p></sidenote>respect to services for which a physician is required to report information in accordance with subsection (c)(8)(B)(i), the Secretary may through rulemaking delay payment of 5 percent of the amount that would otherwise be payable under the physician fee schedule under this section for such services until the information so required is reported.”</content></paragraph> </quotedContent>.</content></subsection> </section> <section id="d354370e12827" identifier="/us/pl/114/10/tV/stB/s524" style="-uslm-lc:I658143"><num class="fontsize12" value="524">SEC. 524. </num><heading>EXTENSION OF SECURE RURAL SCHOOLS AND COMMUNITY SELF-DETERMINATION ACT OF 2000.</heading><subsection class="firstIndent0 fontsize10" id="y58781b88-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Payments for Fiscal Years 2014 and 2015</inline>.—</heading><paragraph class="fontsize10" id="y58781b89-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/a/1" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><heading class="fontsize10"><inline class="smallCaps">Payments required</inline>.—</heading><content>Section 101 of the Secure Rural Schools and Community Self-Determination Act of 2000 (16 <page identifier="/us/stat/129/179">129 STAT. 179</page> U.S.C. 7111) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>2013</quotedText>” both places it appears and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2015</quotedText>”.</content></paragraph> <paragraph class="fontsize10" id="y58781b8a-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/a/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x58781b8b-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Deadline.</p></sidenote><heading class="fontsize10"><inline class="smallCaps">Prompt payment</inline>.—</heading><content>Payments for fiscal year 2014 under title I of the Secure Rural Schools and Community Self-Determination Act of 2000 (<ref href="/us/usc/t16/s7111/etseq">16 U.S.C. 7111 et seq.</ref>), as amended by this section, shall be made not later than 45 days after the date of the enactment of this Act.</content></paragraph> <paragraph class="fontsize10" id="y58781b8c-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/a/3" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><heading class="fontsize10"><inline class="smallCaps">Reduction in fiscal year 2014 payments on account of previous 25- and 50-percent payments</inline>.—</heading><content>Section 101 of the Secure Rural Schools and Community Self-Determination Act of 2000 (<ref href="/us/usc/t16/s7111">16 U.S.C. 7111</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="add">adding</amendingAction> at the end the following new subsection:<quotedContent><subsection class="indentDown1 firstIndent0 fontsize10" id="y5878429d-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">“(c) </num><heading class="fontsize10"><inline class="smallCaps">Special Rule for Fiscal Year 2014 Payments</inline>.—</heading><paragraph class="fontsize10" id="y5878429e-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">“(1) </num><heading class="fontsize10"><inline class="smallCaps">State payment</inline>.—</heading><content>If an eligible county in a State that will receive a share of the State payment for fiscal year 2014 has already received, or will receive, a share of the 25-percent payment for fiscal year 2014 distributed to the State before the date of the enactment of this subsection, the amount of the State payment shall be reduced by the amount of that eligible county’s share of the 25-percent payment.</content></paragraph> <paragraph class="fontsize10" id="y5878429f-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">“(2) </num><heading class="fontsize10"><inline class="smallCaps">County payment</inline>.—</heading><content>If an eligible county that will receive a county payment for fiscal year 2014 has already received a 50-percent payment for that fiscal year, the amount of the county payment shall be reduced by the amount of the 50-percent payment.”</content></paragraph> </subsection> </quotedContent>.</content></paragraph> <paragraph class="fontsize10" id="y587842a0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/a/4" role="instruction" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><heading class="fontsize10"><inline class="smallCaps">Shares of california state payment</inline>.—</heading><content>Section 103(d)(2) of the Secure Rural Schools and Community Self-Determination Act of 2000 (<ref href="/us/usc/t16/s7113/d/2">16 U.S.C. 7113(d)(2)</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>2013</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2015</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y587842a1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/b" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Use of Fiscal Year 2013 Elections and Reservations for Fiscal Years 2014 and 2015</inline>.