[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1458 Introduced in House (IH)]

114th CONGRESS
  1st Session
                                H. R. 1458

  To amend title XVIII of the Social Security Act to provide bundled 
payments for post-acute care services under parts A and B of Medicare, 
                        and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 19, 2015

Mr. McKinley (for himself, Mr. Tom Price of Georgia, and Mr. McNerney) 
 introduced the following bill; which was referred to the Committee on 
    Ways and Means, and in addition to the Committee on Energy and 
Commerce, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to provide bundled 
payments for post-acute care services under parts A and B of Medicare, 
                        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.

    This Act may be cited as the ``Bundling and Coordinating Post-Acute 
Care Act of 2015'' and as the ``BACPAC Act of 2015''.

SEC. 2. PURPOSES.

    The purposes of this Act are to--
            (1) foster the delivery of high-quality post-acute care 
        services in the most cost-effective manner possible;
            (2) preserve the ability of patients, with the guidance of 
        their physicians, to select their preferred providers of post-
        acute care services;
            (3) promote competition among post-acute care providers on 
        the basis of quality, cost, accountability, and customer 
        service;
            (4) achieve long-term sustainability by ensuring 
        operational stability through regional breadth and the 
        engagement of experienced care PAC coordinators;
            (5) advance innovation in fields including telehealth, care 
        coordination, medication management, and hospitalization 
        avoidance; and
            (6) provide for the financial security of the Medicare 
        program by achieving substantial program savings through 
        maximized efficiencies, cost avoidance, and outcomes 
        improvement.

SEC. 3. PROVIDING BUNDLED PAYMENTS FOR POST-ACUTE CARE SERVICES UNDER 
              PARTS A AND B OF MEDICARE.

    Title XVIII of the Social Security Act is amended by inserting 
after section 1866E (42 U.S.C. 1395cc-5) the following new section:

