119 HR 9693 IH: Patients First Act of 2026
U.S. House of Representatives
2026-07-15
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.This Act may be cited as the Patients First Act of 2026
. <enum>I</enum><header>Strengthening reimbursement and patient access</header> <section id="H835F3D95CC044CCEB4D2603484AB9353"><enum>101.</enum><header>Modifying the conversion factor updates applicable to physicians’ services under the Medicare program</header> <subsection id="H76924627E31F43DB8DE0AD0E8EAE4225"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1848(d) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(d)</external-xref>) is amended—</text>
<paragraph id="HAB3F03C3F28449E3BA8C009DB3F1A022"><enum>(1)</enum><text>in paragraph (1)(A), in the second sentence, by inserting <quote>or (21)</quote> after <quote>paragraph (20)</quote>;</text></paragraph> <paragraph id="H2317F3661CC44034945DB8A58A2CA7E0"><enum>(2)</enum><text>in paragraph (20)—</text>
<subparagraph id="HD1563F45C6444B72B52CCF0666A2DC5D"><enum>(A)</enum><text>in the header, by striking <quote><header-in-text level="paragraph" style="OLC">and subsequent years</header-in-text></quote>; and</text></subparagraph> <subparagraph id="H4AA5643F405249DEAA43E57A875BFAA9"><enum>(B)</enum><text>by striking <quote>and each subsequent year</quote>; and</text></subparagraph></paragraph>
<paragraph id="HD8F9EF49C0D54913BD1A30D86A70C949"><enum>(3)</enum><text>by adding at the end the following new paragraph:</text> <quoted-block style="OLC" id="H6D36387491964A369FD42769211C108B" display-inline="no-display-inline"> <paragraph id="H9135C419E7664F6FA7F538734B0F03D3"><enum>(21)</enum><header>Update for 2027 and subsequent years</header> <subparagraph id="HB944F9DB1567467A8479EE886F36B989"><enum>(A)</enum><header>In general</header><text>For 2027 and each subsequent year, the update to the nonqualifying APM conversion factor established under paragraph (1)(A) is, subject to subparagraph (B), the Secretary's estimate of the percentage increase in the MEI (as defined in section 1842(i)(3)) for the year, less 1 percentage point, and the update to the qualifying APM conversion factor established under such paragraph is the update to the nonqualifying APM conversion factor for the year, increased by 0.5 percentage point.</text></subparagraph>
<subparagraph id="H232856EF765D47CD89866CA846865489"><enum>(B)</enum><header>Floor and ceiling on nonqualifying APM conversion factor update</header><text>In the case that the update to the nonqualifying APM conversion factor for a year as calculated under subparagraph (A) is—</text> <clause id="H0D158CCCFCE74763BAF6FBFCF4E6285F"><enum>(i)</enum><text>less than 25 percent of the Secretary’s estimate of the percentage increase in the MEI (as defined in section 1842(i)(3)) for the year, such update shall be deemed to be equal to 25 percent of such estimate; or</text></clause>
<clause id="HE67CDA78C7CA4EA39C7A4F5E68DFD103"><enum>(ii)</enum><text>more than 75 percent of such estimate, such update shall be deemed to be equal to 75 percent of such estimate.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="HBA1987C4F6FC4611ABDDF380DD1D4100"><enum>(b)</enum><header>Reports</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services shall, for 2027 and each year thereafter, submit to Congress a report on the updates to the qualifying APM conversion factor and nonqualifying APM conversion factor under section 1848(d) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(d)</external-xref>) for such year. Such report shall include an analysis of the impact of such updates on Medicare beneficiaries’ access to services under the Medicare program and on the consolidation of physician practices.</text></subsection></section>
<section id="H6E47BE9F469F4E8C9C3C9BFFD1B18FF3"><enum>102.</enum><header>Hybrid payment model for primary care services</header><text display-inline="no-display-inline">Part E of title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x et seq.</external-xref>) is amended by inserting after section 1866G the following new section:</text> <quoted-block style="OLC" id="HB4650F958D75414594E2D483AE230710" display-inline="no-display-inline"> <section id="H92ADF03EAF60432893A1D16EB0C8BF1B"><enum>1866H.</enum><header>Hybrid payment model for primary care services</header> <subsection id="H1FF56BDF92854B69BB85AFB25268721F"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall, for 2027 and each subsequent year through 2031, carry out a hybrid payment model for primary care services (in this section referred to as the <quote>model</quote>) under which the Secretary shall make a monthly payment to each qualifying supplier for each individual attributed to such practice for such year in lieu of payment for any designated primary care services furnished by such supplier to such individuals during such year that would otherwise be made under the payment schedule established under section 1848 (or on the basis of such schedule).</text></subsection>
<subsection id="HC61D31FACE8E4C6185EE947AF8F5DD7F"><enum>(b)</enum><header>Payment amount</header>
<paragraph id="HA540D819C86841AE9BE041A596669C98"><enum>(1)</enum><header>In general</header><text>The monthly amount payable to a qualifying supplier for a year under the model is equal to one-twelfth of the national average amount that the Secretary estimates will be payable under the payment basis established under section 1848 for designated primary care services furnished during such year (so estimated as if no cost sharing requirements applied to individuals enrolled under part B), adjusted by a geographic index determined appropriate by the Secretary and risk adjusted in a manner determined appropriate by the Secretary.</text></paragraph> <paragraph id="HA9DDC52A92074B99A3DA4D96FFCFD1D2"><enum>(2)</enum><header>Nonapplication of cost sharing</header><text>No cost sharing requirement shall apply with respect to a monthly payment made under the model to a qualifying supplier for an individual attributed to such supplier.</text></paragraph></subsection>
<subsection id="HFDF2FE084685405197A9672E3F47798B"><enum>(c)</enum><header>Attribution process</header>
<paragraph id="H9FC3AAFD8BE94DE583BEEF6D123EB8ED"><enum>(1)</enum><header>In general</header><text>The Secretary shall establish a process under which, for each year of the model, individuals enrolled under part B who are not enrolled under an MA plan under part C may designate a qualifying supplier as such individual’s primary care provider for such year.</text></paragraph> <paragraph id="H46B27C34E9AB46019C0A6FCEC0DFC6DE"><enum>(2)</enum><header>Attribution based on prior claims</header><text>In the case of an individual described in paragraph (1) who fails to make a designation for a year but for whom the Secretary determines, based on claims history of items and services furnished under this title, that such individual has a primary care provider who is a qualifying supplier, the Secretary may designate such supplier as such individual’s primary care provider for such year.</text></paragraph>
<paragraph id="HFA0C944C5A3F4DACA92434ACFE2B4B1D"><enum>(3)</enum><header>Treated as attributed</header><text>For purposes of this section, each individual who makes a designation under paragraph (1) (or for whom such a designation is made under paragraph (2)) with respect to a qualifying supplier for a year shall be treated as attributed to such supplier for such year.</text></paragraph></subsection> <subsection id="HFAFE8D09E26441FCA1C057B718898E9B"><enum>(d)</enum><header>No effect on PFS budget neutrality</header><text>Section 1848(c)(2)(B) shall be applied for 2027 and each subsequent year as if the model had never applied.</text></subsection>
<subsection id="HCD745A2B0C054D94A596CEDD56DE7EA1"><enum>(e)</enum><header>Funding</header><text>Payments under the model shall be made from the Federal Supplementary Medical Insurance Trust Fund established under section 1841.</text></subsection> <subsection id="H27C623275473482E8F105AF63C637390"><enum>(f)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text>
<paragraph id="H499D4DC5514047658AF5B5AC44777BB0"><enum>(1)</enum><header>Designated health care practitioner</header><text>The term <quote>designated health care practitioner</quote> means a physician assistant, a nurse practitioner, a clinical nurse specialist, a physical therapist, an occupational therapist, or such other health care practitioner as the Secretary may specify.</text></paragraph> <paragraph id="H3CD298542CA3438BAA36310F3DF1EE62"><enum>(2)</enum><header>Designated primary care services</header><text>The term <quote>designated primary care services</quote> means—</text>
<subparagraph id="HC7D5DE7FDF9A45C294B00469269FA4A8"><enum>(A)</enum><text>care management services;</text></subparagraph> <subparagraph id="HC8F1839F9EAD49B687E00E2FB9B086DB"><enum>(B)</enum><text>behavioral health integration services;</text></subparagraph>
<subparagraph id="HB5BAC662622E40DFA864C9F9CD9B1DAE"><enum>(C)</enum><text>office-based evaluation and management services (whether furnished in person or via telehealth); and</text></subparagraph> <subparagraph id="HDEED1EE8ADC849668D7D21468C8537EE"><enum>(D)</enum><text display-inline="yes-display-inline">communications such as telephone calls, emails and patient portals between patients and their care givers.</text></subparagraph></paragraph>
<paragraph id="H8747FEB2C6D74517975E4A43E0D8219C"><enum>(3)</enum><header>Excluded practice</header>
<subparagraph id="HD1691B31A6734395AD92B204553C95B2"><enum>(A)</enum><header>In general</header><text>The term <quote>excluded practice</quote> means, subject to subparagraph (B), any practice—</text> <clause id="H7EDDEEC901064A21BFA9B63861EA0E67"><enum>(i)</enum><text>in which any entity that is not a physician or designated health care practitioner or a professional corporation, professional association, limited liability company, or other professional body that is majority owned and controlled by physicians or designated health care practitioners has an ownership interest;</text></clause>
<clause id="H7387524DB6F2477283DC807E9FA1CFF0"><enum>(ii)</enum><text>in which any entity described in subparagraph (A) exercises de facto control over employment decisions (including rates of pay and terms of employment), clinical staffing levels, amount of time spent between a supplier and a patient, diagnostic or procedural coding decisions, clinical standards or policy, billing and collection, prices for items and services, contracting with third party payors, or controlling or restricting the practice’s assets;</text></clause> <clause id="HE73CD50668924EE59F29211B2FCBFBE0"><enum>(iii)</enum><text display-inline="yes-display-inline">in which physicians or designated health care practitioners hold 50 percent or less of voting shares or membership interests;</text></clause>
<clause id="HEF3572BA769443F8ADB2185BAEAC69C7"><enum>(iv)</enum><text display-inline="yes-display-inline">that has a governing board in which physicians or designated health care practitioners constitute less than 50 percent of the members; or</text></clause> <clause id="HDACEE4E8C8874612AF5A8842F2DEBF11"><enum>(v)</enum><text display-inline="yes-display-inline">in the case such practice is a corporation or professional association, that permits the removal of directors or officers that are physicians or designated health care practitioners except by majority vote of stakeholders that are physicians or designated health care practitioners.</text></clause></subparagraph>
<subparagraph id="HDAE26D1897AB485B85E1A700537E7A0F"><enum>(B)</enum><header>Exception</header><text>The term <quote>excluded practice</quote> does not include any practice consisting of 15 or fewer designated health care practitioners.</text></subparagraph></paragraph> <paragraph id="H48E8CF4D450E45A481896D310636768E"><enum>(4)</enum><header>Specified practitioner</header><text>The term <quote>specified practitioner</quote> means—</text>
<subparagraph id="H36A9C99C44D8434187DED47CECF75AEE"><enum>(A)</enum><text>a physician with a primary specialty or practice area of family medicine, internal medicine, geriatric medicine, or pediatric medicine; or</text></subparagraph> <subparagraph id="H2A86C8FCBF4D4281B5583482FAE76CF6"><enum>(B)</enum><text>a physician assistant, a nurse practitioner, or a clinical nurse specialist.</text></subparagraph></paragraph>
<paragraph id="H32AA89EC946A4EC7977B4F52BA0108DA"><enum>(5)</enum><header>Qualifying supplier</header><text>The term <quote>qualifying supplier</quote> means, with respect to a year, a specified practitioner—</text> <subparagraph id="H8F08ACED978F44219BBC57BF5CD32964"><enum>(A)</enum><text>who is not part of an excluded practice;</text></subparagraph>
