[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 1871 Placed on Calendar Senate (PCS)]

                                                       Calendar No. 280
113th CONGRESS
  1st Session
                                S. 1871

To amend title XVIII of the Social Security Act to repeal the Medicare 
sustainable growth rate formula and to improve beneficiary access under 
             the Medicare program, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           December 19, 2013

   Mr. Baucus, from the Committee on Finance, reported the following 
     original bill; which was read twice and placed on the calendar

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to repeal the Medicare 
sustainable growth rate formula and to improve beneficiary access under 
             the Medicare program, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``SGR Repeal and 
Medicare Beneficiary Access Act of 2013''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
           TITLE I--MEDICARE PAYMENT FOR PHYSICIANS' SERVICES

Sec. 101. Repealing the sustainable growth rate (SGR) and improving 
                            Medicare payment for physicians' services.
Sec. 102. Priorities and funding for quality measure development.
Sec. 103. Encouraging care management for individuals with chronic care 
                            needs.
Sec. 104. Ensuring accurate valuation of services under the physician 
                            fee schedule.
Sec. 105. Promoting evidence-based care.
Sec. 106. Empowering beneficiary choices through access to information 
                            on physicians' services.
Sec. 107. Expanding claims data availability to improve care.
               TITLE II--EXTENSIONS AND OTHER PROVISIONS

                    Subtitle A--Medicare Extensions

Sec. 201. Work geographic adjustment.
Sec. 202. Medicare payment for therapy services.
Sec. 203. Medicare ambulance services.
Sec. 204. Revision of the Medicare-dependent hospital (MDH) program.
Sec. 205. Revision of Medicare inpatient hospital payment adjustment 
                            for low-volume hospitals.
Sec. 206. Specialized Medicare Advantage plans for special needs 
                            individuals.
Sec. 207. Reasonable cost reimbursement contracts.
Sec. 208. Quality measure endorsement and selection.
Sec. 209. Permanent extension of funding outreach and assistance for 
                            low-income programs.
               Subtitle B--Medicaid and Other Extensions

Sec. 211. Qualifying individual program.
Sec. 212. Transitional Medical Assistance.
Sec. 213. Express lane eligibility.
Sec. 214. Pediatric quality measures.
Sec. 215. Special diabetes programs.
                 Subtitle C--Human Services Extensions

Sec. 221. Abstinence education grants.
Sec. 222. Personal responsibility education program.
Sec. 223. Family-to-family health information centers.
Sec. 224. Health workforce demonstration project for low-income 
                            individuals.
                     Subtitle D--Program Integrity

Sec. 231. Reducing improper Medicare payments.
Sec. 232. Authority for Medicaid fraud control units to investigate and 
                            prosecute complaints of abuse and neglect 
                            of Medicaid patients in home and community-
                            based settings.
Sec. 233. Improved use of funds received by the HHS Inspector General 
                            from oversight and investigative 
                            activities.
Sec. 234. Preventing and reducing improper Medicare and Medicaid 
                            expenditures.
                      Subtitle E--Other Provisions

Sec. 241. Commission on Improving Patient Directed Health Care.
Sec. 242. Expansion of the definition of inpatient hospital services 
                            for certain cancer hospitals.
Sec. 243. Quality measures for certain post-acute care providers 
                            relating to notice and transfer of patient 
                            health information and patient care 
                            preferences.
Sec. 244. Criteria for medically necessary, short inpatient hospital 
                            stays.
Sec. 245. Transparency of reasons for excluding additional procedures 
                            from the Medicare ambulatory surgical 
                            center (ASC) approved list.
Sec. 246. Supervision in critical access hospitals.
Sec. 247. Requiring State licensure of bidding entities under the 
                            competitive acquisition program for certain 
                            durable medical equipment, prosthetics, 
                            orthotics, and supplies (DMEPOS).
Sec. 248. Recognition of attending physician assistants as attending 
                            physicians to serve hospice patients.
Sec. 249. Remote patient monitoring pilot projects.
Sec. 250. Community-Based Institutional Special Needs Plan 
                            Demonstration Program.
Sec. 251. Applying CMMI waiver authority to PACE in order to foster 
                            innovations.
Sec. 252. Improve and modernize Medicaid data systems and reporting.
Sec. 253. Fairness in Medicaid supplemental needs trusts.
Sec. 254. Helping Ensure Life- and Limb-Saving Access to Podiatric 
                            Physicians.
Sec. 255. Demonstration program to improve community mental health 
                            services.
Sec. 256. Annual Medicaid DSH report.
Sec. 257. Implementation.

           TITLE I--MEDICARE PAYMENT FOR PHYSICIANS' SERVICES

SEC. 101. REPEALING THE SUSTAINABLE GROWTH RATE (SGR) AND IMPROVING 
              MEDICARE PAYMENT FOR PHYSICIANS' SERVICES.