       ``providing bundled payments for post-acute care services

    ``Sec. 1866F.  (a) In General.--For a PAC bundle with respect to 
qualifying discharges occurring on or after January 1, 2017, instead of 
the payment otherwise provided under parts A and B, there shall be paid 
a single payment amount (determined under subsection (d) and as limited 
under paragraph (4) of such subsection) to be paid to a PAC coordinator 
(as described in subsection (c)) selected by an individual under such 
subsection.
    ``(b) PAC-Related Definitions.--In this section:
            ``(1) PAC bundle.--The term `PAC bundle' means PAC services 
        furnished to an individual during a PAC period in a PAC area.
            ``(2) PAC services.--
                    ``(A) In general.--The term `PAC services' 
                includes--
                            ``(i) post-hospital extended care services, 
                        subject to subparagraph (C)(i);
                            ``(ii) home health services, subject to 
                        clauses (ii) and (iii) of subparagraph (C);
                            ``(iii) inpatient services provided in a 
                        rehabilitation facility, subject to 
                        subparagraph (C)(iii);
                            ``(iv) inpatient hospital services provided 
                        by a long-term care hospital, subject to 
                        subparagraph (C)(iv);
                            ``(v) durable medical equipment;
                            ``(vi) outpatient physical therapy 
                        services;
                            ``(vii) outpatient occupational therapy 
                        services;
                            ``(viii) outpatient prescription drugs and 
                        biologicals; and
                            ``(ix) skilled nursing facility services.
                    ``(B) Exceptions.--Such term does not include--
                            ``(i) physicians' services;
                            ``(ii) hospice care;
                            ``(iii) outpatient hospital services;
                            ``(iv) ambulance services;
                            ``(v) outpatient speech-language pathology 
                        services; and
                            ``(vi) the items and services described in 
                        section 1861(s)(9).
                    ``(C) Nonapplication of certain coverage 
                limitations.--
                            ``(i) Waiver of skilled nursing facility 
                        three day stay requirement.--In applying 
                        subparagraph (A)(i), the 3-day stay requirement 
                        described in section 1861(i) (requiring that an 
                        individual's inpatient stay in a discharging 
                        hospital be for a duration of not less than 3 
                        consecutive days) shall not apply.
                            ``(ii) Waiver of homebound requirement for 
                        home health services.--In applying subparagraph 
                        (A)(ii), the requirements cited in sections 
                        1814(a)(2)(C) and 1835(a)(2)(A) that home 
                        health services are or were required because 
                        the individual is or was confined to the home 
                        of the individual shall not apply.
                            ``(iii) Waiver of face-to-face 
                        documentation requirement.--In applying the 
                        subparagraph (A)(ii), the requirements cited in 
                        sections 1814(a)(2)(C) and 1835(a)(2)(A) that 
                        the face-to-face encounter described in each 
                        such section must be documented shall not 
                        apply.
                            ``(iv) Nonapplication of rehabilitation 
                        facility percentage requirement.--In applying 
                        subparagraph (A)(iii), any requirement that a 
                        specified percentage of the inpatient 
                        population served by the facility require 
                        intensive rehabilitation services for treatment 
                        of one or more of the conditions specified in 
                        section 412.29(b)(2) of title 42, Code of 
                        Federal Regulations, as of December 19, 2013, 
                        shall not apply.
                            ``(v) Nonapplication of long-term care 
                        hospital percentage requirement.--In applying 
                        subparagraph (A)(iv), any requirement that a 
                        specified percentage of the discharged Medicare 
                        inpatient population of the long-term care 
                        hospital or its satellite facility be admitted 
                        to the hospital or its satellite facility from 
                        its co-located hospital shall not apply.
                            ``(vi) Nonapplication of such other 
                        requirements as determined by the secretary.--
                        In applying subparagraph (A), any other such 
                        requirement that the Secretary determines it is 
                        necessary not to apply in order to ensure 
                        appropriate implementation of this section 
                        shall not apply.
            ``(3) PAC period.--The term `PAC period' means the period 
        beginning on the date of a qualifying discharge (as defined in 
        paragraph (10)) and ending on the date that is the earlier of 
        the following:
                    ``(A) The date that is 90 days after the date of 
                such discharge.
                    ``(B) The date on which the individual is admitted 
                to a hospital for purposes of receiving services for a 
                condition that is not related to the condition for 
                which the individual received the acute care inpatient 
                hospital services described in paragraph (10)(A).
            ``(4) PAC area.--The term `PAC area' means an area with 
        respect to which a PAC coordinator has a PAC agreement in 
        effect under subsection (c)(1)(B).
            ``(5) PAC physician.--The term `PAC physician' means, with 
        respect to an individual receiving a PAC bundle, the physician 
        who has primary responsibility with respect to supervising the 
