[Congressional Record Volume 160, Number 132 (Tuesday, September 16, 2014)]
[House]
[Pages H7605-H7612]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     IMPROVING MEDICARE POST-ACUTE CARE TRANSFORMATION ACT OF 2014

  Mr. BRADY of Texas. Mr. Speaker, I move to suspend the rules and pass 
the bill (H.R. 4994) to amend title XVIII of the Social Security Act to 
provide for standardized post-acute care assessment data for quality, 
payment, and discharge planning, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 4994

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Improving Medicare Post-
     Acute Care Transformation Act of 2014'' or the ``IMPACT Act 
     of 2014''.

     SEC. 2. STANDARDIZATION OF POST-ACUTE CARE DATA.

       (a) In General.--Title XVIII of the Social Security Act is 
     amended by adding at the end the following new section:

     ``SEC. 1899B. STANDARDIZED POST-ACUTE CARE (PAC) ASSESSMENT 
                   DATA FOR QUALITY, PAYMENT, AND DISCHARGE 
                   PLANNING.

       ``(a) Requirement for Standardized Assessment Data.--
       ``(1) In general.--The Secretary shall--
       ``(A) require under the applicable reporting provisions 
     post-acute care providers (as defined in paragraph (2)(A)) to 
     report--
       ``(i) standardized patient assessment data in accordance 
     with subsection (b);
       ``(ii) data on quality measures under subsection (c)(1); 
     and
       ``(iii) data on resource use and other measures under 
     subsection (d)(1);
       ``(B) require data described in subparagraph (A) to be 
     standardized and interoperable so as to allow for the 
     exchange of such data among such post-acute care providers 
     and other providers and the use by such providers of such 
     data that has been so exchanged, including by using common 
     standards and definitions, in order to provide access to 
     longitudinal information for such providers to facilitate 
     coordinated care and improved Medicare beneficiary outcomes; 
     and
       ``(C) in accordance with subsections (b)(1) and (c)(2), 
     modify PAC assessment instruments (as defined in paragraph 
     (2)(B)) applicable to post-acute care providers to--
       ``(i) provide for the submission of standardized patient 
     assessment data under this title with respect to such 
     providers; and
       ``(ii) enable comparison of such assessment data across all 
     such providers to whom such data are applicable.
       ``(2) Definitions.--For purposes of this section:
       ``(A) Post-acute care (pac) provider.--The terms `post-
     acute care provider' and `PAC provider' mean--
       ``(i) a home health agency;
       ``(ii) a skilled nursing facility;
       ``(iii) an inpatient rehabilitation facility; and
       ``(iv) a long-term care hospital (other than a hospital 
     classified under section 1886(d)(1)(B)(iv)(II)).
       ``(B) PAC assessment instrument.--The term `PAC assessment 
     instrument' means--
       ``(i) in the case of home health agencies, the instrument 
     used for purposes of reporting and assessment with respect to 
     the Outcome and Assessment Information Set (OASIS), as 
     described in sections 484.55 and 484.250 of title 42, the 
     Code of Federal Regulations, or any successor regulation, or 
     any other instrument used with respect to home health 
     agencies for such purposes;
       ``(ii) in the case of skilled nursing facilities, the 
     resident's assessment under section 1819(b)(3);
       ``(iii) in the case of inpatient rehabilitation facilities, 
     any Medicare beneficiary assessment instrument established by 
     the Secretary for purposes of section 1886(j); and
       ``(iv) in the case of long-term care hospitals, the 
     Medicare beneficiary assessment instrument used with respect 
     to such hospitals for the collection of data elements 
     necessary to calculate quality measures as described in the 
     August 18, 2011, Federal Register (76 Fed. Reg. 51754-51755), 
     including for purposes of section 1886(m)(5)(C), or any other 
     instrument used with respect to such hospitals for assessment 
     purposes.
       ``(C) Applicable reporting provision.--The term `applicable 
     reporting provision' means--
       ``(i) for home health agencies, section 1895(b)(3)(B)(v);
       ``(ii) for skilled nursing facilities, section 1888(e)(6);
       ``(iii) for inpatient rehabilitation facilities, section 
     1886(j)(7); and
       ``(iv) for long-term care hospitals, section 1886(m)(5).
       ``(D) PAC payment system.--The term `PAC payment system' 
     means--
       ``(i) with respect to a home health agency, the prospective 
     payment system under section 1895;
       ``(ii) with respect to a skilled nursing facility, the 
     prospective payment system under section 1888(e);
       ``(iii) with respect to an inpatient rehabilitation 
     facility, the prospective payment system under section 
     1886(j); and
       ``(iv) with respect to a long-term care hospital, the 
     prospective payment system under section 1886(m).
       ``(E) Specified application date.--The term `specified 
     application date' means the following:
       ``(i) Quality measures.--In the case of quality measures 
     under subsection (c)(1)--

       ``(I) with respect to the domain described in subsection 
     (c)(1)(A) (relating to functional status, cognitive function, 
     and changes in function and cognitive function)--

       ``(aa) for PAC providers described in clauses (ii) and 
     (iii) of paragraph (2)(A), October 1, 2016;
       ``(bb) for PAC providers described in clause (iv) of such 
     paragraph, October 1, 2018; and
       ``(cc) for PAC providers described in clause (i) of such 
     paragraph, January 1, 2019;

       ``(II) with respect to the domain described in subsection 
     (c)(1)(B) (relating to skin integrity and changes in skin 
     integrity)--

       ``(aa) for PAC providers described in clauses (ii), (iii), 
     and (iv) of paragraph (2)(A), October 1, 2016; and
       ``(bb) for PAC providers described in clause (i) of such 
     paragraph, January 1, 2017;

       ``(III) with respect to the domain described in subsection 
     (c)(1)(C) (relating to medication reconciliation)--

       ``(aa) for PAC providers described in clause (i) of such 
     paragraph, January 1, 2017; and
       ``(bb) for PAC providers described in clauses (ii), (iii), 
     and (iv) of such paragraph, October 1, 2018;

       ``(IV) with respect to the domain described in subsection 
     (c)(1)(D) (relating to incidence of major falls)--

       ``(aa) for PAC providers described in clauses (ii), (iii), 
     and (iv) of paragraph (2)(A), October 1, 2016; and
       ``(bb) for PAC providers described in clause (i) of such 
     paragraph, January 1, 2019; and

       ``(V) with respect to the domain described in subsection 
     (c)(1)(E) (relating to accurately communicating the existence 
     of and providing for the transfer of health information and 
     care preferences)--

       ``(aa) for PAC providers described in clauses (ii), (iii), 
     and (iv) of paragraph (2)(A), October 1, 2018; and
       ``(bb) for PAC providers described in clause (i) of such 
     paragraph, January 1, 2019.

[[Page H7606]]

       ``(ii) Resource use and other measures.--In the case of 
     resource use and other measures under subsection (d)(1)--

       ``(I) for PAC providers described in clauses (ii), (iii), 
     and (iv) of paragraph (2)(A), October 1, 2016; and
       ``(II) for PAC providers described in clause (i) of such 
     paragraph, January 1, 2017.

