[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3417 Introduced in House (IH)]

<DOC>






116th CONGRESS
  1st Session
                                H. R. 3417

To amend title XVIII of the Social Security Act to provide for patient 
  improvements and rural and quality improvements under the Medicare 
                                program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 21, 2019

  Mr. Neal (for himself and Mr. Brady) 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 for patient 
  improvements and rural and quality improvements under the Medicare 
                                program.

    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 ``Beneficiary 
Education Tools, Telehealth, and Extenders Reauthorization Act of 
2019'' or the ``BETTER Act of 2019''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
                     TITLE I--PATIENT IMPROVEMENTS

Sec. 101. Beneficiary enrollment notification and eligibility 
                            simplification.
Sec. 102. Extension of funding outreach and assistance for low-income 
                            programs.
Sec. 103. Medicare coverage of certain mental health telehealth 
                            services.
Sec. 104. Requiring prescription drug plan sponsors to include real-
                            time benefit information as part of such 
                            sponsor's electronic prescription program 
                            under the Medicare program.
Sec. 105. Transitional coverage and retroactive Medicare part D 
                            coverage for certain low-income 
                            beneficiaries.
                TITLE II--RURAL AND QUALITY IMPROVEMENTS

Sec. 201. Medicare GME treatment of hospitals establishing new medical 
                            residency training programs after hosting 
                            medical resident rotators for short 
                            durations.
Sec. 202. Extension of the work geographic index floor under the 
                            Medicare program.
Sec. 203. Extension of funding for quality measure endorsement, input, 
                            and selection under Medicare program.
Sec. 204. Improving measurements under the skilled nursing facility 
                            value-based purchasing program under the 
                            Medicare program.

                     TITLE I--PATIENT IMPROVEMENTS

SEC. 101. BENEFICIARY ENROLLMENT NOTIFICATION AND ELIGIBILITY 
              SIMPLIFICATION.

    (a) Eligibility and Enrollment Notices.--
            (1) As part of social security account statement for 
        individuals attaining ages 63 to 65.--Section 1143(a) of the 
        Social Security Act (42 U.S.C. 1320b-13(a)) is amended by 
        adding at the end the following new paragraph:
    ``(4) Medicare Eligibility Information.--
            ``(A) In general.--In the case of statements provided on or 
        after the date that is 2 years after the date of the enactment 
        of this paragraph to individuals who are attaining ages 63, 64, 
        and 65, the statement shall also include a notice containing 
        the information described in subparagraph (B).
            ``(B) Contents of notice.--The notice required under 
        subparagraph (A) shall include a clear, simple explanation of--
                    ``(i) eligibility for benefits under the Medicare 
                program under title XVIII, and in particular benefits 
                under part B of such title;
                    ``(ii) the reasons a late enrollment penalty for 
                failure to timely enroll could be assessed and how such 
                late enrollment penalty is calculated, in particular 
                for benefits under part B;
                    ``(iii) the availability of relief from the late 
                enrollment penalty and retroactive enrollment under 
                section 1837(h) (including as such section is applied 
                under sections 1818(c) and 1818A(c)(3)), with examples 
                of circumstances under which such relief may be granted 
                and examples of circumstances under which such relief 
                would not be granted;
                    ``(iv) the need for coordination of benefits 
                (including primary and secondary coverage scenarios) 
                pursuant to section 1862, in particular for benefits 
                under part B of such title; and
                    ``(v) populations, such as residents of Puerto Rico 
                and veterans, for whom there are special considerations 
                with respect to enrollment under title XVIII.
            ``(C) Development of notice.--
                    ``(i) In general.--The Secretary, in coordination 
                with the Commissioner of Social Security, and taking 
                into consideration information collected pursuant to 
                clause (ii), shall, not later than 12 months after the 
                last day of the period for the request of information 
                described in clause (ii), develop the notice to be 
                provided pursuant to subparagraph (A).
                    ``(ii) Request for information.--Not later than 6 
                months after the date of the enactment of this 
                paragraph, the Secretary shall request written 
                information, including recommendations, from 
                stakeholders (including the groups described in 
                subparagraph (D)) on the information to be included in 
                the notice.
                    ``(iii) Notice improvement.--Beginning 4 years 
                after the date of enactment of this paragraph, and not 
                less than once every two years thereafter, the 
                Secretary, in coordination with the Commissioner of 
                Social Security, shall--
                            ``(I) review the content of the notice to 
                        be provided under subparagraph (A);
                            ``(II) solicit recommendations on the 
                        notice through a request for information 
                        process as described in clause (ii); and
                            ``(III) update and revise such notice as 
                        the Secretary deems appropriate.
            ``(D) Groups for consultation.--For purposes of 
        subparagraph (C)(ii), the groups described in this clause 
        include the following:
                    ``(i) Individuals who are 60 years of age or older.
                    ``(ii) Veterans.
                    ``(iii) Individuals with disabilities.
                    ``(iv) Individuals with end stage renal disease.
                    ``(v) Low-income individuals and families.
                    ``(vi) Employers (including human resources 
                professionals).
                    ``(vii) States (including representatives of State-
                run Health Insurance Exchanges, Medicaid offices, and 
                Departments of Insurance).
                    ``(viii) State Health Insurance Assistance 
                Programs.
                    ``(ix) Health insurers.
                    ``(x) Health insurance agents and brokers.
                    ``(xi) Such other groups as specified by the 
                Secretary.
            ``(E) Posting of notice on websites.--The Commissioner of 
        Social Security and the Secretary shall ensure that the notice 
        being used under subparagraph (A) is posted in a prominent 
        location on the public Internet website of the Social Security 
        Administration and on the public Internet website of the 
        Centers for Medicare & Medicaid Services, respectively.
            ``(F) Reimbursement of costs.--
                    ``(i) In general.--Effective for fiscal years 
                beginning in the year in which the date of enactment of 
                this paragraph occurs, the Commissioner of Social 
                Security and the Secretary shall enter into an 
                agreement which shall provide funding to cover the 
                administrative costs of the Commissioner's activities 
                under this paragraph. Such agreement shall--
                            ``(I) provide funds to the Commissioner for 
                        the full cost of the Social Security 
                        Administration's work related to the 
                        implementation of this paragraph, including any 
                        initial costs incurred prior to the 
                        finalization of such agreement;
                            ``(II) provide such funding quarterly in 
                        advance of the applicable quarter based on 
                        estimating methodology agreed to by the 
                        Commissioner and the Secretary; and
                            ``(III) require an annual accounting and 
                        reconciliation of the actual costs incurred and 
                        funds provided under this paragraph.
                    ``(ii) Limitation.--In no case shall funds from the 
                Social Security Administration's Limitation on 
                Administrative Expenses be used to carry out activities 
                related to the implementation of this paragraph.
            ``(G) No effect on obligation to mail statements.--Nothing 
        in this paragraph shall be construed to relieve the 
        Commissioner of Social Security from any requirement under 
        subsection (c), including the requirement to mail a statement 
        on an annual basis to each eligible individual who is not 
        receiving benefits under title II and for whom a mailing 
        address can be determined through such methods as the 
        Commissioner determines to be appropriate.''.
            (2) Individuals in medicare waiting period.--Title XI of 
        the Social Security Act (42 U.S.C. 1301 et seq.) is amended by 
        inserting after section 1144 the following new section:

