[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.
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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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