[Congressional Record Volume 161, Number 51 (Thursday, March 26, 2015)]
[House]
[Pages H2045-H2083]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT OF 2015
Mr. PITTS. Mr. Speaker, pursuant to House Resolution 173, I call up
the bill (H.R. 2) to amend title XVIII of the Social Security Act to
repeal the Medicare sustainable growth rate and strengthen Medicare
access by improving physician payments and making other improvements,
to reauthorize the Children's Health Insurance Program, and for other
purposes, and ask for its immediate consideration in the House.
The Clerk read the title of the bill.
The SPEAKER pro tempore (Mr. Poe of Texas). Pursuant to House
Resolution 173, the amendment printed in House Report 114-50 is
considered adopted. The bill, as amended, is considered read.
The text of the bill, as amended, is as follows:
H.R. 2
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare
Access and CHIP Reauthorization Act of 2015''.
[[Page H2046]]
(b) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION
Sec. 101. Repealing the sustainable growth rate (SGR) and improving
Medicare payment for physicians' services.
Sec. 102. Priorities and funding for measure development.
Sec. 103. Encouraging care management for individuals with chronic care
needs.
Sec. 104. Empowering beneficiary choices through continued access to
information on physicians' services.
Sec. 105. Expanding availability of Medicare data.
Sec. 106. Reducing administrative burden and other provisions.
TITLE II--MEDICARE AND OTHER HEALTH EXTENDERS
Subtitle A--Medicare Extenders
Sec. 201. Extension of work GPCI floor.
Sec. 202. Extension of therapy cap exceptions process.
Sec. 203. Extension of ambulance add-ons.
Sec. 204. Extension of increased inpatient hospital payment adjustment
for certain low-volume hospitals.
Sec. 205. Extension of the Medicare-dependent hospital (MDH) program.
Sec. 206. Extension for specialized Medicare Advantage plans for
special needs individuals.
Sec. 207. Extension of funding for quality measure endorsement, input,
and selection.
Sec. 208. Extension of funding outreach and assistance for low-income
programs.
Sec. 209. Extension and transition of reasonable cost reimbursement
contracts.
Sec. 210. Extension of home health rural add-on.
Subtitle B--Other Health Extenders
Sec. 211. Permanent extension of the qualifying individual (QI)
program.
Sec. 212. Permanent extension of transitional medical assistance (TMA).
Sec. 213. Extension of special diabetes program for type I diabetes and
for Indians.
Sec. 214. Extension of abstinence education.
Sec. 215. Extension of personal responsibility education program
(PREP).
Sec. 216. Extension of funding for family-to-family health information
centers.
Sec. 217. Extension of health workforce demonstration project for low-
income individuals.
Sec. 218. Extension of maternal, infant, and early childhood home
visiting programs.
Sec. 219. Tennessee DSH allotment for fiscal years 2015 through 2025.
Sec. 220. Delay in effective date for Medicaid amendments relating to
beneficiary liability settlements.
Sec. 221. Extension of funding for community health centers, the
National Health Service Corps, and teaching health
centers.
TITLE III--CHIP
Sec. 301. 2-year extension of the Children's Health Insurance Program.
Sec. 302. Extension of express lane eligibility.
Sec. 303. Extension of outreach and enrollment program.
Sec. 304. Extension of certain programs and demonstration projects.
Sec. 305. Report of Inspector General of HHS on use of express lane
option under Medicaid and CHIP.
TITLE IV--OFFSETS
Subtitle A--Medicare Beneficiary Reforms
Sec. 401. Limitation on certain medigap policies for newly eligible
Medicare beneficiaries.
Sec. 402. Income-related premium adjustment for parts B and D.
Subtitle B--Other Offsets
Sec. 411. Medicare payment updates for post-acute providers.
Sec. 412. Delay of reduction to Medicaid DSH allotments.
Sec. 413. Levy on delinquent providers.
Sec. 414. Adjustments to inpatient hospital payment rates.
TITLE V--MISCELLANEOUS
Subtitle A--Protecting the Integrity of Medicare
Sec. 501. Prohibition of inclusion of Social Security account numbers
on Medicare cards.
Sec. 502. Preventing wrongful Medicare payments for items and services
furnished to incarcerated individuals, individuals not
lawfully present, and deceased individuals.
Sec. 503. Consideration of measures regarding Medicare beneficiary
smart cards.
Sec. 504. Modifying Medicare durable medical equipment face-to-face
encounter documentation requirement.
Sec. 505. Reducing improper Medicare payments.
Sec. 506. Improving senior Medicare patrol and fraud reporting rewards.
Sec. 507. Requiring valid prescriber National Provider Identifiers on
pharmacy claims.
Sec. 508. Option to receive Medicare Summary Notice electronically.
Sec. 509. Renewal of MAC contracts.
Sec. 510. Study on pathway for incentives to States for State
participation in medicaid data match program.
Sec. 511. Guidance on application of Common Rule to clinical data
registries.
Sec. 512. Eliminating certain civil money penalties; gainsharing study
and report.
Sec. 513. Modification of Medicare home health surety bond condition of
participation requirement.
Sec. 514. Oversight of Medicare coverage of manual manipulation of the
spine to correct subluxation.
Sec. 515. National expansion of prior authorization model for
repetitive scheduled non-emergent ambulance transport.
Sec. 516. Repealing duplicative Medicare secondary payor provision.
Sec. 517. Plan for expanding data in annual CERT report.
Sec. 518. Removing funds for Medicare Improvement Fund added by IMPACT
Act of 2014.
Sec. 519. Rule of construction.
Subtitle B--Other Provisions
Sec. 521. Extension of two-midnight PAMA rules on certain medical
review activities.
Sec. 522. Requiring bid surety bonds and State licensure for entities
submitting bids under the Medicare DMEPOS competitive
acquisition program.
Sec. 523. Payment for global surgical packages.
Sec. 524. Extension of Secure Rural Schools and Community Self-
Determination Act of 2000.
Sec. 525. Exclusion from PAYGO scorecards.
TITLE I--SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION
SEC. 101. REPEALING THE SUSTAINABLE GROWTH RATE (SGR) AND
IMPROVING MEDICARE PAYMENT FOR PHYSICIANS'
SERVICES.
(a) Stabilizing Fee Updates.--
(1) Repeal of sgr payment methodology.--Section 1848 of the
Social Security Act (42 U.S.C. 1395w-4) is amended--
(A) in subsection (d)--
(i) in paragraph (1)(A)--
(I) by inserting ``and ending with 2025'' after ``beginning
with 2001''; and
(II) by inserting ``or a subsequent paragraph'' after
``paragraph (4)''; and
(ii) in paragraph (4)--
(I) in the heading, by inserting ``and ending with 2014''
after ``years beginning with 2001''; and
(II) in subparagraph (A), by inserting ``and ending with
2014'' after ``a year beginning with 2001''; and
(B) in subsection (f)--
(i) in paragraph (1)(B), by inserting ``through 2014''
after ``of each succeeding year''; and
(ii) in paragraph (2), in the matter preceding subparagraph
(A), by inserting ``and ending with 2014'' after ``beginning
with 2000''.
(2) Update of rates for 2015 and subsequent years.--
Subsection (d) of section 1848 of the Social Security Act (42
U.S.C. 1395w-4) is amended--
(A) in paragraph (1)(A), by adding at the end the
following: ``There shall be two separate conversion factors
for each year beginning with 2026, one for items and services
furnished by a qualifying APM participant (as defined in
section 1833(z)(2)) (referred to in this subsection as the
`qualifying APM conversion factor') and the other for other
items and services (referred to in this subsection as the
`nonqualifying APM conversion factor'), equal to the
respective conversion factor for the previous year (or, in
the case of 2026, equal to the single conversion factor for
2025) multiplied by the update established under paragraph
(20) for such respective conversion factor for such year.'';
(B) in paragraph (1)(D), by inserting ``(or, beginning with
2026, applicable conversion factor)'' after ``single
conversion factor''; and
(C) by striking paragraph (16) and inserting the following
new paragraphs:
``(16) Update for january through june of 2015.--Subject to
paragraphs (7)(B), (8)(B), (9)(B), (10)(B), (11)(B), (12)(B),
(13)(B), (14)(B), and (15)(B), in lieu of the update to the
single conversion factor established in paragraph (1)(C) that
would otherwise apply for 2015 for the period beginning on
January 1, 2015, and ending on June 30, 2015, the update to
the single conversion factor shall be 0.0 percent.
``(17) Update for july through december of 2015.--The
update to the single conversion factor established in
paragraph (1)(C) for the period beginning on July 1, 2015,
and ending on December 31, 2015, shall be 0.5 percent.
``(18) Update for 2016 through 2019.--The update to the
single conversion factor established in paragraph (1)(C) for
2016 and each subsequent year through 2019 shall be 0.5
percent.
``(19) Update for 2020 through 2025.--The update to the
single conversion factor established in paragraph (1)(C) for
2020 and each subsequent year through 2025 shall be 0.0
percent.
[[Page H2047]]
``(20) Update for 2026 and subsequent years.--For 2026 and
each subsequent year, the update to the qualifying APM
conversion factor established under paragraph (1)(A) is 0.75
percent, and the update to the nonqualifying APM conversion
factor established under such paragraph is 0.25 percent.''.
(3) MedPAC reports.--
(A) Initial report.--Not later than July 1, 2017, the
Medicare Payment Advisory Commission shall submit to Congress
a report on the relationship between--
(i) physician and other health professional utilization and
expenditures (and the rate of increase of such utilization
and expenditures) of items and services for which payment is
made under section 1848 of the Social Security Act (42 U.S.C.
1395w-4); and
(ii) total utilization and expenditures (and the rate of
increase of such utilization and expenditures) under parts A,
B, and D of title XVIII of such Act.
Such report shall include a methodology to describe such
relationship and the impact of changes in such physician and
other health professional practice and service ordering
patterns on total utilization and expenditures under parts A,
B, and D of such title.
(B) Final report.--Not later than July 1, 2021, the
Medicare Payment Advisory Commission shall submit to Congress
a report on the relationship described in subparagraph (A),
including the results determined from applying the
methodology included in the report submitted under such
subparagraph.
(C) Report on update to physicians' services under
medicare.--Not later than July 1, 2019, the Medicare Payment
Advisory Commission shall submit to Congress a report on--
(i) the payment update for professional services applied
under the Medicare program under title XVIII of the Social
Security Act for the period of years 2015 through 2019;
(ii) the effect of such update on the efficiency, economy,
and quality of care provided under such program;
(iii) the effect of such update on ensuring a sufficient
number of providers to maintain access to care by Medicare
beneficiaries; and
(iv) recommendations for any future payment updates for
professional services under such program to ensure adequate
access to care is maintained for Medicare beneficiaries.
(b) Consolidation of Certain Current Law Performance
Programs With New Merit-Based Incentive Payment System.--
(1) EHR meaningful use incentive program.--
(A) Sunsetting separate meaningful use payment
adjustments.--Section 1848(a)(7)(A) of the Social Security
Act (42 U.S.C. 1395w-4(a)(7)(A)) is amended--
(i) in clause (i), by striking ``2015 or any subsequent
payment year'' and inserting ``each of 2015 through 2018'';
(ii) in clause (ii)(III), by striking ``each subsequent
year'' and inserting ``2018''; and
(iii) in clause (iii)--
(I) in the heading, by striking ``and subsequent years'';
(II) by striking ``and each subsequent year''; and
(III) by striking ``, but in no case shall the applicable
percent be less than 95 percent''.
(B) Continuation of meaningful use determinations for
mips.--Section 1848(o)(2) of the Social Security Act (42
U.S.C. 1395w-4(o)(2)) is amended--
(i) in subparagraph (A), in the matter preceding clause
(i)--
(I) by striking ``For purposes of paragraph (1), an'' and
inserting ``An''; and
(II) by inserting ``, or pursuant to subparagraph (D) for
purposes of subsection (q), for a performance period under
such subsection for a year'' after ``under such subsection
for a year''; and
(ii) by adding at the end the following new subparagraph:
``(D) Continued application for purposes of mips.--With
respect to 2019 and each subsequent payment year, the
Secretary shall, for purposes of subsection (q) and in
accordance with paragraph (1)(F) of such subsection,
determine whether an eligible professional who is a MIPS
eligible professional (as defined in subsection (q)(1)(C))
for such year is a meaningful EHR user under this paragraph
for the performance period under subsection (q) for such
year.''.
(2) Quality reporting.--
(A) Sunsetting separate quality reporting incentives.--
Section 1848(a)(8)(A) of the Social Security Act (42 U.S.C.
1395w-4(a)(8)(A)) is amended--
(i) in clause (i), by striking ``2015 or any subsequent
year'' and inserting ``each of 2015 through 2018''; and
(ii) in clause (ii)(II), by striking ``and each subsequent
year'' and inserting ``, 2017, and 2018''.
(B) Continuation of quality measures and processes for
mips.--Section 1848 of the Social Security Act (42 U.S.C.
1395w-4) is amended--
(i) in subsection (k), by adding at the end the following
new paragraph:
``(9) Continued application for purposes of mips and for
certain professionals volunteering to report.--The Secretary
shall, in accordance with subsection (q)(1)(F), carry out the
provisions of this subsection--
``(A) for purposes of subsection (q); and
``(B) for eligible professionals who are not MIPS eligible
professionals (as defined in subsection (q)(1)(C)) for the
year involved.''; and
(ii) in subsection (m)--
(I) by redesignating paragraph (7) added by section
10327(a) of Public Law 111-148 as paragraph (8); and
(II) by adding at the end the following new paragraph:
``(9) Continued application for purposes of mips and for
certain professionals volunteering to report.--The Secretary
shall, in accordance with subsection (q)(1)(F), carry out the
processes under this subsection--
``(A) for purposes of subsection (q); and
``(B) for eligible professionals who are not MIPS eligible
professionals (as defined in subsection (q)(1)(C)) for the
year involved.''.
(3) Value-based payments.--
(A) Sunsetting separate value-based payments.--Clause (iii)
of section 1848(p)(4)(B) of the Social Security Act (42
U.S.C. 1395w-4(p)(4)(B)) is amended to read as follows:
``(iii) Application.--The Secretary shall apply the payment
modifier established under this subsection for items and
services furnished on or after January 1, 2015, with respect
to specific physicians and groups of physicians the Secretary
determines appropriate, and for services furnished on or
after January 1, 2017, with respect to all physicians and
groups of physicians. Such payment modifier shall not be
applied for items and services furnished on or after January
1, 2019.''.
(B) Continuation of value-based payment modifier measures
for mips.--Section 1848(p) of the Social Security Act (42
U.S.C. 1395w-4(p)) is amended--
(i) in paragraph (2), by adding at the end the following
new subparagraph:
``(C) Continued application for purposes of mips.--The
Secretary shall, in accordance with subsection (q)(1)(F),
carry out subparagraph (B) for purposes of subsection (q).'';
and
(ii) in paragraph (3), by adding at the end the following:
``With respect to 2019 and each subsequent year, the
Secretary shall, in accordance with subsection (q)(1)(F),
carry out this paragraph for purposes of subsection (q).''.
(c) Merit-Based Incentive Payment System.--
(1) In general.--Section 1848 of the Social Security Act
(42 U.S.C. 1395w-4) is amended by adding at the end the
following new subsection:
``(q) Merit-Based Incentive Payment System.--
``(1) Establishment.--
``(A) In general.--Subject to the succeeding provisions of
this subsection, the Secretary shall establish an eligible
professional Merit-based Incentive Payment System (in this
subsection referred to as the `MIPS') under which the
Secretary shall--
``(i) develop a methodology for assessing the total
performance of each MIPS eligible professional according to
performance standards under paragraph (3) for a performance
period (as established under paragraph (4)) for a year;
``(ii) using such methodology, provide for a composite
performance score in accordance with paragraph (5) for each
such professional for each performance period; and
``(iii) use such composite performance score of the MIPS
eligible professional for a performance period for a year to
determine and apply a MIPS adjustment factor (and, as
applicable, an additional MIPS adjustment factor) under
paragraph (6) to the professional for the year.
Notwithstanding subparagraph (C)(ii), under the MIPS, the
Secretary shall permit any eligible professional (as defined
in subsection (k)(3)(B)) to report on applicable measures and
activities described in paragraph (2)(B).
``(B) Program implementation.--The MIPS shall apply to
payments for items and services furnished on or after January
1, 2019.
``(C) MIPS eligible professional defined.--
``(i) In general.--For purposes of this subsection, subject
to clauses (ii) and (iv), the term `MIPS eligible
professional' means--
``(I) for the first and second years for which the MIPS
applies to payments (and for the performance period for such
first and second year), a physician (as defined in section
1861(r)), a physician assistant, nurse practitioner, and
clinical nurse specialist (as such terms are defined in
section 1861(aa)(5)), a certified registered nurse
anesthetist (as defined in section 1861(bb)(2)), and a group
that includes such professionals; and
``(II) for the third year for which the MIPS applies to
payments (and for the performance period for such third year)
and for each succeeding year (and for the performance period
for each such year), the professionals described in subclause
(I), such other eligible professionals (as defined in
subsection (k)(3)(B)) as specified by the Secretary, and a
group that includes such professionals.
``(ii) Exclusions.--For purposes of clause (i), the term
`MIPS eligible professional' does not include, with respect
to a year, an eligible professional (as defined in subsection
(k)(3)(B)) who--
``(I) is a qualifying APM participant (as defined in
section 1833(z)(2));
``(II) subject to clause (vii), is a partial qualifying APM
participant (as defined in clause (iii)) for the most recent
period for which data are available and who, for the
performance period with respect to such year, does not report
on applicable measures and activities described in paragraph
(2)(B) that are required to be reported by such a
professional under the MIPS; or
``(III) for the performance period with respect to such
year, does not exceed the low-
[[Page H2048]]
volume threshold measurement selected under clause (iv).
``(iii) Partial qualifying apm participant.--For purposes
of this subparagraph, the term `partial qualifying APM
participant' means, with respect to a year, an eligible
professional for whom the Secretary determines the minimum
payment percentage (or percentages), as applicable, described
in paragraph (2) of section 1833(z) for such year have not
been satisfied, but who would be considered a qualifying APM
participant (as defined in such paragraph) for such year if--
``(I) with respect to 2019 and 2020, the reference in
subparagraph (A) of such paragraph to 25 percent was instead
a reference to 20 percent;
``(II) with respect to 2021 and 2022--
``(aa) the reference in subparagraph (B)(i) of such
paragraph to 50 percent was instead a reference to 40
percent; and
``(bb) the references in subparagraph (B)(ii) of such
paragraph to 50 percent and 25 percent of such paragraph were
instead references to 40 percent and 20 percent,
respectively; and
``(III) with respect to 2023 and subsequent years--
``(aa) the reference in subparagraph (C)(i) of such
paragraph to 75 percent was instead a reference to 50
percent; and
``(bb) the references in subparagraph (C)(ii) of such
paragraph to 75 percent and 25 percent of such paragraph were
instead references to 50 percent and 20 percent,
respectively.
``(iv) Selection of low-volume threshold measurement.--The
Secretary shall select a low-volume threshold to apply for
purposes of clause (ii)(III), which may include one or more
or a combination of the following:
``(I) The minimum number (as determined by the Secretary)
of individuals enrolled under this part who are treated by
the eligible professional for the performance period
involved.
``(II) The minimum number (as determined by the Secretary)
of items and services furnished to individuals enrolled under
this part by such professional for such performance period.
``(III) The minimum amount (as determined by the Secretary)
of allowed charges billed by such professional under this
part for such performance period.
``(v) Treatment of new medicare enrolled eligible
professionals.--In the case of a professional who first
becomes a Medicare enrolled eligible professional during the
performance period for a year (and had not previously
submitted claims under this title such as a person, an
entity, or a part of a physician group or under a different
billing number or tax identifier), such professional shall
not be treated under this subsection as a MIPS eligible
professional until the subsequent year and performance period
for such subsequent year.
``(vi) Clarification.--In the case of items and services
furnished during a year by an individual who is not a MIPS
eligible professional (including pursuant to clauses (ii) and
(v)) with respect to a year, in no case shall a MIPS
adjustment factor (or additional MIPS adjustment factor)
under paragraph (6) apply to such individual for such year.
``(vii) Partial qualifying apm participant
clarifications.--
``(I) Treatment as mips eligible professional.--In the case
of an eligible professional who is a partial qualifying APM
participant, with respect to a year, and who, for the
performance period for such year, reports on applicable
measures and activities described in paragraph (2)(B) that
are required to be reported by such a professional under the
MIPS, such eligible professional is considered to be a MIPS
eligible professional with respect to such year.
``(II) Not eligible for qualifying apm participant
payments.--In no case shall an eligible professional who is a
partial qualifying APM participant, with respect to a year,
be considered a qualifying APM participant (as defined in
paragraph (2) of section 1833(z)) for such year or be
eligible for the additional payment under paragraph (1) of
such section for such year.
``(D) Application to group practices.--
``(i) In general.--Under the MIPS:
``(I) Quality performance category.--The Secretary shall
establish and apply a process that includes features of the
provisions of subsection (m)(3)(C) for MIPS eligible
professionals in a group practice with respect to assessing
performance of such group with respect to the performance
category described in clause (i) of paragraph (2)(A).
``(II) Other performance categories.--The Secretary may
establish and apply a process that includes features of the
provisions of subsection (m)(3)(C) for MIPS eligible
professionals in a group practice with respect to assessing
the performance of such group with respect to the performance
categories described in clauses (ii) through (iv) of such
paragraph.
``(ii) Ensuring comprehensiveness of group practice
assessment.--The process established under clause (i) shall
to the extent practicable reflect the range of items and
services furnished by the MIPS eligible professionals in the
group practice involved.
``(E) Use of registries.--Under the MIPS, the Secretary
shall encourage the use of qualified clinical data registries
pursuant to subsection (m)(3)(E) in carrying out this
subsection.
``(F) Application of certain provisions.--In applying a
provision of subsection (k), (m), (o), or (p) for purposes of
this subsection, the Secretary shall--
``(i) adjust the application of such provision to ensure
the provision is consistent with the provisions of this
subsection; and
``(ii) not apply such provision to the extent that the
provision is duplicative with a provision of this subsection.
``(G) Accounting for risk factors.--
``(i) Risk factors.--Taking into account the relevant
studies conducted and recommendations made in reports under
section 2(d) of the Improving Medicare Post-Acute Care
Transformation Act of 2014, 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 risk factors--
``(I) assess appropriate adjustments to quality measures,
resource use measures, and other measures used under the
MIPS; and
``(II) assess and implement appropriate adjustments to
payment adjustments, composite performance scores, scores for
performance categories, or scores for measures or activities
under the MIPS.
``(2) Measures and activities under performance
categories.--
``(A) Performance categories.--Under the MIPS, the
Secretary shall use the following performance categories
(each of which is referred to in this subsection as a
performance category) in determining the composite
performance score under paragraph (5):
``(i) Quality.
``(ii) Resource use.
``(iii) Clinical practice improvement activities.
``(iv) Meaningful use of certified EHR technology.
``(B) Measures and activities specified for each
category.--For purposes of paragraph (3)(A) and subject to
subparagraph (C), measures and activities specified for a
performance period (as established under paragraph (4)) for a
year are as follows:
``(i) Quality.--For the performance category described in
subparagraph (A)(i), the quality measures included in the
final measures list published under subparagraph (D)(i) for
such year and the list of quality measures described in
subparagraph (D)(vi) used by qualified clinical data
registries under subsection (m)(3)(E).
``(ii) Resource use.--For the performance category
described in subparagraph (A)(ii), the measurement of
resource use for such period under subsection (p)(3), using
the methodology under subsection (r) as appropriate, and, as
feasible and applicable, accounting for the cost of drugs
under part D.
``(iii) Clinical practice improvement activities.--For the
performance category described in subparagraph (A)(iii),
clinical practice improvement activities (as defined in
subparagraph (C)(v)(III)) under subcategories specified by
the Secretary for such period, which shall include at least
the following:
``(I) The subcategory of expanded practice access, such as
same day appointments for urgent needs and after hours access
to clinician advice.
``(II) The subcategory of population management, such as
monitoring health conditions of individuals to provide timely
health care interventions or participation in a qualified
clinical data registry.
``(III) The subcategory of care coordination, such as
timely communication of test results, timely exchange of
clinical information to patients and other providers, and use
of remote monitoring or telehealth.
``(IV) The subcategory of beneficiary engagement, such as
the establishment of care plans for individuals with complex
care needs, beneficiary self-management assessment and
training, and using shared decision-making mechanisms.
``(V) The subcategory of patient safety and practice
assessment, such as through use of clinical or surgical
checklists and practice assessments related to maintaining
certification.
``(VI) The subcategory of participation in an alternative
payment model (as defined in section 1833(z)(3)(C)).
In establishing activities under this clause, the Secretary
shall give consideration to the circumstances of small
practices (consisting of 15 or fewer professionals) and
practices located in rural areas and in health professional
shortage areas (as designated under section 332(a)(1)(A) of
the Public Health Service Act).
``(iv) Meaningful ehr use.--For the performance category
described in subparagraph (A)(iv), the requirements
established for such period under subsection (o)(2) for
determining whether an eligible professional is a meaningful
EHR user.
``(C) Additional provisions.--
``(i) Emphasizing outcome measures under the quality
performance category.--In applying subparagraph (B)(i), the
Secretary shall, as feasible, emphasize the application of
outcome measures.
``(ii) Application of additional system measures.--The
Secretary may use measures used for a payment system other
than for physicians, such as measures for inpatient
hospitals, for purposes of the performance categories
described in clauses (i) and (ii) of subparagraph (A). For
purposes of the previous sentence, the Secretary may not
[[Page H2049]]
use measures for hospital outpatient departments, except in
the case of items and services furnished by emergency
physicians, radiologists, and anesthesiologists.
``(iii) Global and population-based measures.--The
Secretary may use global measures, such as global outcome
measures, and population-based measures for purposes of the
performance category described in subparagraph (A)(i).
``(iv) Application of measures and activities to non-
patient-facing professionals.--In carrying out this
paragraph, with respect to measures and activities specified
in subparagraph (B) for performance categories described in
subparagraph (A), the Secretary--
``(I) shall give consideration to the circumstances of
professional types (or subcategories of those types
determined by practice characteristics) who typically furnish
services that do not involve face-to-face interaction with a
patient; and
``(II) may, to the extent feasible and appropriate, take
into account such circumstances and apply under this
subsection with respect to MIPS eligible professionals of
such professional types or subcategories, alternative
measures or activities that fulfill the goals of the
applicable performance category.
In carrying out the previous sentence, the Secretary shall
consult with professionals of such professional types or
subcategories.
``(v) Clinical practice improvement activities.--
``(I) Request for information.--In initially applying
subparagraph (B)(iii), the Secretary shall use a request for
information to solicit recommendations from stakeholders to
identify activities described in such subparagraph and
specifying criteria for such activities.
``(II) Contract authority for clinical practice improvement
activities performance category.--In applying subparagraph
(B)(iii), the Secretary may contract with entities to assist
the Secretary in--
``(aa) identifying activities described in subparagraph
(B)(iii);
``(bb) specifying criteria for such activities; and
``(cc) determining whether a MIPS eligible professional
meets such criteria.