    ``medicare enrollment notification and eligibility notices for 
                 individuals in medicare waiting period

                               ``Notices

    ``Sec. 1144A. (a)
            ``(1) In General.--The Commissioner of Social Security 
        shall distribute the notice to be provided pursuant to section 
        1143(a)(4), as may be modified under paragraph (2), to 
        individuals in the 24-month waiting period under section 
        226(b).
            ``(2) Authority To Modify Notice.--The Secretary, in 
        coordination with the Commissioner of Social Security, may 
        modify the notice to be distributed under paragraph (1) as 
        necessary to take into account the individuals described in 
        such paragraph.
            ``(3) Posting of Notice on Websites.--The Commissioner of 
        Social Security and the Secretary shall ensure that the notice 
        being used under paragraph (1) is posted in a prominent 
        location on the public Internet website of the Social Security 
        Administration and on the public Internet website of the 
        Centers for Medicare & Medicaid Services, respectively.

                                ``Timing

    ``(b) Beginning not later than 2 years after the date of the 
enactment of this section, a notice required under subsection (a)(1) 
shall be mailed to an individual no less than two times in accordance 
with the following:
            ``(1) The notice shall be provided to such individual not 
        later than 3 months prior to the date on which such 
        individual's enrollment period begins as provided under section 
        1837.
            ``(2) The notice shall subsequently be provided to such 
        individual not later than one month prior to such date.