<subparagraph id="HBB6CF970BB1B49578355237AD091238D"><enum>(B)</enum><text>who furnished items and services under this title during the preceding year;</text></subparagraph> <subparagraph id="H66E22BDE1DEA44FF95B04B730F044C18"><enum>(C)</enum><text>for whom, with respect to payments under this title for all items and services furnished by such practitioner during the preceding year, at least 60 percent of such payments were for designated primary care services; and</text></subparagraph>
<subparagraph id="H958DEC7D3C3D453EA9DE9AF30831BC55"><enum>(D)</enum><text>who has elected to participate in the model for such year through such process as the Secretary shall establish.</text></subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section> <section id="HB586AA7E350E4808ABADA2D3E3FF55E0"><enum>103.</enum><header>Work geographic floor adjustment for high inflationary years</header> <subsection id="HC806750AE673438D85E88AF04FF3C252"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1848(e)(1)(E) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(e)(1)(E)</external-xref>) is amended—</text>
<paragraph id="HA2F775A4C50747AAB3C527B2FEDC7D0C"><enum>(1)</enum><text>by striking the header and inserting <quote><header-in-text level="subparagraph" style="OLC">Work geographic index</header-in-text></quote>;</text></paragraph> <paragraph id="HBE59EE4C4ADE47C1B94E278338DCF642"><enum>(2)</enum><text>by striking <quote>After calculating</quote> and inserting the following:</text>
<quoted-block style="OLC" id="H0FD5202001A9461B98ABC1318946327C" display-inline="no-display-inline">
<clause id="H2C22A1287C4F426B9F93A39F6D984AD9"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">After calculating</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></paragraph> <paragraph id="H61697EC404A7495CA29C14AE54875E80"><enum>(3)</enum><text>in clause (i) (as so inserted)—</text>
<subparagraph id="H019BA07A720845B68DEB847615125989"><enum>(A)</enum><text>by inserting <quote>(or 1.025, in the case such year is a high inflationary year (as defined in clause (iii)))</quote> after <quote>to 1.00</quote>; and</text></subparagraph> <subparagraph id="HA69E727CAE6D497B9392C1FA1F237BFF"><enum>(B)</enum><text>by striking <quote>2027</quote> and inserting <quote>2032</quote>; and</text></subparagraph></paragraph>
<paragraph id="H695EC7ECBDAF422DA684CCCC922A4409"><enum>(4)</enum><text>by adding at the end the following new clauses:</text> <quoted-block style="OLC" id="HDD360A2148554A619FEB2245542951DE" display-inline="no-display-inline"> <clause id="HB2D3A00BC6A440088EE1778C46934099"><enum>(ii)</enum><header>Increase in high inflationary years for other localities</header><text display-inline="yes-display-inline">After calculating the work geographic index in subparagraph (A)(iii), for purposes of payment for services furnished on or after January 1, 2027, and before January 1, 2033, the Secretary shall increase the work geographic index by .02 points if such year is a high inflationary year, unless such work geographic index is subject to an increase under clause (i) for such year.</text></clause>
<clause id="HA4E3B15826C3443C8FDAB7BD6ADC089F"><enum>(iii)</enum><header>Definition</header><text>In this subparagraph, the term <quote>high inflationary year</quote> means a year if, over the 12-month period ending on the last day of the preceding year, the consumer price index for all urban consumers (U.S. city average) increased by more than 2 percent.</text></clause> <clause id="H38B436F5A3BD4C8685B9ADD2569C5A06"><enum>(iv)</enum><header>Publication</header><text display-inline="yes-display-inline">Medicare administrative contractors shall publish the geographically adjusted work relative value units for both the inflation adjustments under clauses (i) and (ii) and the work geographic adjustment for all services on a quarterly basis effective January 1, 2027, for each of their geographic areas.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection>
<subsection id="HCEA599ACD0B44010B35D28825E839ADC">
<enum>(b)</enum>
<header>Report</header>
<text display-inline="yes-display-inline">Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the House Energy and Commerce and Ways and Means Committees and Senate Finance Committee a study on the economic factors that are impacting physician choice, by specialty, regarding the geographic area in which such physicians choose to practice, including salaries, contract terms, cost of living, availability of capital, volume of services, and costs to conduct a practice.</text>
</subsection></section>
<enum>II</enum><header>POINTS</header>
<section id="HAB6B29EB081C480790FACCB7D99FAD35"><enum>201.</enum><header>Implementation of the Patient Outcome Improvement National Tabulation System</header>
<subsection id="HA71BD677EE7448D78D9A666D0C16BD34"><enum>(a)</enum><header>In general</header><text>Effective January 1, 2032, there is established the Patient Outcome Improvement National Tabulation System, which shall consist of the payment system under section 1848(q) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)</external-xref>), including as amended by this section.</text></subsection> <subsection id="HD1C7B072485D47FFBD75ABD3D5024CDB"><enum>(b)</enum><header>References</header><text display-inline="yes-display-inline">Subject to paragraph (3), any reference to the payment system under section 1848(q) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)</external-xref>), including the terms <quote>Merit-based Incentive Payment System</quote> and <quote>MIPS</quote>, shall be deemed a reference to the <quote>Patient Outcome Improvement National Tabulation System</quote> and <quote>POINTS</quote>, respectively.</text></subsection>
<subsection id="H4EF67689EC2945DB9EAF8673380650F9"><enum>(c)</enum><header>Transition</header><text display-inline="yes-display-inline">In order to provide for an orderly transition and avoid provider confusion, the Secretary of Health and Human Services shall provide for an appropriate transition in the use of the terms <quote>Merit-based Incentive Payment System</quote> (and <quote>MIPS</quote>) and <quote>Patient Outcome Improvement National Tabulation System</quote> (and <quote>POINTS</quote>) in reference to the payment system under section 1848(q) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)</external-xref>). Before the completion of such transition, any reference to the <quote>Patient Outcome Improvement National Tabulation System</quote> (or <quote>POINTS</quote>) shall be deemed to include a reference to the <quote>Merit-based Incentive Payment System</quote>.</text></subsection></section> <section id="HD477207C00E0494D8A216321275E8FCE"><enum>202.</enum><header>Payment reform</header> <subsection id="HA5076024A69B48BBB9E4EB43CFFAD6DA"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1848(q) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)</external-xref>) is amended—</text>
<paragraph id="H7B4C8B1E78B84FB7BD2CA62813B37F15"><enum>(1)</enum><text>in paragraph (1)(D)(i)(II), by striking <quote>(iv)</quote> and inserting <quote>(v)</quote>;</text></paragraph> <paragraph id="H734C51C9FDD64F1FBD2A51DC4165FDC8"><enum>(2)</enum><text>in paragraph (2)—</text>
<subparagraph id="H050F58AD23E84425BAA8ED570C1480AB"><enum>(A)</enum><text>in subparagraph (A)—</text> <clause id="H727C39628BBD4275856D422873B74B17"><enum>(i)</enum><text>in clause (iii), by striking <quote>Clinical practice</quote> and inserting <quote>For performance periods beginning before January 1, 2032, clinical practice</quote>;</text></clause>
<clause id="H0FED8B0697764078B01E30AD280BCBA1"><enum>(ii)</enum><text>in clause (iv), by striking <quote>Meaningful use</quote> and inserting <quote>For performance periods before January 1, 2032, meaningful use</quote>; and</text></clause> <clause id="HF9786DDFB1984C61AD633D9D48C0A8D9"><enum>(iii)</enum><text>by adding at the end the following new clause:</text>
<quoted-block style="OLC" id="H385894D2EFE34EA59A8657CB30917564" display-inline="no-display-inline">
<clause id="H7D15F6745D024E109405A3FB07F81662"><enum>(v)</enum><text display-inline="yes-display-inline">For performance periods beginning on or after January 1, 2032, care efficiency.</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></clause></subparagraph> <subparagraph id="H3AA2E9DC51F54F0FAF89C8797854632E"><enum>(B)</enum><text>in subparagraph (B)—</text>
<clause id="HD989B9C9AA7F45DEAFCD69F3C07EF66A"><enum>(i)</enum><text>in clause (ii)—</text> <subclause id="H8D35CCA77173463B894E83C3E35FA076"><enum>(I)</enum><text>by striking <quote>subparagraph (A)(ii), the measurement</quote> and inserting the following:</text>
<quoted-block style="OLC" id="HE788A3B0FCF54269A7C7BCC9EC5D57E4" display-inline="yes-display-inline"><text display-inline="yes-display-inline">subparagraph (A)(ii)—</text> <subclause id="HB5BEF5B7C1614EBDAFBE4BA82B726EB5"><enum>(I)</enum><text display-inline="yes-display-inline">for performance periods beginning before January 1, 2032, the measurement</text></subclause><after-quoted-block>; and</after-quoted-block></quoted-block></subclause>
<subclause id="HA1EF507D0D574E679CC9099180973200"><enum>(II)</enum><text>by striking the period at the end and inserting the following:</text> <quoted-block style="OLC" id="H292E8F10512F469FA75B874FA56C4B2F" display-inline="yes-display-inline"><text display-inline="yes-display-inline">; and</text>
<subclause id="H3BAF25EB153E4597B86B3F9C30E731CB"><enum>(II)</enum><text display-inline="yes-display-inline">for performance periods beginning on or after January 1, 2032, the measurement described in subclause (I) and any resource use measures included in the final measures list published under subparagraph (D)(i) for such period.</text></subclause><after-quoted-block>; and</after-quoted-block></quoted-block></subclause></clause> <clause id="H3B82B3A764D24EAF9DFCAEE23CD5E67F"><enum>(ii)</enum><text>by inserting after clause (iv) the following new clause:</text>
<quoted-block style="OLC" id="HED790A4C6C384DCCB5348AF56EB23A0C" display-inline="no-display-inline">
<clause id="H3FFDE322D88946689211E8AC539AAEB7"><enum>(v)</enum><header>Care efficiency</header><text display-inline="yes-display-inline">For the performance category described in subparagraph (A)(v), care efficiency measures (such as measures relating to reductions in avoidable hospitalizations, reductions in medication burden (when clinically appropriate), reductions in complications from chronic diseases, and referral patterns to the lowest-cost clinically appropriate settings) included in the final measures list published under subparagraph (D)(i) for such period.</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></clause></subparagraph> <subparagraph id="H8D5656EBA3534CCDB36A4F27E9BFB39C"><enum>(C)</enum><text>in subparagraph (D)—</text>
<clause id="H31964272C82148889B1EDDA32FBF873A"><enum>(i)</enum><text>in the header, by striking <quote><header-in-text level="subparagraph" style="OLC">quality</header-in-text></quote>;</text></clause> <clause id="H0EEAC2AFE9FE4F2288CE00CCCBDB5138"><enum>(ii)</enum><text>in clause (i)—</text>
<subclause id="H93A9A8F9C2DE4F1F80D40CCB36385B93"><enum>(I)</enum><text>in the matter preceding subclause (I), by inserting <quote>(or, with respect to performance periods beginning on or after January 1, 2032, an annual final list of quality measures, resource use measures (if determined appropriate by the Secretary), and care efficiency measures)</quote> after <quote>quality measures</quote>; and</text></subclause> <subclause id="HC84DB6826B6345BE97A8D3F8E62BA770"><enum>(II)</enum><text>in subclause (II)—</text>
<item id="HEFF9FDD147044F39B6E9B6858FDEB69C"><enum>(aa)</enum><text>in item (aa), by striking <quote>quality measures</quote> and inserting <quote>measures</quote>;</text></item> <item id="H022A51AADA384306A63DC660A849C15A"><enum>(bb)</enum><text>in item (bb), by inserting <quote>(or, with respect to a final list for a performance period beginning on or after January 1, 2032, new quality measures, resource use measures, or care efficiency measures)</quote> after <quote>quality measures</quote>; and</text></item>
<item id="H8E92D2ACE4214601A8F4C02C2AE42849"><enum>(cc)</enum><text>in item (cc), by striking <quote>quality measures</quote> and inserting <quote>measures</quote>;</text></item></subclause></clause> <clause id="HD15333672A544C85AE068C3936B8FBA8"><enum>(iii)</enum><text>in clause (ii)—</text>