        delivery of services during the course of a PAC period.
            ``(6) PAC provider.--The term `PAC provider' means, with 
        respect to PAC services, the provider of services or supplier 
        furnishing such services.
            ``(7) PAC network agreement.--The term `PAC network 
        agreement' means, in the case that an individual has selected a 
        PAC coordinator under subsection (c)(4)(A) for the furnishing 
        of PAC services, an agreement of a PAC coordinator with one or 
        more PAC providers to provide such services to such individual.
            ``(8) PAC readmission.--The term `PAC readmission' means, 
        with respect to an individual receiving a PAC bundle, the 
        individual's admission to a hospital within 90 days of the date 
        of the qualifying discharge of the individual, for purposes of 
        receiving services for a condition that is related to the 
        condition for which the individual received the acute care 
        inpatient hospital services described in paragraph (10)(A).
            ``(9) PAC assessment tool.--The term `PAC assessment tool' 
        means the Continuity Assessment Record and Evaluation (CARE) 
        tool (or such equivalent assessment tool as the Secretary may 
        specify).
            ``(10) Qualifying discharge.--Subject to subsection (e), 
        the term `qualifying discharge' means a discharge after 
        receiving acute care inpatient hospital services (as defined by 
        the Secretary) in a subsection (d) hospital (as defined in 
        section 1886(d)(1)(B)) for which the discharge plan includes 
        the furnishing of PAC services.
            ``(11) CRG.--The term `CRG' means a condition-related group 
        established under subsection (d)(1).
    ``(c) PAC Coordinators.--
            ``(1) In general.--In this section, the term `PAC 
        coordinator' means a hospital, PAC provider, insurer, third-
        party administrator, or combination of hospital and PAC 
        provider that--
                    ``(A) is certified, under a process established by 
                the Secretary, as meeting appropriate requirements 
                specified by the Secretary, including the requirements 
                specified in paragraph (2); and
                    ``(B) has entered into and has in effect a PAC 
                agreement with the Secretary described in paragraph 
                (3).
        For purposes of subparagraph (A), an entity that meets the 
        requirements specified in paragraph (2) directly or indirectly 
        (including through an arrangement with one or more insurance 
        providers or benefits administrators) shall be considered as 
        meeting the requirements specified in such paragraph.
            ``(2) Requirements.--The requirements specified in this 
        paragraph, with respect to an entity serving a PAC area, are 
        the following:
                    ``(A) Financial solvency.--The entity has the 
                capacity, and provides sufficient assurances of 
                solvency, to bear financial risk as a PAC coordinator 
                under this section.
                    ``(B) Capacity to manage care and funding.--The 
                entity has the capability to manage the care and 
                funding for PAC services in such area.
                    ``(C) PAC network agreements.--
                            ``(i) Network capacity to serve pac area.--
                                    ``(I) In general.--The entity has 
                                entered into PAC network agreements 
                                with a sufficient number of PAC 
                                providers in a PAC area to meet, with 
                                respect to such area, such network 
                                adequacy requirements as are 
                                established by the Secretary.
                                    ``(II) Preservation of patient 
                                choice.--The network adequacy 
                                requirements described in subclause (I) 
                                shall include a requirement that the 
                                entity has, with respect to any group 
                                of PAC providers described in subclause 
                                (III), a governance or financial 
                                relationship (outside of the PAC 
                                network agreement) with less than 50 
                                percent of the PAC providers in such 
                                group.
                                    ``(III) Groups described.--The 
                                groups of PAC providers described in 
                                this subclause are the following:
                                            ``(aa) The group of all the 
                                        PAC providers with which the 
                                        entity has entered into PAC 
                                        network agreements.
                                            ``(bb) Any group of PAC 
                                        providers with which the entity 
                                        has entered into PAC network 
                                        agreements that consists solely 
                                        of a single type of provider 
                                        and that includes all of the 
                                        PAC providers with which the 
                                        entity has entered into such 
                                        agreements that are such type 
                                        of provider.
                            ``(ii) Limitation on balance billing.--Such 
                        a PAC network agreement shall provide that the 
                        PAC provider shall accept as payment in full 
                        for PAC services furnished by such PAC provider 
                        the applicable amount described in paragraph 
                        (3)(C).
                            ``(iii) Quality assurance.--Such a PAC 
                        network agreement shall provide that the PAC 
                        provider shall have in effect a written plan of 
                        quality assurance and improvement, and 
                        procedures implementing such plan, that meet 
                        such quality standards as the Secretary 
                        specifies.