                        ``Reimbursement of Costs

    ``(c)
            ``(1) In General.--Effective for fiscal years beginning in 
        the year in which the date of enactment of this section occurs, 
        the Commissioner of Social Security and the Secretary shall 
        enter into an agreement which shall provide funding to cover 
        the administrative costs of the Commissioner's activities under 
        this section. Such agreement shall--
                    ``(A) provide funds to the Commissioner for the 
                full cost of the Social Security Administration's work 
                related to the implementation of this section, 
                including any initial costs incurred prior to the 
                finalization of such agreement;
                    ``(B) provide such funding quarterly in advance of 
                the applicable quarter based on estimating methodology 
                agreed to by the Commissioner and the Secretary; and
                    ``(C) require an annual accounting and 
                reconciliation of the actual costs incurred and funds 
                provided under this section.
            ``(2) Limitation.--In no case shall funds from the Social 
        Security Administration's Limitation on Administrative Expenses 
        be used to carry out activities related to the implementation 
        of this section.''.
    (b) Beneficiary Enrollment Simplification.--
            (1) Effective date of coverage.--Section 1838(a) of the 
        Social Security Act (42 U.S.C. 1395q(a)) is amended--
                    (A) by amending paragraph (2) to read as follows:
            ``(2)(A) in the case of an individual who enrolls pursuant 
        to subsection (d) of section 1837 before the month in which he 
        first satisfies paragraph (1) or (2) of section 1836, the first 
        day of such month,
            ``(B) in the case of an individual who first satisfies such 
        paragraph in a month beginning before January 2021 and who 
        enrolls pursuant to such subsection (d)--
                    ``(i) in such month in which he first satisfies 
                such paragraph, the first day of the month following 
                the month in which he so enrolls,
                    ``(ii) in the month following such month in which 
                he first satisfies such paragraph, the first day of the 
                second month following the month in which he so 
                enrolls, or
                    ``(iii) more than one month following such month in 
                which he satisfies such paragraph, the first day of the 
                third month following the month in which he so enrolls,
            ``(C) in the case of an individual who first satisfies such 
        paragraph in a month beginning on or after January 1, 2021, and 
        who enrolls pursuant to such subsection (d) in such month in 
        which he first satisfies such paragraph or in any subsequent 
        month of his initial enrollment period, the first day of the 
        month following the month in which he so enrolls, or
            ``(D) in the case of an individual who enrolls pursuant to 
        subsection (e) of section 1837 in a month beginning--
                    ``(i) before January 1, 2021, the July 1 following 
                the month in which he so enrolls, or
                    ``(ii) on or after January 1, 2021, the first day 
                of the month following the month in which he so 
                enrolls, or''; and
                    (B) by amending paragraph (3) to read as follows:
            ``(3) in the case of an individual who is deemed to have 
        enrolled--
                    ``(A) on or before the last day of the third month 
                of his initial enrollment period, the first day of the 
                month in which he first meets the applicable 
                requirements of section 1836 or July 1, 1973, whichever 
                is later, or
                    ``(B) on or after the first day of the fourth month 
                of his initial enrollment period, and where such month 
                begins--
                            ``(i) before January 1, 2021, as prescribed 
                        under subparagraphs (B)(i), (B)(ii), (B)(iii), 
                        and (D) of paragraph (2), or
                            ``(ii) on or after January 1, 2021, as 
                        prescribed under paragraph (2)(C).''.
            (2) Special enrollment periods for exceptional 
        circumstances.--
                    (A) Enrollment.--Section 1837 of the Social 
                Security Act (42 U.S.C. 1395p) is amended by adding at 
                the end the following new subsection:
    ``(m) Beginning January 1, 2021, the Secretary may establish 
special enrollment periods in the case of individuals who meet such 
exceptional conditions as the Secretary may provide, such as 
individuals who reside in an area with an emergency or disaster as 
determined by the Secretary.''.
                    (B) Coverage period.--Section 1838 of the Social 
                Security Act (42 U.S.C. 1395q) is amended by adding at 
                the end the following new subsection:
    ``(g) Notwithstanding subsection (a), in the case of an individual 
who enrolls during a special enrollment period pursuant to section 
1837(m), the coverage period shall begin on a date the Secretary 
provides in a manner consistent (to the extent practicable) with 
protecting continuity of health benefit coverage.''.
                    (C) Conforming amendment.--Section 1839(b) of the 
                Social Security Act (42 U.S.C. 1395r(b)) is amended, in 
                the first sentence, by striking ``or (l)'' and 
                inserting ``, (l), or (m)''.
            (3) Technical correction.--Section 1839(b) of the Social 
        Security Act (42 U.S.C. 1395r(b)) is amended by adding at the 
        end the following new sentence: ``For purposes of determining 
        any increase under this subsection for individuals whose 
        enrollment occurs on or after January 1, 2021, the second 
        sentence of this subsection shall be applied by substituting 
        `close of the month' for `close of the enrollment period' each 
        place it appears.''.
            (4) Report.--Not later than January 1, 2021, the Secretary 
        of Health and Human Services shall submit to the Committee on 
        Ways and Means and Committee on Energy and Commerce of the 
        House of Representatives and the Committee on Finance and 
        Special Committee on Aging of the Senate a report including 
        recommendations on how to align existing Medicare enrollment 
        periods under title XVIII of the Social Security Act, including 
        the general enrollment period under part B of such title and 
        the annual election period under the Medicare Advantage program 
        under part C of such title and under the prescription drug 
        program under part D of such title. Such recommendations shall 
        be consistent with the goals of maximizing coverage continuity 
        and choice and easing beneficiary transition.