       ``(F) Medicare beneficiary.--The term `Medicare 
     beneficiary' means an individual entitled to benefits under 
     part A or, as appropriate, enrolled for benefits under part 
     B.
       ``(b) Standardized Patient Assessment Data.--
       ``(1) Requirement for reporting assessment data.--
       ``(A) In general.--Beginning not later than October 1, 
     2018, for PAC providers described in clauses (ii), (iii), and 
     (iv) of subsection (a)(2)(A) and January 1, 2019, for PAC 
     providers described in clause (i) of such subsection, the 
     Secretary shall require PAC providers to submit to the 
     Secretary, under the applicable reporting provisions and 
     through the use of PAC assessment instruments, the 
     standardized patient assessment data described in 
     subparagraph (B). The Secretary shall require such data be 
     submitted with respect to admission and discharge of an 
     individual (and may be submitted more frequently as the 
     Secretary deems appropriate).
       ``(B) Standardized patient assessment data described.--For 
     purposes of subparagraph (A), the standardized patient 
     assessment data described in this subparagraph is data 
     required for at least the quality measures described in 
     subsection (c)(1) and that is with respect to the following 
     categories:
       ``(i) Functional status, such as mobility and self care at 
     admission to a PAC provider and before discharge from a PAC 
     provider.
       ``(ii) Cognitive function, such as ability to express ideas 
     and to understand, and mental status, such as depression and 
     dementia.
       ``(iii) Special services, treatments, and interventions, 
     such as need for ventilator use, dialysis, chemotherapy, 
     central line placement, and total parenteral nutrition.
       ``(iv) Medical conditions and co-morbidities, such as 
     diabetes, congestive heart failure, and pressure ulcers.
       ``(v) Impairments, such as incontinence and an impaired 
     ability to hear, see, or swallow.
       ``(vi) Other categories deemed necessary and appropriate by 
     the Secretary.
       ``(2) Alignment of claims data with standardized patient 
     assessment data.--To the extent practicable, not later than 
     October 1, 2018, for PAC providers described in clauses (ii), 
     (iii), and (iv) of subsection (a)(2)(A), and January 1, 2019, 
     for PAC providers described in clause (i) of such subsection, 
     the Secretary shall match claims data with assessment data 
     pursuant to this section for purposes of assessing prior 
     service use and concurrent service use, such as antecedent 
     hospital or PAC provider use, and may use such matched data 
     for such other uses as the Secretary determines appropriate.
       ``(3) Replacement of certain existing data.--In the case of 
     patient assessment data being used with respect to a PAC 
     assessment instrument that duplicates or overlaps with 
     standardized patient assessment data within a category 
     described in paragraph (1), the Secretary shall, as soon as 
     practicable, revise or replace such existing data with the 
     standardized data.
       ``(4) Clarification.--Standardized patient assessment data 
     submitted pursuant to this subsection shall not be used to 
     require individuals to be provided post-acute care by a 
     specific type of PAC provider in order for such care to be 
     eligible for payment under this title.
       ``(c) Quality Measures.--
       ``(1) Requirement for reporting quality measures.--Not 
     later than the specified application date, as applicable to 
     measures and PAC providers, the Secretary shall specify 
     quality measures on which PAC providers are required under 
     the applicable reporting provisions to submit standardized 
     patient assessment data described in subsection (b)(1) and 
     other necessary data specified by the Secretary. Such 
     measures shall be with respect to at least the following 
     domains:
       ``(A) Functional status, cognitive function, and changes in 
     function and cognitive function.
       ``(B) Skin integrity and changes in skin integrity.
       ``(C) Medication reconciliation.
       ``(D) Incidence of major falls.
       ``(E) Accurately communicating the existence of and 
     providing for the transfer of health information and care 
     preferences of an individual to the individual, family 
     caregiver of the individual, and providers of services 
     furnishing items and services to the individual, when the 
     individual transitions--
       ``(i) from a hospital or critical access hospital to 
     another applicable setting, including a PAC provider or the 
     home of the individual; or
       ``(ii) from a PAC provider to another applicable setting, 
     including a different PAC provider, a hospital, a critical 
     access hospital, or the home of the individual.
       ``(2) Reporting through pac assessment instruments.--
       ``(A) In general.--To the extent possible, the Secretary 
     shall require such reporting by a PAC provider of quality 
     measures under paragraph (1) through the use of a PAC 
     assessment instrument and shall modify such PAC assessment 
     instrument as necessary to enable the use of such instrument 
     with respect to such quality measures.
       ``(B) Limitation.--The Secretary may not make significant 
     modifications to a PAC assessment instrument more than once 
     per calendar year or fiscal year, as applicable, unless the 
     Secretary publishes in the Federal Register a justification 
     for such significant modification.
       ``(3) Adjustments.--
       ``(A) In general.--The Secretary shall consider applying 
     adjustments to the quality measures under this subsection 
     taking into consideration the studies under section 2(d) of 
     the IMPACT Act of 2014.
       ``(B) Risk adjustment.--Such quality measures shall be risk 
     adjusted, as determined appropriate by the Secretary.
       ``(d) Resource Use and Other Measures.--
       ``(1) Requirement for resource use and other measures.--Not 
     later than the specified application date, as applicable to 
     measures and PAC providers, the Secretary shall specify 
     resource use and other measures on which PAC providers are 
     required under the applicable reporting provisions to submit 
     any necessary data specified by the Secretary, which may 
     include standardized assessment data in addition to claims 
     data. Such measures shall be with respect to at least the 
     following domains:
       ``(A) Resource use measures, including total estimated 
     Medicare spending per beneficiary.
       ``(B) Discharge to community.
       ``(C) Measures to reflect all-condition risk-adjusted 
     potentially preventable hospital readmission rates.
       ``(2) Aligning methodology adjustments for resource use 
     measures.--
       ``(A) Period of time.--With respect to the period of time 
     used for calculating measures under paragraph (1)(A), the 
     Secretary shall, to the extent the Secretary determines 
     appropriate, align resource use with the methodology used for 
     purposes of section 1886(o)(2)(B)(ii).
       ``(B) Geographic and other adjustments.--The Secretary 
     shall standardize measures with respect to the domain 
     described in paragraph (1)(A) for geographic payment rate 
     differences and payment differentials (and other adjustments, 
     as applicable) consistent with the methodology published in 
     the Federal Register on August 18, 2011 (76 Fed. Reg. 51624 
     through 51626), or any subsequent modifications made to the 
     methodology.
       ``(C) Medicare spending per beneficiary.--The Secretary 
     shall adjust, as appropriate, measures with respect to the 
     domain described in paragraph (1)(A) for the factors applied 
     under section 1886(o)(2)(B)(ii).
       ``(3) Adjustments.--
       ``(A) In general.--The Secretary shall consider applying 
     adjustments to the resource use and other measures specified 
     under this subsection with respect to the domain described in 
     paragraph (1)(A), taking into consideration the studies under 
     section 2(d) of the IMPACT Act of 2014.
       ``(B) Risk adjustment.--Such resource use and other 
     measures shall be risk adjusted, as determined appropriate by 
     the Secretary.
       ``(e) Measurement Implementation Phases; Selection of 
     Quality Measures and Resource Use and Other Measures.--
       ``(1) Measurement implementation phases.--In the case of 
     quality measures specified under subsection (c)(1) and 
     resource use and other measures specified under subsection 
     (d)(1), the provisions of this section shall be implemented 
     in accordance with the following phases:
       ``(A) Initial implementation phase.--The initial 
     implementation phase, with respect to such a measure, shall, 
     in accordance with subsections (c) and (d), as applicable, 
     consist of--
       ``(i) measure specification, including informing the public 
     of the measure's numerator, denominator, exclusions, and any 
     other aspects the Secretary determines necessary;
       ``(ii) data collection, including, in the case of quality 
     measures, requiring PAC providers to report data elements 
     needed to calculate such a measure; and
       ``(iii) data analysis, including, in the case of resource 
     use and other measures, the use of claims data to calculate 
     such a measure.
       ``(B) Second implementation phase.--The second 
     implementation phase, with respect to such a measure, shall 
     consist of the provision of feedback reports to PAC 
     providers, in accordance with subsection (f).
       ``(C) Third implementation phase.--The third implementation 
     phase, with respect to such a measure, shall consist of 
     public reporting of PAC providers' performance on such 
     measure in accordance with subsection (g).
       ``(2) Consensus-based entity.--
       ``(A) In general.--Subject to subparagraph (B), each 
     measure specified by the Secretary under this section shall 
     be endorsed by the entity with a contract under section 
     1890(a).
       ``(B) Exception.--In the case of a specified area or 
     medical topic determined appropriate by the Secretary for 
     which a feasible and practical measure has not been endorsed 
     by the entity with a contract under section 1890(a), the 
     Secretary may specify a measure that is not so endorsed as 
     long as due consideration is given to measures that have been 
     endorsed or adopted by a consensus organization identified by 
     the Secretary.
       ``(3) Treatment of application of pre-rulemaking process 
     (measure applications partnership process).--
       ``(A) In general.--Subject to subparagraph (B), the 
     provisions of section 1890A shall