—</heading><chapeau>Section 102 of the Secure Rural Schools and Community Self-Determination Act of 2000 (<ref href="/us/usc/t16/s7112">16 U.S.C. 7112</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y587842a2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/b/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in subsection (b)(1), by <amendingAction type="add">adding</amendingAction> at the end the following new subparagraph:<quotedContent><subparagraph class="fontsize10" id="y587842a3-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Effect of late payment for fiscal years 2014 and 2015</inline>.—</heading><content>The election otherwise required by subparagraph (A) shall not apply for fiscal year 2014 or 2015.”</content></subparagraph> </quotedContent>;</content></paragraph> <paragraph class="fontsize10" id="y587842a4-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/b/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><chapeau>in subsection (b)(2)—</chapeau><subparagraph class="fontsize10" id="y587842a5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/b/2/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><sidenote><p class="leftAlign firstIndent0 fontsize8" id="x587842a6-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote><content>in subparagraph (A), by <amendingAction type="add">adding</amendingAction> at the end the following new sentence: “<quotedText>If such two-fiscal year period included fiscal year 2013, the county election to receive a share of the 25-percent payment or 50-percent payment, as applicable, also shall be effective for fiscal years 2014 and 2015.</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y587842a7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/b/2/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in subparagraph (B), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2013</quotedText>” the second place it appears and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2015</quotedText>”; and</content></subparagraph> </paragraph> <paragraph class="fontsize10" id="y587842a8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/b/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><chapeau>in subsection (d)—</chapeau><subparagraph class="fontsize10" id="y587842a9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/b/3/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>by <amendingAction type="add">adding</amendingAction> at the end of paragraph (1) the following new subparagraph:<quotedContent><subparagraph class="indentUp0 fontsize10" id="y587842aa-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="E">“(E) </num><heading class="fontsize10"><inline class="smallCaps">Effect of late payment for fiscal year 2014</inline>.—</heading><content>The <sidenote><p class="leftAlign firstIndent0 fontsize8" id="x587842ab-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658180">Effective date.</p></sidenote>election made by an eligible county under subparagraph (B), (C), or (D) for fiscal year 2013, or deemed to be made by the county under paragraph (3)(B) for that fiscal year, shall be effective for fiscal years 2014 and 2015.”</content></subparagraph> </quotedContent>; and<page identifier="/us/stat/129/180">129 STAT. 180</page></content></subparagraph> <subparagraph class="fontsize10" id="y587842ac-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/b/3/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>by <amendingAction type="add">adding</amendingAction> at the end of paragraph (3) the following new subparagraph:<quotedContent><subparagraph class="indentUp0 fontsize10" id="y587842ad-e871-11f0-bc57-ad3ac4b1618c" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="C">“(C) </num><heading class="fontsize10"><inline class="smallCaps">Effect of late payment for fiscal year 2014</inline>.—</heading><content>This paragraph does not apply for fiscal years 2014 and 2015.”</content></subparagraph> </quotedContent>.</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y587842ae-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/c" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="c">(c) </num><heading class="fontsize10"><inline class="smallCaps">Special Projects on Federal Land</inline>.—</heading><chapeau>Title II of the Secure Rural Schools and Community Self-Determination Act of 2000 (<ref href="/us/usc/t16/s7121/etseq">16 U.S.C. 7121 et seq.</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y587842af-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/c/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in section 203(a)(1) (<ref href="/us/usc/t16/s7123/a/1">16 U.S.C. 7123(a)(1)</ref>), by <amendingAction type="delete">striking</amendingAction> “<quotedText>September 30 for fiscal year 2008 (or as soon thereafter as the Secretary concerned determines is practicable), and each September 30 thereafter for each succeeding fiscal year through fiscal year 2013</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>September 30 of each fiscal year (or a later date specified by the Secretary concerned for the fiscal year)</quotedText>”;</content></paragraph> <paragraph class="fontsize10" id="y587842b0-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/c/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in