SEC. 102. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR LOW-INCOME 
              PROGRAMS.

    (a) Additional Funding for State Health Insurance Programs.--
Subsection (a)(1)(B) 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), section 610 of the American Taxpayer Relief Act 
of 2012 (Public Law 112-240), section 1110 of the Pathway for SGR 
Reform Act of 2013 (Public Law 113-67), section 110 of the Protecting 
Access to Medicare Act of 2014 (Public Law 113-93), section 208 of the 
Medicare Access and CHIP Reauthorization Act of 2015 (Public Law 114-
10), and section 50207 of the Bipartisan Budget Act of 2018 (Public Law 
115-123), is amended--
            (1) in clause (vii), by striking ``and'' at the end;
            (2) in clause (viii), by striking ``and'' at the end;
            (3) in clause (ix), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (ix) the following new 
        clause:
                            ``(x) for each of fiscal years 2020 through 
                        2022, of $15,000,000.''.
    (b) Additional Funding for Area Agencies on Aging.--Subsection 
(b)(1)(B) of such section 119, as so amended, is amended--
            (1) in clause (vii), by striking ``and'' at the end;
            (2) in clause (viii), by striking ``and'' at the end;
            (3) in clause (ix), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (ix) the following new 
        clause:
                            ``(x) for each of fiscal years 2020 through 
                        2022, of $15,000,000.''.
    (c) Additional Funding for Aging and Disability Resource Centers.--
Subsection (c)(1)(B) of such section 119, as so amended, is amended--
            (1) in clause (vii), by striking ``and'' at the end;
            (2) in clause (viii), by striking ``and'' at the end;
            (3) in clause (ix), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (ix) the following new 
        clause:
                            ``(x) for each of fiscal years 2020 through 
                        2022, of $5,000,000.''.
    (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--
            (1) in clause (vii), by striking ``and'' at the end;
            (2) in clause (viii), by striking ``and'' at the end;
            (3) in clause (ix), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (ix) the following new 
        clause:
                            ``(x) for each of fiscal years 2020 through 
                        2022, of $15,000,000.''.

SEC. 103. MEDICARE COVERAGE OF CERTAIN MENTAL HEALTH TELEHEALTH 
              SERVICES.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is 
amended--
            (1) in paragraph (2)(B)(i), by striking ``and paragraph 
        (6)(C)'' and inserting ``, paragraph (6)(C), and paragraph 
        (8)(C)'';
            (2) in paragraph (4)(C)(i), by striking ``and (7)'' and 
        inserting ``(7), and (8)'';
            (3) in paragraph (4)(F)(i), by inserting ``services 
        identified by CPT codes 90834 and 90837 (and as subsequently 
        modified by the Secretary),'' before ``and any additional 
        service'';
            (4) in paragraph (6)(A), by striking ``paragraph (4)(C)'' 
        and inserting ``paragraph (4)(C)(i)'';
            (5) in paragraph (7), by striking ``The geographic 
        requirements'' and inserting ``Subject to paragraph (8)(D), the 
        geographic requirements''; and
            (6) by adding at the end the following new paragraph:
            ``(8) Treatment of mental health telehealth services.--
                    ``(A) Non-application of originating site 
                requirements.--The requirements described in paragraph 
                (4)(C)(i) shall not apply with respect to telehealth 
                services furnished on or after January 1, 2020, that 
                are mental health telehealth services. Nothing in the 
                previous sentence shall waive any applicable State law 
                requirements.
                    ``(B) Inclusion of certain sites.--With respect to 
                telehealth services described in subparagraph (A), the 
                term `originating site' shall include the home of the 
                eligible telehealth individual at which the individual 
                is located at the time the service is furnished via a 
                telecommunications system.
                    ``(C) No originating site facility fee.--No 
                facility fee shall be paid under paragraph (2)(B) to an 
                originating site with respect to a telehealth service 
                described in subparagraph (A) if the originating site 
                does not otherwise meet the requirements for an 
                originating site under paragraph (4)(C).
                    ``(D) Face-to-face initial assessment; 
                reassessments.--Payment may not be made for mental 
                health telehealth services under this paragraph (if 
                such payment would not otherwise be allowed under this 
                subsection without application of this paragraph or 
                paragraph (7)) furnished to an eligible telehealth 
                individual unless--
                            ``(i) within the 6-month period prior to 
                        the provision of such mental health telehealth 
                        services, the individual receives a face-to-
                        face clinical assessment, without the use of 
                        telehealth, by a physician described in 
                        subparagraph (F)(i) or a practitioner described 
                        in subparagraph (F)(ii) of the needs of such 
                        individual for such services; and
                            ``(ii) the individual receives a 
                        reassessment (at a frequency specified by the 
                        Secretary) by a physician so described or a 
                        practitioner so described of the needs of such 
                        individual for such services.
                    ``(E) Mental health telehealth services defined.--
                For purposes of this paragraph, the term `mental health 
                telehealth service' means services identified by CPT 
                codes 90834 and 90837 (and as subsequently modified by 
                the Secretary).
                    ``(F) Physician and practitioner described.--For 
                purposes of subparagraph (D):
                            ``(i) Physician.--A physician described in 
                        this clause is a physician, as defined in 
                        section 1861(r)(1).
                            ``(ii) Practitioner.--A practitioner 
                        described in this clause is a practitioner 
                        described in any of clauses (i), (iv), or (v) 
                        of section 1842(b)(18)(C).''.