[[Page H7607]]

     apply in the case of a quality measure specified under 
     subsection (c) or a resource use or other measure specified 
     under subsection (d).
       ``(B) Exceptions.--
       ``(i) Expedited procedures.--For purposes of satisfying 
     subparagraph (A), the Secretary may use expedited procedures, 
     such as ad-hoc reviews, as necessary, in the case of a 
     quality measure specified under subsection (c) or a resource 
     use or other measure specified in subsection (d) required 
     with respect to data submissions under the applicable 
     reporting provisions during the 1-year period before the 
     specified application date applicable to such a measure and 
     provider involved.
       ``(ii) Option to waive provisions.--The Secretary may waive 
     the application of the provisions of section 1890A in the 
     case of a quality measure or resource use or other measure 
     described in clause (i), if the application of such 
     provisions (including through the use of an expedited 
     procedure described in such clause) would result in the 
     inability of the Secretary to satisfy any deadline specified 
     in this section with respect to such measure.
       ``(f) Feedback Reports to PAC Providers.--
       ``(1) In general.--Beginning one year after the specified 
     application date, as applicable to PAC providers and quality 
     measures and resource use and other measures under this 
     section, the Secretary shall provide confidential feedback 
     reports to such PAC providers on the performance of such 
     providers with respect to such measures required under the 
     applicable provisions.
       ``(2) Frequency.--To the extent feasible, the Secretary 
     shall provide feedback reports described in paragraph (1) not 
     less frequently than on a quarterly basis. Notwithstanding 
     the previous sentence, with respect to measures described in 
     such paragraph that are reported on an annual basis, the 
     Secretary may provide such feedback reports on an annual 
     basis.
       ``(g) Public Reporting of PAC Provider Performance.--
       ``(1) In general.--Subject to the succeeding paragraphs of 
     this subsection, the Secretary shall provide for public 
     reporting of PAC provider performance on quality measures 
     under subsection (c)(1) and the resource use and other 
     measures under subsection (d)(1), including by establishing 
     procedures for making available to the public information 
     regarding the performance of individual PAC providers with 
     respect to such measures.
       ``(2) Opportunity to review.--The procedures under 
     paragraph (1) shall ensure, including through a process 
     consistent with the process applied under section 
     1886(b)(3)(B)(viii)(VII) for similar purposes, that a PAC 
     provider has the opportunity to review and submit corrections 
     to the data and information that is to be made public with 
     respect to the provider prior to such data being made public.
       ``(3) Timing.--Such procedures shall provide that the data 
     and information described in paragraph (1), with respect to a 
     measure and PAC provider, is made publicly available 
     beginning not later than two years after the specified 
     application date applicable to such a measure and provider.
       ``(4) Coordination with existing programs.--Such procedures 
     shall provide that data and information described in 
     paragraph (1) with respect to quality measures and resource 
     use and other measures under subsections (c)(1) and (d)(1) 
     shall be made publicly available consistent with the 
     following provisions:
       ``(A) In the case of home health agencies, section 
     1895(b)(3)(B)(v)(III).
       ``(B) In the case of skilled nursing facilities, sections 
     1819(i) and 1919(i).
       ``(C) In the case of inpatient rehabilitation facilities, 
     section 1886(j)(7)(E).
       ``(D) In the case of long-term care hospitals, section 
     1886(m)(5)(E).
       ``(h) Removing, Suspending, or Adding Measures.--
       ``(1) In general.--The Secretary may remove, suspend, or 
     add a quality measure or resource use or other measure 
     described in subsection (c)(1) or (d)(1), so long as, subject 
     to paragraph (2), the Secretary publishes in the Federal 
     Register (with a notice and comment period) a justification 
     for such removal, suspension, or addition.
       ``(2) Exception.--In the case of such a quality measure or 
     resource use or other measure for which there is a reason to 
     believe that the continued collection of such measure raises 
     potential safety concerns or would cause other unintended 
     consequences, the Secretary may promptly suspend or remove 
     such measure and satisfy paragraph (1) by publishing in the 
     Federal Register a justification for such suspension or 
     removal in the next rulemaking cycle following such 
     suspension or removal.
       ``(i) Use of Standardized Assessment Data, Quality 
     Measures, and Resource Use and Other Measures To Inform 
     Discharge Planning and Incorporate Patient Preference.--
       ``(1) In general.--Not later than January 1, 2016, and 
     periodically thereafter (but not less frequently than once 
     every 5 years), the Secretary shall promulgate regulations to 
     modify conditions of participation and subsequent 
     interpretive guidance applicable to PAC providers, hospitals, 
     and critical access hospitals. Such regulations and 
     interpretive guidance shall require such providers to take 
     into account quality, resource use, and other measures under 
     the applicable reporting provisions (which, as available, 
     shall include measures specified under subsections (c) and 
     (d), and other relevant measures) in the discharge planning 
     process. Specifically, such regulations and interpretive 
     guidance shall address the settings to which a patient may be 
     discharged in order to assist subsection (d) hospitals, 
     critical access hospitals, hospitals described in section 
     1886(d)(1)(B)(v), PAC providers, patients, and families of 
     such patients with discharge planning from inpatient 
     settings, including such hospitals, and from PAC provider 
     settings. In addition, such regulations and interpretive 
     guidance shall include procedures to address--
       ``(A) treatment preferences of patients; and
       ``(B) goals of care of patients.
       ``(2) Discharge planning.--All requirements applied 
     pursuant to paragraph (1) shall be used to help inform and 
     mandate the discharge planning process.
       ``(3) Clarification.--Such regulations shall not require an 
     individual to be provided post-acute care by a specific type 
     of PAC provider in order for such care to be eligible for 
     payment under this title.
       ``(j) Stakeholder Input.--Before the initial rulemaking 
     process to implement this section, the Secretary shall allow 
     for stakeholder input, such as through town halls, open door 
     forums, and mail-box submissions.
       ``(k) Funding.--For purposes of carrying out this section, 
     the Secretary shall provide for the transfer to the Centers 
     for Medicare & Medicaid Services Program Management Account, 
     from the Federal Hospital Insurance Trust Fund under section 
     1817 and the Federal Supplementary Medical Insurance Trust 
     Fund under section 1841, in such proportion as the Secretary 
     determines appropriate, of $130,000,000. Fifty percent of 
     such amount shall be available on the date of the enactment 
     of this section and fifty percent of such amount shall be 
     equally proportioned for each of fiscal years 2015 through 
     2019. Such sums shall remain available until expended.
       ``(l) Limitation.--There shall be no administrative or 
     judicial review under sections 1869 and 1878 or otherwise of 
     the specification of standardized patient assessment data 
     required, the determination of measures, and the systems to 
     report such standardized data under this section.
       ``(m) Non-Application of Paperwork Reduction Act.--Chapter 
     35 of title 44, United States Code (commonly referred to as 
     the `Paperwork Reduction Act of 1995') shall not apply to 
     this section and the sections referenced in subsection 
     (a)(2)(B) that require modification in order to achieve the 
     standardization of patient assessment data.''.
       (b) Studies of Alternative PAC Payment Models.--
       (1) MedPAC.--Using data from the Post-Acute Payment Reform 
     Demonstration authorized under section 5008 of the Deficit 
     Reduction Act of 2005 (Public Law 109-171) or other data, as 
     available, not later than June 30, 2016, the Medicare Payment 
     Advisory Commission shall submit to Congress a report that 
     evaluates and recommends features of PAC payment systems (as 
     defined in section 1899B(a)(2)(D) of the Social Security Act, 
     as added by subsection (a)) that establish, or a unified 
     post-acute care payment system under title XVIII of the 
     Social Security Act that establishes, payment rates according 
     to characteristics of individuals (such as cognitive ability, 
     functional status, and impairments) instead of according to 
     the post-acute care setting where the Medicare beneficiary 
     involved is treated. To the extent feasible, such report 
     shall consider the impacts of moving from PAC payment systems 
     (as defined in subsection (a)(2)(D) of such section 1899B) in 
     existence as of the date of the enactment of this Act to new 
     post-acute care payment systems under title XVIII of the 
     Social Security Act.
       (2) Recommendations for pac prospective payment.--
       (A) Report by secretary.--Not later than 2 years after the 
     date by which the Secretary of Health and Human Services has 
     collected 2 years of data on quality measures under 
     subsection (c) of section 1899B, as added by subsection (a), 
     the Secretary shall, in consultation with the Medicare 
     Payment Advisory Commission and appropriate stakeholders, 
     submit to Congress a report, including--
       (i) recommendations and a technical prototype, on a post-
     acute care prospective payment system under title XVIII of 
     the Social Security Act that would--