``(III) Clinical practice improvement activities defined.--
For purposes of this subsection, the term `clinical practice
improvement activity' means an activity that relevant
eligible professional organizations and other relevant
stakeholders identify as improving clinical practice or care
delivery and that the Secretary determines, when effectively
executed, is likely to result in improved outcomes.
``(D) Annual list of quality measures available for mips
assessment.--
``(i) In general.--Under the MIPS, the Secretary, through
notice and comment rulemaking and subject to the succeeding
clauses of this subparagraph, shall, with respect to the
performance period for a year, establish an annual final list
of quality measures from which MIPS eligible professionals
may choose for purposes of assessment under this subsection
for such performance period. Pursuant to the previous
sentence, the Secretary shall--
``(I) not later than November 1 of the year prior to the
first day of the first performance period under the MIPS,
establish and publish in the Federal Register a final list of
quality measures; and
``(II) not later than November 1 of the year prior to the
first day of each subsequent performance period, update the
final list of quality measures from the previous year (and
publish such updated final list in the Federal Register),
by--
``(aa) removing from such list, as appropriate, quality
measures, which may include the removal of measures that are
no longer meaningful (such as measures that are topped out);
``(bb) adding to such list, as appropriate, new quality
measures; and
``(cc) determining whether or not quality measures on such
list that have undergone substantive changes should be
included in the updated list.
``(ii) Call for quality measures.--
``(I) In general.--Eligible professional organizations and
other relevant stakeholders shall be requested to identify
and submit quality measures to be considered for selection
under this subparagraph in the annual list of quality
measures published under clause (i) and to identify and
submit updates to the measures on such list. For purposes of
the previous sentence, measures may be submitted regardless
of whether such measures were previously published in a
proposed rule or endorsed by an entity with a contract under
section 1890(a).
``(II) Eligible professional organization defined.--In this
subparagraph, the term `eligible professional organization'
means a professional organization as defined by nationally
recognized specialty boards of certification or equivalent
certification boards.
``(iii) Requirements.--In selecting quality measures for
inclusion in the annual final list under clause (i), the
Secretary shall--
``(I) provide that, to the extent practicable, all quality
domains (as defined in subsection (s)(1)(B)) are addressed by
such measures; and
``(II) ensure that such selection is consistent with the
process for selection of measures under subsections (k), (m),
and (p)(2).
``(iv) Peer review.--Before including a new measure in the
final list of measures published under clause (i) for a year,
the Secretary shall submit for publication in applicable
specialty-appropriate, peer-reviewed journals such measure
and the method for developing and selecting such measure,
including clinical and other data supporting such measure.
``(v) Measures for inclusion.--The final list of quality
measures published under clause (i) shall include, as
applicable, measures under subsections (k), (m), and (p)(2),
including quality measures from among--
``(I) measures endorsed by a consensus-based entity;
``(II) measures developed under subsection (s); and
``(III) measures submitted under clause (ii)(I).
Any measure selected for inclusion in such list that is not
endorsed by a consensus-based entity shall have a focus that
is evidence-based.
``(vi) Exception for qualified clinical data registry
measures.--Measures used by a qualified clinical data
registry under subsection (m)(3)(E) shall not be subject to
the requirements under clauses (i), (iv), and (v). The
Secretary shall publish the list of measures used by such
qualified clinical data registries on the Internet website of
the Centers for Medicare & Medicaid Services.
``(vii) Exception for existing quality measures.--Any
quality measure specified by the Secretary under subsection
(k) or (m), including under subsection (m)(3)(E), and any
measure of quality of care established under subsection
(p)(2) for the reporting period or performance period under
the respective subsection beginning before the first
performance period under the MIPS--
``(I) shall not be subject to the requirements under clause
(i) (except under items (aa) and (cc) of subclause (II) of
such clause) or to the requirement under clause (iv); and
``(II) shall be included in the final list of quality
measures published under clause (i) unless removed under
clause (i)(II)(aa).
``(viii) Consultation with relevant eligible professional
organizations and other relevant stakeholders.--Relevant
eligible professional organizations and other relevant
stakeholders, including State and national medical societies,
shall be consulted in carrying out this subparagraph.
``(ix) Optional application.--The process under section
1890A is not required to apply to the selection of measures
under this subparagraph.
``(3) Performance standards.--
``(A) Establishment.--Under the MIPS, the Secretary shall
establish performance standards with respect to measures and
activities specified under paragraph (2)(B) for a performance
period (as established under paragraph (4)) for a year.
``(B) Considerations in establishing standards.--In
establishing such performance standards with respect to
measures and activities specified under paragraph (2)(B), the
Secretary shall consider the following:
``(i) Historical performance standards.
``(ii) Improvement.
``(iii) The opportunity for continued improvement.
``(4) Performance period.--The Secretary shall establish a
performance period (or periods) for a year (beginning with
2019). Such performance period (or periods) shall begin and
end prior to the beginning of such year and be as close as
possible to such year. In this subsection, such performance
period (or periods) for a year shall be referred to as the
performance period for the year.
``(5) Composite performance score.--
``(A) In general.--Subject to the succeeding provisions of
this paragraph and taking into account, as available and
applicable, paragraph (1)(G), the Secretary shall develop a
methodology for assessing the total performance of each MIPS
eligible professional according to performance standards
under paragraph (3) with respect to applicable measures and
activities specified in paragraph (2)(B) with respect to each
performance category applicable to such professional for a
performance period (as established under paragraph (4)) for a
year. Using such methodology, the Secretary shall provide for
a composite assessment (using a scoring scale of 0 to 100)
for each such professional for the performance period for
such year. In this subsection such a composite assessment for
such a professional with respect to a performance period
shall be referred to as the `composite performance score' for
such professional for such performance period.
``(B) Incentive to report; encouraging use of certified ehr
technology for reporting quality measures.--
``(i) Incentive to report.--Under the methodology
established under subparagraph (A), the Secretary shall
provide that in the case of a MIPS eligible professional who
fails to report on an applicable measure or activity that is
required to be reported by the professional, the professional
shall be treated as achieving the lowest potential score
applicable to such measure or activity.
``(ii) Encouraging use of certified ehr technology and
qualified clinical data registries for reporting quality
measures.--Under the methodology established under
subparagraph (A), the Secretary shall--
``(I) encourage MIPS eligible professionals to report on
applicable measures with respect to the performance category
described in paragraph (2)(A)(i) through the use of certified
EHR technology and qualified clinical data registries; and
[[Page H2050]]
``(II) with respect to a performance period, with respect
to a year, for which a MIPS eligible professional reports
such measures through the use of such EHR technology, treat
such professional as satisfying the clinical quality measures
reporting requirement described in subsection (o)(2)(A)(iii)
for such year.
``(C) Clinical practice improvement activities performance
score.--
``(i) Rule for certification.--A MIPS eligible professional
who is in a practice that is certified as a patient-centered
medical home or comparable specialty practice, as determined
by the Secretary, with respect to a performance period shall
be given the highest potential score for the performance
category described in paragraph (2)(A)(iii) for such period.
``(ii) APM participation.--Participation by a MIPS eligible
professional in an alternative payment model (as defined in
section 1833(z)(3)(C)) with respect to a performance period
shall earn such eligible professional a minimum score of one-
half of the highest potential score for the performance
category described in paragraph (2)(A)(iii) for such
performance period.
``(iii) Subcategories.--A MIPS eligible professional shall
not be required to perform activities in each subcategory
under paragraph (2)(B)(iii) or participate in an alternative
payment model in order to achieve the highest potential score
for the performance category described in paragraph
(2)(A)(iii).
``(D) Achievement and improvement.--
``(i) Taking into account improvement.--Beginning with the
second year to which the MIPS applies, in addition to the
achievement of a MIPS eligible professional, if data
sufficient to measure improvement is available, the
methodology developed under subparagraph (A)--
``(I) in the case of the performance score for the
performance category described in clauses (i) and (ii) of
paragraph (2)(A), shall take into account the improvement of
the professional; and
``(II) in the case of performance scores for other
performance categories, may take into account the improvement
of the professional.
``(ii) Assigning higher weight for achievement.--Subject to
clause (i), under the methodology developed under
subparagraph (A), the Secretary may assign a higher scoring
weight under subparagraph (F) with respect to the achievement
of a MIPS eligible professional than with respect to any
improvement of such professional applied under clause (i)
with respect to a measure, activity, or category described in
paragraph (2).
``(E) Weights for the performance categories.--
``(i) In general.--Under the methodology developed under
subparagraph (A), subject to subparagraph (F)(i) and clause
(ii), the composite performance score shall be determined as
follows:
``(I) Quality.--
``(aa) In general.--Subject to item (bb), thirty percent of
such score shall be based on performance with respect to the
category described in clause (i) of paragraph (2)(A). In
applying the previous sentence, the Secretary shall, as
feasible, encourage the application of outcome measures
within such category.
``(bb) First 2 years.--For the first and second years for
which the MIPS applies to payments, the percentage applicable
under item (aa) shall be increased in a manner such that the
total percentage points of the increase under this item for
the respective year equals the total number of percentage
points by which the percentage applied under subclause
(II)(bb) for the respective year is less than 30 percent.
``(II) Resource use.--
``(aa) In general.--Subject to item (bb), thirty percent of
such score shall be based on performance with respect to the
category described in clause (ii) of paragraph (2)(A).
``(bb) First 2 years.--For the first year for which the
MIPS applies to payments, not more than 10 percent of such
score shall be based on performance with respect to the
category described in clause (ii) of paragraph (2)(A). For
the second year for which the MIPS applies to payments, not
more than 15 percent of such score shall be based on
performance with respect to the category described in clause
(ii) of paragraph (2)(A).
``(III) Clinical practice improvement activities.--Fifteen
percent of such score shall be based on performance with
respect to the category described in clause (iii) of
paragraph (2)(A).
``(IV) Meaningful use of certified ehr technology.--Twenty-
five percent of such score shall be based on performance with
respect to the category described in clause (iv) of paragraph
(2)(A).
``(ii) Authority to adjust percentages in case of high ehr
meaningful use adoption.--In any year in which the Secretary
estimates that the proportion of eligible professionals (as
defined in subsection (o)(5)) who are meaningful EHR users
(as determined under subsection (o)(2)) is 75 percent or
greater, the Secretary may reduce the percent applicable
under clause (i)(IV), but not below 15 percent. If the
Secretary makes such reduction for a year, subject to
subclauses (I)(bb) and (II)(bb) of clause (i), the
percentages applicable under one or more of subclauses (I),
(II), and (III) of clause (i) for such year shall be
increased in a manner such that the total percentage points
of the increase under this clause for such year equals the
total number of percentage points reduced under the preceding
sentence for such year.
``(F) Certain flexibility for weighting performance
categories, measures, and activities.--Under the methodology
under subparagraph (A), if there are not sufficient measures
and activities (described in paragraph (2)(B)) applicable and
available to each type of eligible professional involved, the
Secretary shall assign different scoring weights (including a
weight of 0)--
``(i) which may vary from the scoring weights specified in
subparagraph (E), for each performance category based on the
extent to which the category is applicable to the type of
eligible professional involved; and
``(ii) for each measure and activity specified under
paragraph (2)(B) with respect to each such category based on
the extent to which the measure or activity is applicable and
available to the type of eligible professional involved.
``(G) Resource use.--Analysis of the performance category
described in paragraph (2)(A)(ii) shall include results from
the methodology described in subsection (r)(5), as
appropriate.
``(H) Inclusion of quality measure data from other
payers.--In applying subsections (k), (m), and (p) with
respect to measures described in paragraph (2)(B)(i),
analysis of the performance category described in paragraph
(2)(A)(i) may include data submitted by MIPS eligible
professionals with respect to items and services furnished to
individuals who are not individuals entitled to benefits
under part A or enrolled under part B.
``(I) Use of voluntary virtual groups for certain
assessment purposes.--
``(i) In general.--In the case of MIPS eligible
professionals electing to be a virtual group under clause
(ii) with respect to a performance period for a year, for
purposes of applying the methodology under subparagraph (A)
with respect to the performance categories described in
clauses (i) and (ii) of paragraph (2)(A)--
``(I) the assessment of performance provided under such
methodology with respect to such performance categories that
is to be applied to each such professional in such group for
such performance period shall be with respect to the combined
performance of all such professionals in such group for such
period; and
``(II) with respect to the composite performance score
provided under this paragraph for such performance period for
each such MIPS eligible professional in such virtual group,
the components of the composite performance score that assess
performance with respect to such performance categories shall
be based on the assessment of the combined performance under
subclause (I) for such performance categories and performance
period.
``(ii) Election of practices to be a virtual group.--The
Secretary shall, in accordance with the requirements under
clause (iii), establish and have in place a process to allow
an individual MIPS eligible professional or a group practice
consisting of not more than 10 MIPS eligible professionals to
elect, with respect to a performance period for a year to be
a virtual group under this subparagraph with at least one
other such individual MIPS eligible professional or group
practice. Such a virtual group may be based on appropriate
classifications of providers, such as by geographic areas or
by provider specialties defined by nationally recognized
specialty boards of certification or equivalent certification
boards.
``(iii) Requirements.--The requirements for the process
under clause (ii) shall--
``(I) provide that an election under such clause, with
respect to a performance period, shall be made before the
beginning of such performance period and may not be changed
during such performance period;
``(II) provide that an individual MIPS eligible
professional and a group practice described in clause (ii)
may elect to be in no more than one virtual group for a
performance period and that, in the case of such a group
practice that elects to be in such virtual group for such
performance period, such election applies to all MIPS
eligible professionals in such group practice;
``(III) provide that a virtual group be a combination of
tax identification numbers;
``(IV) provide for formal written agreements among MIPS
eligible professionals electing to be a virtual group under
this subparagraph; and
``(V) include such other requirements as the Secretary
determines appropriate.
``(6) MIPS payments.--
``(A) MIPS adjustment factor.--Taking into account
paragraph (1)(G), the Secretary shall specify a MIPS
adjustment factor for each MIPS eligible professional for a
year. Such MIPS adjustment factor for a MIPS eligible
professional for a year shall be in the form of a percent and
shall be determined--
``(i) by comparing the composite performance score of the
eligible professional for such year to the performance
threshold established under subparagraph (D)(i) for such
year;
``(ii) in a manner such that the adjustment factors
specified under this subparagraph for a year result in
differential payments under this paragraph reflecting that--
``(I) MIPS eligible professionals with composite
performance scores for such year at or above such performance
threshold for such year receive zero or positive payment
adjustment factors for such year in accordance
[[Page H2051]]
with clause (iii), with such professionals having higher
composite performance scores receiving higher adjustment
factors; and
``(II) MIPS eligible professionals with composite
performance scores for such year below such performance
threshold for such year receive negative payment adjustment
factors for such year in accordance with clause (iv), with
such professionals having lower composite performance scores
receiving lower adjustment factors;
``(iii) in a manner such that MIPS eligible professionals
with composite scores described in clause (ii)(I) for such
year, subject to clauses (i) and (ii) of subparagraph (F),
receive a zero or positive adjustment factor on a linear
sliding scale such that an adjustment factor of 0 percent is
assigned for a score at the performance threshold and an
adjustment factor of the applicable percent specified in
subparagraph (B) is assigned for a score of 100; and
``(iv) in a manner such that--
``(I) subject to subclause (II), MIPS eligible
professionals with composite performance scores described in
clause (ii)(II) for such year receive a negative payment
adjustment factor on a linear sliding scale such that an
adjustment factor of 0 percent is assigned for a score at the
performance threshold and an adjustment factor of the
negative of the applicable percent specified in subparagraph
(B) is assigned for a score of 0; and
``(II) MIPS eligible professionals with composite
performance scores that are equal to or greater than 0, but
not greater than \1/4\ of the performance threshold specified
under subparagraph (D)(i) for such year, receive a negative
payment adjustment factor that is equal to the negative of
the applicable percent specified in subparagraph (B) for such
year.
``(B) Applicable percent defined.--For purposes of this
paragraph, the term `applicable percent' means--
``(i) for 2019, 4 percent;
``(ii) for 2020, 5 percent;
``(iii) for 2021, 7 percent; and
``(iv) for 2022 and subsequent years, 9 percent.
``(C) Additional mips adjustment factors for exceptional
performance.--For 2019 and each subsequent year through 2024,
in the case of a MIPS eligible professional with a composite
performance score for a year at or above the additional
performance threshold under subparagraph (D)(ii) for such
year, in addition to the MIPS adjustment factor under
subparagraph (A) for the eligible professional for such year,
subject to subparagraph (F)(iv), the Secretary shall specify
an additional positive MIPS adjustment factor for such
professional and year. Such additional MIPS adjustment
factors shall be in the form of a percent and determined by
the Secretary in a manner such that professionals having
higher composite performance scores above the additional
performance threshold receive higher additional MIPS
adjustment factors.
``(D) Establishment of performance thresholds.--
``(i) Performance threshold.--For each year of the MIPS,
the Secretary shall compute a performance threshold with
respect to which the composite performance score of MIPS
eligible professionals shall be compared for purposes of
determining adjustment factors under subparagraph (A) that
are positive, negative, and zero. Such performance threshold
for a year shall be the mean or median (as selected by the
Secretary) of the composite performance scores for all MIPS
eligible professionals with respect to a prior period
specified by the Secretary. The Secretary may reassess the
selection of the mean or median under the previous sentence
every 3 years.
``(ii) Additional performance threshold for exceptional
performance.--In addition to the performance threshold under
clause (i), for each year of the MIPS, the Secretary shall
compute an additional performance threshold for purposes of
determining the additional MIPS adjustment factors under
subparagraph (C). For each such year, the Secretary shall
apply either of the following methods for computing such
additional performance threshold for such a year:
``(I) The threshold shall be the score that is equal to the
25th percentile of the range of possible composite
performance scores above the performance threshold determined
under clause (i).
``(II) The threshold shall be the score that is equal to
the 25th percentile of the actual composite performance
scores for MIPS eligible professionals with composite
performance scores at or above the performance threshold with
respect to the prior period described in clause (i).
``(iii) Special rule for initial 2 years.--With respect to
each of the first two years to which the MIPS applies, the
Secretary shall, prior to the performance period for such
years, establish a performance threshold for purposes of
determining MIPS adjustment factors under subparagraph (A)
and a threshold for purposes of determining additional MIPS
adjustment factors under subparagraph (C). Each such
performance threshold shall--
``(I) be based on a period prior to such performance
periods; and
``(II) take into account--
``(aa) data available with respect to performance on
measures and activities that may be used under the
performance categories under subparagraph (2)(B); and
``(bb) other factors determined appropriate by the
Secretary.
``(E) Application of mips adjustment factors.--In the case
of items and services furnished by a MIPS eligible
professional during a year (beginning with 2019), the amount
otherwise paid under this part with respect to such items and
services and MIPS eligible professional for such year, shall
be multiplied by--
``(i) 1, plus
``(ii) the sum of--
``(I) the MIPS adjustment factor determined under
subparagraph (A) divided by 100, and
``(II) as applicable, the additional MIPS adjustment factor
determined under subparagraph (C) divided by 100.
``(F) Aggregate application of mips adjustment factors.--
``(i) Application of scaling factor.--
``(I) In general.--With respect to positive MIPS adjustment
factors under subparagraph (A)(ii)(I) for eligible
professionals whose composite performance score is above the
performance threshold under subparagraph (D)(i) for such
year, subject to subclause (II), the Secretary shall increase
or decrease such adjustment factors by a scaling factor in
order to ensure that the budget neutrality requirement of
clause (ii) is met.
``(II) Scaling factor limit.--In no case may the scaling
factor applied under this clause exceed 3.0.
``(ii) Budget neutrality requirement.--
``(I) In general.--Subject to clause (iii), the Secretary
shall ensure that the estimated amount described in subclause
(II) for a year is equal to the estimated amount described in
subclause (III) for such year.
``(II) Aggregate increases.--The amount described in this
subclause is the estimated increase in the aggregate allowed
charges resulting from the application of positive MIPS
adjustment factors under subparagraph (A) (after application
of the scaling factor described in clause (i)) to MIPS
eligible professionals whose composite performance score for
a year is above the performance threshold under subparagraph
(D)(i) for such year.
``(III) Aggregate decreases.--The amount described in this
subclause is the estimated decrease in the aggregate allowed
charges resulting from the application of negative MIPS
adjustment factors under subparagraph (A) to MIPS eligible
professionals whose composite performance score for a year is
below the performance threshold under subparagraph (D)(i) for
such year.
``(iii) Exceptions.--
``(I) In the case that all MIPS eligible professionals
receive composite performance scores for a year that are
below the performance threshold under subparagraph (D)(i) for
such year, the negative MIPS adjustment factors under
subparagraph (A) shall apply with respect to such MIPS
eligible professionals and the budget neutrality requirement
of clause (ii) and the additional adjustment factors under
clause (iv) shall not apply for such year.
``(II) In the case that, with respect to a year, the
application of clause (i) results in a scaling factor equal
to the maximum scaling factor specified in clause (i)(II),
such scaling factor shall apply and the budget neutrality
requirement of clause (ii) shall not apply for such year.
``(iv) Additional incentive payment adjustments.--
``(I) In general.--Subject to subclause (II), in specifying
the MIPS additional adjustment factors under subparagraph (C)
for each applicable MIPS eligible professional for a year,
the Secretary shall ensure that the estimated aggregate
increase in payments under this part resulting from the
application of such additional adjustment factors for MIPS
eligible professionals in a year shall be equal (as estimated
by the Secretary) to $500,000,000 for each year beginning
with 2019 and ending with 2024.
``(II) Limitation on additional incentive payment
adjustments.--The MIPS additional adjustment factor under
subparagraph (C) for a year for an applicable MIPS eligible
professional whose composite performance score is above the
additional performance threshold under subparagraph (D)(ii)
for such year shall not exceed 10 percent. The application of
the previous sentence may result in an aggregate amount of
additional incentive payments that are less than the amount
specified in subclause (I).
``(7) Announcement of result of adjustments.--Under the
MIPS, the Secretary shall, not later than 30 days prior to
January 1 of the year involved, make available to MIPS
eligible professionals the MIPS adjustment factor (and, as
applicable, the additional MIPS adjustment factor) under
paragraph (6) applicable to the eligible professional for
items and services furnished by the professional for such
year. The Secretary may include such information in the
confidential feedback under paragraph (12).
``(8) No effect in subsequent years.--The MIPS adjustment
factors and additional MIPS adjustment factors under
paragraph (6) shall apply only with respect to the year
involved, and the Secretary shall not take into account such
adjustment factors in making payments to a MIPS eligible
professional under this part in a subsequent year.
``(9) Public reporting.--
``(A) In general.--The Secretary shall, in an easily
understandable format, make available on the Physician
Compare Internet website of the Centers for Medicare &
Medicaid Services the following:
``(i) Information regarding the performance of MIPS
eligible professionals under the MIPS, which--
[[Page H2052]]
``(I) shall include the composite score for each such MIPS
eligible professional and the performance of each such MIPS
eligible professional with respect to each performance
category; and
``(II) may include the performance of each such MIPS
eligible professional with respect to each measure or
activity specified in paragraph (2)(B).
``(ii) The names of eligible professionals in eligible
alternative payment models (as defined in section
1833(z)(3)(D)) and, to the extent feasible, the names of such
eligible alternative payment models and performance of such
models.
``(B) Disclosure.--The information made available under
this paragraph shall indicate, where appropriate, that
publicized information may not be representative of the
eligible professional's entire patient population, the
variety of services furnished by the eligible professional,
or the health conditions of individuals treated.
``(C) Opportunity to review and submit corrections.--The
Secretary shall provide for an opportunity for a professional
described in subparagraph (A) to review, and submit
corrections for, the information to be made public with
respect to the professional under such subparagraph prior to
such information being made public.
``(D) Aggregate information.--The Secretary shall
periodically post on the Physician Compare Internet website
aggregate information on the MIPS, including the range of
composite scores for all MIPS eligible professionals and the
range of the performance of all MIPS eligible professionals
with respect to each performance category.
``(10) Consultation.--The Secretary shall consult with
stakeholders in carrying out the MIPS, including for the
identification of measures and activities under paragraph
(2)(B) and the methodologies developed under paragraphs
(5)(A) and (6) and regarding the use of qualified clinical
data registries. Such consultation shall include the use of a
request for information or other mechanisms determined
appropriate.
``(11) Technical assistance to small practices and
practices in health professional shortage areas.--
``(A) In general.--The Secretary shall enter into contracts
or agreements with appropriate entities (such as quality
improvement organizations, regional extension centers (as
described in section 3012(c) of the Public Health Service
Act), or regional health collaboratives) to offer guidance
and assistance to MIPS eligible professionals in practices of
15 or fewer professionals (with priority given to such
practices located in rural areas, health professional
shortage areas (as designated under in section 332(a)(1)(A)
of such Act), and medically underserved areas, and practices
with low composite scores) with respect to--
``(i) the performance categories described in clauses (i)
through (iv) of paragraph (2)(A); or
``(ii) how to transition to the implementation of and
participation in an alternative payment model as described in
section 1833(z)(3)(C).
``(B) Funding for technical assistance.--For purposes of
implementing subparagraph (A), the Secretary shall provide
for the transfer from the Federal Supplementary Medical
Insurance Trust Fund established under section 1841 to the
Centers for Medicare & Medicaid Services Program Management
Account of $20,000,000 for each of fiscal years 2016 through
2020. Amounts transferred under this subparagraph for a
fiscal year shall be available until expended.
``(12) Feedback and information to improve performance.--
``(A) Performance feedback.--
``(i) In general.--Beginning July 1, 2017, the Secretary--
``(I) shall make available timely (such as quarterly)
confidential feedback to MIPS eligible professionals on the
performance of such professionals with respect to the
performance categories under clauses (i) and (ii) of
paragraph (2)(A); and
``(II) may make available confidential feedback to such
professionals on the performance of such professionals with
respect to the performance categories under clauses (iii) and
(iv) of such paragraph.
``(ii) Mechanisms.--The Secretary may use one or more
mechanisms to make feedback available under clause (i), which
may include use of a web-based portal or other mechanisms
determined appropriate by the Secretary. With respect to the
performance category described in paragraph (2)(A)(i),
feedback under this subparagraph shall, to the extent an
eligible professional chooses to participate in a data
registry for purposes of this subsection (including
registries under subsections (k) and (m)), be provided based
on performance on quality measures reported through the use
of such registries. With respect to any other performance
category described in paragraph (2)(A), the Secretary shall
encourage provision of feedback through qualified clinical
data registries as described in subsection (m)(3)(E)).
``(iii) Use of data.--For purposes of clause (i), the
Secretary may use data, with respect to a MIPS eligible
professional, from periods prior to the current performance
period and may use rolling periods in order to make
illustrative calculations about the performance of such
professional.
``(iv) Disclosure exemption.--Feedback made available under
this subparagraph shall be exempt from disclosure under
section 552 of title 5, United States Code.
``(v) Receipt of information.--The Secretary may use the
mechanisms established under clause (ii) to receive
information from professionals, such as information with
respect to this subsection.
``(B) Additional information.--
``(i) In general.--Beginning July 1, 2018, the Secretary
shall make available to MIPS eligible professionals
information, with respect to individuals who are patients of
such MIPS eligible professionals, about items and services
for which payment is made under this title that are furnished
to such individuals by other suppliers and providers of
services, which may include information described in clause
(ii). Such information may be made available under the
previous sentence to such MIPS eligible professionals by
mechanisms determined appropriate by the Secretary, which may
include use of a web-based portal. Such information may be
made available in accordance with the same or similar terms
as data are made available to accountable care organizations
participating in the shared savings program under section
1899.