SEC. 104. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS TO INCLUDE REAL-
              TIME BENEFIT INFORMATION AS PART OF SUCH SPONSOR'S 
              ELECTRONIC PRESCRIPTION PROGRAM UNDER THE MEDICARE 
              PROGRAM.

    Section 1860D-4(e)(2) of the Social Security Act (42 U.S.C. 1395w-
104(e)(2)) is amended--
            (1) in subparagraph (D), by striking ``To the extent'' and 
        inserting ``Except as provided in subparagraph (F), to the 
        extent''; and
            (2) by adding at the end the following new subparagraph:
                    ``(F) Real-time benefit information.--
                            ``(i) In general.--Not later than January 
                        1, 2021, the program shall provide for the 
                        real-time electronic transmission to 
                        prescribing health care professionals, using 
                        technology capable of integrating with such 
                        professionals' electronic prescribing and 
                        electronic health record systems, of 
                        individual-specific formulary and benefit 
                        information under a prescription drug plan with 
                        respect to an individual enrolled in such plan. 
                        Such information shall include, with respect to 
                        the prescribing of a covered part D drug to 
                        such individual, the following:
                                    ``(I) A description of any 
                                clinically-appropriate alternatives to 
                                such drug included in the formulary of 
                                such plan.
                                    ``(II) Information relating to 
                                applicable cost-sharing requirements 
                                for such drug and such alternatives, 
                                including a description of any variance 
                                in such requirements based on the 
                                pharmacy dispensing such drug or such 
                                alternatives.
                                    ``(III) Information relating to any 
                                prior authorization or other 
                                utilization management requirements 
                                applicable to such drug and such 
                                alternatives within the formulary of 
                                such plan.
                            ``(ii) Special rule for 2021.--The program 
                        shall be deemed to be in compliance with clause 
                        (i) for 2021 if the program complies with the 
                        provisions of section 423.160(b)(7) of title 
                        42, Code of Federal Regulations (or a successor 
                        regulation), for such year.''.

SEC. 105. TRANSITIONAL COVERAGE AND RETROACTIVE MEDICARE PART D 
              COVERAGE FOR CERTAIN LOW-INCOME BENEFICIARIES.