       (I) in lieu of the rates that would otherwise apply under 
     PAC payment systems (as defined in subsection (a)(2)(D) of 
     such section 1899B), base payments under such title, with 
     respect to items and services furnished to an individual by a 
     PAC provider (as defined in subsection (a)(2)(A) of such 
     section), according to individual characteristics (such as 
     cognitive ability, functional status, and impairments) of 
     such individual instead of the post-acute care setting in 
     which the individual is furnished such items and services;
       (II) account for the clinical appropriateness of items and 
     services so furnished and Medicare beneficiary outcomes;
       (III) be designed to incorporate (or otherwise account for) 
     standardized patient assessment data under section 1899B; and
       (IV) further clinical integration, such as by motivating 
     greater coordination around a single condition or procedure 
     to integrate hospital systems with PAC providers (as so 
     defined).

       (ii) recommendations on which Medicare fee-for-service 
     regulations for post-acute care payment systems under title 
     XVIII of the Social Security Act should be altered (such as 
     the skilled nursing facility 3-day

[[Page H7608]]

     stay and inpatient rehabilitation facility 60 percent rule);
       (iii) an analysis of the impact of the recommended payment 
     system described in clause (i) on Medicare beneficiary cost-
     sharing, access to care, and choice of setting;
       (iv) a projection of any potential reduction in 
     expenditures under title XVIII of the Social Security Act 
     that may be attributable to the application of the 
     recommended payment system described in clause (i); and
       (v) a review of the value of subsection (d) hospitals (as 
     defined in section 1886(d)(1)(B) of the Social Security Act 
     (42 U.S.C. 1395ww(d)(1)(B)), hospitals described in section 
     1886(d)(1)(B)(v) of such Act (42 U.S.C. 1395ww(d)(1)(B)(v)), 
     and critical access hospitals described in section 
     1820(c)(2)(B) of such Act (42 U.S.C. 1395i-4(c)(2)(B)) 
     collecting and reporting to the Secretary standardized 
     patient assessment data with respect to inpatient hospital 
     services furnished by such a hospital or critical access 
     hospital to individuals who are entitled to benefits under 
     part A of title XVIII of such Act or, as appropriate, 
     enrolled for benefits under part B of such title.
       (B) Report by medpac.--Not later than the first June 30th 
     following the date on which the report is required under 
     subparagraph (A), the Medicare Payment Advisory Commission 
     shall submit to Congress a report, including recommendations 
     and a technical prototype, on a post-acute care prospective 
     payment system under title XVIII of the Social Security Act 
     that would satisfy the criteria described in subparagraph 
     (A).
       (3) Medicare beneficiary defined.--For purposes of this 
     subsection, the term ``Medicare beneficiary'' has the meaning 
     given such term in section 1899B(a)(2) of the Social Security 
     Act, as added by subsection (a).
       (c) Payment Consequences Under the Applicable Reporting 
     Provisions.--
       (1) Home health agencies.--Section 1895(b)(3)(B)(v) of the 
     Social Security Act (42 U.S.C. 1395fff(b)(3)(B)(v)) is 
     amended--
       (A) in subclause (I), by striking ``subclause (II)'' and 
     inserting ``subclauses (II) and (IV)'';
       (B) in subclause (II), by striking ``For 2007'' and 
     inserting ``Subject to subclause (V), for 2007'';
       (C) in subclause (III), by inserting ``and subclause 
     (IV)(aa)'' after ``subclause (II)''; and
       (D) by adding at the end the following new subclauses:

       ``(IV) Submission of additional data.--

       ``(aa) In general.--For the year beginning on the specified 
     application date (as defined in subsection (a)(2)(E) of 
     section 1899B), as applicable with respect to home health 
     agencies and quality measures under subsection (c)(1) of such 
     section and measures under subsection (d)(1) of such section, 
     and each subsequent year, in addition to the data described 
     in subclause (II), each home health agency shall submit to 
     the Secretary data on such quality measures and any necessary 
     data specified by the Secretary under such subsection (d)(1).
       ``(bb) Standardized patient assessment data.--For 2019 and 
     each subsequent year, in addition to such data described in 
     item (aa), each home health agency shall submit to the 
     Secretary standardized patient assessment data required under 
     subsection (b)(1) of section 1899B.
       ``(cc) Submission.--Data shall be submitted under items 
     (aa) and (bb) in the form and manner, and at the time, 
     specified by the Secretary for purposes of this clause.

       ``(V) Non-duplication.--To the extent data submitted under 
     subclause (IV) duplicates other data required to be submitted 
     under subclause (II), the submission of such data under 
     subclause (IV) shall be in lieu of the submission of such 
     data under subclause (II). The previous sentence shall not 
     apply insofar as the Secretary determines it is necessary to 
     avoid a delay in the implementation of section 1899B, taking 
     into account the different specified application dates under 
     subsection (a)(2)(E) of such section.''.