<subclause id="H5B3DD6C675B8455AA8E9CD902573D46F"><enum>(I)</enum><text>in the header, by striking <quote>quality</quote>; and</text></subclause> <subclause id="H0C558D64DBBF43A6BEE00DCF8857B4FD"><enum>(II)</enum><text>in subclause (I)—</text>
<item id="H49B960641CF04ECAAD223113311D142F"><enum>(aa)</enum><text>by inserting <quote>(or, with respect to such an annual list for a performance period beginning on or after January 1, 2032, quality measures, resource use measures, and care efficiency measures)</quote> after <quote>submit quality measures</quote>; and</text></item> <item id="H0C81D0704B1E44E981F47289CF7F37B8"><enum>(bb)</enum><text>by striking <quote>quality measures published</quote> and inserting <quote>measures published</quote>;</text></item></subclause></clause>
<clause id="HA9C019F51B554FC39701A637BB861023"><enum>(iv)</enum><text>in clause (iii)—</text> <subclause id="H6596560C95D4400DA0500D17D82C3811"><enum>(I)</enum><text>in the matter preceding subclause (I), by striking <quote>quality</quote>;</text></subclause>
<subclause id="H12E248C6BD4942C4AE6D3C530CCC9EB8"><enum>(II)</enum><text>in subclause (I), by striking <quote>and</quote> at the end;</text></subclause> <subclause id="H21D568EA1B804557BA85363C65A742A5"><enum>(III)</enum><text>in subclause (II)—</text>
<item id="H01BA42C372874A6097C134959214B22B"><enum>(aa)</enum><text>by striking <quote>ensure that</quote> and inserting <quote>with respect to such an annual final list for a performance period beginning before January 1, 2032, ensure that</quote>; and</text></item> <item id="H865665DC3C964A11BBD2C3F9C3F1CBD4"><enum>(bb)</enum><text>by striking the period at the end and inserting <quote>; and</quote>; and</text></item></subclause>
<subclause id="HAB1428B541F14132A339A0B7532CD884"><enum>(IV)</enum><text>by adding at the end the following new subclause:</text> <quoted-block style="OLC" id="HEBEF427E0A8D42F09FDD0DD77A8CE2CC" display-inline="no-display-inline"> <subclause id="H02D482F4E1CA422F9A3EDE25BAAD80CC"><enum>(III)</enum><text display-inline="yes-display-inline">with respect to such an annual final list for a performance period beginning on or after January 1, 2032, provide that—</text>
<item id="H3624DB39736C4A6085F5A30DF57A6A06"><enum>(aa)</enum><text>no quality measure applicable to a medical specialty is included on such list if—</text> <subitem id="H317F4258E26842FDAC81C6AB0B1A6154"><enum>(AA)</enum><text>the task force established under subparagraph (E) has issued recommendations on quality measures for use under this subsection with respect to such specialty; and</text></subitem>
<subitem id="H59747D9096E44AC785F51A00CBF367D7"><enum>(BB)</enum><text>the quality measure does not have in effect such a recommendation; and</text></subitem></item> <item id="H90E088CC3D7A4A73944573EF57017F58"><enum>(bb)</enum><text>no resource use measure or care efficiency measure is included on such list unless such measure has in effect a recommendation from such task force.</text></item></subclause><after-quoted-block>;</after-quoted-block></quoted-block></subclause></clause>
<clause id="H61F4680F885F420F8B6B52336BFB51A4"><enum>(v)</enum><text>in clause (v), in the matter preceding subclause (I), by inserting <quote>for a performance period beginning before January 1, 2032,</quote> after <quote>published under clause (i)</quote>;</text></clause> <clause id="H309B2FEB2DC9447BB1E7E37159D8996D"><enum>(vi)</enum><text>in clause (vi), by striking <quote>under clauses (i), (iv), and (v)</quote> and inserting <quote>under this subparagraph</quote>; and</text></clause>
<clause id="HC42AA5F33E1444679C8B8EB85458F95F"><enum>(vii)</enum><text>in clause (vii)(II), by striking <quote>shall be</quote> and inserting <quote>subject to clause (iii)(III)(aa), shall be</quote>;</text></clause></subparagraph> </paragraph> <paragraph id="HEEACDE7FEC8946D59A766ACEBB36E85B"><enum>(3)</enum><text>in paragraph (5)—</text>
<subparagraph id="HB4B996CEDC4E4A56AC400C1ED2031D23"><enum>(A)</enum><text>in subparagraph (B)—</text> <clause id="H6C4CD4DCEF3F4881A74E4DA2E8E9C4C2"><enum>(i)</enum><text>in clause (ii)—</text>
<subclause id="HD996773DEAE840C787C69B7FCBCB6BB2"><enum>(I)</enum><text>in subclause (I)—</text> <item id="HB1F531C0A4DB4F5EBE019944A58EB0DC"><enum>(aa)</enum><text>by striking <quote>encourage</quote> and inserting <quote>with respect to a performance period beginning before January 1, 2032, encourage</quote>; and</text></item>
<item id="HC26FF62AA3AC4510A5A6AD748C75EDD0"><enum>(bb)</enum><text>by striking <quote>and</quote> at the end;</text></item></subclause> <subclause id="H397E6C1D3EAB4CFA85A6F27AA98F586E"><enum>(II)</enum><text>in subclause (II), by striking the period and inserting <quote>; and</quote>; and</text></subclause>
<subclause id="H0D0BC38E82914FB7B095FBF31259A5A2"><enum>(III)</enum><text>by adding at the end the following new subclause:</text> <quoted-block style="OLC" id="HC6C2DF3ADBE2494AA4C33500BB6A418A" display-inline="no-display-inline"> <subclause id="H344343C58E88444B9FF0828035F98374"><enum>(III)</enum><text display-inline="yes-display-inline">with respect to a performance period beginning on or after January 1, 2032, with respect to a year, provide that in the case of a MIPS eligible professional who fails to report on an applicable quality measure through the use of certified EHR technology or clinical data registries, the professional shall be treated as achieving the lowest potential score applicable to such measure.</text></subclause><after-quoted-block>; and</after-quoted-block></quoted-block></subclause></clause>
<clause id="H9FE9039956ED4FC8BC12BB644EFF49A5"><enum>(ii)</enum><text>by adding at the end the following new clause:</text> <quoted-block style="OLC" id="H839D336374434402B22914AD12E2A8C1" display-inline="no-display-inline"> <clause id="H63A2E14BC1D64ADEB77C47A2DA5FC545"><enum>(iii)</enum><header>Incentive to report on certain measures</header> <subclause id="H9170990AAC124D6DB8E8CFC2792986AB"><enum>(I)</enum><header>In general</header><text display-inline="yes-display-inline">With respect to performance periods for years beginning on or after January 1, 2027, in the case a MIPS eligible professional elects to report on a measure for such period that, with respect to such professional and such period, is a new measure described in subclause (II), a substantively changed measure described in subclause (III), or a measure described in paragraph (2)(B)(i) for which the Secretary is unable to establish a benchmark, such professional shall be treated as achieving the highest possible score with respect to such measure.</text></subclause>
<subclause id="HC17A989AB46D44068141D31E2BAC1CD4"><enum>(II)</enum><header>New measures</header><text display-inline="yes-display-inline">For purposes of subclause (I), a new measure described in this subclause, with respect to a MIPS eligible professional and performance period for a year, is a measure applicable to such professional with respect to the performance category described in paragraph (2)(A)(i) that is included in the final list of quality measures published under paragraph (2)(D)(i) (or the list of quality measures described in paragraph (2)(D)(vi) used by qualified clinical data registries under subsection (m)(3)(E)) for such year but was not included in such final list under paragraph (2)(D)(i) (or list under paragraph (2)(D)(vi)) for any of the previous 3 years.</text></subclause> <subclause id="HFAD20DD76A854A25A874077EFE102A57"><enum>(III)</enum><header>Substantively changed measure</header><text display-inline="yes-display-inline">For purposes of subclause (I), a substantively changed measure described in this subclause, with respect to a MIPS eligible professional and performance period for a year, is a measure applicable to such professional with respect to the performance category described in paragraph (2)(A)(i) that is included in the final list of quality measures published under paragraph (2)(D)(i) (or the list of quality measures described in paragraph (2)(D)(vi) used by qualified clinical data registries under subsection (m)(3)(E)) for such year and each of the previous three years but that underwent a substantive change (as defined by the Secretary) during any of such previous three years.</text></subclause></clause><after-quoted-block>; and</after-quoted-block></quoted-block></clause></subparagraph>
<subparagraph id="H8394A6E22B4A4FB88C2698E682109C41" commented="no"><enum>(B)</enum><text>in subparagraph (E)—</text> <clause id="H1DA6ED378E3B4AAEB2013B31C559A5A5"><enum>(i)</enum><text>in clause (i)—</text>
<subclause id="HA096F89212A141FD92EB86360F8F9A88"><enum>(I)</enum><text>in subclause (I)(aa), by inserting <quote>(or, with respect to 2032 and subsequent years, 65 percent)</quote> after <quote>thirty percent</quote>;</text></subclause> <subclause id="HF3A5A389D8E04195A8FF1682F6C444D9"><enum>(II)</enum><text display-inline="yes-display-inline">in subclause (II)(aa), by inserting <quote>(or, with respect to 2032 and subsequent years, 20 percent)</quote> after <quote>thirty percent</quote>;</text></subclause>
<subclause id="H042C513BC993424599879D37E37F4FD7"><enum>(III)</enum><text>in subclause (III), by inserting <quote>(or, with respect to 2032 and subsequent years, 0 percent)</quote> after <quote>fifteen percent</quote>;</text></subclause> <subclause id="HACF56E1876D243AEA62D58A162F070A0"><enum>(IV)</enum><text display-inline="yes-display-inline">in subclause (IV), by inserting <quote>(or, with respect to 2032 and subsequent years, 0 percent)</quote> after <quote>twenty-five percent</quote>; and</text></subclause>
<subclause id="H310397B0F22443F39055E7BF05AB46F6"><enum>(V)</enum><text>by adding at the end the following new subclause:</text> <quoted-block style="OLC" id="H373531FCD39D4E8EA7C2B4ADE9AE297A" display-inline="no-display-inline"> <subclause id="H84D456B5545E4FA1A7D0F846CCAB3639"><enum>(V)</enum><header>Care efficiency</header><text display-inline="yes-display-inline">With respect to 2032 and subsequent years, 15 percent of such score shall be based on performance with respect to the category described in clause (v) of paragraph (2)(A).</text></subclause><after-quoted-block>; and</after-quoted-block></quoted-block></subclause></clause>
<clause id="H539734A9D3744F85862B7C797558D04E"><enum>(ii)</enum><text>in clause (ii), by inserting <quote>(before 2032)</quote> after <quote>In any year</quote>;</text></clause></subparagraph></paragraph> <paragraph id="H2A4BD99808274C15AB9AEC38B9BAAE78"><enum>(4)</enum><text>in paragraph (11)(A)(i), by striking <quote>clauses (i) through (iv) of</quote>; and</text></paragraph>
<paragraph id="H5389BB99D03A4F0184909E48BFA72B1B"><enum>(5)</enum><text>in paragraph (12)(A)(i)(II), by striking <quote>and (iv)</quote> and inserting <quote>through (v)</quote>.</text></paragraph></subsection> <subsection id="HD15EB0666A8243E8AD96075B4A6A448B"> <enum>(b)</enum> <header>Improvements to resource use performance category</header> <text display-inline="yes-display-inline">Section 1848(r) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(r)</external-xref>) is amended—</text>
<paragraph id="HAFD24E47777347B28977BEB9E0F2E72E">
<enum>(1)</enum>
<text>in paragraph (2)(H), by adding at the end the following new sentence: <quote>In making such revisions for 2027 and subsequent years, the Secretary shall revise care episode groups and patient condition groups without regard to any target described in subparagraph (D)(i)(I).</quote>; and</text>
</paragraph>
<paragraph id="H5E8A94BDA3704333B35396CD66DC4DCE">
<enum>(2)</enum>
<text>in paragraph (5)(C)(i)—</text> <subparagraph id="H5AEB3F4CA0854FEA8E832C11C66A9751"> <enum>(A)</enum> <text>by inserting <quote>, for years before 2027,</quote> after <quote>shall</quote>; and</text>
</subparagraph>
<subparagraph id="H441174C7E3B24B9C883D1BC6417B56C3">
<enum>(B)</enum>
<text>by inserting <quote>and shall, for 2027 and subsequent years, use such care episode codes and patient condition codes</quote> before the period.</text>
</subparagraph>
</paragraph>
</subsection></section>
<section id="H27537AC4A3654DBA9920CB481C5D94EE"><enum>203.</enum><header>Quality reform task force</header><text display-inline="no-display-inline">Section 1848(q)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)(2)</external-xref>) is amended by adding at the end the following new subparagraph:</text>
<quoted-block style="OLC" id="HD58BA6B9D8E04B96863CCCDD4F964790" display-inline="no-display-inline">
<subparagraph id="H79D43B55A15E4A6FA194B8859ED69CD4"><enum>(E)</enum><header>Quality Reform Task Force</header>