                    ``(D) Credit-worthiness.--The entity has 
                demonstrated credit-worthiness.
                    ``(E) Medical director.--The entity employs or 
                contracts with a medical director who has an 
                appropriate medical background.
                    ``(F) PAC coordinator performance.--The entity has 
                in effect a written plan of quality assurance and 
                improvement, and procedures implementing such plan, 
                that meet such quality standards as the Secretary may 
                specify. For purposes of implementing the preceding 
                sentence, the standards specified by the Secretary 
                shall address access to care, beneficiary choice, 
                clinical quality of network providers, patient 
                experience of care, care coordination, efficiency, and 
                such other domains as are identified by the Secretary.
            ``(3) Terms of pac agreement.--The PAC agreement described 
        in this paragraph between an entity and the Secretary shall, 
        with respect to the PAC area specified under subparagraph (B), 
        have such terms and conditions as are specified by the 
        Secretary consistent with this section and shall include the 
        following:
                    ``(A) Care coordination.--With respect to an 
                individual who selects the entity under paragraph 
                (4)(A)--
                            ``(i) the individual shall select one or 
                        more PAC providers in such area to furnish, 
                        directly or indirectly, clinically appropriate 
                        PAC services (as determined through the use of 
                        the PAC assessment tool) to the individual; and
                            ``(ii) the entity shall coordinate the 
                        furnishing of all such services for the 
                        individual.
                    ``(B) PAC area covered.--The PAC agreement shall 
                specify the PAC area under the PAC agreement.
                    ``(C) Payment amount for pac services.--For PAC 
                services furnished by a PAC provider and furnished with 
                respect to a qualifying discharge, the entity shall pay 
                the PAC provider under the PAC network agreement 
                between the entity and the PAC provider--
                            ``(i) with respect to such PAC services 
                        that are services for which the PAC provider 
                        would receive payment under this title without 
                        regard to this section, an amount that is not 
                        less than the amount that would otherwise be 
                        paid to such PAC provider under this title for 
                        such services; and
                            ``(ii) with respect to such PAC services 
                        that are services for which the PAC provider 
                        would not receive payment under this title 
                        without regard to this section, an amount 
                        specified under such PAC network agreement; and
                    ``(D) Distribution of savings.--Insofar as the 
                payment amount to a PAC coordinator under subsection 
                (d)(3) for a PAC bundle furnished to an individual is 
                greater than the aggregate amounts paid to PAC 
                providers under subparagraph (C) for such bundle for 
                such individual, the entity shall not retain an amount 
                greater than 55 percent of such savings and shall pay 
                an amount equivalent to--
                            ``(i) not less than 15 percent of such 
                        savings to such PAC providers;
                            ``(ii) not less than 15 percent of such 
                        savings to the PAC physician of the individual; 
                        and
                            ``(iii) in the case that there is no PAC 
                        readmission of the individual, not less than 15 
                        percent of such savings to the hospital 
                        discharging the individual immediately prior to 
                        the furnishing of such services.
                Payments shall be made under each of clauses (i), (ii), 
                and (iii) to individuals and entities independent of 
                whether payment may be made to such an individual or 
                entity under another such clause.
                    ``(E) Maintenance of advisory committee.--The 
                entity shall maintain an advisory committee of PAC 
                providers and of patient stakeholders to advise the 
                entity regarding its activities under this section.
                    ``(F) Use of technology.--
                            ``(i) In general.--The entity shall utilize 
                        information technology to receive and maintain 
                        documentation regarding interactions between 
                        PAC providers that have entered into PAC 
                        network agreements with the entity and 
                        individuals who have selected the entity under 
                        paragraph (4)(A).
                            ``(ii) Format.--The entity shall receive 
                        and maintain the documentation described in 
                        clause (i) in data fields that are in a format 
                        that allows and for such data fields to 
                        integrate with electronic medical records in a 
                        standardized manner (as determined by the 
                        Secretary).
                    ``(G) Evidence-based guidelines.--The entity shall 
                encourage PAC providers that have entered into PAC 
                network agreements with the entity to use evidence-
                based guidelines to inform clinical care decisions made 
                with respect to individuals who have selected the 
                entity under paragraph (4)(A).
            ``(4) Selection and change of selection of pac coordinators 
        by individual.--
                    ``(A) In general.--The Secretary shall establish a 
                process for the selection and change of selection of a 
                PAC coordinator by an individual who is receiving 
                inpatient hospital services and whose discharge has 