       (2) Inpatient rehabilitation facilities.--Section 
     1886(j)(7) of the Social Security Act (42 U.S.C. 
     1395ww(j)(7)) is amended--
       (A) in subparagraph (A)(i), by striking ``subparagraph 
     (C)'' and inserting ``subparagraphs (C) and (F)'';
       (B) in subparagraph (C), by striking ``For fiscal year 2014 
     and each subsequent rate year'' and inserting ``Subject to 
     subparagraph (G), for fiscal year 2014 and each subsequent 
     fiscal year'';
       (C) in subparagraph (E), by inserting ``and subparagraph 
     (F)(i)'' after ``subparagraph (C)''; and
       (D) by adding at the end the following new subparagraphs:
       ``(F) Submission of additional data.--
       ``(i) In general.--For the fiscal year beginning on the 
     specified application date (as defined in subsection 
     (a)(2)(E) of section 1899B), as applicable with respect to 
     inpatient rehabilitation facilities and quality measures 
     under subsection (c)(1) of such section and measures under 
     subsection (d)(1) of such section, and each subsequent fiscal 
     year, in addition to such data on the quality measures 
     described in subparagraph (C), each rehabilitation facility 
     shall submit to the Secretary data on the quality measures 
     under such subsection (c)(1) and any necessary data specified 
     by the Secretary under such subsection (d)(1).
       ``(ii) Standardized patient assessment data.--For fiscal 
     year 2019 and each subsequent fiscal year, in addition to 
     such data described in clause (i), each rehabilitation 
     facility shall submit to the Secretary standardized patient 
     assessment data required under subsection (b)(1) of section 
     1899B.
       ``(iii) Submission.--Such data shall be submitted in the 
     form and manner, and at the time, specified by the Secretary 
     for purposes of this subparagraph.
       ``(G) Non-duplication.--To the extent data submitted under 
     subparagraph (F) duplicates other data required to be 
     submitted under subparagraph (C), the submission of such data 
     under subparagraph (F) shall be in lieu of the submission of 
     such data under subparagraph (C). The previous sentence shall 
     not apply insofar as the Secretary determines it is necessary 
     to avoid a delay in the implementation of section 1899B, 
     taking into account the different specified application dates 
     under subsection (a)(2)(E) of such section.''.
       (3) Long-term care hospitals.--Section 1886(m)(5) of the 
     Social Security Act (42 U.S.C. 1395ww(m)(5)) is amended--
       (A) in subparagraph (A)(i), by striking ``subparagraph 
     (C)'' and inserting ``subparagraphs (C) and (F)'';
       (B) in subparagraph (C), by striking ``For rate year'' and 
     inserting ``Subject to subparagraph (G), for rate year'';
       (C) in subparagraph (E), by inserting ``and subparagraph 
     (F)(i)'' after ``subparagraph (C)''; and
       (D) by adding at the end the following new subparagraphs:
       ``(F) Submission of additional data.--
       ``(i) In general.--For the rate year beginning on the 
     specified application date (as defined in subsection 
     (a)(2)(E) of section 1899B), as applicable with respect to 
     long-term care hospitals and quality measures under 
     subsection (c)(1) of such section and measures under 
     subsection (d)(1) of such section, and each subsequent rate 
     year, in addition to the data on the quality measures 
     described in subparagraph (C), each long-term care hospital 
     (other than a hospital classified under subsection 
     (d)(1)(B)(iv)(II)) shall submit to the Secretary data on the 
     quality measures under such subsection (c)(1) and any 
     necessary data specified by the Secretary under such 
     subsection (d)(1).
       ``(ii) Standardized patient assessment data.--For rate year 
     2019 and each subsequent rate year, in addition to such data 
     described in clause (i), each long-term care hospital (other 
     than a hospital classified under subsection 
     (d)(1)(B)(iv)(II)) shall submit to the Secretary standardized 
     patient assessment data required under subsection (b)(1) of 
     section 1899B.
       ``(iii) Submission.--Such data shall be submitted in the 
     form and manner, and at the time, specified by the Secretary 
     for purposes of this subparagraph.
       ``(G) Non-duplication.--To the extent data submitted under 
     subparagraph (F) duplicates other data required to be 
     submitted under subparagraph (C), the submission of such data 
     under subparagraph (F) shall be in lieu of the submission of 
     such data under subparagraph (C). The previous sentence shall 
     not apply insofar as the Secretary determines it is necessary 
     to avoid a delay in the implementation of section 1899B, 
     taking into account the different specified application dates 
     under subsection (a)(2)(E) of such section.''.
       (4) Skilled nursing facilities.--
       (A) In general.--Paragraph (6) of section 1888(e) of the 
     Social Security Act (42 U.S.C. 1395yy(e)) is amended to read 
     as follows:
       ``(6) Reporting of assessment and quality data.--
       ``(A) Reduction in update for failure to report.--
       ``(i) In general.--For fiscal years beginning with fiscal 
     year 2018, in the case of a skilled nursing facility that 
     does not submit data, as applicable, in accordance with 
     subclauses (II) and (III) of subparagraph (B)(i) with respect 
     to such a fiscal year, after determining the percentage 
     described in paragraph (5)(B)(i), and after application of 
     paragraph (5)(B)(ii), the Secretary shall reduce such 
     percentage for payment rates during such fiscal year by 2 
     percentage points.
       ``(ii) Special rule.--The application of this subparagraph 
     may result in the percentage described in paragraph 
     (5)(B)(i), after application of paragraph (5)(B)(ii), being 
     less than 0.0 for a fiscal year, and may result in payment 
     rates under this subsection for a fiscal year being less than 
     such payment rates for the preceding fiscal year.
       ``(iii) Noncumulative application.--Any reduction under 
     clause (i) shall apply only with respect to the fiscal year 
     involved and the Secretary shall not take into account such 
     reduction in computing the payment amount under this 
     subsection for a subsequent fiscal year.
       ``(B) Assessment and measure data.--
       ``(i) In general.--A skilled nursing facility, or a 
     facility (other than a critical access hospital) described in 
     paragraph (7)(B), shall submit to the Secretary, in a manner 
     and within the timeframes prescribed by the Secretary--

       ``(I) subject to clause (iii), the resident assessment data 
     necessary to develop and implement the rates under this 
     subsection;
       ``(II) for fiscal years beginning on or after the specified 
     application date (as defined in subsection (a)(2)(E) of 
     section 1899B), as applicable with respect to skilled nursing 
     facilities and quality measures under subsection (c)(1) of 
     such section and measures under subsection (d)(1) of such 
     section, data on such quality measures under such subsection 
     (c)(1) and any necessary data specified by the Secretary 
     under such subsection (d)(1); and

[[Page H7609]]

       ``(III) for fiscal years beginning on or after October 1, 
     2018, standardized patient assessment data required under 
     subsection (b)(1) of section 1899B.