    (a) Stabilizing Fee Updates.--
            (1) Repeal of sgr payment methodology.--Section 1848 of the 
        Social Security Act (42 U.S.C. 1395w-4) is amended--
                    (A) in subsection (d)--
                            (i) in paragraph (1)(A), by inserting ``or 
                        a subsequent paragraph'' after ``paragraph 
                        (4)''; and
                            (ii) in paragraph (4)--
                                    (I) in the heading, by inserting 
                                ``and ending with 2013'' after ``years 
                                beginning with 2001''; and
                                    (II) in subparagraph (A), by 
                                inserting ``and ending with 2013'' 
                                after ``a year beginning with 2001''; 
                                and
                    (B) in subsection (f)--
                            (i) in paragraph (1)(B), by inserting 
                        ``through 2013'' after ``of each succeeding 
                        year''; and
                            (ii) in paragraph (2), by inserting ``and 
                        ending with 2013'' after ``beginning with 
                        2000''.
            (2) Update of rates for 2014 and subsequent years.--
        Subsection (d) of section 1848 of the Social Security Act (42 
        U.S.C. 1395w-4) is amended by adding at the end the following 
        new paragraphs:
            ``(15) Update for 2014 through 2023.--The update to the 
        single conversion factor established in paragraph (1)(C) for 
        each of 2014 through 2023 shall be zero percent.
            ``(16) Update for 2024 and subsequent years.--The update to 
        the single conversion factor established in paragraph (1)(C) 
        for 2024 and each subsequent year shall be--
                    ``(A) for items and services furnished by a 
                qualifying APM participant (as defined in section 
                1833(z)(2)) for such year, 2 percent; and
                    ``(B) for other items and services, 1 percent.''.
            (3) MedPAC reports.--
                    (A) Initial report.--Not later than July 1, 2016, 
                the Medicare Payment Advisory Commission shall submit 
                to Congress a report on the relationship between--
                            (i) 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 
                        (42 U.S.C. 1395w-4); and
                            (ii) 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.
                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.
                    (B) Final report.--Not later than July 1, 2020, 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.
    (b) Consolidation of Certain Current Law Performance Programs With 
New Value-based Performance Incentive Program.--
            (1) EHR meaningful use incentive program.--
                    (A) Sunsetting separate meaningful use payment 
                adjustments.--Section 1848(a)(7)(A) of the Social 
                Security Act (42 U.S.C. 1395w-4(a)(7)(A)) is amended--
                            (i) in clause (i), by striking ``or any 
                        subsequent payment year'' and inserting ``or 
                        2016'';
                            (ii) in clause (ii)--
                                    (I) in the matter preceding 
                                subclause (I), by striking ``Subject to 
                                clause (iii), for'' and inserting 
                                ``For'';
                                    (II) in subclause (I), by adding at 
                                the end ``and'';
                                    (III) in subclause (II), by 
                                striking ``; and'' and inserting a 
                                period; and
                                    (IV) by striking subclause (III); 
                                and
                            (iii) by striking clause (iii).
                    (B) Continuation of meaningful use determinations 
                for vbp program.--Section 1848(o)(2) of the Social 
                Security Act (42 U.S.C. 1395w-4(o)(2)) is amended--
                            (i) in subparagraph (A), in the matter 
                        preceding clause (i)--
                                    (I) by striking ``For purposes of 
                                paragraph (1), an'' and inserting 
                                ``An''; and
                                    (II) by inserting ``, or pursuant 
                                to subparagraph (D) for purposes of 
                                subsection (q), for a performance 
                                period under such subsection for a 
                                year'' after ``under such subsection 
                                for a year''; and
                            (ii) by adding at the end the following new 
                        subparagraph:
                    ``(D) Continued application for purposes of vbp 
                program.--With respect to 2017 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 VBP 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.''.
            (2) Quality reporting.--
                    (A) Sunsetting separate quality reporting 
                incentives.--Section 1848(a)(8)(A) of the Social 
                Security Act (42 U.S.C. 1395w-4(a)(8)(A)) is amended--
                            (i) in clause (i), by striking ``or any 
                        subsequent year'' and inserting ``or 2016''; 
                        and
                            (ii) in clause (ii)(II), by striking ``and 
                        each subsequent year''.
                    (B) Continuation of quality measures and processes 
                for vbp program.--Section 1848 of the Social Security 
                Act (42 U.S.C. 1395w-4) is amended--
                            (i) in subsection (k), by adding at the end 
                        the following new paragraph:
            ``(9) Continued application for purposes of vbp program.--
        The Secretary shall, in accordance with subsection (q)(1)(F), 
        carry out the provisions of this subsection for purposes of 
        subsection (q).''; and
                            (ii) in subsection (m)--
                                    (I) by redesignating the paragraph 
                                (7) added by section 10327(a) of Public 
                                Law 111-148 as paragraph (8); and
                                    (II) by adding at the end the 
                                following new paragraph:
            ``(9) Continued application for purposes of vbp program.--
        The Secretary shall, in accordance with subsection (q)(1)(F), 
        carry out the processes under this subsection for purposes of 
        subsection (q).''.
            (3) Value-based payments.--
                    (A) Sunsetting separate value-based payments.--
                Clause (iii) of section 1848(p)(4)(B) of the Social 
                Security Act (42 U.S.C. 1395w-4(p)(4)(B)) is amended to 
                read as follows:
                            ``(iii) Application.--The Secretary shall 
                        apply the payment modifier established under 
                        this subsection for items and services 
                        furnished on or after January 1, 2015, but 
                        before January 1, 2017, with respect to 
                        specific physicians and groups of physicians 
                        the Secretary determines appropriate. Such 
                        payment modifier shall not be applied for items 
                        and services furnished on or after January 1, 
                        2017.''.
                    (B) Continuation of value-based payment modifier 
                measures for vbp program.--Section 1848(p) of the 
                Social Security Act (42 U.S.C. 1395w-4(p)) is amended--
                            (i) in paragraph (2), by adding at the end 
                        the following new subparagraph:
                    ``(C) Continued application for purposes of vbp 
                program.--The Secretary shall, in accordance with 
                subsection (q)(1)(F), carry out subparagraph (B) for 
                purposes of subsection (q).''; and
                            (ii) in paragraph (3), by adding at the end 
                        the following: ``With respect to 2017 and each 
                        subsequent year, the Secretary shall, in 
                        accordance with subsection (q)(1)(F), carry out 
                        this paragraph for purposes of subsection 
                        (q).''.
    (c) Value-based Performance Incentive Program.--
            (1) In general.--Section 1848 of the Social Security Act 
        (42 U.S.C. 1395w-4) is amended by adding at the end the 
        following new subsection:
    ``(q) Value-based Performance Incentive Program.--
            ``(1) Establishment.--
                    ``(A) In general.--Subject to the succeeding 
                provisions of this subsection, the Secretary shall 
                establish an eligible professional value-based 
                performance incentive program (in this subsection 
                referred to as the `VBP program') under which the 
                Secretary shall--
                            ``(i) develop a methodology for assessing 
                        the total performance of each VBP eligible 
                        professional according to performance standards 
                        under paragraph (3) for a performance period 
                        (as established under paragraph (4)) for a 
                        year;
                            ``(ii) using such methodology, provide for 
                        a composite performance score in accordance 
                        with paragraph (5) for each such professional 
                        for each performance period; and
                            ``(iii) use such composite performance 
                        score of the VBP eligible professional for a 
                        performance period for a year to make VBP 
                        program incentive payments under paragraph (7) 
                        to the professional for the year.
                    ``(B) Program implementation.--The VBP program 
                shall apply to payments for items and services 
                furnished on or after January 1, 2017.
                    ``(C) VBP eligible professional defined.--
                            ``(i) In general.--For purposes of this 
                        subsection, subject to clauses (ii) and (iv), 
                        the term `VBP eligible professional' means--
                                    ``(I) for the first and second 
                                years for which the VBP program 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)), and a 
                                certified registered nurse anesthetist 
                                (as defined in section 1861(bb)(2)); 
                                and
                                    ``(II) for the third year for which 
                                the VBP program 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) and such other eligible 
                                professionals (as defined in subsection 
                                (k)(3)(B)) as specified by the 
                                Secretary.
                            ``(ii) Exclusions.--For purposes of clause 
                        (i), the term `VBP eligible professional' does 
                        not include, with respect to a year, an 
                        eligible professional (as defined in subsection 
                        (k)(3)(B))--
                                    ``(I) who is a qualifying APM 
                                participant (as defined in section 
                                1833(z)(2));
                                    ``(II) who, subject to clause 
                                (vii), is a partial qualifying APM 
                                participant (as defined in clause 
                                (iii)) 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 VBP program; or
                                    ``(III) who, for the performance 
                                period with respect to such year, does 
                                not exceed the low-volume threshold 
                                measurement selected under clause (iv).
                            ``(iii) Partial qualifying apm 
                        participant.--For purposes of this 
                        subparagraph, the term `partial qualifying APM 
                        participant' 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--
                                    ``(I) with respect to 2017 and 
                                2018, the reference in subparagraph (A) 
                                of such paragraph to 25 percent was 
                                instead a reference to 20 percent;
                                    ``(II) with respect to 2019 and 
                                2020--
                                            ``(aa) the reference in 
                                        subparagraph (B)(i) of such 
                                        paragraph to 50 percent was 
                                        instead a reference to 40 
                                        percent; and
                                            ``(bb) 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
                                    ``(III) with respect to 2021 and 
                                subsequent years--
                                            ``(aa) the reference in 
                                        subparagraph (C)(i) of such 
                                        paragraph to 75 percent was 
                                        instead a reference to 50 
                                        percent; and
                                            ``(bb) 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.
                            ``(iv) Selection of low-volume threshold 
                        measurement.--The Secretary shall select one of 
                        the following low-volume threshold measurements 
                        to apply for purposes of clause (ii)(III):
                                    ``(I) The minimum number (as 
                                determined by the Secretary) of 
                                individuals enrolled under this part 
                                who are treated by the VBP eligible 
                                professional for the performance period 
                                involved.
                                    ``(II) 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.
                                    ``(III) The minimum amount (as 
                                determined by the Secretary) of allowed 
                                charges billed by such professional 
                                under this part for such performance 
                                period.
                            ``(v) Treatment of new medicare enrolled 
                        eligible professionals.--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 
                        VBP eligible professional until the subsequent 
                        year and performance period for such subsequent 
                        year.
                            ``(vi) Clarification.--In the case of items 
                        and services furnished during a year by an 
                        individual who is not a VBP eligible 
                        professional (including pursuant to clauses 
                        (ii) and (v)) with respect to a year, in no 
                        case shall a reduction under paragraph (6) or a 
                        VBP program incentive payment under paragraph 
                        (7) apply to such individual for such year.
                            ``(vii) Partial qualifying apm participant 
                        clarification.--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 
                        VBP program, such eligible professional is 
                        considered to be a VBP eligible professional 
                        with respect to such year.
                    ``(D) Application to group practices.--
                            ``(i) In general.--Under the VBP program:
                                    ``(I) Quality performance 
                                category.--The Secretary shall 
                                establish and apply a process that 
                                includes features of the provisions of 
                                subsection (m)(3)(C) for VBP 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).
                                    ``(II) Other performance 
                                categories.--The Secretary may 
                                establish and apply a process that 
                                includes features of the provisions of 
                                subsection (m)(3)(C) for VBP 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.
                            ``(ii) Ensuring comprehensiveness of group 
                        practice assessment.--The process established 
                        under clause (i) shall to the extent 
                        practicable reflect the full range of items and 
                        services furnished by the VBP eligible 
                        professionals in the group practice involved.
                            ``(iii) Clarification.--VBP eligible 
                        professionals electing to be a virtual group 
                        under paragraph (5)(J) shall not be considered 
                        VBP eligible professionals in a group practice 
                        for purposes of applying this subparagraph.
                    ``(E) Use of registries.--Under the VBP program, 
                the Secretary shall encourage the use of qualified 
                clinical data registries pursuant to subsection 
                (m)(3)(E) in carrying out this subsection.
                    ``(F) Application of certain provisions.--In 
                applying a provision of subsection (k), (m), (o), or 
                (p) for purposes of this subsection, the Secretary 
                shall--
                            ``(i) adjust the application of such 
                        provision to ensure the provision is consistent 
                        with the provisions of this subsection; and
                            ``(ii) not apply such provision to the 
                        extent that the provision is duplicative with a 
                        provision of this subsection.
            ``(2) Measures and activities under performance 
        categories.--
                    ``(A) Performance categories.--Under the VBP 
                program, 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):
                            ``(i) Quality.
                            ``(ii) Resource use.
                            ``(iii) Clinical practice improvement 
                        activities.
                            ``(iv) Meaningful use of certified EHR 
                        technology.
                    ``(B) Measures and activities specified for each 
                category.--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:
                            ``(i) Quality.--For the performance 
                        category described in subparagraph (A)(i), the 
                        quality measures established for such period 
                        under subsections (k) and (m), including under 
                        subsection (m)(3)(E), and the measures of 
                        quality of care established for such period 
                        under subsection (p)(2).
                            ``(ii) Resource use.--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 covered part D drugs.
                            ``(iii) Clinical practice improvement 
                        activities.--For the performance category 
                        described in subparagraph (A)(iii), clinical 
                        practice improvement activities under 
                        subcategories specified by the Secretary for 
                        such period, which shall include at least the 
                        following:
                                    ``(I) The subcategory of expanded 
                                practice access, which shall include 
                                activities such as same day 
                                appointments for urgent needs and after 
                                hours access to clinician advice.
                                    ``(II) The subcategory of 
                                population management, which shall 
                                include activities such as monitoring 
                                health conditions of individuals to 
                                provide timely health care 
                                interventions or participation in a 
                                qualified clinical data registry.
                                    ``(III) The subcategory of care 
                                coordination, which shall include 
                                activities such as timely communication 
                                of test results, timely exchange of 
                                clinical information to patients and 
                                other providers, and use of remote 
                                monitoring or telehealth.
                                    ``(IV) The subcategory of 
                                beneficiary engagement, which shall 
                                include activities such as the 
                                establishment of care plans for 
                                individuals with complex care needs, 
                                beneficiary self-management training, 
                                and using shared decision-making 
                                mechanisms.
                                    ``(V) The subcategory of patient 
                                safety and practice assessment, such as 
                                through use of clinical or surgical 
                                checklists and practice assessments 
                                related to maintaining certification.
                                    ``(VI) The subcategory of 
                                participation in an alternative payment 
                                model (as defined in section 
                                1833(z)(3)(C)).
                        In establishing activities under this clause, 
                        the Secretary shall give consideration to the 
                        circumstances of small practices (consisting of 
                        10 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).
                            ``(iv) Meaningful ehr use.--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.
                    ``(C) Additional provisions.--
                            ``(i) Emphasizing outcome measures under 
                        quality performance category.--In applying 
                        subparagraph (B)(i), the Secretary shall, as 
                        feasible, emphasize the application of outcome 
                        measures.
                            ``(ii) Application of additional system 
                        measures.--The Secretary may use measures used 
                        for a payment system other than for physicians 
                        for purposes of the performance category 
                        described in subparagraph (A)(i).
                            ``(iii) Global and population-based 
                        measures.--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).
                            ``(iv) Request for information for clinical 
                        practice improvement activities.--In initially 
                        applying subparagraph (B)(iii), the Secretary 
                        shall use a request for information to solicit 
                        recommendations from stakeholders for 
                        identifying activities described in such 
                        subparagraph and specifying criteria for such 
                        activities.
                            ``(v) Contract authority for clinical 
                        practice improvement activities performance 
                        category.--In applying subparagraph (B)(iii), 
                        the Secretary may contract with entities to 
                        assist the Secretary in--
                                    ``(I) identifying activities 
                                described in subparagraph (B)(iii);
                                    ``(II) specifying criteria for such 
                                activities; and
                                    ``(III) determining whether a VBP 
                                eligible professional meets such 
                                criteria.
            ``(3) Performance standards.--
                    ``(A) Establishment.--Under the VBP program, 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.
                    ``(B) Considerations in establishing standards.--In 
                establishing such performance standards with respect to 
                measures and activities specified under paragraph 
                (2)(B), the Secretary shall take into account the 
                following:
                            ``(i) Historical performance standards.
                            ``(ii) Improvement rates.
                            ``(iii) The opportunity for continued 
                        improvement.
            ``(4) Performance period.--The Secretary shall establish a 
        performance period (or periods) for a year (beginning with the 
        year described in paragraph (1)(B)). 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.
            ``(5) Composite performance score.--
                    ``(A) In general.--Subject to the succeeding 
                provisions of this paragraph, the Secretary shall 
                develop a methodology for assessing the total 
                performance of each VBP 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 (in this subsection 
                referred to as the `composite performance score') for 
                each such professional for each performance period.
                    ``(B) Weighting performance categories, measures, 
                and activities.--Under the methodology under 
                subparagraph (A), the Secretary--
                            ``(i) may assign different scoring weights 
                        (including a weight of 0) for--
                                    ``(I) each performance category 
                                based on the extent to which the 
                                category is applicable to the type of 
                                eligible professional involved; and
                                    ``(II) 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 to the type of 
                                eligible professional involved; and
                            ``(ii) with respect to the performance 
                        category described in paragraph (2)(A)(i)--
                                    ``(I) shall assign a higher scoring 
                                weight to outcomes measures than to 
                                other measures and increase the scoring 
                                weight for outcome measures over time; 
                                and
                                    ``(II) may assign a higher scoring 
                                weight to patient experience measures.
                    ``(C) Incentive to report; encouraging use of 
                certified ehr technology for reporting quality 
                measures.--
                            ``(i) Incentive to report.--Under the 
                        methodology established under subparagraph (A), 
                        the Secretary shall provide that in the case of 
                        a VBP 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.
                            ``(ii) Encouraging use of certified ehr 
                        technology for reporting quality measures.--
                        Under the methodology established under 
                        subparagraph (A), the Secretary shall--
                                    ``(I) encourage VBP 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
                                    ``(II) with respect to a 
                                performance period, with respect to a 
                                year, for which a VBP 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.
                    ``(D) Clinical practice improvement activities 
                performance score.--
                            ``(i) Rule for accreditation.--A VBP 
                        eligible professional who is in a practice that 
                        is certified as a patient-centered medical home 
                        or comparable specialty practice pursuant to 
                        subsection (b)(8)(B)(i) 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.
                            ``(ii) APM participation.--Participation by 
                        a VBP 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 
                        one-half of the highest potential score for the 
                        performance category described in paragraph 
                        (2)(A)(iii) for such performance period. 
                        Nothing in the previous sentence shall prevent 
                        such professional from earning more than one-
                        half of such highest potential score for such 
                        performance period by performing additional 
                        activities with respect to such performance 
                        category.
                            ``(iii) Subcategories.--A VBP eligible 
                        professional shall not be required to perform 
                        activities in each subcategory under paragraph 
                        (2)(B)(iii) to achieve the highest potential 
                        score for the performance category described in 
                        paragraph (2)(A)(iii).
                    ``(E) Distribution.--The Secretary shall ensure 
                that the application of the methodology developed under 
                subparagraph (A) results in a continuous distribution 
                of performance scores, which shall result in 
                differential payments under paragraph (7).
                    ``(F) Achievement and improvement.--
                            ``(i) Taking into account improvement.--
                        Beginning with the second year to which the VBP 
                        program applies, in addition to the achievement 
                        score of a VBP eligible professional, the 
                        methodology developed under subparagraph (A)--
                                    ``(I) 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
                                    ``(II) in the case of performance 
                                scores for other performance 
                                categories, may take into account the 
                                improvement of the professional.
                            ``(ii) Assigning higher weight for 
                        achievement.--Beginning with the fourth year to 
                        which the VBP program applies, under the 
                        methodology developed under subparagraph (A), 
                        the Secretary shall assign a higher scoring 
                        weight under subparagraph (B) with respect to 
                        the achievement score of a VBP eligible 
                        professional with respect to a measure or 
                        activity specified under paragraph (2)(B) (or 
                        with respect to such a measure or activity and 
                        with respect to categories described in 
                        paragraph (2)(A)) than to any improvement score 
                        applied under clause (i) with respect to such 
                        measure or activity (or such measure or 
                        activity and categories).
                    ``(G) Weights for the performance categories.--
                            ``(i) In general.--Under the methodology 
                        developed under subparagraph (A), subject to 
                        clauses (ii) and (iii), the composite 
                        performance score shall be determined as 
                        follows:
                                    ``(I) Quality.--Thirty percent of 
                                such score shall be based on 
                                performance with respect to the 
                                category described in clause (i) of 
                                paragraph (2)(A).
                                    ``(II) Resource use.--Thirty 
                                percent of such score shall be based on 
                                performance with respect to the 
                                category described in clause (ii) of 
                                paragraph (2)(A).
                                    ``(III) Clinical practice 
                                improvement activities.--Fifteen 
                                percent of such score shall be based on 
                                performance with respect to the 
                                category described in clause (iii) of 
                                paragraph (2)(A).
                                    ``(IV) Meaningful use of certified 
                                ehr technology.--Twenty-five percent of 
                                such score shall be based on 
                                performance with respect to the 
                                category described in clause (iv) of 
                                paragraph (2)(A).
                            ``(ii) Authority to adjust percentages in 
                        case of high ehr meaningful use adoption.--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), but not below 15 percent. 
                        If the Secretary makes such reduction for a 
                        year, 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.
                            ``(iii) Authority to adjust percentages for 
                        quality and resource use.--
                                    ``(I) In general.--Subject to 
                                subclause (II), the percentages 
                                described in subclauses (I) and (II) of 
                                clause (i), including after application 
                                of clause (ii), shall be equal.
                                    ``(II) Exception.--For the first 2 
                                years for which the VBP program 
                                applies, after application of clause 
                                (ii), the Secretary may increase the 
                                percentage applicable under subclause 
                                (I) or (II) of clause (i) as long as 
                                the Secretary decreases the percentage 
                                applicable under the other subclause by 
                                an equal number of percentage points 
                                and the number of percentage points 
                                applicable under each of subclauses (I) 
                                and (II) is not less than 15.
                    ``(H) Resource use.--Analysis of the performance 
                category described in paragraph (2)(A)(ii) shall 
                include results from the methodology described in 
                subsection (r)(5), as appropriate.
                    ``(I) Inclusion of quality measure data from 
                multiple payers.--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 VBP eligible professionals with respect to 
                multiple payers.
                    ``(J) Use of voluntary virtual groups for certain 
                assessment purposes.--
                            ``(i) In general.--In the case of VBP 
                        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)--
                                    ``(I) the assessment of performance 
                                provided under such methodology with 
                                respect to the performance categories 
                                described in clauses (i) and (ii) of 
                                paragraph (2)(A) 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
                                    ``(II) the composite score provided 
                                under this paragraph for such 
                                performance period with respect to each 
                                such performance category for each such 
                                VBP eligible professional in such 
                                virtual group shall be based on the 
                                assessment of the combined performance 
                                under subclause (I) for the performance 
                                category and performance period.
                            ``(ii) Election of practices to be a 
                        virtual group.--The Secretary shall, in 
                        accordance with clause (iii), establish and 
                        have in place a process to allow an individual 
                        VBP eligible professional or a group practice 
                        consisting of not more than 10 VBP eligible 
                        professionals to elect, with respect to a 
                        performance period for a year, for such 
                        individual VBP eligible professional or all 
                        such VBP eligible professionals in such group 
                        practice, respectively, to be a virtual group 
                        under this subparagraph with at least one other 
                        such individual VBP eligible professional or 
                        group practice making such an election.
                            ``(iii) Requirements.--The process under 
                        clause (ii) shall provide that--
                                    ``(I) 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; and
                                    ``(II) a practice described in such 
                                clause, and each VBP eligible 
                                professional in such practice, may 
                                elect to be in no more than one virtual 
                                group for a performance period.
            ``(6) Funding for vbp program incentive payments.--
                    ``(A) Total amount for incentive payments.--The 
                total amount for VBP program incentive payments under 
                paragraph (7) for all VBP eligible professionals for a 
                year shall be equal to the total amount of the 
                performance funding pool for all VBP eligible 
                professionals under subparagraph (B) for such year, as 
                estimated by the Secretary.
                    ``(B) Performance funding pool.--
                            ``(i) In general.--In the case of items and 
                        services furnished by a VBP eligible 
                        professional during a year (beginning with 
                        2017), the otherwise applicable fee schedule 
                        amount (as defined in clause (iii)) with 
                        respect to such items and services and eligible 
                        professional for such year shall be reduced by 
                        the applicable percent under clause (ii). The 
                        total amount of such reductions for a year 
                        shall be referred to in this subsection as the 
                        `performance funding pool' for such year.
                            ``(ii) Applicable percent defined.--For 
                        purposes of clause (i), the term `applicable 
                        percent' means--
                                    ``(I) for 2017, 4 percent;
                                    ``(II) for 2018, 6 percent;
                                    ``(III) for 2019, 8 percent;
                                    ``(IV) for 2020, 10 percent; and
                                    ``(V) for 2021 and subsequent 
                                years, a percent specified by the 
                                Secretary (but in no case less than 10 
                                percent or more than 12 percent).
                            ``(iii) Otherwise applicable fee schedule 
                        amount.--For purposes of this subparagraph and 
                        paragraph (7), the term `otherwise applicable 
                        fee schedule amount' means, with respect to 
                        items and services furnished by a VBP eligible 
                        professional during a year, the fee schedule 
                        amount for such items and services and year 
                        that would otherwise apply (without application 
                        of this subparagraph or paragraph (7)) with 
                        respect to such eligible professional under 
                        subsection (b), after application of subsection 
                        (a)(3), or under another fee schedule under 
                        this part.
            ``(7) VBP program incentive payments.--
                    ``(A) VBP program incentive payment adjustment 
                factor.--The Secretary shall specify a VBP program 
                incentive payment adjustment factor for each VBP 
                eligible professional for a year. Such VBP program 
                incentive payment adjustment factor for a VBP eligible 
                professional for a year shall be determined--
                            ``(i) by the composite performance score of 
                        the eligible professional for such year;
                            ``(ii) in a manner such that the adjustment 
                        factors specified under this subparagraph for a 
                        year results in differential payments under 
                        this paragraph reflecting the full range of the 
                        distribution of composite performance scores of 
                        VBP eligible professionals determined under 
                        paragraph (5)(E) for such year, with such 
                        professionals having higher composite 
                        performance scores receiving higher payment; 
                        and
                            ``(iii) in a manner such that the 
                        adjustment factors specified under this 
                        subparagraph for a year--
                                    ``(I) do not result in a payment 
                                reduction for such year by an amount 
                                that exceeds the applicable percent 
                                described in paragraph (6)(B)(ii) for 
                                such year; and
                                    ``(II) do not result in a payment 
                                increase for such year by an amount 
                                that exceeds the applicable percent 
                                described in paragraph (6)(B)(ii) for 
                                such year.
                    ``(B) Calculation of vbp program incentive payment 
                amounts.--The VBP program incentive payment amount with 
                respect to items and services furnished by a VBP 
                eligible professional during a year shall be equal to 
                the difference between--
                            ``(i) the product of--
                                    ``(I) the VBP program incentive 
                                payment adjustment factor determined 
                                under subparagraph (A) for such VBP 
                                eligible professional for such year; 
                                and
                                    ``(II) the otherwise applicable fee 
                                schedule amount (as defined in 
                                paragraph (6)(B)(iii)) with respect to 
                                such items and services and eligible 
                                professional for such year; and
                            ``(ii) the otherwise applicable fee 
                        schedule amount, as reduced under paragraph 
                        (6)(B), with respect to such items and 
                        services, eligible professional, and year.
                The application of the preceding sentence may result in 
                the VBP program incentive payment amount being 0.0 with 
                respect to an item or service furnished by a VBP 
                eligible professional.
                    ``(C) Application of vbp program incentive payment 
                amount.--In the case of items and services furnished by 
                a VBP eligible professional during a year (beginning 
                with 2017), the otherwise applicable fee schedule 
                amount, as reduced under paragraph (6)(B), with respect 
                to such items and services and eligible professional 
                for such year shall be increased, if applicable, by the 
                VBP program incentive payment amount determined under 
                subparagraph (B) with respect to such items and 
                services, professional, and year.
                    ``(D) Budget neutrality.--In specifying the VBP 
                program incentive payment adjustment factor for each 
                VBP eligible professional for a year under subparagraph 
                (A), the Secretary shall ensure that the total amount 
                of VBP program incentive payment amounts under this 
                paragraph for all VBP eligible professionals in a year 
                shall be equal to the performance funding pool for such 
                year under paragraph (6), as estimated by the 
                Secretary.
            ``(8) Announcement of result of adjustments.--Under the VBP 
        program, the Secretary shall, not later than 60 days prior to 
        the year involved, make available to each VBP eligible 
        professional the VBP program incentive payment adjustment 
        factor under paragraph (7) and the payment reduction under 
        paragraph (6) applicable to the eligible professional for items 
        and services furnished by the professional in such year. The 
        Secretary may include such information in the confidential 
        feedback under paragraph (13).
            ``(9) No effect in subsequent years.--The VBP program 
        incentive payment under paragraph (7) and the payment reduction 
        under paragraph (6) shall each apply only with respect to the 
        year involved, and the Secretary shall not take into account 
        such VBP program incentive payment or payment reduction in 
        making payments to a VBP eligible professional under this part 
        in a subsequent year.
            ``(10) Public reporting.--
                    ``(A) In general.--The Secretary shall, in an 
                easily understandable format, make available on the 
                Physician Compare Internet website under subsection (t) 
                the following:
                            ``(i) Information regarding the performance 
                        of VBP eligible professionals under the VBP 
                        program, which--
                                    ``(I) shall include the composite 
                                score for each such VBP eligible 
                                professional and the performance of 
                                each such VBP eligible professional 
                                with respect to each performance 
                                category; and
                                    ``(II) may include the performance 
                                of each such VBP eligible professional 
                                with respect to each measure or 
                                activity specified in paragraph (2)(B).
                            ``(ii) 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.
                    ``(B) Opportunity to review and submit 
                corrections.--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.
                    ``(C) Aggregate information.--The Secretary shall 
                periodically post on the Physician Compare Internet 
                website aggregate information on the VBP program, 
                including the range of composite scores for all VBP 
                eligible professionals and the range of the performance 
                of all VBP eligible professionals with respect to each 
                performance category.
            ``(11) Consultation.--The Secretary shall consult with 
        stakeholders in carrying out the VBP program, including for the 
        identification of measures and activities under paragraph 
        (2)(B) and the methodologies developed under paragraphs (5)(A) 
        and (7). Such consultation shall include the use of a request 
        for information or other mechanisms determined appropriate.
            ``(12) Technical assistance to small practices and 
        practices in health professional shortage areas.--
                    ``(A) In general.--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 VBP 
                eligible professionals in practices of 10 or fewer 
                professionals (with priority given to such practices 
                located in rural areas, health professional shortage 
                areas (as designated in section 332(a)(1)(A) of the 
                Public Health Service Act), medically underserved 
                areas, or practices with low composite scores) with 
                respect to--
                            ``(i) the performance categories described 
                        in clauses (i) through (iv) of paragraph 
                        (2)(A); or
                            ``(ii) how to transition to the 
                        implementation of and participation in an 
                        alternative payment model as described in 
                        section 1833(z)(3)(C).
                    ``(B) Funding for implementation.--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 $25,000,000 for each of 
                fiscal years 2014 through 2018. Of amounts transferred 
                under the preceding sentence, not less than $10,000,000 
                shall be available for technical assistance to small 
                practices (consisting of 10 or fewer professionals) in 
                health professional shortage areas (as so designated). 
                Amounts transferred under this subparagraph for a 
                fiscal year shall be available until expended.
            ``(13) Feedback and information to improve performance.--
                    ``(A) Performance feedback.--
                            ``(i) In general.--Beginning July 1, 2015, 
                        the Secretary--
                                    ``(I) shall make available timely 
                                (such as quarterly) confidential 
                                feedback to each VBP eligible 
                                professional on the performance of such 
                                professional with respect to the 
                                performance categories under clauses 
                                (i) and (ii) of paragraph (2)(A); and
                                    ``(II) may make available 
                                confidential feedback to each such 
                                professional on the performance of such 
                                professional with respect to the 
                                performance categories under clauses 
                                (iii) and (iv) of such paragraph.
                            ``(ii) Mechanisms.--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. The 
                        Secretary shall encourage provision of feedback 
                        through qualified clinical data registries, as 
                        described in subsection (m)(3)(E).
                            ``(iii) Use of data.--For purposes of 
                        clause (i), the Secretary may use data, with 
                        respect to a VBP 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.
                            ``(iv) Disclosure exemption.--Feedback made 
                        available under this subparagraph shall be 
                        exempt from disclosure under section 552 of 
                        title 5, United States Code.
                            ``(v) Receipt of information.--The 
                        Secretary may use the mechanisms established 
                        under clause (ii) to receive information from 
                        professionals, such as information with respect 
                        to this subsection.
                    ``(B) Additional information.--
                            ``(i) In general.--Beginning July 1, 2016, 
                        the Secretary shall make available to each VBP 
                        eligible professional information, with respect 
                        to individuals who are patients of such VBP 
                        eligible professional, 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 shall be made available under 
                        the previous sentence to such VBP eligible 
                        professionals by mechanisms determined 
                        appropriate by the Secretary, which may include 
                        use of a web-based portal. Such information 
                        shall be made available in accordance with the 
                        same or similar terms as data are made 
                        available to accountable care organizations 
                        under section 1899, including a beneficiary 
                        opt-out.
                            ``(ii) Type of information.--For purposes 
                        of clause (i), the information described in 
                        this clause, is the following:
                                    ``(I) 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 VBP 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), 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.
                                    ``(II) Historical 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) for care episodes for 
                                such period.
            ``(14) Review.--
                    ``(A) Targeted review.--The Secretary shall 
                establish a process under which a VBP eligible 
                professional may seek an informal review of the 
                calculation of the VBP program incentive payment 
                adjustment factor 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 (7) with respect to a year (other than 
                with respect to the calculation of such eligible 
                professional's VBP program incentive payment adjustment 
                factor for such year) after the factors determined in 
                subparagraph (A) of such paragraph have been determined 
                for such year.
                    ``(B) Limitation.--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:
                            ``(i) The methodology used to determine the 
                        amount of the VBP program incentive payment 
                        adjustment factor under paragraph (7) and the 
                        determination of such amount.
                            ``(ii) The determination of the amount of 
                        funding available for such VBP program 
                        incentive payments under paragraph (6)(A) and 
                        the payment reduction under paragraph 
                        (6)(B)(i).
                            ``(iii) The establishment of the 
                        performance standards under paragraph (3) and 
                        the performance period under paragraph (4).
                            ``(iv) 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 (10).
                            ``(v) 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.''.
            (2) GAO reports.--
                    (A) Evaluation of eligible professional vbp 
                program.--Not later than October 1, 2018, and October 
                1, 2021, the Comptroller General of the United States 
                shall submit to Congress a report evaluating the 
                eligible professional value-based performance incentive 
                program under subsection (q) of section 1848 of the 
                Social Security Act (42 U.S.C. 1395w-4), as added by 
                paragraph (1). Such report shall--
                            (i) examine the distribution of the 
                        performance and incentive payments for VBP 
                        eligible professionals (as defined in 
                        subsection (q)(1)(C) of such section) under 
                        such program, and patterns relating to such 
                        performance and incentive payments, including 
                        those based on type of provider, practice size, 
                        geographic location, and patient mix;
                            (ii) provide recommendations for improving 
                        such program;
                            (iii) evaluate the impact of technical 
                        assistance funding under section 1848(q)(12) 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)(1)), 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
                            (iv) provide recommendations for optimizing 
                        the use of such technical assistance funds.
                    (B) Study to examine alignment of quality measures 
                used in public and private programs.--
                            (i) In general.--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--
                                    (I) 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 under 
                                title XIX of such Act, and private 
                                payer arrangements; and
                                    (II) makes recommendations on how 
                                to reduce the administrative burden 
                                involved in applying such quality 
                                measures.
                            (ii) Requirements.--The report under clause 
                        (i) shall--
                                    (I) 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
                                    (II) focus on those measures that 
                                comprise the most significant component 
                                of the quality performance category of 
                                the eligible professional value-based 
                                performance incentive program under 
                                subsection (q) of section 1848 of the 
                                Social Security Act (42 U.S.C. 1395w-
                                4), as added by paragraph (1).
                    (C) Study to examine rural and health professional 
                shortage area alternative payment models.--Not later 
                than October 1, 2019, and 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)(1)). Such report shall 
                make recommendations for removing administrative 
                barriers to practices in rural areas, health 
                professional shortage areas, and medically underserved 
                areas to participation in such models.
            (3) Funding for implementation.--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 $50,000,000 from the Supplementary 
        Medical Insurance Trust Fund established under section 1841 of 
        the Social Security Act (42 U.S.C. 1395t) to the Centers for 
        Medicare & Medicaid Program Management Account for each of the 
        fiscal years 2014 through 2017. Amounts transferred under this 
        paragraph shall be available until expended.
    (d) Improving Quality Reporting for Composite Scores.--
            (1) Changes for group reporting option.--
                    (A) In general.--Section 1848(m)(3)(C)(ii) of the 
                Social Security Act (42 U.S.C. 1395w-4(m)(3)(C)(ii)) is 
                amended by inserting ``and, for 2014 and subsequent 
                years, may provide'' after ``shall provide''.
                    (B) Clarification of qualified clinical data 
                registry reporting to group practices.--Section 
                1848(m)(3)(D) of the Social Security Act (42 U.S.C. 
                1395w-4(m)(3)(D)) is amended by inserting ``and, for 
                2015 and subsequent years, subparagraph (A) or (C)'' 
                after ``subparagraph (A)''.
            (2) Changes for multiple reporting periods and alternative 
        criteria for satisfactory reporting.--Section 1848(m)(5)(F) of 
        the Social Security Act (42 U.S.C. 1395w-4(m)(5)(F)) is 
        amended--
                    (A) by striking ``and subsequent years'' and 
                inserting ``through reporting periods occurring in 
                2013''; and
                    (B) by inserting ``and, for reporting periods 
                occurring in 2014 and subsequent years, the Secretary 
                may establish'' following ``shall establish''.
            (3) Physician feedback program reports succeeded by reports 
        under vbp program.--Section 1848(n) of the Social Security Act 
        (42 U.S.C. 1395w-4(n)) is amended by adding at the end the 
        following new paragraph:
            ``(11) Reports ending with 2016.--Reports under the Program 
        shall not be provided after December 31, 2016. See subsection 
        (q)(13) for reports beginning with 2017.''.
            (4) Coordination with satisfying meaningful ehr use 
        clinical quality measure reporting requirement.--Section 
        1848(o)(2)(A)(iii) of the Social Security Act (42 U.S.C. 1395w-
        4(o)(2)(A)(iii)) is amended by inserting ``and subsection 
        (q)(5)(C)(ii)(II)'' after ``Subject to subparagraph (B)(ii)''.
    (e) Promoting Alternative Payment Models.--
            (1) Incentive payments for participation in eligible 
        alternative payment models.--Section 1833 of the Social 
        Security Act (42 U.S.C. 1395l) is amended by adding at the end 
        the following new subsection:
    ``(z) Incentive Payments for Participation in Eligible Alternative 
Payment Models.--
            ``(1) Payment incentive.--
                    ``(A) In general.--In the case of covered 
                professional services furnished by an eligible 
                professional during a year that is in the period 
                beginning with 2017 and ending with 2022 and for which 
                the professional is a qualifying APM participant, in 
                addition to the 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 
                payment amount for the 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 Secretary shall 
                establish policies to implement this subparagraph in 
                cases where payment for covered professional services 
                furnished by a qualifying APM participant in an 
                alternative payment model is made to an entity 
                participating in the alternative payment model rather 
                than directly to the qualifying APM participant.
                    ``(B) Form of payment.--Payments under this 
                subsection shall be made in a lump sum, on an annual 
                basis, as soon as practicable.
                    ``(C) Treatment of payment incentive.--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.
                    ``(D) Coordination.--The amount of the additional 
                payment for an item or service under this subsection or 
                subsection (m) shall be determined without regard to 
                any additional payment for the item or service under 
                subsection (m) and this subsection, respectively. The 
                amount of the additional payment for an item or service 
                under this subsection or subsection (x) shall be 
                determined without regard to any additional payment for 
                the item or service under subsection (x) and this 
                subsection, respectively. The amount of the additional 
                payment for an item or service under this subsection or 
                subsection (y) shall be determined without regard to 
                any additional payment for the item or service under 
                subsection (y) and this subsection, respectively.
            ``(2) Qualifying apm participant.--For purposes of this 
        subsection, the term `qualifying APM participant' means the 
        following:
                    ``(A) 2017 and 2018.--With respect to 2017 and 
                2018, 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 entity that participates in 
                an eligible alternative payment model with respect to 
                such services.
                    ``(B) 2019 and 2020.--With respect to 2019 and 
                2020, an eligible professional described in either of 
                the following clauses:
                            ``(i) Medicare revenue threshold option.--
                        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 data are 
                        available (which may be less than a year) were 
                        attributable to such services furnished under 
                        this part through an entity that participates 
                        in an eligible alternative payment model with 
                        respect to such services.
                            ``(ii) Combination all-payer and medicare 
                        revenue threshold option.--An eligible 
                        professional--
                                    ``(I) 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--
                                            ``(aa) payments described 
                                        in clause (i); and
                                            ``(bb) all other payments, 
                                        regardless of payer (other than 
                                        payments made by the Secretary 
                                        of Defense or the Secretary of 
                                        Veterans Affairs under chapter 
                                        55 of title 10, United States 
                                        Code, or title 38, United 
                                        States Code, or any other 
                                        provision of law, 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).
                                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);
                                    ``(II) 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 entity that 
                                participates in an eligible alternative 
                                payment model with respect to such 
                                services; and
                                    ``(III) 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.
                            ``(iii) Requirement.--For purposes of 
                        clause (ii)(I)--
                                    ``(I) the requirement described in 
                                this subclause, with respect to 
                                payments described in item (aa) of such 
                                clause, is that such payments are made 
                                under an eligible alternative payment 
                                model; and
                                    ``(II) the requirement described in 
                                this subclause, with respect to 
                                payments described in item (bb) of such 
                                clause, is that such payments are made 
                                under an arrangement in which--
                                            ``(aa) quality measures 
                                        comparable to measures under 
                                        the performance category 
                                        described in section 
                                        1848(q)(2)(B)(i) apply;
                                            ``(bb) certified EHR 
                                        technology is used; and
                                            ``(cc) the eligible 
                                        professional (AA) bears more 
                                        than nominal financial risk if 
                                        actual aggregate expenditures 
                                        exceeds expected aggregate 
                                        expenditures; or (BB) is a 
                                        medical home (with respect to 
                                        beneficiaries under title XIX) 
                                        that meets criteria comparable 
                                        to medical homes expanded under 
                                        section 1115A(c).
                    ``(C) Beginning in 2021.--With respect to 2021 and 
                each subsequent year, an eligible professional 
                described in either of the following clauses:
                            ``(i) Medicare revenue threshold option.--
                        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 entity that participates 
                        in an eligible alternative payment model with 
                        respect to such services.
                            ``(ii) Combination all-payer and medicare 
                        revenue threshold option.--An eligible 
                        professional--
                                    ``(I) 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--
                                            ``(aa) payments described 
                                        in clause (i); and
                                            ``(bb) all other payments, 
                                        regardless of payer (other than 
                                        payments made by the Secretary 
                                        of Defense or the Secretary of 
                                        Veterans Affairs under chapter 
                                        55 of title 10, United States 
                                        Code, or title 38, United 
                                        States Code, or any other 
                                        provision of law, 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.
                                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);
                                    ``(II) 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 entity that 
                                participates in an eligible alternative 
                                payment model with respect to such 
                                services; and
                                    ``(III) 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.
                            ``(iii) Requirement.--For purposes of 
                        clause (ii)(I)--
                                    ``(I) the requirement described in 
                                this subclause, with respect to 
                                payments described in item (aa) of such 
                                clause, is that such payments are made 
                                under an eligible alternative payment 
                                model; and
                                    ``(II) the requirement described in 
                                this subclause, with respect to 
                                payments described in item (bb) of such 
                                clause, is that such payments are made 
                                under an arrangement in which--
                                            ``(aa) quality measures 
                                        comparable to measures under 
                                        the performance category 
                                        described in section 
                                        1848(q)(2)(B)(i) apply;
                                            ``(bb) certified EHR 
                                        technology is used; and
                                            ``(cc) the eligible 
                                        professional (AA) bears more 
                                        than nominal financial risk if 
                                        actual aggregate expenditures 
                                        exceeds expected aggregate 
                                        expenditures; or (BB) is a 
                                        medical home (with respect to 
                                        beneficiaries under title XIX) 
                                        that meets criteria comparable 
                                        to medical homes expanded under 
                                        section 1115A(c).
            ``(3) Additional definitions.--In this subsection:
                    ``(A) Covered professional services.--The term 
                `covered professional services' has the meaning given 
                that term in section 1848(k)(3)(A).
                    ``(B) Eligible professional.--The term `eligible 
                professional' has the meaning given that term in 
                section 1848(k)(3)(B).
                    ``(C) Alternative payment model (apm).--The term 
                `alternative payment model' means any of the following:
                            ``(i) A model under section 1115A (other 
                        than a health care innovation award).
                            ``(ii) An accountable care organization 
                        under section 1899.
                            ``(iii) A demonstration under section 
                        1866C.
                            ``(iv) A demonstration required by Federal 
                        law.
                    ``(D) Eligible alternative payment model (apm).--
                            ``(i) In general.--The term `eligible 
                        alternative payment model' means, with respect 
                        to a year, an alternative payment model--
                                    ``(I) that requires use of 
                                certified EHR technology (as defined in 
                                subsection (o)(4));
                                    ``(II) that 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
                                    ``(III) that satisfies the 
                                requirement described in clause (ii).
                            ``(ii) Additional requirement.--For 
                        purposes of clause (i)(III), the requirement 
                        described in this clause, with respect to a 
                        year and an alternative payment model, is that 
                        the alternative payment model--
                                    ``(I) is one in which one or more 
                                entities bear financial risk for 
                                monetary losses under such model that 
                                are in excess of a nominal amount; or
                                    ``(II) is a medical home expanded 
                                under section 1115A(c).
            ``(4) Limitation.--There shall be no administrative or 
        judicial review under section 1869, 1878, or otherwise, of the 
        following:
                    ``(A) The determination that an eligible 
                professional is a qualifying APM participant under 
                paragraph (2) and the determination that an alternative 
                payment model is an eligible alternative payment model 
                under paragraph (3)(D).
                    ``(B) The determination of the amount of the 5 
                percent payment incentive under paragraph (1)(A), 
                including any estimation as part of such 
                determination.''.
            (2) Coordination conforming amendments.--Section 1833 of 
        the Social Security Act (42 U.S.C. 1395l) is further amended--
                    (A) in subsection (x)(3), by adding at the end the 
                following new sentence: ``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.''; and
                    (B) in subsection (y)(3), by adding at the end the 
                following new sentence: ``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.''.
            (3) Encouraging development and testing of certain 
        models.--Section 1115A(b)(2) of the Social Security Act (42 
        U.S.C. 1315a(b)(2)) is amended--
                    (A) in subparagraph (B), by adding at the end the 
                following new clauses:
                            ``(xxi) Focusing primarily on physicians' 
                        services (as defined in section 1848(j)(3)) 
                        furnished by physicians who are not primary 
                        care practitioners.
                            ``(xxii) Focusing on practices of 10 or 
                        fewer professionals.
                            ``(xxiii) Focusing primarily on title XIX, 
                        working in conjunction with the Center for 
                        Medicaid and CHIP Services within the Centers 
                        for Medicare & Medicaid Services.''; and
                    (B) in subparagraph (C)(viii), by striking ``other 
                public sector or private sector payers'' and inserting 
                ``other public sector payers, private sector payers, or 
                Statewide payment models''.
            (4) Construction regarding telehealth services.--Nothing in 
        the provisions of, or amendments made by, this Act shall be 
        construed as precluding an alternative payment model or a 
        qualifying APM participant (as those terms are 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 (42 U.S.C. 1395m(m)).
            (5) Plan for integrating medicare advantage alternative 
        payment models.--Not later than July 1, 2015, the Secretary of 
        Health and Human Services shall submit to Congress a plan to 
        integrate Medicare Advantage alternative payment models that 
        take into account a budget neutral value-based modifier.
    (f) Study and Report on Fraud Related to Alternative Payment Models 
Under the Medicare Program.--
            (1) Study.--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--
                    (A) 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 (42 U.S.C. 
                1395l(z)(3)(C)));
                    (B) identifies aspects of such alternative payment 
                models that are vulnerable to fraudulent activity; and
                    (C) examines the implications of waivers to such 
                laws granted in support of such alternative payment 
                models, including under any potential expansion of such 
                models.
            (2) Report.--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 
        paragraph (1). 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.
    (g) Improving Payment Accuracy.--
            (1) Studies and reports of effect of certain information on 
        quality and resource use .--
                    (A) Study using existing medicare data.--
                            (i) Study.--The Secretary of Health and 
                        Human Services (in this subsection referred to 
                        as the ``Secretary'') shall conduct a study 
                        that examines the effect of individuals' 
                        socioeconomic status on quality and resource 
                        use outcome measures for individuals under the 
                        Medicare program. The study shall use 
                        information collected on such individuals in 
                        carrying out such program, such as urban and 
                        rural location, eligibility for Medicaid 
                        (recognizing and accounting for varying 
                        Medicaid eligibility across States), and 
                        eligibility for benefits under the supplemental 
                        security income (SSI) program. The Secretary 
                        shall carry out this paragraph acting through 
                        the Assistant Secretary for Planning and 
                        Evaluation.
                            (ii) Report.--Not later than 2 years after 
                        the date of the enactment of this Act, the 
                        Secretary shall submit to Congress a report on 
                        the study conducted under clause (i).
                    (B) Study using other data.--
                            (i) Study.--The Secretary shall conduct a 
                        study that examines the impact of risk factors, 
                        such as those described in section 1848(p)(3) 
                        of the Social Security Act (42 U.S.C. 1395w-
                        4(p)(3)), race, health literacy, limited 
                        English proficiency (LEP), and patient 
                        activation, on quality and resource use outcome 
                        measures under the Medicare program. In 
                        conducting such study the Secretary may use 
                        existing Federal data and collect such 
                        additional data as may be necessary to complete 
                        the study.
                            (ii) Report.--Not later than 5 years after 
                        the date of the enactment of this Act, the 
                        Secretary shall submit to Congress a report on 
                        the study conducted under clause (i).
                    (C) Examination of data in conducting studies.--In 
                conducting the studies under subparagraphs (A) and (B), 
                the Secretary shall examine what non-Medicare data 
                sets, such as data from the American Community Survey 
                (ACS), can be useful in conducting the types of studies 
                under such paragraphs and how such data sets that are 
                identified as useful can be coordinated with Medicare 
                administrative data in order to improve the overall 
                data set available to do such studies and for the 
                administration of the Medicare program.
                    (D) Recommendations to account for information in 
                payment adjustment mechanisms.--If the studies 
                conducted under subparagraphs (A) and (B) find a 
                relationship between the factors examined in the 
                studies and quality and resource use outcome measures, 
                then the Secretary shall also provide recommendations 
                for how the Centers for Medicare & Medicaid Services 
                should--
                            (i) obtain access to the necessary data (if 
                        such data is not already being collected) on 
                        such factors, including recommendations on how 
                        to address barriers to the Centers in accessing 
                        such data; and
                            (ii) account for such factors in 
                        determining payment adjustments based on 
                        quality and resource use outcome measures under 
                        the eligible professional value-based 
                        performance incentive program under section 
                        1848(q) of the Social Security Act (42 U.S.C. 
                        1395w-4(q)) and, as the Secretary determines 
                        appropriate, other similar provisions of title 
                        XVIII of such Act.
                    (E) Funding.--There are hereby appropriated from 
                the Federal Supplemental Medical Insurance Trust Fund 
                to the Secretary to carry out this paragraph 
                $6,000,000, to remain available until expended.
            (2) CMS activities.--
                    (A) Hierarchal condition category (hcc) 
                improvement.--Taking into account the relevant studies 
                conducted and recommendations made in reports under 
                paragraph (1), the Secretary, on an ongoing basis, 
                shall estimate how an individual's health status and 
                other risk factors affect quality and resource use 
                outcome measures and, as feasible, shall incorporate 
                information from quality and resource use outcome 
                measurement (including care episode and patient 
                condition groups) into the eligible professional value-
                based performance incentive program under section 
                1848(q) of the Social Security Act and, as the 
                Secretary determines appropriate, other similar 
                provisions of title XVIII of such Act.
                    (B) Accounting for other factors in payment 
                adjustment mechanisms.--
                            (i) In general.--Taking into account the 
                        studies conducted and recommendations made in 
                        reports under paragraph (1), the Secretary 
                        shall account for identified factors (other 
                        than those applied under subparagraph (A)) with 
                        an effect on quality and resource use outcome 
                        measures when determining payment adjustments 
                        under the eligible professional value-based 
                        performance incentive program under section 
                        1848(q) of the Social Security Act and, as the 
                        Secretary determines appropriate, other similar 
                        provisions of title XVIII of such Act.
                            (ii) Accessing data.--The Secretary shall 
                        collect or otherwise obtain access to the data 
                        necessary to carry out this paragraph through 
                        existing and new data sources.
                            (iii) Periodic analyses.--The Secretary 
                        shall carry out periodic analyses, at least 
                        every 3 years, based on the factors referred to 
                        in clause (i) so as to monitor changes in 
                        possible relationships.
                    (C) Funding.--There are hereby appropriated from 
                the Federal Supplemental Medical Insurance Trust Fund 
                to the Secretary to carry out this paragraph 
                $10,000,000, to remain available until expended.
            (3) Strategic plan for accessing race and ethnicity data.--
        Not later than 18 months after the date of the enactment of 
        this Act, the Secretary shall develop and report to Congress on 
        a strategic plan for collecting or otherwise accessing data on 
        race and ethnicity for purposes of carrying out the Medicare 
        program.
    (h) Collaborating With the Physician, Practitioner, and Other 
Stakeholder Communities to Improve Resource Use Measurement.--Section 
1848 of the Social Security Act (42 U.S.C. 1395w-4), as amended by 
subsection (c), is further amended by adding at the end the following 
new subsection:
    ``(r) Collaborating With the Physician, Practitioner, and Other 
Stakeholder Communities To Improve Resource Use Measurement.--
            ``(1) In general.--In order to involve the physician, 
        practitioner, and other stakeholder communities in enhancing 
        the infrastructure for resource use measurement, including for 
        purposes of the value-based performance incentive program 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.
            ``(2) Development of care episode and patient condition 
        groups and classification codes.--
                    ``(A) In general.--In order to classify similar 
                patients into distinct care episode groups and distinct 
                patient condition groups, the Secretary shall undertake 
                the steps described in the succeeding provisions of 
                this paragraph.
                    ``(B) Public availability of existing efforts to 
                design an episode grouper.--Not later than 60 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.
                    ``(C) Stakeholder input.--The Secretary shall 
                accept, through the date that is 60 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--
                            ``(i) distinct care episode groups; and
                            ``(ii) distinct patient condition groups.
                    ``(D) Development of proposed classification 
                codes.--
                            ``(i) In general.--Taking into account the 
                        information described in subparagraph (B) and 
                        the information received under subparagraph 
                        (C), the Secretary shall--
                                    ``(I) establish distinct care 
                                episode groups and distinct patient 
                                condition groups, which account for at 
                                least an estimated two-thirds of 
                                expenditures under parts A and B; and
                                    ``(II) assign codes to such groups.
                            ``(ii) Care episode groups.--In 
                        establishing the care episode groups under 
                        clause (i), the Secretary shall take into 
                        account--
                                    ``(I) 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 is anticipated or 
                                occurs, and the principal procedures or 
                                services planned or furnished; and
                                    ``(II) other factors determined 
                                appropriate by the Secretary.
                            ``(iii) Patient condition groups.--In 
                        establishing the patient condition groups under 
                        clause (i), the Secretary shall take into 
                        account--
                                    ``(I) the patient's clinical 
                                history at the time of each 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
                                    ``(II) 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).
                    ``(E) Draft care episode and patient condition 
                groups and classification codes.--Not later than 120 
                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).
                    ``(F) Solicitation of input.--The Secretary shall 
                seek, through the date that is 60 days after the 
                Secretary posts the list pursuant to subparagraph (E), 
                comments from physician specialty societies, applicable 
                practitioner organizations, and other stakeholders, 
                including 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.
                    ``(G) Operational list of care episode and patient 
                condition groups and codes.--Not later than 120 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).
                    ``(H) Subsequent revisions.--Not later than 
                November 1 of each year (beginning with 2016), 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 individuals entitled to 
                benefits under part A or enrolled under this part.
            ``(3) Attribution of patients to physicians or 
        practitioners.--
                    ``(A) In general.--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.
                    ``(B) Development of patient relationship 
                categories and codes.--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 may reflect 
                combinations of such categories), such as a physician 
                or applicable practitioner who--
                            ``(i) considers themself to have the 
                        primary responsibility for the general and 
                        ongoing care for the patient over extended 
                        periods of time;
                            ``(ii) 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;
                            ``(iii) 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;
                            ``(iv) furnishes items and services to the 
                        patient on an occasional basis, usually at the 
                        request of another physician or practitioner; 
                        or
                            ``(v) furnishes items and services only as 
                        ordered by another physician or practitioner.
                    ``(C) Draft list of patient relationship categories 
                and codes.--Not 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 draft list of the 
                patient relationship categories and codes developed 
                under subparagraph (B).
                    ``(D) Stakeholder input.--The Secretary shall seek, 
                through the date that is 60 days after the Secretary 
                posts the list pursuant to subparagraph (C), comments 
                from physician specialty societies, applicable 
                practitioner organizations, and other stakeholders, 
                including 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, or other appropriate 
                mechanisms.
                    ``(E) Operational list of patient relationship 
                categories and codes.--Not later than 120 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.
                    ``(F) Subsequent revisions.--Not later than 
                November 1 of each year (beginning with 2016), 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 individuals entitled to benefits under part A 
                or enrolled under this part.
            ``(4) Reporting of information for resource use 
        measurement.--Claims submitted for items and services furnished 
        by a physician or applicable practitioner on or after January 
        1, 2016, shall, as determined appropriate by the Secretary, 
        include--
                    ``(A) applicable codes established under paragraphs 
                (2) and (3); and
                    ``(B) the national provider identifier of the 
                ordering physician or applicable practitioner (if 
                different from the billing physician or applicable 
                practitioner).
            ``(5) Methodology for resource use analysis.--
                    ``(A) In general.--In order to evaluate the 
                resources used to treat patients (with respect to care 
                episode and patient condition groups), the Secretary 
                shall--
                            ``(i) 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;
                            ``(ii) 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
                            ``(iii) conduct an analysis of resource use 
                        (with respect to care episodes and patient 
                        condition groups of such patients), as the 
                        Secretary determines appropriate.
                    ``(B) Analysis of patients of physicians and 
                practitioners.--In conducting the analysis described in 
                subparagraph (A)(iii) with respect to patients 
                attributed to physicians and applicable practitioners, 
                the Secretary shall, as feasible--
                            ``(i) use the claims data experience of 
                        such patients by patient condition codes during 
                        a common period, such as 12 months; and
                            ``(ii) use the claims data experience of 
                        such patients by care episode codes--
                                    ``(I) in the case of episodes 
                                without a hospitalization, during 
                                periods of time (such as the number of 
                                days) determined appropriate by the 
                                Secretary; and
                                    ``(II) in the case of episodes with 
                                a hospitalization, during periods of 
                                time (such as the number of days) 
                                before, during, and after the 
                                hospitalization.
                    ``(C) Measurement of resource use.--In measuring 
                such resource use, the Secretary--
                            ``(i) shall use per patient total allowed 
                        amounts 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
                            ``(ii) may, as determined appropriate, use 
                        other measures of allowed amounts (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).
                    ``(D) Stakeholder input.--The Secretary shall seek 
                comments from the physician specialty societies, 
                applicable practitioner organizations, and other 
                stakeholders, including 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, or other appropriate 
                mechanisms.
            ``(6) Limitation.--There shall be no administrative or 
        judicial review under section 1869, section 1878, or otherwise 
        of--
                    ``(A) care episode and patient condition groups and 
                codes established under paragraph (2);
                    ``(B) patient relationship categories and codes 
                established under paragraph (3); and
                    ``(C) measurement of, and analyses of resource use 
                with respect to, care episode and patient condition 
                codes and patient relationship codes pursuant to 
                paragraph (5).
            ``(7) Administration.--Chapter 35 of title 44, United 
        States Code, shall not apply to this section.
            ``(8) Definitions.--In this section:
                    ``(A) Physician.--The term `physician' has the 
                meaning given such term in section 1861(r).
                    ``(B) Applicable practitioner.--The term 
                `applicable practitioner' means--
                            ``(i) a physician assistant, nurse 
                        practitioner, and clinical nurse specialist (as 
                        such terms are defined in section 1861(aa)(5)); 
                        and
                            ``(ii) beginning January 1, 2017, such 
                        other eligible professionals (as defined in 
                        subsection (k)(3)(B)) as specified by the 
                        Secretary.
            ``(9) Clarification.--The provisions of sections 
        1890A(b)(2) and 1890B shall not apply to this subsection.''.

SEC. 102. PRIORITIES AND FUNDING FOR QUALITY MEASURE DEVELOPMENT.

