[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 3191 Introduced in Senate (IS)]

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114th CONGRESS
  2d Session
                                S. 3191

To amend titles XVIII and XIX of the Social Security Act to improve the 
    quality of health care furnished in rural areas, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 13, 2016

  Mr. Franken (for himself and Ms. Heitkamp) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend titles XVIII and XIX of the Social Security Act to improve the 
    quality of health care furnished in rural areas, 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 ``Rural Health Care 
Quality Improvement Act of 2016''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
                       TITLE I--RURAL HEALTH CARE

Sec. 101. Establishment of core set of rural health care quality 
                            measures.
Sec. 102. Revisions to Medicare rural grants.
                 TITLE II--RURAL-BASED PAYMENT REFORMS

Sec. 201. Integrating core set of rural health care quality measures 
                            into certain payment models.
Sec. 202. Center for Medicare and Medicaid Innovation testing of 
                            providing financial incentives for rural 
                            providers of services and suppliers to 
                            submit data on quality measures.
Sec. 203. Center for Medicare and Medicaid Innovation testing of value-
                            based payment models for rural providers of 
                            services and suppliers.
Sec. 204. Center for Medicare and Medicaid Innovation testing of 
                            hospital readmissions reduction program for 
                            rural hospitals.
Sec. 205. Participation by rural health clinics and Federally qualified 
                            health centers in Comprehensive Primary 
                            Care Plus model.
               TITLE III--IMPROVING RURAL REPRESENTATION

Sec. 301. Inclusion of rural representation on CMS Rural Health 
                            Council.
Sec. 302. Ensuring rural representation on the Medicare Payment 
                            Advisory Commission and the Medicaid and 
                            CHIP Payment and Access Commission.

                       TITLE I--RURAL HEALTH CARE

SEC. 101. ESTABLISHMENT OF CORE SET OF RURAL HEALTH CARE QUALITY 
              MEASURES.

    (a) In General.--Title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) is amended by inserting after section 1890A the following 
new section:

                  ``rural health care quality measures

    ``Sec. 1890B.  (a) Establishment.--Not later than January 1, 2018, 
the Secretary shall, using the process described in section 1890(b)(7), 
establish a core set of relevant quality measures that address the 
following with respect to rural providers of services and suppliers who 
furnish items and services to individuals in rural areas:
            ``(1) Improving patient outcomes, such as mortality rates, 
        hospital acquired infections, hospital readmissions, and other 
        patient-reported outcomes.
            ``(2) Improving care coordination, transitions, and 
        medicine reconciliation.
            ``(3) Reducing costs.
            ``(4) Improving patient safety.
            ``(5) Use of preventive care services, including 
        immunizations and screening tests.
            ``(6) Improving care for individuals with chronic disease, 
        including cardiovascular disease, diabetes, behavioral health, 
        and other chronic conditions.
            ``(7) Other purposes specified by the Secretary.
    ``(b) Aligning Measures With Existing Quality Reporting 
Requirements.--In establishing the core set of quality measures under 
subsection (a), the Secretary shall reduce reporting burdens for small 
rural providers of services and suppliers (as determined by the 
Secretary) by, to the extent practicable, ensuring that such quality 
measures are consistent with measures applicable under other quality 
and value-based payment reporting requirements under this title, as 
determined by the Secretary, including the Merit-Based Incentive 
Payment System under section 1848(q) and incentive payments for the 
meaningful use of certified EHR technology under section 
1886(b)(3)(B)(ix).
    ``(c) Implementation.--The provisions of paragraphs (4) and (5) of 
section 1890A(a) shall apply to the establishment of the core set of 
quality measures under subsection (a) in the same manner as such 
provisions apply to the selection of quality and efficiency measures 
described in section 1890(b)(7)(B).
    ``(d) Annual Updating.--The Secretary shall, using the process 
described in section 1890A, review and update the core set of quality 
measures established under subsection (a) in accordance with section 
1890A(c) to ensure such quality measures remain reliable, 
scientifically valid, and appropriate for quality measurement 
purposes.''.
    (b) Conforming Amendment.--Section 1890(b)(5)(A)(iv) of the Social 
Security Act (42 U.S.C. 1395aaa(b)(5)(A)(iv)) is amended by inserting 
``and (beginning with 2019) rural health care quality measures under 
section 1890B'' after ``Public Health Service Act''.

SEC. 102. REVISIONS TO MEDICARE RURAL GRANTS.