       ``(ii) Use of standard instrument.--For purposes of meeting 
     the requirement under clause (i), a skilled nursing facility, 
     or a facility (other than a critical access hospital) 
     described in paragraph (7)(B), may submit the resident 
     assessment data required under section 1819(b)(3), using the 
     standard instrument designated by the State under section 
     1819(e)(5).
       ``(iii) Non-duplication.--To the extent data submitted 
     under subclause (II) or (III) of clause (i) duplicates other 
     data required to be submitted under clause (i)(I), the 
     submission of such data under such a subclause shall be in 
     lieu of the submission of such data under clause (i)(I). The 
     previous sentence shall not apply insofar as the Secretary 
     determines it is necessary to avoid a delay in the 
     implementation of section 1899B, taking into account the 
     different specified application dates under subsection 
     (a)(2)(E) of such section.''.
       (B) Funding for nursing home compare website.--Section 
     1819(i) of the Social Security Act (42 U.S.C. 1395i-3(i)) is 
     amended by adding at the end the following new paragraph:
       ``(3) Funding.--The Secretary shall transfer to the Centers 
     for Medicare & Medicaid Services Program Management Account, 
     from the Federal Hospital Insurance Trust Fund under section 
     1817 a one-time allocation of $11,000,000. The amount shall 
     be available on the date of the enactment of this paragraph. 
     Such sums shall remain available until expended. Such sums 
     shall be used to implement section 1128I(g).''.
       (d) Improving Payment Accuracy Under the PAC Payment 
     Systems and Other Medicare Payment Systems.--
       (1) Studies and reports of effect of certain information on 
     quality and resource use.--
       (A) Study using existing medicare data.--
       (i) Study.--The Secretary of Health and Human Services (in 
     this subsection referred to as the ``Secretary'') shall 
     conduct a study that examines the effect of individuals' 
     socioeconomic status on quality measures and resource use and 
     other measures for individuals under the Medicare program 
     under title XVIII of the Social Security Act (42 U.S.C. 1395 
     et seq.) (such as to recognize that less healthy individuals 
     may require more intensive interventions). The study shall 
     use information collected on such individuals in carrying out 
     such program, such as urban and rural location, eligibility 
     for Medicaid under title XIX of such Act (42 U.S.C. 1396 et 
     seq.) (recognizing and accounting for varying Medicaid 
     eligibility across States), and eligibility for benefits 
     under the supplemental security income (SSI) program. The 
     Secretary shall carry out this paragraph acting through the 
     Assistant Secretary for Planning and Evaluation.
       (ii) Report.--Not later than 2 years after the date of the 
     enactment of this Act, the Secretary shall submit to Congress 
     a report on the study conducted under clause (i).
       (B) Study using other data.--
       (i) Study.--The Secretary shall conduct a study that 
     examines the impact of risk factors, such as those described 
     in section 1848(p)(3) of the Social Security Act (42 U.S.C. 
     1395w-4(p)(3)), race, health literacy, limited English 
     proficiency (LEP), and Medicare beneficiary activation, on 
     quality measures and resource use and other measures under 
     the Medicare program (such as to recognize that less healthy 
     individuals may require more intensive interventions). In 
     conducting such study the Secretary may use existing Federal 
     data and collect such additional data as may be necessary to 
     complete the study.
       (ii) Report.--Not later than 5 years after the date of the 
     enactment of this Act, the Secretary shall submit to Congress 
     a report on the study conducted under clause (i).
       (C) Examination of data in conducting studies.--In 
     conducting the studies under subparagraphs (A) and (B), the 
     Secretary shall examine what non-Medicare data sets, such as 
     data from the American Community Survey (ACS), can be useful 
     in conducting the types of studies under such paragraphs and 
     how such data sets that are identified as useful can be 
     coordinated with Medicare administrative data in order to 
     improve the overall data set available to do such studies and 
     for the administration of the Medicare program.
       (D) Recommendations to account for information in payment 
     adjustment mechanisms.--If the studies conducted under 
     subparagraphs (A) and (B) find a relationship between the 
     factors examined in the studies and quality measures and 
     resource use and other measures, then the Secretary shall 
     also provide recommendations for how the Centers for Medicare 
     & Medicaid Services should--
       (i) obtain access to the necessary data (if such data is 
     not already being collected) on such factors, including 
     recommendations on how to address barriers to the Centers in 
     accessing such data; and
       (ii) account for such factors--

       (I) in quality measures, resource use measures, and other 
     measures under title XVIII of the Social Security Act 
     (including such measures specified under subsections (c) and 
     (d) of section 1899B of such Act, as added by subsection 
     (a)); and
       (II) in determining payment adjustments based on such 
     measures in other applicable provisions of such title.

       (E) Funding.--There are hereby appropriated to the 
     Secretary from the Federal Hospital Insurance Trust Fund 
     under section 1817 of the Social Security Act (42 U.S.C. 
     1395i) and the Federal Supplementary Medical Insurance Trust 
     Fund under section 1841 of such Act (42 U.S.C. 1395t) (in 
     proportions determined appropriate by the Secretary) to carry 
     out this paragraph $6,000,000, to remain available until 
     expended.
       (2) CMS activities.--
       (A) In general.--Taking into account the relevant studies 
     conducted and recommendations made in reports under paragraph 
     (1) and, as appropriate, other information, including 
     information collected before completion of such studies and 
     recommendations, the Secretary, on an ongoing basis, shall, 
     as the Secretary determines appropriate and based on an 
     individual's health status and other factors--
       (i) assess appropriate adjustments to quality measures, 
     resource use measures, and other measures under title XVIII 
     of the Social Security Act (42 U.S.C. 1395 et seq.) 
     (including measures specified in subsections (c) and (d) of 
     section 1899B of such Act, as added by subsection (a)); and
       (ii) assess and implement appropriate adjustments to 
     payments under such title based on measures described in 
     clause (i).
       (B) Accessing data.--The Secretary shall collect or 
     otherwise obtain access to the data necessary to carry out 
     this paragraph through existing and new data sources.
       (C) Periodic analyses.--The Secretary shall carry out 
     periodic analyses, at least every 3 years, based on the 
     factors referred to in subparagraph (A) so as to monitor 
     changes in possible relationships.
       (D) Funding.--There are hereby appropriated to the 
     Secretary from the Federal Hospital Insurance Trust Fund 
     under section 1817 of the Social Security Act (42 U.S.C. 
     1395i) and the Federal Supplementary Medical Insurance Trust 
     Fund under section 1841 of such Act (42 U.S.C. 1395t) (in 
     proportions determined appropriate by the Secretary) to carry 
     out this paragraph $10,000,000, to remain available until 
     expended.
       (3) Strategic plan for accessing race and ethnicity data.--
     Not later than 18 months after the date of the enactment of 
     this Act, the Secretary shall develop and report to Congress 
     on a strategic plan for collecting or otherwise accessing 
     data on race and ethnicity for purposes of specifying quality 
     measures and resource use and other measures under 
     subsections (c) and (d) of section 1899B of the Social 
     Security Act, as added by subsection (a), and, as the 
     Secretary determines appropriate, other similar provisions 
     of, including payment adjustments under, title XVIII of such 
     Act (42 U.S.C. 1395 et seq.).

     SEC. 3. HOSPICE CARE.

       (a) Hospice Survey Requirement.--
       (1) In general.--Section 1861(dd)(4) of the Social Security 
     Act (42 U.S.C. 1395x(dd)(4)) is amended by adding at the end 
     the following new subparagraph:
       ``(C) Any entity that is certified as a hospice program 
     shall be subject to a standard survey by an appropriate State 
     or local survey agency, or an approved accreditation agency, 
     as determined by the Secretary, not less frequently than once 
     every 36 months beginning 6 months after the date of the 
     enactment of this subparagraph and ending September 30, 
     2025.''.
       (2) Funding.--For purposes of carrying out subparagraph (C) 
     of section 1861(dd)(4) of the Social Security Act (42 U.S.C. 
     1395x(dd)(4)), as added by paragraph (1), there shall be 
     transferred from the Federal Hospital Insurance Trust Fund 
     under section 1817 of such Act (42 U.S.C. 1395i) to the 
     Centers for Medicare & Medicaid Services Program Management 
     Account--
       (A) $25,000,000 for fiscal years 2015 through 2017, to be 
     made available for such purposes in equal parts for each such 
     fiscal year; and
       (B) $45,000,000 for fiscal years 2018 through 2025, to be 
     made available for such purposes in equal parts for each such 
     fiscal year.
       (b) Hospice Program Eligibility Recertification Technical 
     Correction to Apply Limitation on Liability of Beneficiary 
     Rules.--Section 1879 of the Social Security Act (42 U.S.C. 
     1395pp) is amended by adding at the end the following new 
     subsection:
       ``(i) The provisions of this section shall apply with 
     respect to a denial of a payment under this title by reason 
     of section 1814(a)(7)(E) in the same manner as such 
     provisions apply with respect to a denial of a payment under 
     this title by reason of section 1862(a)(1).''.
       (c) Revision to Requirement for Medical Review of Certain 
     Hospice Care.--Section 1814(a)(7) of the Social Security Act 
     (42 U.S.C. 1395f(a)(7)) is amended--
       (1) in subparagraph (C), by striking ``and'' at the end;
       (2) in subparagraph (D), in the matter preceding clause 
     (i), by inserting ``(and, in the case of clause (ii), before 
     the date of enactment of subparagraph (E))'' after ``2011''; 
     and
       (3) by adding at the end the following new subparagraph:
       ``(E) on and after the date of enactment of this 
     subparagraph, in the case of hospice care provided an 
     individual for more than 180 days by a hospice program for 
     which the number of such cases for such program comprises 
     more than a percent (specified by the Secretary) of the total 
     number of all cases of