    Section 1848 of the Social Security Act (42 U.S.C. 1395w-4), as 
amended by subsections (c) and (h) of section 101, is further amended 
by inserting at the end the following new subsection:
    ``(s) Priorities and Funding for Quality Measure Development.--
            ``(1) Plan identifying measure development priorities and 
        timelines.--
                    ``(A) Draft measure development plan.--
                            ``(i) Draft plan.--
                                    ``(I) In general.--Not later than 
                                October 1, 2014, 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 
                                provisions.
                                    ``(II) Requirement.--Such plan 
                                shall address how measures used by 
                                private payers and integrated delivery 
                                systems could be incorporated under 
                                such subsection.
                            ``(ii) Consideration.--In developing the 
                        draft plan under subparagraph (A), the 
                        Secretary shall consider--
                                    ``(I) gap analyses conducted by the 
                                entity with a contract under section 
                                1890(a) or other contractors or 
                                entities; and
                                    ``(II) whether measures are 
                                applicable across health care settings.
                            ``(iii) Priorities.--In developing the 
                        draft plan under subparagraph (A), the 
                        Secretary shall give priority to the following 
                        types of measures:
                                    ``(I) Outcome measures including 
                                patient reported outcome and functional 
                                status measures.
                                    ``(II) Patient experience measures.
                                    ``(III) Care coordination measures.
                                    ``(IV) Measures of appropriate use 
                                of services, including measures of over 
                                use.
                            ``(iv) Definition of applicable 
                        provisions.--In this subsection, the term 
                        `applicable provisions' means the following 
                        provisions:
                                    ``(I) Subsection (q)(2)(B)(i).
                                    ``(II) Section 1833(z)(2)(C).
                    ``(B) Stakeholder input.--The Secretary shall 
                accept through December 1, 2014, comments on the draft 
                plan posted under paragraph (1)(A) from the public, 
                including health care providers, payers, consumers, and 
                other stakeholders.
                    ``(C) Operational measure development plan.--Not 
                later than February 1, 2015, taking into account the 
                comments received under subparagraph (B), the Secretary 
                shall post on the Internet website of the Centers for 
                Medicare & Medicaid Services an operational plan for 
                the development of quality measures for use under 
                subsection (q)(2)(A)(i).
            ``(2) Contracts and other arrangements for quality measure 
        development.--
                    ``(A) In general.--The Secretary shall enter into 
                contracts or other arrangements with entities for the 
                purpose of developing, improving, updating, or 
                expanding quality measures for application under the 
                applicable provisions. Such entities may include 
                physician specialty societies and other practitioner 
                organizations.
                    ``(B) Prioritization.--
                            ``(i) In general.--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)(A)(iii).
                            ``(ii) Consideration.--In selecting 
                        measures for development under this subsection, 
                        the Secretary shall consider whether such 
                        measures would be electronically specified.
            ``(3) Annual report by the secretary.--
                    ``(A) In general.--Not later than February 1, 2016, 
                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.
                    ``(B) Requirements.--Each report submitted pursuant 
                to paragraph (1) shall include the following:
                            ``(i) A description of the Secretary's 
                        efforts to implement this subsection.
                            ``(ii) With respect to the measures 
                        developed during the previous year--
                                    ``(I) a description of the total 
                                number of quality measures developed 
                                and the types of such measures, such as 
                                an outcome or patient experience 
                                measure;
                                    ``(II) the name of each measure 
                                developed;
                                    ``(III) the name of the developer 
                                and steward of each measure;
                                    ``(IV) 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
                                    ``(V) whether the measure would be 
                                electronically specified.
                            ``(iii) With respect to measures in 
                        development at the time of the report--
                                    ``(I) the information described in 
                                clause (ii), if available; and
                                    ``(II) a timeline for completion of 
                                the development of such measures.
                            ``(iv) An update on the progress in 
                        developing the types of measures described in 
                        paragraph (1)(A)(iii), including a description 
                        of issues affecting such progress.
                            ``(v) A list of quality topics and concepts 
                        that are being considered for development of 
                        measures and the rationale for the selection of 
                        topics and concepts including their 
                        relationship to gap analyses.
                            ``(vi) 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.
                            ``(vii) Other information the Secretary 
                        determines to be appropriate.
            ``(4) Stakeholder input.--With respect to measures 
        applicable under the applicable provisions, the Secretary shall 
        seek stakeholder input with respect to--
                    ``(A) the identification of gaps where no quality 
                measures exist, particularly with respect to the types 
                of measures described in paragraph (1)(A)(iii);
                    ``(B) prioritizing quality measure development to 
                address such gaps; and
                    ``(C) other areas related to quality measure 
                development determined appropriate by the Secretary.
            ``(5) Funding.--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 2014 through 2018. Amounts transferred under this 
        paragraph shall remain available through the end of fiscal year 
        2021.''.

SEC. 103. ENCOURAGING CARE MANAGEMENT FOR INDIVIDUALS WITH CHRONIC CARE 
              NEEDS.

    (a) In General.--Section 1848(b) of the Social Security Act (42 
U.S.C. 1395w-4(b)) is amended by adding at the end the following new 
paragraph:
            ``(8) Encouraging care management for individuals with 
        chronic care needs.--
                    ``(A) In general.--In order to encourage the 
                management of care by an applicable provider (as 
                defined in subparagraph (B)) for individuals with 
                chronic care needs the Secretary shall--
                            ``(i) establish one or more HCPCS codes for 
                        chronic care management services for such 
                        individuals; and
                            ``(ii) subject to subparagraph (D), make 
                        payment (as the Secretary determines to be 
                        appropriate) under this section for such 
                        management services furnished on or after 
                        January 1, 2015, by an applicable provider.
                    ``(B) Applicable provider defined.--For purposes of 
                this paragraph, the term `applicable provider' means a 
                physician (as defined in section 1861(r)(1)), physician 
                assistant or nurse practitioner (as defined in section 
                1861(aa)(5)(A)), or clinical nurse specialist (as 
                defined in section 1861(aa)(5)(B)) who furnishes 
                services as part of a patient-centered medical home or 
                a comparable specialty practice that--
                            ``(i) is recognized as such a medical home 
                        or comparable specialty practice by an 
                        organization that is recognized by the 
                        Secretary for purposes of such recognition as 
                        such a medical home or practice; or
                            ``(ii) meets such other comparable 
                        qualifications as the Secretary determines to 
                        be appropriate.
                    ``(C) Budget neutrality.--The budget neutrality 
                provision under subsection (c)(2)(B)(ii)(II) shall 
                apply in establishing the payment under subparagraph 
                (A)(ii).
                    ``(D) Policies relating to payment.--In carrying 
                out this paragraph, with respect to chronic care 
                management services, the Secretary shall--
                            ``(i) make payment to only one applicable 
                        provider for such services furnished to an 
                        individual during a period;
                            ``(ii) not make payment under subparagraph 
                        (A) if such payment would be duplicative of 
                        payment that is otherwise made under this title 
                        for such services (such as in the case of 
                        hospice care or home health services); and
                            ``(iii) not require that an annual wellness 
                        visit (as defined in section 1861(hhh)) or an 
                        initial preventive physical examination (as 
                        defined in section 1861(ww)) be furnished as a 
                        condition of payment for such management 
                        services.''.
    (b) Education and Outreach.--
            (1) Campaign.--
                    (A) In general.--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.
                    (B) Requirements.--Such campaign shall--
                            (i) 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
                            (ii) focus on encouraging participation by 
                        underserved rural populations and racial and 
                        ethnic minority populations.
            (2) Report.--
                    (A) In general.--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--
                            (i) identify barriers to receiving chronic 
                        care management services; and
                            (ii) make recommendations for increasing 
                        the appropriate use of chronic care management 
                        services.

SEC. 104. ENSURING ACCURATE VALUATION OF SERVICES UNDER THE PHYSICIAN 
              FEE SCHEDULE.

    (a) Authority To Collect and Use Information on Physicians' 
Services in the Determination of Relative Values.--
            (1) In general.--Section 1848(c)(2) of the Social Security 
        Act (42 U.S.C. 1395w-4(c)(2)) is amended by adding at the end 
        the following new subparagraph:
                    ``(M) Authority to collect and use information on 
                physicians' services in the determination of relative 
                values.--
                            ``(i) Collection of information.--
                        Notwithstanding any other provision of law, the 
                        Secretary may collect or obtain information on 
                        the resources directly or indirectly related to 
                        furnishing services for which payment is made 
                        under the fee schedule established under 
                        subsection (b). Such information may be 
                        collected or obtained from any eligible 
                        professional or any other source.
                            ``(ii) Use of information.--Notwithstanding 
                        any other provision of law, subject to clause 
                        (v), the Secretary may (as the Secretary 
                        determines appropriate) use information 
                        collected or obtained pursuant to clause (i) in 
                        the determination of relative values for 
                        services under this section.
                            ``(iii) Types of information.--The types of 
                        information described in clauses (i) and (ii) 
                        may, at the Secretary's discretion, include any 
                        or all of the following:
                                    ``(I) Time involved in furnishing 
                                services.
                                    ``(II) Amounts and types of 
                                practice expense inputs involved with 
                                furnishing services.
                                    ``(III) Prices (net of any 
                                discounts) for practice expense inputs, 
                                which may include paid invoice prices 
                                or other documentation or records.
                                    ``(IV) Overhead and accounting 
                                information for practices of physicians 
                                and other suppliers.
                                    ``(V) Any other element that would 
                                improve the valuation of services under 
                                this section.
                            ``(iv) Information collection mechanisms.--
                        Information may be collected or obtained 
                        pursuant to this subparagraph from any or all 
                        of the following:
                                    ``(I) Surveys of physicians, other 
                                suppliers, providers of services, 
                                manufacturers, and vendors.
                                    ``(II) Surgical logs, billing 
                                systems, or other practice or facility 
                                records.
                                    ``(III) Electronic health records.
                                    ``(IV) Any other mechanism 
                                determined appropriate by the 
                                Secretary.
                            ``(v) Transparency of use of information.--
                                    ``(I) In general.--Subject to 
                                subclauses (II) and (III), if the 
                                Secretary uses information collected or 
                                obtained under this subparagraph in the 
                                determination of relative values under 
                                this subsection, the Secretary shall 
                                disclose the information source and 
                                discuss the use of such information in 
                                such determination of relative values 
                                through notice and comment rulemaking.
                                    ``(II) Thresholds for use.--The 
                                Secretary may establish thresholds in 
                                order to use such information, 
                                including the exclusion of information 
                                collected or obtained from eligible 
                                professionals who use very high 
                                resources (as determined by the 
                                Secretary) in furnishing a service.
                                    ``(III) Disclosure of 
                                information.--The Secretary shall make 
                                aggregate information available under 
                                this subparagraph but shall not 
                                disclose information in a form or 
                                manner that identifies an eligible 
                                professional or a group practice, or 
                                information collected or obtained 
                                pursuant to a nondisclosure agreement.
                            ``(vi) Incentive to participate.--The 
                        Secretary may provide for such payments under 
                        this part to an eligible professional that 
                        submits such solicited information under this 
                        subparagraph as the Secretary determines 
                        appropriate in order to compensate such 
                        eligible professional for such submission. Such 
                        payments shall be provided in a form and manner 
                        specified by the Secretary.
                            ``(vii) Administration.--Chapter 35 of 
                        title 44, United States Code, shall not apply 
                        to information collected or obtained under this 
                        subparagraph.
                            ``(viii) Definition of eligible 
                        professional.--In this subparagraph, the term 
                        `eligible professional' has the meaning given 
                        such term in subsection (k)(3)(B).
                            ``(ix) Funding.--For purposes of carrying 
                        out this subparagraph, in addition to funds 
                        otherwise appropriated, the Secretary shall 
                        provide for the transfer, from the Federal 
                        Supplementary Medical Insurance Trust Fund 
                        under section 1841, of $2,000,000 to the 
                        Centers for Medicare & Medicaid Services 
                        Program Management Account for each fiscal year 
                        beginning with fiscal year 2014. Amounts 
                        transferred under the preceding sentence for a 
                        fiscal year shall be available until 
                        expended.''.
            (2) Limitation on review.--Section 1848(i)(1) of the Social 
        Security Act (42 U.S.C. 1395w-4(i)(1)) is amended--
                    (A) in subparagraph (D), by striking ``and'' at the 
                end;
                    (B) in subparagraph (E), by striking the period at 
                the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(F) the collection and use of information in the 
                determination of relative values under subsection 
                (c)(2)(M).''.
    (b) Authority for Alternative Approaches To Establishing Practice 
Expense Relative Values.--Section 1848(c)(2) of the Social Security Act 
(42 U.S.C. 1395w-4(c)(2)), as amended by subsection (a), is amended by 
adding at the end the following new subparagraph:
                    ``(N) Authority for alternative approaches to 
                establishing practice expense relative values.--The 
                Secretary may establish or adjust practice expense 
                relative values under this subsection using cost, 
                charge, or other data from suppliers or providers of 
                services, including information collected or obtained 
                under subparagraph (M).''.
    (c) Revised and Expanded Identification of Potentially Misvalued 
Codes.--Section 1848(c)(2)(K)(ii) of the Social Security Act (42 U.S.C. 
1395w-4(c)(2)(K)(ii)) is amended to read as follows:
                            ``(ii) Identification of potentially 
                        misvalued codes.--For purposes of identifying 
                        potentially misvalued codes pursuant to clause 
                        (i)(I), the Secretary shall examine codes (and 
                        families of codes as appropriate) based on any 
                        or all of the following criteria:
                                    ``(I) Codes that have experienced 
                                the fastest growth.
                                    ``(II) Codes that have experienced 
                                substantial changes in practice 
                                expenses.
                                    ``(III) Codes that describe new 
                                technologies or services within an 
                                appropriate time period (such as 3 
                                years) after the relative values are 
                                initially established for such codes.
                                    ``(IV) Codes which are multiple 
                                codes that are frequently billed in 
                                conjunction with furnishing a single 
                                service.
                                    ``(V) Codes with low relative 
                                values, particularly those that are 
                                often billed multiple times for a 
                                single treatment.
                                    ``(VI) Codes that have not been 
                                subject to review since implementation 
                                of the fee schedule.
                                    ``(VII) Codes that account for the 
                                majority of spending under the 
                                physician fee schedule.
                                    ``(VIII) Codes for services that 
                                have experienced a substantial change 
                                in the hospital length of stay or 
                                procedure time.
                                    ``(IX) Codes for which there may be 
                                a change in the typical site of service 
                                since the code was last valued.
                                    ``(X) Codes for which there is a 
                                significant difference in payment for 
                                the same service between different 
                                sites of service.
                                    ``(XI) Codes for which there may be 
                                anomalies in relative values within a 
                                family of codes.
                                    ``(XII) Codes for services where 
                                there may be efficiencies when a 
                                service is furnished at the same time 
                                as other services.
                                    ``(XIII) Codes with high intra-
                                service work per unit of time.
                                    ``(XIV) Codes with high practice 
                                expense relative value units.
                                    ``(XV) Codes with high cost 
                                supplies.
                                    ``(XVI) Codes as determined 
                                appropriate by the Secretary.''.
    (d) Target for Relative Value Adjustments for Misvalued Services.--
            (1) In general.--Section 1848(c)(2) of the Social Security 
        Act (42 U.S.C. 1395w-4(c)(2)), as amended by subsections (a) 
        and (b), is amended by adding at the end the following new 
        subparagraph:
                    ``(O) Target for relative value adjustments for 
                misvalued services.--With respect to fee schedules 
                established for each of 2015 through 2018, the 
                following shall apply:
                            ``(i) Determination of net reduction in 
                        expenditures.--For each year, the Secretary 
                        shall determine the estimated net reduction in 
                        expenditures under the fee schedule under this 
                        section with respect to the year as a result of 
                        adjustments to the relative values established 
                        under this paragraph for misvalued codes.
                            ``(ii) Budget neutral redistribution of 
                        funds if target met and counting overages 
                        towards the target for the succeeding year.--If 
                        the estimated net reduction in expenditures 
                        determined under clause (i) for the year is 
                        equal to or greater than the target for the 
                        year--
                                    ``(I) reduced expenditures 
                                attributable to such adjustments shall 
                                be redistributed for the year in a 
                                budget neutral manner in accordance 
                                with subparagraph (B)(ii)(II); and
                                    ``(II) the amount by which such 
                                reduced expenditures exceeds the target 
                                for the year shall be treated as a 
                                reduction in expenditures described in 
                                clause (i) for the succeeding year, for 
                                purposes of determining whether the 
                                target has or has not been met under 
                                this subparagraph with respect to that 
                                year.
                            ``(iii) Exemption from budget neutrality if 
                        target not met.--If the estimated net reduction 
                        in expenditures determined under clause (i) for 
                        the year is less than the target for the year, 
                        reduced expenditures in an amount equal to the 
                        target recapture amount shall not be taken into 
                        account in applying subparagraph (B)(ii)(II) 
                        with respect to fee schedules beginning with 
                        2015.
                            ``(iv) Target recapture amount.--For 
                        purposes of clause (iii), the target recapture 
                        amount is, with respect to a year, an amount 
                        equal to the difference between--
                                    ``(I) the target for the year; and
                                    ``(II) the estimated net reduction 
                                in expenditures determined under clause 
                                (i) for the year.
                            ``(v) Target.--For purposes of this 
                        subparagraph, with respect to a year, the 
                        target is calculated as 0.5 percent of the 
                        estimated amount of expenditures under the fee 
                        schedule under this section for the year.''.
            (2) Conforming amendment.--Section 1848(c)(2)(B)(v) of the 
        Social Security Act (42 U.S.C. 1395w-4(c)(2)(B)(v)) is amended 
        by adding at the end the following new subclause:
                                    ``(VIII) Reductions for misvalued 
                                services if target not met.--Effective 
                                for fee schedules beginning with 2015, 
                                reduced expenditures attributable to 
                                the application of the target recapture 
                                amount described in subparagraph 
                                (O)(iii).''.
    (e) Phase-in of Significant Relative Value Unit (RVU) Reductions.--
            (1) In general.--Section 1848(c) of the Social Security Act 
        (42 U.S.C. 1395w-4(c)) is amended by adding at the end the 
        following new paragraph:
            ``(7) Phase-in of significant relative value unit (rvu) 
        reductions.--Effective for fee schedules established beginning 
        with 2015, if the total relative value units for a service for 
        a year would otherwise be decreased by an estimated amount 
        equal to or greater than 20 percent as compared to the total 
        relative value units for the previous year, the applicable 
        adjustments in work, practice expense, and malpractice relative 
        value units shall be phased-in over a 2-year period.''.
            (2) Conforming amendments.--Section 1848(c)(2) of the 
        Social Security Act (42 U.S.C. 1395w-4(c)(2)) is amended--
                    (A) in subparagraph (B)(ii)(I), by striking 
                ``subclause (II)'' and inserting ``subclause (II) and 
                paragraph (7)''; and
                    (B) in subparagraph (K)(iii)(VI)--
                            (i) by striking ``provisions of 
                        subparagraph (B)(ii)(II)'' and inserting 
                        ``provisions of subparagraph (B)(ii)(II) and 
                        paragraph (7)''; and
                            (ii) by striking ``under subparagraph 
                        (B)(ii)(II)'' and inserting ``under 
                        subparagraph (B)(ii)(I)''.
    (f) Authority To Smooth Relative Values Within Groups of 
Services.--Section 1848(c)(2)(C) of the Social Security Act (42 U.S.C. 
1395w-4(c)(2)(C)) is amended--
            (1) in each of clauses (i) and (iii), by striking ``the 
        service'' and inserting ``the service or group of services'' 
        each place it appears; and
            (2) in the first sentence of clause (ii), by inserting ``or 
        group of services'' before the period.
    (g) GAO Study and Report on Relative Value Scale Update 
Committee.--
            (1) Study.--The Comptroller General of the United States 
        (in this subsection referred to as the ``Comptroller General'') 
        shall conduct a study of the processes used by the Relative 
        Value Scale Update Committee (RUC) to provide recommendations 
        to the Secretary of Health and Human Services regarding 
        relative values for specific services under the Medicare 
        physician fee schedule under section 1848 of the Social 
        Security Act (42 U.S.C. 1395w-4).
            (2) Report.--Not later than 1 year after the date of the 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1).

SEC. 105. PROMOTING EVIDENCE-BASED CARE.

    (a) Recognizing Appropriate Use Criteria for Certain Imaging 
Services.--
            (1) In general.--Section 1834 of the Social Security Act 
        (42 U.S.C. 1395m) is amended by adding at the end the following 
        new subsection:
    ``(p) Recognizing Appropriate Use Criteria for Certain Imaging 
Services.--
            ``(1) Program established.--
                    ``(A) In general.--The Secretary shall establish a 
                program to promote the use of appropriate use criteria 
                (as defined in subparagraph (B)) for applicable imaging 
                services (as defined in subparagraph (C)) furnished in 
                an applicable setting (as defined in subparagraph (D)) 
                by ordering professionals and furnishing professionals 
                (as defined in subparagraphs (E) and (F), 
                respectively).
                    ``(B) Appropriate use criteria defined.--In this 
                subsection, the term `appropriate use criteria' means 
                criteria, only developed or endorsed by national 
                professional medical specialty societies or other 
                provider-led entities, to assist ordering professionals 
                and furnishing professionals in making the most 
                appropriate treatment decision for a specific clinical 
                condition. To the extent feasible, such criteria shall 
                be evidence-based.
                    ``(C) Applicable imaging service defined.--In this 
                subsection, the term `applicable imaging service' means 
                an advanced diagnostic imaging service (as defined in 
                subsection (e)(1)(B)) for which the Secretary 
                determines--
                            ``(i) one or more applicable appropriate 
                        use criteria specified under paragraph (2) 
                        apply;
                            ``(ii) there are one or more qualified 
                        clinical decision support mechanisms listed 
                        under paragraph (3)(C); and
                            ``(iii) one or more of such mechanisms is 
                        available free of charge.
                    ``(D) Applicable setting defined.--In this 
                subsection, the term `applicable setting' means a 
                physician's office, a hospital outpatient department 
                (including an emergency department), an ambulatory 
                surgical center, and any other provider-led outpatient 
                setting determined appropriate by the Secretary.
                    ``(E) Ordering professional defined.--In this 
                subsection, the term `ordering professional' means a 
                physician (as defined in section 1861(r)) or a 
                practitioner described in section 1842(b)(18)(C) who 
                orders an applicable imaging service for an individual.
                    ``(F) Furnishing professional defined.--In this 
                subsection, the term `furnishing professional' means a 
                physician (as defined in section 1861(r)) or a 
                practitioner described in section 1842(b)(18)(C) who 
                furnishes an applicable imaging service for an 
                individual.
            ``(2) Establishment of applicable appropriate use 
        criteria.--
                    ``(A) In general.--Not later than November 15, 
                2015, the Secretary shall through rulemaking, and in 
                consultation with physicians, practitioners, and other 
                stakeholders, specify applicable appropriate use 
                criteria for applicable imaging services only from 
                among appropriate use criteria developed or endorsed by 
                national professional medical specialty societies or 
                other provider-led entities.
                    ``(B) Considerations.--In specifying applicable 
                appropriate use criteria under subparagraph (A), the 
                Secretary shall take into account whether the 
                criteria--
                            ``(i) have stakeholder consensus;
                            ``(ii) have been determined to be 
                        scientifically valid and are evidence based; 
                        and
                            ``(iii) are based on studies that are 
                        published and reviewable by stakeholders.
                    ``(C) Revisions.--The Secretary shall periodically 
                update and revise (as appropriate) such specification 
                of applicable appropriate use criteria.
                    ``(D) Treatment of multiple applicable appropriate 
                use criteria.--In the case where the Secretary 
                determines that more than one appropriate use criteria 
                applies with respect to an applicable imaging service, 
                the Secretary shall specify one or more applicable 
                appropriate use criteria under this paragraph for the 
                service.
            ``(3) Mechanisms for consultation with applicable 
        appropriate use criteria.--
                    ``(A) Identification of mechanisms to consult with 
                applicable appropriate use criteria.--
                            ``(i) In general.--The Secretary shall 
                        specify one or more qualified clinical decision 
                        support mechanisms that could be used by 
                        ordering professionals to consult with 
                        applicable appropriate use criteria for 
                        applicable imaging services.
                            ``(ii) Consultation.--The Secretary shall 
                        consult with physicians, practitioners, and 
                        other stakeholders in specifying mechanisms 
                        under this paragraph.
                            ``(iii) Inclusion of certain mechanisms.--
                        Mechanisms specified under this paragraph may 
                        include any or all of the following that meet 
                        the requirements described in subparagraph 
                        (B)(ii):
                                    ``(I) Use of clinical decision 
                                support modules in certified EHR 
                                technology (as defined in section 
                                1848(o)(4)).
                                    ``(II) Use of private sector 
                                clinical decision support mechanisms 
                                that are independent from certified EHR 
                                technology, which may include use of 
                                clinical decision support mechanisms 
                                available from medical specialty 
                                organizations.
                                    ``(III) Use of a clinical decision 
                                support mechanism established by the 
                                Secretary.
                    ``(B) Qualified clinical decision support 
                mechanisms.--
                            ``(i) In general.--For purposes of this 
                        subsection, a qualified clinical decision 
                        support mechanism is a mechanism that the 
                        Secretary determines meets the requirements 
                        described in clause (ii).
                            ``(ii) Requirements.--The requirements 
                        described in this clause are the following:
                                    ``(I) The mechanism makes available 
                                to the ordering professional applicable 
                                appropriate use criteria specified 
                                under paragraph (2) and the supporting 
                                documentation for the applicable 
                                imaging service ordered.
                                    ``(II) In the case where there are 
                                more than one applicable appropriate 
                                use criteria specified under such 
                                paragraph for an applicable imaging 
                                service, the mechanism indicates the 
                                criteria that it uses for the service.
                                    ``(III) The mechanism determines 
                                the extent to which an applicable 
                                imaging service ordered is consistent 
                                with the applicable appropriate use 
                                criteria so specified.
                                    ``(IV) The mechanism generates and 
                                provides to the ordering professional a 
                                certification or documentation that 
                                documents that the qualified clinical 
                                decision support mechanism was 
                                consulted by the ordering professional.
                                    ``(V) The mechanism is updated on a 
                                timely basis to reflect revisions to 
                                the specification of applicable 
                                appropriate use criteria under such 
                                paragraph.
                                    ``(VI) The mechanism meets privacy 
                                and security standards under applicable 
                                provisions of law.
                                    ``(VII) The mechanism performs such 
                                other functions as specified by the 
                                Secretary, which may include a 
                                requirement to provide aggregate 
                                feedback to the ordering professional.
                    ``(C) List of mechanisms for consultation with 
                applicable appropriate use criteria.--
                            ``(i) Initial list.--Not later than April 
                        1, 2016, the Secretary shall publish a list of 
                        mechanisms specified under this paragraph.
                            ``(ii) Periodic updating of list.--The 
                        Secretary shall periodically update the list of 
                        qualified clinical decision support mechanisms 
                        specified under this paragraph.
            ``(4) Consultation with applicable appropriate use 
        criteria.--
                    ``(A) Consultation by ordering professional.--
                Beginning with January 1, 2017, subject to subparagraph 
                (C), with respect to an applicable imaging service 
                ordered by an ordering professional that would be 
                furnished in an applicable setting and paid for under 
                an applicable payment system (as defined in 
                subparagraph (D)), an ordering professional shall--
                            ``(i) consult with a qualified decision 
                        support mechanism listed under paragraph 
                        (3)(C); and
                            ``(ii) provide to the furnishing 
                        professional the information described in 
                        clauses (i) through (iii) of subparagraph (B).
                    ``(B) Reporting by furnishing professional.--
                Beginning with January 1, 2017, subject to subparagraph 
                (C), with respect to an applicable imaging service 
                furnished in an applicable setting and paid for under 
                an applicable payment system (as defined in 
                subparagraph (D)), payment for such service may only be 
                made if the claim for the service includes the 
                following:
                            ``(i) Information about which qualified 
                        clinical decision support mechanism was 
                        consulted by the ordering professional for the 
                        service.
                            ``(ii) Information regarding--
                                    ``(I) whether the service ordered 
                                would adhere to the applicable 
                                appropriate use criteria specified 
                                under paragraph (2);
                                    ``(II) whether the service ordered 
                                would not adhere to such criteria; or
                                    ``(III) whether such criteria was 
                                not applicable to the service ordered.
                            ``(iii) The national provider identifier of 
                        the ordering professional (if different from 
                        the furnishing professional).
                    ``(C) Exceptions.--The provisions of subparagraphs 
                (A) and (B) and paragraph (6)(A) shall not apply to the 
                following:
                            ``(i) Emergency services.--An applicable 
                        imaging service ordered for an individual with 
                        an emergency medical condition (as defined in 
                        section 1867(e)(1)).
                            ``(ii) Inpatient services.--An applicable 
                        imaging service ordered for an inpatient and 
                        for which payment is made under part A.
                            ``(iii) Alternative payment models.--An 
                        applicable imaging service ordered by an 
                        ordering professional with respect to an 
                        individual attributed to an alternative payment 
                        model (as defined in section 1833(z)(3)(C)).
                            ``(iv) Significant hardship.--An applicable 
                        imaging service ordered by an ordering 
                        professional who the Secretary may, on a case-
                        by-case basis, exempt from the application of 
                        such provisions if the Secretary determines, 
                        subject to annual renewal, that consultation 
                        with applicable appropriate use criteria would 
                        result in a significant hardship, such as in 
                        the case of a professional who practices in a 
                        rural area without sufficient Internet access.
                    ``(D) Applicable payment system defined.--In this 
                subsection, the term `applicable payment system' means 
                the following:
                            ``(i) The physician fee schedule 
                        established under section 1848(b).
                            ``(ii) The prospective payment system for 
                        hospital outpatient department services under 
                        section 1833(t).
                            ``(iii) The ambulatory surgical center 
                        payment systems under section 1833(i).
            ``(5) Identification of outlier ordering professionals.--
                    ``(A) In general.--With respect to applicable 
                imaging services furnished beginning with 2017, the 
                Secretary shall determine, on a periodic basis (which 
                may be annually), ordering professionals who are 
                outlier ordering professionals.
                    ``(B) Outlier ordering professionals.--The 
                determination of an outlier ordering professional 
                shall--
                            ``(i) be based on low adherence to 
                        applicable appropriate use criteria specified 
                        under paragraph (2), which may be based on 
                        comparison to other ordering professionals; and
                            ``(ii) include data for ordering 
                        professionals for whom prior authorization 
                        under paragraph (6)(A) applies.
                    ``(C) Use of two years of data.--The Secretary 
                shall use two years of data to identify outlier 
                ordering professionals under this paragraph.
                    ``(D) Consultation with stakeholders.--The 
                Secretary shall consult with physicians, practitioners 
                and other stakeholders in developing methods to 
                identify outlier ordering professionals under this 
                paragraph.
            ``(6) Prior authorization for ordering professionals who 
        are outliers.--
                    ``(A) In general.--Beginning January 1, 2020, 
                subject to paragraph (4)(C), with respect to services 
                furnished during a year, the Secretary shall, for a 
                period determined appropriate by the Secretary, apply 
                prior authorization for applicable imaging services 
                that are ordered by an outlier ordering professional 
                identified under paragraph (5).
                    ``(B) Funding.--For purposes of carrying out this 
                paragraph, the Secretary shall provide for the 
                transfer, from the Federal Supplementary Medical 
                Insurance Trust Fund under section 1841, of $5,000,000 
                to the Centers for Medicare & Medicaid Services Program 
                Management Account for each of fiscal years 2019 
                through 2021. Amounts transferred under the preceding 
                sentence shall remain available until expended.''.
            (2) Conforming amendment.--Section 1833(t)(16) of the 
        Social Security Act (42 U.S.C. 1395l(t)(16)) is amended by 
        adding at the end the following new subparagraph:
                    ``(E) Application of appropriate use criteria for 
                certain imaging services.--For provisions relating to 
                the application of appropriate use criteria for certain 
                imaging services, see section 1834(p).''.
    (b) Establishment of Appropriate Use Program for Other Part B 
Services.--Section 1834 of the Social Security Act (42 U.S.C. 1395m), 
as amended by subsection (a), is amended by adding at the end the 
following new subsection:
    ``(q) Establishment of Appropriate Use Program for Other Part B 
Services.--
            ``(1) Establishment.--
                    ``(A) In general.--The Secretary may establish an 
                appropriate use program for services under this part 
                (other than applicable imaging services under 
                subsection (p)) using a process that is comparable to 
                the process under such subsection. With respect to 
                appropriate use criteria, such process shall replicate 
                the provider-developed or provider-endorsed criteria 
                framework for appropriate use criteria for applicable 
                imaging services under such subsection.
                    ``(B) Requirements.--In determining whether to 
                establish a program under subparagraph (A), the 
                Secretary shall take into consideration--
                            ``(i) the applicability of the provider-
                        developed or provider-endorsed criteria 
                        framework for appropriate use criteria for 
                        applicable imaging services under subsection 
                        (p);
                            ``(ii) the implementation of provider-
                        developed or provider-endorsed appropriate use 
                        criteria for such applicable imaging services; 
                        and
                            ``(iii) the report under paragraph (2).
                    ``(C) Input from stakeholders in advance of 
                rulemaking.--Before issuing a notice of proposed 
                rulemaking to establish a program under subparagraph 
                (A), the Secretary shall issue an advance notice of 
                proposed rulemaking.
            ``(2) Report on experience of imaging appropriate use 
        criteria program.--Not later than 18 months after the date of 
        the enactment of this subsection, the Comptroller General of 
        the United States shall submit to Congress a report that 
        includes a description of the extent to which appropriate use 
        criteria could be used for other services under this part, such 
        as radiation therapy and clinical diagnostic laboratory 
        services.''.

SEC. 106. EMPOWERING BENEFICIARY CHOICES THROUGH ACCESS TO INFORMATION 
              ON PHYSICIANS' SERVICES.