    Section 1860D-14 of the Social Security Act (42 U.S.C. 1395w-114) 
is amended--
            (1) by redesignating subsection (e) as subsection (f); and
            (2) by adding after subsection (d) the following new 
        subsection:
    ``(e) Limited Income Newly Eligible Transition Program.--
            ``(1) In general.--Beginning not later than January 1, 
        2021, the Secretary shall carry out a program to provide 
        transitional coverage for covered part D drugs for LI NET 
        eligible individuals in accordance with this subsection.
            ``(2) LI net eligible individual defined.--For purposes of 
        this subsection, the term `LI NET eligible individual' means a 
        part D eligible individual who--
                    ``(A) meets the requirements of clauses (ii) and 
                (iii) of subsection (a)(3)(A); and
                    ``(B) has not yet enrolled in a prescription drug 
                plan or an MA-PD plan, or, who has so enrolled, but 
                with respect to whom coverage under such plan has not 
                yet taken effect.
            ``(3) Transitional coverage.--For purposes of this 
        subsection, the term `transitional coverage' means with respect 
        to an LI NET eligible individual--
                    ``(A) immediate access to covered part D drugs at 
                the point of sale during the period that begins on the 
                first day of the month such individual is determined to 
                meet the requirements of clauses (ii) and (iii) of 
                subsection (a)(3)(A) and ends on the date that coverage 
                under a prescription drug plan or MA-PD plan takes 
                effect with respect to such individual; and
                    ``(B) in the case of an LI NET eligible individual 
                who is a full-benefit dual eligible individual (as 
                defined in section 1935(c)(6)) or a recipient of 
                supplemental security income benefits under title XVI, 
                retroactive coverage (in the form of reimbursement of 
                the amounts that would have been paid under this part 
                had such individual been enrolled in a prescription 
                drug plan or MA-PD plan) of covered part D drugs 
                purchased by such individual during the period that 
                begins on the date that is the later of--
                            ``(i) the date that such individual was 
                        first eligible for a low-income subsidy under 
                        this part; or
                            ``(ii) the date that is 36 months prior to 
                        the date such individual enrolls in a 
                        prescription drug plan or MA-PD plan,
                and ends on the date that coverage under such plan 
                takes effect.
            ``(4) Program administration.--
                    ``(A) Single point of contact.--The Secretary 
                shall, to the extent feasible, administer the program 
                under this subsection through a contract with a single 
                program administrator.
                    ``(B) Benefit design.--The Secretary shall ensure 
                that the transitional coverage provided to LI NET 
                eligible individuals under this subsection--
                            ``(i) provides access to all covered part D 
                        drugs under an open formulary;
                            ``(ii) permits all pharmacies determined by 
                        the Secretary to be in good standing to process 
                        claims under the program;
                            ``(iii) is consistent with such 
                        requirements as the Secretary considers 
                        necessary to improve patient safety and ensure 
                        appropriate dispensing of medication; and
                            ``(iv) meets such other requirements as the 
                        Secretary may establish.
            ``(5) Relationship to other provisions of this title; 
        waiver authority.--
                    ``(A) In general.--The following provisions shall 
                not apply with respect to the program under this 
                subsection:
                            ``(i) Paragraphs (1) and (3)(B) of section 
                        1860D-4(a) (relating to dissemination of 
                        general information; availability of 
                        information on changes in formulary through the 
                        Internet).
                            ``(ii) Subparagraphs (A) and (B) of section 
                        1860D-4(b)(3) (relating to requirements on 
                        development and application of formularies; 
                        formulary development).
                            ``(iii) Paragraphs (1)(C) and (2) of 
                        section 1860D-4(c) (relating to medication 
                        therapy management program).
                    ``(B) Waiver authority.--The Secretary may waive 
                such other requirements of title XI and this title as 
                may be necessary to carry out the purposes of the 
                program established under this subsection.''.

                TITLE II--RURAL AND QUALITY IMPROVEMENTS

SEC. 201. MEDICARE GME TREATMENT OF HOSPITALS ESTABLISHING NEW MEDICAL 
              RESIDENCY TRAINING PROGRAMS AFTER HOSTING MEDICAL 
              RESIDENT ROTATORS FOR SHORT DURATIONS.