    (a) Reauthorization.--Section 1820(j) of the Social Security Act 
(42 U.S.C. 1395i-4(j)) is amended--
            (1) by striking ``Appropriations.--There'' and inserting 
        the following: ``Appropriations.--
            ``(1) HI trust fund.--There''; and
            (2) by adding at the end the following new paragraph:
            ``(2) General revenues.--There are authorized to be 
        appropriated, from amounts in the Treasury not otherwise 
        appropriated, for making grants to all States under subsection 
        (g), $50,000,000 in each of fiscal years 2017 through 2021, to 
        remain available until expended.''.
    (b) Medicare Rural Emergency Medical Services Grants.--Section 
1820(g)(2)(A) of the Social Security Act (42 U.S.C. 1395i-4(g)(2)(A)) 
is amended by inserting the following before the period at the end: ``, 
which may include plans to support emergency medical transportation 
services, particularly in rural communities that have lost their rural 
hospital''.
    (c) Grants To Provide Technical Assistance for Quality Improvement 
Reporting by Critical Access Hospitals.--Section 1820(g) of the Social 
Security Act (42 U.S.C. 1395i-4(g)) is amended by adding at the end the 
following new paragraph:
            ``(8) Technical assistance for quality improvement 
        reporting by critical access hospitals.--
                    ``(A) Grants.--The Secretary may award grants to 
                critical access hospitals that have submitted 
                applications in accordance with subparagraph (B) for--
                            ``(i) assisting such hospitals in 
                        establishing or expanding a quality improvement 
                        reporting program; and
                            ``(ii) supporting the provision of 
                        technical assistance for quality improvement 
                        reporting.
                    ``(B) Application.--A critical access hospital 
                seeking a grant under this paragraph shall submit an 
                application to the Secretary on or before such date and 
                in such form and manner as the Secretary specifies.
                    ``(C) Reporting requirement in order to continue to 
                receive grants after second year.--The Secretary may 
                not award a grant under this paragraph to a critical 
                access hospital for more than 2 years unless the 
                hospital agrees to submit, for each year after that 
                second year, such relevant quality data specified by 
                the Secretary, including data on rural health care 
                quality measures established under section 1890B, as 
                appropriate.
                    ``(D) Availability to public.--The Secretary shall 
                establish procedures for making data submitted under 
                subparagraph (C) available to the public.
                    ``(E) Opportunity to review.--The procedures 
                established under subparagraph (D) shall ensure that a 
                critical access hospital has the opportunity to review 
                the data that are to be made public with respect to the 
                hospital prior to such data being made public.
                    ``(F) Measures.--The Secretary shall report quality 
                measures of process, structure, outcome, patients' 
                perspective on care, efficiency, and costs of care that 
                relate to services furnished in such hospitals on the 
                Internet website of the Centers for Medicare & Medicaid 
                Services.''.

                 TITLE II--RURAL-BASED PAYMENT REFORMS

SEC. 201. INTEGRATING CORE SET OF RURAL HEALTH CARE QUALITY MEASURES 
              INTO CERTAIN PAYMENT MODELS.

    Section 1890B of the Social Security Act, as added by section 101, 
is amended by adding at the end the following new subsection:
    ``(e) Inclusion Under Alternative Payment Models and Value-Based 
Demonstration Projects.--Effective beginning with calendar year or 
fiscal year 2021, as applicable, the Secretary shall ensure that rural 
health care quality measures established under this section are 
included in quality reporting under alternative payment models and 
value-based payment demonstration projects under this title, as 
appropriate, including the shared savings program under section 1899 
and the Merit-Based Incentive Payment System under section 1848(q).''.

SEC. 202. CENTER FOR MEDICARE AND MEDICAID INNOVATION TESTING OF 
              PROVIDING FINANCIAL INCENTIVES FOR RURAL PROVIDERS OF 
              SERVICES AND SUPPLIERS TO SUBMIT DATA ON QUALITY 
              MEASURES.

    Section 1115A of the Social Security Act (42 U.S.C. 1315a) is 
amended--
            (1) in subsection (b)(2)(A), by adding at the end the 
        following new sentence: ``The models selected under this 
        subparagraph shall include the model described in subsection 
        (h).''; and
            (2) by adding at the end the following new subsection:
    ``(h) Providing Financial Incentives for Rural Providers of 
Services and Suppliers To Submit Data on Quality Measures.--The 
Secretary shall test a model providing financial incentives to 
providers of services and suppliers located in rural areas to submit 
data on applicable quality measures under title XVIII, including rural 
health care quality measures established under section 1890B.''.