<clause id="HD1C3CB5D5A344B11AD512023D80787DE"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 6 months after the date of the enactment of this subparagraph, the Secretary shall establish a Quality Reform Task Force (in this subparagraph referred to as the <quote>Task Force</quote>) for purposes of issuing recommendations with respect to the use of quality, resource use, and care efficiency measures under this subsection.</text></clause> <clause id="H8D6A666B03D6439C945B7B2473AD8E93"><enum>(ii)</enum><header>Membership</header> <subclause id="H944BF54A84B64F16B37FC2A88C4028CC"><enum>(I)</enum><header>In general</header><text>Members of the Task Force shall be appointed by the Secretary and shall include—</text>
<item id="HB75AD5B7B5064CF29B0A2D85A5AFDCB6"><enum>(aa)</enum><text>representatives of the Department of Health and Human Services;</text></item> <item id="H097DFD1BF4D540409CC84756632E0A8D"><enum>(bb)</enum><text>representatives of eligible professional organizations (as defined in subparagraph (D)(ii)(II)); and</text></item>
<item id="HA403B8D256A94A92B164FEF379602524"><enum>(cc)</enum><text>other experts determined appropriate by the Secretary.</text></item></subclause> <subclause id="H8D1A9BDBA4FD4E4D8212EDBE1D30E451"><enum>(II)</enum><header>Appropriate representation</header><text>In making appointments under subclause (I), the Secretary shall ensure that—</text>
<item id="H2B5F97E1B80946B39E50027CA4145E4C"><enum>(aa)</enum><text>each medical specialty or subspecialty as determined appropriate by the Secretary in which a MIPS eligible professional may practice is adequately represented on the Task Force through a relevant organization described in subclause (I)(bb) if a measure relating to such specialty or subspecialty is under consideration;</text></item> <item id="HCA5DDF0E3C5E44AF86712057541EAF6C"><enum>(bb)</enum><text>a majority of the Task Force is comprised of designated health care practitioners (as defined in section 1866H(f)) or representatives of designated health care professional-led professional organizations described in subclause (I)(bb);</text></item>
<item id="HF793BE2A9F954034A04B1B9F54510E61"><enum>(cc)</enum><text>not more than 3 members of the Task Force are representatives of group health plans, health insurance issuers, or Medicare Advantage organizations; and</text></item> <item id="H7DD3C950D7584E11A03A8212A9D4A70D"><enum>(dd)</enum><text>at least 1 designated health care practitioner who is not part of an excluded practice (as defined in section 1866H(f)) who practices in a medical specialty or subspecialty is included on the Task Force when the Task Force is considering measures relating to such specialty or subspecialty.</text></item></subclause>
<subclause id="H920DC20275FA4CA08F0FFBFD8CB70016"><enum>(III)</enum><header>Maximum number of members</header><text>The number of members of the Task Force may not exceed 25.</text></subclause></clause> <clause id="H51004052EE0245E68956F29267B87953"><enum>(iii)</enum><header>Duties</header> <subclause id="HCB35076716694977BABFB90726423894"><enum>(I)</enum><header>In general</header><text display-inline="yes-display-inline">The Task Force shall, with respect to each performance period beginning on or after January 1, 2032—</text>
<item id="HF4046DF03A2D42D7ACF963F8B88EF3DC"><enum>(aa)</enum><text>issue recommendations on quality, resource use, and care efficiency measures for use under this subsection; and</text></item> <item id="H2DA37438DB7A4377AA3E3148D63B5006"><enum>(bb)</enum><text>update any recommendations previously issued by the Task Force as determined appropriate by the Task Force.</text></item></subclause>
<subclause id="H417D2A4532814C6394D2379F3DA5116B"><enum>(II)</enum><header>Requirements</header><text>The Task Force—</text> <item id="H19718CBF9A3645B7A40F1543E55DD465"><enum>(aa)</enum><text display-inline="yes-display-inline">shall ensure that any measure recommended under subclause (I) conforms with applicable clinical guidelines developed by a professional organization representing the medical specialty or subspecialty to be subject to such measure and is designed to promote quality of care, improve resource use, or reduce costs;</text></item>
<item id="H3BB9B214CD334234ACEF44F8DDC6C0AF"><enum>(bb)</enum><text display-inline="yes-display-inline">may only recommend a quality measure to the extent that data for such measure can be submitted through certified EHR technology, administrative or billing claims, or a qualified clinical data registry;</text></item> <item id="HE5B6B5A2DD984277B60A38627A30A30E"><enum>(cc)</enum><text display-inline="yes-display-inline">shall take into account the circumstances of practitioners in specialty types that furnish services that do not typically involve face-to-face interaction with patients (or that typically involve such interaction only at the direction of another practitioner ordering such services);</text></item>
<item id="HD90BA16355754547B8004DBA11C4480A"><enum>(dd)</enum><text>shall, in reviewing measures and making recommendations, take into account—</text> <subitem id="HE2980F79B5E04679971D1795A9A5E612"><enum>(AA)</enum><text display-inline="yes-display-inline">how the measure relates to an episode of care or a continuum of health care, as applicable, involved;</text></subitem>
<subitem id="HD1986C2930BC499796AD37C948A4BDC2"><enum>(BB)</enum><text display-inline="yes-display-inline">the context of the respective performance category of such measure and how the measure may serve to complement or align with measures applicable in other performance categories under this subsection;</text></subitem> <subitem id="H006FEC62C0234D0AA21ABE735C161E6B"><enum>(CC)</enum><text display-inline="yes-display-inline">measures developed by qualified clinical data registries; and</text></subitem>
<subitem id="H246506EFCD174685950BC37E21A5C140"><enum>(DD)</enum><text display-inline="yes-display-inline">consult with such registries as necessary in the development and evaluation of measures; and</text></subitem></item> <item id="H67F4ED927EBB42008513BF2A0442A3CD"><enum>(ee)</enum><text display-inline="yes-display-inline">ensure that the role of qualified clinical data registries in the development, maintenance, and refinement of measures is preserved or strengthened.</text></item></subclause> </clause>
<clause id="H16E75E4AF20144108AD780A81C9258F0"><enum>(iv)</enum><header>Secretarial response to recommendations</header>
<subclause id="H93182C4078FD4E75A8CBC2FDD0D470EA"><enum>(I)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 120 days after the Task Force issues recommendations with respect to measures for a performance period, the Secretary shall transmit to the Task Force and to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a formal written response that, with respect to each such recommendation, affirmatively states one of the following:</text> <item id="H8A197FBE89774A87AEFE079C55E4F02E"><enum>(aa)</enum><text display-inline="yes-display-inline">The Secretary will implement the recommendation as issued.</text></item>
<item id="H7DEAB04D35EE4A7F8A08C2B113207C2D"><enum>(bb)</enum><text display-inline="yes-display-inline">The Secretary will implement the recommendation with specified modifications, accompanied by a written explanation of the modifications and the clinical, administrative, or program integrity basis for each such modification.</text></item> <item id="H67D4716A4352463AACDECF769AED6CC9"><enum>(cc)</enum><text display-inline="yes-display-inline">The Secretary will implement the recommendation in part, accompanied by a written explanation of which elements will be implemented and the basis for declining the remainder.</text></item>
<item id="HC075DEEABCE54BF6A852D15B4F85D417"><enum>(dd)</enum><text display-inline="yes-display-inline">The Secretary declines to implement the recommendation, accompanied by a detailed written explanation of the clinical, administrative, or program integrity basis for the decision.</text></item></subclause> <subclause id="H849350BB691747CAA2B32EFD352B4FC9"><enum>(II)</enum><header>Inclusion of measures</header> <item id="H447E3E74486D4508969329658C719E9E"><enum>(aa)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall include a measure receiving a recommendation from the Task Force for a performance period in the final measures list published under subparagraph (D)(i) for such performance period unless the Secretary, not later than 90 days after receiving the recommendation, publishes in the Federal Register a written determination explaining the specific clinical, administrative, or program integrity basis for excluding the measure.</text></item>
<item id="H10BF178C1917450BAD7C9D8C77B88812"><enum>(bb)</enum><header>Further requirements for certain recommendations</header><text display-inline="yes-display-inline">Notwithstanding item (aa), with respect to any measure recommended by the Task Force for a performance period with the support of not fewer than 75 percent of the members of the Task Force, the Secretary may not exclude such measure from the final measures list published under subparagraph (D)(i) for such performance period unless the Secretary—</text> <subitem id="HFC69C79AD7DE4DCBAF750BFCCCC9F6B7"><enum>(AA)</enum><text>consults with the task force regarding such proposed exclusion; and</text></subitem>
<subitem id="HC0CF0E028FCE4EA1A9003A4FDA45AEA9"><enum>(BB)</enum><text display-inline="yes-display-inline">includes in the written determination under subclause (I) a response to the Task Force's position and a specific finding that the basis for exclusion outweighs the clinical judgment of the Task Force.</text></subitem></item></subclause> <subclause id="HB70931A8955044C2B76F1AADA4938A52"><enum>(III)</enum><header>Annual report</header><text display-inline="yes-display-inline">Not later than March 1 of each year beginning with the first calendar year after the Task Force issues its initial recommendations, the Secretary shall submit to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate, and shall make publicly available on the website of the Centers for Medicare & Medicaid Services, a report that includes, for each recommendation issued by the Task Force during the preceding calendar year—</text>
<item id="H3FF8B245D01B409DB6CF4604BD0E53A9"><enum>(aa)</enum><text display-inline="yes-display-inline">the text of the recommendation and the vote of the Task Force;</text></item> <item id="HFEC8A35ACCAB415282B78AA6D771F225"><enum>(bb)</enum><text>the Secretary’s response under subclause (I);</text></item>
<item id="H346CC540360C4005BEEE2103ACCCE0F9"><enum>(cc)</enum><text display-inline="yes-display-inline">the outcome with respect to the final measures list published under subparagraph (D)(i), including whether the recommended measure was included, included with modifications, or excluded; and</text></item> <item id="HC7E2B203708C4ABCA387BF44FF7283F9"><enum>(dd)</enum><text display-inline="yes-display-inline">if the measure was excluded or modified, the written justification provided under subclause (I).</text></item></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section id="HA6A8DC02B6D74E149AA079B5E28438FA"><enum>204.</enum><header>Modification of MIPS payment adjustments</header>
<subsection id="H340FB5EB70474D9D8083D4306FA03730"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1848(q)(6)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)(6)(B)</external-xref>) is amended—</text> <paragraph id="H115E408EE3364560965F1B46B4A18D3B"><enum>(1)</enum><text>in clause (iii), by striking <quote>and</quote> at the end;</text></paragraph>
<paragraph id="HD9B313AA2F6947659CB057D77010EF89"><enum>(2)</enum><text>in clause (iv), by amending such clause to read as follows:</text> <quoted-block style="OLC" id="H306AB77451F142B78CC49B354C06FDFA" display-inline="no-display-inline"> <clause id="HB3E0ED4DADD44ED58E49148D594F81E0"><enum>(iv)</enum><text display-inline="yes-display-inline">for 2022 and subsequent years (through 2026), 9 percent; </text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph>
<paragraph id="H7A1EDDCCD49D4A84A3057078A5184AED"><enum>(3)</enum><text>by adding at the end the following new clauses:</text> <quoted-block style="OLC" id="H67B0BB5DC88E45E3AAB1028D5C1FD95E" display-inline="no-display-inline"> <clause id="HEA2B5384A3D04D1C8CBB2E1668472C3B"><enum>(v)</enum><text>for 2027 through 2031, 2 percent;</text></clause>
<clause id="H6364F798C3054F6BAE561DD45E93D1C4"><enum>(vi)</enum><text display-inline="yes-display-inline">for 2032, 3 percent;</text></clause> <clause id="H1271EC11A21943A398FF7BEC563D2E6D"><enum>(vii)</enum><text>for 2033, 4 percent; and</text></clause>