                been or is likely to be classified as a qualifying 
                discharge.
                    ``(B) Limitation on selection due to network 
                adequacy.--The process established under subparagraph 
                (A) may not allow an individual to select (or to change 
                a selection to) a PAC coordinator in a PAC area unless 
                the PAC coordinator has entered into PAC network 
                agreements with such PAC providers in such PAC area 
                such that the PAC coordinator has a sufficient number 
                and range of health care professionals and providers 
                willing to provide services under the terms of the PAC 
                agreement.
                    ``(C) Limitation on selection imposed by 
                discharging hospital.--
                            ``(i) In general.--Subject to clause (ii), 
                        the process established under subparagraph (A) 
                        shall allow the hospital in which the 
                        individual receives the acute care inpatient 
                        hospital services described in subsection 
                        (b)(10) to limit the selection of a PAC 
                        coordinator by the individual to such PAC 
                        coordinators as the hospital identifies (such 
                        as through the adoption, by the hospital, of 
                        additional standards that a PAC coordinator 
                        must meet in order for such an individual to 
                        select the PAC coordinator).
                            ``(ii) Minimum selection standards.--With 
                        respect to an individual described in clause 
                        (i), a hospital described in such clause may 
                        not, in identifying PAC coordinators under such 
                        clause from which the individual may make a 
                        selection described in subparagraph (A), do 
                        either of the following:
                                    ``(I) Identify less than two PAC 
                                coordinators.
                                    ``(II) Identify only PAC 
                                coordinators that have a governance or 
                                financial relationship with the 
                                hospital.
                    ``(D) Assignment in case of no selection by 
                individual.--In the case that an individual described 
                in subparagraph (A) does not select a PAC coordinator 
                through the process established under such 
                subparagraph, the Secretary shall assign a PAC 
                coordinator to the individual. For purposes of this 
                section, an assignment described in the preceding 
                sentence shall be considered to be a selection by the 
                individual under subparagraph (A).
            ``(5) Construction relating to pac coordinators offering 
        non-pac services.--Nothing in this section shall be construed 
        as prohibiting PAC providers from offering, either directly or 
        indirectly, services that contribute to patient care, safety, 
        and readmission avoidance (such as medication management, 
        telehealth technologies, home environment services, and 
        transportation services) that are not PAC services.
            ``(6) Construction regarding flexibility in the delivery of 
        pac services.--Nothing in this section shall be construed to 
        prevent a PAC network agreement from permitting a PAC provider 
        to subcontract for the furnishing of PAC services that the PAC 
        provider is otherwise obligated to provide under the agreement 
        so long as the subcontractor meets the same terms and 
        conditions in furnishing such services as would apply if the 
        PAC provider were to provide such services.
    ``(d) Payment Amounts.--
            ``(1) Classification of conditions by crgs; methodology for 
        classification.--The Secretary shall use standardized post-
        acute care assessment data reported pursuant to section 1899B 
        to establish a classification of the conditions of individuals 
        receiving a PAC bundle by CRG and a methodology for classifying 
        specific PAC bundles within these groups. The methodology 
        shall, to the extent feasible, classify such bundles through 
        the use of the PAC assessment tool.
            ``(2) Computation of base rate.--
                    ``(A) In general.--The Secretary shall compute an 
                average payment rate for PAC bundles classified in each 
                CRG and furnished during a PAC period ending in the 
                base year selected under subparagraph (B).
                    ``(B) Base year selection.--The Secretary shall 
                select as a base year the most recent year ending 
                before the date of the enactment of this section for 
                which data are available to carry out this section.
                    ``(C) Budget-neutral computation.--The average 
                payment rate for a PAC bundle classified in a CRG shall 
                be computed in a manner so that, if it had been applied 
                in the base year, the aggregate payments for PAC 
                bundles classified in such CRG and furnished during a 
                PAC period ending in such year would be equivalent to 
                the aggregate payments under this title for such 
                bundles.
            ``(3) Calculation of payment amount based on base rate.--
        Subject to the succeeding provisions of this subsection, the 
        amount of the single payment described in this paragraph, with 
        respect to a PAC bundle classified within a CRG and furnished 
        to an individual during a PAC period ending--
                    ``(A) in 2020, is the base average payment rate for 
                such bundle computed under paragraph (2), increased by 
                such percentage as the Secretary estimates is the 
                average rate of increase in payments under this title 
                for such bundle between the base year and 2020; and
                    ``(B) in a subsequent year, is the amount of the 
                single payment for such bundle computed under this 
                paragraph for the previous year, increased, subject to 