``(ii) Type of information.--For purposes of clause (i),
the information described in this clause, is the following:
``(I) With respect to selected items and services (as
determined appropriate by the Secretary) for which payment is
made under this title and that are furnished to individuals,
who are patients of a MIPS eligible professional, by another
supplier or provider of services during the most recent
period for which data are available (such as the most recent
three-month period), such as the name of such providers
furnishing such items and services to such patients during
such period, the types of such items and services so
furnished, and the dates such items and services were so
furnished.
``(II) Historical data, such as averages and other measures
of the distribution if appropriate, of the total, and
components of, allowed charges (and other figures as
determined appropriate by the Secretary).
``(13) Review.--
``(A) Targeted review.--The Secretary shall establish a
process under which a MIPS eligible professional may seek an
informal review of the calculation of the MIPS adjustment
factor (or factors) applicable to such eligible professional
under this subsection for a year. The results of a review
conducted pursuant to the previous sentence shall not be
taken into account for purposes of paragraph (6) with respect
to a year (other than with respect to the calculation of such
eligible professional's MIPS adjustment factor for such year
or additional MIPS adjustment factor for such year) after the
factors determined in subparagraph (A) and subparagraph (C)
of such paragraph have been determined for such year.
``(B) Limitation.--Except as provided for in subparagraph
(A), there shall be no administrative or judicial review
under section 1869, section 1878, or otherwise of the
following:
``(i) The methodology used to determine the amount of the
MIPS adjustment factor under paragraph (6)(A) and the amount
of the additional MIPS adjustment factor under paragraph
(6)(C) and the determination of such amounts.
``(ii) The establishment of the performance standards under
paragraph (3) and the performance period under paragraph (4).
``(iii) The identification of measures and activities
specified under paragraph (2)(B) and information made public
or posted on the Physician Compare Internet website of the
Centers for Medicare & Medicaid Services under paragraph (9).
``(iv) The methodology developed under paragraph (5) that
is used to calculate performance scores and the calculation
of such scores, including the weighting of measures and
activities under such methodology.''.
(2) GAO reports.--
(A) Evaluation of eligible professional mips.--Not later
than October 1, 2021, the Comptroller General of the United
States shall submit to Congress a report evaluating the
eligible professional Merit-based Incentive Payment System
under subsection (q) of section 1848 of the Social Security
Act (42 U.S.C. 1395w-4), as added by paragraph (1). Such
report shall--
(i) examine the distribution of the composite performance
scores and MIPS adjustment factors (and additional MIPS
adjustment factors) for MIPS eligible professionals (as
defined in subsection (q)(1)(c) of such section) under such
program, and patterns relating to such scores and adjustment
factors, including based on type of provider, practice size,
geographic location, and patient mix;
(ii) provide recommendations for improving such program;
(iii) evaluate the impact of technical assistance funding
under section 1848(q)(11) of the Social Security Act, as
added by paragraph (1), on the ability of professionals to
improve within such program or successfully transition to an
alternative payment model (as defined in section 1833(z)(3)
of the Social Security Act, as added by subsection (e)), with
priority for such evaluation given to practices located in
rural areas, health professional shortage areas (as
designated in section 332(a)(1)(A) of the Public Health
Service Act), and medically underserved areas; and
(iv) provide recommendations for optimizing the use of such
technical assistance funds.
(B) Study to examine alignment of quality measures used in
public and private programs.--
(i) In general.--Not later than 18 months after the date of
the enactment of this Act,
[[Page H2053]]
the Comptroller General of the United States shall submit to
Congress a report that--
(I) compares the similarities and differences in the use of
quality measures under the original Medicare fee-for-service
program under parts A and B of title XVIII of the Social
Security Act, the Medicare Advantage program under part C of
such title, selected State Medicaid programs under title XIX
of such Act, and private payer arrangements; and
(II) makes recommendations on how to reduce the
administrative burden involved in applying such quality
measures.
(ii) Requirements.--The report under clause (i) shall--
(I) consider those measures applicable to individuals
entitled to, or enrolled for, benefits under such part A, or
enrolled under such part B and individuals under the age of
65; and
(II) focus on those measures that comprise the most
significant component of the quality performance category of
the eligible professional MIPS incentive program under
subsection (q) of section 1848 of the Social Security Act (42
U.S.C. 1395w-4), as added by paragraph (1).
(C) Study on role of independent risk managers.--Not later
than January 1, 2017, the Comptroller General of the United
States shall submit to Congress a report examining whether
entities that pool financial risk for physician practices,
such as independent risk managers, can play a role in
supporting physician practices, particularly small physician
practices, in assuming financial risk for the treatment of
patients. Such report shall examine barriers that small
physician practices currently face in assuming financial risk
for treating patients, the types of risk management entities
that could assist physician practices in participating in
two-sided risk payment models, and how such entities could
assist with risk management and with quality improvement
activities. Such report shall also include an analysis of any
existing legal barriers to such arrangements.
(D) Study to examine rural and health professional shortage
area alternative payment models.--Not later than October 1,
2021, the Comptroller General of the United States shall
submit to Congress a report that examines the transition of
professionals in rural areas, health professional shortage
areas (as designated in section 332(a)(1)(A) of the Public
Health Service Act), or medically underserved areas to an
alternative payment model (as defined in section 1833(z)(3)
of the Social Security Act, as added by subsection (e)). Such
report shall make recommendations for removing administrative
barriers to practices, including small practices consisting
of 15 or fewer professionals, in rural areas, health
professional shortage areas, and medically underserved areas
to participation in such models.
(3) Funding for implementation.--For purposes of
implementing the provisions of and the amendments made by
this section, the Secretary of Health and Human Services
shall provide for the transfer of $80,000,000 from the
Supplementary Medical Insurance Trust Fund established under
section 1841 of the Social Security Act (42 U.S.C. 1395t) to
the Centers for Medicare & Medicaid Program Management
Account for each of the fiscal years 2015 through 2019.
Amounts transferred under this paragraph shall be available
until expended.
(d) Improving Quality Reporting for Composite Scores.--
(1) Changes for group reporting option.--
(A) In general.--Section 1848(m)(3)(C)(ii) of the Social
Security Act (42 U.S.C. 1395w-4(m)(3)(C)(ii)) is amended by
inserting ``and, for 2016 and subsequent years, may provide''
after ``shall provide''.
(B) Clarification of qualified clinical data registry
reporting to group practices.--Section 1848(m)(3)(D) of the
Social Security Act (42 U.S.C. 1395w-4(m)(3)(D)) is amended
by inserting ``and, for 2016 and subsequent years,
subparagraph (A) or (C)'' after ``subparagraph (A)''.
(2) Changes for multiple reporting periods and alternative
criteria for satisfactory reporting.--Section 1848(m)(5)(F)
of the Social Security Act (42 U.S.C. 1395w-4(m)(5)(F)) is
amended--
(A) by striking ``and subsequent years'' and inserting
``through reporting periods occurring in 2015''; and
(B) by inserting ``and, for reporting periods occurring in
2016 and subsequent years, the Secretary may establish''
after ``shall establish''.
(3) Physician feedback program reports succeeded by reports
under mips.--Section 1848(n) of the Social Security Act (42
U.S.C. 1395w-4(n)) is amended by adding at the end the
following new paragraph:
``(11) Reports ending with 2017.--Reports under the Program
shall not be provided after December 31, 2017. See subsection
(q)(12) for reports under the eligible professionals Merit-
based Incentive Payment System.''.
(4) Coordination with satisfying meaningful ehr use
clinical quality measure reporting requirement.--Section
1848(o)(2)(A)(iii) of the Social Security Act (42 U.S.C.
1395w-4(o)(2)(A)(iii)) is amended by inserting ``and
subsection (q)(5)(B)(ii)(II)'' after ``Subject to
subparagraph (B)(ii)''.
(e) Promoting Alternative Payment Models.--
(1) Increasing transparency of physician-focused payment
models.--Section 1868 of the Social Security Act (42 U.S.C.
1395ee) is amended by adding at the end the following new
subsection:
``(c) Physician-Focused Payment Models.--
``(1) Technical advisory committee.--
``(A) Establishment.--There is established an ad hoc
committee to be known as the `Physician-Focused Payment Model
Technical Advisory Committee' (referred to in this subsection
as the `Committee').
``(B) Membership.--
``(i) Number and appointment.--The Committee shall be
composed of 11 members appointed by the Comptroller General
of the United States.
``(ii) Qualifications.--The membership of the Committee
shall include individuals with national recognition for their
expertise in physician-focused payment models and related
delivery of care. No more than 5 members of the Committee
shall be providers of services or suppliers, or
representatives of providers of services or suppliers.
``(iii) Prohibition on federal employment.--A member of the
Committee shall not be an employee of the Federal Government.
``(iv) Ethics disclosure.--The Comptroller General shall
establish a system for public disclosure by members of the
Committee of financial and other potential conflicts of
interest relating to such members. Members of the Committee
shall be treated as employees of Congress for purposes of
applying title I of the Ethics in Government Act of 1978
(Public Law 95-521).
``(v) Date of initial appointments.--The initial
appointments of members of the Committee shall be made by not
later than 180 days after the date of enactment of this
subsection.
``(C) Term; vacancies.--
``(i) Term.--The terms of members of the Committee shall be
for 3 years except that the Comptroller General shall
designate staggered terms for the members first appointed.
``(ii) Vacancies.--Any member appointed to fill a vacancy
occurring before the expiration of the term for which the
member's predecessor was appointed shall be appointed only
for the remainder of that term. A member may serve after the
expiration of that member's term until a successor has taken
office. A vacancy in the Committee shall be filled in the
manner in which the original appointment was made.
``(D) Duties.--The Committee shall meet, as needed, to
provide comments and recommendations to the Secretary, as
described in paragraph (2)(C), on physician-focused payment
models.
``(E) Compensation of members.--
``(i) In general.--Except as provided in clause (ii), a
member of the Committee shall serve without compensation.
``(ii) Travel expenses.--A member of the Committee shall be
allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for an employee of an agency
under subchapter I of chapter 57 of title 5, United States
Code, while away from the home or regular place of business
of the member in the performance of the duties of the
Committee.
``(F) Operational and technical support.--
``(i) In general.--The Assistant Secretary for Planning and
Evaluation shall provide technical and operational support
for the Committee, which may be by use of a contractor. The
Office of the Actuary of the Centers for Medicare & Medicaid
Services shall provide to the Committee actuarial assistance
as needed.
``(ii) Funding.--The Secretary shall provide for the
transfer, from the Federal Supplementary Medical Insurance
Trust Fund under section 1841, such amounts as are necessary
to carry out this paragraph (not to exceed $5,000,000) for
fiscal year 2015 and each subsequent fiscal year. Any amounts
transferred under the preceding sentence for a fiscal year
shall remain available until expended.
``(G) Application.--Section 14 of the Federal Advisory
Committee Act (5 U.S.C. App.) shall not apply to the
Committee.
``(2) Criteria and process for submission and review of
physician-focused payment models.--
``(A) Criteria for assessing physician-focused payment
models.--
``(i) Rulemaking.--Not later than November 1, 2016, the
Secretary shall, through notice and comment rulemaking,
following a request for information, establish criteria for
physician-focused payment models, including models for
specialist physicians, that could be used by the Committee
for making comments and recommendations pursuant to paragraph
(1)(D).
``(ii) MedPAC submission of comments.--During the comment
period for the proposed rule described in clause (i), the
Medicare Payment Advisory Commission may submit comments to
the Secretary on the proposed criteria under such clause.
``(iii) Updating.--The Secretary may update the criteria
established under this subparagraph through rulemaking.
``(B) Stakeholder submission of physician-focused payment
models.--On an ongoing basis, individuals and stakeholder
entities may submit to the Committee proposals for physician-
focused payment models that such individuals and entities
believe meet the criteria described in subparagraph (A).
``(C) Committee review of models submitted.--The Committee
shall, on a periodic
[[Page H2054]]
basis, review models submitted under subparagraph (B),
prepare comments and recommendations regarding whether such
models meet the criteria described in subparagraph (A), and
submit such comments and recommendations to the Secretary.
``(D) Secretary review and response.--The Secretary shall
review the comments and recommendations submitted by the
Committee under subparagraph (C) and post a detailed response
to such comments and recommendations on the Internet website
of the Centers for Medicare & Medicaid Services.
``(3) Rule of construction.--Nothing in this subsection
shall be construed to impact the development or testing of
models under this title or titles XI, XIX, or XXI.''.
(2) Incentive payments for participation in eligible
alternative payment models.--Section 1833 of the Social
Security Act (42 U.S.C. 1395l) is amended by adding at the
end the following new subsection:
``(z) Incentive Payments for Participation in Eligible
Alternative Payment Models.--
``(1) Payment incentive.--
``(A) In general.--In the case of covered professional
services furnished by an eligible professional during a year
that is in the period beginning with 2019 and ending with
2024 and for which the professional is a qualifying APM
participant with respect to such year, in addition to the
amount of payment that would otherwise be made for such
covered professional services under this part for such year,
there also shall be paid to such professional an amount equal
to 5 percent of the estimated aggregate payment amounts for
such covered professional services under this part for the
preceding year. For purposes of the previous sentence, the
payment amount for the preceding year may be an estimation
for the full preceding year based on a period of such
preceding year that is less than the full year. The Secretary
shall establish policies to implement this subparagraph in
cases in which payment for covered professional services
furnished by a qualifying APM participant in an alternative
payment model--
``(i) is made to an eligible alternative payment entity
rather than directly to the qualifying APM participant; or
``(ii) is made on a basis other than a fee-for-service
basis (such as payment on a capitated basis).
``(B) Form of payment.--Payments under this subsection
shall be made in a lump sum, on an annual basis, as soon as
practicable.
``(C) Treatment of payment incentive.--Payments under this
subsection shall not be taken into account for purposes of
determining actual expenditures under an alternative payment
model and for purposes of determining or rebasing any
benchmarks used under the alternative payment model.
``(D) Coordination.--The amount of the additional payment
under this subsection or subsection (m) shall be determined
without regard to any additional payment under subsection (m)
and this subsection, respectively. The amount of the
additional payment under this subsection or subsection (x)
shall be determined without regard to any additional payment
under subsection (x) and this subsection, respectively. The
amount of the additional payment under this subsection or
subsection (y) shall be determined without regard to any
additional payment under subsection (y) and this subsection,
respectively.
``(2) Qualifying apm participant.--For purposes of this
subsection, the term `qualifying APM participant' means the
following:
``(A) 2019 and 2020.--With respect to 2019 and 2020, an
eligible professional for whom the Secretary determines that
at least 25 percent of payments under this part for covered
professional services furnished by such professional during
the most recent period for which data are available (which
may be less than a year) were attributable to such services
furnished under this part through an eligible alternative
payment entity.
``(B) 2021 and 2022.--With respect to 2021 and 2022, an
eligible professional described in either of the following
clauses:
``(i) Medicare payment threshold option.--An eligible
professional for whom the Secretary determines that at least
50 percent of payments under this part for covered
professional services furnished by such professional during
the most recent period for which data are available (which
may be less than a year) were attributable to such services
furnished under this part through an eligible alternative
payment entity.
``(ii) Combination all-payer and medicare payment threshold
option.--An eligible professional--
``(I) for whom the Secretary determines, with respect to
items and services furnished by such professional during the
most recent period for which data are available (which may be
less than a year), that at least 50 percent of the sum of--
``(aa) payments described in clause (i); and
``(bb) all other payments, regardless of payer (other than
payments made by the Secretary of Defense or the Secretary of
Veterans Affairs and other than payments made under title XIX
in a State in which no medical home or alternative payment
model is available under the State program under that title),
meet the requirement described in clause (iii)(I) with
respect to payments described in item (aa) and meet the
requirement described in clause (iii)(II) with respect to
payments described in item (bb);
``(II) for whom the Secretary determines at least 25
percent of payments under this part for covered professional
services furnished by such professional during the most
recent period for which data are available (which may be less
than a year) were attributable to such services furnished
under this part through an eligible alternative payment
entity; and
``(III) who provides to the Secretary such information as
is necessary for the Secretary to make a determination under
subclause (I), with respect to such professional.
``(iii) Requirement.--For purposes of clause (ii)(I)--
``(I) the requirement described in this subclause, with
respect to payments described in item (aa) of such clause, is
that such payments are made to an eligible alternative
payment entity; and
``(II) the requirement described in this subclause, with
respect to payments described in item (bb) of such clause, is
that such payments are made under arrangements in which--
``(aa) quality measures comparable to measures under the
performance category described in section 1848(q)(2)(B)(i)
apply;
``(bb) certified EHR technology is used; and
``(cc) the eligible professional participates in an entity
that--
``(AA) bears more than nominal financial risk if actual
aggregate expenditures exceeds expected aggregate
expenditures; or
``(BB) with respect to beneficiaries under title XIX, is a
medical home that meets criteria comparable to medical homes
expanded under section 1115A(c).
``(C) Beginning in 2023.--With respect to 2023 and each
subsequent year, an eligible professional described in either
of the following clauses:
``(i) Medicare payment threshold option.--An eligible
professional for whom the Secretary determines that at least
75 percent of payments under this part for covered
professional services furnished by such professional during
the most recent period for which data are available (which
may be less than a year) were attributable to such services
furnished under this part through an eligible alternative
payment entity.
``(ii) Combination all-payer and medicare payment threshold
option.--An eligible professional--
``(I) for whom the Secretary determines, with respect to
items and services furnished by such professional during the
most recent period for which data are available (which may be
less than a year), that at least 75 percent of the sum of--
``(aa) payments described in clause (i); and
``(bb) all other payments, regardless of payer (other than
payments made by the Secretary of Defense or the Secretary of
Veterans Affairs and other than payments made under title XIX
in a State in which no medical home or alternative payment
model is available under the State program under that title),
meet the requirement described in clause (iii)(I) with
respect to payments described in item (aa) and meet the
requirement described in clause (iii)(II) with respect to
payments described in item (bb);
``(II) for whom the Secretary determines at least 25
percent of payments under this part for covered professional
services furnished by such professional during the most
recent period for which data are available (which may be less
than a year) were attributable to such services furnished
under this part through an eligible alternative payment
entity; and
``(III) who provides to the Secretary such information as
is necessary for the Secretary to make a determination under
subclause (I), with respect to such professional.
``(iii) Requirement.--For purposes of clause (ii)(I)--
``(I) the requirement described in this subclause, with
respect to payments described in item (aa) of such clause, is
that such payments are made to an eligible alternative
payment entity; and
``(II) the requirement described in this subclause, with
respect to payments described in item (bb) of such clause, is
that such payments are made under arrangements in which--
``(aa) quality measures comparable to measures under the
performance category described in section 1848(q)(2)(B)(i)
apply;
``(bb) certified EHR technology is used; and
``(cc) the eligible professional participates in an entity
that--
``(AA) bears more than nominal financial risk if actual
aggregate expenditures exceeds expected aggregate
expenditures; or
``(BB) with respect to beneficiaries under title XIX, is a
medical home that meets criteria comparable to medical homes
expanded under section 1115A(c).
``(D) Use of patient approach.--The Secretary may base the
determination of whether an eligible professional is a
qualifying APM participant under this subsection and the
determination of whether an eligible professional is a
partial qualifying APM participant under section
1848(q)(1)(C)(iii) by using counts of patients in lieu of
using payments and using the same or similar percentage
criteria (as specified in this subsection and such section,
respectively), as the Secretary determines appropriate.
``(3) Additional definitions.--In this subsection:
``(A) Covered professional services.--The term `covered
professional services' has the meaning given that term in
section 1848(k)(3)(A).
``(B) Eligible professional.--The term `eligible
professional' has the meaning given
[[Page H2055]]
that term in section 1848(k)(3)(B) and includes a group that
includes such professionals.
``(C) Alternative payment model (apm).--The term
`alternative payment model' means, other than for purposes of
subparagraphs (B)(ii)(I)(bb) and (C)(ii)(I)(bb) of paragraph
(2), any of the following:
``(i) A model under section 1115A (other than a health care
innovation award).
``(ii) The shared savings program under section 1899.
``(iii) A demonstration under section 1866C.
``(iv) A demonstration required by Federal law.
``(D) Eligible alternative payment entity.--The term
`eligible alternative payment entity' means, with respect to
a year, an entity that--
``(i) participates in an alternative payment model that--
``(I) requires participants in such model to use certified
EHR technology (as defined in subsection (o)(4)); and
``(II) provides for payment for covered professional
services based on quality measures comparable to measures
under the performance category described in section
1848(q)(2)(B)(i); and
``(ii)(I) bears financial risk for monetary losses under
such alternative payment model that are in excess of a
nominal amount; or
``(II) is a medical home expanded under section 1115A(c).
``(4) Limitation.--There shall be no administrative or
judicial review under section 1869, 1878, or otherwise, of
the following:
``(A) The determination that an eligible professional is a
qualifying APM participant under paragraph (2) and the
determination that an entity is an eligible alternative
payment entity under paragraph (3)(D).
``(B) The determination of the amount of the 5 percent
payment incentive under paragraph (1)(A), including any
estimation as part of such determination.''.
(3) Coordination conforming amendments.--Section 1833 of
the Social Security Act (42 U.S.C. 1395l) is further
amended--
(A) in subsection (x)(3), by adding at the end the
following new sentence: ``The amount of the additional
payment for a service under this subsection and subsection
(z) shall be determined without regard to any additional
payment for the service under subsection (z) and this
subsection, respectively.''; and
(B) in subsection (y)(3), by adding at the end the
following new sentence: ``The amount of the additional
payment for a service under this subsection and subsection
(z) shall be determined without regard to any additional
payment for the service under subsection (z) and this
subsection, respectively.''.
(4) Encouraging development and testing of certain
models.--Section 1115A(b)(2) of the Social Security Act (42
U.S.C. 1315a(b)(2)) is amended--
(A) in subparagraph (B), by adding at the end the following
new clauses:
``(xxi) Focusing primarily on physicians' services (as
defined in section 1848(j)(3)) furnished by physicians who
are not primary care practitioners.
``(xxii) Focusing on practices of 15 or fewer
professionals.
``(xxiii) Focusing on risk-based models for small physician
practices which may involve two-sided risk and prospective
patient assignment, and which examine risk-adjusted decreases
in mortality rates, hospital readmissions rates, and other
relevant and appropriate clinical measures.
``(xxiv) Focusing primarily on title XIX, working in
conjunction with the Center for Medicaid and CHIP
Services.''; and
(B) in subparagraph (C)(viii), by striking ``other public
sector or private sector payers'' and inserting ``other
public sector payers, private sector payers, or statewide
payment models''.
(5) Construction regarding telehealth services.--Nothing in
the provisions of, or amendments made by, this title shall be
construed as precluding an alternative payment model or a
qualifying APM participant (as those terms are defined in
section 1833(z) of the Social Security Act, as added by
paragraph (1)) from furnishing a telehealth service for which
payment is not made under section 1834(m) of the Social
Security Act (42 U.S.C. 1395m(m)).
(6) Integrating medicare advantage alternative payment
models.--Not later than July 1, 2016, the Secretary of Health
and Human Services shall submit to Congress a study that
examines the feasibility of integrating alternative payment
models in the Medicare Advantage payment system. The study
shall include the feasibility of including a value-based
modifier and whether such modifier should be budget neutral.
(7) Study and report on fraud related to alternative
payment models under the medicare program.--
(A) Study.--The Secretary of Health and Human Services, in
consultation with the Inspector General of the Department of
Health and Human Services, shall conduct a study that--
(i) examines the applicability of the Federal fraud
prevention laws to items and services furnished under title
XVIII of the Social Security Act for which payment is made
under an alternative payment model (as defined in section
1833(z)(3)(C) of such Act (42 U.S.C. 1395l(z)(3)(C)));
(ii) identifies aspects of such alternative payment models
that are vulnerable to fraudulent activity; and
(iii) examines the implications of waivers to such laws
granted in support of such alternative payment models,
including under any potential expansion of such models.
(B) Report.--Not later than 2 years after the date of the
enactment of this Act, the Secretary shall submit to Congress
a report containing the results of the study conducted under
subparagraph (A). Such report shall include recommendations
for actions to be taken to reduce the vulnerability of such
alternative payment models to fraudulent activity. Such
report also shall include, as appropriate, recommendations of
the Inspector General for changes in Federal fraud prevention
laws to reduce such vulnerability.
(f) Collaborating With the Physician, Practitioner, and
Other Stakeholder Communities To Improve Resource Use
Measurement.--Section 1848 of the Social Security Act (42
U.S.C. 1395w-4), as amended by subsection (c), is further
amended by adding at the end the following new subsection:
``(r) Collaborating With the Physician, Practitioner, and
Other Stakeholder Communities To Improve Resource Use
Measurement.--
``(1) In general.--In order to involve the physician,
practitioner, and other stakeholder communities in enhancing
the infrastructure for resource use measurement, including
for purposes of the Merit-based Incentive Payment System
under subsection (q) and alternative payment models under
section 1833(z), the Secretary shall undertake the steps
described in the succeeding provisions of this subsection.
``(2) Development of care episode and patient condition
groups and classification codes.--
``(A) In general.--In order to classify similar patients
into care episode groups and patient condition groups, the
Secretary shall undertake the steps described in the
succeeding provisions of this paragraph.
``(B) Public availability of existing efforts to design an
episode grouper.--Not later than 180 days after the date of
the enactment of this subsection, the Secretary shall post on
the Internet website of the Centers for Medicare & Medicaid
Services a list of the episode groups developed pursuant to
subsection (n)(9)(A) and related descriptive information.
``(C) Stakeholder input.--The Secretary shall accept,
through the date that is 120 days after the day the Secretary
posts the list pursuant to subparagraph (B), suggestions from
physician specialty societies, applicable practitioner
organizations, and other stakeholders for episode groups in
addition to those posted pursuant to such subparagraph, and
specific clinical criteria and patient characteristics to
classify patients into--
``(i) care episode groups; and
``(ii) patient condition groups.
``(D) Development of proposed classification codes.--
``(i) In general.--Taking into account the information
described in subparagraph (B) and the information received
under subparagraph (C), the Secretary shall--
``(I) establish care episode groups and patient condition
groups, which account for a target of an estimated \1/2\ of
expenditures under parts A and B (with such target increasing
over time as appropriate); and
``(II) assign codes to such groups.
``(ii) Care episode groups.--In establishing the care
episode groups under clause (i), the Secretary shall take
into account--
``(I) the patient's clinical problems at the time items and
services are furnished during an episode of care, such as the
clinical conditions or diagnoses, whether or not inpatient
hospitalization occurs, and the principal procedures or
services furnished; and
``(II) other factors determined appropriate by the
Secretary.
``(iii) Patient condition groups.--In establishing the
patient condition groups under clause (i), the Secretary
shall take into account--
``(I) the patient's clinical history at the time of a
medical visit, such as the patient's combination of chronic
conditions, current health status, and recent significant
history (such as hospitalization and major surgery during a
previous period, such as 3 months); and
``(II) other factors determined appropriate by the
Secretary, such as eligibility status under this title
(including eligibility under section 226(a), 226(b), or 226A,
and dual eligibility under this title and title XIX).