<clause id="H13104254CE8D43438CCA4157E523214F"><enum>(viii)</enum><text>for 2034, 5 percent.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="H57591A636B984D1D8BCF64E6EBF77D53"> <enum>(b)</enum> <header>No reduction in case of failure To provide feedback</header> <paragraph id="H6383B5A5356A4E3EB736B0B72C3CC92B"> <enum>(1)</enum> <header>In general</header> <text display-inline="yes-display-inline">Section 1848(q)(6) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)(6)</external-xref>) is amended by adding at the end the following new subparagraph:</text>
<quoted-block style="OLC" id="H474256E41BC94F0EB27FC93E19378330"
display-inline="no-display-inline">
<subparagraph id="HF6C28E9A8F0045719B717FF945FBEB31">
<enum>(G)</enum>
<header>No reduction in payments in case of failure to provide feedback</header>
<text display-inline="yes-display-inline">Notwithstanding the preceding provisions of this paragraph, in the case that the Secretary fails to provide a MIPS eligible professional feedback required under paragraph (12) with respect to the performance of such professional for a performance period with respect to a year for administrative claims-based measures included in the performance categories described in subparagraph (A)(i)(II) of such paragraph, if application of subparagraph (E) would result in a negative adjustment to payment for covered professional services furnished by such professional during such year, the product otherwise determined under such subparagraph for such professional and year shall be deemed to be zero.</text>
</subparagraph>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</paragraph>
<paragraph id="H7DCD43999A9F49E2BFC0486257E0B740">
<enum>(2)</enum>
<header>Modification of feedback requirements</header>
<text display-inline="yes-display-inline">Section 1848(q)(12) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)(12)</external-xref>) is amended—</text>
<subparagraph id="HC7EF18746B6049BBAB229733F128F8DC">
<enum>(A)</enum>
<text>in subparagraph (A)(i)(II), by inserting <quote>(and, beginning with 2032, shall, on a quarterly basis and with respect to administrative claims-based measures in accordance with clause (vi))</quote> after <quote>may</quote>; and</text>
</subparagraph>
<subparagraph id="H34D365F5240545D284C9F72478CBC923">
<enum>(B)</enum>
<text>by adding at the end the following new clause:</text> <quoted-block style="OLC" id="HFC7C05216AAC435CA820D95BD83CE06F" display-inline="no-display-inline"> <clause id="HDE04633B4DAE4C51AB14ACEC7181DBC2"> <enum>(vi)</enum> <header>Feedback on administrative-claims based measures</header> <text display-inline="yes-display-inline">With respect to quarters beginning on or after January 1, 2032, the Secretary shall, not later than 60 days after each such quarter, provide to each MIPS eligible professional, with respect to administrative claims-based measures included in the performance categories described in subparagraph (A)(i)(II), feedback on such professional’s performance, including—</text>
<subclause id="HFD8665C3620F4D9BA138453EE9E6E4BE">
<enum>(I)</enum>
<text display-inline="yes-display-inline">a description of the patients and episodes attributed with respect to such measures for purposes of assessing the performance of such professional during such quarter;</text>
</subclause>
<subclause id="HB54B7F00888148CBB71899997898E189">
<enum>(II)</enum>
<text display-inline="yes-display-inline">an identification of the items and services furnished by such professional or another individual that will contribute to the assessment of the performance of such professional during such quarter with respect to such measures; and</text>
</subclause>
<subclause id="H016698CC22B5479B806B9C64AE44D245">
<enum>(III)</enum>
<text display-inline="yes-display-inline">an identification of whether each item or service identified under subitem (BB) for the quarter was furnished by such professional or another individual (and, in the case that the performance of such professional for such quarter with respect to such measures is assessed based on participation in a group practice or other group, whether each such item or service was furnished by such professional, another individual in such group, or another individual outside of such group).</text>
</subclause>
</clause>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subparagraph>
</paragraph>
</subsection>
<subsection id="H1708B60FF6AD47CF953D266882ABC2FA"><enum>(c)</enum><header>Extension of additional incentive payments for certain professionals</header><text display-inline="yes-display-inline">Section 1848(q)(6) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)(6)</external-xref>) is amended—</text> <paragraph id="HB12BC8043A164D4BAB08D6397084ACCC"><enum>(1)</enum><text>in subparagraph (C)—</text>
<subparagraph id="H3176515E01054E7D8A643F53C0474412"><enum>(A)</enum><text>by inserting <quote>and for 2032 and each subsequent year</quote> after <quote>2024,</quote>; and</text></subparagraph> <subparagraph id="H24ACA46C43334CABBB46DE655227A4D2"><enum>(B)</enum><text>by inserting <quote>(other than, with respect to 2032 and each subsequent year, such a professional that is part of an excluded practice (as defined in section 1866H(f)))</quote> after <quote>MIPS eligible professional</quote>; and</text></subparagraph></paragraph>
<paragraph id="HA8376A89FB2940AB9F2AF39561B4BA0D"><enum>(2)</enum><text>in subparagraph (F)(iv)(I), by inserting <quote>and for 2032 and each subsequent year</quote> before the period.</text></paragraph></subsection> <subsection id="H90B98EF4D4684EA4AF24B8880AEDBC60"><enum>(d)</enum><header>Reduction in positive adjustments for certain professionals</header><text>Section 1848(q)(6) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)(6)</external-xref>), as amended by paragraph (1), is further amended by adding at the end the following new subparagraph:</text>
<quoted-block style="OLC" id="HCF4A8555D4E74C418FB201A54E5D6E98" display-inline="no-display-inline">
<subparagraph id="HF697E913BC44478C8932F6B29263F738"><enum>(H)</enum><header>Reduction in positive adjustments for certain professionals</header><text display-inline="yes-display-inline">The Secretary shall reduce each positive MIPS adjustment factor otherwise determined under this paragraph for a year (beginning with 2032) for a MIPS eligible professional who is part of an excluded practice (as defined in section 1866H(f)) by 50 percent. The preceding sentence shall be applied in a budget neutral manner.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection> </section> <section id="H39AE028AC816445AA6AA2FC0C61496AF"><enum>205.</enum><header>Modifying requirements and approval periods for qualified clinical data registries</header><text display-inline="no-display-inline">Section 1848(m)(3)(E) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(m)(3)(E)</external-xref>) is amended—</text>
<paragraph id="H95498A899AAD422498AB2BDDEDAC2875"><enum>(1)</enum><text display-inline="yes-display-inline">in clause (i), by adding at the end the following:</text> <quoted-block style="OLC" id="H30764C50407A4D71B9FD0CCC56E1AAAA" display-inline="yes-display-inline"><text display-inline="yes-display-inline">Beginning January 1, 2027, such requirements shall include a requirement that the entity— </text>
<subclause id="HD802B6724E1C4E58B81CC47C0D03C56C"><enum>(I)</enum><text display-inline="yes-display-inline">be established and operated by a professional society that is controlled or led by a designated practitioner (as defined in section 1866H) and that has demonstrated expertise in developing evidence-based clinical practice guidelines and quality measures for improving patient outcomes;</text></subclause> <subclause id="HD4C199E917CE4394A07292C264947256"><enum>(II)</enum><text display-inline="yes-display-inline">demonstrates adherence to data quality and fidelity standards, including standards relating to data elements, data completeness, and validation processes;</text></subclause>
<subclause id="H1139E3A7916B4D09B022BAC6FD626E07"><enum>(III)</enum><text display-inline="yes-display-inline">demonstrates capacity to generate timely, actionable feedback to participating practitioners to support continuous quality improvement and track practitioner use of such feedback; </text></subclause> <subclause id="H6EE7E7510E214A18A3A60E0022641F59"><enum>(IV)</enum><text>demonstrate transparency in measure development (including the methodology used in such measures and any risk adjustment used in such measures); and</text></subclause>
<subclause id="HC9126EDB083C419F9FA26FADE7F35844"><enum>(V)</enum><text>has established self-audit or review processes focusing on data accuracy, measure integrity, and appropriate use of results.</text></subclause><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph> <paragraph id="H2D7B7D78BA7C4F44A1EFCE2FB3E87802"><enum>(2)</enum><text>in clause (v), by adding the following flush matter at the end:</text>
<quoted-block style="OLC" id="H6910DDD1E0E1495D8BD56A9456DF4F23" display-inline="no-display-inline">
<quoted-block-continuation-text quoted-block-continuation-text-level="clause">A determination or designation made under this clause on or after January 1, 2027, shall be effective for a period of 3 years. At the end of such period, the Secretary (or, in the case of a designation made by an organization, such organization) may extend such determination or designation (as applicable) for subsequent 3-year periods based on a showing by such entity that such entity continues to meet the requirements of clause (i). </quoted-block-continuation-text><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section>
<section id="HE196AA9D38924EDAA08F71ECFF9D876B"><enum>206.</enum><header>Expanded access to claims data to facilitate research and quality improvement</header>
<subsection id="H45B5A9053BFF4DDCBBA59551DE7B5AE8"><enum>(a)</enum><header>In general</header><text>Not later than January 1, 2027, the Secretary of Health and Human Services shall establish a process to allow a qualified clinical data registry under section 1848(m)(3)(E) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(m)(3)(E)</external-xref>) or a clinician-led clinical data registry under section 4005 of the 21st Century Cures Act (<external-xref legal-doc="public-law" parsable-cite="pl/114/255">Public Law 114–255</external-xref>) to request claims data described in subsection (b) (in a form and manner determined to be appropriate by the Secretary) for the purposes of—</text> <paragraph id="H44613B796D16454B957DB69E8AA9A680"><enum>(1)</enum><text>linking such data with clinical outcomes data;</text></paragraph>
<paragraph id="H4772CAC5D89244A3945BF55B2939BC7A"> <enum>(2)</enum> <text>conducting quality assessments and quality improvement activities of providers of services (as defined in subsection (u) of section 1861 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>) and suppliers (as defined in subsection (d) of such section)), reporting the results of such assessments and activities to such providers and suppliers, and performing risk-adjusted, scientifically valid analyses and research to support quality improvement or patient safety; and</text> </paragraph> <paragraph id="H706F9883CB674EAB8CFF8EF0251FE810"><enum>(3)</enum><text>publishing research and quality improvement analyses, which may include deidentified combined claims and clinical outcomes data.</text></paragraph></subsection>
<subsection id="HA9B8ECDC1ED84CC89ABFD4E79163E6C9"><enum>(b)</enum><header>Claims data described</header><text>For purposes of subsection (a), the claims data described in this subsection—</text> <paragraph id="HD5AA4F092B8B4DD381433B9EE186D9C7"><enum>(1)</enum><text>are—</text>
<subparagraph id="H92A55A1CD208428EB1C2DC3EA26AF5B0"><enum>(A)</enum><text>claims data under the Medicare program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>); and</text></subparagraph> <subparagraph id="H8EAFE031E1A941C4AFC969682CC4FBEB"><enum>(B)</enum><text>if the Secretary determines appropriate, claims data under the Medicaid program under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>) and the State Children’s Health Insurance Program under title XXI of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397aa">42 U.S.C. 1397aa et seq.</external-xref>); and</text></subparagraph></paragraph>