[[Page H7610]]

     individuals provided hospice care by the program under this 
     title, the hospice care provided to such individual is 
     medically reviewed (in accordance with procedures established 
     by the Secretary); and''.
       (d) Update of Hospice Aggregate Payment Cap.--Section 
     1814(i)(2)(B) of the Social Security Act (42 U.S.C. 
     1395f(i)(2)(B)) is amended--
       (1) by striking ``(B) For purposes'' and inserting ``(B)(i) 
     Except as provided in clause (ii), for purposes''; and
       (2) by adding at the end the following:
       ``(ii) For purposes of subparagraph (A) for accounting 
     years that end after September 30, 2016, and before October 
     1, 2025, the `cap amount' is the cap amount under this 
     subparagraph for the preceding accounting year updated by the 
     percentage update to payment rates for hospice care under 
     paragraph (1)(C) for services furnished during the fiscal 
     year beginning on the October 1 preceding the beginning of 
     the accounting year (including the application of any 
     productivity or other adjustment under clause (iv) of that 
     paragraph).
       ``(iii) For accounting years that end after September 30, 
     2025, the cap amount shall be computed under clause (i) as if 
     clause (ii) had never applied.''.
       (e) Medicare Improvement Fund.--Section 1898 of the Social 
     Security Act (42 U.S.C. 1395iii) is amended--
       (1) by amending the heading to read as follows: ``medicare 
     improvement fund'';
       (2) by amending subsection (a) to read as follows:
       ``(a) Establishment.--The Secretary shall establish under 
     this title a Medicare Improvement Fund (in this section 
     referred to as the `Fund') which shall be available to the 
     Secretary to make improvements under the original Medicare 
     fee-for-service program under parts A and B for individuals 
     entitled to, or enrolled for, benefits under part or enrolled 
     under part B including adjustments to payments for items and 
     services furnished by providers of services and suppliers 
     under such original Medicare fee-for-service program.'';
       (3) in subsection (b)(1), by striking ``during'' and all 
     that follows and inserting ``during and after fiscal year 
     2020, $195,000,000.''; and
       (4) in subsection (b)(2), by striking ``from the Federal'' 
     and all that follows and inserting ``from the Federal 
     Hospital Insurance Trust Fund and the Federal Supplementary 
     Medical Insurance Trust Fund in such proportion as the 
     Secretary determines appropriate.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Texas (Mr. Brady) and the gentleman from Michigan (Mr. Levin) each will 
control 20 minutes.
  The Chair recognizes the gentleman from Texas.


                             General Leave

  Mr. BRADY of Texas. Mr. Speaker, I ask unanimous consent that all 
Members have 5 legislative days in which to revise and extend their 
remarks and to include extraneous material on the subject of the bill 
under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BRADY of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, today I rise in support of the IMPACT Act. This bill has 
a clever name and it will do what it says; it will have a positive 
impact on the Medicare program.
  Much work has been done to investigate how to improve care for 
seniors, and last June, the Ways and Means Health Subcommittee held a 
hearing on care delivery after a hospitalization, or what we call post-
acute care. Much like the IMPACT Act, the hearing was bipartisan and 
focused on post-acute reforms that the President advanced in his annual 
budget.
  It has been over a decade since meaningful changes have been made in 
the care of Medicare patients after hospitalization is paid.
  We have recently made progress. Site-neutral payments for long-term 
care hospitals and a value-based readmission program for nursing homes 
have been signed into law. These changes are a positive step in the 
right direction.
  Talks of broader reform have been ongoing as concerns of the impact 
of the solvency of the major source of funding for this care, the 
Medicare hospital insurance ``HI'' trust fund, persist.
  The Medicare trustees have explicitly told us the trajectory of 
spending from the HI trust fund is unsustainable. The trustees' current 
estimate is that the HI trust fund will be insolvent by 2030.
  Since 2008, the trust fund has been spending more money than it has 
been taking in. No wonder the HI trust fund has not met the trustees' 
formal test of short-range adequacy since 2003.
  This is a major problem. The HI trust fund is a ticking time bomb.
  The IMPACT Act is not the full solution, but it is a vital step on 
the path toward the solution. The IMPACT Act lays the foundation for 
future reform.
  The act establishes standard data and metrics across all of 
Medicare's post-hospitalization settings, including nursing homes and 
rehabilitation facilities. This important information will allow 
Congress to make future reforms armed with the facts.
  We all owe it to the seniors across America to catapult the Medicare 
program into the 21st century, and that is exactly what this bill does.
  Caring for our seniors after they are in the hospital is important, 
and we need to ensure the trust fund is solvent to allow us to continue 
to provide this care to our children and grandchildren.
  This is just plain, good, commonsense policy. I am voting in favor of 
the IMPACT Act, and I urge my colleagues to do the same.
  Mr. Speaker, I reserve the balance of my time.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore. The Chair understands that this bill is 
being considered as amended.
  Mr. LEVIN. Mr. Speaker, I yield myself such time as I shall consume.
  This legislation is truly a bipartisan effort. I congratulate Mr. 
Brady and all of my colleagues on both sides of the aisle on the 
committee who worked on this. And I think Mr. Brady would like to join 
me, I am sure, in thanking the staff for their very considerable work 
on this.
  The Affordable Care Act is making major strides towards improving our 
health care system, including moving toward accountable, quality-driven 
care. This legislation furthers this quality effort in the post-acute 
care space.
  It is also the first step towards modernizing post-acute care 
payments to Medicare providers. The current lack of apples-to-apples 
quality and patient assessment data in post-acute settings makes it 
difficult to evaluate the quality and cost effectiveness of these 
providers.
  This bipartisan, bicameral legislation, crafted with my colleagues on 
the Ways and Means and Senate Finance Committees, requires post-acute 
providers to report common data elements across settings, including 
patient assessments of function and mobility and quality and resource 
use measures. Over time, this data will enable health care providers, 
patients, and their families to determine the best post-acute setting 
for that patient's particular condition and preferences.
  The legislation also asks the Secretary and MEDPAC to provide 
suggestions and models for how Congress may reform post-acute care 
payments in the future.
  As we continue to strive for quality and value in the Medicare 
program, it is important we do not discourage providers from caring for 
complex patient populations. That is why this legislation directs the 
Secretary to study the effect of individual socioeconomic status, 
health literacy, English language proficiency, and other factors on 
quality and research use measurement, and then incorporate those 
findings into value-based performance programs.
  Lastly, the IMPACT Act ensures quality within the hospice benefit by 
requiring that providers are surveyed by an appropriate accrediting 
agency at least once every 3 years.
  Overall, the IMPACT Act is supported by a multitude of stakeholder 
organizations. So I encourage my colleagues to vote ``yes'' and to take 
this important step--and I want to underline that--this important step 
towards modernizing vital post-acute care.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BRADY of Texas. Mr. Speaker, I yield 2 minutes to the gentleman 
from New York (Mr. Reed), a key member of the Ways and Means Committee 
and a champion for affordable health care.
  Mr. REED. I thank the gentleman from Texas for yielding.
  Mr. Speaker, I rise tonight in strong support of the IMPACT Act, H.R. 
4994. In particular, I would direct my comments tonight in regards to 
the provisions that deal with hospice care in America. I thank the 
ranking member, Mr. Levin, a friend who has stood with