``(E) Draft care episode and patient condition groups and
classification codes.--Not later than 270 days after the end
of the comment period described in subparagraph (C), the
Secretary shall post on the Internet website of the Centers
for Medicare & Medicaid Services a draft list of the care
episode and patient condition codes established under
subparagraph (D) (and the criteria and characteristics
assigned to such code).
``(F) Solicitation of input.--The Secretary shall seek,
through the date that is 120 days after the Secretary posts
the list pursuant to subparagraph (E), comments from
physician specialty societies, applicable practitioner
organizations, and other stakeholders, including
representatives of individuals entitled to benefits under
part A or enrolled under this part, regarding the care
episode and patient condition groups (and codes) posted under
subparagraph (E). In seeking such comments, the Secretary
shall use one or more mechanisms (other than notice and
comment rulemaking) that may include use of open door forums,
town
[[Page H2056]]
hall meetings, or other appropriate mechanisms.
``(G) Operational list of care episode and patient
condition groups and codes.--Not later than 270 days after
the end of the comment period described in subparagraph (F),
taking into account the comments received under such
subparagraph, the Secretary shall post on the Internet
website of the Centers for Medicare & Medicaid Services an
operational list of care episode and patient condition codes
(and the criteria and characteristics assigned to such code).
``(H) Subsequent revisions.--Not later than November 1 of
each year (beginning with 2018), the Secretary shall, through
rulemaking, make revisions to the operational lists of care
episode and patient condition codes as the Secretary
determines may be appropriate. Such revisions may be based on
experience, new information developed pursuant to subsection
(n)(9)(A), and input from the physician specialty societies,
applicable practitioner organizations, and other
stakeholders, including representatives of individuals
entitled to benefits under part A or enrolled under this
part.
``(3) Attribution of patients to physicians or
practitioners.--
``(A) In general.--In order to facilitate the attribution
of patients and episodes (in whole or in part) to one or more
physicians or applicable practitioners furnishing items and
services, the Secretary shall undertake the steps described
in the succeeding provisions of this paragraph.
``(B) Development of patient relationship categories and
codes.--The Secretary shall develop patient relationship
categories and codes that define and distinguish the
relationship and responsibility of a physician or applicable
practitioner with a patient at the time of furnishing an item
or service. Such patient relationship categories shall
include different relationships of the physician or
applicable practitioner to the patient (and the codes may
reflect combinations of such categories), such as a physician
or applicable practitioner who--
``(i) considers themself to have the primary responsibility
for the general and ongoing care for the patient over
extended periods of time;
``(ii) considers themself to be the lead physician or
practitioner and who furnishes items and services and
coordinates care furnished by other physicians or
practitioners for the patient during an acute episode;
``(iii) furnishes items and services to the patient on a
continuing basis during an acute episode of care, but in a
supportive rather than a lead role;
``(iv) furnishes items and services to the patient on an
occasional basis, usually at the request of another physician
or practitioner; or
``(v) furnishes items and services only as ordered by
another physician or practitioner.
``(C) Draft list of patient relationship categories and
codes.--Not later than one year after the date of the
enactment of this subsection, the Secretary shall post on the
Internet website of the Centers for Medicare & Medicaid
Services a draft list of the patient relationship categories
and codes developed under subparagraph (B).
``(D) Stakeholder input.--The Secretary shall seek, through
the date that is 120 days after the Secretary posts the list
pursuant to subparagraph (C), comments from physician
specialty societies, applicable practitioner organizations,
and other stakeholders, including representatives of
individuals entitled to benefits under part A or enrolled
under this part, regarding the patient relationship
categories and codes posted under subparagraph (C). In
seeking such comments, the Secretary shall use one or more
mechanisms (other than notice and comment rulemaking) that
may include open door forums, town hall meetings, web-based
forums, or other appropriate mechanisms.
``(E) Operational list of patient relationship categories
and codes.--Not later than 240 days after the end of the
comment period described in subparagraph (D), taking into
account the comments received under such subparagraph, the
Secretary shall post on the Internet website of the Centers
for Medicare & Medicaid Services an operational list of
patient relationship categories and codes.
``(F) Subsequent revisions.--Not later than November 1 of
each year (beginning with 2018), the Secretary shall, through
rulemaking, make revisions to the operational list of patient
relationship categories and codes as the Secretary determines
appropriate. Such revisions may be based on experience, new
information developed pursuant to subsection (n)(9)(A), and
input from the physician specialty societies, applicable
practitioner organizations, and other stakeholders, including
representatives of individuals entitled to benefits under
part A or enrolled under this part.
``(4) Reporting of information for resource use
measurement.--Claims submitted for items and services
furnished by a physician or applicable practitioner on or
after January 1, 2018, shall, as determined appropriate by
the Secretary, include--
``(A) applicable codes established under paragraphs (2) and
(3); and
``(B) the national provider identifier of the ordering
physician or applicable practitioner (if different from the
billing physician or applicable practitioner).
``(5) Methodology for resource use analysis.--
``(A) In general.--In order to evaluate the resources used
to treat patients (with respect to care episode and patient
condition groups), the Secretary shall, as the Secretary
determines appropriate--
``(i) use the patient relationship codes reported on claims
pursuant to paragraph (4) to attribute patients (in whole or
in part) to one or more physicians and applicable
practitioners;
``(ii) use the care episode and patient condition codes
reported on claims pursuant to paragraph (4) as a basis to
compare similar patients and care episodes and patient
condition groups; and
``(iii) conduct an analysis of resource use (with respect
to care episodes and patient condition groups of such
patients).
``(B) Analysis of patients of physicians and
practitioners.--In conducting the analysis described in
subparagraph (A)(iii) with respect to patients attributed to
physicians and applicable practitioners, the Secretary shall,
as feasible--
``(i) use the claims data experience of such patients by
patient condition codes during a common period, such as 12
months; and
``(ii) use the claims data experience of such patients by
care episode codes--
``(I) in the case of episodes without a hospitalization,
during periods of time (such as the number of days)
determined appropriate by the Secretary; and
``(II) in the case of episodes with a hospitalization,
during periods of time (such as the number of days) before,
during, and after the hospitalization.
``(C) Measurement of resource use.--In measuring such
resource use, the Secretary--
``(i) shall use per patient total allowed charges for all
services under part A and this part (and, if the Secretary
determines appropriate, part D) for the analysis of patient
resource use, by care episode codes and by patient condition
codes; and
``(ii) may, as determined appropriate, use other measures
of allowed charges (such as subtotals for categories of items
and services) and measures of utilization of items and
services (such as frequency of specific items and services
and the ratio of specific items and services among attributed
patients or episodes).
``(D) Stakeholder input.--The Secretary shall seek comments
from the physician specialty societies, applicable
practitioner organizations, and other stakeholders, including
representatives of individuals entitled to benefits under
part A or enrolled under this part, regarding the resource
use methodology established pursuant to this paragraph. In
seeking comments the Secretary shall use one or more
mechanisms (other than notice and comment rulemaking) that
may include open door forums, town hall meetings, web-based
forums, or other appropriate mechanisms.
``(6) Implementation.--To the extent that the Secretary
contracts with an entity to carry out any part of the
provisions of this subsection, the Secretary may not contract
with an entity or an entity with a subcontract if the entity
or subcontracting entity currently makes recommendations to
the Secretary on relative values for services under the fee
schedule for physicians' services under this section.
``(7) Limitation.--There shall be no administrative or
judicial review under section 1869, section 1878, or
otherwise of--
``(A) care episode and patient condition groups and codes
established under paragraph (2);
``(B) patient relationship categories and codes established
under paragraph (3); and
``(C) measurement of, and analyses of resource use with
respect to, care episode and patient condition codes and
patient relationship codes pursuant to paragraph (5).
``(8) Administration.--Chapter 35 of title 44, United
States Code, shall not apply to this section.
``(9) Definitions.--In this subsection:
``(A) Physician.--The term `physician' has the meaning
given such term in section 1861(r)(1).
``(B) Applicable practitioner.--The term `applicable
practitioner' means--
``(i) a physician assistant, nurse practitioner, and
clinical nurse specialist (as such terms are defined in
section 1861(aa)(5)), and a certified registered nurse
anesthetist (as defined in section 1861(bb)(2)); and
``(ii) beginning January 1, 2019, such other eligible
professionals (as defined in subsection (k)(3)(B)) as
specified by the Secretary.
``(10) Clarification.--The provisions of sections
1890(b)(7) and 1890A shall not apply to this subsection.''.
SEC. 102. PRIORITIES AND FUNDING FOR MEASURE DEVELOPMENT.
Section 1848 of the Social Security Act (42 U.S.C. 1395w-
4), as amended by subsections (c) and (f) of section 101, is
further amended by inserting at the end the following new
subsection:
``(s) Priorities and Funding for Measure Development.--
``(1) Plan identifying measure development priorities and
timelines.--
``(A) Draft measure development plan.--Not later than
January 1, 2016, the Secretary shall develop, and post on the
Internet website of the Centers for Medicare & Medicaid
Services, a draft plan for the development of quality
measures for application under the applicable provisions (as
defined in paragraph (5)). Under such plan the Secretary
shall--
``(i) address how measures used by private payers and
integrated delivery systems could be incorporated under title
XVIII;
[[Page H2057]]
``(ii) describe how coordination, to the extent possible,
will occur across organizations developing such measures; and
``(iii) take into account how clinical best practices and
clinical practice guidelines should be used in the
development of quality measures.
``(B) Quality domains.--For purposes of this subsection,
the term `quality domains' means at least the following
domains:
``(i) Clinical care.
``(ii) Safety.
``(iii) Care coordination.
``(iv) Patient and caregiver experience.
``(v) Population health and prevention.
``(C) Consideration.--In developing the draft plan under
this paragraph, the Secretary shall consider--
``(i) gap analyses conducted by the entity with a contract
under section 1890(a) or other contractors or entities;
``(ii) whether measures are applicable across health care
settings;
``(iii) clinical practice improvement activities submitted
under subsection (q)(2)(C)(iv) for identifying possible areas
for future measure development and identifying existing gaps
with respect to such measures; and
``(iv) the quality domains applied under this subsection.
``(D) Priorities.--In developing the draft plan under this
paragraph, the Secretary shall give priority to the following
types of measures:
``(i) Outcome measures, including patient reported outcome
and functional status measures.
``(ii) Patient experience measures.
``(iii) Care coordination measures.
``(iv) Measures of appropriate use of services, including
measures of over use.
``(E) Stakeholder input.--The Secretary shall accept
through March 1, 2016, comments on the draft plan posted
under paragraph (1)(A) from the public, including health care
providers, payers, consumers, and other stakeholders.
``(F) Final measure development plan.--Not later than May
1, 2016, taking into account the comments received under this
subparagraph, the Secretary shall finalize the plan and post
on the Internet website of the Centers for Medicare &
Medicaid Services an operational plan for the development of
quality measures for use under the applicable provisions.
Such plan shall be updated as appropriate.
``(2) Contracts and other arrangements for quality measure
development.--
``(A) In general.--The Secretary shall enter into contracts
or other arrangements with entities for the purpose of
developing, improving, updating, or expanding in accordance
with the plan under paragraph (1) quality measures for
application under the applicable provisions. Such entities
shall include organizations with quality measure development
expertise.
``(B) Prioritization.--
``(i) In general.--In entering into contracts or other
arrangements under subparagraph (A), the Secretary shall give
priority to the development of the types of measures
described in paragraph (1)(D).
``(ii) Consideration.--In selecting measures for
development under this subsection, the Secretary shall
consider--
``(I) whether such measures would be electronically
specified; and
``(II) clinical practice guidelines to the extent that such
guidelines exist.
``(3) Annual report by the secretary.--
``(A) In general.--Not later than May 1, 2017, and annually
thereafter, the Secretary shall post on the Internet website
of the Centers for Medicare & Medicaid Services a report on
the progress made in developing quality measures for
application under the applicable provisions.
``(B) Requirements.--Each report submitted pursuant to
subparagraph (A) shall include the following:
``(i) A description of the Secretary's efforts to implement
this paragraph.
``(ii) With respect to the measures developed during the
previous year--
``(I) a description of the total number of quality measures
developed and the types of such measures, such as an outcome
or patient experience measure;
``(II) the name of each measure developed;
``(III) the name of the developer and steward of each
measure;
``(IV) with respect to each type of measure, an estimate of
the total amount expended under this title to develop all
measures of such type; and
``(V) whether the measure would be electronically
specified.
``(iii) With respect to measures in development at the time
of the report--
``(I) the information described in clause (ii), if
available; and
``(II) a timeline for completion of the development of such
measures.
``(iv) A description of any updates to the plan under
paragraph (1) (including newly identified gaps and the status
of previously identified gaps) and the inventory of measures
applicable under the applicable provisions.
``(v) Other information the Secretary determines to be
appropriate.
``(4) Stakeholder input.--With respect to paragraph (1),
the Secretary shall seek stakeholder input with respect to--
``(A) the identification of gaps where no quality measures
exist, particularly with respect to the types of measures
described in paragraph (1)(D);
``(B) prioritizing quality measure development to address
such gaps; and
``(C) other areas related to quality measure development
determined appropriate by the Secretary.
``(5) Definition of applicable provisions.--In this
subsection, the term `applicable provisions' means the
following provisions:
``(A) Subsection (q)(2)(B)(i).
``(B) Section 1833(z)(2)(C).
``(6) Funding.--For purposes of carrying out this
subsection, the Secretary shall provide for the transfer,
from the Federal Supplementary Medical Insurance Trust Fund
under section 1841, of $15,000,000 to the Centers for
Medicare & Medicaid Services Program Management Account for
each of fiscal years 2015 through 2019. Amounts transferred
under this paragraph shall remain available through the end
of fiscal year 2022.
``(7) Administration.--Chapter 35 of title 44, United
States Code, shall not apply to the collection of information
for the development of quality measures.''.
SEC. 103. ENCOURAGING CARE MANAGEMENT FOR INDIVIDUALS WITH
CHRONIC CARE NEEDS.
(a) In General.--Section 1848(b) of the Social Security Act
(42 U.S.C. 1395w-4(b)) is amended by adding at the end the
following new paragraph:
``(8) Encouraging care management for individuals with
chronic care needs.--
``(A) In general.--In order to encourage the management of
care for individuals with chronic care needs the Secretary
shall, subject to subparagraph (B), make payment (as the
Secretary determines to be appropriate) under this section
for chronic care management services furnished on or after
January 1, 2015, by a physician (as defined in section
1861(r)(1)), physician assistant or nurse practitioner (as
defined in section 1861(aa)(5)(A)), clinical nurse specialist
(as defined in section 1861(aa)(5)(B)), or certified nurse
midwife (as defined in section 1861(gg)(2)).
``(B) Policies relating to payment.--In carrying out this
paragraph, with respect to chronic care management services,
the Secretary shall--
``(i) make payment to only one applicable provider for such
services furnished to an individual during a period;
``(ii) not make payment under subparagraph (A) if such
payment would be duplicative of payment that is otherwise
made under this title for such services; and
``(iii) not require that an annual wellness visit (as
defined in section 1861(hhh)) or an initial preventive
physical examination (as defined in section 1861(ww)) be
furnished as a condition of payment for such management
services.''.
(b) Education and Outreach.--
(1) Campaign.--
(A) In general.--The Secretary of Health and Human Services
(in this subsection referred to as the ``Secretary'') shall
conduct an education and outreach campaign to inform
professionals who furnish items and services under part B of
title XVIII of the Social Security Act and individuals
enrolled under such part of the benefits of chronic care
management services described in section 1848(b)(8) of the
Social Security Act, as added by subsection (a), and
encourage such individuals with chronic care needs to receive
such services.
(B) Requirements.--Such campaign shall--
(i) be directed by the Office of Rural Health Policy of the
Department of Health and Human Services and the Office of
Minority Health of the Centers for Medicare & Medicaid
Services; and
(ii) focus on encouraging participation by underserved
rural populations and racial and ethnic minority populations.
(2) Report.--Not later than December 31, 2017, the
Secretary shall submit to Congress a report on the use of
chronic care management services described in such section
1848(b)(8) by individuals living in rural areas and by racial
and ethnic minority populations. Such report shall--
(A) identify barriers to receiving chronic care management
services; and
(B) make recommendations for increasing the appropriate use
of chronic care management services.
SEC. 104. EMPOWERING BENEFICIARY CHOICES THROUGH CONTINUED
ACCESS TO INFORMATION ON PHYSICIANS' SERVICES.
(a) In General.--On an annual basis (beginning with 2015),
the Secretary shall make publicly available, in an easily
understandable format, information with respect to physicians
and, as appropriate, other eligible professionals on items
and services furnished to Medicare beneficiaries under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
(b) Type and Manner of Information.--The information made
available under this section shall be similar to the type of
information in the Medicare Provider Utilization and Payment
Data: Physician and Other Supplier Public Use File released
by the Secretary with respect to 2012 and shall be made
available in a manner similar to the manner in which the
information in such file is made available.
(c) Requirements.--The information made available under
this section shall include, at a minimum, the following:
(1) Information on the number of services furnished by the
physician or other eligible professional under part B of
title XVIII of the Social Security Act (42 U.S.C. 1395j et
seq.), which may include information on the most frequent
services furnished or groupings of services.
[[Page H2058]]
(2) Information on submitted charges and payments for
services under such part.
(3) A unique identifier for the physician or other eligible
professional that is available to the public, such as a
national provider identifier.
(d) Searchability.--The information made available under
this section shall be searchable by at least the following:
(1) The specialty or type of the physician or other
eligible professional.
(2) Characteristics of the services furnished, such as
volume or groupings of services.
(3) The location of the physician or other eligible
professional.
(e) Integration on Physician Compare.--Beginning with 2016,
the Secretary shall integrate the information made available
under this section on Physician Compare.
(f) Definitions.--In this section:
(1) Eligible professional; physician; secretary.--The terms
``eligible professional'', ``physician'', and ``Secretary''
have the meaning given such terms in section 10331(i) of
Public Law 111-148.
(2) Physician compare.--The term ``Physician Compare''
means the Physician Compare Internet website of the Centers
for Medicare & Medicaid Services (or a successor website).
SEC. 105. EXPANDING AVAILABILITY OF MEDICARE DATA.
(a) Expanding Uses of Medicare Data by Qualified
Entities.--
(1) Additional analyses.--
(A) In general.--Subject to subparagraph (B), to the extent
consistent with applicable information, privacy, security,
and disclosure laws (including paragraph (3)),
notwithstanding paragraph (4)(B) of section 1874(e) of the
Social Security Act (42 U.S.C. 1395kk(e)) and the second
sentence of paragraph (4)(D) of such section, beginning July
1, 2016, a qualified entity may use the combined data
described in paragraph (4)(B)(iii) of such section received
by such entity under such section, and information derived
from the evaluation described in such paragraph (4)(D), to
conduct additional non-public analyses (as determined
appropriate by the Secretary) and provide or sell such
analyses to authorized users for non-public use (including
for the purposes of assisting providers of services and
suppliers to develop and participate in quality and patient
care improvement activities, including developing new models
of care).
(B) Limitations with respect to analyses.--
(i) Employers.--Any analyses provided or sold under
subparagraph (A) to an employer described in paragraph
(9)(A)(iii) may only be used by such employer for purposes of
providing health insurance to employees and retirees of the
employer.
(ii) Health insurance issuers.--A qualified entity may not
provide or sell an analysis to a health insurance issuer
described in paragraph (9)(A)(iv) unless the issuer is
providing the qualified entity with data under section
1874(e)(4)(B)(iii) of the Social Security Act (42 U.S.C.
1395kk(e)(4)(B)(iii)).
(2) Access to certain data.--
(A) Access.--To the extent consistent with applicable
information, privacy, security, and disclosure laws
(including paragraph (3)), notwithstanding paragraph (4)(B)
of section 1874(e) of the Social Security Act (42 U.S.C.
1395kk(e)) and the second sentence of paragraph (4)(D) of
such section, beginning July 1, 2016, a qualified entity
may--
(i) provide or sell the combined data described in
paragraph (4)(B)(iii) of such section to authorized users
described in clauses (i), (ii), and (v) of paragraph (9)(A)
for non-public use, including for the purposes described in
subparagraph (B); or
(ii) subject to subparagraph (C), provide Medicare claims
data to authorized users described in clauses (i), (ii), and
(v), of paragraph (9)(A) for non-public use, including for
the purposes described in subparagraph (B).
(B) Purposes described.--The purposes described in this
subparagraph are assisting providers of services and
suppliers in developing and participating in quality and
patient care improvement activities, including developing new
models of care.
(C) Medicare claims data must be provided at no cost.--A
qualified entity may not charge a fee for providing the data
under subparagraph (A)(ii).
(3) Protection of information.--
(A) In general.--Except as provided in subparagraph (B), an
analysis or data that is provided or sold under paragraph (1)
or (2) shall not contain information that individually
identifies a patient.
(B) Information on patients of the provider of services or
supplier.--To the extent consistent with applicable
information, privacy, security, and disclosure laws, an
analysis or data that is provided or sold to a provider of
services or supplier under paragraph (1) or (2) may contain
information that individually identifies a patient of such
provider or supplier, including with respect to items and
services furnished to the patient by other providers of
services or suppliers.
(C) Prohibition on using analyses or data for marketing
purposes.--An authorized user shall not use an analysis or
data provided or sold under paragraph (1) or (2) for
marketing purposes.
(4) Data use agreement.--A qualified entity and an
authorized user described in clauses (i), (ii), and (v) of
paragraph (9)(A) shall enter into an agreement regarding the
use of any data that the qualified entity is providing or
selling to the authorized user under paragraph (2). Such
agreement shall describe the requirements for privacy and
security of the data and, as determined appropriate by the
Secretary, any prohibitions on using such data to link to
other individually identifiable sources of information. If
the authorized user is not a covered entity under the rules
promulgated pursuant to the Health Insurance Portability and
Accountability Act of 1996, the agreement shall identify the
relevant regulations, as determined by the Secretary, that
the user shall comply with as if it were acting in the
capacity of such a covered entity.
(5) No redisclosure of analyses or data.--
(A) In general.--Except as provided in subparagraph (B), an
authorized user that is provided or sold an analysis or data
under paragraph (1) or (2) shall not redisclose or make
public such analysis or data or any analysis using such data.
(B) Permitted redisclosure.--A provider of services or
supplier that is provided or sold an analysis or data under
paragraph (1) or (2) may, as determined by the Secretary,
redisclose such analysis or data for the purposes of
performance improvement and care coordination activities but
shall not make public such analysis or data or any analysis
using such data.
(6) Opportunity for providers of services and suppliers to
review.--Prior to a qualified entity providing or selling an
analysis to an authorized user under paragraph (1), to the
extent that such analysis would individually identify a
provider of services or supplier who is not being provided or
sold such analysis, such qualified entity shall provide such
provider or supplier with the opportunity to appeal and
correct errors in the manner described in section
1874(e)(4)(C)(ii) of the Social Security Act (42 U.S.C.
1395kk(e)(4)(C)(ii)).
(7) Assessment for a breach.--
(A) In general.--In the case of a breach of a data use
agreement under this section or section 1874(e) of the Social
Security Act (42 U.S.C. 1395kk(e)), the Secretary shall
impose an assessment on the qualified entity both in the case
of--
(i) an agreement between the Secretary and a qualified
entity; and
(ii) an agreement between a qualified entity and an
authorized user.
(B) Assessment.--The assessment under subparagraph (A)
shall be an amount up to $100 for each individual entitled
to, or enrolled for, benefits under part A of title XVIII of
the Social Security Act or enrolled for benefits under part B
of such title--
(i) in the case of an agreement described in subparagraph
(A)(i), for whom the Secretary provided data on to the
qualified entity under paragraph (2); and
(ii) in the case of an agreement described in subparagraph
(A)(ii), for whom the qualified entity provided data on to
the authorized user under paragraph (2).
(C) Deposit of amounts collected.--Any amounts collected
pursuant to this paragraph shall be deposited in Federal
Supplementary Medical Insurance Trust Fund under section 1841
of the Social Security Act (42 U.S.C. 1395t).
(8) Annual reports.--Any qualified entity that provides or
sells an analysis or data under paragraph (1) or (2) shall
annually submit to the Secretary a report that includes--
(A) a summary of the analyses provided or sold, including
the number of such analyses, the number of purchasers of such
analyses, and the total amount of fees received for such
analyses;
(B) a description of the topics and purposes of such
analyses;
(C) information on the entities who received the data under
paragraph (2), the uses of the data, and the total amount of
fees received for providing, selling, or sharing the data;
and
(D) other information determined appropriate by the
Secretary.
(9) Definitions.--In this subsection and subsection (b):
(A) Authorized user.--The term ``authorized user'' means
the following:
(i) A provider of services.
(ii) A supplier.
(iii) An employer (as defined in section 3(5) of the
Employee Retirement Insurance Security Act of 1974).
(iv) A health insurance issuer (as defined in section 2791
of the Public Health Service Act).
(v) A medical society or hospital association.
(vi) Any entity not described in clauses (i) through (v)
that is approved by the Secretary (other than an employer or
health insurance issuer not described in clauses (iii) and
(iv), respectively, as determined by the Secretary).
(B) Provider of services.--The term ``provider of
services'' has the meaning given such term in section 1861(u)
of the Social Security Act (42 U.S.C. 1395x(u)).
(C) Qualified entity.--The term ``qualified entity'' has
the meaning given such term in section 1874(e)(2) of the
Social Security Act (42 U.S.C. 1395kk(e)).
(D) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(E) Supplier.--The term ``supplier'' has the meaning given
such term in section 1861(d) of the Social Security Act (42
U.S.C. 1395x(d)).
(b) Access to Medicare Data by Qualified Clinical Data
Registries To Facilitate Quality Improvement.--
(1) Access.--
[[Page H2059]]
(A) In general.--To the extent consistent with applicable
information, privacy, security, and disclosure laws,
beginning July 1, 2016, the Secretary shall, at the request
of a qualified clinical data registry under section
1848(m)(3)(E) of the Social Security Act (42 U.S.C. 1395w-
4(m)(3)(E)), provide the data described in subparagraph (B)
(in a form and manner determined to be appropriate) to such
qualified clinical data registry for purposes of linking such
data with clinical outcomes data and performing risk-
adjusted, scientifically valid analyses and research to
support quality improvement or patient safety, provided that
any public reporting of such analyses or research that
identifies a provider of services or supplier shall only be
conducted with the opportunity of such provider or supplier
to appeal and correct errors in the manner described in
subsection (a)(6).
(B) Data described.--The data described in this
subparagraph is--
(i) claims data under the Medicare program under title
XVIII of the Social Security Act; and
(ii) if the Secretary determines appropriate, claims data
under the Medicaid program under title XIX of such Act and
the State Children's Health Insurance Program under title XXI
of such Act.
(2) Fee.--Data described in paragraph (1)(B) shall be
provided to a qualified clinical data registry under
paragraph (1) at a fee equal to the cost of providing such
data. Any fee collected pursuant to the preceding sentence
shall be deposited in the Centers for Medicare & Medicaid
Services Program Management Account.
(c) Expansion of Data Available to Qualified Entities.--
Section 1874(e) of the Social Security Act (42 U.S.C.