SEC. 203. CENTER FOR MEDICARE AND MEDICAID INNOVATION TESTING OF VALUE-
              BASED PAYMENT MODELS FOR RURAL PROVIDERS OF SERVICES AND 
              SUPPLIERS.

    Section 1115A of the Social Security Act (42 U.S.C. 1315a), as 
amended by section 202, is amended--
            (1) in subsection (b)(2)(A), by striking ``model described 
        in subsection (h)'' and inserting ``models described in 
        subsections (h) and (i)''; and
            (2) by adding at the end the following new subsection:
    ``(i) Value-Based Payment Models for Rural Providers of Services 
and Suppliers.--The Secretary shall test value-based payment models, 
including value-based purchasing, for items and services furnished by 
providers of services and suppliers located in rural areas under title 
XVIII, including critical access hospitals.''.

SEC. 204. CENTER FOR MEDICARE AND MEDICAID INNOVATION TESTING OF 
              HOSPITAL READMISSIONS REDUCTION PROGRAM FOR RURAL 
              HOSPITALS.

    Section 1115A of the Social Security Act (42 U.S.C. 1315a), as 
amended by sections 202 and 203, is amended--
            (1) in subsection (b)(2)(A), by striking ``and (i)'' and 
        inserting ``, (i), and (j)''; and
            (2) by adding at the end the following new subsection:
    ``(j) Hospital Readmissions Reduction Program for Rural 
Hospitals.--The Secretary shall test a hospital readmissions reduction 
program under title XVIII for hospitals located in rural areas that are 
not otherwise subject to the program under section 1886(q).''.

SEC. 205. PARTICIPATION BY RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED 
              HEALTH CENTERS IN COMPREHENSIVE PRIMARY CARE PLUS MODEL.

    Notwithstanding any other provision of law, the Secretary of Health 
and Human Services shall permit a rural health clinic (as defined in 
section 1861(aa)(2) of the Social Security Act (42 U.S.C. 
1395x(aa)(2))) or a Federally qualified health center (as defined in 
section 1861(aa)(4) of such Act (42 U.S.C. 1395x(aa)(4))) to 
participate in the Comprehensive Primary Care Plus model tested under 
section 1115A of such Act (42 U.S.C. 1315a).

               TITLE III--IMPROVING RURAL REPRESENTATION

SEC. 301. INCLUSION OF RURAL REPRESENTATION ON CMS RURAL HEALTH 
              COUNCIL.

    (a) In General.--To the extent the Administrator of the Centers for 
Medicare & Medicaid Services (in this section referred to as the 
``Administrator'') establishes a CMS Rural Health Council, the 
Administrator shall ensure that such Council includes external 
stakeholders who have objective rural health expertise, such as 
representatives of rural health research centers, quality improvement 
organizations, and State offices of rural health, who shall serve in an 
ex officio capacity as nonvoting members.
    (b) Collaboration With Health Care Payment Learning and Action 
Network.--The Council described in subsection (a) shall, to the extent 
practicable, work in collaboration with the Health Care Payment 
Learning and Action Network within the Department of Health and Human 
Services.

SEC. 302. ENSURING RURAL REPRESENTATION ON THE MEDICARE PAYMENT 
              ADVISORY COMMISSION AND THE MEDICAID AND CHIP PAYMENT AND 
              ACCESS COMMISSION.

    (a) Medicare Payment Advisory Commission.--
            (1) In general.--Section 1805(c)(2)(A) of the Social 
        Security Act (42 U.S.C. 1395b-6(c)(2)(A)) is amended by 
        inserting the following before the period at the end: ``, 
        including at least two members who represent a rural area''.
            (2) Applicable to future appointments.--Any appointment to 
        the Medicare Payment Advisory Commission made by the 
        Comptroller General of the United States after the date of 
        enactment of this Act shall be made in a manner that complies 
        with the requirements of section 1805(c)(2)(A) of the Social 
        Security Act, as amended by paragraph (1).
    (b) Medicaid and CHIP Payment and Access Commission.--
            (1) In general.--Section 1900(c)(2)(A) of the Social 
        Security Act (42 U.S.C. 1396(c)(2)(A)) is amended by inserting 
        the following before the period at the end: ``, including at 
        least two members who represent a rural area''.
            (2) Applicable to future appointments.--Any appointment to 
        the Medicaid and CHIP Payment and Access Commission made by the 
        Comptroller General of the United States after the date of 
        enactment of this Act shall be made in a manner that complies 
        with the requirements of section 1900(c)(2)(A) of the Social 
        Security Act, as amended by paragraph (1).
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