    (a) Transferring Freestanding Physician Compare Provision to the 
Social Security Act.--
            (1) In general.--Section 10331 of Public Law 111-148 is 
        transferred and redesignated as subsection (t) of section 1848 
        of the Social Security Act (42 U.S.C. 1395w-4), as amended by 
        subsections (c) and (h) of section 101 and by section 102.
            (2) Conforming redesignations.--Section 1848(t) of the 
        Social Security Act (42 U.S.C. 1395w-4(t)), as transferred and 
        redesignated by paragraph (1), is further amended--
                    (A) by striking the subsection heading and 
                inserting the following new subsection heading: 
                ``Public Reporting of Performance and Other Information 
                on Physician Compare'';
                    (B) by redesignating subsections (a) through (i) as 
                paragraphs (1) through (9), respectively, and indenting 
                appropriately;
                    (C) in paragraph (1), as redesignated by 
                subparagraph (B)--
                            (i) by redesignating paragraphs (1) and (2) 
                        as subparagraphs (A) and (B), respectively, and 
                        indenting appropriately;
                            (ii) in subparagraph (B), as redesignated 
                        by clause (i), by redesignating subparagraphs 
                        (A) through (G) as clauses (i) through (vii), 
                        respectively, and indenting appropriately;
                    (D) in paragraph (2), as redesignated by 
                subparagraph (B), by redesignating paragraphs (1) 
                through (7) as subparagraphs (A) through (G), 
                respectively, and indenting appropriately; and
                    (E) in paragraph (9), as redesignated by 
                subparagraph (B), by redesignating paragraphs (1) 
                through (4) as subparagraphs (A) through (D), 
                respectively, and indenting appropriately.
            (3) Conforming amendments.--Section 1848(t) of the Social 
        Security Act (42 U.S.C. 1395w-4(t)), as amended by paragraph 
        (2), is further amended--
                    (A) in paragraph (1)--
                            (i) in subparagraph (A)--
                                    (I) by striking ``the Medicare 
                                program under section 1866(j) of the 
                                Social Security Act (42 U.S.C. 
                                1395cc(j))'' and inserting ``the 
                                program under this title under section 
                                1866(j)''; and
                                    (II) by striking ``of such Act (42 
                                U.S.C. 1395w-4)''; and
                            (ii) in subparagraph (B), in the matter 
                        preceding clause (i)--
                                    (I) by striking ``subsection (c)'' 
                                and inserting ``paragraph (3)'';
                                    (II) by striking ``the Medicare 
                                program under such section 1866(j)'' 
                                and inserting ``the program under this 
                                title under section 1866(j)''; and
                                    (III) by striking ``this section'' 
                                and inserting ``this subsection'';
                    (B) in paragraph (2)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``subsection (a)(2)'' and 
                        inserting ``paragraph (1)(B)'';
                            (ii) in subparagraph (D), by striking ``the 
                        Medicare program'' and inserting ``the program 
                        under this title''; and
                            (iii) in each of subparagraphs (F) and (G), 
                        by striking ``this section'' and inserting 
                        ``this subsection'';
                    (C) in paragraph (3), by striking ``this section'' 
                and inserting ``this subsection'';
                    (D) in paragraph (4)--
                            (i) by striking ``of the Social Security 
                        Act, as added by section 3014 of this Act''; 
                        and
                            (ii) by striking ``this section'' and 
                        inserting ``this subsection'';
                    (E) in paragraph (5)--
                            (i) by striking ``this subsection (a)(2)'' 
                        and inserting ``paragraph (1)(B)''; and
                            (ii) by striking ``(Public Law 110-275)'';
                    (F) in paragraph (6), by striking ``subsection 
                (a)(1)'' and inserting ``paragraph (1)(A)'';
                    (G) in paragraph (7)--
                            (i) by striking ``subsection (f)'' and 
                        inserting ``paragraph (6)''; and
                            (ii) by striking ``title XVIII of the 
                        Social Security Act'' and inserting ``this 
                        title'';
                    (H) in paragraph (8)--
                            (i) by striking ``subparagraphs (A) through 
                        (G) of subsection (a)(2)'' and inserting 
                        ``clauses (i) through (vii) of paragraph 
                        (1)(B)'';
                            (ii) by striking ``title XVIII of the 
                        Social Security Act'' and inserting ``this 
                        title''; and
                            (iii) by striking ``such title'' and 
                        inserting ``this title''; and
                    (I) in paragraph (9)--
                            (i) in the matter preceding subparagraph 
                        (8), by striking ``this section'' and inserting 
                        ``this subsection'';
                            (ii) in subparagraph (A), by striking ``of 
                        the Social Security Act (42 U.S.C. 1395w-4)'';
                            (iii) in subparagraph (B), by striking ``of 
                        such Act (42 U.S.C. 1395x(r))'';
                            (iv) in subparagraph (C), by striking 
                        ``subsection (a)(1)'' and inserting ``paragraph 
                        (1)(A)''; and
                            (v) by striking subparagraph (D).
    (b) Public Availability of Medicare Data.--Section 1848(t) of the 
Social Security Act (42 U.S.C. 1395w-4(t)), as amended by subsection 
(a), is further amended--
            (1) by redesignating paragraph (9) as paragraph (10);
            (2) by inserting after paragraph (8) the following new 
        paragraph:
            ``(9) Public availability of eligible professional claims 
        data.--
                    ``(A) In general.--The Secretary shall make 
                publicly available on Physician Compare the information 
                described in subparagraph (B) with respect to eligible 
                professionals.
                    ``(B) Information described.--The following 
                information, with respect to an eligible professional, 
                is described in this subparagraph:
                            ``(i) Information on the number of services 
                        furnished by the eligible professional, which 
                        may include information on the most frequent 
                        services furnished or groupings of services.
                            ``(ii) Information on submitted charges and 
                        payments for services under this part.
                            ``(iii) A unique identifier for the 
                        eligible professional that is available to the 
                        public, such as a national provider identifier.
                    ``(C) Searchability.--The information made 
                available under this paragraph shall be searchable by 
                at least the following:
                            ``(i) The specialty or type of the eligible 
                        professional.
                            ``(ii) Characteristics of the services 
                        furnished, such as volume or groupings of 
                        services.
                            ``(iii) The location of the eligible 
                        professional.
                    ``(D) Disclosure.--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.
                    ``(E) Implementation.--
                            ``(i) Initial implementation.--Physician 
                        Compare shall include the information described 
                        in subparagraph (B)--
                                    ``(I) with respect to physicians, 
                                by not later than July 1, 2015; and
                                    ``(II) with respect to other 
                                eligible professionals, by not later 
                                than July 1, 2016.
                            ``(ii) Annual updating.--The information 
                        made available under this paragraph shall be 
                        updated on Physician Compare not less 
                        frequently than on an annual basis.
                    ``(F) Opportunity to review and submit 
                corrections.--The Secretary shall provide for an 
                opportunity for an eligible professional to review, and 
                submit corrections for, the information to be made 
                public with respect to the eligible professional under 
                this paragraph prior to such information being made 
                public.''; and
            (3) in paragraph (10)(C), as redesignated by paragraph (1), 
        by inserting ``(or a successor website)'' before the period at 
        the end.

SEC. 107. EXPANDING CLAIMS DATA AVAILABILITY TO IMPROVE CARE.

    (a) Expansion of Uses of Claims Data by Qualified Entities.--
Section 1874(e) of the Social Security Act (42 U.S.C. 1395kk(e)) is 
amended by adding at the end the following new paragraphs:
            ``(5) Expansion of uses of claims data by qualified 
        entities.--
                    ``(A) Expansion.--To the extent consistent with 
                applicable information, privacy, security, and 
                disclosure laws, beginning July 1, 2014, 
                notwithstanding paragraph (4)(B) (other than clause 
                (iii) of such paragraph) and the second sentence of 
                paragraph (4)(D), a qualified entity may, as determined 
                appropriate by the Secretary, do any or all of the 
                following:
                            ``(i)(I) Use the combined data described in 
                        paragraph (4)(B)(iii) to conduct analyses, 
                        other than for reports described in paragraph 
                        (4), for entities described in subparagraph (B) 
                        for non-public uses, as determined appropriate 
                        by the Secretary, such as for the purposes 
                        described in subclause (II).
                            ``(II) The purposes described in this 
                        subclause are assisting providers of services 
                        and suppliers in developing and participating 
                        in quality and patient care improvement 
                        activities (including developing new models of 
                        care), population health management, and 
                        disease monitoring, and the purposes described 
                        in subparagraph (C).
                            ``(ii) Provide or sell such analyses to 
                        entities described in subparagraph (B).
                            ``(iii) Provide entities described in 
                        clauses (i), (ii), (v), and (vi) of 
                        subparagraph (B) with access to the combined 
                        data described in paragraph (4)(B)(iii) through 
                        a qualified data enclave (as defined in 
                        subparagraph (F)) that is maintained by the 
                        qualified entity, or through an approved 
                        alternative method (as defined in subparagraph 
                        (G)), in order for entities described in such 
                        clauses to conduct analyses for non-public 
                        uses, such as for the purposes described in 
                        clause (i)(II) (but excluding the purposes 
                        described in subparagraph (C)).
                    ``(B) Entities described.--For the purpose of 
                subparagraph (A) clauses (i) and (ii), the entities 
                described in this subparagraph are the following:
                            ``(i) A provider of services.
                            ``(ii) A supplier.
                            ``(iii) Subject to subparagraph (C), an 
                        employer (as defined in section 3(5) of the 
                        Employee Retirement Insurance Security Act of 
                        1974).
                            ``(iv) A health insurance issuer (as 
                        defined in section 2791 of the Public Health 
                        Service Act) that provides data under paragraph 
                        (4)(B)(iii).
                            ``(v) A medical society or hospital 
                        association.
                            ``(vi) Other entities approved by the 
                        Secretary (other than an employer (as so 
                        defined) and a health insurance issuer (as so 
                        defined)).
                    ``(C) Limitation for employers with respect to 
                analyses.--Any analyses provided or sold under this 
                paragraph to an employer (as so defined) may only be 
                used by such employer for purposes of providing health 
                insurance to employees and retirees of the employer.
                    ``(D) Protection of patient identification in 
                analyses.--
                            ``(i) In general.--Except as provided in 
                        clause (ii), an analysis provided or sold under 
                        this paragraph shall not contain information 
                        that individually identifies a patient.
                            ``(ii) Information on patients of the 
                        provider of services or supplier.--An analysis 
                        that is provided or sold under this paragraph 
                        to a provider of services or supplier may 
                        contain data that individually identifies a 
                        patient of such provider or supplier but only 
                        with respect to items and services furnished by 
                        such provider or supplier to such patient.
                            ``(iii) Opportunity for providers of 
                        services and suppliers to review.--Prior to a 
                        qualified entity providing or selling an 
                        analysis under this paragraph to an entity 
                        described in subparagraph (B), 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 an opportunity 
                        for such provider or supplier to review and 
                        submit corrections to such analysis.
                    ``(E) No redisclosure of analyses or data.--An 
                entity described in subparagraph (B) that is provided 
                or sold analyses under this paragraph, or an entity 
                described in subparagraph (A)(iii) that receives data 
                under this paragraph through a qualified data enclave 
                or an approved alternative method, shall not redisclose 
                or make public such analyses, such data, or analyses 
                using such data.
                    ``(F) Requirements for a qualified data enclave.--
                            ``(i) Definition.--For purposes of this 
                        paragraph, the term `qualified data enclave' 
                        means a data enclave that the Secretary 
                        determines meets the following:
                                    ``(I) The data enclave is a virtual 
                                private network or comparable 
                                mechanism.
                                    ``(II) Subject to the requirements 
                                described in clause (ii) and such other 
                                requirements as the Secretary may 
                                specify, the data enclave is capable of 
                                providing access to the combined data 
                                described in subparagraph (A)(iii).
                            ``(ii) Enclave access requirements.--The 
                        requirements described in this clause are the 
                        following:
                                    ``(I) A qualified data enclave 
                                shall preclude any entity that obtains 
                                access to the data from removing or 
                                extracting the data from such enclave.
                                    ``(II) Subject to the succeeding 
                                sentence, the enclave shall preclude 
                                access to data that individually 
                                identifies a patient, including data on 
                                the patient's name and date of birth 
                                and such other data as the Secretary 
                                shall specify. Such data enclave may 
                                provide providers of services and 
                                suppliers with access to such 
                                individually identifiable patient data 
                                but only with respect to items and 
                                services furnished by such provider or 
                                supplier to such patient.
                                    ``(III) Access to data in the 
                                enclave shall not be provided to any 
                                entity unless the qualified entity and 
                                the entity have entered into a data use 
                                agreement, the terms of which contain 
                                the requirements of this paragraph and 
                                paragraph (6) and such other terms the 
                                Secretary may specify.
                    ``(G) Approved alternative method.--For purposes of 
                this paragraph, the term `approved alternative method' 
                means a method of providing access to the data 
                described in subparagraph (A)(iii) (other than through 
                a qualified data enclave) to entities described in such 
                paragraph that the Secretary determines meets the 
                following:
                            ``(i) The method is as secure as a 
                        qualified data enclave.
                            ``(ii) The method meets the requirements 
                        applicable to a qualified data enclave under 
                        subclauses (II) and (III) of subparagraph 
                        (F)(ii).
                            ``(iii) The method meets other requirements 
                        determined appropriate by the Secretary.
                    ``(H) Annual reports.--Any qualified entity that 
                provides or sells analyses pursuant to subparagraph 
                (A)(ii), or provides access to a data through an 
                approved data enclave or an approved alternative 
                method, shall annually submit to the Secretary a report 
                that includes--
                            ``(i) a summary of the analyses provided or 
                        sold, including the number of such analyses, 
                        the number of purchasers of such analyses, and 
                        the total amount of fees received for such 
                        analyses;
                            ``(ii) a description of the topics and 
                        purposes of such analyses;
                            ``(iii) information on the entities who 
                        obtained access to data pursuant to 
                        subparagraph (A)(iii), the uses of the data, 
                        and the total amount of fees received for 
                        providing such access; and
                            ``(iv) other information determined 
                        appropriate by the Secretary.
            ``(6) Civil monetary penalties for a breach of a data use 
        agreement.--A data use agreement under this subsection shall 
        provide for civil monetary penalties (as determined appropriate 
        by the Secretary) for a breach of such agreement.''.
    (b) Expansion of Data Available to Qualified Entities.--Section 
1874(e) of the Social Security Act (42 U.S.C. 1395kk(e)) is amended--
            (1) in the subsection heading, by striking ``Medicare''; 
        and
            (2) in paragraph (3)--
                    (A) by inserting after the first sentence the 
                following new sentence: ``Effective July 1, 2014, 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.''; and
                    (B) in the last sentence, by inserting ``or under 
                titles XIX or XXI'' before the period at the end.
    (c) Access to Medicare Data by Qualified Clinical Data Registries 
To Facilitate Quality Improvement.--Section 1848(m)(3)(E) of the Social 
Security Act (42 U.S.C. 1395w-4(m)(3)(E)) is amended by adding at the 
end the following new clause:
                            ``(vi) Access to medicare data to 
                        facilitate quality improvement.--
                                    ``(I) In general.--To the extent 
                                consistent with applicable information, 
                                privacy, security, and disclosure laws, 
                                and subject to other requirements as 
                                the Secretary may specify, beginning 
                                July 1, 2014, the Secretary shall, if 
                                requested by a qualified clinical data 
                                registry under this subparagraph, 
                                subject to subclauses (II) and (III), 
                                provide data as described in section 
                                1874(e)(3) (in a form and manner 
                                determined to be appropriate) to such 
                                registry for purposes of linking such 
                                data with clinical data and performing 
                                analyses and research to support 
                                quality improvement or patient safety.
                                    ``(II) Protection.--A qualified 
                                clinical data registry may not publicly 
                                report any data made available under 
                                subclause (I) (or any analyses or 
                                research described in such subclause) 
                                that individually identifies a provider 
                                of services, supplier, or individual 
                                unless the registry obtains the consent 
                                of such provider, supplier, or 
                                individual prior to such reporting.
                                    ``(III) Fee.--The data described in 
                                subclause (I) shall be made available 
                                to qualified clinical data registries 
                                at a fee equal to the cost of making 
                                such data available. Any fee collected 
                                pursuant to the preceding sentence 
                                shall be deposited in the Centers for 
                                Medicare & Medicaid Services Program 
                                Management Account.''.
    (d) Revision of Placement of Fees.--Section 1874(e)(4)(A) of the 
Social Security Act (42 U.S.C. 1395kk(e)(4)(A)) is amended, in the 
second sentence--
            (1) by inserting ``, for periods prior to July 1, 2014,'' 
        after ``deposited''; and
            (2) by inserting the following before the period at the 
        end: ``, and, beginning July 1, 2014, into the Centers for 
        Medicare & Medicaid Services Program Management Account''.

               TITLE II--EXTENSIONS AND OTHER PROVISIONS

                    Subtitle A--Medicare Extensions

SEC. 201. WORK GEOGRAPHIC ADJUSTMENT.

    Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``and before January 1, 2014,''.

SEC. 202. MEDICARE PAYMENT FOR THERAPY SERVICES.

    (a) Repeal of Therapy Cap and 1-year Extension of Threshold for 
Manual Medical Review.--Section 1833(g) of the Social Security Act (42 
U.S.C. 1395l(g)) is amended--
            (1) in paragraph (4)--
                    (A) by striking ``This subsection'' and inserting 
                ``Except as provided in paragraph (5)(C), this 
                subsection''; and
                    (B) by inserting the following before the period at 
                the end: ``or with respect to services furnished on or 
                after the date of enactment of the SGR Repeal and 
                Medicare Beneficiary Access Act of 2013''.
            (2) in paragraph (5)(C)--
                    (A) in clause (i), by inserting ``and before 
                January 1, 2015,'' after ``2012,''; and
                    (B) by adding at the end the following new clause:
    ``(iii) With respect to services furnished during the period 
beginning on the date of enactment of the SGR Repeal and Medicare 
Beneficiary Access Act of 2013, and ending on December 31, 2014, the 
provisions of this paragraph shall only apply to the extent necessary 
to carry out the manual medical review process under this 
subparagraph.''.
    (b) Medical Review of Outpatient Therapy Services.--
            (1) Medical review of outpatient therapy services.--Section 
        1833 of the Social Security Act (42 U.S.C. 1395l), as amended 
        by section 101(e), is amended by adding at the end the 
        following new subsection:
    ``(aa) Medical Review of Outpatient Therapy Services.--
            ``(1) In general.--
                    ``(A) Process for medical review.--The Secretary 
                shall implement a process for the medical review (as 
                described in paragraph (2)) of outpatient therapy 
                services (as defined in paragraph (10)) and, subject to 
                paragraph (12), apply such process to such services 
                furnished on or after January 1, 2015, focusing on 
                services identified under subparagraph (B).
                    ``(B) Identification of services for review.--Under 
                the process, the Secretary shall identify services for 
                medical review, using such factors as the Secretary 
                determines appropriate, which may include the 
                following:
                            ``(i) Services furnished by a therapy 
                        provider (as defined in paragraph (10)) whose 
                        pattern of billing is higher compared to peers.
                            ``(ii) Services furnished by a therapy 
                        provider who, in a prior period, has a high 
                        claims denial percentage or is least compliant 
                        with other applicable requirements under this 
                        title.
                            ``(iii) Services furnished by a therapy 
                        provider that is newly enrolled under this 
                        title.
                            ``(iv) Services furnished by a therapy 
                        provider who has questionable billing 
                        practices, such as billing medically unlikely 
                        units of services in a day.
                            ``(v) Services furnished to treat a type of 
                        medical condition.
                            ``(vi) Services identified by use of the 
                        standardized data elements required to be 
                        reported under section 1834(p).
                            ``(vii) Services furnished by a single 
                        therapy provider or a group that includes a 
                        therapy provider identified by factors 
                        described in this subparagraph.
                            ``(viii) Other services as determined 
                        appropriate by the Secretary.
            ``(2) Medical review.--
                    ``(A) Prior authorization medical review.--
                            ``(i) In general.--Subject to the 
                        succeeding provisions of this subparagraph, the 
                        Secretary shall use prior authorization medical 
                        review for outpatient therapy services 
                        furnished to an individual above one or more 
                        thresholds established by the Secretary, such 
                        as a dollar threshold or a threshold based on 
                        factors such as the type of outpatient therapy 
                        service or setting.
                            ``(ii) Ending application of prior 
                        authorization for a therapy provider.--The 
                        Secretary shall end the application of prior 
                        authorization medical review to outpatient 
                        therapy services furnished by a therapy 
                        provider if the Secretary determines that the 
                        provider has a low denial rate under such prior 
                        authorization. The Secretary may subsequently 
                        reapply prior authorization medical review to 
                        such therapy provider if the Secretary 
                        determines it to be appropriate.
                            ``(iii) Prior authorization of multiple 
                        services.--The Secretary shall, where 
                        practicable, provide for prior authorization 
                        medical review for multiple services at a 
                        single time, such as services in a therapy plan 
                        of care described in section 1861(p)(2).
                    ``(B) Other types of medical review.--The Secretary 
                may use pre-payment review or post-payment review for 
                services identified under paragraph (1)(B) that are not 
                subject to prior authorization medical review under 
                subparagraph (A).
                    ``(C) Limitation for law enforcement activities.--
                The Secretary may determine that medical review under 
                this subsection does not apply in the case where fraud 
                may be involved.
            ``(3) Review contractors.--The Secretary shall conduct 
        prior authorization medical review of outpatient therapy 
        services under this subsection using medicare administrative 
        contractors (as described in section 1874A) or other review 
        contractors (other than contractors under section 1893(h) or 
        contractors paid on a contingent basis).
            ``(4) No payment without prior authorization.--With respect 
        to an outpatient therapy service for which prior authorization 
        medical review under this subsection applies, no payment shall 
        be made under this part for the service unless a prior 
        authorization determination is made, in advance of furnishing 
        such service, that such service would meet the applicable 
        requirements of section 1862(a)(1)(A).
            ``(5) Submission of information.--A therapy provider may 
        submit the information 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, but not later than 24 months 
        after the date of enactment of this subsection.
            ``(6) Timeliness.--The Secretary shall make a prior 
        authorization determination under this subsection within 10 
        business days of the date of the Secretary's receipt of medical 
        documentation needed to make such determination or the 
        Secretary shall be deemed to have found the services to meet 
        the applicable requirements of section 1862(a)(1)(A).
            ``(7) Construction.--With respect to an outpatient therapy 
        service 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.
            ``(8) Beneficiary protections.--With respect to services 
        furnished on or after January 1, 2015, where payment may not be 
        made as a result of application of medical review under this 
        subsection, 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).
            ``(9) Implementation.--
                    ``(A) Authority.--The Secretary may implement the 
                provisions of this subsection by interim final rule 
                with comment period.
                    ``(B) Administration.--Chapter 35 of title 44, 
                United States Code, shall not apply to medical review 
                under this subsection.
            ``(10) Definitions.--For purposes of this subsection:
                    ``(A) Outpatient therapy services.--The term 
                `outpatient therapy services' means the following 
                services for which payment is made under section 1848, 
                1834(g), or 1834(k):
                            ``(i) Physical therapy services of the type 
                        described in section 1861(p).
                            ``(ii) Speech-language pathology services 
                        of the type described in such section though 
                        the application of section 1861(ll)(2).
                            ``(iii) Occupational therapy services of 
                        the type described in section 1861(p) through 
                        the operation of section 1861(g).
                    ``(B) Therapy provider.--The term `therapy 
                provider' means a provider of services (as defined in 
                section 1861(u)) or a supplier (as defined in section 
                1861(d)) who submits a claim for outpatient therapy 
                services.
            ``(11) Funding.--For purposes of implementing this 
        subsection, the Secretary shall provide for the transfer, from 
        the Federal Supplementary Medical Insurance Trust Fund under 
        section 1841, of $35,000,000 to the Centers for Medicare & 
        Medicaid Services Program Management Account for each fiscal 
        year (beginning with fiscal year 2014). Amounts transferred 
        under this paragraph shall remain available until expended.
            ``(12) Scaling back.--
                    ``(A) Periodic determinations.--Beginning with 
                2017, and every two years thereafter, the Secretary 
                shall--
                            ``(i) make a determination of the improper 
                        payment rate for outpatient therapy services 
                        for a 12-month period; and
                            ``(ii) make such determination publicly 
                        available.
                    ``(B) Scaling back.--If the improper payment rate 
                for outpatient therapy services determined for a 12-
                month period under subparagraph (A) is 50 percent or 
                less of the Medicare fee-for-service improper payment 
                rate for such period, the Secretary shall--
                            ``(i) reduce the amount and extent of 
                        medical review conducted for a prospective year 
                        under the process established in this 
                        subsection; and
                            ``(ii) return an appropriate portion of the 
                        funding provided for such year under paragraph 
                        (11).''.
            (2) GAO study and report.--
                    (A) Study.--The Comptroller General of the United 
                States shall conduct a study on the effectiveness of 
                medical review of outpatient therapy services under 
                section 1833(aa) of the Social Security Act, as added 
                by paragraph (2). Such study shall include an analysis 
                of--
                            (i) aggregate data on--
                                    (I) the number of individuals, 
                                therapy providers, and claims subject 
                                to such review; and
                                    (II) the number of reviews 
                                conducted under such section; and
                            (ii) the outcomes of such reviews.
                    (B) Report.--Not later than 3 years after the date 
                of enactment of this Act, the Comptroller General shall 
                submit to Congress a report containing the results of 
                the study under subparagraph (A), together with 
                recommendations for such legislation and administrative 
                action as the Comptroller General determines 
                appropriate.
    (c) Collection of Standardized Data Elements for Outpatient Therapy 
Services.--
            (1) Collection of standardized data elements for outpatient 
        therapy services.--Section 1834 of the Social Security Act (42 
        U.S.C. 1395m) is amended by adding at the end the following new 
        subsection:
    ``(p) Collection of Standardized Data Elements for Outpatient 
Therapy Services.--
            ``(1) Standardized data elements.--
                    ``(A) In general.--Not later than 6 months after 
                the date of enactment of this subsection, the Secretary 
                shall post on the Internet website of the Centers for 
                Medicare & Medicaid Services a draft list of 
                standardized data elements for individuals receiving 
                outpatient therapy services.
                    ``(B) Domains.--Such standardized data elements 
                shall include information with respect to the following 
                domains, as determined appropriate by the Secretary:
                            ``(i) Demographic information.
                            ``(ii) Diagnosis.
                            ``(iii) Severity.
                            ``(iv) Affected body structures and 
                        functions.
                            ``(v) Limitations with activities of daily 
                        living and participation.
                            ``(vi) Functional status.
                            ``(vii) Other domains determined to be 
                        appropriate by the Secretary.
                    ``(C) Solicitation of input.--The Secretary shall 
                accept comments from stakeholders through the date that 
                is 60 days after the date the Secretary posts the draft 
                list of standardized data elements pursuant to 
                subparagraph (A). In seeking such comments, the 
                Secretary shall use one or more mechanisms to solicit 
                input from stakeholders that may include use of open 
                door forums, town hall meetings, requests for 
                information, or other mechanisms determined appropriate 
                by the Secretary.
                    ``(D) Operational list of standardized data 
                elements.--Not later than 120 days after the end of the 
                comment period described in subparagraph (C), the 
                Secretary, taking into account such comments, shall 
                post on the Internet website of the Centers for 
                Medicare & Medicaid Services an operational list of 
                standardized data elements.
                    ``(E) Subsequent revisions.--Subsequent revisions 
                to the operational list of standardized data elements 
                shall be made through rulemaking. Such revisions may be 
                based on experience and input from stakeholders.
            ``(2) System to report standardized data elements.--
                    ``(A) In general.--Not later than 18 months after 
                the date the Secretary posts the operational list of 
                standardized data elements pursuant to paragraph 
                (1)(D), the Secretary shall develop and implement an 
                electronic system (which may be a web portal) for 
                therapy providers to report the standardized data 
                elements for individuals with respect to outpatient 
                therapy services.
                    ``(B) Consultation.--The Secretary shall seek 
                comments from stakeholders regarding the best way to 
                report the standardized data elements.
            ``(3) Reporting.--
                    ``(A) Frequency of reporting.--The Secretary shall 
                specify the frequency of reporting standardized data 
                elements. The Secretary shall seek comments from 
                stakeholders regarding the frequency of the reporting 
                of such data elements.
                    ``(B) Reporting requirement.--Beginning on the date 
                the system to report standardized data elements under 
                this subsection is operational, no payment shall be 
                made under this part for outpatient therapy services 
                furnished to an individual unless a therapy provider 
                reports the standardized data elements for such 
                individual.
            ``(4) Report on new payment system for outpatient therapy 
        services.--
                    ``(A) In general.--Not later than 18 months after 
                the date described in paragraph (3)(B), the Secretary 
                shall submit to Congress a report on the design of a 
                new payment system for outpatient therapy services. The 
                report shall include an analysis of the standardized 
                data elements collected and other appropriate data and 
                information.
                    ``(B) Features.--Such report shall consider--
                            ``(i) appropriate adjustments to payment 
                        (such as case mix and outliers);
                            ``(ii) payments on an episode of care 
                        basis; and
                            ``(iii) reduced payment for multiple 
                        episodes.
                    ``(C) Consultation.--The Secretary shall consult 
                with stakeholders regarding the design of such a new 
                payment system.
            ``(5) Implementation.--
                    ``(A) Funding.--For purposes of implementing this 
                subsection, the Secretary shall provide for the 
                transfer, from the Federal Supplementary Medical 
                Insurance Trust Fund under section 1841, of $7,000,000 
                to the Centers for Medicare & Medicaid Services Program 
                Management Account for each of fiscal years 2014 
                through 2018. Amounts transferred under this 
                subparagraph shall remain available until expended.
                    ``(B) Administration.--Chapter 35 of title 44, 
                United States Code, shall not apply to specification of 
                the standardized data elements and implementation of 
                the system to report such standardized data elements 
                under this subsection.
                    ``(C) Limitation.--There shall be no administrative 
                or judicial review under section 1869, section 1878, or 
                otherwise of the specification of standardized data 
                elements required under this subsection or the system 
                to report such standardized data elements.
                    ``(D) Definition of outpatient therapy services and 
                therapy provider.--In this subsection, the terms 
                `outpatient therapy services' and `therapy provider' 
                have the meaning given those term in section 
                1833(aa).''.
            (2) Sunset of current claims-based collection of therapy 
        data.--Section 3005(g)(1) of the Middle Class Tax Extension and 
        Job Creation Act of 2012 (42 U.S.C. 1395l note) is amended, in 
        the first sentence, by inserting ``and ending on the date the 
        system to report standardized data elements under section 
        1834(p) of the Social Security Act (42 U.S.C. 1395m(p)) is 
        implemented,'' after ``January 1, 2013,''.
    (d) Reporting of Certain Information.--Section 1842(t) of the 
Social Security Act (42 U.S.C. 1395u(t)) is amended by adding at the 
end the following new paragraph:
    ``(3) Each request for payment, or bill submitted, by a therapy 
provider (as defined in section 1833(aa)(10)) for an outpatient therapy 
service (as defined in such section) furnished by a therapy assistant 
on or after January 1, 2015, shall include (in a form and manner 
specified by the Secretary) an indication that the service was 
furnished by a therapy assistant.''.

SEC. 203. MEDICARE AMBULANCE SERVICES.

    (a) Extension of Certain Ambulance Add-on Payments.--
            (1) Ground ambulance.--Section 1834(l)(13)(A) of the Social 
        Security Act (42 U.S.C. 1395m(l)(13)(A)) is amended by striking 
        ``January 1, 2014'' and inserting ``January 1, 2019'' each 
        place it appears.
            (2) Super rural ambulance.--Section 1834(l)(12)(A) of the 
        Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended, in 
        the first sentence, by striking ``January 1, 2014'' and 
        inserting ``January 1, 2019''.
    (b) Requiring Ambulance Providers To Submit Cost and Other 
Information.--Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)) is amended by adding at the end the following new paragraph:
            ``(16) Submission of cost and other information.--
                    ``(A) Development of data collection system.--The 
                Secretary shall develop a data collection system (which 
                may include use of a cost survey and standardized 
                definitions) for providers and suppliers of ambulance 
                services to collect cost, revenue, utilization, and 
                other information determined appropriate by the 
                Secretary. Such system shall be designed to submit 
                information--
                            ``(i) needed to evaluate the 
                        appropriateness of payment rates under this 
                        subsection;
                            ``(ii) on the utilization of capital 
                        equipment and ambulance capacity; and
                            ``(iii) on different types of ambulance 
                        services furnished in different geographic 
                        locations, including rural areas and low 
                        population density areas described in paragraph 
                        (12).
                    ``(B) Specification of data collection system.--
                            ``(i) In general.--Not later than January 
                        1, 2015, the Secretary shall--
                                    ``(I) specify the data collection 
                                system under subparagraph (A); and
                                    ``(II) identify the providers and 
                                suppliers of ambulance services who 
                                would be required to submit the 
                                information under such data collection 
                                system.
                            ``(ii) Respondents.--Subject to 
                        subparagraph (D)(ii), the Secretary shall 
                        determine an appropriate sample of providers 
                        and suppliers of ambulance services to submit 
                        information under the data collection system 
                        each year.
                    ``(C) Reporting of cost information.--Beginning 
                July 1, 2015, a 5 percent reduction to payments under 
                this part shall be made for a 1-year period to a 
                provider or supplier of ambulance services who--
                            ``(i) is identified under subparagraph 
                        (B)(i)(II) as being required to submit the 
                        information under the data collection system; 
                        and
                            ``(ii) does not submit such information.
                    ``(D) Ongoing data collection.--
                            ``(i) Revision of data collection system.--
                        The Secretary may revise, as the Secretary 
                        determines appropriate, the data collection 
                        system. The Secretary shall consult with 
                        providers and suppliers of ambulance services 
                        when revising such system.
                            ``(ii) Subsequent data collection.--In 
                        order to continue to evaluate the 
                        appropriateness of payment rates under this 
                        subsection, the Secretary shall require 
                        providers and suppliers of ambulance services 
                        to submit information for years after 2015 as 
                        the Secretary determines appropriate, but in no 
                        case less often than once every 3 years.
                    ``(E) Consultation.--The Secretary shall consult 
                with stakeholders in carrying out the development of 
                the system and collection of information under this 
                paragraph, including the activities described in 
                subparagraphs (A) and (D). Such consultation shall 
                include the use of requests for information and other 
                mechanisms determined appropriate by the Secretary.
                    ``(F) Administration.--Chapter 35 of title 44, 
                United States Code, shall not apply to the collection 
                of information required under this subsection.
                    ``(G) Limitations on review.--There shall be no 
                administrative or judicial review under section 1869, 
                section 1878, or otherwise of the data collection 
                system or identification of respondents under this 
                paragraph.
                    ``(H) Funding for implementation.--For purposes of 
                carrying out subparagraph (A), the Secretary shall 
                provide for the transfer, from the Federal 
                Supplementary Medical Insurance Trust Fund under 
                section 1841, of $1,000,000 to the Centers for Medicare 
                & Medicaid Services Program Management Account for 
                fiscal year 2014. Amounts transferred under this 
                subparagraph shall remain available until expended.''.