1395kk(e)) is amended--
(1) in the subsection heading, by striking ``Medicare'';
and
(2) in paragraph (3)--
(A) by inserting after the first sentence the following new
sentence: ``Beginning July 1, 2016, if the Secretary
determines appropriate, the data described in this paragraph
may also include standardized extracts (as determined by the
Secretary) of claims data under titles XIX and XXI for
assistance provided under such titles for one or more
specified geographic areas and time periods requested by a
qualified entity.''; and
(B) in the last sentence, by inserting ``or under titles
XIX or XXI'' before the period at the end.
(d) Revision of Placement of Fees.--Section 1874(e)(4)(A)
of the Social Security Act (42 U.S.C. 1395kk(e)(4)(A)) is
amended, in the second sentence--
(1) by inserting ``, for periods prior to July 1, 2016,''
after ``deposited''; and
(2) by inserting the following before the period at the
end: ``, and, beginning July 1, 2016, into the Centers for
Medicare & Medicaid Services Program Management Account''.
SEC. 106. REDUCING ADMINISTRATIVE BURDEN AND OTHER
PROVISIONS.
(a) Medicare Physician and Practitioner Opt-Out to Private
Contract.--
(1) Indefinite, continuing automatic extension of opt out
election.--
(A) In general.--Section 1802(b)(3) of the Social Security
Act (42 U.S.C. 1395a(b)(3)) is amended--
(i) in subparagraph (B)(ii), by striking ``during the 2-
year period beginning on the date the affidavit is signed''
and inserting ``during the applicable 2-year period (as
defined in subparagraph (D))'';
(ii) in subparagraph (C), by striking ``during the 2-year
period described in subparagraph (B)(ii)'' and inserting
``during the applicable 2-year period''; and
(iii) by adding at the end the following new subparagraph:
``(D) Applicable 2-year periods for effectiveness of
affidavits.--In this subsection, the term `applicable 2-year
period' means, with respect to an affidavit of a physician or
practitioner under subparagraph (B), the 2-year period
beginning on the date the affidavit is signed and includes
each subsequent 2-year period unless the physician or
practitioner involved provides notice to the Secretary (in a
form and manner specified by the Secretary), not later than
30 days before the end of the previous 2-year period, that
the physician or practitioner does not want to extend the
application of the affidavit for such subsequent 2-year
period.''.
(B) Effective date.--The amendments made by subparagraph
(A) shall apply to affidavits entered into on or after the
date that is 60 days after the date of the enactment of this
Act.
(2) Public availability of information on opt-out
physicians and practitioners.--Section 1802(b) of the Social
Security Act (42 U.S.C. 1395a(b)) is amended--
(A) in paragraph (5), by adding at the end the following
new subparagraph:
``(D) Opt-out physician or practitioner.--The term `opt-out
physician or practitioner' means a physician or practitioner
who has in effect an affidavit under paragraph (3)(B).'';
(B) by redesignating paragraph (5) as paragraph (6); and
(C) by inserting after paragraph (4) the following new
paragraph:
``(5) Posting of information on opt-out physicians and
practitioners.--
``(A) In general.--Beginning not later than February 1,
2016, the Secretary shall make publicly available through an
appropriate publicly accessible website of the Department of
Health and Human Services information on the number and
characteristics of opt-out physicians and practitioners and
shall update such information on such website not less often
than annually.
``(B) Information to be included.--The information to be
made available under subparagraph (A) shall include at least
the following with respect to opt-out physicians and
practitioners:
``(i) Their number.
``(ii) Their physician or professional specialty or other
designation.
``(iii) Their geographic distribution.
``(iv) The timing of their becoming opt-out physicians and
practitioners, relative, to the extent feasible, to when they
first enrolled in the program under this title and with
respect to applicable 2-year periods.
``(v) The proportion of such physicians and practitioners
who billed for emergency or urgent care services.''.
(b) Promoting Interoperability of Electronic Health Record
Systems.--
(1) Recommendations for achieving widespread ehr
interoperability.--
(A) Objective.--As a consequence of a significant Federal
investment in the implementation of health information
technology through the Medicare and Medicaid EHR incentive
programs, Congress declares it a national objective to
achieve widespread exchange of health information through
interoperable certified EHR technology nationwide by December
31, 2018.
(B) Definitions.--In this paragraph:
(i) Widespread interoperability.--The term ``widespread
interoperability'' means interoperability between certified
EHR technology systems employed by meaningful EHR users under
the Medicare and Medicaid EHR incentive programs and other
clinicians and health care providers on a nationwide basis.
(ii) Interoperability.--The term ``interoperability'' means
the ability of two or more health information systems or
components to exchange clinical and other information and to
use the information that has been exchanged using common
standards as to provide access to longitudinal information
for health care providers in order to facilitate coordinated
care and improved patient outcomes.
(C) Establishment of metrics.--Not later than July 1, 2016,
and in consultation with stakeholders, the Secretary shall
establish metrics to be used to determine if and to the
extent that the objective described in subparagraph (A) has
been achieved.
(D) Recommendations if objective not achieved.--If the
Secretary of Health and Human Services determines that the
objective described in subparagraph (A) has not been achieved
by December 31, 2018, then the Secretary shall submit to
Congress a report, by not later than December 31, 2019, that
identifies barriers to such objective and recommends actions
that the Federal Government can take to achieve such
objective. Such recommended actions may include
recommendations--
(i) to adjust payments for not being meaningful EHR users
under the Medicare EHR incentive programs; and
(ii) for criteria for decertifying certified EHR technology
products.
(2) Preventing blocking the sharing of information.--
(A) For meaningful use ehr professionals.--Section
1848(o)(2)(A)(ii) of the Social Security Act (42 U.S.C.
1395w-4(o)(2)(A)(ii)) is amended by inserting before the
period at the end the following: ``, and the professional
demonstrates (through a process specified by the Secretary,
such as the use of an attestation) that the professional has
not knowingly and willfully taken action (such as to disable
functionality) to limit or restrict the compatibility or
interoperability of the certified EHR technology''.
(B) For meaningful use ehr hospitals.--Section
1886(n)(3)(A)(ii) of the Social Security Act (42 U.S.C.
1395ww(n)(3)(A)(ii)) is amended by inserting before the
period at the end the following: ``, and the hospital
demonstrates (through a process specified by the Secretary,
such as the use of an attestation) that the hospital has not
knowingly and willfully taken action (such as to disable
functionality) to limit or restrict the compatibility or
interoperability of the certified EHR technology''.
(C) Effective date.--The amendments made by this subsection
shall apply to meaningful EHR users as of the date that is
one year after the date of the enactment of this Act.
(3) Study and report on the feasibility of establishing a
mechanism to compare certified ehr technology products.--
(A) Study.--The Secretary shall conduct a study to examine
the feasibility of establishing one or more mechanisms to
assist providers in comparing and selecting certified EHR
technology products. Such mechanisms may include--
(i) a website with aggregated results of surveys of
meaningful EHR users on the functionality of certified EHR
technology products to enable such users to directly compare
the functionality and other features of such products; and
(ii) information from vendors of certified products that is
made publicly available in a standardized format.
The aggregated results of the surveys described in clause (i)
may be made available through contracts with physicians,
hospitals, or other organizations that maintain such
comparative information described in such clause.
[[Page H2060]]
(B) Report.--Not later than 1 year after the date of the
enactment of this Act, the Secretary shall submit to Congress
a report on mechanisms that would assist providers in
comparing and selecting certified EHR technology products.
The report shall include information on the benefits of, and
resources needed to develop and maintain, such mechanisms.
(4) Definitions.--In this subsection:
(A) The term ``certified EHR technology'' has the meaning
given such term in section 1848(o)(4) of the Social Security
Act (42 U.S.C. 1395w-4(o)(4)).
(B) The term ``meaningful EHR user'' has the meaning given
such term under the Medicare EHR incentive programs.
(C) The term ``Medicare and Medicaid EHR incentive
programs'' means--
(i) in the case of the Medicare program under title XVIII
of the Social Security Act, the incentive programs under
section 1814(l)(3), section 1848(o), subsections (l) and (m)
of section 1853, and section 1886(n) of the Social Security
Act (42 U.S.C. 1395f(l)(3), 1395w-4(o), 1395w-23, 1395ww(n));
and
(ii) in the case of the Medicaid program under title XIX of
such Act, the incentive program under subsections (a)(3)(F)
and (t) of section 1903 of such Act (42 U.S.C. 1396b).
(D) The term ``Secretary'' means the Secretary of Health
and Human Services.
(c) GAO Studies and Reports on the Use of Telehealth Under
Federal Programs and on Remote Patient Monitoring Services.--
(1) Study on telehealth services.--The Comptroller General
of the United States shall conduct a study on the following:
(A) How the definition of telehealth across various Federal
programs and Federal efforts can inform the use of telehealth
in the Medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(B) Issues that can facilitate or inhibit the use of
telehealth under the Medicare program under such title,
including oversight and professional licensure, changing
technology, privacy and security, infrastructure
requirements, and varying needs across urban and rural areas.
(C) Potential implications of greater use of telehealth
with respect to payment and delivery system transformations
under the Medicare program under such title XVIII and the
Medicaid program under title XIX of such Act (42 U.S.C. 1396
et seq.).
(D) How the Centers for Medicare & Medicaid Services
monitors payments made under the Medicare program under such
title XVIII to providers for telehealth services.
(2) Study on remote patient monitoring services.--
(A) In general.--The Comptroller General of the United
States shall conduct a study--
(i) of the dissemination of remote patient monitoring
technology in the private health insurance market;
(ii) of the financial incentives in the private health
insurance market relating to adoption of such technology;
(iii) of the barriers to adoption of such services under
the Medicare program under title XVIII of the Social Security
Act;
(iv) that evaluates the patients, conditions, and clinical
circumstances that could most benefit from remote patient
monitoring services; and
(v) that evaluates the challenges related to establishing
appropriate valuation for remote patient monitoring services
under the Medicare physician fee schedule under section 1848
of the Social Security Act (42 U.S.C. 1395w-4) in order to
accurately reflect the resources involved in furnishing such
services.
(B) Definitions.--For purposes of this paragraph:
(i) Remote patient monitoring services.--The term ``remote
patient monitoring services'' means services furnished
through remote patient monitoring technology.
(ii) Remote patient monitoring technology.--The term
``remote patient monitoring technology'' means a coordinated
system that uses one or more home-based or mobile monitoring
devices that automatically transmit vital sign data or
information on activities of daily living and may include
responses to assessment questions collected on the devices
wirelessly or through a telecommunications connection to a
server that complies with the Federal regulations (concerning
the privacy of individually identifiable health information)
promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996, as part of an
established plan of care for that patient that includes the
review and interpretation of that data by a health care
professional.
(3) Reports.--Not later than 24 months after the date of
the enactment of this Act, the Comptroller General shall
submit to Congress--
(A) a report containing the results of the study conducted
under paragraph (1); and
(B) a report containing the results of the study conducted
under paragraph (2).
A report required under this paragraph shall be submitted
together with recommendations for such legislation and
administrative action as the Comptroller General determines
appropriate. The Comptroller General may submit one report
containing the results described in subparagraphs (A) and (B)
and the recommendations described in the previous sentence.
(d) Rule of Construction Regarding Health Care Providers.--
(1) In general.--Subject to paragraph (3), the development,
recognition, or implementation of any guideline or other
standard under any Federal health care provision shall not be
construed to establish the standard of care or duty of care
owed by a health care provider to a patient in any medical
malpractice or medical product liability action or claim.
(2) Definitions.--For purposes of this subsection:
(A) Federal health care provision.--The term ``Federal
health care provision'' means any provision of the Patient
Protection and Affordable Care Act (Public Law 111-148),
title I or subtitle B of title II of the Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152), or
title XVIII or XIX of the Social Security Act (42 U.S.C. 1395
et seq., 42 U.S.C. 1396 et seq.).
(B) Health care provider.--The term ``health care
provider'' means any individual, group practice, corporation
of health care professionals, or hospital--
(i) licensed, registered, or certified under Federal or
State laws or regulations to provide health care services; or
(ii) required to be so licensed, registered, or certified
but that is exempted by other statute or regulation.
(C) Medical malpractice or medical product liability action
or claim.--The term ``medical malpractice or medical product
liability action or claim'' means a medical malpractice
action or claim (as defined in section 431(7) of the Health
Care Quality Improvement Act of 1986 (42 U.S.C. 11151(7)))
and includes a liability action or claim relating to a health
care provider's prescription or provision of a drug, device,
or biological product (as such terms are defined in section
201 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
321) or section 351 of the Public Health Service Act (42
U.S.C. 262)).
(D) State.--The term ``State'' includes the District of
Columbia, Puerto Rico, and any other commonwealth,
possession, or territory of the United States.
(3) No preemption.--Nothing in paragraph (1) or any
provision of the Patient Protection and Affordable Care Act
(Public Law 111-148), title I or subtitle B of title II of
the Health Care and Education Reconciliation Act of 2010
(Public Law 111-152), or title XVIII or XIX of the Social
Security Act (42 U.S.C. 1395 et seq., 42 U.S.C. 1396 et seq.)
shall be construed to preempt any State or common law
governing medical professional or medical product liability
actions or claims.
TITLE II--MEDICARE AND OTHER HEALTH EXTENDERS
Subtitle A--Medicare Extenders
SEC. 201. EXTENSION OF WORK GPCI FLOOR.
Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C.
1395w-4(e)(1)(E)) is amended by striking ``April 1, 2015''
and inserting ``January 1, 2018''.
SEC. 202. EXTENSION OF THERAPY CAP EXCEPTIONS PROCESS.
(a) In General.--Section 1833(g) of the Social Security Act
(42 U.S.C. 1395l(g)) is amended--
(1) in paragraph (5)(A), in the first sentence, by striking
``March 31, 2015'' and inserting ``December 31, 2017''; and
(2) in paragraph (6)(A)--
(A) by striking ``March 31, 2015'' and inserting ``December
31, 2017''; and
(B) by striking ``2012, 2013, 2014, or the first three
months of 2015'' and inserting ``2012 through 2017''.
(b) Targeted Reviews Under Manual Medical Review Process
for Outpatient Therapy Services.--
(1) In general.--Section 1833(g)(5) of the Social Security
Act (42 U.S.C. 1395l(g)(5)) is amended--
(A) in subparagraph (C)(i), by inserting ``, subject to
subparagraph (E),'' after ``manual medical review process
that''; and
(B) by adding at the end the following new subparagraph:
``(E)(i) In place of the manual medical review process
under subparagraph (C)(i), the Secretary shall implement a
process for medical review under this subparagraph under
which the Secretary shall identify and conduct medical review
for services described in subparagraph (C)(i) furnished by a
provider of services or supplier (in this subparagraph
referred to as a `therapy provider') using such factors as
the Secretary determines to be appropriate.
``(ii) Such factors may include the following:
``(I) The therapy provider has had a high claims denial
percentage for therapy services under this part or is less
compliant with applicable requirements under this title.
``(II) The therapy provider has a pattern of billing for
therapy services under this part that is aberrant compared to
peers or otherwise has questionable billing practices for
such services, such as billing medically unlikely units of
services in a day.
``(III) The therapy provider is newly enrolled under this
title or has not previously furnished therapy services under
this part.
``(IV) The services are furnished to treat a type of
medical condition.
``(V) The therapy provider is part of group that includes
another therapy provider identified using the factors
determined under this subparagraph.
``(iii) For purposes of carrying out this subparagraph, the
Secretary shall provide for the transfer, from the Federal
Supplementary Medical Insurance Trust Fund under section
1841, of $5,000,000 to the Centers for Medicare & Medicaid
Services Program Management Account for fiscal years 2015 and
2016, to remain available until expended. Such funds may not
be used by a contractor
[[Page H2061]]
under section 1893(h) for medical reviews under this
subparagraph.
``(iv) The targeted review process under this subparagraph
shall not apply to services for which expenses are incurred
beyond the period for which the exceptions process under
subparagraph (A) is implemented.''.
(2) Effective date.--The amendments made by this subsection
shall apply with respect to requests described in section
1833(g)(5)(C)(i) of the Social Security Act (42 U.S.C.
1395l(g)(5)(C)(i)) with respect to which the Secretary of
Health and Human Services has not conducted medical review
under such section by a date (not later than 90 days after
the date of the enactment of this Act) specified by the
Secretary.
SEC. 203. EXTENSION OF AMBULANCE ADD-ONS.
(a) Ground Ambulance.--Section 1834(l)(13)(A) of the Social
Security Act (42 U.S.C. 1395m(l)(13)(A)) is amended by
striking ``April 1, 2015'' and inserting ``January 1, 2018''
each place it appears.
(b) Super Rural Ground Ambulance.--Section 1834(l)(12)(A)
of the Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is
amended, in the first sentence, by striking ``April 1, 2015''
and inserting ``January 1, 2018''.
SEC. 204. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT
ADJUSTMENT FOR CERTAIN LOW-VOLUME HOSPITALS.
Section 1886(d)(12) of the Social Security Act (42 U.S.C.
1395ww(d)(12)) is amended--
(1) in subparagraph (B), in the matter preceding clause
(i), by striking ``in fiscal year 2015 (beginning on April 1,
2015), fiscal year 2016, and subsequent fiscal years'' and
inserting ``in fiscal year 2018 and subsequent fiscal
years'';
(2) in subparagraph (C)(i), by striking ``fiscal years 2011
through 2014 and fiscal year 2015 (before April 1, 2015),''
and inserting ``fiscal years 2011 through 2017,'' each place
it appears; and
(3) in subparagraph (D), by striking ``fiscal years 2011
through 2014 and fiscal year 2015 (before April 1, 2015),''
and inserting ``fiscal years 2011 through 2017,''.
SEC. 205. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL (MDH)
PROGRAM.
(a) In General.--Section 1886(d)(5)(G) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended--
(1) in clause (i), by striking ``April 1, 2015'' and
inserting ``October 1, 2017''; and
(2) in clause (ii)(II), by striking ``April 1, 2015'' and
inserting ``October 1, 2017''.
(b) Conforming Amendments.--
(1) Extension of target amount.--Section 1886(b)(3)(D) of
the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is
amended--
(A) in the matter preceding clause (i), by striking ``April
1, 2015'' and inserting ``October 1, 2017''; and
(B) in clause (iv), by striking ``through fiscal year 2014
and the portion of fiscal year 2015 before April 1, 2015''
and inserting ``through fiscal year 2017''.
(2) Permitting hospitals to decline reclassification.--
Section 13501(e)(2) of the Omnibus Budget Reconciliation Act
of 1993 (42 U.S.C. 1395ww note) is amended by striking
``through the first 2 quarters of fiscal year 2015'' and
inserting ``through fiscal year 2017''.
SEC. 206. EXTENSION FOR SPECIALIZED MEDICARE ADVANTAGE PLANS
FOR SPECIAL NEEDS INDIVIDUALS.
Section 1859(f)(1) of the Social Security Act (42 U.S.C.
1395w-28(f)(1)) is amended by striking ``2017'' and inserting
``2019''.
SEC. 207. EXTENSION OF FUNDING FOR QUALITY MEASURE
ENDORSEMENT, INPUT, AND SELECTION.
Section 1890(d)(2) of the Social Security Act (42 U.S.C.
1395aaa(d)(2)) is amended by striking ``and $15,000,000 for
the first 6 months of fiscal year 2015'' and inserting ``and
$30,000,000 for each of fiscal years 2015 through 2017''.
SEC. 208. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR
LOW-INCOME PROGRAMS.
(a) Additional Funding for State Health Insurance
Programs.--Subsection (a)(1)(B) of section 119 of the
Medicare Improvements for Patients and Providers Act of 2008
(42 U.S.C. 1395b-3 note), as amended by section 3306 of the
Patient Protection and Affordable Care Act (Public Law 111-
148), section 610 of the American Taxpayer Relief Act of 2012
(Public Law 112-240), section 1110 of the Pathway for SGR
Reform Act of 2013 (Public Law 113-67), and section 110 of
the Protecting Access to Medicare Act of 2014 (Public Law
113-93), is amended--
(1) in clause (iv), by striking ``and'' at the end;
(2) by striking clause (v); and
(3) by adding at the end the following new clauses:
``(v) for fiscal year 2015, of $7,500,000;
``(vi) for fiscal year 2016, of $13,000,000; and
``(vii) for fiscal year 2017, of $13,000,000.''.
(b) Additional Funding for Area Agencies on Aging.--
Subsection (b)(1)(B) of such section 119, as so amended, is
amended--
(1) in clause (iv), by striking ``and'' at the end;
(2) by striking clause (v); and
(3) by inserting after clause (iv) the following new
clauses:
``(v) for fiscal year 2015, of $7,500,000;
``(vi) for fiscal year 2016, of $7,500,000; and
``(vii) for fiscal year 2017, of $7,500,000.''.
(c) Additional Funding for Aging and Disability Resource
Centers.--Subsection (c)(1)(B) of such section 119, as so
amended, is amended--
(1) in clause (iv), by striking ``and'' at the end;
(2) by striking clause (v); and
(3) by inserting after clause (iv) the following new
clauses:
``(v) for fiscal year 2015, of $5,000,000;
``(vi) for fiscal year 2016, of $5,000,000; and
``(vii) for fiscal year 2017, of $5,000,000.''.
(d) Additional Funding for Contract With the National
Center for Benefits and Outreach Enrollment.--Subsection
(d)(2) of such section 119, as so amended, is amended--
(1) in clause (iv), by striking ``and'' at the end;
(2) by striking clause (v); and
(3) by inserting after clause (iv) the following new
clauses:
``(v) for fiscal year 2015, of $5,000,000;
``(vi) for fiscal year 2016, of $12,000,000; and
``(vii) for fiscal year 2017, of $12,000,000.''.
SEC. 209. EXTENSION AND TRANSITION OF REASONABLE COST
REIMBURSEMENT CONTRACTS.
(a) One-Year Transition and Notice Regarding Transition.--
Section 1876(h)(5)(C) of the Social Security Act (42 U.S.C.
1395mm(h)(5)(C)) is amended--
(1) in clause (ii), in the matter preceding subclause (I),
by striking ``For any'' and inserting ``Subject to clause
(iv), for any'';
(2) in clause (iii)(I), by inserting ``cost plan service''
after ``With respect to any portion of the'';
(3) in clause (iii)(II), by inserting ``cost plan service''
after ``With respect to any other portion of such''; and
(4) by adding at the end the following new clauses:
``(iv) In the case of an eligible organization that is
offering a reasonable cost reimbursement contract that may no
longer be extended or renewed because of the application of
clause (ii), or where such contract has been extended or
renewed but the eligible organization has informed the
Secretary in writing not later than a date determined
appropriate by the Secretary that such organization
voluntarily plans not to seek renewal of the reasonable cost
reimbursement contract, the following shall apply:
``(I) Notwithstanding such clause, such contract may be
extended or renewed for the two years subsequent to 2016. The
final year in which such contract is extended or renewed is
referred to in this subsection as the `last reasonable cost
reimbursement contract year for the contract'.
``(II) The organization may not enroll a new enrollee under
such contract during the last reasonable cost reimbursement
contract year for the contract (but may continue to enroll
new enrollees through the end of the year immediately
preceding such year) unless such enrollee is any of the
following:
``(aa) An individual who chooses enrollment in the
reasonable cost contract during the annual election period
with respect to such last year.
``(bb) An individual whose spouse, at the time of the
individual's enrollment is an enrollee under the reasonable
cost reimbursement contract.
``(cc) An individual who is covered under an employer group
health plan that offers coverage through the reasonable cost
reimbursement contract.
``(dd) An individual who becomes entitled to benefits under
part A, or enrolled under part B, and was enrolled in a plan
offered by the eligible organization immediately prior to the
individual's enrollment under the reasonable cost
reimbursement contract.
``(III) Not later than a date determined appropriate by the
Secretary prior to the beginning of the last reasonable cost
reimbursement contract year for the contract, the
organization shall provide notice to the Secretary as to
whether the organization will apply to have the contract
converted over, in whole or in part, and offered as a
Medicare Advantage plan under part C for the year following
the last reasonable cost reimbursement contract year for the
contract.
``(IV) If the organization provides the notice described in
subclause (III) that the contract will be converted, in whole
or in part, the organization shall, not later than a date
determined appropriate by the Secretary, provide the
Secretary with such information as the Secretary determines
appropriate in order to carry out section 1851(c)(4) and to
carry out section 1854(a)(5), including subparagraph (C)(ii)
of such section.
``(V) In the case that the organization enrolls a new
enrollee under such contract during the last reasonable cost
reimbursement contract year for the contract, the
organization shall provide the individual with a notification
that such year is the last year for such contract.
``(v) If an eligible organization that is offering a
reasonable cost reimbursement contract that is extended or
renewed pursuant to clause (iv) provides the notice described
in clause (iv)(III) that the contract will be converted, in
whole or in part, the following shall apply:
``(I) The deemed enrollment under section 1851(c)(4).
``(II) The special rule for quality increase under section
1853(o)(4)(C).
``(III) During the last reasonable cost reimbursement
contract year for the contract and the year immediately
preceding such year, the eligible organization, or the
corporate parent organization of the eligible organization,
shall be permitted to offer an MA plan in the area that such
contract is being offered and enroll Medicare Advantage
eligible individuals in such MA plan and such cost plan.''.
[[Page H2062]]
(b) Deemed Enrollment From Reasonable Cost Reimbursement
Contracts Converted to Medicare Advantage Plans.--
(1) In general.--Section 1851(c) of the Social Security Act
(42 U.S.C. 1395w-21(c)) is amended--
(A) in paragraph (1), by striking ``Such elections'' and
inserting ``Subject to paragraph (4), such elections''; and
(B) by adding at the end the following:
``(4) Deemed enrollment relating to converted reasonable
cost reimbursement contracts.--
``(A) In general.--On the first day of the annual,
coordinated election period under subsection (e)(3) for plan
years beginning on or after January 1, 2017, an MA eligible
individual described in clause (i) or (ii) of subparagraph
(B) is deemed, unless the individual elects otherwise, to
have elected to receive benefits under this title through an
applicable MA plan (and shall be enrolled in such plan)
beginning with such plan year, if--
``(i) the individual is enrolled in a reasonable cost
reimbursement contract under section 1876(h) in the previous
plan year;
``(ii) such reasonable cost reimbursement contract was
extended or renewed for the last reasonable cost
reimbursement contract year of the contract (as described in
subclause (I) of section 1876(h)(5)(C)(iv)) pursuant to such
section;
``(iii) the eligible organization that is offering such
reasonable cost reimbursement contract provided the notice
described in subclause (III) of such section that the
contract was to be converted;
``(iv) the applicable MA plan--
``(I) is the plan that was converted from the reasonable
cost reimbursement contract described in clause (iii);
``(II) is offered by the same entity (or an organization
affiliated with such entity that has a common ownership
interest of control) that entered into such contract; and
``(III) is offered in the service area where the individual
resides;
``(v) in the case of reasonable cost reimbursement
contracts that provide coverage under parts A and B (and, to
the extent the Secretary determines it to be feasible,
contracts that provide only part B coverage), the difference
between the estimated individual costs (as determined
applicable by the Secretary) for the applicable MA plan and
such costs for the predecessor cost plan does not exceed a
threshold established by the Secretary; and
``(vi) the applicable MA plan--
``(I) provides coverage for enrollees transitioning from
the converted reasonable cost reimbursement contract to such
plan to maintain current providers of services and suppliers
and course of treatment at the time of enrollment for a
period of at least 90 days after enrollment; and
``(II) during such period, pays such providers of services
and suppliers for items and services furnished to the
enrollee an amount that is not less than the amount of
payment applicable for such items and services under the
original Medicare fee-for-service program under parts A and
B.