    (a) Redetermination of Approved FTE Resident Amount.--Section 
1886(h)(2)(F) of the Social Security Act (42 U.S.C. 1395ww(h)(2)(F)) is 
amended--
            (1) by inserting ``(i)'' before ``In the case of''; and
            (2) by adding at the end the following:
                    ``(ii) In applying this subparagraph in the case of 
                a hospital that, on or after the date of the enactment 
                of this clause, begins to train residents and has not 
                entered into a GME affiliation agreement (as defined by 
                the Secretary for purposes of paragraph (4)(H)(ii)), 
                the Secretary shall not establish an FTE resident 
                amount until such time as the Secretary determines that 
                the hospital has trained at least 1.0 full-time-
                equivalent resident in an approved medical residency 
                training program in a cost reporting period.
                    ``(iii) In applying this subparagraph for cost 
                reporting periods beginning on or after the date of 
                enactment of this clause, in the case of a hospital 
                that, as of such date of enactment, has an approved FTE 
                resident amount based on the training in an approved 
                medical residency program of--
                            ``(I) less than 1.0 full-time-equivalent 
                        resident in any cost reporting period beginning 
                        before October 1, 1997, as determined by the 
                        Secretary; or
                            ``(II) no more than 3.0 full-time-
                        equivalent residents in any cost reporting 
                        period beginning on or after October 1, 1997, 
                        and before the date of the enactment of this 
                        clause, as determined by the Secretary,
                in lieu of such FTE resident amount the Secretary 
                shall, in accordance with the methodology described in 
                section 413.77(e) of title 42 of the Code of Federal 
                Regulations (or any successor regulation), establish a 
                new FTE resident amount if the hospital trains at least 
                1.0 full-time-equivalent resident (in the case of a 
                hospital described in subclause (I)) or more than 3.0 
                full-time-equivalent residents (in the case of a 
                hospital described in subclause (II)) in a cost 
                reporting period beginning on or after such date of 
                enactment and before the date that is 5 years after 
                such date of enactment.
                    ``(iv) For purposes of carrying out this 
                subparagraph for cost reporting periods beginning on or 
                after the date of the enactment of this clause, a 
                hospital shall report full-time-equivalent residents on 
                its cost report for a cost reporting period if the 
                hospital trains at least 1.0 full-time-equivalent 
                resident in an approved medical residency training 
                program in such period.
                    ``(v) As appropriate, the Secretary may consider 
                information from any cost reporting period necessary to 
                establish a new FTE resident amount as described in 
                clause (iii).''.
    (b) Redetermination of FTE Resident Limitation.--Section 
1886(h)(4)(H)(i) of the Social Security Act (42 U.S.C. 
1395ww(h)(4)(H)(i)) is amended--
            (1) by inserting ``(I)'' before ``The Secretary''; and
            (2) by adding at the end the following:
                            ``(II) In applying this clause in the case 
                        of a hospital that, on or after the date of the 
                        enactment of this subclause, begins to train 
                        residents in a new approved medical residency 
                        training program (as defined by the Secretary), 
                        the Secretary shall not determine a limitation 
                        applicable to the hospital under subparagraph 
                        (F) until such time as the Secretary determines 
                        that the hospital has trained at least 1.0 
                        full-time-equivalent resident in such new 
                        approved medical residency training program in 
                        a cost reporting period.
                            ``(III) In applying this clause in the case 
                        of a hospital that, as of the date of the 
                        enactment of this subclause, has a limitation 
                        under subparagraph (F), based on a cost 
                        reporting period beginning before October 1, 
                        1997, of less than 1.0 full-time-equivalent 
                        resident, the Secretary shall adjust the 
                        limitation in the manner applicable to a new 
                        approved medical residency training program if 
                        the Secretary determines the hospital trains at 
                        least 1.0 full-time-equivalent resident in a 
                        program year beginning on or after such date of 
                        enactment and before the date that is 5 years 
                        after such date of enactment.
                            ``(IV) In applying this clause in the case 
                        of a hospital that, as of the date of the 
                        enactment of this subclause, has a limitation 
                        under subparagraph (F), based on a cost 
                        reporting period beginning on or after October 
                        1, 1997, and before such date of enactment, of 
                        no more than 3.0 full-time-equivalent 
                        residents, the Secretary shall adjust the 
                        limitation in the manner applicable to a new 
                        approved medical residency training program if 
                        the Secretary determines the hospital begins 
                        training more than 3.0 full-time-equivalent 
                        residents in a program year beginning on or 
                        after such date of enactment and before the 
                        date that is 5 years after such date of 
                        enactment.
                            ``(V) An adjustment to the limitation 
                        applicable to a hospital made pursuant to 
                        subclause (III) or (IV) shall be made in a 
                        manner consistent with the methodology, as 
                        appropriate, in section 413.79(e) of title 42, 
                        Code of Federal Regulations (or any successor 
                        regulation). As appropriate, the Secretary may 
                        consider information from any cost reporting 
                        periods necessary to make such an adjustment to 
                        the limitation.''.
    (c) Technical and Conforming Amendments.--Section 1886 of the 
Social Security Act (42 U.S.C. 1395ww) is amended--
            (1) in subsection (d)(5)(B)(viii), by striking ``subsection 
        (h)(4)(H)'' and inserting ``paragraphs (2)(F)(iv) and (4)(H) of 
        subsection (h)''; and
            (2) in subsection (h)--
                    (A) in paragraph (4)(H)(iv), by striking ``an rural 
                area'' and inserting ``a rural area''; and
                    (B) in paragraph (7)(E), by striking ``under this'' 
                and all that follows through the period at the end and 
                inserting the following: ``under this paragraph, 
                paragraph (8), clause (i), (ii), (iii), or (v) of 
                paragraph (2)(F), or clause (i) or (vi) of paragraph 
                (4)(H).''.
    (d) Effective Date.--The amendments made by this section shall 
apply to payment under section 1886 of the Social Security Act (42 
U.S.C. 1395ww) for cost reporting periods beginning on or after the 
date of the enactment of this Act.

SEC. 202. EXTENSION OF THE WORK GEOGRAPHIC INDEX FLOOR UNDER THE 
              MEDICARE PROGRAM.

    Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``2020'' and inserting ``2023''.

SEC. 203. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSEMENT, INPUT, 
              AND SELECTION UNDER MEDICARE PROGRAM.