SEC. 204. REVISION OF THE MEDICARE-DEPENDENT HOSPITAL (MDH) PROGRAM.

    (a) Permanent Extension of Payment Methodology.--
            (1) In general.--Section 1886(d)(5)(G) of the Social 
        Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended--
                    (A) in clause (i), by striking ``and before October 
                1, 2013,''; and
                    (B) in clause (ii)(II), by striking ``and before 
                October 1, 2013,''.
            (2) Conforming amendments.--
                    (A) Target amount.--Section 1886(b)(3)(D) of the 
                Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is 
                amended--
                            (i) in the matter preceding clause (i), by 
                        striking ``and before October 1, 2013,''; and
                            (ii) in clause (iv), by striking ``through 
                        fiscal year 2013'' and inserting ``or a 
                        subsequent fiscal year''.
                    (B) Hospital value-based purchasing program.--
                Section 1886(o)(7)(D)(ii)(I) of the Social Security Act 
                (42 U.S.C. 1395ww(o)(7)(D)(ii)(I)) is amended by 
                striking ``(with respect to discharges occurring during 
                fiscal year 2012 and 2013)''.
                    (C) Hospital readmission reduction program.--
                Section 1886(q)(2)(B)(i) of the Social Security Act (42 
                U.S.C. 1395ww(q)(2)(B)(i)) is amended by striking 
                ``(with respect to discharges occurring during fiscal 
                years 2012 and 2013)''.
                    (D) Permitting hospitals to decline 
                reclassification.--Section 13501(e)(2) of the Omnibus 
                Budget Reconciliation Act of 1993 (42 U.S.C. 1395ww 
                note) is amended by striking ``fiscal year 1998, fiscal 
                year 1999, or fiscal year 2000 through fiscal year 
                2013'' and inserting ``or fiscal year 1998 or a 
                subsequent fiscal year''.
    (b) GAO Study and Report on Medicare-dependent Hospitals.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct a study on the following:
                    (A) The payor mix of medicare-dependent, small 
                rural hospitals (as defined in section 
                1886(d)(5)(G)(iv)), how such mix will trend in future 
                years, and whether or not the requirement under 
                subclause (IV) of such section should be revised.
                    (B) The characteristics of medicare-dependent, 
                small rural hospitals that meet the requirement of such 
                subclause (IV) through the application of paragraph 
                (a)(iii)(A) or (a)(iii)(B) of section 412.108 of the 
                Code of Federal Regulations, including Medicare 
                inpatient and outpatient utilization, payor mix, and 
                financial status, including Medicare and total margins, 
                and whether or not Medicare payments for such hospitals 
                should be revised.
                    (C) Such other items related to medicare-dependent, 
                small rural hospitals as the Comptroller General 
                determines appropriate.
            (2) Report.--Not later than 12 months after the date of the 
        enactment of this Act, the Comptroller General of the United 
        States shall submit to Congress a report on the study conducted 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller 
        General determines appropriate.
    (c) Implementation.--Notwithstanding any other provision of law, 
the Secretary of Health and Human Services may implement the provisions 
of, and the amendments made by, this section through program 
instruction or otherwise.

SEC. 205. REVISION OF MEDICARE INPATIENT HOSPITAL PAYMENT ADJUSTMENT 
              FOR LOW-VOLUME HOSPITALS.

    (a) In General.--Section 1886(d)(12) of the Social Security Act (42 
U.S.C. 1395ww(d)(12)) is amended--
            (1) in subparagraph (B)--
                    (A) in the subparagraph heading, by inserting ``for 
                fiscal years 2005 through 2010'' after ``increase''; 
                and
                    (B) in the matter preceding clause (i), by striking 
                ``and for discharges occurring in fiscal year 2014 and 
                subsequent years'';
            (2) in subparagraph (C)(i), by striking ``fiscal years 
        2011, 2012, and 2013'' and inserting ``fiscal year 2011 and 
        subsequent fiscal years'' each place it appears; and
            (3) in subparagraph (D)--
                    (A) in the heading, by striking ``Temporary 
                applicable percentage increase'' and inserting 
                ``Applicable percentage increase for fiscal year 2011 
                and subsequent fiscal years''; and
                    (B) by striking ``fiscal years 2011, 2012, and 
                2013'' and inserting ``fiscal year 2011 or a subsequent 
                fiscal year'';
    (b) Implementation.--Notwithstanding any other provision of law, 
the Secretary of Health and Human Services may implement the provisions 
of, and the amendments made by, this section through program 
instruction or otherwise.

SEC. 206. SPECIALIZED MEDICARE ADVANTAGE PLANS FOR SPECIAL NEEDS 
              INDIVIDUALS.

    (a) Extension.--Section 1859(f)(1) of the Social Security Act (42 
U.S.C. 1395w-28(f)(1)) is amended--
            (1) by striking ``enrollment.--In the case'' and inserting 
        ``enrollment.--
                    ``(A) In general.--Subject to subparagraphs (B) and 
                (C), in the case'';
            (2) in subparagraph (A), as added by paragraph (1), by 
        striking ``and for periods before January 1, 2015''; and
            (3) by adding at the end the following new subparagraphs:
                    ``(B) Application to dual snps.--Subparagraph (A) 
                shall only apply to a specialized MA plan for special 
                needs individuals described in subsection (b)(6)(B)(ii) 
                for periods before January 1, 2021.
                    ``(C) Application to severe or disabling chronic 
                condition snps.--Subparagraph (A) shall only apply to a 
                specialized MA plan for special needs individuals 
                described in subsection (b)(6)(B)(iii) for periods 
                before January 1, 2018.''.
    (b) Increased Integration of Dual SNPs.--
            (1) In general.--Section 1859(f) of the Social Security Act 
        (42 U.S.C. 1395w-28(f)) is amended--
                    (A) in paragraph (3), by adding at the end the 
                following new subparagraph:
                    ``(F) The plan meets the requirements applicable 
                under paragraph (8).''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(8) Increased integration of dual snps.--
                    ``(A) Designated contact.--The Secretary, acting 
                through the Federal Coordinated Health Care Office 
                (Medicare-Medicaid Coordination Office) established 
                under section 2602 of the Patient Protection and 
                Affordable Care Act (in this paragraph referred to as 
                the `MMCO'), shall serve as a dedicated point of 
                contact for States to address misalignments that arise 
                with the integration of specialized MA plans for 
                special needs individuals described in subsection 
                (b)(6)(B)(ii) under this paragraph. Consistent with 
                such role, the MMCO shall--
                            ``(i) establish a uniform process for 
                        disseminating to State Medicaid agencies 
                        information under this title impacting 
                        contracts between such agencies and such plans 
                        under this subsection; and
                            ``(ii) establish basic resources for States 
                        interested in exploring such plans as a 
                        platform for integration.
                    ``(B) Unified appeals process.--
                            ``(i) In general.--Not later than April 1, 
                        2015, the Secretary shall establish procedures 
                        unifying the appeals procedures under sections 
                        1852(g), 1902(a)(3), and 1902(a)(5) for items 
                        and services provided by specialized MA plans 
                        for special needs individuals described in 
                        subsection (b)(6)(B)(ii) under this title and 
                        title XIX. The Secretary shall solicit comment 
                        in developing such procedures from States, 
                        plans, beneficiary representatives, and other 
                        relevant stakeholders.
                            ``(ii) Procedures.--To the extent 
                        compatible with a unified process, the 
                        procedures established under clause (i) shall--
                                    ``(I) adopt the most protective 
                                provisions for the enrollee under 
                                current law, including continuation of 
                                benefits under title XIX pending appeal 
                                if an appeal is filed in a timely 
                                manner;
                                    ``(II) take into account 
                                differences in State plans under title 
                                XIX;
                                    ``(III) be easily navigable by an 
                                enrollee; and
                                    ``(IV) include the elements 
                                described in clause (iii).
                            ``(iii) Elements described.--The following 
                        elements are described in this clause:
                                    ``(I) Single notification of all 
                                applicable appeal rights under this 
                                title and title XIX.
                                    ``(II) Notices written in plain 
                                language and available in a language 
                                and format that is accessible to the 
                                enrollee.
                                    ``(III) Unified timeframes for 
                                internal and external appeals 
                                processes, such as an individual's 
                                filing of appeals, a plan's 
                                acknowledgment and resolution of 
                                appeals, and notification of appeals 
                                decisions.
                                    ``(IV) Mechanisms to allow the plan 
                                to track and resolve grievances.
                    ``(C) Requirement for unified appeals.--
                            ``(i) In general.--For 2016 and subsequent 
                        years, the contract of a specialized MA plan 
                        for special needs individuals described in 
                        subsection (b)(6)(B)(ii) with a State Medicaid 
                        agency under this subsection shall require the 
                        use of unified appeals procedures as described 
                        in subparagraph (B).
                            ``(ii) Consideration of application for 
                        other snps.--The Secretary shall consider 
                        applying the unified appeals process described 
                        in subparagraph (B) to specialized MA plans for 
                        special needs individuals described in 
                        subsection (b)(6)(B)(i) and subsection 
                        (b)(6)(B)(iii).
                    ``(D) Requirement for full integration for certain 
                dual snps.--
                            ``(i) Requirement.--Subject to the 
                        succeeding provisions of this subparagraph, for 
                        2018 and subsequent years, a specialized MA 
                        plan for special needs individuals described in 
                        subsection (b)(6)(B)(ii) shall--
                                    ``(I) integrate all benefits under 
                                this title and title XIX; and
                                    ``(II) meet the requirements of a 
                                fully integrated plan described in 
                                section 1853(a)(1)(B)(iv)(II) (other 
                                than the requirement that the plan have 
                                similar average levels of frailty, as 
                                determined by the Secretary, as the 
                                PACE program), including with respect 
                                to long-term care services or 
                                behavioral health services to the 
                                extent State law permits capitation of 
                                those services under such plan.
                            ``(ii) Initial sanctions for failure to 
                        meet requirement for 2018 or 2019.--For each of 
                        2018 and 2019, if the Secretary determines that 
                        a plan has failed to meet the requirement 
                        described in clause (i), the Secretary shall 
                        impose one of the following on the plan:
                                    ``(I) A reduction in payments under 
                                this part.
                                    ``(II) Closing enrollment in the 
                                plan.
                                    ``(III) Sanctioning the plan in 
                                accordance with section 1857(g).
                                    ``(IV) Other reasonable action 
                                (other than the sanction described in 
                                clause (iii)) the Secretary determines 
                                appropriate.
                            ``(iii) Sanctions for failure to meet 
                        requirement for 2020 and subsequent years.--For 
                        2020 and subsequent years, if the Secretary 
                        determines that a plan has failed to meet the 
                        requirement described in clause (i), the plan 
                        shall be deemed to no longer meet the 
                        definition of a specialized MA plan for special 
                        needs individuals described in subsection 
                        (b)(6)(B)(ii).
                            ``(iv) Limitation.--This subparagraph shall 
                        not apply to a specialized MA plan for special 
                        needs individuals described in subsection 
                        (b)(6)(B)(ii) that only enrolls individuals for 
                        whom the only medical assistance to which the 
                        individuals are entitled under the State plan 
                        is medicare cost sharing described in section 
                        1905(p)(3)(A)(ii).''.
            (2) Conforming amendment to responsibilities of federal 
        coordinated health care office (mmco).--Section 2602(d) of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 1315b(d)) 
        is amended by adding at the end the following new paragraph:
            ``(6) To act as a designated contact for States under 
        subsection (f)(8)(A) of section 1859 of the Social Security Act 
        (42 U.S.C. 1395w-28) with respect to the integration of 
        specialized MA plans for special needs individuals described in 
        subsection (b)(6)(B)(ii) of such section.''.
    (c) Improvements to Care Management Requirements for Severe or 
Disabling Chronic Condition SNPs.--Section 1859(f)(5) of the Social 
Security Act (42 U.S.C. 1395w-28(f)(5)) is amended--
            (1) by striking ``all snps.--The requirements'' and 
        inserting ``all snps.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                requirements'';
            (2) by redesignating subparagraphs (A) and (B) as clauses 
        (i) and (ii), respectively, and indenting appropriately;
            (3) in clause (ii), as redesignated by paragraph (2), by 
        redesignating clauses (i) through (iii) as subclauses (I) 
        through (III), respectively, and indenting appropriately; and
            (4) by adding at the end the following new subparagraph:
                    ``(B) Improvements to care management requirements 
                for severe or disabling chronic condition snps.--For 
                2016 and subsequent years, in the case of a specialized 
                MA plan for special needs individuals described in 
                subsection (b)(6)(B)(iii), the requirements described 
                in this paragraph include the following:
                            ``(i) The interdisciplinary team under 
                        subparagraph (A)(ii)(III) includes a team of 
                        providers with demonstrated expertise, 
                        including training in an applicable specialty, 
                        in treating individuals similar to the targeted 
                        population of the plan.
                            ``(ii) Requirements developed by the 
                        Secretary to provide face-to-face encounters 
                        with individuals enrolled in the plan.
                            ``(iii) As part of the model of care under 
                        clause (i) of subparagraph (A), the results of 
                        the initial assessment and annual reassessment 
                        under clause (ii)(I) of such subparagraph of 
                        each individual enrolled in the plan are 
                        addressed in the individual's individualized 
                        care plan under clause (ii)(II) of such 
                        subparagraph.
                            ``(iv) As part of the annual evaluation and 
                        approval of such model of care, the Secretary 
                        shall take into account whether the plan 
                        fulfilled the previous year's goals (as 
                        required under the model of care).
                            ``(v) The Secretary shall establish a 
                        minimum benchmark for each element of the model 
                        of care of a plan. The Secretary shall only 
                        approve a plan's model of care under this 
                        paragraph if each element of the model of care 
                        meets the minimum benchmark applicable under 
                        the preceding sentence.''.
    (d) GAO Study on Quality Improvement.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct a study on how the Secretary of Health and Human 
        Services could change the quality measurement system under the 
        Medicare Advantage program under part C of title XVIII of the 
        Social Security Act (42 U.S.C. 1395w-21 et seq.) to allow an 
        accurate comparison of the quality of care provided by 
        specialized MA plans for special needs individuals (as defined 
        in section 1859(b)(6) of such Act (42 U.S.C. 1395w-28(b)(6)), 
        both for individual plans and such plans overall, compared to 
        the quality of care delivered by the original Medicare fee-for-
        service program under parts A and B of such title and other 
        Medicare Advantage plans under such part C across similar 
        populations.
            (2) Report.--Not later than July 1, 2016, the Comptroller 
        General shall submit to Congress a report containing the 
        results of the study under paragraph (1), together with 
        recommendations for such legislation and administrative action 
        as the Comptroller General determines appropriate.
    (e) Changes to Quality Ratings and Measurement of SNPs.--Section 
1853(o) of the Social Security Act (42 U.S.C. 1395w-23(o)) is amended 
by adding at the end the following new paragraph:
            ``(6) Changes to quality ratings of snps.--
                    ``(A) Emphasis on improvement across snps.--Subject 
                to subparagraph (B), beginning in plan year 2016, in 
                the case of a specialized MA plan for special needs 
                individuals, the Secretary shall increase the emphasis 
                on the plan's improvement or decline in performance 
                when determining the star rating of the plan under this 
                subsection for the year as follows:
                            ``(i) At least 25 percent, but not more 
                        than 33 percent, of the total star rating of 
                        the plan shall be based on improvement or 
                        decline in performance.
                            ``(ii) Improvement or decline in 
                        performance under this subparagraph shall be 
                        measured based on net change in the individual 
                        star rating measures of the plan, with 
                        appropriate weight given to specific individual 
                        star ratings measures, such as readmission 
                        rates, as determined by the Secretary.
                            ``(iii) The Secretary shall make an 
                        appropriate adjustment to the improvement 
                        rating of a plan under this subparagraph if the 
                        plan has achieved a 5-star rating or the 
                        highest rating possible overall or for an 
                        individual measure in order to ensure that the 
                        plan is not punished in cases where it is not 
                        possible to improve.
                    ``(B) No application to certain plans.--
                Subparagraph (A) shall not apply, with respect to a 
                year, to a specialized MA plan for special needs 
                individuals that has a rating that does not exceed two-
                and-one-half stars.
                    ``(C) Quality measurement at the plan level.--
                            ``(i) In general.--The Secretary may 
                        require reporting for and apply under this 
                        subsection quality measures at the plan level 
                        for specialized MA plan for special needs 
                        individuals instead of at the contract level.
                            ``(ii) Consideration.--The Secretary shall 
                        take into consideration the minimum number of 
                        enrollees in a specialized MA plan for special 
                        needs individuals in order to determine if a 
                        valid measurement of quality at the plan level 
                        is possible under clause (i).
                            ``(iii) Application.--If the Secretary 
                        applies quality measurement at the plan level 
                        under this subparagraph--
                                    ``(I) such quality measurement 
                                shall include Medicare Health Outcomes 
                                Survey (HOS), Healthcare Effectiveness 
                                Data and Information Set (HEDIS), and 
                                Consumer Assessment of Healthcare 
                                Providers and Systems (CAHPS) measures; 
                                and
                                    ``(II) payment and other 
                                administrative actions linked to 
                                quality measurement (including the 5-
                                star rating system under this 
                                subsection) shall be applied at the 
                                plan level in accordance with this 
                                subparagraph.''.

SEC. 207. REASONABLE COST REIMBURSEMENT CONTRACTS.

    (a) One-year Transition and Notice Regarding Transition.--Section 
1876(h)(5)(C) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)) is 
amended--
            (1) in clause (ii), in the matter preceding subclause (I), 
        by striking ``For any'' and inserting ``Subject to clause (iv), 
        for any''; and
            (2) by adding at the end the following new clauses:
    ``(iv) 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)--
            ``(I) notwithstanding such clause, such contract may be 
        extended or renewed for one last reasonable cost reimbursement 
        contract year;
            ``(II) the organization may not enroll any new enrollees 
        under such contract during such last reasonable cost 
        reimbursement contract year; and
            ``(III) on a date determined by the Secretary prior to the 
        beginning of such last reasonable cost reimbursement contract 
        year, the organization shall provide notice to the Secretary as 
        to whether or not the organization will apply to have the 
        contract converted over and offered as a Medicare Advantage 
        plan under part C for the year following such last reasonable 
        cost reimbursement contract year.
    ``(v) 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--
            ``(I) the deemed enrollment under section 1851(c)(4) shall 
        apply; and
            ``(II) the special rule for quality increases under 
        1853(o)(3)(A)(iv) shall apply.''.
    (b) Deemed Enrollment From Reasonable Cost Reimbursement Contracts 
Converted to Medicare Advantage Plans.--
            (1) In general.--Section 1851(c) of the Social Security Act 
        (42 U.S.C. 1395w-21(c)) is amended--
                    (A) in paragraph (1), by striking ``Such 
                elections'' and inserting ``Subject to paragraph (4), 
                such elections''; and
                    (B) by adding at the end the following:
            ``(4) Deemed enrollment relating to converted reasonable 
        cost reimbursement contracts.--
                    ``(A) In general.--On the first day of the annual, 
                coordinated election period under subsection (e)(3) for 
                plan years beginning on or after January 1, 2016, an MA 
                eligible individual described in clause (i) or (ii) of 
                subparagraph (B) is deemed to 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--
                            ``(i) the individual is enrolled in a 
                        reasonable cost reimbursement contract under 
                        section 1876(h) in the previous plan year;
                            ``(ii) such reasonable cost reimbursement 
                        contract was extended or renewed for one last 
                        reasonable cost reimbursement contract year 
                        pursuant to section 1876(h)(5)(C)(iv);
                            ``(iii) 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;
                            ``(iv) the applicable MA plan--
                                    ``(I) is the plan that was 
                                converted from the reasonable cost 
                                reimbursement contract described in 
                                clause (iii);
                                    ``(II) is offered by the same 
                                entity (or an organization affiliated 
                                with such entity) that entered into 
                                such contract; and
                                    ``(III) is offered in the service 
                                area where the individual resides;
                            ``(v) the amount of the MA monthly basic 
                        beneficiary premium for such applicable MA plan 
                        with respect to the plan year does not exceed 
                        monthly premiums under such reasonable cost 
                        reimbursement contract for the previous plan 
                        year by more than 10 percent;
                            ``(vi) the applicable MA plan provides 
                        benefits, premiums, and access to providers 
                        that are comparable to the benefits, premiums, 
                        and access to providers under such reasonable 
                        cost reimbursement contract for the previous 
                        plan year; and
                            ``(vii) the applicable MA plan--
                                    ``(I) allows enrollees 
                                transitioning from the converted 
                                reasonable cost contract to such plan 
                                to maintain current providers and 
                                course of treatment at the time of 
                                enrollment for at least 90 days after 
                                enrollment; and
                                    ``(II) during such period, pays 
                                non-contracting providers for items and 
                                services furnished to the enrollee an 
                                amount that is not less than the amount 
                                of payment applicable for those items 
                                and services under the original 
                                medicare fee-for-service program under 
                                parts A and B.
                    ``(B) MA eligible individuals described.--
                            ``(i) Without prescription drug coverage.--
                        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 does not, for such previous plan year, 
                        receive any prescription drug coverage under 
                        part D, including coverage under section 1860D-
                        22.
                            ``(ii) With prescription drug coverage.--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, receives 
                        prescription drug coverage under part D--
                                    ``(I) through such contract; or
                                    ``(II) 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.
                    ``(C) Applicable ma plan defined.--In this 
                paragraph, the term `applicable MA plan' means, in the 
                case of an individual described in--
                            ``(i) subparagraph (B)(i), an MA plan that 
                        is not an MA-PD plan; and
                            ``(ii) subparagraph (B)(ii), an MA-PD plan.
                    ``(D) Identification of deemed individuals.--Not 
                later than 30 days before the first day of the annual, 
                coordinated election period under subsection (e)(3) for 
                plan years beginning on or after January 1, 2016, the 
                Secretary shall identify the individuals who will be 
                subject to deemed elections under subparagraph (A) on 
                the first day of such period.''.
            (2) Beneficiary option to discontinue or change ma plan or 
        ma-pd plan after deemed enrollment.--
                    (A) In general.--Section 1851(e)(2) of the Social 
                Security Act (42 U.S.C. 1395w-21(e)(4)) is amended by 
                adding at the end the following:
                    ``(F) Special period for certain deemed 
                elections.--
                            ``(i) In general.--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).
                            ``(ii) Limitation of one change.--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).''.
                    (B) Conforming amendments.--
                            (i) Plan requirement for open enrollment.--
                        Section 1851(e)(6)(A) of the Social Security 
                        Act (42 U.S.C. 1395w-21(e)(6)(A)) is amended by 
                        striking ``paragraph (1),'' and inserting 
                        ``paragraph (1), during the period described in 
                        paragraph (2)(F),''.
                            (ii) Part d.--Section 1860D-1(b)(1)(B) of 
                        such Act (42 U.S.C. 1395w-101(b)(1)(B)) is 
                        amended--
                                    (I) in clause (ii), by adding ``and 
                                paragraph (4)'' after ``paragraph 
                                (3)(A)''; and
                                    (II) in clause (iii) by striking 
                                ``and (E)'' and inserting ``(E), and 
                                (F)''.
            (3) Treatment of esrd for deemed enrollment.--Section 
        1851(a)(3)(B) of the Social Security Act (42 U.S.C. 1395w-
        21(a)(3)(B)) is amended by adding at the end the following 
        flush sentence:
                ``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).''.
    (c) Information Requirements.--Section 1851(d)(2)(B) of the Social 
Security Act (42 U.S.C. 1395w-21(d)(2)(B)) is amended--
            (1) by striking the subparagraph heading and inserting the 
        following: ``(i) notification to newly eligible medicare 
        advantage eligible individuals.--''; and
            (2) by adding at the end the following:
                    ``(ii) Notification related to certain deemed 
                elections.--The Secretary shall, not later than 15 days 
                prior to the first day of the annual, coordinated 
                election period under subsection (e)(3) of a year, mail 
                to any individual identified by the Secretary under 
                subsection (c)(4)(D) for such year--
                            ``(I) a notification that such individual 
                        will, on such day, be deemed to have made an 
                        election 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;
                            ``(II) the information described in 
                        subparagraph (A);
                            ``(III) 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; and
                            ``(IV) information about the special period 
                        for elections under subsection (e)(2)(F).''.
    (d) Treatment of Transition Plan for Quality Rating for Payment 
Purposes.--Section 1853(o)(3)(A) of the Social Security Act (42 U.S.C. 
1395w-23(o)(3)(A)) is amended by adding at the end the following new 
clause:
                            ``(iv) Special rule for first 2 plan years 
                        for plans that were converted from a reasonable 
                        cost reimbursement contract.--In applying 
                        paragraph (1) for the first 2 plan years under 
                        this part in the case of a plan that is a new 
                        MA plan (as defined in clause (iii)(II)) to 
                        which deemed enrollment applies under section 
                        1851(e)(4), the Secretary shall use the star 
                        rating that applied to the converted reasonable 
                        cost reimbursement contract for the year 
                        preceding the first plan year for such plan 
                        under this part.''.

SEC. 208. QUALITY MEASURE ENDORSEMENT AND SELECTION.

    (a) Contract With an Entity Regarding Input on the Selection of 
Measures.--
            (1) In general.--Title XVIII of the Social Security Act (42 
        U.S.C. 1395 et seq.) is amended--
                    (A) by redesignating section 1890A as section 
                1890B; and
                    (B) by inserting after section 1890 the following 
                new section:

 ``contract with an entity regarding input on the selection of measures

    ``Sec. 1890A  (a) Contract.--
            ``(1) In general.--For purposes of activities conducted 
        under this Act, the Secretary shall identify and have in effect 
        a contract with an entity that meets the requirements described 
        in subsection (c). Such contract shall provide that the entity 
        will perform the duties described in subsection (b).
            ``(2) Timing for first contract.--The first contract under 
        paragraph (1) shall begin on October 1, 2014.
            ``(3) Period of contract.--A contract under paragraph (1) 
        shall be for a period of 3 years (except as may be renewed 
        after a subsequent bidding process).
            ``(4) Competitive procedures.--Competitive procedures (as 
        defined in section 4(5) of the Office of Federal Procurement 
        Policy Act (41 U.S.C. 403(5))) shall be used to enter into a 
        contract under paragraph (1).
    ``(b) Duties.--The duties described in this subsection are the 
following:
    ``(c) Requirements Described.--The requirements described in this 
subsection are the following:
            ``(1) Private nonprofit, board membership, membership fees, 
        and not a measure developer.--The requirements described in 
        paragraphs (1), (2), (7), and (8) of section 1890(c).
            ``(2) Experience.--The entity has at least 4 years of 
        experience working with quality and efficiency measures.''.
            (2) Duties of entity.--
                    (A) Transfer of priority setting process.--
                Paragraph (1) of section 1890(b) of the Social Security 
                Act (42 U.S.C. 1395aaa(b)) is redesignated as paragraph 
                (1) of section 1890A(b) of such Act, as added by 
                paragraph (1).
                    (B) Transfer of multi-stakeholder process.--
                Paragraphs (7) and (8) of such section 1890(b) are 
                redesignated as paragraphs (2) and (3), respectively, 
                of section 1890A(b) of such Act, as added by paragraph 
                (1) and amended by subparagraph (A).
                    (C) Additional duties.--Section 1890A(b) of such 
                Act, as added by paragraph (1) and amended by 
                subparagraphs (A) and (B), is amended by adding at the 
                end the following new paragraphs:
            ``(4) Facilitation to better coordinate and align public 
        and private sector use of quality measures.--
                    ``(A) In general.--The entity shall facilitate 
                increased coordination and alignment between the public 
                and private sector with respect to quality and 
                efficiency measures.
                    ``(B) Reports.--The entity shall prepare and make 
                available to the public annual reports on its findings 
                under this paragraph. Such public availability shall 
                include posting each report on the Internet website of 
                the entity.
            ``(5) Gap analysis.--The entity shall conduct an ongoing 
        analysis of--
                    ``(A) gaps in endorsed quality and efficiency 
                measures, which shall include measures that are within 
                priority areas identified by the Secretary under the 
                national strategy established under section 399HH of 
                the Public Health Service Act; and
                    ``(B) areas where quality measures are unavailable 
                or inadequate to identify or address such gaps.
            ``(6) Annual report to congress and the secretary; 
        secretarial publication and comment.--
                    ``(A) Annual report.--By not later than March 1 of 
                each year, the entity shall submit to Congress and the 
                Secretary a report containing--
                            ``(i) a description of--
                                    ``(I) the recommendations made 
                                under paragraph (1);
                                    ``(II) the matters described in 
                                clauses (i) and (ii) of paragraph 
                                (2)(A);
                                    ``(III) the results of the analysis 
                                under paragraph (5); and
                                    ``(IV) the performance by the 
                                entity of the duties required under the 
                                contract entered into with the 
                                Secretary under subsection (a); and
                            ``(ii) any other items determined 
                        appropriate by the Secretary.
                    ``(B) Secretarial review and publication of annual 
                report.--Not later than 6 months after receiving a 
                report under subparagraph (A) for a year, the Secretary 
                shall--
                            ``(i) review such report; and
                            ``(ii) publish such report in the Federal 
                        Register, together with any comments of the 
                        Secretary on such report.''.
                    (D) Additional amendments.--Section 1890A(b) of 
                such Act, as so added and amended, is amended--
                            (i) in paragraph (2)--
                                    (I) in the heading of subparagraph 
                                (B) by inserting ``and efficiency'' 
                                after ``Quality'';
                                    (II) in subparagraph (B)(i)(III), 
                                by striking ``this Act'' and inserting 
                                ``this title''; and
                                    (III) by adding at the end the 
                                following new subparagraphs:
                    ``(E) Input.--In providing the input described in 
                subparagraph (A), the multi-stakeholder groups--
                            ``(i) shall include a detailed description 
                        of the rationale for each recommendation made 
                        by the multi-stakeholder group, including in 
                        areas relating to--
                                    ``(I) the expected impact that 
                                implementing the measure will have on 
                                individuals;
                                    ``(II) the burden on providers of 
                                services and suppliers;
                                    ``(III) the expected influence over 
                                the behavior of providers of services 
                                and suppliers;
                                    ``(IV) the applicability of a 
                                measure for more than one setting or 
                                program; and
                                    ``(V) other areas determined in 
                                consultation with the Secretary; and
                            ``(ii) may consider whether it is 
                        appropriate to provide separate recommendations 
                        with respect to measures for internal use, 
                        public reporting, and payment provisions.
                    ``(F) Equal representation.--In convening multi-
                stakeholder groups pursuant to this paragraph, the 
                entity shall, to the extent feasible, make every effort 
                to ensure such groups are balanced across 
                stakeholders.''; and
                            (ii) in paragraph (3), by striking ``Not 
                        later'' and all that follows through the period 
                        at the end and inserting the following: ``Not 
                        later than the applicable dates described in 
                        section 1890B(a)(3) of each year (or, as 
                        applicable, the timeframe described in section 
                        1890A(a)(4)), the entity shall transmit to the 
                        Secretary the input of the multi-stakeholder 
                        group under paragraph (2).''.
    (b) Revisions to Contract With Consensus-based Entity.--
            (1) Contract.--Section 1890(a) of the Social Security Act 
        (42 U.S.C. 1395aaa(a)) is amended--
                    (A) in paragraph (1), by striking ``, such as the 
                National Quality Forum,''; and
                    (B) in paragraph (3), by striking ``4 years'' and 
                inserting ``3 years''.
            (2) Duties.--Section 1890(b) of the Social Security Act (42 
        U.S.C. 1395aaa(b)), as amended by subsection (a)(2), is 
        amended--
                    (A) by redesignating paragraphs (2) and (3) as 
                paragraphs (1) and (2), respectively;
                    (B) in paragraph (2), as redesignated by 
                subparagraph (A), by striking ``paragraph (2)'' and 
                inserting ``paragraph (1)'';
                    (C) by striking paragraphs (5) and (6); and
                    (D) by adding at the end the following new 
                paragraphs:
            ``(3) Facilitation to better coordinate and align public 
        and private sector use of quality measures.--
                    ``(A) In general.--The entity shall facilitate 
                increased coordination and alignment between the public 
                and private sector with respect to quality and 
                efficiency measures.
                    ``(B) Reports.--The entity shall prepare and make 
                available to the public annual reports on its findings 
                under this paragraph. Such public availability shall 
                include posting each report on the Internet website of 
                the entity.
            ``(4) Annual report to congress and the secretary; 
        secretarial publication and comment.--
                    ``(A) Annual report.--By not later than March 1 of 
                each year, the entity shall submit to Congress and the 
                Secretary a report containing--
                            ``(i) a description of--
                                    ``(I) the coordination of quality 
                                initiatives under this Act with quality 
                                initiatives implemented by other 
                                payers;
                                    ``(II) areas in which evidence is 
                                insufficient to support endorsement of 
                                quality measures in priority areas 
                                identified by the Secretary under the 
                                national strategy established under 
                                section 399HH of the Public Health 
                                Service Act and where targeted research 
                                may address such gaps; and
                                    ``(III) the performance by the 
                                entity of the duties required under the 
                                contract entered into with the 
                                Secretary under subsection (a); and
                            ``(ii) any other items determined 
                        appropriate by the Secretary.
                    ``(B) Secretarial review and publication of annual 
                report.--Not later than 6 months after receiving a 
                report under subparagraph (A) for a year, the Secretary 
                shall--
                            ``(i) review such report; and
                            ``(ii) publish such report in the Federal 
                        Register, together with any comments of the 
                        Secretary on such report.''.
            (3) Requirements.--Section 1890(c) of the Social Security 
        Act (42 U.S.C. 1395aaa(c)) is amended by adding at the end the 
        following new paragraph:
            ``(8) Not a measure developer.--The entity is not a measure 
        developer.''.
    (c) Revisions to Duties of the Secretary Regarding Use of 
Measures.--
            (1) In general.--Section 1890B(a) of the Social Security 
        Act (42 U.S.C. 1395aaa-1(a)), as redesignated by subsection 
        (a)(1)(A), is amended--
                    (A) by striking ``section 1890(b)(7)(B)'' each 
                place it appears and inserting ``section 
                1890A(b)(2)(B)'';
                    (B) in paragraph (1)--
                            (i) by striking ``section 1890(b)(7)'' and 
                        inserting ``section 1890A(b)(2)''; and
                            (ii) by striking ``section 1890'' and 
                        inserting ``section 1890A'';
                    (C) by striking paragraphs (2) and (3) and 
                inserting the following:
            ``(2) Public availability of measures considered for 
        selection.--Subject to paragraph (4), not later than October 1 
        or December 31 of each year, the Secretary shall make available 
        to the public a list of quality and efficiency measures 
        described in section 1890A(b)(2)(B) that the Secretary is 
        considering under this title. The Secretary shall provide for 
        an appropriate balance of the number of measures to be made 
        available by each such date in a year.
            ``(3) Transmission of multi-stakeholder input.--
                    ``(A) In general.--Subject to paragraph (4), not 
                later than the applicable date described in 
                subparagraph (B) of each year, the entity with a 
                contract under section 1890A shall, pursuant to 
                subsection (b)(3) of such section, transmit to the 
                Secretary the input of multi-stakeholder groups 
                described in paragraph (1).
                    ``(B) Applicable date described.--The applicable 
                date described in this subparagraph for a year is--
                            ``(i) February 1 with respect to quality 
                        and efficiency measures made available under 
                        paragraph (2) by October 1 of the preceding 
                        year; and
                            ``(ii) April 1 with respect to quality and 
                        efficiency measures made available under 
                        paragraph (2) by December 31 of the preceding 
                        year.'';
                    (D) by redesignating--
                            (i) paragraph (6) as paragraph (8); and
                            (ii) paragraphs (4) and (5) as paragraphs 
                        (5) and (6), respectively;
                    (E) by inserting after paragraph (3) the following 
                new paragraph:
            ``(4) Limited process for additional multi-stakeholder 
        input.--In addition to the Secretary making measures publically 
        available pursuant to the dates described in paragraph (2) and 
        multi-stakeholder groups transmitting the input pursuant to the 
        applicable dates described in paragraph (3)--
                    ``(A) the Secretary may, at times that do not meet 
                the time requirements described in paragraph (2), make 
                available to the public a limited number of quality and 
                efficiency measures described in section 1890A(b)(2) 
                that the Secretary is considering under this title; and
                    ``(B) if the Secretary uses the authority under 
                subparagraph (A), the entity with a contract under 
                section 1890A shall, pursuant to section 1890A(b)(3), 
                transmit to the Secretary on a timely basis the input 
                from a multi-stakeholder group described in paragraph 
                (1) with respect to such measures.'';
                    (F) in paragraph (6), as redesignated by 
                subparagraph (D)(ii), by inserting ``or that has not 
                been recommended by the multi-stakeholder group under 
                section 1890A(b)(2)'' before the period at the end; and
                    (G) by inserting after paragraph (6) the following 
                new paragraph:
            ``(7) Concordance rates.--For each year (beginning with 
        2015), the Secretary shall include a list of concordance rates 
        for each type of provider of services and supplier in the 
        annual final rule applicable to such type of provider or 
        supplier.''.
            (2) Review.--Section 1890B(c) of the Social Security Act 
        (42 U.S.C. 1395aaa-1(c)), as redesignated by subsection 
        (a)(1)(A), is amended--
                    (A) in paragraph (1)(A), by striking ``section 
                1890(b)(7)(B)'' and inserting ``section 
                1890A(b)(2)(B)''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (A), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (B), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(C) take into consideration the benefits of the 
                alignment of measures between the public and private 
                sector.''.
    (d) Funding for Quality Measure Endorsement and Selection.--
            (1) Fiscal year 2014.--In addition to amounts transferred 
        under section 3014(c) of the Patient Protection and Affordable 
        Care Act (Public Law 111-148), for purposes of carrying out 
        section 1890 and section 1890A (other than subsections (e) and 
        (f)), the Secretary shall provide for the transfer, from the 
        Federal Hospital Insurance Trust Fund under section 1817 and 
        the Federal Supplementary Medical Insurance Trust Fund under 
        section 1841, in such proportion as the Secretary determines 
        appropriate, to the Centers for Medicare & Medicaid Services 
        Program Management Account of $7,000,000 for fiscal year 2014. 
        Amounts transferred under the preceding sentence shall remain 
        available until expended.
            (2) Fiscal years 2015 through 2017.--Section 1890B of the 
        Social Security Act (42 U.S.C. 1395aaa-1), as redesignated by 
        subsection (a)(1)(A), is amended by adding at the end the 
        following new subsection:
    ``(g) Funding.--
            ``(1) In general.--For purposes of carrying out this 
        section (other than subsections (e) and (f)) and sections 1890 
        and 1890A, the Secretary shall provide for the transfer, from 
        the Federal Hospital Insurance Trust Fund under section 1817 
        and the Federal Supplementary Medical Insurance Trust Fund 
        under section 1841, in such proportion as the Secretary 
        determines appropriate, to the Centers for Medicare & Medicaid 
        Services Program Management Account of $25,000,000 for each of 
        fiscal years 2015 through 2017.
            ``(2) Availability.--Amounts transferred under paragraph 
        (1) shall remain available until expended.''.
            (3) Conforming amendment.--Subsection (d) of section 1890 
        of the Social Security Act (42 U.S.C. 1395aaa) is repealed.
    (e) Conforming Amendments.--(1) Section 1848(m)(3)(E)(iii) of the 
Social Security Act (42 U.S.C. 1395w-4(m)(3)(E)(iii)) is amended by 
striking ``section 1890(b)(7) and 1890A(a)'' and inserting ``section 
1890A(b)(2) and 1890B(a)''.
    (2) Section 1866D(b)(2)(C) of the Social Security Act (42 U.S.C. 
1395cc-4(b)(2)(C)) is amended by striking ``section 1890 and 1890A'' 
and inserting ``sections 1890, 1890A, and 1890B''.
    (3) Section 1899A(n)(2)(A) of the Social Security Act (42 U.S.C. 
1395cc-4(n)(2)(A)) is amended by striking ``section 1890(b)(7)(B)'' and 
inserting ``section 1890A(b)(2)(B)''.
    (f) Effective Date.--
            (1) In general.--The amendments made by this section shall 
        take effect on October 1, 2014, and shall apply with respect to 
        contract periods under sections 1890 and 1890A of the Social 
        Security Act that begin on or after such date.
            (2) New contracts beginning with fiscal year 2015.--The 
        Secretary of Health and Human Services shall enter into a new 
        contract under both sections 1890 and 1890A of the Social 
        Security Act, as amended by this Act, for a contract period 
        beginning on October 1, 2014.