``(B) MA eligible individuals described.--
``(i) Without prescription drug coverage.--An MA eligible
individual described in this clause, with respect to a plan
year, is an MA eligible individual who is enrolled in a
reasonable cost reimbursement contract under section 1876(h)
in the previous plan year and who is not, for such previous
plan year, enrolled in a prescription drug plan under part D,
including coverage under section 1860D-22.
``(ii) With prescription drug coverage.--An MA eligible
individual described in this clause, with respect to a plan
year, is an MA eligible individual who is enrolled in a
reasonable cost reimbursement contract under section 1876(h)
in the previous plan year and who, for such previous plan
year, is enrolled in a prescription drug plan under part D--
``(I) through such contract; or
``(II) through a prescription drug plan, if the sponsor of
such plan is the same entity (or an organization affiliated
with such entity) that entered into such contract.
``(C) Applicable ma plan defined.--In this paragraph, the
term `applicable MA plan' means, in the case of an individual
described in--
``(i) subparagraph (B)(i), an MA plan that is not an MA-PD
plan; and
``(ii) subparagraph (B)(ii), an MA-PD plan.
``(D) Identification and notification of deemed
individuals.--Not later than 45 days before the first day of
the annual, coordinated election period under subsection
(e)(3) for plan years beginning on or after January 1, 2017,
the Secretary shall identify and notify the individuals who
will be subject to deemed elections under subparagraph (A) on
the first day of such period.''.
(2) Beneficiary option to discontinue or change ma plan or
ma-pd plan after deemed enrollment.--
(A) In general.--Section 1851(e)(2) of the Social Security
Act (42 U.S.C. 1395w-21(e)(4)) is amended by adding at the
end the following:
``(F) Special period for certain deemed elections.--
``(i) In general.--At any time during the period beginning
after the last day of the annual, coordinated election period
under paragraph (3) in which an individual is deemed to have
elected to enroll in an MA plan or MA-PD plan under
subsection (c)(4) and ending on the last day of February of
the first plan year for which the individual is enrolled in
such plan, such individual may change the election under
subsection (a)(1) (including changing the MA plan or MA-PD
plan in which the individual is enrolled).
``(ii) Limitation of one change.--An individual may
exercise the right under clause (i) only once during the
applicable period described in such clause. The limitation
under this clause shall not apply to changes in elections
effected during an annual, coordinated election period under
paragraph (3) or during a special enrollment period under
paragraph (4).''.
(B) Conforming amendments.--
(i) Plan requirement for open enrollment.--Section
1851(e)(6)(A) of the Social Security Act (42 U.S.C. 1395w-
21(e)(6)(A)) is amended by striking ``paragraph (1),'' and
inserting ``paragraph (1), during the period described in
paragraph (2)(F),''.
(ii) Part d.--Section 1860D-1(b)(1)(B) of such Act (42
U.S.C. 1395w-101(b)(1)(B)) is amended--
(I) in clause (ii), by adding ``and paragraph (4)'' after
``paragraph (3)(A)''; and
(II) in clause (iii) by striking ``and (E)'' and inserting
``(E), and (F)''.
(3) Treatment of esrd for deemed enrollment.--Section
1851(a)(3)(B) of the Social Security Act (42 U.S.C. 1395w-
21(a)(3)(B)) is amended by adding at the end the following
flush sentence: ``An individual who develops end-stage renal
disease while enrolled in a reasonable cost reimbursement
contract under section 1876(h) shall be treated as an MA
eligible individual for purposes of applying the deemed
enrollment under subsection (c)(4).''.
(c) Information Requirements.--Section 1851(d)(2)(B) of the
Social Security Act (42 U.S.C. 1395w-21(d)(2)(B)) is
amended--
(1) in the heading, by striking ``Notification to newly
eligible medicare advantage eligible individuals'' and
inserting the following: ``Notifications required.--
``(i) Notification to newly eligible medicare advantage
eligible individuals.--''; and
(2) by adding at the end the following new clause:
``(ii) Notification related to certain deemed elections.--
The Secretary shall require a Medicare Advantage organization
that is offering a Medicare Advantage plan that has been
converted from a reasonable cost reimbursement contract
pursuant to section 1876(h)(5)(C)(iv) to mail, not later than
30 days prior to the first day of the annual, coordinated
election period under subsection (e)(3) of a year, to any
individual enrolled under such contract and identified by the
Secretary under subsection (c)(4)(D) for such year--
``(I) a notification that such individual will, on such
day, be deemed to have made an election with respect to such
plan to receive benefits under this title through an MA plan
or MA-PD plan (and shall be enrolled in such plan) for the
next plan year under subsection (c)(4)(A), but that the
individual may make a different election during the annual,
coordinated election period for such year;
``(II) the information described in subparagraph (A);
``(III) a description of the differences between such MA
plan or MA-PD plan and the reasonable cost reimbursement
contract in which the individual was most recently enrolled
with respect to benefits covered under such plans, including
cost-sharing, premiums, drug coverage, and provider networks;
``(IV) information about the special period for elections
under subsection (e)(2)(F); and
``(V) other information the Secretary may specify.''.
(d) Treatment of Transition Plan for Quality Rating for
Payment Purposes.--Section 1853(o)(4) of the Social Security
Act (42 U.S.C. 1395w-23(o)(4)) is amended by adding at the
end the following new subparagraph:
``(C) Special rule for first 3 plan years for plans that
were converted from a reasonable cost reimbursement
contract.--For purposes of applying paragraph (1) and section
1854(b)(1)(C) for the first 3 plan years under this part in
the case of an MA plan to which deemed enrollment applies
under section 1851(c)(4)--
``(i) such plan shall not be treated as a new MA plan (as
defined in paragraph (3)(A)(iii)(II)); and
``(ii) in determining the star rating of the plan under
subparagraph (A), to the extent that Medicare Advantage data
for such plan is not available for a measure used to
determine such star rating, the Secretary shall use data from
the period in which such plan was a reasonable cost
reimbursement contract.''.
SEC. 210. EXTENSION OF HOME HEALTH RURAL ADD-ON.
Section 421(a) of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (Public Law 108-
173; 117 Stat. 2283; 42 U.S.C. 1395fff note), as amended by
section 5201(b) of the Deficit Reduction Act of 2005 (Public
Law 109-171; 120 Stat. 46) and by section 3131(c) of the
Patient Protection and Affordable Care Act (Public Law 111-
148; 124 Stat. 428), is amended by striking ``January 1,
2016'' and inserting ``January 1, 2018'' each place it
appears.
Subtitle B--Other Health Extenders
SEC. 211. PERMANENT EXTENSION OF THE QUALIFYING INDIVIDUAL
(QI) PROGRAM.
(a) Permanent Extension.--Section 1902(a)(10)(E)(iv) of the
Social Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is
amended by striking ``(but only for premiums payable
[[Page H2063]]
with respect to months during the period beginning with
January 1998, and ending with March 2015)''.
(b) Allocations.--Section 1933(g) of the Social Security
Act (42 U.S.C. 1396u-3(g)) is amended--
(1) in paragraph (2)--
(A) by striking subparagraphs (A) through (H);
(B) in subparagraph (V), by striking ``and'' at the end;
(C) in subparagraph (W), by striking the period at the end
and inserting a semicolon;
(D) by redesignating subparagraphs (I) through (W) as
subparagraphs (A) through (O), respectively; and
(E) by adding at the end the following new subparagraphs:
``(P) for the period that begins on April 1, 2015, and ends
on December 31, 2015, the total allocation amount is
$535,000,000; and
``(Q) for 2016 and, subject to paragraph (4), for each
subsequent year, the total allocation amount is
$980,000,000.'';
(2) in paragraph (3), by striking ``(P), (R), (T), or (V)''
and inserting ``or (P)''; and
(3) by adding at the end the following new paragraph:
``(4) Adjustment to allocations.--The Secretary may
increase the allocation amount under paragraph (2)(Q) for a
year (beginning with 2017) up to an amount that does not
exceed the product of the following:
``(A) Maximum allocation amount for previous year.--In the
case of 2017, the allocation amount for 2016, or in the case
of a subsequent year, the maximum allocation amount allowed
under this paragraph for the previous year.
``(B) Increase in part b premium.--The monthly premium rate
determined under section 1839 for the year divided by the
monthly premium rate determined under such section for the
previous year.
``(C) Increase in part b enrollment.--The average number of
individuals (as estimated by the Chief Actuary of the Centers
for Medicare & Medicaid Services in September of the previous
year) to be enrolled under part B of title XVIII for months
in the year divided by the average number of such individuals
(as so estimated) under this subparagraph with respect to
enrollments in months in the previous year.''.
SEC. 212. PERMANENT EXTENSION OF TRANSITIONAL MEDICAL
ASSISTANCE (TMA).
(a) In General.--Section 1925 of the Social Security Act
(42 U.S.C. 1396r-6) is amended--
(1) by striking subsection (f); and
(2) by redesignating subsection (g) as subsection (f).
(b) Conforming Amendment.--Section 1902(e)(1) of the Social
Security Act (42 U.S.C. 1396a(e)(1)) is amended to read as
follows:
``(1) Beginning April 1, 1990, for provisions relating to
the extension of eligibility for medical assistance for
certain families who have received aid pursuant to a State
plan approved under part A of title IV and have earned
income, see section 1925.''.
SEC. 213. EXTENSION OF SPECIAL DIABETES PROGRAM FOR TYPE I
DIABETES AND FOR INDIANS.
(a) Special Diabetes Programs for Type I Diabetes.--Section
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C.
254c-2(b)(2)(C)) is amended by striking ``2015'' and
inserting ``2017''.
(b) Special Diabetes Programs for Indians.--Section
330C(c)(2)(C) of the Public Health Service Act (42 U.S.C.
254c-3(c)(2)(C)) is amended by striking ``2015'' and
inserting ``2017''.
SEC. 214. EXTENSION OF ABSTINENCE EDUCATION.
(a) In General.--Section 510 of the Social Security Act (42
U.S.C. 710) is amended--
(1) in subsection (a), striking ``2015'' and inserting
``2017''; and
(2) in subsection (d), by inserting ``and an additional
$75,000,000 for each of fiscal years 2016 and 2017'' after
``2015''.
(b) Budget Scoring.--Notwithstanding section 257(b)(2) of
the Balanced Budget and Emergency Deficit Control Act of
1985, the baseline shall be calculated assuming that no grant
shall be made under section 510 of the Social Security Act
(42 U.S.C. 710) after fiscal year 2017.
(c) Reallocation of Unused Funding.--The remaining
unobligated balances of the amount appropriated for fiscal
years 2016 and 2017 by section 510(d) of the Social Security
Act (42 U.S.C. 710(d)) for which no application has been
received by the Funding Opportunity Announcement deadline,
shall be made available to States that require the
implementation of each element described in subparagraphs (A)
through (H) of the definition of abstinence education in
section 510(b)(2). The remaining unobligated balances shall
be reallocated to such States that submit a valid application
consistent with the original formula for this funding.
SEC. 215. EXTENSION OF PERSONAL RESPONSIBILITY EDUCATION
PROGRAM (PREP).
Section 513 of the Social Security Act (42 U.S.C. 713) is
amended--
(1) in paragraphs (1)(A) and (4)(A) of subsection (a), by
striking ``2015'' and inserting ``2017'' each place it
appears;
(2) in subsection (a)(4)(B)(i), by striking ``, 2013, 2014,
and 2015'' and inserting ``through 2017''; and
(3) in subsection (f), by striking ``2015'' and inserting
``2017''.
SEC. 216. EXTENSION OF FUNDING FOR FAMILY-TO-FAMILY HEALTH
INFORMATION CENTERS.
Section 501(c)(1)(A) of the Social Security Act (42 U.S.C.
701(c)(1)(A)) is amended--
(1) by striking clause (vi); and
(2) by adding after clause (v) the following new clause:
``(vi) $5,000,000 for each of fiscal years 2015 through
2017.''.
SEC. 217. EXTENSION OF HEALTH WORKFORCE DEMONSTRATION PROJECT
FOR LOW-INCOME INDIVIDUALS.
Section 2008(c)(1) of the Social Security Act (42 U.S.C.
1397g(c)(1)) is amended by striking ``2015'' and inserting
``2017''.
SEC. 218. EXTENSION OF MATERNAL, INFANT, AND EARLY CHILDHOOD
HOME VISITING PROGRAMS.
Section 511(j)(1) of the Social Security Act (42 U.S.C.
711(j)) is amended--
(1) by striking ``and'' at the end of subparagraph (E);
(2) in subparagraph (F)--
(A) by striking ``for the period beginning on October 1,
2014, and ending on March 31, 2015'' and inserting ``for
fiscal year 2015'';
(B) by striking ``an amount equal to the amount provided in
subparagraph (E)'' and inserting ``$400,000,000''; and
(C) by striking the period at the end and inserting a
semicolon; and
(3) by adding at the end the following new subparagraphs:
``(G) for fiscal year 2016, $400,000,000; and
``(H) for fiscal year 2017, $400,000,000.''.
SEC. 219. TENNESSEE DSH ALLOTMENT FOR FISCAL YEARS 2015
THROUGH 2025.
Section 1923(f)(6)(A) of the Social Security Act (42 U.S.C.
1396r-4(f)(6)(A)) is amended by adding at the end the
following:
``(vi) Allotment for fiscal years 2015 through 2025.--
Notwithstanding any other provision of this subsection, any
other provision of law, or the terms of the TennCare
Demonstration Project in effect for the State, the DSH
allotment for Tennessee for fiscal year 2015, and for each
fiscal year thereafter through fiscal year 2025, shall be
$53,100,000 for each such fiscal year.''.
SEC. 220. DELAY IN EFFECTIVE DATE FOR MEDICAID AMENDMENTS
RELATING TO BENEFICIARY LIABILITY SETTLEMENTS.
Section 202(c) of the Bipartisan Budget Act of 2013
(division A of Public Law 113-67; 42 U.S.C. 1396a note), as
amended by section 211 of the Protecting Access to Medicare
Act of 2014 (Public Law 113-93; 128 Stat. 1047) is amended by
striking ``October 1, 2016'' and inserting ``October 1,
2017''.
SEC. 221. EXTENSION OF FUNDING FOR COMMUNITY HEALTH CENTERS,
THE NATIONAL HEALTH SERVICE CORPS, AND TEACHING
HEALTH CENTERS.
(a) Funding for Community Health Centers and the National
Health Service Corps.--
(1) Community health centers.--Section 10503(b)(1)(E) of
the Patient Protection and Affordable Care Act (42 U.S.C.
254b-2(b)(1)(E)) is amended by striking ``for fiscal year
2015'' and inserting ``for each of fiscal years 2015 through
2017''.
(2) National health service corps.--Section 10503(b)(2)(E)
of the Patient Protection and Affordable Care Act (42 U.S.C.
254b-2(b)(2)(E)) is amended by striking ``for fiscal year
2015'' and inserting ``for each of fiscal years 2015 through
2017''.
(b) Extension of Teaching Health Centers Program.--Section
340H(g) of the Public Health Service Act (42 U.S.C. 256h(g))
is amended by inserting ``and $60,000,000 for each of fiscal
years 2016 and 2017'' before the period at the end.
(c) Application.--Amounts appropriated pursuant to this
section for fiscal year 2016 and fiscal year 2017 are subject
to the requirements contained in Public Law 113-235 for funds
for programs authorized under sections 330 through 340 of the
Public Health Service Act (42 U.S.C. 254b-256).
TITLE III--CHIP
SEC. 301. 2-YEAR EXTENSION OF THE CHILDREN'S HEALTH INSURANCE
PROGRAM.
(a) Funding.--Section 2104(a) of the Social Security Act
(42 U.S.C. 1397dd(a)) is amended--
(1) in paragraph (17), by striking ``and'' at the end;
(2) in paragraph (18)(B), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following new paragraphs:
``(19) for fiscal year 2016, $19,300,000,000; and
``(20) for fiscal year 2017, for purposes of making 2 semi-
annual allotments--
``(A) $2,850,000,000 for the period beginning on October 1,
2016, and ending on March 31, 2017; and
``(B) $2,850,000,000 for the period beginning on April 1,
2017, and ending on September 30, 2017.''.
(b) Allotments.--
(1) In general.--Section 2104(m) of the Social Security Act
(42 U.S.C. 1397dd(m)) is amended--
(A) in the subsection heading, by striking ``Through 2015''
and inserting ``and Thereafter'';
(B) in paragraph (2)--
(i) in the paragraph heading, by striking ``2014'' and
inserting ``2016''; and
(ii) by striking subparagraph (B) and inserting the
following new subparagraph:
``(B) Fiscal year 2013 and each succeeding fiscal year.--
Subject to paragraphs (5) and (7), from the amount made
available under paragraphs (16) through (19) of subsection
(a) for fiscal year 2013 and each succeeding fiscal year,
respectively, the Secretary shall compute a State allotment
for each State (including the District of Columbia and each
[[Page H2064]]
commonwealth and territory) for each such fiscal year as
follows:
``(i) Rebasing in fiscal year 2013 and each succeeding odd-
numbered fiscal year.--For fiscal year 2013 and each
succeeding odd-numbered fiscal year (other than fiscal years
2015 and 2017), the allotment of the State is equal to the
Federal payments to the State that are attributable to (and
countable toward) the total amount of allotments available
under this section to the State in the preceding fiscal year
(including payments made to the State under subsection (n)
for such preceding fiscal year as well as amounts
redistributed to the State in such preceding fiscal year),
multiplied by the allotment increase factor under paragraph
(6) for such odd-numbered fiscal year.
``(ii) Growth factor update for fiscal year 2014 and each
succeeding even-numbered fiscal year.--Except as provided in
clauses (iii) and (iv), for fiscal year 2014 and each
succeeding even-numbered fiscal year, the allotment of the
State is equal to the sum of--
``(I) the amount of the State allotment under clause (i)
for the preceding fiscal year; and
``(II) the amount of any payments made to the State under
subsection (n) for such preceding fiscal year,
multiplied by the allotment increase factor under paragraph
(6) for such even-numbered fiscal year.
``(iii) Special rule for 2016.--For fiscal year 2016, the
allotment of the State is equal to the Federal payments to
the State that are attributable to (and countable toward) the
total amount of allotments available under this section to
the State in the preceding fiscal year (including payments
made to the State under subsection (n) for such preceding
fiscal year as well as amounts redistributed to the State in
such preceding fiscal year), but determined as if the last
two sentences of section 2105(b) were in effect in such
preceding fiscal year and then multiplying the result by the
allotment increase factor under paragraph (6) for fiscal year
2016.
``(iv) Reduction in 2018.--For fiscal year 2018, with
respect to the allotment of the State for fiscal year 2017,
any amounts of such allotment that remain available for
expenditure by the State in fiscal year 2018 shall be reduced
by one-third.'';
(C) in paragraph (4), by inserting ``or 2017'' after
``2015'';
(D) in paragraph (6)--
(i) in subparagraph (A), by striking ``2015'' and inserting
``2017''; and
(ii) in the second sentence, by striking ``or fiscal year
2014'' and inserting ``fiscal year 2014, or fiscal year
2016'';
(E) in paragraph (8)--
(i) in the paragraph heading, by striking ``fiscal year
2015'' and inserting ``fiscal years 2015 and 2017''; and
(ii) by inserting ``or fiscal year 2017'' after ``2015'';
(F) by redesignating paragraphs (4) through (8) as
paragraphs (5) through (9), respectively; and
(G) by inserting after paragraph (3) the following new
paragraph:
``(4) For fiscal year 2017.--
``(A) First half.--Subject to paragraphs (5) and (7), from
the amount made available under subparagraph (A) of paragraph
(20) of subsection (a) for the semi-annual period described
in such paragraph, increased by the amount of the
appropriation for such period under section 301(b)(3) of the
Medicare Access and CHIP Reauthorization Act of 2015, the
Secretary shall compute a State allotment for each State
(including the District of Columbia and each commonwealth and
territory) for such semi-annual period in an amount equal to
the first half ratio (described in subparagraph (D)) of the
amount described in subparagraph (C).
``(B) Second half.--Subject to paragraphs (5) and (7), from
the amount made available under subparagraph (B) of paragraph
(20) of subsection (a) for the semi-annual period described
in such paragraph, the Secretary shall compute a State
allotment for each State (including the District of Columbia
and each commonwealth and territory) for such semi-annual
period in an amount equal to the amount made available under
such subparagraph, multiplied by the ratio of--
``(i) the amount of the allotment to such State under
subparagraph (A); to
``(ii) the total of the amount of all of the allotments
made available under such subparagraph.
``(C) Full year amount based on rebased amount.--The amount
described in this subparagraph for a State is equal to the
Federal payments to the State that are attributable to (and
countable towards) the total amount of allotments available
under this section to the State in fiscal year 2016
(including payments made to the State under subsection (n)
for fiscal year 2016 as well as amounts redistributed to the
State in fiscal year 2016), multiplied by the allotment
increase factor under paragraph (6) for fiscal year 2017.
``(D) First half ratio.--The first half ratio described in
this subparagraph is the ratio of--
``(i) the sum of--
``(I) the amount made available under subsection
(a)(20)(A); and
``(II) the amount of the appropriation for such period
under section 301(b)(3) of the Medicare Access and CHIP
Reauthorization Act of 2015; to
``(ii) the sum of the--
``(I) amount described in clause (i); and
``(II) the amount made available under subsection
(a)(20)(B).''.
(2) Conforming amendments.----
(A) Section 2104(c)(1) of the Social Security Act (42
U.S.C. 1397dd(c)(1)) is amended by striking ``(m)(4)'' and
inserting ``(m)(5)''.
(B) Section 2104(m) of such Act (42 U.S.C. 1397dd(m)), as
amended by paragraph (1), is further amended--
(ii) in paragraph (1)--
(I) by striking ``paragraph (4)'' each place it appears in
subparagraphs (A) and (B) and inserting ``paragraph (5)'';
and
(II) by striking ``the allotment increase factor determined
under paragraph (5)'' each place it appears and inserting
``the allotment increase factor determined under paragraph
(6)'';
(iii) in paragraph (2)(A), by striking ``the allotment
increase factor under paragraph (5)'' and inserting ``the
allotment increase factor under paragraph (6)'';
(iv) in paragraph (3)--
(I) by striking ``paragraphs (4) and (6)'' and inserting
``paragraphs (5) and (7)'' each place it appears; and
(II) by striking ``the allotment increase factor under
paragraph (5)'' and inserting ``the allotment increase factor
under paragraph (6)'';
(v) in paragraph (5) (as redesignated by paragraph (1)(F)),
by striking ``paragraph (1), (2), or (3)'' and inserting
``paragraph (1), (2), (3), or (4)'';
(vi) in paragraph (7) (as redesignated by paragraph
(1)(F)), by striking ``subject to paragraph (4)'' and
inserting ``subject to paragraph (5)''; and
(vii) in paragraph (9), (as redesignated by paragraph
(1)(F)), by striking ``paragraph (3)'' and inserting
``paragraph (3) or (4)''.
(C) Section 2104(n)(3)(B)(ii) of such Act (42 U.S.C.
1397dd(n)(3)(B)(ii)) is amended by striking ``subsection
(m)(5)(B)'' and inserting ``subsection (m)(6)(B)''.
(D) Section 2111(b)(2)(B)(i) of such Act (42 U.S.C.
1397kk(b)(2)(B)(i)) is amended by striking ``section
2104(m)(4)'' and inserting ``section 2104(m)(5)''.
(3) One-time appropriation for fiscal year 2017.--There is
appropriated to the Secretary of Health and Human Services,
out of any money in the Treasury not otherwise appropriated,
$14,700,000,000 to accompany the allotment made for the
period beginning on October 1, 2016, and ending on March 31,
2017, under paragraph (20)(A) of section 2104(a) of the
Social Security Act (42 U.S.C. 1397dd(a)) (as added by
subsection (a)(1)), to remain available until expended. Such
amount shall be used to provide allotments to States under
paragraph (4) of section 2104(m) of such Act (42 U.S.C.
1397dd(m)) (as amended by paragraph (1)(G)) for the first 6
months of fiscal year 2017 in the same manner as allotments
are provided under subsection (a)(20)(A) of such section 2104
and subject to the same terms and conditions as apply to the
allotments provided from such subsection (a)(20)(A).
(c) Extension of Qualifying States Option.--Section
2105(g)(4) of the Social Security Act (42 U.S.C.
1397ee(g)(4)) is amended--
(1) in the paragraph heading, by striking ``2015'' and
inserting ``2017''; and
(2) in subparagraph (A), by striking ``2015'' and inserting
``2017''.
(d) Extension of the Child Enrollment Contingency Fund.--
(1) In general.--Section 2104(n) of the Social Security Act
(42 U.S.C. 1397dd(n)) is amended--
(A) in paragraph (2)--
(i) in subparagraph (A)(ii)--
(I) by striking ``2010 through 2014'' and inserting ``2010,
2011, 2012, 2013, 2014, and 2016''; and
(II) by inserting ``and fiscal year 2017'' after ``2015'';
and
(ii) in subparagraph (B)--
(I) by striking ``2010 through 2014'' and inserting ``2010,
2011, 2012, 2013, 2014, and 2016''; and
(II) by inserting ``and fiscal year 2017'' after ``2015'';
and
(B) in paragraph (3)(A), in the matter preceding clause
(i), by striking ``fiscal year 2009, fiscal year 2010, fiscal
year 2011, fiscal year 2012, fiscal year 2013, fiscal year
2014, or a semi-annual allotment period for fiscal year
2015'' and inserting ``any of fiscal years 2009 through 2014,
fiscal year 2016, or a semi-annual allotment period for
fiscal year 2015 or 2017''.
SEC. 302. EXTENSION OF EXPRESS LANE ELIGIBILITY.
Section 1902(e)(13)(I) of the Social Security Act (42
U.S.C. 1396a(e)(13)(I)) is amended by striking ``2015'' and
inserting ``2017''.
SEC. 303. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM.
Section 2113 of the Social Security Act (42 U.S.C. 1397mm)
is amended--
(1) in subsection (a)(1), by striking ``2015'' and
inserting ``2017''; and
(2) in subsection (g), by inserting ``and $40,000,000 for
the period of fiscal years 2016 and 2017'' after ``2015''.
SEC. 304. EXTENSION OF CERTAIN PROGRAMS AND DEMONSTRATION
PROJECTS.
(a) Childhood Obesity Demonstration Project.--Section
1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b-
9a(e)(8)) is amended by inserting ``, and $10,000,000 for the
period of fiscal years 2016 and 2017'' after ``2014''.
(b) Pediatric Quality Measures Program.--Section 1139A(i)
of the Social Security Act (42 U.S.C. 1320b-9a(i)) is amended
in the first sentence by inserting before the period at the
end the following: ``, and there is
[[Page H2065]]
appropriated for the period of fiscal years 2016 and 2017,
$20,000,000 for the purpose of carrying out this section
(other than subsections (e), (f), and (g))''.