<paragraph id="HB7279BA311364E9D8E366B3301654398"><enum>(2)</enum><text>may include provider-specific claims data, clinical specialty-specific claims data, State-specific claims data, or nationwide claims data.</text></paragraph></subsection> <subsection id="H2A4AB744891B40F3869FE6DB5B04C48D"><enum>(c)</enum><header>Treatment of qualified clinical data registries and clinician-Led clinical data registries</header><text>For the purposes of this section, qualified clinical data registries and clinician-led clinical data registries shall not be required to be qualified entities, as defined in section 1874(e)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395kk">42 U.S.C. 1395kk(e)(2)</external-xref>), or quasi-qualified entities, to access claims data pursuant to subsection (a).</text></subsection>
<subsection id="H07D3A7E47C6C4F30BA72E22A86C23887"><enum>(d)</enum><header>Fee</header><text display-inline="yes-display-inline">Data described in subsection (b) shall be made available to a qualified clinical data registry or clinician-led clinical data registry under this section at a reasonable fee equal to the cost of making such data available. Any fee collected pursuant to the preceding sentence shall be deposited into the Centers for Medicare & Medicaid Services Program Management Account.</text></subsection></section> <section commented="no" display-inline="no-display-inline" id="HD75EB2C53BE24F4387E1927A41A0630B"><enum>207.</enum><header>Modification of appropriate use criteria data collection for applicable imaging services</header> <subsection commented="no" display-inline="no-display-inline" id="HF39C3BB39E1E4FC8B3FE5E3305ADEDA6"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1834(q) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(q)</external-xref>) is amended—</text>
<paragraph id="H3AE83A09A5BC4A3C9F5B27302599F2F1"><enum>(1)</enum><text>in paragraph (3)(B)(ii)—</text> <subparagraph commented="no" display-inline="no-display-inline" id="H419C12F89C034CBD84B0E376DAE9597B"><enum>(A)</enum><text>in subclause (IV), by striking <quote>generates and provides to the ordering professional a certification or documentation that</quote>; and</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HDE9CD763DB71429589F66092A7B57111"><enum>(B)</enum><text>by adding at the end the following new subclause:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="HA99FE947314F4A9A81690BDC76AA4C22"> <subclause id="HBF7F3CE3AEE641DE8F08FA0AA392DC8B"><enum>(VIII)</enum><text>Beginning January 1, 2027, the mechanism provides to the Secretary—</text>
<item commented="no" display-inline="no-display-inline" id="HD509F08171014085807B00A9ECB64A3B"><enum>(aa)</enum><text>the information described in subclauses (III) and (IV);</text></item> <item commented="no" display-inline="no-display-inline" id="H128E94D74EEC4A16BBDEC7CAAD773DA3"><enum>(bb)</enum><text>the information described in paragraph (4)(B); and</text></item>
<item commented="no" display-inline="no-display-inline" id="HFB3D915219A54057B4C46870254E89C8"><enum>(cc)</enum><text>such other information as the Secretary determines to be appropriate, at such time, and in such form and manner, as the Secretary may specify.</text></item></subclause><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="HBBA9FDA8F34B4953ABF9913F1D21CC9B"><enum>(2)</enum><text>in paragraph (4)—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H570F66B0DBDE4A0F9A4D2CB1F9734C76"><enum>(A)</enum><text>in subparagraph (A), by striking clause (ii) and inserting the following:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="H6515A8DBFB574A3583FD9062BBF8D031"> <clause commented="no" display-inline="no-display-inline" id="H198E2B09E4854EBEA7674BC096636759"><enum>(ii)</enum><text>beginning January 1, 2027, comply with such requirements as the Secretary may establish.</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HF9F60C3EC818447BAAE1610A7DB4FF7A"><enum>(B)</enum><text>in subparagraph (B)—</text> <clause commented="no" display-inline="no-display-inline" id="HC72151E170C049B1AE7C0BDB1165724D"><enum>(i)</enum><text>in the heading, by striking <quote><header-in-text style="OLC" level="subparagraph">furnishing professional</header-in-text></quote> and inserting <quote><header-in-text style="OLC" level="subparagraph">qualified clinical decision support mechanism</header-in-text></quote>;</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HBCCF3DD4A08B4AE684C23468B2774A3F"><enum>(ii)</enum><text>in the matter preceding clause (i)—</text> <subclause commented="no" display-inline="no-display-inline" id="HC00B35D161F3413AA66743C2EBA315DA"><enum>(I)</enum><text display-inline="yes-display-inline">by striking <quote>with January 1, 2017</quote> and inserting <quote>January 1, 2027</quote>; and</text></subclause>
<subclause commented="no" display-inline="no-display-inline" id="HF5143E40B97B4988ACBE176BA141D65E"><enum>(II)</enum><text>by striking <quote>payment for such service may only be made if the claim for the service includes</quote> and inserting <quote>the qualified decision support mechanism shall maintain and report to the Secretary under subparagraph (F)</quote>; and</text></subclause></clause> <clause commented="no" display-inline="no-display-inline" id="H7DBE51307A3E492392993E121147E889"><enum>(iii)</enum><text>in clause (iii), by striking <quote>(if different from the furnishing professional)</quote>;</text></clause></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H48A6F5E72E2942268DA94A52E31122C9"><enum>(C)</enum><text>in subparagraph (C), by adding at the end the following new clauses:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="H29C4D059ABB1477AA700669E5D38A18C"> <clause id="HE1B1AC6B78D445A3B178EA584C8D76E1"><enum>(iv)</enum><header>Clinical trials</header><text>An applicable imaging service that is ordered for an individual as part of a clinical trial.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H918AB5FEE05B4938B37EF698FD32D8DD"><enum>(v)</enum><header>Small and rural practices</header><text display-inline="yes-display-inline">An applicable imaging service ordered by an ordering professional practicing in a small practice (consisting of 15 or fewer ordering professionals), or a practice in a health professional shortage area (as designated under section 332(a)(1)(A) of the Public Health Service Act) located in a rural area.</text></clause> <clause commented="no" display-inline="no-display-inline" id="HC16EA40BAD824E56A633ADCC5E930D26"><enum>(vi)</enum><header>Specified exemptions</header><text display-inline="yes-display-inline">The following types of applicable imaging services:</text>
<subclause commented="no" display-inline="no-display-inline" id="HD91F5F79B2D54D529517A1A75C5785F6"><enum>(I)</enum><text display-inline="yes-display-inline">A mammography.</text></subclause> <subclause commented="no" display-inline="no-display-inline" id="HAACCA836CEAD4BF5950CA0F89F15F2B5"><enum>(II)</enum><text display-inline="yes-display-inline">A lung cancer screening performed using computed tomography.</text></subclause>
<subclause commented="no" display-inline="no-display-inline" id="HEDA4781AFFE04F46A8BC6C151942EB61"><enum>(III)</enum><text display-inline="yes-display-inline">A colonography performed using computed tomography.</text></subclause> <subclause id="H180A33A056CC4A018A3BF67C463162F6"><enum>(IV)</enum><text>Such a service furnished to treat an emergency medical condition or a suspected emergency medical condition.</text></subclause>
<subclause commented="no" display-inline="no-display-inline" id="H1DD146C1861B40AD9C02D81E1DEE91D4"><enum>(V)</enum><text display-inline="yes-display-inline">Such other preventive or screening imaging services as the Secretary determines appropriate.</text></subclause></clause><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="H0A4C3757C7F54002AE7714FB3A23B4EE"><enum>(D)</enum><text>in subparagraph (D), by adding at the end the following new clause:</text>
<quoted-block style="OLC" display-inline="no-display-inline" id="H3456C4F4BC094866AB842582C9B0C071">
<clause id="H3EECF0CF9E634D529246CFC03A50C37A"><enum>(iv)</enum><text>Any other payment system determined appropriate by the Secretary.</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="H5EA752E2767A41EDA7DA664D67EE7B2B"><enum>(E)</enum><text>by adding at the end the following new subparagraphs:</text>
<quoted-block style="OLC" display-inline="no-display-inline" id="H03344E2F6E14446C97E0ADF06D4B981C">
<subparagraph id="H50E6BE49DA2643548B9D2E15579B7D18"><enum>(E)</enum><header>Furnishing professional requirement</header><text>Beginning January 1, 2027, with respect to an applicable imaging service furnished in an applicable setting and paid for under an applicable payment system (as defined in subparagraph (D)), the furnishing professional shall include the national provider identifier of the ordering professional (if different from the furnishing professional) on the claim for the service.</text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="H4D11236691FD43E3BFF8C73EBAD6FD1D"><enum>(F)</enum><header>Reporting requirements</header><text display-inline="yes-display-inline">The Secretary shall provide, through guidance or rulemaking, information on appropriate ways that each qualified clinical decision support mechanism may report the information maintained under subparagraph (B) to the Secretary to support the Secretary in implementing paragraphs (5) and (6).</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H70AA24829A8A4E82BD444CA4D51D58FF"><enum>(3)</enum><text>in paragraph (5)—</text> <subparagraph commented="no" display-inline="no-display-inline" id="H5C7D509BAF2A460E87B2123326E6AA6D"><enum>(A)</enum><text display-inline="yes-display-inline">in the heading, by striking <quote><header-in-text level="paragraph" style="OLC">outlier</header-in-text></quote> and inserting <quote><header-in-text level="paragraph" style="OLC">low compliant</header-in-text></quote>;</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H3DC15E73258A4107AEB6B2D2EA45D6C5"><enum>(B)</enum><text>by striking subparagraphs (A) and (B) and inserting the following:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="H94D36539848949A6B93BCCC4D597CBD3"> <subparagraph commented="no" display-inline="no-display-inline" id="H663A25C3CC6E43D987625B0539D55BA8"><enum>(A)</enum><header>In general</header><text>With respect to applicable imaging services furnished on or after January 1, 2027, the Secretary shall determine on an annual basis the total number of ordering professionals who are designated as low compliant ordering professionals under subparagraph (B).</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H9CDBC8F02B9B4942990E957BE3C0D614"><enum>(B)</enum><header>Low compliant ordering professionals</header><text>The Secretary shall designate ordering professionals with a compliance rate (as determined under subparagraph (D)) lower than an amount determined by the Secretary as low compliant ordering professionals.</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="H1DC6189B05324AE6839B713454A18916"><enum>(C)</enum><text>in paragraph (C), by striking <quote>outlier</quote> and inserting <quote>low compliant</quote>;</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H2B87249BB0CD4DC6A2C4A6FD9B52D254"><enum>(D)</enum><text>by striking subparagraph (D) and inserting the following:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="HBFA0C1656D0A4C818975930C8B4369EF"> <subparagraph commented="no" display-inline="no-display-inline" id="H8445CA8E9E834C97946BE60CC505835B"><enum>(D)</enum><header>Determination of compliance rate</header> <clause commented="no" display-inline="no-display-inline" id="H9C79B5626EB04B778872F16F5BB04A6A"><enum>(i)</enum><header>In general</header> <subclause commented="no" display-inline="no-display-inline" id="H3C4CC0C4BED94A6F87F1F1846FB72462"><enum>(I)</enum><header>Compliance rates</header><text>For applicable imaging services furnished on or after January 1, 2027, the Secretary shall determine a compliance rate (as defined in clause (ii)) for each ordering professional for a period specified by the Secretary.</text></subclause>