                paragraph (4), by such percentage as the Secretary 
                estimates is the average rate of increase in payments 
                under this title for such bundle between such previous 
                year and such subsequent year.
            ``(4) Calculation of annual percentage increase.--In 
        calculating the percentage increases applied under paragraph 
        (3)(B), the Secretary shall ensure that total expenditures for 
        all PAC bundles provided in accordance with this section over 
        the 8-fiscal year period beginning with fiscal year 2020 do not 
        exceed 96 percent of the expenditures that would have been made 
        over such period but for the application of this section.
            ``(5) Adjustment for readmissions during pac period.--The 
        amount paid to a PAC coordinator under this subsection for a 
        PAC bundle in a PAC period that includes a PAC readmission 
        shall be reduced by an amount equal to the aggregate amount of 
        payments made for such PAC readmission of such individual.
            ``(6) Adjustment for geographic, risk, and socio-economic 
        and demographic factors.--The Secretary shall adjust the amount 
        of payment described in paragraph (3) with respect to services 
        furnished to an individual in a PAC area in a budget-neutral 
        manner for a year--
                    ``(A) by an appropriate factor that reflects 
                variations in costs for the furnishing of PAC bundles 
                among different geographic areas;
                    ``(B) by an appropriate factor that accounts for 
                variations in costs for the furnishing of such PAC 
                services to the individual based upon the health status 
                of the individual; and
                    ``(C) by an appropriate factor that accounts for 
                variations in socioeconomic and demographic 
                characteristics of the individual, such as whether the 
                individual is both eligible for benefits under title 
                XVIII and eligible under a State plan for medical 
                assistance under title XIX, and whether the individual 
                has a willing and able caregiver.
            ``(7) Adjustment in case of change of selection by 
        individual.--In the case of a change of selection of PAC 
        coordinator by the individual under subsection (c)(4) during a 
        PAC period, the Secretary shall adjust the amount of payment 
        described in paragraph (3) in order to provide appropriate 
        partial payments to be paid to the PAC coordinator selected 
        initially by the individual and to the PAC coordinator selected 
        under the change of selection by the individual. The method of 
        calculating the respective amounts of such appropriate partial 
        payments shall be based on the method used for the Home Health 
        Partial Episode Payment adjustment.
            ``(8) Adjustment in case of death of individual.--In the 
        case of the death of an individual during a PAC period who has 
        selected a PAC coordinator under subsection (c)(4), the 
        Secretary shall adjust the amount of payment described in 
        paragraph (3) to the PAC coordinator in a manner that reduces 
        such payment by a proportion equal to the proportion by which 
        the 90-day PAC period of the individual was reduced by the 
        death of the individual.
            ``(9) Use of pac assessment tool for purposes of adjustment 
        for risk factors.--In determining an appropriate factor under 
        paragraph (6)(B) with respect to an individual, the Secretary 
        shall take into account an assessment of the individual 
        conducted using the PAC assessment tool.
    ``(e) Phase-In.--
            ``(1) Determination of pac expenditures by crg.--Based on 
        the most recent data available, the Secretary shall determine 
        the aggregate amount of expenditures under this title for PAC 
        services furnished during the PAC period for each CRG (as 
        defined in paragraph (b)(11)).
            ``(2) Ranking of crgs by volume of expenditure.--The 
        Secretary shall rank the CRGs in order based on the aggregate 
        amount of expenditures for PAC services described in clause (i) 
        for each CRG.
            ``(3) Grouping of crgs.--The Secretary shall group CRGs 
        into four groups as follows:
                    ``(A) First group.--The first group consists of the 
                CRGs that have the highest rank under clause (ii) and 
                that collectively account for 25 percent of the 
                aggregate amount of expenditures for PAC services 
                described in clause (i).
                    ``(B) Second group.--The second group consists of 
                the CRGs that have the next highest rank under clause 
                (ii) after the first group in subclause (I) and that 
                collectively account for 25 percent of the aggregate 
                amount of expenditures for PAC services described in 
                clause (i).
                    ``(C) Third group.--The third group consists of the 
                CRGs that have the next highest rank under clause (ii) 
                after the second group in subclause (II) and that 
                collectively account for 25 percent of the aggregate 
                amount of expenditures for PAC services described in 
                clause (i).
                    ``(D) Fourth group.--The fourth group consists of 
                the CRGs that are not included in the first, second, or 
                third group under this clause.
            ``(4) Phase-in by crg grouping.--In applying this section 
        for discharges in--
                    ``(A) 2020, only discharges that are classified 
                within the first group under subclause (I) of clause 
                (iii) shall be included;
                    ``(B) 2021, only discharges that are classified 
                within the first or second group under subclause (I) or 
                (II) of clause (iii) shall be included;
                    ``(C) 2022, only discharges that are classified 
                within the first, second, or third group under 
                subclause (I), (II), or (III) of clause (iii) shall be 
                included; and
                    ``(D) 2023 and subsequent years, discharges that 
                are classified within any group of CRGs shall be 
                included.''.