SEC. 305. REPORT OF INSPECTOR GENERAL OF HHS ON USE OF
EXPRESS LANE OPTION UNDER MEDICAID AND CHIP.
Not later than 18 months after the date of the enactment of
this Act, the Inspector General of the Department of Health
and Human Services shall submit to the Committee on Energy
and Commerce of the House of Representatives and the
Committee on Finance of the Senate a report that--
(1) provides data on the number of individuals enrolled in
the Medicaid program under title XIX of the Social Security
Act (referred to in this section as ``Medicaid'') and the
Children's Health Insurance Program under title XXI of such
Act (referred to in this section as ``CHIP'') through the use
of the Express Lane option under section 1902(e)(13) of the
Social Security Act (42 U.S.C. 1396a(e)(13));
(2) assesses the extent to which individuals so enrolled
meet the eligibility requirements under Medicaid or CHIP (as
applicable); and
(3) provides data on Federal and State expenditures under
Medicaid and CHIP for individuals so enrolled and
disaggregates such data between expenditures made for
individuals who meet the eligibility requirements under
Medicaid or CHIP (as applicable) and expenditures made for
individuals who do not meet such requirements.
TITLE IV--OFFSETS
Subtitle A--Medicare Beneficiary Reforms
SEC. 401. LIMITATION ON CERTAIN MEDIGAP POLICIES FOR NEWLY
ELIGIBLE MEDICARE BENEFICIARIES.
Section 1882 of the Social Security Act (42 U.S.C. 1395ss)
is amended by adding at the end the following new subsection:
``(z) Limitation on Certain Medigap Policies for Newly
Eligible Medicare Beneficiaries.--
``(1) In general.--Notwithstanding any other provision of
this section, on or after January 1, 2020, a medicare
supplemental policy that provides coverage of the part B
deductible, including any such policy (or rider to such a
policy) issued under a waiver granted under subsection
(p)(6), may not be sold or issued to a newly eligible
Medicare beneficiary.
``(2) Newly eligible medicare beneficiary defined.--In this
subsection, the term `newly eligible Medicare beneficiary'
means an individual who is neither of the following:
``(A) An individual who has attained age 65 before January
1, 2020.
``(B) An individual who was entitled to benefits under part
A pursuant to section 226(b) or 226A, or deemed to be
eligible for benefits under section 226(a), before January 1,
2020.
``(3) Treatment of waivered states.--In the case of a State
described in subsection (p)(6), nothing in this section shall
be construed as preventing the State from modifying its
alternative simplification program under such subsection so
as to eliminate the coverage of the part B deductible for any
medical supplemental policy sold or issued under such program
to a newly eligible Medicare beneficiary on or after January
1, 2020.
``(4) Treatment of references to certain policies.--In the
case of a newly eligible Medicare beneficiary, except as the
Secretary may otherwise provide, any reference in this
section to a medicare supplemental policy which has a benefit
package classified as `C' or `F' shall be deemed, as of
January 1, 2020, to be a reference to a medicare supplemental
policy which has a benefit package classified as `D' or `G',
respectively.
``(5) Enforcement.--The penalties described in clause (ii)
of subsection (d)(3)(A) shall apply with respect to a
violation of paragraph (1) in the same manner as it applies
to a violation of clause (i) of such subsection.''.
SEC. 402. INCOME-RELATED PREMIUM ADJUSTMENT FOR PARTS B AND
D.
(a) In General.--Section 1839(i)(3)(C)(i) of the Social
Security Act (42 U.S.C. 1395r(i)(3)(C)(i)) is amended--
(1) by inserting after ``In general.--'' the following:
``(I) Subject to paragraphs (5) and (6), for years before
2018:''; and
(2) by adding at the end the following:
``(II) Subject to paragraph (5), for years beginning with
2018:
``If the modified adjusted gross income is: The applicable
percentage is:
More than $85,000 but not more than $107,000..... 35 percent
More than $107,000 but not more than $133,500.... 50 percent
More than $133,500 but not more than $160,000.... 65 percent
More than $160,000............................... 80 percent.''.
(b) Conforming Amendments.--Section 1839(i) of the Social
Security Act (42 U.S.C. 1395r(i)) is amended--
(1) in paragraph (2)(A), by inserting ``(or, beginning with
2018, $85,000)'' after ``$80,000'';
(2) in paragraph (3)(A)(i), by inserting ``applicable''
before ``table'';
(3) in paragraph (5)(A)--
(A) in the matter before clause (i), by inserting ``(other
than 2018 and 2019)'' after ``2007''; and
(B) in clause (ii), by inserting ``(or, in the case of a
calendar year beginning with 2020, August 2018)'' after
``August 2006''; and
(4) in paragraph (6), in the matter before subparagraph
(A), by striking ``2019'' and inserting ``2017''.
Subtitle B--Other Offsets
SEC. 411. MEDICARE PAYMENT UPDATES FOR POST-ACUTE PROVIDERS.
(a) SNFs.--Section 1888(e) of the Social Security Act (42
U.S.C. 1395yy(e))--
(1) in paragraph (5)(B)--
(A) in clause (i), by striking ``clause (ii)'' and
inserting ``clauses (ii) and (iii)'';
(B) in clause (ii), by inserting ``subject to clause
(iii),'' after ``each subsequent fiscal year,''; and
(C) by adding at the end the following new clause:
``(iii) Special rule for fiscal year 2018.--For fiscal year
2018 (or other similar annual period specified in clause
(i)), the skilled nursing facility market basket percentage,
after application of clause (ii), is equal to 1 percent.'';
and
(2) in paragraph (6)(A), by striking ``paragraph
(5)(B)(ii)'' and inserting ``clauses (ii) and (iii) of
paragraph (5)(B)'' each place it appears.
(b) IRFs.--Section 1886(j) of the Social Security Act (42
U.S.C. 1395ww(j)) is amended--
(1) in paragraph (3)(C)--
(A) in clause (i), by striking ``clause (ii)'' and
inserting ``clauses (ii) and (iii)'';
(B) in clause (ii), by striking ``After'' and inserting
``Subject to clause (iii), after''; and
(C) by adding at the end the following new clause:
``(iii) Special rule for fiscal year 2018.--The increase
factor to be applied under this subparagraph for fiscal year
2018, after the application of clause (ii), shall be 1
percent.''; and
(2) in paragraph (7)(A)(i), by striking ``paragraph
(3)(D)'' and inserting ``subparagraphs (C)(iii) and (D) of
paragraph (3)''.
(c) HHAs.--Section 1895(b)(3)(B) of the Social Security Act
(42 U.S.C. 1395fff(b)(3)(B)) is amended--
(1) in clause (iii), by adding at the end the following:
``Notwithstanding the previous sentence, the home health
market basket percentage increase for 2018 shall be 1
percent.''; and
(2) in clause (vi)(I), by inserting ``(except 2018)'' after
``each subsequent year''.
(d) Hospice.--Section 1814(i) of the Social Security Act
(42 U.S.C. 1395f(i)) is amended--
(1) in paragraph (1)(C)--
(A) in clause (ii)(VII), by striking ``clause (iv),,'' and
inserting ``clauses (iv) and (vi),'';
(B) in clause (iii), by striking ``clause (iv),'' and
inserting ``clauses (iv) and (vi),'';
(C) in clause (iv), by striking ``After determining'' and
inserting ``Subject to clause (vi), after determining''; and
(D) by adding at the end the following new clause:
``(vi) For fiscal year 2018, the market basket percentage
increase under clause (ii)(VII) or (iii), as applicable,
after application of clause (iv), shall be 1 percent.''; and
(2) in paragraph (5)(A)(i), by striking ``paragraph
(1)(C)(iv)'' and inserting ``clauses (iv) and (vi) of
paragraph (1)(C)''.
(e) LTCHs.--Section 1886(m)(3) of the Social Security Act
(42 U.S.C. 1395ww(m)(3)) is amended--
(1) in subparagraph (A), in the matter preceding clause
(i), by striking ``In implementing'' and inserting ``Subject
to subparagraph (C), in implementing''; and
(2) by adding at the end the following new subparagraph:
``(C) Additional special rule.--For fiscal year 2018, the
annual update under subparagraph (A) for the fiscal year,
after application of clauses (i) and (ii) of subparagraph
(A), shall be 1 percent.''.
SEC. 412. DELAY OF REDUCTION TO MEDICAID DSH ALLOTMENTS.
Section 1923(f) of the Social Security Act (42 U.S.C.
1396r-4(f)) is amended--
(1) in paragraph (7)(A)--
(A) in clause (i), by striking ``2017 through 2024'' and
inserting ``2018 through 2025'';
(B) by striking clause (ii) and inserting the following new
clause:
``(ii) Aggregate reductions.--The aggregate reductions in
DSH allotments for all States under clause (i)(I) shall be
equal to--
``(I) $2,000,000,000 for fiscal year 2018;
``(II) $3,000,000,000 for fiscal year 2019;
``(III) $4,000,000,000 for fiscal year 2020;
``(IV) $5,000,000,000 for fiscal year 2021;
``(V) $6,000,000,000 for fiscal year 2022;
``(VI) $7,000,000,000 for fiscal year 2023;
``(VII) $8,000,000,000 for fiscal year 2024; and
``(VIII) $8,000,000,000 for fiscal year 2025.''; and
[[Page H2066]]
(C) by adding at the end the following new clause:
``(v) Distribution of aggregate reductions.--The Secretary
shall distribute the aggregate reductions under clause (ii)
among States in accordance with subparagraph (B).''; and
(2) in paragraph (8), by striking ``2024'' and inserting
``2025''.
SEC. 413. LEVY ON DELINQUENT PROVIDERS.
(a) In General.--Paragraph (3) of section 6331(h) of the
Internal Revenue Code of 1986 is amended by striking ``30
percent'' and inserting ``100 percent''.
(b) Effective Date.--The amendment made by this section
shall apply to payments made after 180 days after the date of
the enactment of this Act.
SEC. 414. ADJUSTMENTS TO INPATIENT HOSPITAL PAYMENT RATES.
Section 7(b) of the TMA, Abstinence Education, and QI
Programs Extension Act of 2007 (Public Law 110-90), as
amended by section 631(b) of the American Taxpayer Relief Act
of 2012 (Public Law 112-240), is amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A), by striking
``, 2009, or 2010'' and inserting ``or 2009''; and
(B) in subparagraph (B)--
(i) in clause (i), by striking ``and'' at the end;
(ii) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(iii) by adding at the end the following new clause:
``(iii) make an additional adjustment to the standardized
amounts under such section 1886(d) of an increase of 0.5
percentage points for discharges occurring during each of
fiscal years 2018 through 2023 and not make the adjustment
(estimated to be an increase of 3.2 percent) that would
otherwise apply for discharges occurring during fiscal year
2018 by reason of the completion of the adjustments required
under clause (ii).'';
(2) in paragraph (3)--
(A) by striking ``shall be construed'' and all that follows
through ``providing authority'' and inserting ``shall be
construed as providing authority''; and
(B) by inserting ``and each succeeding fiscal year through
fiscal year 2023'' after ``2017'';
(3) by redesignating paragraphs (3) and (4) as paragraphs
(4) and (5), respectively; and
(4) by inserting after paragraph (2) the following new
paragraph:
``(3) Prohibition.--The Secretary shall not make an
additional prospective adjustment (estimated to be a decrease
of 0.55 percent) to the standardized amounts under such
section 1886(d) to offset the amount of the increase in
aggregate payments related to documentation and coding
changes for discharges occurring during fiscal year 2010.''.
TITLE V--MISCELLANEOUS
Subtitle A--Protecting the Integrity of Medicare
SEC. 501. PROHIBITION OF INCLUSION OF SOCIAL SECURITY ACCOUNT
NUMBERS ON MEDICARE CARDS.
(a) In General.--Section 205(c)(2)(C) of the Social
Security Act (42 U.S.C. 405(c)(2)(C)) is amended--
(1) by moving clause (x), as added by section 1414(a)(2) of
the Patient Protection and Affordable Care Act, 6 ems to the
left;
(2) by redesignating clause (x), as added by section
2(a)(1) of the Social Security Number Protection Act of 2010,
and clause (xi) as clauses (xi) and (xii), respectively; and
(3) by adding at the end the following new clause:
``(xiii) The Secretary of Health and Human Services, in
consultation with the Commissioner of Social Security, shall
establish cost-effective procedures to ensure that a Social
Security account number (or derivative thereof) is not
displayed, coded, or embedded on the Medicare card issued to
an individual who is entitled to benefits under part A of
title XVIII or enrolled under part B of title XVIII and that
any other identifier displayed on such card is not
identifiable as a Social Security account number (or
derivative thereof).''.
(b) Implementation.--In implementing clause (xiii) of
section 205(c)(2)(C) of the Social Security Act (42 U.S.C.
405(c)(2)(C)), as added by subsection (a)(3), the Secretary
of Health and Human Services shall do the following:
(1) In general.--Establish a cost-effective process that
involves the least amount of disruption to, as well as
necessary assistance for, Medicare beneficiaries and health
care providers, such as a process that provides such
beneficiaries with access to assistance through a toll-free
telephone number and provides outreach to providers.
(2) Consideration of medicare beneficiary identified.--
Consider implementing a process, similar to the process
involving Railroad Retirement Board beneficiaries, under
which a Medicare beneficiary identifier which is not a Social
Security account number (or derivative thereof) is used
external to the Department of Health and Human Services and
is convertible over to a Social Security account number (or
derivative thereof) for use internal to such Department and
the Social Security Administration.
(c) Funding for Implementation.--For purposes of
implementing the provisions of and the amendments made by
this section, the Secretary of Health and Human Services
shall provide for the following transfers from the Federal
Hospital Insurance Trust Fund under section 1817 of the
Social Security Act (42 U.S.C. 1395i) and from the Federal
Supplementary Medical Insurance Trust Fund established under
section 1841 of such Act (42 U.S.C. 1395t), in such
proportions as the Secretary determines appropriate:
(1) To the Centers for Medicare & Medicaid Program
Management Account, transfers of the following amounts:
(A) For fiscal year 2015, $65,000,000, to be made available
through fiscal year 2018.
(B) For each of fiscal years 2016 and 2017, $53,000,000, to
be made available through fiscal year 2018.
(C) For fiscal year 2018, $48,000,000, to be made available
until expended.
(2) To the Social Security Administration Limitation on
Administration Account, transfers of the following amounts:
(A) For fiscal year 2015, $27,000,000, to be made available
through fiscal year 2018.
(B) For each of fiscal years 2016 and 2017, $22,000,000, to
be made available through fiscal year 2018.
(C) For fiscal year 2018, $27,000,000, to be made available
until expended.
(3) To the Railroad Retirement Board Limitation on
Administration Account, the following amount:
(A) For fiscal year 2015, $3,000,000, to be made available
until expended.
(d) Effective Date.--
(1) In general.--Clause (xiii) of section 205(c)(2)(C) of
the Social Security Act (42 U.S.C. 405(c)(2)(C)), as added by
subsection (a)(3), shall apply with respect to Medicare cards
issued on and after an effective date specified by the
Secretary of Health and Human Services, but in no case shall
such effective date be later than the date that is four years
after the date of the enactment of this Act.
(2) Reissuance.--The Secretary shall provide for the
reissuance of Medicare cards that comply with the
requirements of such clause not later than four years after
the effective date specified by the Secretary under paragraph
(1).
SEC. 502. PREVENTING WRONGFUL MEDICARE PAYMENTS FOR ITEMS AND
SERVICES FURNISHED TO INCARCERATED INDIVIDUALS,
INDIVIDUALS NOT LAWFULLY PRESENT, AND DECEASED
INDIVIDUALS.
(a) Requirement for the Secretary To Establish Policies and
Claims Edits Relating to Incarcerated Individuals,
Individuals Not Lawfully Present, and Deceased Individuals.--
Section 1874 of the Social Security Act (42 U.S.C. 1395kk) is
amended by adding at the end the following new subsection:
``(f) Requirement for the Secretary To Establish Policies
and Claims Edits Relating to Incarcerated Individuals,
Individuals Not Lawfully Present, and Deceased Individuals.--
The Secretary shall establish and maintain procedures,
including procedures for using claims processing edits,
updating eligibility information to improve provider
accessibility, and conducting recoupment activities such as
through recovery audit contractors, in order to ensure that
payment is not made under this title for items and services
furnished to an individual who is one of the following:
``(1) An individual who is incarcerated.
``(2) An individual who is not lawfully present in the
United States and who is not eligible for coverage under this
title.
``(3) A deceased individual.''.
(b) Report.--Not later than 18 months after the date of the
enactment of this section, and periodically thereafter as
determined necessary by the Office of Inspector General of
the Department of Health and Human Services, such Office
shall submit to Congress a report on the activities described
in subsection (f) of section 1874 of the Social Security Act
(42 U.S.C. 1395kk), as added by subsection (a), that have
been conducted since such date of enactment.
SEC. 503. CONSIDERATION OF MEASURES REGARDING MEDICARE
BENEFICIARY SMART CARDS.
To the extent the Secretary of Health and Human Services
determines that it is cost effective and technologically
viable to use electronic Medicare beneficiary and provider
cards (such as cards that use smart card technology,
including an embedded and secure integrated circuit chip), as
presented in the Government Accountability Office report
required by the conference report accompanying the
Consolidated Appropriations Act, 2014 (Public Law 113-76),
the Secretary shall consider such measures as determined
appropriate by the Secretary to implement such use of such
cards for beneficiary and provider use under title XVIII of
the Social Security Act (42 U.S.C. 1395 et seq.). In the case
that the Secretary considers measures under the preceding
sentence, the Secretary shall submit to the Committees on
Ways and Means and Energy and Commerce of the House of
Representatives, and to the Committee on Finance of the
Senate, a report outlining the considerations undertaken by
the Secretary under such sentence.
SEC. 504. MODIFYING MEDICARE DURABLE MEDICAL EQUIPMENT FACE-
TO-FACE ENCOUNTER DOCUMENTATION REQUIREMENT.
(a) In General.--Section 1834(a)(11)(B)(ii) of the Social
Security Act (42 U.S.C. 1395m(a)(11)(B)(ii)) is amended--
(1) by striking ``the physician documenting that''; and
(2) by striking ``has had a face-to-face encounter'' and
inserting ``documenting such physician, physician assistant,
practitioner, or specialist has had a face-to-face
encounter''.
[[Page H2067]]
(b) Implementation.--Notwithstanding any other provision of
law, the Secretary of Health and Human Services may implement
the amendments made by subsection (a) by program instruction
or otherwise.
SEC. 505. REDUCING IMPROPER MEDICARE PAYMENTS.
(a) Medicare Administrative Contractor Improper Payment
Outreach and Education Program.--Section 1874A of the Social
Security Act (42 U.S.C. 1395kk-1) is amended--
(1) in subsection (a)(4)--
(A) by redesignating subparagraph (G) as subparagraph (H);
and
(B) by inserting after subparagraph (F) the following new
subparagraph:
``(G) Improper payment outreach and education program.--
Having in place an improper payment outreach and education
program described in subsection (h).''; and
(2) by adding at the end the following new subsection:
``(h) Improper Payment Outreach and Education Program.--
``(1) In general.--In order to reduce improper payments
under this title, each medicare administrative contractor
shall establish and have in place an improper payment
outreach and education program under which the contractor,
through outreach, education, training, and technical
assistance or other activities, shall provide providers of
services and suppliers located in the region covered by the
contract under this section with the information described in
paragraph (2). The activities described in the preceding
sentence shall be conducted on a regular basis.
``(2) Information to be provided through activities.--The
information to be provided under such payment outreach and
education program shall include information the Secretary
determines to be appropriate, which may include the following
information:
``(A) A list of the providers' or suppliers' most frequent
and expensive payment errors over the last quarter.
``(B) Specific instructions regarding how to correct or
avoid such errors in the future.
``(C) A notice of new topics that have been approved by the
Secretary for audits conducted by recovery audit contractors
under section 1893(h).
``(D) Specific instructions to prevent future issues
related to such new audits.
``(E) Other information determined appropriate by the
Secretary.
``(3) Priority.--A medicare administrative contractor shall
give priority to activities under such program that will
reduce improper payments that are one or more of the
following:
``(A) Are for items and services that have the highest rate
of improper payment.
``(B) Are for items and service that have the greatest
total dollar amount of improper payments.
``(C) Are due to clear misapplication or misinterpretation
of Medicare policies.
``(D) Are clearly due to common and inadvertent clerical or
administrative errors.
``(E) Are due to other types of errors that the Secretary
determines could be prevented through activities under the
program.
``(4) Information on improper payments from recovery audit
contractors.--
``(A) In general.--In order to assist medicare
administrative contractors in carrying out improper payment
outreach and education programs, the Secretary shall provide
each contractor with a complete list of the types of improper
payments identified by recovery audit contractors under
section 1893(h) with respect to providers of services and
suppliers located in the region covered by the contract under
this section. Such information shall be provided on a time
frame the Secretary determines appropriate which may be on a
quarterly basis.
``(B) Information.--The information described in
subparagraph (A) shall include information such as the
following:
``(i) Providers of services and suppliers that have the
highest rate of improper payments.
``(ii) Providers of services and suppliers that have the
greatest total dollar amounts of improper payments.
``(iii) Items and services furnished in the region that
have the highest rates of improper payments.
``(iv) Items and services furnished in the region that are
responsible for the greatest total dollar amount of improper
payments.
``(v) Other information the Secretary determines would
assist the contractor in carrying out the program.
``(5) Communications.--Communications with providers of
services and suppliers under an improper payment outreach and
education program are subject to the standards and
requirements of subsection (g).''.
(b) Use of Certain Funds Recovered by RACs.--Section
1893(h) of the Social Security Act (42 U.S.C. 1395ddd(h)) is
amended--
(1) in paragraph (2), by inserting ``or paragraph (10)''
after ``paragraph (1)(C)''; and
(2) by adding at the end the following new paragraph:
``(10) Use of certain recovered funds.--
``(A) In general.--After application of paragraph (1)(C),
the Secretary shall retain a portion of the amounts recovered
by recovery audit contractors for each year under this
section which shall be available to the program management
account of the Centers for Medicare & Medicaid Services for
purposes of, subject to subparagraph (B), carrying out
sections 1833(z), 1834(l)(16), and 1874A(a)(4)(G), carrying
out section 514(b) of the Medicare Access and CHIP
Reauthorization Act of 2015, and implementing strategies
(such as claims processing edits) to help reduce the error
rate of payments under this title. The amounts retained under
the preceding sentence shall not exceed an amount equal to 15
percent of the amounts recovered under this subsection, and
shall remain available until expended.
``(B) Limitation.--Except for uses that support claims
processing (including edits) or system functionality for
detecting fraud, amounts retained under subparagraph (A) may
not be used for technological-related infrastructure, capital
investments, or information systems.
``(C) No reduction in payments to recovery audit
contractors.--Nothing in subparagraph (A) shall reduce
amounts available for payments to recovery audit contractors
under this subsection.''.
SEC. 506. IMPROVING SENIOR MEDICARE PATROL AND FRAUD
REPORTING REWARDS.
(a) In General.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
develop a plan to revise the incentive program under section
203(b) of the Health Insurance Portability and Accountability
Act of 1996 (42 U.S.C. 1395b-5(b)) to encourage greater
participation by individuals to report fraud and abuse in the
Medicare program. Such plan shall include recommendations
for--
(1) ways to enhance rewards for individuals reporting under
the incentive program, including rewards based on information
that leads to an administrative action; and
(2) extending the incentive program to the Medicaid
program.
(b) Public Awareness and Education Campaign.--The plan
developed under subsection (a) shall also include
recommendations for the use of the Senior Medicare Patrols
authorized under section 411 of the Older Americans Act of
1965 (42 U.S.C. 3032) to conduct a public awareness and
education campaign to encourage participation in the revised
incentive program under subsection (a).
(c) Submission of Plan.--Not later than 180 days after the
date of enactment of this Act, the Secretary shall submit to
Congress the plan developed under subsection (a).
SEC. 507. REQUIRING VALID PRESCRIBER NATIONAL PROVIDER
IDENTIFIERS ON PHARMACY CLAIMS.
Section 1860D-4(c) of the Social Security Act (42 U.S.C.
1395w-104(c)) is amended by adding at the end the following
new paragraph:
``(4) Requiring valid prescriber national provider
identifiers on pharmacy claims.--
``(A) In general.--For plan year 2016 and subsequent plan
years, the Secretary shall require a claim for a covered part
D drug for a part D eligible individual enrolled in a
prescription drug plan under this part or an MA-PD plan under
part C to include a prescriber National Provider Identifier
that is determined to be valid under the procedures
established under subparagraph (B)(i).
``(B) Procedures.--
``(i) Validity of prescriber national provider
identifiers.--The Secretary, in consultation with appropriate
stakeholders, shall establish procedures for determining the
validity of prescriber National Provider Identifiers under
subparagraph (A).
``(ii) Informing beneficiaries of reason for denial.--The
Secretary shall establish procedures to ensure that, in the
case that a claim for a covered part D drug of an individual
described in subparagraph (A) is denied because the claim
does not meet the requirements of this paragraph, the
individual is properly informed at the point of service of
the reason for the denial.
``(C) Report.--Not later than January 1, 2018, the
Inspector General of the Department of Health and Human
Services shall submit to Congress a report on the
effectiveness of the procedures established under
subparagraph (B)(i).''.
SEC. 508. OPTION TO RECEIVE MEDICARE SUMMARY NOTICE
ELECTRONICALLY.
(a) In General.--Section 1806 of the Social Security Act
(42 U.S.C. 1395b-7) is amended by adding at the end the
following new subsection:
``(c) Format of Statements From Secretary.--
``(1) Electronic option beginning in 2016.--Subject to
paragraph (2), for statements described in subsection (a)
that are furnished for a period in 2016 or a subsequent year,
in the case that an individual described in subsection (a)
elects, in accordance with such form, manner, and time
specified by the Secretary, to receive such statement in an
electronic format, such statement shall be furnished to such
individual for each period subsequent to such election in
such a format and shall not be mailed to the individual.
``(2) Limitation on revocation option.--
``(A) In general.--Subject to subparagraph (B), the
Secretary may determine a maximum number of elections
described in paragraph (1) by an individual that may be
revoked by the individual.
``(B) Minimum of one revocation option.--In no case may the
Secretary determine a maximum number under subparagraph (A)
that is less than one.
``(3) Notification.--The Secretary shall ensure that, in
the most cost effective manner and beginning January 1, 2017,
a clear notification of the option to elect to receive
statements described in subsection (a) in an electronic
format is made available, such as through the notices
distributed under section 1804, to individuals described in
subsection (a).''.
(b) Encouraged Expansion of Electronic Statements.--To the
extent to which the
[[Page H2068]]
Secretary of Health and Human Services determines
appropriate, the Secretary shall--
(1) apply an option similar to the option described in
subsection (c)(1) of section 1806 of the Social Security Act
(42 U.S.C. 1395b-7) (relating to the provision of the
Medicare Summary Notice in an electronic format), as added by
subsection (a), to other statements and notifications under
title XVIII of such Act (42 U.S.C. 1395 et seq.); and
(2) provide such Medicare Summary Notice and any such other
statements and notifications on a more frequent basis than is
otherwise required under such title.