<subclause commented="no" display-inline="no-display-inline" id="H29EB50C8EA8A473E93D0F0F7719DBD23"><enum>(II)</enum><header>Use of data</header><text>In determining a compliance rate for an ordering professional under subclause (I), the Secretary shall use data made available to the Secretary by qualified clinical decision support mechanisms published in the list under paragraph (3)(C) that were consulted by the ordering professional for the period specified by the Secretary under subclause (I).</text></subclause></clause> <clause commented="no" display-inline="no-display-inline" id="HF2CD40E70448429FBA250965A147AC5E"><enum>(ii)</enum><header>Definition of compliance rate</header> <subclause commented="no" display-inline="no-display-inline" id="HFAB5C0D381F34EB3A8E033BDF31C0CC8"> <enum>(I)</enum> <header>In general</header> <text display-inline="yes-display-inline">In this subparagraph, the term ‘compliance rate’ means, with respect to the requirement under paragraph (4)(A) that an order from an ordering professional for an applicable imaging service was the subject of consultation with a qualified decision support mechanism, the ratio (expressed as a percentage) of—</text>
<item commented="no" display-inline="no-display-inline"
id="H2B8BD621F83E478BA6458E070CA91B11">
<enum>(aa)</enum>
<text display-inline="yes-display-inline">the number of orders from such ordering professional included in a report from one or more qualified decision support mechanisms described in paragraph (3)(B); and</text>
</item>
<item commented="no" display-inline="no-display-inline"
id="HB88D9AFF449F4F319A820537E0338700">
<enum>(bb)</enum>
<text display-inline="yes-display-inline">the aggregate number of such orders from such ordering professional for such period.</text>
</item>
</subclause>
<subclause commented="no" display-inline="no-display-inline" id="H64518269BA814F0599C39DD4A55434A7"><enum>(II)</enum><header>Exclusion of excepted orders</header><text display-inline="yes-display-inline">In calculating the compliance rate for an ordering professional under subclause (I), the Secretary shall exclude from the total number of orders in item (bb) of such subclause any order for an applicable imaging service described in paragraph (4)(C).</text></subclause></clause></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="HE68501354B0840EC9F0C03E2FED63342"><enum>(E)</enum><text>in subparagraph (E), by striking <quote>outlier</quote> and inserting <quote>low compliant</quote>;</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H40A5611340654B23BFE04E96FA0112C9"><enum>(4)</enum><text>by striking paragraph (6) and inserting the following:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="H8D023A4EE27141518262408EA2B87C62"> <paragraph id="HF7F6D9431D194EC185399EF9FF209070"><enum>(6)</enum><header>Study and report on low compliant ordering professionals and utilization of applicable imaging services</header> <subparagraph commented="no" display-inline="no-display-inline" id="HB9A32DB39E514AA38E163E19D0869D09"><enum>(A)</enum><header>In general</header><text>Not later than January 1, 2031, and every 5 years thereafter, the Secretary shall conduct a study regarding the compliance rates calculated under paragraph (5) and submit a report to Congress that—</text>
<clause commented="no" display-inline="no-display-inline" id="H34E7FA7085354B8DAE73349A597A2273"><enum>(i)</enum><text display-inline="yes-display-inline">discusses—</text> <subclause commented="no" display-inline="no-display-inline" id="HB08EDF5838254CB488D22D8EF5C97014"><enum>(I)</enum><text display-inline="yes-display-inline">such rates and compliance with this subsection;</text></subclause>
<subclause commented="no" display-inline="no-display-inline" id="HF3100F645D9B45E4B7A1028F1F83DF53"><enum>(II)</enum><text>the impact this subsection has on the utilization of applicable imaging services; and</text></subclause> <subclause commented="no" display-inline="no-display-inline" id="H5E5B89D6EA0E4A8EBFC8917CD4EA5DD9"><enum>(III)</enum><text>potential mechanisms for improving compliance with this subsection, including—</text>
<item commented="no" display-inline="no-display-inline" id="H83513D1D0FA7458CB1CC444B445F3A3E"><enum>(aa)</enum><text>prior authorization for applicable imaging services ordered by low compliant ordering professionals;</text></item> <item commented="no" display-inline="no-display-inline" id="H7F51DF632B7C4285929905F6A589AA53"><enum>(bb)</enum><text>any payment adjustment related to the services, or a subset of services, that the Secretary may designate under the fee schedule under section 1848; or</text></item>
<item commented="no" display-inline="no-display-inline" id="HD66304F995FB412FB47C4E0015DA76A3"><enum>(cc)</enum><text>other mechanisms determined appropriate by the Secretary; and</text></item></subclause></clause> <clause commented="no" display-inline="no-display-inline" id="H4A729D38129242D69E3750A447E1BE07"><enum>(ii)</enum><text display-inline="yes-display-inline">proposes alternative compliance rate thresholds for low compliant ordering professionals for purposes of paragraph (5)(B).</text></clause></subparagraph></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H6B7FB5EBD930410EB809EBAD64E3F1EA"><enum>(5)</enum><text>by adding at the end the following new paragraph:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="H788268ADA95D439E8FC093AB2E28CE3D"> <paragraph id="H9783DB96B4BF4ED0AC55870C39696ACE" commented="no" display-inline="no-display-inline"><enum>(8)</enum><header display-inline="yes-display-inline">Specialty society endorsement</header><text display-inline="yes-display-inline">In specifying applicable appropriate use criteria for applicable imaging services under paragraph (2) and qualified clinical decision support mechanisms under paragraph (3), the Secretary shall substantially adhere to the approach described in section 414.94 of title 42, Code of Federal Regulations (as in effect on January 1, 2023).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection id="HA6AB3C8483024605868FEBBC51FE2B37"><enum>(b)</enum><header>Effective date</header><text>The amendments made by subsection (a) shall apply with respect to items and services furnished on or after January 1, 2027.</text></subsection></section> <section id="H666519E5806643DFA4739DD2687E14DD" commented="no"><enum>208.</enum><header>Rules of construction</header> <subsection id="HA1B615BEC31A45EBAED22A8AF90DC8B3"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">None of the amendments made by this title may be construed to—</text>
<paragraph id="HF78A2BB750BA455CA70D642F4D534525"><enum>(1)</enum><text display-inline="yes-display-inline">transfer ownership of a measure developed by a qualified clinical data registry to the Secretary or any other entity without the authorization of the qualified clinical data registry; or</text></paragraph> <paragraph id="H079F38C578794C32B1063FA2258249B4"><enum>(2)</enum><text display-inline="yes-display-inline">require a qualified clinical data registry to relinquish intellectual property rights as a condition of having a measure considered for inclusion in the annual final list of measures.</text></paragraph></subsection>
<subsection id="HB23689F6DD6548CE87D29D6062D2CA0F">
<enum>(b)</enum>
<header>IP</header>
<text display-inline="yes-display-inline">The Secretary of Health and Human Services shall recognize that measures developed by qualified clinical data registries are the intellectual property of such registries, including any specifications, methodologies, scoring algorithms, specialty or subspecialty guidelines, and related materials associated with such measures. Nothing in this title shall prohibit a qualified clinical data registry from voluntarily licensing a measure to the Secretary or other entities under terms agreed to by such registry.</text>
</subsection></section>
<enum>III</enum><header>APM improvement</header>
<section id="H96A58F1A2898401088FD890D4B217FD2"><enum>301.</enum><header>Qualifying APM participant threshold freeze</header>
<subsection id="H48FB27D716AA44F5A8CC0FC8D117452D"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1833(z)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(z)(2)</external-xref>) is amended—</text> <paragraph id="H2353392737FD42D1B8E33FBF859E9818"><enum>(1)</enum><text>in subparagraph (B)—</text>
<subparagraph id="H2F0429538B53407588C98230739266C0"><enum>(A)</enum><text>in the header, by striking <quote><header-in-text level="subparagraph" style="OLC">2026 and 2028</header-in-text></quote> and inserting <quote><header-in-text level="subparagraph" style="OLC">2029</header-in-text></quote>; and</text></subparagraph> <subparagraph id="H6815D4129287428B84116CD365737C64"><enum>(B)</enum><text>in the matter preceding clause (i), by striking <quote>2026 and 2028</quote> and inserting <quote>2029</quote>; and</text></subparagraph></paragraph>
<paragraph id="H29BB0CB37AB445D7B70A5D4C4E7CA3CC"><enum>(2)</enum><text>in subparagraph (C)—</text> <subparagraph id="H1DFC58ADDCAE4C29B71876036109335C"><enum>(A)</enum><text>in the header, by striking <quote><header-in-text level="subparagraph" style="OLC">2027 and 2029</header-in-text></quote> and inserting <quote><header-in-text level="subparagraph" style="OLC">2030</header-in-text></quote>; and</text></subparagraph>
<subparagraph id="H7377F71A542D43EDB83AF90E2AA9C224"><enum>(B)</enum><text>in the matter preceding clause (i), by striking <quote>2027 and 2029</quote> and inserting <quote>2030</quote>.</text></subparagraph></paragraph></subsection> <subsection id="HA9F2DAC6440242F79AF0DD9417F65482"><enum>(b)</enum><header>Conforming amendments</header><text display-inline="yes-display-inline">Section 1848(q)(1)(C)(iii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)(1)(C)(iii)</external-xref>) is amended—</text>
<paragraph id="H34E6F42101044750B5FC7D0E54B01F28"><enum>(1)</enum><text>in subclause (II), in the matter preceding item (aa), by striking <quote>2026 and 2028</quote> and inserting <quote>2029</quote>; and</text></paragraph> <paragraph id="HE8100B0DBF674F77B08A2AA8FFF0C323"><enum>(2)</enum><text>in subclause (III), the matter preceding item (aa), by striking <quote>2027 and 2029</quote> and inserting <quote>2030</quote>.</text></paragraph></subsection>
<subsection id="H4486385AC9134C19BBDFE5C8372C249C">
<enum>(c)</enum>
<header>Authority To modify thresholds</header>
<text>Section 1848(q)(1)(C)(iii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)(1)(C)(iii)</external-xref>) is amended—</text>
<paragraph id="HF55D66CF2A4B496CA9B0287D461C9A54">
<enum>(1)</enum>
<text>in subclause (II)—</text> <subparagraph id="H62462398E6044F1BB6AE4D38289BCD4E"> <enum>(A)</enum> <text>in item (aa), by inserting <quote>(or such lower percentage as may be specified by the Secretary)</quote> after <quote>40 percent</quote>; and</text>
</subparagraph>
<subparagraph id="H38819653213948ECB0A88EF5EC19A8B1">
<enum>(B)</enum>
<text>in item (bb), by inserting <quote>(or such lower percentages as may be specified by the Secretary)</quote> after <quote>respectively</quote>; and</text>
</subparagraph>
</paragraph>
<paragraph id="H3D1098A5004E484983C882DBAA9959E7">
<enum>(2)</enum>
<text>in subclause (III)—</text> <subparagraph id="H56344AA1FDC54462ADBD994EDE2621BD"> <enum>(A)</enum> <text>in item (aa), by inserting <quote>(or such lower percentage as may be specified by the Secretary)</quote> after <quote>50 percent</quote>; and</text>
</subparagraph>
<subparagraph id="H76CF6AA89A8144F9B6CEF660D3C61D30">
<enum>(B)</enum>
<text display-inline="yes-display-inline">in item (bb), by inserting <quote>(or such lower percentages as may be specified by the Secretary)</quote> after <quote>respectively</quote>.</text>
</subparagraph>
</paragraph>
</subsection></section>
<section id="H6838AE71938A4A9480512172AAFABBD3"><enum>302.</enum><header>CMI model requirements</header><text display-inline="no-display-inline">Section 1115A of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1315a">42 U.S.C. 1315a</external-xref>) is amended—</text> <paragraph id="HD803022DE40A4888B0085F655B10970C"><enum>(1)</enum><text>in subsection (b)(3)(B), by inserting <quote>, pursuant to notice-and-comment rulemaking,</quote> after <quote>The Secretary shall</quote>;</text></paragraph>
<paragraph id="H4D676C8B1254482A982C2820EF13C567"><enum>(2)</enum><text>in subsection (c), in the flush matter at the end, by adding at the end the following new sentence: <quote>The Secretary may terminate a model expanded under this subsection prior to the date set for such termination at the time of such expansion only pursuant to notice and comment rulemaking.</quote>; and</text></paragraph> <paragraph id="H32D500C1796749F289C97D81C740C601"><enum>(3)</enum><text>in subsection (g), by adding at the end the following new sentence: <quote>Each such report submitted in 2027 or a subsequent year shall contain, with respect to each model tested under subsection (b), a description of any savings generated by such model.</quote>.</text></paragraph></section>