SEC. 4. STUDY AND REPORT ON INTEGRATION OF POST-ACUTE CARE PAYMENTS 
              WITH ACUTE CARE PAYMENTS.

    (a) Study.--The Secretary of Health and Human Services shall 
conduct a study to examine the feasibility of integrating (or 
``bundling'') all payments under the Medicare program for post acute 
care services under section 1866F of the Social Security Act, as added 
by section 3, with payments for acute care inpatient hospital services 
(as defined by the Secretary pursuant to subsection (b)(10) of such 
section 1866F) in a subsection (d) hospital (as defined in section 
1886(d)(1)(B) of such Act (42 U.S.C. 1395ww(d)(1)(B))), including an 
examination of the anticipated timing and impact of such integration.
    (b) Report.--Not later than January 1, 2020, the Secretary shall 
submit a report to the Committees on Ways and Means and on Energy and 
Commerce in the House of Representatives, and to the Committee on 
Finance in the Senate, on the results of the study conducted under 
subsection (a).

SEC. 5. MORATORIUM ON IPPS PAYMENT RATE IN CERTAIN CASES.

    Section 1886(m)(6) of the Social Security Act (42 U.S.C. 
1395ww(m)(6)) is amended in--
            (1) subparagraph (A)(i), by striking ``2015'' and inserting 
        ``2021'';
            (2) subparagraph (B)(i)(I), by striking ``2016'' and 
        ``2017'' and inserting ``2022'' and ``2023'', respectively;
            (3) subparagraph (B)(i)(II), by striking ``2018'' and 
        inserting ``2024'';
            (4) subparagraph (C)(i), by striking ``2016'' and inserting 
        ``2022'';
            (5) subparagraph (C)(ii), by striking ``2020'' and 
        inserting ``2026''; and
            (6) subparagraph (C)(iv), by striking ``2020'' and 
        inserting ``2026''.

SEC. 6. TRANSITIONAL CARE MANAGEMENT PAYMENTS FOR PHYSICIANS.

    For purposes of encouraging transitional care management by PAC 
physicians (as defined in section 1866F(b)(5) of the Social Security 
Act), in carrying out section 1848(e) of the Social Security Act (42 
U.S.C. 1395w-4(e)), the Secretary of Health and Human Services shall 
establish a new Transitional Care Management (TCM) code to pay for care 
management by such a PAC physician or revise and expand the use of 
existing TCM codes 99495 and 99494.
                                 <all>