section 204(e)(3)(B)(iii) (<ref href="/us/usc/t16/s7124/e/3/B/iii">16 U.S.C. 7124(e)(3)(B)(iii)</ref>), by <amendingAction type="delete">striking</amendingAction> “<quotedText>each of fiscal years 2010 through 2013</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>fiscal year 2010 and fiscal years thereafter</quotedText>”;</content></paragraph> <paragraph class="fontsize10" id="y587842b1-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/c/3" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="3">(3) </num><content>in section 207(a) (<ref href="/us/usc/t16/s7127/a">16 U.S.C. 7127(a)</ref>), by <amendingAction type="delete">striking</amendingAction> “<quotedText>September 30, 2008 (or as soon thereafter as the Secretary concerned determines is practicable), and each September 30 thereafter for each succeeding fiscal year through fiscal year 2013</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>September 30 of each fiscal year (or a later date specified by the Secretary concerned for the fiscal year)</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y587868c2-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/c/4" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="4">(4) </num><chapeau>in section 208 (<ref href="/us/usc/t16/s7128">16 U.S.C. 7128</ref>)—</chapeau><subparagraph class="fontsize10" id="y587868c3-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/c/4/A" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="A">(A) </num><content>in subsection (a), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2013</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>”; and</content></subparagraph> <subparagraph class="fontsize10" id="y587868c4-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/c/4/B" style="-uslm-lc:I658124"><num class="fontsize10" style="-uslm-lc:emspace2" value="B">(B) </num><content>in subsection (b), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2014</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2018</quotedText>”.</content></subparagraph> </paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y587868c5-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/d" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="d">(d) </num><heading class="fontsize10"><inline class="smallCaps">County Funds</inline>.—</heading><chapeau>Section 304 of the Secure Rural Schools and Community Self-Determination Act of 2000 (<ref href="/us/usc/t16/s7144">16 U.S.C. 7144</ref>) <amendingAction type="amend">is amended</amendingAction>—</chapeau><paragraph class="fontsize10" id="y587868c6-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/d/1" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="1">(1) </num><content>in subsection (a), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2013</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2017</quotedText>”; and</content></paragraph> <paragraph class="fontsize10" id="y587868c7-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/d/2" style="-uslm-lc:I658122"><num class="fontsize10" style="-uslm-lc:emspace2" value="2">(2) </num><content>in subsection (b), by <amendingAction type="delete">striking</amendingAction> “<quotedText>2014</quotedText>” and <amendingAction type="insert">inserting</amendingAction> “<quotedText>2018</quotedText>”.</content></paragraph> </subsection> <subsection class="firstIndent0 fontsize10" id="y587868c8-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s524/e" role="instruction" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="e">(e) </num><heading class="fontsize10"><inline class="smallCaps">Authorization of Appropriations</inline>.—</heading><content>Section 402 of the Secure Rural Schools and Community Self-Determination Act of 2000 (<ref href="/us/usc/t16/s7152">16 U.S.C. 7152</ref>) <amendingAction type="amend">is amended</amendingAction> by <amendingAction type="delete">striking</amendingAction> “<quotedText>for each of fiscal years 2008 through 2013</quotedText>”.</content></subsection> </section> <section id="d354370e13218" identifier="/us/pl/114/10/tV/stB/s525" style="-uslm-lc:I658143"><num class="fontsize12" value="525">SEC. 525. </num><heading>EXCLUSION FROM PAYGO SCORECARDS.</heading><subsection class="firstIndent0 fontsize10" id="y587868c9-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s525/a" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="a">(a) </num><heading class="fontsize10"><inline class="smallCaps">Statutory Pay-As-You-Go Scorecards</inline>.—</heading><content>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.<page identifier="/us/stat/129/181">129 STAT. 181</page></content></subsection> <subsection class="firstIndent0 fontsize10" id="y587868ca-e871-11f0-bc57-ad3ac4b1618c" identifier="/us/pl/114/10/tV/stB/s525/b" style="-uslm-lc:I658120"><num class="fontsize10" style="-uslm-lc:emspace2" value="b">(b) </num><heading class="fontsize10"><inline class="smallCaps">Senate PAYGO Scorecards</inline>.—</heading><content>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).</content></subsection> </section> </subtitle> Approved April 16, 2015.