    (a) In General.--Section 1890(d)(2) of the Social Security Act (42 
U.S.C. 1395aaa(d)(2)) is amended--
            (1) by striking ``and $7,500,000'' and inserting 
        ``$7,500,000''; and
            (2) by striking ``and 2019.'' and inserting ``and 2019, and 
        $30,000,000 for each of fiscal years 2020 through 2022.''.
    (b) Input for Removal of Measures.--Section 1890(b) of the Social 
Security Act (42 U.S.C. 1395aaa(b)) is amended by inserting after 
paragraph (3) the following:
            ``(4) Removal of measures.--The entity may provide input to 
        the Secretary on quality and efficiency measures described in 
        paragraph (7)(B) that could be considered for removal.''.
    (c) Prioritization of Measure Endorsement.--Section 1890(b) of the 
Social Security Act (42 U.S.C. 1395aaa(b)) is amended by adding at the 
end the following:
            ``(9) Prioritization of measure endorsement.--The 
        Secretary--
                    ``(A) during the period beginning on the date of 
                the enactment of this paragraph and ending on December 
                31, 2023, shall prioritize the endorsement of measures 
                relating to maternal morbidity and mortality by the 
                entity with a contract under subsection (a) in 
                connection with endorsement of measures described in 
                paragraph (2); and
                    ``(B) on and after January 1, 2024, may prioritize 
                the endorsement of such measures by such entity.''.

SEC. 204. IMPROVING MEASUREMENTS UNDER THE SKILLED NURSING FACILITY 
              VALUE-BASED PURCHASING PROGRAM UNDER THE MEDICARE 
              PROGRAM.

    (a) In General.--Section 1888(h) of the Social Security Act (42 
U.S.C. 1395yy(h)) is amended--
            (1) in paragraph (1), by adding at the end the following 
        new subparagraph:
                    ``(C) Exclusions.--With respect to payments for 
                services furnished on or after October 1, 2021, this 
                subsection shall not apply to a facility for which 
                there are not a minimum number (as determined by the 
                Secretary) of--
                            ``(i) cases for the measures that apply to 
                        the facility for the performance period for the 
                        applicable fiscal year; or
                            ``(ii) measures that apply to the facility 
                        for the performance period for the applicable 
                        fiscal year.'';
            (2) in paragraph (2)(A)--
                    (A) by striking ``The Secretary shall apply'' and 
                inserting ``The Secretary--
                            ``(i) shall apply'';
                    (B) by striking the period at the end and inserting 
                ``; and''; and
                    (C) by adding at the end the following:
                            ``(ii) may, with respect to payments for 
                        services furnished on or after October 1, 2022, 
                        apply additional measures determined 
                        appropriate by the Secretary, which may include 
                        measures of functional status, patient safety, 
                        care coordination, or patient experience.
                Subject to the succeeding sentence, in the case that 
                the Secretary applies additional measures under clause 
                (ii), the Secretary shall consider and apply, as 
                appropriate, quality measures specified under section 
                1899B(c)(1). In no case may the Secretary apply more 
                than 10 measures under this subparagraph.'';
            (3) in subparagraph (A) of each of paragraphs (3) and (4), 
        by striking ``measure'' and inserting ``measures''; and
            (4) by adding at the end the following new paragraph:
            ``(12) Validation.--
                    ``(A) In general.--The Secretary shall apply to the 
                measures applied under this subsection and the data 
                submitted under subsection (e)(6) a process to validate 
                such measures and data, as appropriate, which may be 
                similar to the process specified in section 
                1886(b)(3)(B)(viii)(XI) for validating inpatient 
                hospital measures.
                    ``(B) Funding.--For purposes of carrying out this 
                paragraph, the Secretary shall provide for the 
                transfer, from the Federal Hospital Insurance Trust 
                Fund established under section 1817, of $5,000,000 to 
                the Centers for Medicare & Medicaid Services Program 
                Management Account for each of fiscal years 2022 
                through 2024.''.
    (b) Report by MedPAC.--Not later than March 15, 2021, the Medicare 
Payment Advisory Commission shall submit to Congress a report on 
establishing a prototype value-based payment program under a unified 
prospective payment system for post-acute care services under the 
Medicare program under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.). Such report--
            (1) shall--
                    (A) consider design elements such as--
                            (i) measures that are important to the 
                        Medicare program and to beneficiaries under 
                        such program;
                            (ii) methodologies for scoring provider 
                        performance and effects on payment; and
                            (iii) other elements determined appropriate 
                        by the Commission; and
                    (B) analyze the effects of implementing such 
                prototype program; and
            (2) may--
                    (A) discuss the possible effects, with respect to 
                the Medicare program, on program spending, post-acute 
                care providers, patient outcomes, and other effects 
                determined appropriate by the Commission; and
                    (B) include recommendations with respect to such 
                prototype program, as determined appropriate by the 
                Commission, to Congress and the Secretary of Health and 
                Human Services.
                                 <all>