[[Page H7611]]

us in regards to this act, and I echo his support and request for 
support for its passage this evening.
  When we drafted the Hospice Opportunities for Supporting Patients 
with Integrity and Care Evaluations, otherwise known as the HOSPICE, 
Act, I was glad to bring those issues to the forefront in the debate 
that has been incorporated in the IMPACT Act tonight.
  To me, hospice care is the right thing to do for our fellow Americans 
that face those hard decisions as we deal with health care at the end 
of our lives.
  To me, the HOSPICE Act and the provisions in the IMPACT Act go to 
ensure that there is quality care when it comes to hospice care for our 
fellow Americans.
  These reforms are necessary. They are the right thing to do, and they 
will ensure that hospice in America is done in a quality, well-
conducted manner for all of our fellow Americans.
  I would like to thank my coauthor on this, Mr. Mike Thompson from 
California, with his bipartisan support, and with my colleague on the 
other side joining us in regards to these reforms to hospice care 
across America.
  Mr. Speaker, I ask my colleagues to support this legislation.
  Mr. LEVIN. Mr. Speaker, I yield myself such time as I may consume.
  I will close just briefly to reiterate, this is a product of months 
and months of work across the aisle, our staffs working together many, 
many hours, I think, probably at various hours of the day and night, 
maybe even as late as it is tonight on other days. So I think we should 
be proud of this product, and I hope all of us will support it.
  I thank Mr. Brady for his work on this.
  Mr. Speaker, I yield back the balance of my time.
  Mr. BRADY of Texas. Mr. Speaker, I yield myself as much time as I may 
consume to close.
  The bill began with an open letter to stakeholders, as Ranking Member 
Levin said. Following our bipartisan call to action, we received over 
70 comments in response to our letter asking for specific 
recommendations to improve care for seniors.

                              {time}  2145

  There were three central themes that stakeholders urged us to pursue, 
and they are very simple:
  One, create a common measure set with standardized data to assess the 
quality of health care, the way it is delivered;
  Two, carefully research and study Medicare's post-acute settings to 
inform future payment and delivery system reform;
  And then third, place an emphasis on informing the patient and team 
of caregivers during the discharge planning process in order to more 
effectively coordinate care.
  The IMPACT Act achieves these important objectives.
  Support for IMPACT comes from hospitals, nursing homes, home health 
care providers, leading quality groups like the National Quality Forum, 
and leading beneficiary advocates. I would like to highlight a few:
  From the National Home Care and Hospice Association:
  ``We are very supportive of the goals behind the IMPACT Act and fully 
support the development of a uniform patient assessment and discharge 
planning process.''
  From the American Academy of Physical Medicine and Rehabilitation, 
which represents rehab physicians:
  ``The presence of these quality measures will ensure that patients 
are receiving the best possible care in the most appropriate setting.''
  Finally, from the National Coalition on Health Care, which represents 
many Medicare beneficiary organizations:
  ``With this information, payers, providers, consumers, and family 
caregivers can work together to identify the best care setting for each 
individual, and policymakers can begin the challenging work of 
implementing broader reform to Medicare's post-acute system.''
  On behalf of Chairman Dave Camp, I want to thank the ranking member, 
Mr. Levin, and his staff for all of their good work and thank Senator 
Wyden and Senator Hatch in joining us in this bipartisan, bicameral 
effort.
  It is time to support our seniors and improve the Medicare program on 
which they rely. I urge my colleagues to join me and vote ``yes.''
  Mr. Speaker, I yield back the balance of my time.
  Mr. WAXMAN. Mr. Speaker, there is an old saying, ``you get what you 
pay for.'' This is true in medicine as in many other fields, and it is 
why federal healthcare payment policies are so important.
  The Affordable Care Act made important reforms in this area. We 
established many new programs to move us away from a healthcare system 
that rewards volume over value, such as the Hospital Value Based 
Purchasing program, the Physician Value-Based Payment Modifier, the 
Medicare Shared Savings Program or ACOs, and the many new payment 
models being tested under the Center for Medicare and Medicaid 
Innovation (CMMI).
  Although we have yet to pass final legislation, the bipartisan, 
bicameral Sustainable Growth Rate (SGR) physician payment reform 
policies we adopted in the House earlier this year would make valuable 
additional reforms.
  And the bill before us, the Improving Medicare Post-Acute Care 
Transformation Act of 2014, would take another crucial step toward the 
modernization of Medicare payments to healthcare providers.
  Post-acute care providers, such as nursing homes, long-term care 
hospitals, and home health agencies are the logical next providers to 
undergo payment and delivery system transformations. There is 
tremendous variation in healthcare spending across post-acute care 
settings. And there is only inconclusive evidence to support which 
patients should receive which services in which settings of care.
  Before we revamp how providers are paid in these settings, we must 
ensure we have the information we need to make informed decisions. 
Comprehensive and reliable quality and outcomes data must be collected 
and analyzed before we can implement payment reforms, such as equalized 
payments across settings or bundled payments.
  And that is exactly what this bill does. It gathers the data we need 
to compare quality across different post-acute care providers, improve 
hospital and post-acute care discharge planning, and understand how to 
appropriately account for socio-economic status in payment and quality 
performance. This information will help us improve the payment and 
delivery systems for post-acute care, thereby ensuring Medicare 
beneficiaries receive the right high-quality care, in the right 
setting, at the right time.
  I am pleased to see this important bipartisan effort to reform post-
acute care move forward, which will lead to improved quality, improved 
outcomes, and lower healthcare costs. I urge my colleagues to vote for 
its swift passage.
  Mr. McDERMOTT. Mr. Speaker, I rise today in support of H.R. 4994, the 
IMPACT Act. This bipartisan, bicameral legislation makes several small 
changes to improve post-acute care quality measures and reporting 
systems in Medicare.
  This bill will lay the groundwork for future changes that will reform 
how Medicare pays for post-acute care.
  This bill has support across the post-acute care community, including 
providers and beneficiaries.
  This bill is budget neutral. In short, this is an innocuous bill.
  Yet, the bottom line is this:
  Congress must do more than pass small, innocuous bills. My 
constituents in Seattle--and constituents from coast to coast--are 
coping with a list of growing challenges.
  Yet, this Congress is content to push the urgent work of tackling 
these challenges to another day.
  Seniors, patients and doctors need Congress to find a permanent fix 
for the flawed Sustainable Growth Rate formula in Medicare.
  American seniors deserve greater safety and security, but Congress' 
most recent SGR patch--thrown together last Spring--expires in March.
  By then, Congress--just like the 17 times before--will be up against 
an urgent deadline and flailing to find a permanent solution.
  American families need Congress to reauthorize the Children's Health 
Insurance Program.
  More than 8 million children and pregnant women access affordable 
health coverage through CHIP.
  But federal funding faces a cliff next year, and this Congress isn't 
doing anything about it.
  America needs a reenergized primary care workforce.
  By 2020, our nation's health system will be staggered by a shortage 
of 45,000 primary care doctors.
  But this Congress isn't talking about extending Medicaid payment 
parity before it expires in December.
  This Congress isn't talking about reauthorizing the National Health 
Service Corps.
  And this Congress certainly isn't talking about new ideas like R-
DOCS--a program, modeled on our military's ROTC program, to train and 
place new primary care doctors where they are needed most.

[[Page H7612]]

  Yes, we might pass legislation like the IMPACT Act this week. But the 
American people demand and deserve bolder action and bigger results 
from their Congress.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Texas (Mr. Brady) that the House suspend the rules and 
pass the bill, H.R. 4994, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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