<section id="HE9FC7C000E724A6BB5883504EAD2120A"><enum>303.</enum><header>Report on barriers to participation in value-based payment models</header><text display-inline="no-display-inline">Not later than December 31, 2029, the Comptroller General of the United States, in consultation with the Medicare Payment Advisory Commission, shall submit to the Committees on Energy and Commerce and Ways and Means of the House of Representatives, and the Committee on Finance of the Senate, a report on ongoing barriers to participation in value-based payment models for specialty providers under the Medicare program. Such report shall contain specific policy recommendations to reduce such barriers.</text></section> <enum>IV</enum><header>Physician payment improvements</header> <section id="HFE439C56B3874461AEA6FDB03E948F33" display-inline="no-display-inline" section-type="subsequent-section"><enum>401.</enum><header>Updating the budget neutrality threshold</header><text display-inline="no-display-inline">Section 1848(c)(2)(B)(ii)(II) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(B)(ii)(II)</external-xref>) is amended—</text>
<paragraph id="H6F2E1025A11B49E285596BA52C4EFB38" display-inline="no-display-inline"><enum>(1)</enum><text>by striking <quote>Subject to</quote> and inserting the following:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="HC770F0265A0443B9A7D567817C9DD230"> <item id="H7BB9B1781DDD4C1FA8352F32EDE9C4DC"><enum>(aa)</enum><header>In general</header><text display-inline="yes-display-inline">Subject to</text></item><after-quoted-block>;</after-quoted-block></quoted-block></paragraph>
<paragraph id="H4114565AF81241578EFE3759DA63B934" commented="no"><enum>(2)</enum><text>in item (aa), as inserted by paragraph (1), by striking <quote>$20,000,000</quote> and inserting <quote>the amount specified in item (bb) for such year</quote>; and</text></paragraph> <paragraph id="HF773D81284C94C74A2C9671BC6E4C389"><enum>(3)</enum><text>by adding at the end the following new items:</text>
<quoted-block style="OLC" display-inline="no-display-inline" id="H49F8F98B3B884C0D92D34762884203DA">
<item id="HDFC027B832A645CB87EF65B4FBD0919D"><enum>(bb)</enum><header>Amount specified</header><text>For purposes of item (aa), subject to item (cc), the amount specified in this item is—</text> <subitem id="HEFEBB9A67EC84FFD8137AABBBE2776D1"><enum>(AA)</enum><text>for years before 2028, $20,000,000;</text></subitem>
<subitem id="HDDEC01DB637E48D58401039203259986"><enum>(BB)</enum><text>for 2028, $57,640,000; and</text></subitem> <subitem id="H9AAAB9325367436099DA84E64F435A5D"><enum>(CC)</enum><text>for 2029 and each subsequent year, the amount specified in this item for the preceding year.</text></subitem></item>
<item id="H4504D01F16F34A62B58EBD788930D993"><enum>(cc)</enum><header>Indexing limitation on annual adjustments</header><text display-inline="yes-display-inline">For 2033 and every subsequent fifth year, the Secretary shall increase the amount specified in item (bb) for such year by the cumulative percentage increase in the MEI (as defined in section 1842(i)(3)) applicable to physicians’ services for each year occurring during the 5-year period ending on the last day of the preceding year.</text></item><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section> <section id="H60594F8E19704B528C062D64B788CD04" display-inline="no-display-inline" section-type="subsequent-section"><enum>402.</enum><header>Budget neutrality corrections relating to estimated utilization</header> <subsection id="H5912FD9E94014697897B4829100B83C7"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1848(c)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(B)</external-xref>) is amended by adding at the end the following new clause:</text>
<quoted-block id="H21D196E9A14D445CB3CE9B0202AD39FC" style="OLC">
<clause id="HC554690AD45F4255AB45C970E688381E"><enum>(vii)</enum><header>Budget neutrality corrections relating to estimated utilization</header>
<subclause id="H0C1B682254324D0B88B6002192407241"><enum>(I)</enum><header>In general</header><text>In the case of a budget neutrality adjustment applied pursuant to clause (ii)(II) for a year (beginning with 2029) that is determined in part using estimated utilization (as defined in subclause (II)(bb)) with respect to a specified service (as defined in subclause (II)(cc)), the Secretary shall, as part of the final rule establishing the physician fee schedule under this section for the assumption correction period (as defined in subclause (II)(aa)) with respect to such year—</text> <item id="H84D1D26048BA425681A050B6642394EE"><enum>(aa)</enum><text display-inline="yes-display-inline">determine the difference between expenditures for such service in such year using estimated utilization and actual utilization for such service (in a manner determined appropriate by the Secretary); and</text> </item>
<item id="H7B845B9FDBE94396AB6DB3AE73996DB0"><enum>(bb)</enum><text display-inline="yes-display-inline">in the case that the Secretary determines the difference described in item (aa) is greater than the threshold amount (as defined in subclause (II)(dd)) for such year, adjust the conversion factor under this section for such assumption correction period by such amount to reconcile such difference (which may be positive or negative), as determined by the Secretary.</text></item></subclause> <subclause id="H5235728B262E41D880AB487E2D5F48DB"><enum>(II)</enum><header>Definitions</header><text>For purposes of this clause:</text>
<item id="HAE7E7E3947F04E1C8884DCCA933EE8F4"><enum>(aa)</enum><header>Assumption correction period</header><text>The term <term>assumption correction period</term> means, with respect to a year, the second year beginning after such year.</text></item> <item id="HA99282D354BB433D9B011EBFB46F5BE2"><enum>(bb)</enum><header>Estimated utilization</header><text display-inline="yes-display-inline">The term <term>estimated utilization</term> means an estimate of utilization used for purposes of applying clause (ii)(II).</text></item>
<item id="HF6CA1CF008124C5182DBC51F0F87EC5D"><enum>(cc)</enum><header>Specified service</header><text>The term <term>specified service</term> means, with respect to a year, a service—</text> <subitem id="H03B283A1515B456392F58B6DD2B19B23"><enum>(AA)</enum><text>with expected expenditures for such year under this section based on estimated utilization that exceed the threshold amount (as defined in item (dd)) for such year; and</text></subitem>
<subitem id="HD4B3717938C9488EB444BF6961F41E5F"><enum>(BB)</enum><text>for which payment had been bundled into payment for another service during the preceding year and for which a separate payment or add-on payment is made during such year.</text></subitem></item> <item id="H1A944559EE6147AF999ECD1D5B6C9498"><enum>(dd)</enum><header>Threshold amount</header><text>The term <term>threshold amount</term> means, with respect to a year, 0.1 percent of the total estimated expenditures under this part for services furnished under this section during such year.</text> </item></subclause></clause> <after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H3061764C9DE149ACB3689CE8048C3182"><enum>(b)</enum><header>Nonapplication of budget neutrality to reconciliation adjustments</header><text display-inline="yes-display-inline">Section 1848(c)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(B)</external-xref>) is amended—</text> <paragraph id="H7FA40B48A04D446DB47DBBC6FDE0F5E5"><enum>(1)</enum><text>in clause (iv)—</text>
<subparagraph id="H24FE78EF92A0423EA30D760842C0EB43"><enum>(A)</enum><text>in subclause (V), by striking <quote>and</quote> at the end;</text></subparagraph> <subparagraph id="H9E95DD37C1354C7BB7C6243F8B3224D6"><enum>(B)</enum><text>in subclause (VI), by striking the period and inserting <quote>; and</quote>; and</text></subparagraph>
<subparagraph id="HF68B065733694A7DAA4747F3B0531427"><enum>(C)</enum><text>by adding at the end the following new subclause:</text> <quoted-block style="OLC" id="H303BE11D257C4CBEB4A78532A22F8646" display-inline="no-display-inline"> <subclause id="H026B2DDB6FE14DF09DD2247AEAAB458B"> <enum>(VII)</enum> <text display-inline="yes-display-inline">clause (vii)(I)(bb) for an assumption correction period (as defined in clause (vii)(II)) shall not be taken into account in applying clause (ii)(II) with respect to such period.</text> </subclause> <after-quoted-block>; and</after-quoted-block> </quoted-block></subparagraph></paragraph>
<paragraph id="H8AFA2B74779643B08FCEE0207F4170C1"><enum>(2)</enum><text>in clause (v), by adding at the end the following new subclause:</text> <quoted-block style="OLC" id="HD04530A6863246DAB261532EA90902FA" display-inline="no-display-inline"> <subclause id="HC9F45F042A65402EBC3BF7F5014E45C5"><enum>(XII)</enum><header>Reductions attributable to an assumption correction</header><text display-inline="yes-display-inline">For an assumption correction period (as defined in clause (vii)(II)), reduced expenditures attributable to application of clause (vii)(I)(bb) with respect to such period.</text></subclause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> </section>
<section id="H6A21414CD9B64E1F8692D474F0A564F3"><enum>403.</enum><header>Timely updates to direct costs used to calculate practice expense RVUs</header><text display-inline="no-display-inline">Section 1848(c)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(B)</external-xref>), as amended by section 3, is further amended by adding at the end the following new clause:</text> <quoted-block id="HC1D0C6C3F9CD490DA3F314BA1A3D94BE" style="OLC"> <clause id="HFA1673044D004C769C03F3D9D353A092"><enum>(viii)</enum><header>Timely updates to direct costs used to calculate practice expense relative value units</header> <subclause id="HEEFEB51D4E1044E4BC02807C79850635"><enum>(I)</enum><header>Simultaneous updates to direct cost inputs at least once every 5 years</header><text>The Secretary shall, not less often than every 5 years, update the prices and rates, as applicable, on a category-wide basis for each of the categories of direct cost inputs described in subclause (II) used in the methodology for calculating the practice expense relative value units under this subsection for physicians’ services. Updates made pursuant to the previous sentence shall be made in the same year for all categories of direct cost inputs described in such subclause.</text></subclause>
<subclause id="HDEA5996B59C34A5499C958A53CF8BD9F"><enum>(II)</enum><header>Direct cost inputs categories described</header><text>For purposes of this clause, the categories of direct cost inputs described in this subclause are clinical staff wage rates, prices of medical supplies, prices of equipment, and any other category of such inputs used in the methodology described in subclause (I) (as specified by the Secretary).</text></subclause> <subclause id="HBA883BAC9B6C4F68ABC4004FD6CEC28F"><enum>(III)</enum><header>Consultation</header><text>In making the updates under this clause, the Secretary shall consult with relevant stakeholders, including physician specialty societies.</text></subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section id="HBBCF8077C57C4BCA9A0CA7225BFD2766"><enum>404.</enum><header>Limitation on year-to-year conversion factor variance</header><text display-inline="no-display-inline">Section 1848(c)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(B)</external-xref>), as amended by sections 3 and 4, is further amended by adding at the end the following new clause:</text> <quoted-block style="OLC" id="H9BD63B1C9CF647E0BEB8B3E9D177067A" display-inline="no-display-inline"> <clause id="H08D52AAE4088464FB3322DB3D1DC5316"><enum>(ix)</enum><header>Limitation on conversion factor variance</header> <subclause id="HF8D41845B5EB4003BCD236E64EF288A2"><enum>(I)</enum><header>In general</header><text display-inline="yes-display-inline">Beginning with 2027, the Secretary may not, for purposes of complying with clause (ii)(II), apply a budget neutrality adjustment to a conversion factor established under subsection (d) for such year that would cause such factor, not taking into account any adjustment to such factor for such year provided under such subsection, to vary by more than 2.5 percent compared to such factor so established for the preceding year.</text></subclause>
<subclause id="H3325B3CA48D64EAFB6D9CB7F20593EBB"><enum>(II)</enum><header>Continued applicability of budget neutrality requirement</header><text>Nothing in subclause (I) may be construed to alter the requirement described in clause (ii)(II).</text></subclause> </clause><after-quoted-block>.</after-quoted-block></quoted-block></section>