SEC. 209. PERMANENT EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR 
              LOW-INCOME PROGRAMS.

    (a) Additional Funding for State Health Insurance Programs.--
Subsection (a)(1)(B)(iii) of section 119 of the Medicare Improvements 
for Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note), as 
amended by section 3306 of the Patient Protection and Affordable Care 
Act (Public Law 111-148) and section 610 of the American Taxpayer 
Relief Act of 2012 (Public Law 112-240), is amended by inserting ``and 
for each subsequent fiscal year'' after ``fiscal year 2013''.
    (b) Additional Funding for Area Agencies on Aging.--Subsection 
(b)(1)(B) of such section 119, as so amended, is amended by inserting 
``and for each subsequent fiscal year'' after ``fiscal year 2013''.
    (c) Additional Funding for Aging and Disability Resource Centers.--
Subsection (c)(1)(B) of such section 119, as so amended, is amended by 
inserting ``and for each subsequent fiscal year'' after ``fiscal year 
2013''.
    (d) Additional Funding for Contract With the National Center for 
Benefits and Outreach Enrollment.--Subsection (d)(2) of such section 
119, as so amended, is amended by inserting ``and for each subsequent 
fiscal year'' after ``fiscal year 2013''.

               Subtitle B--Medicaid and Other Extensions

SEC. 211. QUALIFYING INDIVIDUAL PROGRAM.

    (a) Extension.--Section 1902(a)(10)(E)(iv) of the Social Security 
Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by striking ``December 
2013'' and inserting ``December 2018''.
    (b) Eliminating Limitations on Eligibility.--Section 1933 of the 
Social Security Act (42 U.S.C. 1396u-3) is amended by striking 
subsections (b) and (e).
    (c) Eliminating Allocations.--Section 1933 of the Social Security 
Act (42 U.S.C. 1396u-3) is amended by striking subsections (c) and (g). 

    (d) Conforming Amendments.--
            (1) In general.--Section 1933 of the Social Security Act 
        (42 U.S.C. 1396u-3), as amended by subsections (b) and (c), is 
        further amended--
                    (A) by striking subsection (a) and inserting the 
                following new subsection:
    ``(a) Applicable FMAP.--With respect to assistance described in 
section 1902(a)(10)(E)(iv) furnished in a State, the Federal medical 
assistance percentage shall be equal to 100 percent.'';
                    (B) by striking subsection (d); and
                    (C) by redesignating subsection (f) as subsection 
                (b).
            (2) Definition of fmap.--Section 1905(b) of the Social 
        Security Act (42 U.S.C. 1396d(b)) is amended by striking 
        ``section 1933(d)'' and inserting ``section 1933(a)''.
    (e) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2014, and shall apply with respect to calendar 
quarters beginning on or after such date.

SEC. 212. TRANSITIONAL MEDICAL ASSISTANCE.

    (a) Extension.--Sections 1902(e)(1)(B) and 1925(f) of the Social 
Security Act (42 U.S.C. 1396a(e)(1)(B), 1396r-6(f)) are each amended by 
striking ``December 31, 2013'' and inserting ``December 31, 2018''.
    (b) Opt-out Option for States That Expand Adult Coverage and 
Provide 12-month Continuous Eligibility Under Medicaid and CHIP.--
            (1) In general.--Section 1925 of the Social Security Act 
        (42 U.S.C. 1396r-6), as amended by subsection (a), is further 
        amended--
                    (A) in subsection (a)--
                            (i) in paragraph (1)(A), by striking 
                        ``paragraph (5)'' and inserting ``paragraphs 
                        (5) and (6)''; and
                            (ii) by adding at the end the following:
            ``(6) Opt-out option for states that expand adult coverage 
        and provide 12-month continuous eligibility under medicaid and 
        chip.--
                    ``(A) In general.--In the case of a State described 
                in subparagraph (B), the State may elect through a 
                State plan amendment to have this section and sections 
                408(a)(11)(A), 1902(a)(52), 1902(e)(1), and 1931(c)(2) 
                not apply to the State.
                    ``(B) State described.--A State is described in 
                this subparagraph if the State is one of the 50 States 
                or the District of Columbia and--
                            ``(i) has elected to provide medical 
                        assistance to individuals under subclause 
                        (VIII) of section 1902(a)(10)(A)(i);
                            ``(ii) has elected under section 
                        1902(e)(12)(A) the option to provide continuous 
                        eligibility for a 12-month period for 
                        individuals under 19 years of age;
                            ``(iii) has elected under section 
                        1902(e)(12)(B) the option to provide continuous 
                        eligibility for a 12-month period for all 
                        categories of individuals described in that 
                        section; and
                            ``(iv) has elected to apply section 
                        1902(e)(12)(A) to the State child health plan 
                        under title XXI.''; and
                    (B) in subsection (b)(1), by striking ``subsection 
                (a)(5)'' and inserting ``paragraphs (5) and (6) of 
                subsection (a)''.
            (2) Conforming amendment to 4-month requirement.--Section 
        1902(e)(1) of the Social Security Act (42 U.S.C. 1396a(e)(1)), 
        as amended by subsection (a), is further amended--
                    (A) in subparagraph (B), by striking ``Subparagraph 
                (A)'' and inserting ``Subject to subparagraph (C), 
                subparagraph (A)''; and
                    (B) by adding at the end the following:
    ``(C) If a State has made an election under section 1925(a)(6), 
subparagraph (A) and section 1925 shall not apply to the State.''.
    (c) Extension of 12-month Continuous Eligibility Option to Certain 
Adult Enrollees Under Medicaid; Clarification of Application to CHIP.--
            (1) In general.--Section 1902(e)(12) of the Social Security 
        Act (42 U.S.C. 1396a(e)(12)) is amended--
                    (A) by redesignating subparagraphs (A) and (B) as 
                clauses (i) and (ii), respectively;
                    (B) by inserting ``(A)'' after ``(12)''; and
                    (C) by adding at the end the following:
    ``(B) At the option of the State, the plan may provide that an 
individual who is determined to be eligible for benefits under a State 
plan approved under this title under any of the following eligibility 
categories, or who is redetermined to be eligible for such benefits 
under any of such categories, shall be considered to meet the 
eligibility requirements met on the date of application and shall 
remain eligible for those benefits until the end of the 12-month period 
following the date of the determination or redetermination of 
eligibility:
            ``(i) Section 1902(a)(10)(A)(i)(VIII).
            ``(ii) Section 1931.''.
            (2) Application to chip.--Section 2107(e)(1) of the Social 
        Security Act (42 U.S.C. 1397gg(e)(1)) is amended--
                    (A) by redesignating subparagraphs (E) through (O) 
                as subparagraphs (F) through (P), respectively; and
                    (B) by inserting after subparagraph (D), the 
                following:
                    ``(E) Section 1902(e)(12)(A) (relating to the State 
                option for 12-month continuous eligibility and 
                enrollment).''.
    (d) Conforming and Technical Amendments Relating to Section 1931 
Transitional Coverage Requirements.--
            (1) In general.--Section 1931(c) of the Social Security Act 
        (42 U.S.C. 1396u-1(c)) is amended--
                    (A) in paragraph (1)--
                            (i) in the paragraph heading, by striking 
                        ``child'' and inserting ``spousal'';
                            (ii) by striking ``The provisions'' and 
                        inserting ``Subject to paragraph (3), the 
                        provisions''; and
                            (iii) by striking ``child or'';
                    (B) in paragraph (2), by striking ``For continued'' 
                and inserting ``Subject to paragraph (3), for 
                continued''; and
                    (C) by adding at the end the following:
            ``(3) Opt-out option for states that expand adult coverage 
        and provide 12-month continuous eligibility under medicaid and 
        chip.--
                    ``(A) In general.--In the case of a State described 
                in subparagraph (B), the State may elect through a 
                State plan amendment to have paragraphs (1) and (2) of 
                this subsection and sections 408(a)(11), 1902(a)(52), 
                1902(e)(1), and 1925 not apply to the State.
                    ``(B) State described.--A State is described in 
                this subparagraph if the State is one of the 50 States 
                or the District of Columbia and--
                            ``(i) has elected to provide medical 
                        assistance to individuals under subclause 
                        (VIII) of section 1902(a)(10)(A)(i);
                            ``(ii) has elected under section 
                        1902(e)(12)(A) the option to provide continuous 
                        eligibility for a 12-month period for 
                        individuals under 19 years of age;
                            ``(iii) has elected under section 
                        1902(e)(12)(B) the option to provide continuous 
                        eligibility for a 12-month period for all 
                        categories of individuals described in that 
                        section; and
                            ``(iv) has elected to apply section 
                        1902(e)(12)(A) to the State child health plan 
                        under title XXI.''.
            (2) Conforming amendment to section 408.--Section 
        408(a)(11) of the Social Security Act (42 U.S.C. 608(a)(11) is 
        amended--
                    (A) in the paragraph heading, by striking ``child'' 
                and inserting ``spousal''; and
                    (B) in subparagraph (B)--
                            (i) in the subparagraph heading, by 
                        striking ``Child'' and inserting ``Spousal''; 
                        and
                            (ii) by striking ``child or''.
    (e) Conforming Amendment Relating to Maintenance of Effort for 
Children.--Section 1902(gg)(4) of the Social Security Act (42 U.S.C. 
1396a(gg)(4)) is amended by adding at the end the following:
                    ``(C) States that expand adult coverage and elect 
                to opt-out of transitional coverage.--
                            ``(i) In general.--For purposes of 
                        determining compliance with the requirements of 
                        paragraph (2), a State which exercises the 
                        option under sections 1925(a)(6) and 1931(c)(3) 
                        to provide no transitional medical assistance 
                        or other extended eligibility (as applicable) 
                        shall not, as a result of exercising such 
                        option, be considered to have in effect 
                        eligibility standards, methodologies, or 
                        procedures described in clause (ii) that are 
                        more restrictive than the standards, 
                        methodologies, or procedures in effect under 
                        the State plan or under a waiver of the plan on 
                        the date of enactment of the Patient Protection 
                        and Affordable Care Act.
                            ``(ii) Standards, methodologies, or 
                        procedures described.--The eligibility 
                        standards, methodologies, or procedures 
                        described in this clause are those standards, 
                        methodologies, or procedures applicable to 
                        determining the eligibility for medical 
                        assistance of any child under 19 years of age 
                        (or such higher age as the State may have 
                        elected).''.
    (f) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2014.

SEC. 213. EXPRESS LANE ELIGIBILITY.

    Section 1902(e)(13)(I) of the Social Security Act (42 U.S.C. 
1396a(e)(13)(I)) is amended by striking ``September 30, 2014'' and 
inserting ``September 30, 2015''.

SEC. 214. PEDIATRIC QUALITY MEASURES.

    (a) Continuation of Funding for Pediatric Quality Measures for 
Improving the Quality of Children's Health Care.--Section 1139B(e) of 
the Social Security Act (42 U.S.C. 1320b-9b(e)) is amended by adding at 
the end the following: ``Of the funds appropriated under this 
subsection, not less than $15,000,000 shall be used to carry out 
section 1139A(b).''.
    (b) Elimination of Restriction on Medicaid Quality Measurement 
Program.--Section 1139B(b)(5)(A) of the Social Security Act (42 U.S.C. 
1320b-9b(b)(5)(A)) is amended by striking ``The aggregate amount 
awarded by the Secretary for grants and contracts for the development, 
testing, and validation of emerging and innovative evidence-based 
measures under such program shall equal the aggregate amount awarded by 
the Secretary for grants under section 1139A(b)(4)(A)''.

SEC. 215. SPECIAL DIABETES PROGRAMS.

    (a) Special Diabetes Programs for Type I Diabetes.--Section 
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-
2(b)(2)(C)) is amended by striking ``2014'' and inserting ``2019''.
    (b) Special Diabetes Programs for Indians.--Section 330C(c)(2)(C) 
of the Public Health Service Act (42 U.S.C. 254c-3(c)(2)(C)) is amended 
by striking ``2014'' and inserting ``2019''.

                 Subtitle C--Human Services Extensions

SEC. 221. ABSTINENCE EDUCATION GRANTS.

    (a) In General.--Section 510 of the Social Security Act (42 U.S.C. 
710) is amended--
            (1) in subsection (a), in the matter preceding paragraph 
        (1), by striking ``2010 through 2014'' and inserting ``2015 
        through 2019''; and
            (2) in subsection (d)--
                    (A) by striking ``2010 through 2014'' and inserting 
                ``2015 through 2019''; and
                    (B) by striking the second sentence.
    (b) Effective Date.--The amendments made by this section shall take 
effect on October 1, 2014.

SEC. 222. PERSONAL RESPONSIBILITY EDUCATION PROGRAM.

    (a) In General.--Section 513 of the Social Security Act (42 U.S.C. 
713) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)(A), by striking ``2010 through 
                2014'' and inserting ``2015 through 2019'';
                    (B) in paragraph (4)--
                            (i) in subparagraph (A)--
                                    (I) by striking ``2010 or 2011'' 
                                and inserting ``2015 or 2016'';
                                    (II) by striking ``2010 through 
                                2014'' and inserting ``2015 through 
                                2019''; and
                                    (III) by striking ``2012 through 
                                2014'' and inserting ``2017 through 
                                2019''; and
                            (ii) in subparagraph (B)(i)--
                                    (I) by striking ``2012, 2013, and 
                                2014'' and inserting ``2017, 2018, and 
                                2019''; and
                                    (II) by striking ``2010 or 2011'' 
                                and inserting ``2015 or 2016''; and
                    (C) in paragraph (5), by striking ``2009'' and 
                inserting ``2014'';
            (2) in subsection (b)(2)(A), in the matter preceding clause 
        (i), by inserting ``and youth at risk of becoming victims of 
        sex trafficking (as defined in section 103(10) of the 
        Trafficking Victims Protection Act of 2000 (22 U.S.C. 
        7102(10))) or victims of a severe form of trafficking in 
        persons described in paragraph (9)(A) of that Act (22 U.S.C. 
        7102(9)(A)'' after ``adolescents'';
            (3) in subsection(c)(1), by inserting ``youth at risk of 
        becoming victims of sex trafficking (as defined in section 
        103(10) of the Trafficking Victims Protection Act of 2000 (22 
        U.S.C. 7102(10))) or victims of a severe form of trafficking in 
        persons described in paragraph (9)(A) of that Act (22 U.S.C. 
        7102(9)(A),'' after ``youth in foster care,''; and
            (4) in subsection (f), by striking ``2010 through 2014'' 
        and inserting ``2015 through 2019''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on October 1, 2014.

SEC. 223. FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS.

    (a) In General.--Section 501(c) of the Social Security Act (42 
U.S.C. 701(c)) is amended--
            (1) in paragraph (1)(A)--
                    (A) in clause (ii), by striking ``and'' after the 
                semicolon;
                    (B) in clause (iii), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
                            ``(iv) $6,000,000 for each of fiscal years 
                        2014 through 2018.''; and
            (2) by striking paragraph (5).
    (b) Effective Date.--The amendments made by this section shall take 
effect as if enacted on October 1, 2013.

SEC. 224. HEALTH WORKFORCE DEMONSTRATION PROJECT FOR LOW-INCOME 
              INDIVIDUALS.

    Section 2008(c)(1) of the Social Security Act (42 U.S.C. 
1397g(c)(1)) is amended by striking `` through 2014'' and inserting 
``2012, and only to carry out subsection (a), $85,000,000 for each of 
fiscal years 2013 through 2016''.

                     Subtitle D--Program Integrity

SEC. 231. REDUCING IMPROPER MEDICARE PAYMENTS.

    (a) Medicare Administrative Contractor Improper Payment Outreach 
and Education Program.--
            (1) In general.--Section 1874A of the Social Security Act 
        (42 U.S.C. 1395kk-1) is amended--
                    (A) in subsection (a)(4)--
                            (i) by redesignating subparagraph (G) as 
                        subparagraph (H); and
                            (ii) by inserting after subparagraph (F) 
                        the following new subparagraph:
                    ``(G) Improper payment outreach and education 
                program.--Having in place an improper payment outreach 
                and education program described in subsection (h).''; 
                and
                    (B) by adding at the end the following new 
                subsection:
    ``(h) Improper Payment Outreach and Education Program.--
            ``(1) In general.--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 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 (3). The activities 
        described in the preceding sentence shall be conducted on a 
        regular basis.
            ``(2) Forms of outreach, education, training, and technical 
        assistance activities.--The outreach, education, training, and 
        technical assistance activities under a payment outreach and 
        education program shall be carried out through any of the 
        following:
                    ``(A) Emails and other electronic communications.
                    ``(B) Webinars.
                    ``(C) Telephone calls.
                    ``(D) In-person training.
                    ``(E) Other forms of communications determined 
                appropriate by the Secretary.
            ``(3) Information to be provided through activities.--The 
        information to be provided to providers of services and 
        suppliers under a payment outreach and education program shall 
        include all of the following information:
                    ``(A) A list of the provider's or supplier's most 
                frequent and expensive payment errors over the last 
                quarter.
                    ``(B) Specific instructions regarding how to 
                correct or avoid such errors in the future.
                    ``(C) A notice of all new topics that have been 
                approved by the Secretary for audits conducted by 
                recovery audit contractors under section 1893(h).
                    ``(D) Specific instructions to prevent future 
                issues related to such new audits.
                    ``(E) Other information determined appropriate by 
                the Secretary.
            ``(4) Error rate reduction training.--
                    ``(A) In general.--The activities under a payment 
                outreach and education program shall include error rate 
                reduction training.
                    ``(B) Requirements.--
                            ``(i) In general.--The training described 
                        in subparagraph (A) shall--
                                    ``(I) be provided at least 
                                annually; and
                                    ``(II) focus on reducing the 
                                improper payments described in 
                                paragraph (5).
                    ``(C) Invitation.--A medicare administrative 
                contractor shall ensure that all providers of services 
                and suppliers located in the region covered by the 
                contract under this section are invited to attend the 
                training described in subparagraph (A) either in person 
                or online.
            ``(5) Priority.--A medicare administrative contractor shall 
        give priority to activities under the improper payment outreach 
        and education program that will reduce improper payments for 
        items and services that--
                    ``(A) have the highest rate of improper payment;
                    ``(B) have the greatest total dollar amount of 
                improper payments;
                    ``(C) are due to clear misapplication or 
                misinterpretation of Medicare policies;
                    ``(D) are clearly due to common and inadvertent 
                clerical or administrative errors; or
                    ``(E) are due to other types of errors that the 
                Secretary determines could be prevented through 
                activities under the program.
            ``(6) Information on improper payments from recovery audit 
        contractors.--
                    ``(A) In general.--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 
                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 quarterly basis.
                    ``(B) Information.--The information described in 
                subparagraph (A) shall include the following 
                information:
                            ``(i) The providers of services and 
                        suppliers that have the highest rate of 
                        improper payments.
                            ``(ii) The providers of services and 
                        suppliers that have the greatest total dollar 
                        amounts of improper payments.
                            ``(iii) The items and services furnished in 
                        the region that have the highest rates of 
                        improper payments.
                            ``(iv) The items and services furnished in 
                        the region that are responsible for the 
                        greatest total dollar amount of improper 
                        payments.
                            ``(v) Other information the Secretary 
                        determines would assist the contractor in 
                        carrying out the improper payment outreach and 
                        education program.
                    ``(C) Format of information.--The information 
                furnished to medicare administrative contractors by the 
                Secretary under this paragraph shall be transmitted in 
                a manner that permits the contractor to easily identify 
                the areas of the Medicare program in which targeted 
                outreach, education, training, and technical assistance 
                would be most effective. In carrying out the preceding 
                sentence, the Secretary shall ensure that--
                            ``(i) the information with respect to 
                        improper payments made to a provider of 
                        services or supplier clearly displays the name 
                        and address of the provider or supplier, the 
                        amount of the improper payment, and any other 
                        information the Secretary determines 
                        appropriate; and
                            ``(ii) the information is in an electronic, 
                        easily searchable database.
            ``(7) Communications.--All communications with providers of 
        services and suppliers under a payment outreach and education 
        program are subject to the standards and requirements of 
        subsection (g).
            ``(8) Funding.--After application of paragraph (1)(C) of 
        section 1893(h), the Secretary shall retain a portion of the 
        amounts recovered by recovery audit contractors under such 
        section which shall be available to the program management 
        account of the Centers for Medicare & Medicaid Services for 
        purposes of carrying out this subsection and to implement 
        corrective actions to help reduce the error rate of payments 
        under this title. The amount retained under the preceding 
        sentence shall not exceed an amount equal to 25 percent of the 
        amounts recovered under section 1893(h).''.
            (2) Funding conforming amendment.--Section 1893(h)(2) of 
        the Social Security Act (42 U.S.C. 1395ddd(h)(2)) is amended by 
        inserting ``or section 1874(h)(8)'' after ``paragraph (1)(C)''.
            (3) Effective date.--The amendments made by this subsection 
        take effect on January 1, 2015.
    (b) Transparency.--Section 1893(h)(8) of the Social Security Act 
(42 U.S.C. 1395ddd(h)(8)) is amended--
            (1) by striking ``report.--The Secretary'' and inserting 
        ``report.--
                    ``(A) In general.--The Secretary''; and
            (2) by adding at the end the following new subparagraph:
                    ``(B) Inclusion of certain information.--
                            ``(i) In general.--For reports submitted 
                        under this paragraph for 2015 or a subsequent 
                        year, each such report shall include the 
                        information described in clause (ii) with 
                        respect to each of the following categories of 
                        audits carried out by recovery audit 
                        contractors under this subsection:
                                    ``(I) Automated.
                                    ``(II) Complex.
                                    ``(III) Medical necessity review.
                                    ``(IV) Part A.
                                    ``(V) Part B.
                                    ``(VI) Durable medical equipment.
                            ``(ii) Information described.--For purposes 
                        of clause (i), the information described in 
                        this clause, with respect to a category of 
                        audit described in clause (i), is the result of 
                        all appeals for each individual level of 
                        appeals in such category.''.
    (c) Recovery Audit Contractor Demonstration Project.--
            (1) In general.--The Secretary shall conduct a 
        demonstration project under title XVIII of the Social Security 
        Act that--
                    (A) targets audits by recovery audit contractors 
                under section 1893(h) of the Social Security Act (42 
                U.S.C. 1395ddd(h)) with respect to high error providers 
                of services and suppliers identified under paragraph 
                (3); and
                    (B) rewards low error providers of services and 
                suppliers identified under such paragraph.
            (2) Scope.--
                    (A) Duration.--The demonstration project shall be 
                implemented not later than January 1, 2015, and shall 
                be conducted for a period of three years.
                    (B) Demonstration area.--In determining the 
                geographic area of the demonstration project, the 
                Secretary shall consider the following:
                            (i) The total number of providers of 
                        services and suppliers in the region.
                            (ii) The diversity of types of providers of 
                        services and suppliers in the region.
                            (iii) The level and variation of improper 
                        payment rates of and among individual providers 
                        of services and suppliers in the region.
                            (iv) The inclusion of a mix of both urban 
                        and rural areas.
            (3) Identification of low error and high error providers of 
        services and suppliers.--
                    (A) In general.--In conducting the demonstration 
                project, the Secretary shall identify the following two 
                groups of providers in accordance with this paragraph:
                            (i) Low error providers of services and 
                        suppliers.
                            (ii) High error providers of services and 
                        suppliers.
                    (B) Analysis.--For purposes of identifying the 
                groups under subparagraph (A), the Secretary shall 
                analyze the following as they relate to the total 
                number and amount of claims submitted in the area and 
                by each provider:
                            (i) The improper payment rates of 
                        individual providers of services and suppliers.
                            (ii) The amount of improper payments made 
                        to individual providers of services and 
                        suppliers.
                            (iii) The frequency of errors made by the 
                        provider of services or supplier over time.
                            (iv) Other information determined 
                        appropriate by the Secretary.
                    (C) Assignment based on composite score.--The 
                Secretary shall assign selected providers of services 
                and suppliers under the demonstration program based on 
                a composite score determined using the analysis under 
                subparagraph (B) as follows:
                            (i) Providers of services and suppliers 
                        with high, expensive, and frequent errors shall 
                        receive a high score and be identified as high 
                        error providers of services and suppliers under 
                        subparagraph (A).
                            (ii) Providers of services and suppliers 
                        with few, inexpensive, and infrequent errors 
                        shall receive a low score and be identified as 
                        low error providers of services and suppliers 
                        under such subparagraph.
                            (iii) Only a small proportion of the total 
                        providers of services and suppliers and 
                        individual types of providers of services and 
                        suppliers in the geographic area of the 
                        demonstration project shall be assigned to 
                        either group identified under such 
                        subparagraph.
                    (D) Timeframe of identification.--
                            (i) In general.--Any identification of a 
                        provider of services or a supplier under 
                        subparagraph (A) shall be for a period of 12 
                        months.
                            (ii) Reevaluation.--The Secretary shall 
                        reevaluate each such identification at the end 
                        of such period.
                            (iii) Use of most current information.--In 
                        carrying out the reevaluation under clause (ii) 
                        with respect to a provider of services or 
                        supplier, the Secretary shall--
                                    (I) consider the most current 
                                information available with respect to 
                                the provider of services or supplier 
                                under the analysis under subparagraph 
                                (B); and
                                    (II) take into account improvement 
                                or regression of the provider of 
                                services or supplier.
            (4) Adjustment of record request maximum.--Under the 
        demonstration project, the Secretary shall establish procedures 
        to--
                    (A) increase the maximum record request made by 
                recovery audit contractors to providers of services and 
                suppliers identified as high error providers of 
                services and suppliers under paragraph (3); and
                    (B) decrease the maximum record request made by 
                recovery audit contractors to providers of services and 
                suppliers identified as low error providers of services 
                and supplier under such paragraph.
            (5) Additional adjustments.--
                    (A) In general.--Under the demonstration project, 
                the Secretary may make additional adjustments to 
                requirements for recovery audit contractors under 
                section 1893(h) of the Social Security Act (42 U.S.C. 
                1395ddd(h)) and the conduct of audits with respect to 
                low error providers of services and suppliers 
                identified under paragraph (3) and high error providers 
                of services and suppliers identified under such 
                paragraph as the Secretary determines necessary in 
                order to incentivize reductions in improper payment 
                rates under title XVIII of such Act (42 U.S.C. 1395 et 
                seq.).
                    (B) Limitation.--The Secretary shall not exempt any 
                group of providers of services or suppliers in the 
                demonstration project from being subject to audit by a 
                recovery audit contractor under such section 1893(h).
            (6) Evaluation and report.--
                    (A) Evaluation.--The Inspector General of the 
                Department of Health and Human Services shall conduct 
                an evaluation of the demonstration project under this 
                subsection. The evaluation shall include an analysis 
                of--
                            (i) the error rates of providers of 
                        services and suppliers--
                                    (I) identified under paragraph (3) 
                                as low error providers of services and 
                                suppliers;
                                    (II) identified under such 
                                paragraph as high error providers of 
                                services and suppliers; and
                                    (III) that are located in the 
                                geographic area of the demonstration 
                                project and are not identified as 
                                either a low error or high error 
                                provider of services or supplier under 
                                such paragraph; and
                            (ii) any improvements in the error rates of 
                        those high error providers of services and 
                        suppliers identified under such paragraph.
                    (B) Report.--Not later than 12 months after 
                completion of the demonstration project, the Inspector 
                General shall submit to Congress a report containing 
                the results of the evaluation conducted under 
                subparagraph (A), together with recommendations on 
                whether the demonstration project should be continued 
                or expanded, including on a permanent or nationwide 
                basis.
            (7) Funding.--
                    (A) Funding for implementation.--For purposes of 
                carrying out the demonstration project under this 
                subsection (other than the evaluation and report under 
                paragraph (6)), the Secretary shall provide for the 
                transfer, from the Federal Hospital Insurance Trust 
                Fund under section 1817 (42 U.S.C. 1395i) and the 
                Federal Supplementary Medical Insurance Trust Fund 
                under section 1841 (42 U.S.C. 1395t), in such 
                proportion as the Secretary determines appropriate, of 
                $10,000,000 to the Centers for Medicare & Medicaid 
                Services Program Management Account.
                    (B) Funding for inspector general evaluation and 
                report.--For purposes of carrying out the evaluation 
                and report under paragraph (6), the Secretary shall 
                provide for the transfer, from the Federal Hospital 
                Insurance Trust Fund under such section 1817 and the 
                Federal Supplementary Medical Insurance Trust Fund 
                under such section 1841, in such proportion as the 
                Secretary determines appropriate, of $245,000 to the 
                Inspector General of the Department of Health and Human 
                Services.
                    (C) Availability.--Amounts transferred under 
                subparagraph (A) or (B) shall remain available until 
                expended.
            (8) Definitions.--In this section:
                    (A) Demonstration project.--The term 
                ``demonstration project'' means the demonstration 
                project under this subsection.
                    (B) Provider of services.--The term ``provider of 
                services'' has the meaning given that term in section 
                1861(u).
                    (C) Recovery audit contractor.--The term ``recovery 
                audit contractor'' means an entity with a contract 
                under section 1893(h) of the Social Security Act (42 
                U.S.C. 1395ddd(h)).
                    (D) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services.
                    (E) Supplier.--The term ``supplier'' has the 
                meaning given that term in section 1861(d).

SEC. 232. AUTHORITY FOR MEDICAID FRAUD CONTROL UNITS TO INVESTIGATE AND 
              PROSECUTE COMPLAINTS OF ABUSE AND NEGLECT OF MEDICAID 
              PATIENTS IN HOME AND COMMUNITY-BASED SETTINGS.

    (a) In General.--Section 1903(q)(4)(A) of the Social Security Act 
(42 U.S.C. 1396b(q)(4)(A)) is amended to read as follows:
            ``(4)(A) The entity's function includes a statewide program 
        for the--
                    ``(i) investigation and prosecution, or referral 
                for prosecution or other action, of complaints of abuse 
                or neglect of patients in health care facilities which 
                receive payments under the State plan under this title 
                or under a waiver of such plan;
                    ``(ii) at the option of the entity, investigation 
                and prosecution, or referral for prosecution or other 
                action, of complaints of abuse or neglect of 
                individuals in connection with any aspect of the 
                provision of medical assistance and the activities of 
                providers of such assistance in a home or community 
                based setting that is paid for under the State plan 
                under this title or under a waiver of such plan; and
                    ``(iii) at the option of the entity, investigation 
                and prosecution, or referral for prosecution or other 
                action, of complaints of abuse or neglect of patients 
                residing in board and care facilities.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on January 1, 2015.

SEC. 233. IMPROVED USE OF FUNDS RECEIVED BY THE HHS INSPECTOR GENERAL 
              FROM OVERSIGHT AND INVESTIGATIVE ACTIVITIES.

    (a) In General.--Section 1128C(b) of the Social Security Act (42 
U.S.C. 1320a-7c(b)) is amended to read as follows:
    ``(b) Additional Use of Funds by Inspector General.--
            ``(1) Collections from medicare and medicaid recovery 
        actions.--Notwithstanding section 3302 of title 31, United 
        States Code, or any other provision of law affecting the 
        crediting of collections, the Inspector General of the 
        Department of Health and Human Services may receive and retain 
        three percent of all amounts collected pursuant to civil debt 
        collection actions related to false claims or frauds involving 
        the Medicare program under title XVIII or the Medicaid program 
        under title XIX.
            ``(2) Crediting.--Funds received by the Inspector General 
        under paragraph (1) shall be deposited to the credit of any 
        appropriation available for oversight and enforcement 
        activities of the Inspector General permitted under subsection 
        (a), and shall remain available until expended.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to funds received from settlements finalized, or judgements 
entered, on or after the date of the enactment of this Act.

SEC. 234. PREVENTING AND REDUCING IMPROPER MEDICARE AND MEDICAID 
              EXPENDITURES.

    (a) Requiring Valid Prescriber National Provider Identifiers on 
Pharmacy Claims.--Section 1860D-4(c) of the Social Security Act (42 
U.S.C. 1395w-104(c)) is amended by adding at the end the following new 
paragraph:
            ``(4) Requiring valid prescriber national provider 
        identifiers on pharmacy claims.--
                    ``(A) In general.--For plan year 2015 and 
                subsequent plan years, subject to subparagraph (B), the 
                Secretary shall prohibit PDP sponsors of prescription 
                drug plans from paying claims for prescription drugs 
                under this part that do not include a valid prescriber 
                National Provider Identifier.
                    ``(B) Procedures.--The Secretary shall establish 
                procedures for determining the validity of prescriber 
                National Provider Identifiers under subparagraph (A).
                    ``(C) Report.--Not later than January 1, 2017, 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).''.
    (b) Reforming How CMS Tracks and Corrects the Vulnerabilities 
Identified by Recovery Audit Contractors.--Section 1893(h) of the 
Social Security Act (42 U.S.C. 1395ddd(h)) is amended--
            (1) in paragraph (8), as amended by section 231, by adding 
        at the end the following new subparagraphs:
                    ``(C) Inclusion of improper payment vulnerabilities 
                identified.--For reports submitted under this paragraph 
                for 2015 or a subsequent year, each such report shall 
                include--
                            ``(i) a description of--
                                    ``(I) the types and financial cost 
                                to the program under this title of 
                                improper payment vulnerabilities 
                                identified by recovery audit 
                                contractors under this subsection; and
                                    ``(II) how the Secretary is 
                                addressing such improper payment 
                                vulnerabilities; and
                            ``(ii) an assessment of the effectiveness 
                        of changes made to payment policies and 
                        procedures under this title in order to address 
                        the vulnerabilities so identified.
                    ``(D) Limitation.--The Secretary shall ensure that 
                each report submitted under subparagraph (A) does not 
                include information that the Secretary determines would 
                be sensitive or would otherwise negatively impact 
                program integrity.''; and
            (2) by adding at the end the following new paragraph:
            ``(10) Addressing improper payment vulnerabilities.--The 
        Secretary shall address improper payment vulnerabilities 
        identified by recovery audit contractors under this subsection 
        in a timely manner, prioritized based on the risk to the 
        program under this title.''.
    (c) Strengthening Medicaid Program Integrity Through Flexibility.--
Section 1936 of the Social Security Act (42 U.S.C. 1396u-6) is 
amended--
            (1) in subsection (a), by inserting ``, or otherwise,'' 
        after ``entities''; and
            (2) in subsection (e)--
                    (A) in paragraph (1), in the matter preceding 
                subparagraph (A), by inserting ``(including the costs 
                of equipment, salaries and benefits, and travel and 
                training)'' after ``Program under this section''; and
                    (B) in paragraph (3), by striking ``by 100'' and 
                inserting ``by 100, or such number as determined 
                necessary by the Secretary to carry out the Program 
                under this section,''.
    (d) Access to the National Directory of New Hires.--Section 453(j) 
of the Social Security Act (42 U.S.C. 653(j)) is amended by adding at 
the end the following new paragraph:
            ``(12) Information comparisons and disclosures to assist in 
        administration of the medicare program and state health subsidy 
        programs.--
                    ``(A) Disclosure to the administrator of the 
                centers for medicare & medicaid services.--The 
                Administrator of the Centers for Medicare & Medicaid 
                shall have access to the information in the National 
                Directory of New Hires for purposes of determining the 
                eligibility of an applicant for, or enrollee in, the 
                Medicare program under title XVIII or an applicable 
                State health subsidy program (as defined in section 
                1413(e) of the Patient Protection and Affordable Care 
                Act (42 U.S.C. 18083(e)).
                    ``(B) Disclosure to the inspector general of the 
                department of health and human services.--
                            ``(i) In general.--If the Inspector General 
                        of the Department of Health and Human Services 
                        transmits to the Secretary the names and social 
                        security account numbers of individuals, the 
                        Secretary shall disclose to the Inspector 
                        General information on such individuals and 
                        their employers maintained in the National 
                        Directory of New Hires.
                            ``(ii) Use of information.--The Inspector 
                        General of the Department of Health and Human 
                        Services may use information provided under 
                        clause (i) only for purposes of --
                                    ``(I) determining the eligibility 
                                of an applicant for, or enrollee in, 
                                the Medicare program under title XVIII 
                                or an applicable State health subsidy 
                                program (as defined in section 1413(e) 
                                of the Patient Protection and 
                                Affordable Care Act (42 U.S.C. 
                                18083(e)); or
                                    ``(II) evaluating the integrity of 
                                the Medicare program or an applicable 
                                State health subsidy program (as so 
                                defined).
                    ``(C) Disclosure to state agencies.--
                            ``(i) In general.--If, for purposes of 
                        determining the eligibility of an applicant 
                        for, or an enrollee in, an applicable State 
                        health subsidy program (as defined in section 
                        1413(e) of the Patient Protection and 
                        Affordable Care Act (42 U.S.C. 18083(e)), a 
                        State agency responsible for administering such 
                        program transmits to the Secretary the names, 
                        dates of birth, and social security account 
                        numbers of individuals, the Secretary shall 
                        disclose to such State agency information on 
                        such individuals and their employers maintained 
                        in the National Directory of New Hires, subject 
                        to this subparagraph.
                            ``(ii) Condition on disclosure by the 
                        secretary.--The Secretary shall make a 
                        disclosure under clause (i) only to the extent 
                        that the Secretary determines that the 
                        disclosure would not interfere with the 
                        effective operation of the program under this 
                        part.
                            ``(iii) Use and disclosure of information 
                        by state agencies.--
                                    ``(I) In general.--A State agency 
                                may not use or disclose information 
                                provided under clause (i) except for 
                                purposes of determining the eligibility 
                                of an applicant for, or an enrollee in, 
                                a program referred to in clause (i).
                                    ``(II) Information security.--The 
                                State agency shall have in effect data 
                                security and control policies that the 
                                Secretary finds adequate to ensure the 
                                security of information obtained under 
                                clause (i) and to ensure that access to 
                                such information is restricted to 
                                authorized persons for purposes of 
                                authorized uses and disclosures.
                                    ``(III) Penalty for misuse of 
                                information.--An officer or employee of 
                                the State agency who fails to comply 
                                with this clause shall be subject to 
                                the sanctions under subsection (l)(2) 
                                to the same extent as if such officer 
                                or employee were an officer or employee 
                                of the United States.
                            ``(iv) Procedural requirements.--State 
                        agencies requesting information under clause 
                        (i) shall adhere to uniform procedures 
                        established by the Secretary governing 
                        information requests and data matching under 
                        this paragraph.
                            ``(v) Reimbursement of costs.--The State 
                        agency shall reimburse the Secretary, in 
                        accordance with subsection (k)(3), for the 
                        costs incurred by the Secretary in furnishing 
                        the information requested under this 
                        subparagraph.''.
    (e) Improving the Sharing of Data Between the Federal Government 
and State Medicaid Programs.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') shall 
        establish a plan to encourage and facilitate the participation 
        of States in the Medicare-Medicaid Data Match Program (commonly 
        referred to as the ``Medi-Medi Program'') under section 1893(g) 
        of the Social Security Act (42 U.S.C. 1395ddd(g)).
            (2) Program revisions to improve medi-medi data match 
        program participation by states.--Section 1893(g)(1)(A) of the 
        Social Security Act (42 U.S.C. 1395ddd(g)(1)(A)) is amended--
                    (A) in the matter preceding clause (i), by 
                inserting ``or otherwise'' after ``eligible entities'';
                    (B) in clause (i)--
                            (i) by inserting ``to review claims data'' 
                        after ``algorithms''; and
                            (ii) by striking ``service, time, or 
                        patient'' and inserting ``provider, service, 
                        time, or patient'';
                    (C) in clause (ii)--
                            (i) by inserting ``to investigate and 
                        recover amounts with respect to suspect 
                        claims'' after ``appropriate actions''; and
                            (ii) by striking ``; and'' and inserting a 
                        semicolon;
                    (D) in clause (iii), by striking the period and 
                inserting ``; and''; and
                    (E) by adding at end the following new clause:
                            ``(iv) furthering the Secretary's design, 
                        development, installation, or enhancement of an 
                        automated data system architecture--
                                    ``(I) to collect, integrate, and 
                                assess data for purposes of program 
                                integrity, program oversight, and 
                                administration, including the Medi-Medi 
                                Program; and
                                    ``(II) that improves the 
                                coordination of requests for data from 
                                States.''.
            (3) Providing states with data on improper payments made 
        for items or services provided to dual eligible individuals.--
                    (A) In general.--The Secretary shall develop and 
                implement a plan that allows each State agency 
                responsible for administering a State plan for medical 
                assistance under title XIX of the Social Security Act 
                access to relevant data on improper or fraudulent 
                payments made under the Medicare program under title 
                XVIII of the Social Security Act (42 U.S.C. 1395 et 
                seq.) for health care items or services provided to 
                dual eligible individuals.
                    (B) Dual eligible individual defined.--In this 
                paragraph, the term ``dual eligible individual'' means 
                an individual who is entitled to, or enrolled for, 
                benefits under part A of title XVIII of the Social 
                Security Act (42 U.S.C. 1395c et seq.), or enrolled for 
                benefits under part B of title XVIII of such Act (42 
                U.S.C. 1395j et seq.), and is eligible for medical 
                assistance under a State plan under title XIX of such 
                Act (42 U.S.C. 1396 et seq.) or under a waiver of such 
                plan.

                      Subtitle E--Other Provisions

SEC. 241. COMMISSION ON IMPROVING PATIENT DIRECTED HEALTH CARE.

    (a) Findings.--Congress finds the following:
            (1) In order to elevate the role of patient choices in the 
        health care system, the American public must engage in an 
        informed, national, public debate on how the current health 
        care system empowers and informs health care decision-making, 
        and what can be done to improve the likelihood patients receive 
        the care they want and need.
            (2) Research suggests that patients often do not receive 
        the care they want. As a result, the end of life is associated 
        with a substantial burden of suffering by the patient and 
        negative health and financial consequences that extend to 
        family members and society.
            (3) Patients face a complex and fragmented health care 
        system that may decrease the likelihood that health care 
        choices are known and carried out. The health care system 
        should embed principles that take into account patient wishes.
            (4) Decisions concerning health care, including end-of-life 
        issues, affect an increasing number of Americans.
            (5) Medical advances are prolonging life expectancy in the 
        United States both in acute life-threatening situations and 
        protracted battles with illness. These advances raise new 
        challenges surrounding health care decision-making.
            (6) The United States health care system should promote 
        consideration of a person's preference in health care decision-
        making and end-of-life choices.
    (b) Commission.--The Social Security Act is amended by inserting 
after section 1150B (42 U.S.C. 1320b-24) the following new section:

``SEC. 1150C. COMMISSION ON IMPROVING PATIENT DIRECTED HEALTH CARE.

    ``(a) Purposes.--The purposes of this section are to--
            ``(1) provide a forum for a nationwide public debate on 
        improving patient self-determination in health care decision-
        making;
            ``(2) identify strategies that ensure every American has 
        the health care they want; and
            ``(3) provide recommendations to Congress that result from 
        the debate.
    ``(b) Establishment.--The Secretary shall establish an entity to be 
known as the Commission on Improving Patient Directed Health Care 
(referred to in this section as the `Commission').
    ``(c) Membership.--
            ``(1) Number and appointment.--The Commission shall be 
        composed of 15 members. One member shall be the Secretary. The 
        Comptroller General of the United States shall appoint 14 
        members.
            ``(2) Qualifications.--The membership of the Commission 
        shall include--
                    ``(A) health care consumers impacted by decision-
                making in advance of a health care crisis, such as 
                individuals of advanced age, individuals with chronic, 
                terminal and mental illnesses, family care givers, and 
                individuals with disabilities;
                    ``(B) providers in settings where crucial health 
                care decision-making occurs, such as those working in 
                intensive care settings, emergency room departments, 
                primary care settings, nursing homes, hospice, or 
                palliative care settings;
                    ``(C) payors ensuring patients get the level of 
                care they want;
                    ``(D) experts in advance care planning, hospice, 
                palliative care, information technology, bioethics, 
                aging policy, disability policy, pediatric ethics, 
                cultural sensitivity, psychology, and health care 
                financing;
                    ``(E) individuals who represent culturally diverse 
                perspectives on patient self-determination and end-of-
                life issues; and
                    ``(F) members of the faith community.
    ``(d) Period of Appointment.--Members of the Commission shall be 
appointed for the life of the Commission. Any vacancies shall not 
affect the power and duties of the Commission but shall be filled in 
the same manner as the original appointment.
    ``(e) Designation of the Chairperson.--Not later than 15 days after 
the date on which all members of the Commission have been appointed, 
the Comptroller General shall designate the chairperson of the 
Commission.
    ``(f) Subcommittees.--The Commission may establish subcommittees if 
doing so increases the efficiency of the Commission in completing 
tasks.
    ``(g) Duties.--
            ``(1) Hearings.--Not later than 90 days after the date of 
        designation of the chairperson under subsection (e), the 
        Commission shall hold no fewer than 8 hearings to examine--
                    ``(A) the current state of health care decision-
                making and advance care planning laws in the United 
                States at the Federal level and across the States, as 
                well as options for improving advance care planning 
                tools, especially with regard to use, portability, and 
                storage;
                    ``(B) consumer-focused approaches that educate the 
                American public about patient choices, care planning, 
                and other end-of-life issues;
                    ``(C) the use of comprehensive, patient-centered 
                care plans by providers, the impact care plans have on 
                health care delivery, and methods to expand the use of 
                high quality care planning tools in both public and 
                private health care systems;
                    ``(D) the role of electronic medical records and 
                other technologies in improving patient-directed health 
                care;
                    ``(E) innovative tools for improving patient 
                experience with advanced illness, such as palliative 
                care, hospice, and other models;
                    ``(F) the role social determinants of health, such 
                as socio-economic status, play in patient self-
                direction in health care;
                    ``(G) the use of culturally-competent tools for 
                health care decision-making;
                    ``(H) strategies for educating providers on care 
                planning, palliative care, hospice care, and other 
                issues surrounding honoring patient choices;
                    ``(I) the sociological and psychological factors 
                that influence health care decision-making and end-of-
                life choices; and
                    ``(J) the role of spirituality and religion in 
                patient self-determination in health care.
            ``(2) Additional hearings.--The Commission may hold 
        additional hearings on subjects other than those listed in 
        paragraph (1) so long as such hearings are determined necessary 
        by the Commission in carrying out the purposes of this section. 
        Such additional hearings do not have to be completed within the 
        time period specified but shall not delay the other activities 
        of the Commission under this section.
            ``(3) Number and location of hearings and additional 
        hearings.--The Commission shall hold no fewer than 8 hearings 
        as indicated in paragraph (1) and in sufficient number in order 
        to receive information that reflects--
                    ``(A) the geographic differences throughout the 
                United States;
                    ``(B) diverse populations; and
                    ``(C) a balance among urban and rural populations.
            ``(4) Interactive technology.--The Commission may encourage 
        public participation in hearings through interactive technology 
        and other means as determined appropriate by the Commission.
            ``(5) Report to the american people on patient directed 
        health care.--Not later than 90 days after the hearings 
        described in paragraphs (1) and (2) are completed, the 
        Commission shall prepare and make available to health care 
        consumers through the Internet and other appropriate public 
        channels, a report to be entitled, `Report to the American 
        People on Patient Directed Health Care'. Such a report shall be 
        understandable to the general public and include--
                    ``(A) a summary of--
                            ``(i) the hearings described in such 
                        paragraphs;
                            ``(ii) how the current health care system 
                        empowers and informs decision-making in advance 
                        of a health care crisis;
                            ``(iii) factors that contribute to the 
                        provision of health care that does not adhere 
                        to patient wishes;
                            ``(iv) the impact of care that does not 
                        follow patient choices, particularly at the 
                        end-of-life, on patients, families, providers, 
                        and the health care system;
                            ``(v) the laws surrounding advance care 
                        planning and health care decision-making 
                        including issues of portability, use, and 
                        storage;
                            ``(vi) consumer-focused approaches to 
                        education of the American public about patient 
                        choices, care planning, and other end-of-life 
                        issues;
                            ``(vii) the role of care plans in health 
                        care decision-making;
                            ``(viii) the role of providers in ensuring 
                        patients receive the care they want;
                            ``(ix) the role of electronic medical 
                        records and other technologies in improving 
                        patient directed health care;
                            ``(x) the impact of social determinants on 
                        patient self-direction in health care services;
                            ``(xi) the use of culturally competent 
                        methods for health care decision-making;
                            ``(xii) the sociological and psychological 
                        factors that influence patient self-
                        determination; and
                            ``(xiii) the role of spirituality and 
                        religion in health care decision-making and 
                        end-of-life care;
                    ``(B) best practices from communities, providers, 
                and payors that document patient wishes and provide 
                health care that adheres to those wishes; and
                    ``(C) information on educating providers about 
                health care decision-making and end-of-life issues.
            ``(6) Interim requirements.--Not later than 180 days after 
        the date of completion of the hearings, the Commission shall 
        prepare and make available to the public through the Internet 
        and other appropriate public channels, an interim set of 
        recommendations on patient self-determination in health care 
        and ways to improve and strengthen the health care system based 
        on the information and preferences expressed at the community 
        meetings. There shall be a 90-day public comment period on such 
        recommendations.
    ``(h) Recommendations.--Not later than 120 days after the 
expiration of the public comment period described in subsection (g)(6), 
the Commission shall submit to Congress and the President a final set 
of recommendations. The recommendations must be comprehensive and 
detailed. The recommendations must contain recommendations or proposals 
for legislative or administrative action as the Commission deems 
appropriate, including proposed legislative language to carry out the 
recommendations or proposals.
    ``(i) Administration.--
            ``(1) Executive director.--There shall be an Executive 
        Director of the Commission who shall be appointed by the 
        chairperson of the Commission in consultation with the members 
        of the Commission.
            ``(2) Compensation.--While serving on the business of the 
        Commission (including travel time), a member of the Commission 
        shall be entitled to compensation at the per diem equivalent of 
        the rate provided for level IV of the Executive Schedule under 
        section 5315 of title 5, United States Code, and while so 
        serving away from home and the member's regular place of 
        business, a member may be allowed travel expenses, as 
        authorized by the chairperson of the Commission. For purposes 
        of pay and employment benefits, rights, and privileges, all 
        personnel of the Commission shall be treated as if they were 
        employees of the Senate.
            ``(3) Information from federal agencies.--The Commission 
        may secure directly from any Federal department or agency such 
        information as the Commission considers necessary to carry out 
        this section. Upon request of the Commission the head of such 
        department or agency shall furnish such information.
            ``(4) Postal services.--The Commission may use the United 
        States mails in the same manner and under the same conditions 
        as other departments and agencies of the Federal Government.
    ``(j) Detail.--Not more than 5 Federal Government employees 
employed by the Department of Labor, 5 Federal Government employees 
employed by the Social Security Administration, and 10 Federal 
Government employees employed by the Department of Health and Human 
Services may be detailed to the Commission under this section without 
further reimbursement. Any detail of an employee shall be without 
interruption or loss of civil service status or privilege.
    ``(k) Temporary and Intermittent Services.--The chairperson of the 
Commission may procure temporary and intermittent services under 
section 3109(b) of title 5, United States Code, at rates for 
individuals which do not exceed the daily equivalent of the annual rate 
of basic pay prescribed for level V of the Executive Schedule under 
section 5316 of such title.
    ``(l) Annual Report.--Not later than 1 year after the date of 
enactment of this Act, and annually thereafter during the existence of 
the Commission, the Commission shall report to Congress and make public 
a detailed description of the expenditures of the Commission used to 
carry out its duties under this section.
    ``(m) Sunset of Commission.--The Commission shall terminate on the 
date that is 4 years after the date on which all the members of the 
Commission have been appointed under subsection (c)(1) and 
appropriations are first made available to carry out this section.
    ``(n) Administration Review and Comments.--Not later than 45 days 
after receiving the final recommendations of the Commission under 
subsection (h), the President shall submit a report to Congress which 
shall contain--
            ``(1) additional views and comments on such 
        recommendations; and
            ``(2) recommendations for such legislation and 
        administrative action as the President considers appropriate.
    ``(o) Required Congressional Action.--Not later than 45 days after 
receiving the report submitted by the President under subsection (n), 
each committee of jurisdiction of Congress, the Committee on Finance of 
the Senate, the Committee on Health, Education, Labor, and Pensions of 
the Senate, the Committee on Ways and Means of the House of 
Representatives, the Committee on Energy and Commerce of the House of 
Representatives, and the Committee on Education and the Workforce of 
the House of Representatives, shall hold at least 1 hearing on such 
report and on the final recommendations of the Commission submitted 
under subsection (h).
    ``(p) Authorization of Appropriations.--
            ``(1) In general.--There are authorized to be appropriated 
        to carry out this section, $3,000,000 for each of fiscal years 
        2014 and 2015.
            ``(2) Report to the american people on patient directed 
        health care.--There are authorized to be appropriated for the 
        preparation and dissemination of the Report to the American 
        People on Patient Directed Health Care described in subsection 
        (g)(5), such sums as may be necessary for the fiscal year in 
        which the report is required to be submitted.''.

SEC. 242. EXPANSION OF THE DEFINITION OF INPATIENT HOSPITAL SERVICES 
              FOR CERTAIN CANCER HOSPITALS.

    Section 1861(b)(3) of the Social Security Act (42 U.S.C. 
1395x(b)(3)) is amended--
            (1) by inserting ``(A)'' after ``(3)''; and
            (2) by adding ``and'' after the semicolon at the end; and
            (3) by adding at the end the following new subparagraph:
            ``(B) with respect to a hospital that is described in 
        section 1886(d)(1)(B)(v) and that, as of the date of the 
        enactment of the SGR Repeal and Medicare Beneficiary Access Act 
        of 2013, is located in the same building, or on the same 
        campus, as another hospital, items and services described in 
        paragraphs (1) and (2) furnished on or after such date of 
        enactment by the hospital described in such section or by 
        others under arrangements with them made by the hospital;''.

SEC. 243. QUALITY MEASURES FOR CERTAIN POST-ACUTE CARE PROVIDERS 
              RELATING TO NOTICE AND TRANSFER OF PATIENT HEALTH 
              INFORMATION AND PATIENT CARE PREFERENCES.

    (a) Development.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall provide for the 
development of one or more quality measures under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.) to accurately communicate 
the existence and provide for the transfer of patient health 
information and patient care preferences when an individual transitions 
from a hospital to return home or move to other post-acute care 
settings.
    (b) Use of Measure Developers.--The Secretary shall arrange for the 
development of such measures by appropriate measure developers.
    (c) Endorsement.--The Secretary shall arrange for such developed 
measures to be submitted for endorsement to a consensus-based entity as 
described in section 1890(a) of the Social Security Act (42 U.S.C. 
1395aaa(a)), as amended by section 208.
    (d) Use of Measures.--The Secretary shall, through notice and 
comment rulemaking, use such measures under the quality reporting 
programs with respect to--
            (1) inpatient hospitals under section 1886(b)(3)(B)(viii) 
        of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(viii));
            (2) skilled nursing facilities under section 1888(e) of 
        such Act (42 U.S.C. 1395yy(e));
            (3) home health services under section 1895(b)(3)(B)(v) of 
        such Act (42 U.S.C. 1395fff(b)(3)(B)(v)); and
            (4) other providers of services (as defined in section 
        1861(u) of such Act) and suppliers (as defined in section 
        1861(d) of such Act) that the Secretary determines appropriate.

SEC. 244. CRITERIA FOR MEDICALLY NECESSARY, SHORT INPATIENT HOSPITAL 
              STAYS.

    (a) In General.--The Secretary of Health and Human Services shall 
consult with, and seek input from, interested stakeholders to determine 
appropriate criteria for payment under the Medicare program under title 
VIII of the Social Security Act of an inpatient hospital admission 
that--
            (1) is medically necessary; and
            (2) is an inpatient hospital stay that is less than two 
        midnights, as described in section 412.3 of title 42, Code of 
        Federal Regulation, as finalized in the final rule published by 
        the Centers for Medicare & Medicaid Services in the Federal 
        Register on August 19, 2013 (78 Federal Register 50496) 
        entitled ``Medicare Program; Hospital Inpatient Prospective 
        Payment Systems for Acute Care Hospitals and the Long-Term Care 
        Hospital Prospective Payment System and Fiscal Year 2014 Rates; 
        Quality Reporting Requirements for Specific Providers; Hospital 
        Conditions of Participation; Payment Policies Related to 
        Patient Status''.
    (b) Interested Stakeholders.--In subsection (a), the term 
``interested stakeholders'' means the following:
            (1) Hospitals.
            (2) Physicians
            (3) Medicare administrative contractors under section 1874A 
        of the Social Security Act (42 U.S.C. 1395kk-1).
            (4) Recovery audit contractors under section 1893(h) of 
        such Act (42 U.S.C. 1395ddd(h)).
            (5) Other parties determined appropriate by the Secretary.

SEC. 245. TRANSPARENCY OF REASONS FOR EXCLUDING ADDITIONAL PROCEDURES 
              FROM THE MEDICARE AMBULATORY SURGICAL CENTER (ASC) 
              APPROVED LIST.

    Section 1833(i)(1) of the Social Security Act (42 U.S.C. 
1395l(i)(1)) is amended by adding at the end the following: ``In 
updating such lists for application in years beginning after December 
31, 2014, for each procedure that was requested to be included on such 
lists during the public comment period but which the Secretary does not 
propose (in the final rule updating such lists) to so include, the 
Secretary shall describe in such final rule the specific safety 
criteria for not including such procedure on such lists.''.

SEC. 246. SUPERVISION IN CRITICAL ACCESS HOSPITALS.

    (a) General Supervision in Critical Access Hospitals.--Section 
1834(g) of the Social Security Act (42 U.S.C. 1395m(g)) is amended by 
adding at the end the following new paragraph:
            ``(6) Supervision.--In the case of services furnished on or 
        after the date of the enactment of this paragraph, the level of 
        supervision with respect to outpatient critical access hospital 
        services shall be general supervision (as defined by the 
        Secretary).''.
    (b) Supervision of Cardiac and Pulmonary Rehabilitation Programs in 
Critical Access Hospitals.--Section 1861(eee)(2)(B) of the Social 
Security Act (42 U.S.C. 1395x(eee)(2)(B)) is amended by inserting ``, 
or in the case of a critical access hospital, a physician, or 
(beginning on the date of enactment of the SGR Repeal and Medicare 
Beneficiary Access Act of 2013) a nurse practitioner, clinical nurse 
specialist, or physician assistant (as such terms are defined in 
subsection (aa)(5)),'' after ``a physician''.

SEC. 247. REQUIRING STATE LICENSURE OF BIDDING ENTITIES UNDER THE 
              COMPETITIVE ACQUISITION PROGRAM FOR CERTAIN DURABLE 
              MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES 
              (DMEPOS).

    Section 1847(a)(1) of the Social Security Act (42 U.S.C. 1395w-
3(a)(1)) is amended by adding at the end the following new 
subparagraph:
                    ``(G) Requiring state licensure of bidding 
                entities.--With respect to rounds of competitions 
                beginning on or after the date of enactment of this 
                subparagraph, the Secretary may only accept a bid from 
                an entity for an area if the entity meets applicable 
                State licensure requirements for such area for all 
                items in such bid.''.

SEC. 248. RECOGNITION OF ATTENDING PHYSICIAN ASSISTANTS AS ATTENDING 
              PHYSICIANS TO SERVE HOSPICE PATIENTS.

    (a) Recognition of Attending Physician Assistants as Attending 
Physicians To Serve Hospice Patients.--
            (1) In general.--Section 1861(dd)(3)(B) of the Social 
        Security Act (42 U.S.C. 1395x(dd)(3)(B)) is amended--
                    (A) by striking ``or nurse'' and inserting ``, the 
                nurse''; and
                    (B) by inserting ``, or the physician assistant (as 
                defined in such subsection)'' after ``subsection 
                (aa)(5))''.
            (2) Clarification of hospice role of physician 
        assistants.--Section 1814(a)(7)(A)(i)(I) of the Social Security 
        Act (42 U.S.C. 1395f(a)(7)(A)(i)(I)) is amended by inserting 
        ``or a physician assistant'' after ``a nurse practitioner''.
    (b) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2015.

SEC. 249. REMOTE PATIENT MONITORING PILOT PROJECTS.

    (a) Pilot Projects.--
            (1) In general.--Not later than 9 months after the date of 
        the enactment of this Act, the Secretary shall conduct pilot 
        projects under title XVIII of the Social Security Act for the 
        purpose of providing incentives to home health agencies to 
        furnish remote patient monitoring services that reduce 
        expenditures under such title.
            (2) Site requirements.--
                    (A) Urban and rural.--The Secretary shall conduct 
                the pilot projects under this section in both urban and 
                rural areas.
                    (B) Site in a small state.--The Secretary shall 
                conduct at least 1 of the pilot projects in a State 
                with a population of less than 1,000,000.
    (b) Medicare Beneficiaries Within the Scope of Projects.--
            (1) In general.--The Secretary shall specify the criteria 
        for identifying those Medicare beneficiaries who shall be 
        considered within the scope of the pilot projects under this 
        section for purposes of the application of subsection (c) and 
        for the assessment of the effectiveness of the home health 
        agency in achieving the objectives of this section.
            (2) Criteria.--The criteria specified under paragraph (1)--
                    (A) shall include conditions and clinical 
                circumstances, including congestive heart failure, 
                diabetes, and chronic pulmonary obstructive disease, 
                and other conditions determined appropriate by the 
                Secretary; and
                    (B) may provide for the inclusion in the projects 
                of Medicare beneficiaries who begin receiving home 
                health services under title XVIII of the Social 
                Security Act after the date of the implementation of 
                the projects.
    (c) Incentives.--
            (1) Performance targets.--The Secretary shall establish for 
        each home health agency participating in a pilot project under 
        this section a performance target using one of the following 
        methodologies, as determined appropriate by the Secretary:
                    (A) Adjusted historical performance target.--The 
                Secretary shall establish for the agency--
                            (i) a base expenditure amount equal to the 
                        average total payments made under parts A, B, 
                        and D of title XVIII of the Social Security Act 
                        for Medicare beneficiaries determined to be 
                        within the scope of the pilot project in a base 
                        period determined by the Secretary; and
                            (ii) an annual per capita expenditure 
                        target for such beneficiaries, reflecting the 
                        base expenditure amount adjusted for risk, 
                        changes in costs, and growth rates.
                    (B) Comparative performance target.--The Secretary 
                shall establish for the agency a comparative 
                performance target equal to the average total payments 
                made under such parts A, B, and D during the pilot 
                project for comparable individuals in the same 
                geographic area that are not determined to be within 
                the scope of the pilot project.
            (2) Payment.--Subject to paragraph (3), the Secretary shall 
        pay to each home health agency participating in a pilot project 
        a payment for each year under the pilot project equal to a 75 
        percent share of the total Medicare cost savings realized for 
        such year relative to the performance target under paragraph 
        (1).
            (3) Limitation on expenditures.--The Secretary shall limit 
        payments under this section in order to ensure that the 
        aggregate expenditures under title XVIII of the Social Security 
        Act (including payments under this subsection) do not exceed 
        the amount that the Secretary estimates would have been 
        expended if the pilot projects under this section had not been 
        implemented, including any reasonable costs incurred by the 
        Secretary in the administration of the pilot projects.
            (4) No duplication in participation in shared savings 
        programs.--A home health agency that participates in any of the 
        following shall not be eligible to participate in the pilot 
        projects under this section:
                    (A) A model tested or expanded under section 1115A 
                of the Social Security Act (42 U.S.C. 1315a) that 
                involves shared savings under title XVIII of such Act 
                or any other program or demonstration project that 
                involves such shared savings.
                    (B) The independence at home medical practice 
                demonstration program under section 1866E of such Act 
                (42 U.S.C. 1395cc-5).
    (d) Waiver Authority.--The Secretary may waive such provisions of 
titles XI and XVIII of the Social Security Act as the Secretary 
determines to be appropriate for the conduct of the pilot projects 
under this section.
    (e) Report to Congress.--Not later than 3 years after the date that 
the first pilot project under this section is implemented, the 
Secretary shall submit to Congress a report on the projects. Such 
report shall contain--
            (1) a detailed description of the projects, including any 
        changes in clinical outcomes for Medicare beneficiaries under 
        the projects, Medicare beneficiary satisfaction under the 
        projects, utilization of items and services under parts A, B, 
        and D of title XVIII of the Social Security Act by Medicare 
        beneficiaries under the projects, and Medicare per-beneficiary 
        and Medicare aggregate spending under the projects;
            (2) a detailed description of issues related to the 
        expansion of the projects under subsection (f);
            (3) recommendations for such legislation and administrative 
        actions as the Secretary considers appropriate; and
            (4) other items considered appropriate by the Secretary.
    (f) Expansion.--If the Secretary determines that any of the pilot 
projects under this section enhance health outcomes for Medicare 
beneficiaries and reduce expenditures under title XVIII of the Social 
Security Act, the Secretary shall initiate comparable projects in 
additional areas.
    (g) Payments Have No Effect on Other Medicare Payments to Home 
Health Agencies.--A payment under this section shall have no effect on 
the amount of payments that a home health agency would otherwise 
receive under title XVIII of the Social Security Act for the provision 
of home health services.
    (h) Study and Report on the Appropriate Valuation for Remote 
Patient Monitoring Services Under the Medicare Physician Fee 
Schedule.--
            (1) Study.--The Secretary shall conduct a study on the 
        appropriate valuation for remote patient monitoring services 
        under the Medicare physician fee schedule under section 1848 of 
        the Social Security Act (42 U.S.C. 1395w-4) in order to 
        accurately reflect the resources involved in furnishing such 
        services.
            (2) Report.--Not later than 6 months after the date of the 
        enactment of this Act, the Secretary shall submit to Congress a 
        report on the study conducted under paragraph (1), together 
        with such recommendations as the Secretary determines 
        appropriate.
    (i) Definitions.--In this section:
            (1) Home health agency.--The term ``home health agency'' 
        has the meaning given that term in section 1861(o) of the 
        Social Security Act (42 U.S.C. 1395x(o)).
            (2) Remote patient monitoring services.--
                    (A) In general.--The term ``remote patient 
                monitoring services'' means services furnished in the 
                home using remote patient monitoring technology which--
                            (i) shall include patient monitoring or 
                        patient assessment; and
                            (ii) may include in-home technology-based 
                        professional consultations, patient training 
                        services, clinical observation, treatment, and 
                        any additional services that utilize 
                        technologies specified by the Secretary.
                    (B) Limitation.--The term ``remote patient 
                monitoring services'' shall not include a 
                telecommunication that consists solely of a telephone 
                audio conversation, facsimile, or electronic text mail 
                between a health care professional and a patient.
            (3) Remote patient monitoring technology.--The term 
        ``remote patient monitoring technology'' 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) 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.
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

SEC. 250. COMMUNITY-BASED INSTITUTIONAL SPECIAL NEEDS PLAN 
              DEMONSTRATION PROGRAM.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall establish a 
Community-Based Institutional Special Needs Plan (CBI-SNP) 
demonstration program to prevent and delay institutionalization under 
Medicaid among targeted low-income Medicare beneficiaries.
    (b) Establishment.--The Secretary shall enter into agreements with 
not more than 5 specialized MA plans for special needs individuals, as 
defined in section 1859(b)(6)(B)(i) of the Social Security Act (42 
U.S.C. 1395w-28(b)(6)(B)(i)), to conduct the CBI-SNP demonstration 
program. Under the CBI-SNP demonstration program, a targeted low-income 
Medicare beneficiary shall receive, as supplemental benefits under 
section 1852(a)(3) of such Act (42 U.S.C. 1395w-22(a)(3)), long-term 
care services or supports that--
            (1) the Secretary determines appropriate for the purposes 
        of the CBI-SNP demonstration program; and
            (2) for which payment may be made under the State plan 
        under title XIX of such Act (42 U.S.C. 1396 et seq.) of the 
        State in which the targeted low-income Medicare beneficiary is 
        located.
    (c) Eligible Plans.--To be eligible to participate in the CBI-SNP 
demonstration program, a specialized MA plan for special needs 
individuals must--
            (1) serve special needs individuals (as defined in section 
        1859(b)(6)(B)(i) of the Social Security Act (42 U.S.C. 1395w-
        28(b)(6)(B)(i));
            (2) have experience in offering special needs plans for 
        nursing home-eligible, non-institutionalized Medicare 
        beneficiaries who live in the community;
            (3) be located in a State that the Secretary has determined 
        will participate in the CBI-SNP demonstration program by 
        agreeing to make available data necessary for purposes of 
        conducting the independent evaluation required under subsection 
        (f); and
            (4) meet such other criteria as the Secretary may require.
    (d) Targeted Low-income Medicare Beneficiary Defined.--In this 
section, the term ``targeted low-income Medicare beneficiary'' means a 
Medicare beneficiary who--
            (1) is enrolled in a specialized MA plan for special needs 
        individuals that has been selected to participate in the CBI-
        SNP demonstration program;
            (2) is a subsidy eligible individual (as defined in section 
        1860D-14(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-
        114(a)(3)(A)); and
            (3) is unable to perform 2 or more activities of daily 
        living (as defined in section 7702B(c)(2)(B) of the Internal 
        Revenue Code of 1986).
    (e) Implementation Deadline; Duration.--The CBI-SNP demonstration 
program shall be implemented not later than January 1, 2016, and shall 
be conducted for a period of 3 years.
    (f) Independent Evaluation and Reports.--
            (1) Independent evaluation.--Not later than 2 years after 
        the completion of the CBI-SNP demonstration program, the 
        Secretary shall provide for the evaluation of the CBI-SNP 
        demonstration program by an independent third party. The 
        evaluation shall determine whether the CBI-SNP demonstration 
        program has improved patient care and quality of life for the 
        targeted low-income Medicare beneficiaries participating in the 
        CBI-SNP demonstration program. Specifically, the evaluation 
        shall determine if the CBI-SNP demonstration program has--
                    (A) reduced hospitalizations or re-
                hospitalizations;
                    (B) reduced Medicaid nursing home facility stays; 
                and
                    (C) reduced spenddown of income and assets for 
                purposes of becoming eligible for Medicaid.
            (2) Reports.--Not later than 3 years after the completion 
        of the CBI-SNP demonstration program, the Secretary shall 
        submit to Congress a report containing the results of the 
        evaluation conducted under paragraph (1), together with such 
        recommendations for legislative or administrative action as the 
        Secretary determines appropriate.
    (g) Funding.--
            (1) Funding for implementation.--For purposes of carrying 
        out the demonstration program under this section (other than 
        the evaluation and report under subsection (f)), the Secretary 
        shall provide for the transfer from the Federal Hospital 
        Insurance Trust Fund under section 1817 of the Social Security 
        Act (42 U.S.C. 1395i) and the Federal Supplementary Medical 
        Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 
        1395t), in such proportion as the Secretary determines 
        appropriate, of $3,000,000 to the Centers for Medicare & 
        Medicaid Services Program Management Account.
            (2) Funding for evaluation and report.--For purposes of 
        carrying out the evaluation and report under subsection (f), 
        the Secretary shall provide for the transfer from the Federal 
        Hospital Insurance Trust Fund under such section 1817 and the 
        Federal Supplementary Medical Insurance Trust Fund under such 
        section 1841, in such proportion as the Secretary determines 
        appropriate, of $500,000.
            (3) Availability.--Amounts transferred under paragraph (1) 
        or (2) shall remain available until expended.
    (h) Budget Neutrality.--In conducting the CBI-SNP demonstration 
program, the Secretary shall ensure that the aggregate payments made by 
the Secretary do not exceed the amount which the Secretary estimates 
would have been expended under titles XVIII and XIX of the Social 
Security Act (42 U.S.C. 1395 et seq., 1396 et seq.) if the CBI-SNP 
demonstration program had not been implemented.
    (i) Paperwork Reduction Act.--Chapter 35 of title 44, United States 
Code, shall not apply to the testing and evaluation of the CBI-SNP 
demonstration program under this section.

SEC. 251. APPLYING CMMI WAIVER AUTHORITY TO PACE IN ORDER TO FOSTER 
              INNOVATIONS.

    (a) CMMI Waiver Authority.--Subsection (d)(1) of section 1115A of 
the Social Security Act (42 U.S.C. 1315a) is amended--
            (1) by inserting ``(other than subsections (b)(1)(A) and 
        (c)(5) of section 1894)'' after ``XVIII''; and
            (2) by striking ``and 1903(m)(2)(A)(iii)'' and inserting 
        ``1903(m)(2)(A)(iii), and 1934 (other than subsections 
        (b)(1)(A) and (c)(5) of such section)''.
    (b) Sense of the Senate.--It is the sense of the Senate that the 
Secretary of Health and Human Services should use the waiver authority 
provided under the amendments made by this section to provide, in a 
budget neutral manner, programs of all-inclusive care for the elderly 
(PACE programs) with increased operational flexibility to support the 
ability of such programs to improve and innovate and to reduce 
technical and administrative barriers that have hindered enrollment in 
such programs.

SEC. 252. IMPROVE AND MODERNIZE MEDICAID DATA SYSTEMS AND REPORTING.

    (a) In General.--The Secretary of Health and Human Services shall 
implement a strategic plan to increase the usefulness of data about 
State Medicaid programs reported by States to the Centers for Medicare 
& Medicaid Services. The strategic plan shall address redundancies and 
gaps in Medicaid data systems and reporting through improvements to, 
and modernization of, computer and data systems. Areas for improvement 
under the plan shall include (but not be limited to) the following:
            (1) The reporting of encounter data by managed care plans.
            (2) The timeliness and quality of reported data, including 
        enrollment data.
            (3) The consistency of data reported from multiple sources.
            (4) Information about State program policies.
    (b) Implementation Status Report.--Not later than 1 year after the 
date of enactment of this Act, the Secretary of Health and Human 
Services shall submit a report to Congress on the status of the 
implementation of the strategic plan required under subsection (a).
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary of Health and Human Services for the 
period of fiscal years 2015 through 2109, such sums as may be necessary 
to carry out this section.

SEC. 253. FAIRNESS IN MEDICAID SUPPLEMENTAL NEEDS TRUSTS.

    (a) In General.--Section 1917(d)(4)(A) of the Social Security Act 
(42 U.S.C. 1396p(d)(4)(A)) is amended by inserting ``the individual,'' 
after ``for the benefit of such individual by''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to trusts established on or after the date of the enactment of 
this Act.

SEC. 254. HELPING ENSURE LIFE- AND LIMB-SAVING ACCESS TO PODIATRIC 
              PHYSICIANS.

    (a) Including Podiatrists as Physicians Under the Medicaid 
Program.--
            (1) In general.--Section 1905(a)(5)(A) of the Social 
        Security Act (42 U.S.C. 1396d(a)(5)(A)) is amended by striking 
        ``section 1861(r)(1)'' and inserting ``paragraphs (1) and (3) 
        of section 1861(r)''.
            (2) Effective date.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the amendment made by paragraph (1) shall apply to 
                services furnished on or after the date of enactment of 
                this Act.
                    (B) Extension of effective date for state law 
                amendment.--In the case of a State plan under title XIX 
                of the Social Security Act (42 U.S.C. 1396 et seq.) 
                which the Secretary of Health and Human Services 
                determines requires State legislation in order for the 
                plan to meet the additional requirement imposed by the 
                amendment made by paragraph (1), the State plan shall 
                not be regarded as failing to comply with the 
                requirements of such title solely on the basis of its 
                failure to meet these additional requirements before 
                the first day of the first calendar quarter beginning 
                after the close of the first regular session of the 
                State legislature that begins after the date of 
                enactment of this Act. For purposes of the previous 
                sentence, in the case of a State that has a 2-year 
                legislative session, each year of the session is 
                considered to be a separate regular session of the 
                State legislature.
    (b) Modifications to Requirements for Diabetic Shoes to Be Included 
Under Medical and Other Health Services Under Medicare.--
            (1) In general.--Section 1861(s)(12) of the Social Security 
        Act (42 U.S.C. 1395x(s)(12)) is amended to read as follows:
            ``(12) subject to section 4072(e) of the Omnibus Budget 
        Reconciliation Act of 1987, extra-depth shoes with inserts or 
        custom molded shoes (in this paragraph referred to as 
        `therapeutic shoes') with inserts for an individual with 
        diabetes, if--
                    ``(A) the physician who is managing the 
                individual's diabetic condition--
                            ``(i) documents that the individual has 
                        diabetes;
                            ``(ii) certifies that the individual is 
                        under a comprehensive plan of care related to 
                        the individual's diabetic condition; and
                            ``(iii) documents agreement with the 
                        prescribing podiatrist or other qualified 
                        physician (as established by the Secretary) 
                        that it is medically necessary for the 
                        individual to have such extra-depth shoes with 
                        inserts or custom molded shoes with inserts;
                    ``(B) the therapeutic shoes are prescribed by a 
                podiatrist or other qualified physician (as established 
                by the Secretary) who--
                            ``(i) examines the individual and 
                        determines the medical necessity for the 
                        individual to receive the therapeutic shoes; 
                        and
                            ``(ii) communicates in writing the medical 
                        necessity to the physician described in 
                        subparagraph (A) for the individual to have 
                        therapeutic shoes along with findings that the 
                        individual has peripheral neuropathy with 
                        evidence of callus formation, a history of pre-
                        ulcerative calluses, a history of previous 
                        ulceration, foot deformity, previous 
                        amputation, or poor circulation; and
                    ``(C) the therapeutic shoes are fitted and 
                furnished by a podiatrist or other qualified supplier 
                (as established by the Secretary), such as a pedorthist 
                or orthotist, who is not the physician described in 
                subparagraph (A) (unless the Secretary finds that the 
                physician is the only such qualified individual in the 
                area);''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply with respect to items and services furnished on or 
        after January 1, 2015.

SEC. 255. DEMONSTRATION PROGRAM TO IMPROVE COMMUNITY MENTAL HEALTH 
              SERVICES.

    (a) Establishment.--Not later than January 1, 2016, the Secretary 
of Health and Human Services (referred to in this section as the 
``Secretary''), in coordination with the Administrator of the Substance 
Abuse and Mental Health Services Administration, shall award planning 
grants to not to exceed 10 States to enable such States to carry out 5-
year demonstration programs to improve the provision of behavioral 
health services provided by certified community behavioral health 
clinics in the State.
    (b) Eligibility.--
            (1) Application.--To be eligible to receive a grant under 
        subsection (a), a State shall--
                    (A) submit to the Secretary an application at such 
                time, in such manner, and containing such information 
                as the Secretary may require;
                    (B) certify to the Secretary that behavioral health 
                providers that are provided assistance under the 
                demonstration program meet the criteria for certified 
                community behavioral health clinics under subsection 
                (c);
                    (C) conduct a financial assessment of the 
                demonstration program to be carried out under the grant 
                by providing a detailed estimate of eligible clinics 
                and Medicaid expenditures over the entire projected 
                period of the demonstration program; and
                    (D) comply with any other requirement determined 
                appropriate by the Secretary.
            (2) Waiver of medicaid requirement.--In approving States to 
        conduct demonstration programs under this section, the 
        Secretary shall waive section 1902(a)(1) of the Social Security 
        Act (42 U.S.C. 1396a(a)(1)) (relating to statewideness) as may 
        be necessary to conduct the demonstration program in accordance 
        with the requirements of this section
    (c) Criteria.--
            (1) Criteria for certified community behavioral health 
        clinics.--The criteria referred to in subsection (b)(1)(B) are 
        that the center performs each of the following:
                    (A) Provide services in locations that ensure 
                services will be available and accessible promptly and 
                in a manner which preserves human dignity and assures 
                continuity of care.
                    (B) Provide services in a mode of service delivery 
                appropriate for the target population.
                    (C) Provide individuals with a choice of service 
                options, including developmentally appropriate evidence 
                based interventions, where there is more than one 
                efficacious treatment.
                    (D) Employ a core clinical staff that is trained to 
                provide evidence-based practices and is 
                multidisciplinary and culturally and linguistically 
                competent, including the availability of translation or 
                similar services and arrangements if the clinic is 
                located in a geographic area of limited English-
                speaking ability.
                    (E) Establish an emergency plan to support 
                continuity of services for individuals during an 
                emergency or disaster.
                    (F) Demonstrate the capacity to comply with 
                behavioral health and related health care quality 
                measures promulgated by such entities as the National 
                Quality Forum, the National Committee for Quality 
                Assurance, or other nationally recognized accrediting 
                bodies.
                    (G) Provide services to any individual residing or 
                employed in the service area of the clinic and ensure 
                that no patient or consumer will be denied mental 
                health or other health care services due to an 
                individual's inability to pay for such services.
                    (H) Ensure that any fees or payments required by 
                the clinic for such services will be imposed for 
                individuals eligible for medical assistance under the 
                State Medicaid plan under title XIX of the Social 
                Security Act in accordance with the requirements of 
                such State plan and for any other individuals will be 
                reduced or waived to enable the clinic to comply with 
                subparagraph (G), including preparing a schedule of 
                fees or payments for the provision of services that is 
                consistent with locally prevailing rates or charges 
                designed to cover the reasonable costs to the clinic of 
                operation along with a corresponding schedule of 
                discounts to be applied to the payment of such fees or 
                payments, such discounts to be adjusted on the basis of 
                the patient's ability to pay.
                    (I) Report required encounter data, clinical 
                outcomes data, and quality data.
                    (J) Provide, directly or through contract, to the 
                extent covered for adults in the State Medicaid plan 
                under title XIX of the Social Security Act and for 
                children in accordance with section 1905(r) of such Act 
                regarding early and periodic screening, diagnosis, and 
                treatment, each of the following services:
                            (i) Screening, assessment, and diagnosis, 
                        including risk assessment.
                            (ii) Person-centered treatment planning or 
                        similar processes, including risk assessment 
                        and crisis planning.
                            (iii) Outpatient mental health and 
                        substance use services, including screening, 
                        assessment, diagnosis, psychotherapy, cognitive 
                        behavioral therapy, applied behavioral 
                        analysis, medication management, and integrated 
                        treatment for trauma, mental illness, and 
                        substance abuse which shall be evidence-based 
                        (including cognitive behavioral therapy, long 
                        acting injectable medications, and other such 
                        therapies which are evidence-based).
                            (iv) Outpatient clinic primary care 
                        screening and monitoring of key health 
                        indicators and health risk (including screening 
                        for diabetes, hypertension, and cardiovascular 
                        disease and monitoring of weight, height, body 
                        mass index (BMI), blood pressure, blood glucose 
                        or HbA1C, and lipid profile).
                            (v) Crisis mental health services, 
                        including 24-hour mobile crisis teams, 
                        emergency crisis intervention services, and 
                        crisis stabilization.
                            (vi) Targeted case management (services to 
                        assist individuals gaining access to needed 
                        medical, social, educational, and other 
                        services and applying for income security and 
                        other benefits to which they may be entitled), 
                        and care coordination.
                            (vii) Psychiatric rehabilitation services 
                        including skills training, assertive community 
                        treatment, family psychoeducation, disability 
                        self-management, supported employment, 
                        supported housing services, therapeutic foster 
                        care services, and such other evidence-based 
                        practices as the Secretary may require.
                            (viii) Peer support and counselor services 
                        and family supports.
                    (K) Maintain linkages, and where possible enter 
                into formal contracts, agreements, or partnerships with 
                at least one federally qualified health center, unless 
                there is no such center serving the service area, in 
                order to ensure that the delivery of behavioral health 
                care is integrated with primary and preventive care 
                services, so long as such linkages, contract, 
                agreement, or partnership meets requirements as 
                prescribed by the Secretary;
                    (L) Maintain additional linkages and where possible 
                enter into formal contracts with the following:
                            (i) Inpatient psychiatric facilities and 
                        substance use detoxification, post-
                        detoxification step-down services, and 
                        residential programs.
                            (ii) Adult and youth peer support and 
                        counselor services.
                            (iii) Family support services for families 
                        of children with serious mental or substance 
                        use disorders.
                            (iv) Other community or regional services, 
                        supports, and providers, including schools, 
                        child welfare agencies, juvenile and criminal 
                        justice agencies and facilities, Indian Health 
                        Service youth regional treatment centers, 
                        housing agencies and programs, employers, State 
                        licensed and nationally accredited child 
                        placing agencies for therapeutic foster care 
                        service, and other social and human services.
                            (v) Onsite or offsite access to primary 
                        care services.
                            (vi) Enabling services, including outreach, 
                        transportation, and translation.
                            (vii) Health and wellness services, 
                        including services for tobacco cessation.
                            (viii) Department of Veterans Affairs 
                        medical centers, independent outpatient 
                        clinics, drop-in centers, and other facilities 
                        of the Department as defined in section 1801 of 
                        title 38, United States Code.
                            (ix) Inpatient acute care hospitals and 
                        hospital outpatient clinics.
                    (M) Where feasible, provide outreach and engagement 
                to encourage individuals who could benefit from mental 
                health care to freely participate in receiving the 
                administrative services described in this subsection.
                    (N) Where feasible, provide intensive, community-
                based mental health care for members of the armed 
                forces and veterans, particularly those members and 
                veterans located in rural areas, such care to be 
                consistent with minimum clinical mental health 
                guidelines promulgated by the Veterans Health 
                Administration including clinical guidelines contained 
                in the Uniform Mental Health Services Handbook of such 
                Administration.
                    (O) Where feasible, require certified community 
                behavioral health clinics to provide valid and reliable 
                trauma screening and functional or developmental 
                assessment to determine need, match services to needs, 
                and to measure progress over time.
            (2) Regulations.--Prior to the selection of participating 
        States, and not later than 18 months after the date of the 
        enactment of this Act, the Secretary, in consultation with the 
        Substance Abuse and Mental Health Services Administration and 
        the State Mental Health and Substance Abuse Authorities, shall 
        issue final regulations for certifying non-profit and local 
        government behavioral health authorities and Indian Health 
        Service tribal facilities as community behavioral health 
        clinics.
    (d) Requirements.--In awarding grants under this section, the 
Secretary shall--
            (1) ensure the geographic diversity of grantee States;
            (2) ensure that certified community behavioral health 
        clinics in such States that are located in rural areas, as 
        defined by the Secretary, and other mental health professional 
        shortage areas are fairly and appropriately considered with the 
        objective of facilitating access to mental health services in 
        such areas;
            (3) take into account the ability of clinics in such States 
        to provide required services, and the ability of such clinics 
        to report required data as required under this section; and
            (4) take into account the ability of such States to provide 
        such required services on a statewide basis.
    (e) Exemption.--For purposes of this section, certified community 
behavioral health clinics that receive payments under section 1902(bb) 
of the Social Security Act which are located in rural areas, as defined 
by the Secretary, shall be exempt from the requirements contained in 
subparagraphs (A) and (J)(v) of subsection (c)(1).
    (f) Treatment of Certain Services Provided by Community Behavioral 
Health Clinics as Medical Assistance.--
            (1) In general.--For purposes of the demonstration program 
        under this section, community behavioral health clinic services 
        (as defined in subsection (h)(1)) that are provided by 
        certified community behavioral health clinics receiving 
        assistance under this section shall be considered medical 
        assistance for purposes of payments to States under paragraph 
        (3)(C).
            (2) Grant condition.--As a condition of receiving a grant 
        under this section, a State shall agree to provide for payment 
        for community behavioral health clinic services in accordance 
        with the prospective payment system established by the 
        Secretary under paragraph (3).
            (3) Prospective payment system.--
                    (A) In general.--Not later than 18 months after the 
                date of enactment of this Act, the Secretary shall 
                establish a prospective payment system for community 
                behavioral health clinic services furnished by a 
                community behavioral health clinic receiving assistance 
                under this section in the same manner as payments are 
                required to be made under section 1902(bb) of the 
                Social Security Act (42 U.S.C. 1396a(bb)) for services 
                described in section 1905(a)(2)(C) of such Act (42 
                U.S.C. 1396d(a)(2)(C)) furnished by a Federally-
                qualified health center and services described in 
                section 1905(a)(2)(B) of such Act (42 U.S.C. 
                1396d(a)(2)(B)) furnished by a rural health clinic.
                    (B) Requirements.--The prospective payment system 
                established by the Secretary under subparagraph (A) 
                shall provide that--
                            (i) no payment shall be made for inpatient 
                        care, residential treatment, room and board 
                        expenses, or any other non-ambulatory services, 
                        as determined by the Secretary; and
                            (ii) no payment shall be made to satellite 
                        facilities of community behavioral health 
                        clinics if such facilities are established 
                        after the date of enactment of this Act.
                    (C) Payments to states.--The Secretary shall pay 
                each State awarded a grant under this section an amount 
                each quarter equal to the enhanced FMAP (as defined in 
                section 2105(b) of the Social Security Act (42 U.S.C. 
                1397dd(b)) but without regard to the second and third 
                sentences of that section) of the State's expenditures 
                in the quarter for medical assistance for community 
                behavioral health clinic services provided by certified 
                community behavioral health clinics in the State that 
                receive assistance under this section. Payments to 
                States made under this subparagraph shall be considered 
                to have been under, and are subject to the requirements 
                of, section 1903 of the Social Security Act (42 U.S.C. 
                1396b).
    (g) Annual Report.--
            (1) In general.--Not later than 1 year after the date on 
        which the first grants are awarded under this section, and 
        annually thereafter, the Secretary shall submit to Congress an 
        annual report on the use of funds provided under the 
        demonstration program. Each such report shall include--
                    (A) an assessment of access to community-based 
                mental health services under the Medicaid program in 
                the States awarded such grants;
                    (B) an assessment of the quality and scope of 
                services provided by certified community behavioral 
                health clinics under the grants as compared against 
                community-based mental health services provided in 
                States that are not receiving such grants; and
                    (C) an assessment of the impact of the 
                demonstration programs on the costs of a full range of 
                mental health services (including inpatient, emergency 
                and ambulatory services).
            (2) Recommendations.--Not later than December 31, 2019, the 
        Secretary shall submit to Congress recommendations concerning 
        whether the demonstration programs under this section should be 
        continued and expanded on a national basis.
    (h) Definitions.--In this section:
            (1) Community behavioral health clinic services.--The term 
        ``community behavioral health clinic services'' means 
        ambulatory behavioral health services of the type described in 
        subparagraphs (J), (M), (N), and (O) of subsection (c)(1) that 
        are provided by certified community behavioral health clinics 
        receiving assistance under this section.
            (2) State.--The term ``State'' has the meaning given such 
        term for purposes of title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.).
    (i) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $50,000,000 for fiscal year 
2016, to remain available until expended.

SEC. 256. ANNUAL MEDICAID DSH REPORT.

    Section 1923 of the Social Security Act (42 U.S.C. 1396r-4) is 
amended by adding at the end the following:
    ``(k) Annual Report to Congress.--
            ``(1) In general.--Beginning January 1, 2015, and annually 
        thereafter, the Secretary shall submit a report to Congress on 
        the program established under this section for making payment 
        adjustments to disproportionate share hospitals for the purpose 
        of providing Congress with information relevant to determining 
        an appropriate level of overall funding for such payment 
        adjustments during and after the period in which aggregate 
        reductions in the DSH allotments to States are required under 
        paragraphs (7) and (8) of subsection (f).
            ``(2) Required report information.--Except as otherwise 
        provided, each report submitted under this subsection shall 
        include the following:
                    ``(A) Information and data relating to changes in 
                the number of uninsured individuals for the most recent 
                year for which such data are available as compared to 
                2013 and as compared to the Congressional Budget Office 
                estimates of uninsured individuals made at the time of 
                the enactment of the Patient Protection and Affordable 
                Care Act (Public Law 111-148) and the Health Care and 
                Education Reconciliation Act of 2010 (Public Law 111-
                152).
                    ``(B) Information and data relating to the extent 
                to which hospitals continue to incur uncompensated care 
                costs from providing unreimbursed or under-reimbursed 
                services to individuals who either are eligible for 
                medical assistance under the State plan under this 
                title or under a waiver of such plan or who have no 
                health insurance (or other source of third party 
                coverage) for such services.
                    ``(C) Information and data relating to the extent 
                to which hospitals continue to provide charity care and 
                unreimbursed or under-reimbursed services, or otherwise 
                incur bad debt, under the program established under 
                this title, the State Children's Health Insurance 
                Program established under title XXI, and State or local 
                indigent care programs, as reported on cost reports 
                submitted under title XVIII or such other data as the 
                Secretary determines appropriate.
                    ``(D) In the first report submitted under this 
                section, a methodology for estimating the amount of 
                unpaid patient deductibles, copayments and coinsurance 
                incurred by hospitals for patients enrolled in 
                qualified health plans through an American Health 
                Benefits Exchange, using existing data and minimizing 
                the administrative burden on hospitals to the extent 
                possible, and in subsequent reports, data regarding 
                such uncompensated care costs collected pursuant to 
                such methodology.
                    ``(E) For each State, information and data relating 
                to the difference between the DSH allotment for the 
                State for the fiscal year that began on October 1 of 
                the year preceding the year in which the report is 
                submitted and the aggregate amount of uncompensated 
                care costs for all disproportionate share hospitals in 
                the State.
                    ``(F) Information and data relating to the extent 
                to which there are certain vital hospital systems that 
                are disproportionately experiencing high levels of 
                uncompensated care and that have multiple other 
                missions, such as a commitment to graduate medical 
                education, the provision of tertiary and trauma care 
                services, providing public health and essential 
                community services, and providing comprehensive, 
                coordinated care.
                    ``(G) Such other information and data relevant to 
                the determination of the level of funding for, and 
                amount of, State DSH allotments as the Secretary 
                determines appropriate
            ``(3) Authorization of appropriations.--There is authorized 
        to be appropriated to the Secretary for the period of fiscal 
        years 2015 through 2109, such sums as may be necessary to carry 
        out this subsection.''.

SEC. 257. IMPLEMENTATION.

    To the extent the Secretary of Health and Human Services issues a 
regulation to carry out the provisions of this Act, the Secretary 
shall, unless otherwise specified in this Act--
            (1) issue a notice of proposed rulemaking that includes the 
        proposed regulation;
            (2) provide a period of not less than 60 calendar days for 
        comments on the proposed regulation;
            (3) not more than 24 months following the date of 
        publication of the proposed rule, publish the final regulation 
        or take alternative action (such as withdrawing the rule or 
        proposing a revised rule with a new comment period) on the 
        proposed regulation; and
            (4) not less than 30 days before the effective date of the 
        final regulation, publish the final regulation or take 
        alternative action (such as withdrawing the rule or proposing a 
        revised rule with a new comment period) on the proposed 
        regulation.
                                                       Calendar No. 280

113th CONGRESS

  1st Session

                                S. 1871

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                                 A BILL

To amend title XVIII of the Social Security Act to repeal the Medicare 
sustainable growth rate formula and to improve beneficiary access under 
             the Medicare program, and for other purposes.

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                           December 19, 2013

                 Read twice and placed on the calendar