SEC. 509. RENEWAL OF MAC CONTRACTS.
(a) In General.--Section 1874A(b)(1)(B) of the Social
Security Act (42 U.S.C. 1395kk-1(b)(1)(B)) is amended by
striking ``5 years'' and inserting ``10 years''.
(b) Application.--The amendments made by subsection (a)
shall apply to contracts entered into on or after, and to
contracts in effect as of, the date of the enactment of this
Act.
(c) Contractor Performance Transparency.--Section
1874A(b)(3)(A) of the Social Security Act (42 U.S.C. 1395kk-
1(b)(3)(A)) is amended by adding at the end the following new
clause:
``(iv) Contractor performance transparency.--To the extent
possible without compromising the process for entering into
and renewing contracts with medicare administrative
contractors under this section, the Secretary shall make
available to the public the performance of each medicare
administrative contractor with respect to such performance
requirements and measurement standards.''.
SEC. 510. STUDY ON PATHWAY FOR INCENTIVES TO STATES FOR STATE
PARTICIPATION IN MEDICAID DATA MATCH PROGRAM.
Section 1893(g) of the Social Security Act (42 U.S.C.
1395ddd(g)) is amended by adding at the end the following new
paragraph:
``(3) Incentives for states.--The Secretary shall study
and, as appropriate, may specify incentives for States to
work with the Secretary for the purposes described in
paragraph (1)(A)(ii). The application of the previous
sentence may include use of the waiver authority described in
paragraph (2).''.
SEC. 511. GUIDANCE ON APPLICATION OF COMMON RULE TO CLINICAL
DATA REGISTRIES.
Not later than one year after the date of the enactment of
this section, the Secretary of Health and Human Services
shall issue a clarification or modification with respect to
the application of subpart A of part 46 of title 45, Code of
Federal Regulations, governing the protection of human
subjects in research (and commonly known as the ``Common
Rule''), to activities, including quality improvement
activities, involving clinical data registries, including
entities that are qualified clinical data registries pursuant
to section 1848(m)(3)(E) of the Social Security Act (42
U.S.C. 1395w-4(m)(3)(E)).
SEC. 512. ELIMINATING CERTAIN CIVIL MONEY PENALTIES;
GAINSHARING STUDY AND REPORT.
(a) Eliminating Civil Money Penalties for Inducements to
Physicians To Limit Services That Are Not Medically
Necessary.--
(1) In general.--Section 1128A(b)(1) of the Social Security
Act (42 U.S.C. 1320a-7a(b)(1)) is amended by inserting
``medically necessary'' after ``reduce or limit''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to payments made on or after the date of the
enactment of this Act.
(b) Gainsharing Study and Report.--Not later than 12 months
after the date of the enactment of this Act, the Secretary of
Health and Human Services, in consultation with the Inspector
General of the Department of Health and Human Services, shall
submit to Congress a report with options for amending
existing fraud and abuse laws in, and regulations related to,
titles XI and XVIII of the Social Security Act (42 U.S.C. 301
et seq.), through exceptions, safe harbors, or other narrowly
targeted provisions, to permit gainsharing arrangements that
otherwise would be subject to the civil money penalties
described in paragraphs (1) and (2) of section 1128A(b) of
such Act (42 U.S.C. 1320a-7a(b)), or similar arrangements
between physicians and hospitals, and that improve care while
reducing waste and increasing efficiency. The report shall--
(1) consider whether such provisions should apply to
ownership interests, compensation arrangements, or other
relationships;
(2) describe how the recommendations address
accountability, transparency, and quality, including how best
to limit inducements to stint on care, discharge patients
prematurely, or otherwise reduce or limit medically necessary
care; and
(3) consider whether a portion of any savings generated by
such arrangements (as compared to an historical benchmark or
other metric specified by the Secretary to determine the
impact of delivery and payment system changes under such
title XVIII on expenditures made under such title) should
accrue to the Medicare program under title XVIII of the
Social Security Act.
SEC. 513. MODIFICATION OF MEDICARE HOME HEALTH SURETY BOND
CONDITION OF PARTICIPATION REQUIREMENT.
Section 1861(o)(7) of the Social Security Act (42 U.S.C.
1395x(o)(7)) is amended to read as follows:
``(7) provides the Secretary with a surety bond--
``(A) in a form specified by the Secretary and in an amount
that is not less than the minimum of $50,000; and
``(B) that the Secretary determines is commensurate with
the volume of payments to the home health agency; and''.
SEC. 514. OVERSIGHT OF MEDICARE COVERAGE OF MANUAL
MANIPULATION OF THE SPINE TO CORRECT
SUBLUXATION.
(a) In General.--Section 1833 of the Social Security Act
(42 U.S.C. 1395l) is amended by adding at the end the
following new subsection:
``(z) Medical Review of Spinal Subluxation Services.--
``(1) In general.--The Secretary shall implement a process
for the medical review (as described in paragraph (2)) of
treatment by a chiropractor described in section 1861(r)(5)
by means of manual manipulation of the spine to correct a
subluxation (as described in such section) of an individual
who is enrolled under this part and apply such process to
such services furnished on or after January 1, 2017, focusing
on services such as--
``(A) services furnished by a such a chiropractor whose
pattern of billing is aberrant compared to peers; and
``(B) services furnished by such a chiropractor who, in a
prior period, has a services denial percentage in the 85th
percentile or greater, taking into consideration the extent
that service denials are overturned on appeal.
``(2) Medical review.--
``(A) Prior authorization medical review.--
``(i) In general.--Subject to clause (ii), the Secretary
shall use prior authorization medical review for services
described in paragraph (1) that are furnished to an
individual by a chiropractor described in section 1861(r)(5)
that are part of an episode of treatment that includes more
than 12 services. For purposes of the preceding sentence, an
episode of treatment shall be determined by the underlying
cause that justifies the need for services, such as a
diagnosis code.
``(ii) Ending application of prior authorization medical
review.--The Secretary shall end the application of prior
authorization medical review under clause (i) to services
described in paragraph (1) by such a chiropractor if the
Secretary determines that the chiropractor has a low denial
rate under such prior authorization medical review. The
Secretary may subsequently reapply prior authorization
medical review to such chiropractor if the Secretary
determines it to be appropriate and the chiropractor has, in
the time period subsequent to the determination by the
Secretary of a low denial rate with respect to the
chiropractor, furnished such services described in paragraph
(1).
``(iii) Early request for prior authorization review
permitted.--Nothing in this subsection shall be construed to
prevent such a chiropractor from requesting prior
authorization for services described in paragraph (1) that
are to be furnished to an individual before the chiropractor
furnishes the twelfth such service to such individual for an
episode of treatment.
``(B) Type of review.--The Secretary may use pre-payment
review or post-payment review of services described in
section 1861(r)(5) that are not subject to prior
authorization medical review under subparagraph (A).
``(C) Relationship to law enforcement activities.--The
Secretary may determine that medical review under this
subsection does not apply in the case where potential fraud
may be involved.
``(3) No payment without prior authorization.--With respect
to a service described in paragraph (1) for which prior
authorization medical review under this subsection applies,
the following shall apply:
``(A) Prior authorization determination.--The Secretary
shall make a determination, prior to the service being
furnished, of whether the service would or would not meet the
applicable requirements of section 1862(a)(1)(A).
``(B) Denial of payment.--Subject to paragraph (5), no
payment may be made under this part for the service unless
the Secretary determines pursuant to subparagraph (A) that
the service would meet the applicable requirements of such
section 1862(a)(1)(A).
``(4) Submission of information.--A chiropractor described
in section 1861(r)(5) may submit the information necessary
for medical review by fax, by mail, or by electronic means.
The Secretary shall make available the electronic means
described in the preceding sentence as soon as practicable.
``(5) Timeliness.--If the Secretary does not make a prior
authorization determination under paragraph (3)(A) within 14
business days of the date of the receipt of medical
documentation needed to make such determination, paragraph
(3)(B) shall not apply.
``(6) Application of limitation on beneficiary liability.--
Where payment may not be made as a result of the application
of paragraph (2)(B), section 1879 shall apply in the same
manner as such section applies to a denial that is made by
reason of section 1862(a)(1).
``(7) Review by contractors.--The medical review described
in paragraph (2) may be conducted by medicare administrative
contractors pursuant to section 1874A(a)(4)(G) or by any
other contractor determined appropriate by the Secretary that
is not a recovery audit contractor.
``(8) Multiple services.--The Secretary shall, where
practicable, apply the medical review under this subsection
in a manner so as to allow an individual described in
paragraph (1) to obtain, at a single time rather
[[Page H2069]]
than on a service-by-service basis, an authorization in
accordance with paragraph (3)(A) for multiple services.
``(9) Construction.--With respect to a service described in
paragraph (1) that has been affirmed by medical review under
this subsection, nothing in this subsection shall be
construed to preclude the subsequent denial of a claim for
such service that does not meet other applicable requirements
under this Act.
``(10) Implementation.--
``(A) Authority.--The Secretary may implement the
provisions of this subsection by interim final rule with
comment period.
``(B) Administration.--Chapter 35 of title 44, United
States Code, shall not apply to medical review under this
subsection.''.
(b) Improving Documentation of Services.--
(1) In general.--The Secretary of Health and Human Services
shall, in consultation with stakeholders (including the
American Chiropractic Association) and representatives of
medicare administrative contractors (as defined in section
1874A(a)(3)(A) of the Social Security Act (42 U.S.C. 1395kk-
1(a)(3)(A))), develop educational and training programs to
improve the ability of chiropractors to provide documentation
to the Secretary of services described in section 1861(r)(5)
in a manner that demonstrates that such services are, in
accordance with section 1862(a)(1) of such Act (42 U.S.C.
1395y(a)(1)), reasonable and necessary for the diagnosis or
treatment of illness or injury or to improve the functioning
of a malformed body member.
(2) Timing.--The Secretary shall make the educational and
training programs described in paragraph (1) publicly
available not later than January 1, 2016.
(3) Funding.--The Secretary shall use funds made available
under paragraph (10) of section 1893(h) of the Social
Security Act (42 U.S.C. 1395ddd(h)), as added by section 505,
to carry out this subsection.
(c) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
shall conduct a study on the effectiveness of the process for
medical review of services furnished as part of a treatment
by means of manual manipulation of the spine to correct a
subluxation implemented under subsection (z) of section 1833
of the Social Security Act (42 U.S.C. 1395l), as added by
subsection (a). Such study shall include an analysis of--
(A) aggregate data on--
(i) the number of individuals, chiropractors, and claims
for services subject to such review; and
(ii) the number of reviews conducted under such section;
and
(B) the outcomes of such reviews.
(2) Report.--Not later than four years after the date of
enactment of this Act, the Comptroller General shall submit
to Congress a report containing the results of the study
conducted under paragraph (1), including recommendations for
such legislation and administrative action with respect to
the process for medical review implemented under subsection
(z) of section 1833 of the Social Security Act (42 U.S.C.
1395l) as the Comptroller General determines appropriate.
SEC. 515. NATIONAL EXPANSION OF PRIOR AUTHORIZATION MODEL FOR
REPETITIVE SCHEDULED NON-EMERGENT AMBULANCE
TRANSPORT.
(a) Initial Expansion.--
(1) In general.--In implementing the model described in
paragraph (2) proposed to be tested under subsection (b) of
section 1115A of the Social Security Act (42 U.S.C. 1315a),
the Secretary of Health and Human Services shall revise the
testing under subsection (b) of such section to cover,
effective not later than January 1, 2016, States located in
medicare administrative contractor (MAC) regions L and 11
(consisting of Delaware, the District of Columbia, Maryland,
New Jersey, Pennsylvania, North Carolina, South Carolina,
West Virginia, and Virginia).
(2) Model described.--The model described in this paragraph
is the testing of a model of prior authorization for
repetitive scheduled non-emergent ambulance transport
proposed to be carried out in New Jersey, Pennsylvania, and
South Carolina.
(3) Funding.--The Secretary shall allocate funds made
available under section 1115A(f)(1)(B) of the Social Security
Act (42 U.S.C. 1315a(f)(1)(B)) to carry out this subsection.
(b) National Expansion.--Section 1834(l) of the Social
Security Act (42 U.S.C. 1395m(l)) is amended by adding at the
end the following new paragraph:
``(16) Prior authorization for repetitive scheduled non-
emergent ambulance transports.--
``(A) In general.--Beginning January 1, 2017, if the
expansion to all States of the model of prior authorization
described in paragraph (2) of section 515(a) of the Medicare
Access and CHIP Reauthorization Act of 2015 meets the
requirements described in paragraphs (1) through (3) of
section 1115A(c), then the Secretary shall expand such model
to all States.
``(B) Funding.--The Secretary shall use funds made
available under section 1893(h)(10) to carry out this
paragraph.
``(C) Clarification regarding budget neutrality.--Nothing
in this paragraph may be construed to limit or modify the
application of section 1115A(b)(3)(B) to models described in
such section, including with respect to the model described
in subparagraph (A) and expanded beginning on January 1,
2017, under such subparagraph.''.
SEC. 516. REPEALING DUPLICATIVE MEDICARE SECONDARY PAYOR
PROVISION.
(a) In General.--Section 1862(b)(5) of the Social Security
Act (42 U.S.C. 1395y(b)(5)) is amended by inserting at the
end the following new subparagraph:
``(E) End date.--The provisions of this paragraph shall not
apply to information required to be provided on or after July
1, 2016.''.
(b) Effective Date.--The amendment made by subsection (a)
shall take effect on the date of the enactment of this Act
and shall apply to information required to be provided on or
after January 1, 2016.
SEC. 517. PLAN FOR EXPANDING DATA IN ANNUAL CERT REPORT.
Not later than June 30, 2015, the Secretary of Health and
Human Services shall submit to the Committee on Finance of
the Senate, and to the Committees on Energy and Commerce and
Ways and Means of the House of Representatives--
(1) a plan for including, in the annual report of the
Comprehensive Error Rate Testing (CERT) program, data on
services (or groupings of services) (other than medical
visits) paid under the physician fee schedule under section
1848 of the Social Security Act (42 U.S.C. 1395w-4) where the
fee schedule amount is in excess of $250 and where the error
rate is in excess of 20 percent; and
(2) to the extent practicable by such date, specific
examples of services described in paragraph (1).
SEC. 518. REMOVING FUNDS FOR MEDICARE IMPROVEMENT FUND ADDED
BY IMPACT ACT OF 2014.
Section 1898(b)(1) of the Social Security Act (42 U.S.C.
1395iii(b)(1)), as amended by section 3(e)(3) of the IMPACT
Act of 2014 (Public Law 113-185), is amended by striking
``$195,000,000'' and inserting ``$0''.
SEC. 519. RULE OF CONSTRUCTION.
Except as explicitly provided in this subtitle, nothing in
this subtitle, including the amendments made by this
subtitle, shall be construed as preventing the use of notice
and comment rulemaking in the implementation of the
provisions of, and the amendments made by, this subtitle.
Subtitle B--Other Provisions
SEC. 521. EXTENSION OF TWO-MIDNIGHT PAMA RULES ON CERTAIN
MEDICAL REVIEW ACTIVITIES.
Section 111 of the Protecting Access to Medicare Act of
2014 (Public Law 113-93; 42 U.S.C. 1395ddd note) is amended--
(1) in subsection (a), by striking ``the first 6 months of
fiscal year 2015'' and inserting ``through the end of fiscal
year 2015'';
(2) in subsection (b), by striking ``March 31, 2015'' and
inserting ``September 30, 2015''; and
(3) by adding at the end the following new subsection:
``(c) Construction.--Except as provided in subsections (a)
and (b), nothing in this section shall be construed as
limiting the Secretary's authority to pursue fraud and abuse
activities under such section 1893(h) or otherwise.''.
SEC. 522. REQUIRING BID SURETY BONDS AND STATE LICENSURE FOR
ENTITIES SUBMITTING BIDS UNDER THE MEDICARE
DMEPOS COMPETITIVE ACQUISITION PROGRAM.
(a) Bid Surety Bonds.--Section 1847(a)(1) of the Social
Security Act (42 U.S.C. 1395w-3(a)(1)) is amended by adding
at the end the following new subparagraphs:
``(G) Requiring bid bonds for bidding entities.--With
respect to rounds of competitions beginning under this
subsection for contracts beginning not earlier than January
1, 2017, and not later than January 1, 2019, an entity may
not submit a bid for a competitive acquisition area unless,
as of the deadline for bid submission, the entity has
obtained (and provided the Secretary with proof of having
obtained) a bid surety bond (in this paragraph referred to as
a `bid bond') in a form specified by the Secretary consistent
with subparagraph (H) and in an amount that is not less than
$50,000 and not more than $100,000 for each competitive
acquisition area in which the entity submits the bid.
``(H) Treatment of bid bonds submitted.--
``(i) For bidders that submit bids at or below the median
and are offered but do not accept the contract.--In the case
of a bidding entity that is offered a contract for any
product category for a competitive acquisition area, if--
``(I) the entity's composite bid for such product category
and area was at or below the median composite bid rate for
all bidding entities included in the calculation of the
single payment amounts for such product category and area;
and
``(II) the entity does not accept the contract offered for
such product category and area,
the bid bond submitted by such entity for such area shall be
forfeited by the entity and the Secretary shall collect on
it.
``(ii) Treatment of other bidders.--In the case of a
bidding entity for any product category for a competitive
acquisition area, if the entity does not meet the bid
forfeiture conditions in subclauses (I) and (II) of clause
(i) for any product category for such area, the bid bond
submitted by such entity for such area shall be returned
within 90 days of the public announcement of the contract
suppliers for such area.''.
(b) State Licensure.--
(1) In general.--Section 1847(b)(2)(A) of the Social
Security Act (42 U.S.C. 1395w-3(b)(2)(A)) is amended by
adding at the end the following new clause:
[[Page H2070]]
``(v) The entity meets applicable State licensure
requirements.''.
(2) Construction.--Nothing in the amendment made by
paragraph (1) shall be construed as affecting the authority
of the Secretary of Health and Human Services to require
State licensure of an entity under the Medicare competitive
acquisition program under section 1847 of the Social Security
Act (42 U.S.C. 1395w-3) before the date of the enactment of
this Act.
(c) GAO Report on Bid Bond Impact on Small Suppliers.--
(1) Study.--The Comptroller General of the United States
shall conduct a study that evaluates the effect of the bid
surety bond requirement under the amendment made by
subsection (a) on the participation of small suppliers in the
Medicare DMEPOS competitive acquisition program under section
1847 of the Social Security Act (42 U.S.C. 1395w-3).
(2) Report.--Not later than 6 months after the date
contracts are first awarded subject to such bid surety bond
requirement, the Comptroller General shall submit to Congress
a report on the study conducted under paragraph (1). Such
report shall include recommendations for changes in such
requirement in order to ensure robust participation by
legitimate small suppliers in the Medicare DMEPOS competition
acquisition program.
SEC. 523. PAYMENT FOR GLOBAL SURGICAL PACKAGES.
(a) In General.--Section 1848(c) of the Social Security Act
(42 U.S.C. 1395w-4(c)) is amended by adding at the end the
following new paragraph:
``(8) Global surgical packages.--
``(A) Prohibition of implementation of rule regarding
global surgical packages.--
``(i) In general.--The Secretary shall not implement the
policy established in the final rule published on November
13, 2014 (79 Fed. Reg. 67548 et seq.), that requires the
transition of all 10-day and 90-day global surgery packages
to 0-day global periods.
``(ii) Construction.--Nothing in clause (i) shall be
construed to prevent the Secretary from revaluing misvalued
codes for specific surgical services or assigning values to
new or revised codes for surgical services.
``(B) Collection of data on services included in global
surgical packages.--
``(i) In general.--Subject to clause (ii), the Secretary
shall through rulemaking develop and implement a process to
gather, from a representative sample of physicians, beginning
not later than January 1, 2017, information needed to value
surgical services. Such information shall include the number
and level of medical visits furnished during the global
period and other items and services related to the surgery
and furnished during the global period, as appropriate. Such
information shall be reported on claims at the end of the
global period or in another manner specified by the
Secretary. For purposes of carrying out this paragraph (other
than clause (iii)), the Secretary shall transfer from the
Federal Supplemental Medical Insurance Trust Fund under
section 1841 $2,000,000 to the Center for Medicare & Medicaid
Services Program Management Account for fiscal year 2015.
Amounts transferred under the previous sentence shall remain
available until expended.
``(ii) Reassessment and potential sunset.--Every 4 years,
the Secretary shall reassess the value of the information
collected pursuant to clause (i). Based on such a
reassessment and by regulation, the Secretary may discontinue
the requirement for collection of information under such
clause if the Secretary determines that the Secretary has
adequate information from other sources, such as qualified
clinical data registries, surgical logs, billing systems or
other practice or facility records, and electronic health
records, in order to accurately value global surgical
services under this section.
``(iii) Inspector general audit.--The Inspector General of
the Department of Health and Human Services shall audit a
sample of the information reported under clause (i) to verify
the accuracy of the information so reported.
``(C) Improving accuracy of pricing for surgical
services.--For years beginning with 2019, the Secretary shall
use the information reported under subparagraph (B)(i) as
appropriate and other available data for the purpose of
improving the accuracy of valuation of surgical services
under the physician fee schedule under this section.''.
(b) Incentive for Reporting Information on Global Surgical
Services.--Section 1848(a) of the Social Security Act (42
U.S.C. 1395w-4(a)) is amended by adding at the end the
following new paragraph:
``(9) Information reporting on services included in global
surgical packages.--With respect to services for which a
physician is required to report information in accordance
with subsection (c)(8)(B)(i), the Secretary may through
rulemaking delay payment of 5 percent of the amount that
would otherwise be payable under the physician fee schedule
under this section for such services until the information so
required is reported.''.
SEC. 524. EXTENSION OF SECURE RURAL SCHOOLS AND COMMUNITY
SELF-DETERMINATION ACT OF 2000.
(a) Payments for Fiscal Years 2014 and 2015.--
(1) Payments required.--Section 101 of the Secure Rural
Schools and Community Self-Determination Act of 2000 (16
U.S.C. 7111) is amended by striking ``2013'' both places it
appears and inserting ``2015''.
(2) Prompt payment.--Payments for fiscal year 2014 under
title I of the Secure Rural Schools and Community Self-
Determination Act of 2000 (16 U.S.C. 7111 et seq.), as
amended by this section, shall be made not later than 45 days
after the date of the enactment of this Act.
(3) Reduction in fiscal year 2014 payments on account of
previous 25- and 50-percent payments.--Section 101 of the
Secure Rural Schools and Community Self-Determination Act of
2000 (16 U.S.C. 7111) is amended by adding at the end the
following new subsection:
``(c) Special Rule for Fiscal Year 2014 Payments.--
``(1) State payment.--If an eligible county in a State that
will receive a share of the State payment for fiscal year
2014 has already received, or will receive, a share of the
25-percent payment for fiscal year 2014 distributed to the
State before the date of the enactment of this subsection,
the amount of the State payment shall be reduced by the
amount of that eligible county's share of the 25-percent
payment.
``(2) County payment.--If an eligible county that will
receive a county payment for fiscal year 2014 has already
received a 50-percent payment for that fiscal year, the
amount of the county payment shall be reduced by the amount
of the 50-percent payment.''.
(4) Shares of california state payment.--Section 103(d)(2)
of the Secure Rural Schools and Community Self-Determination
Act of 2000 (16 U.S.C. 7113(d)(2)) is amended by striking
``2013'' and inserting ``2015''.
(b) Use of Fiscal Year 2013 Elections and Reservations for
Fiscal Years 2014 and 2015.--Section 102 of the Secure Rural
Schools and Community Self-Determination Act of 2000 (16
U.S.C. 7112) is amended--
(1) in subsection (b)(1), by adding at the end the
following new subparagraph:
``(C) Effect of late payment for fiscal years 2014 and
2015.--The election otherwise required by subparagraph (A)
shall not apply for fiscal year 2014 or 2015.'';
(2) in subsection (b)(2)--
(A) in subparagraph (A), by adding at the end the following
new sentence: ``If such two-fiscal year period included
fiscal year 2013, the county election to receive a share of
the 25-percent payment or 50-percent payment, as applicable,
also shall be effective for fiscal years 2014 and 2015.'';
and
(B) in subparagraph (B), by striking ``2013'' the second
place it appears and inserting ``2015''; and
(3) in subsection (d)--
(A) by adding at the end of paragraph (1) the following new
subparagraph:
``(E) Effect of late payment for fiscal year 2014.--The
election made by an eligible county under subparagraph (B),
(C), or (D) for fiscal year 2013, or deemed to be made by the
county under paragraph (3)(B) for that fiscal year, shall be
effective for fiscal years 2014 and 2015.''; and
(B) by adding at the end of paragraph (3) the following new
subparagraph:
``(C) Effect of late payment for fiscal year 2014.--This
paragraph does not apply for fiscal years 2014 and 2015.''.
(c) Special Projects on Federal Land.--Title II of the
Secure Rural Schools and Community Self-Determination Act of
2000 (16 U.S.C. 7121 et seq.) is amended--
(1) in section 203(a)(1) (16 U.S.C. 7123(a)(1)), by
striking ``September 30 for fiscal year 2008 (or as soon
thereafter as the Secretary concerned determines is
practicable), and each September 30 thereafter for each
succeeding fiscal year through fiscal year 2013'' and
inserting ``September 30 of each fiscal year (or a later date
specified by the Secretary concerned for the fiscal year)'';
(2) in section 204(e)(3)(B)(iii) (16 U.S.C.
7124(e)(3)(B)(iii)), by striking ``each of fiscal years 2010
through 2013'' and inserting ``fiscal year 2010 and fiscal
years thereafter'';
(3) in section 207(a) (16 U.S.C. 7127(a)), by striking
``September 30, 2008 (or as soon thereafter as the Secretary
concerned determines is practicable), and each September 30
thereafter for each succeeding fiscal year through fiscal
year 2013'' and inserting ``September 30 of each fiscal year
(or a later date specified by the Secretary concerned for the
fiscal year)''; and
(4) in section 208 (16 U.S.C. 7128)--
(A) in subsection (a), by striking ``2013'' and inserting
``2017''; and
(B) in subsection (b), by striking ``2014'' and inserting
``2018''.
(d) County Funds.--Section 304 of the Secure Rural Schools
and Community Self-Determination Act of 2000 (16 U.S.C. 7144)
is amended--
(1) in subsection (a), by striking ``2013'' and inserting
``2017''; and
(2) in subsection (b), by striking ``2014'' and inserting
``2018''.
(e) Authorization of Appropriations.--Section 402 of the
Secure Rural Schools and Community Self-Determination Act of
2000 (16 U.S.C. 7152) is amended by striking ``for each of
fiscal years 2008 through 2013''.
SEC. 525. EXCLUSION FROM PAYGO SCORECARDS.
(a) Statutory Pay-As-You-Go Scorecards.--The budgetary
effects of this Act shall not be entered on either PAYGO
scorecard maintained pursuant to section 4(d) of the
Statutory Pay-As-You-Go Act of 2010.
(b) Senate PAYGO Scorecards.--The budgetary effects of this
Act shall not be entered on any PAYGO scorecard maintained
for purposes of section 201 of S. Con. Res. 21 (110th
Congress).
[[Page H2071]]
The SPEAKER pro tempore. The bill shall be debatable for 1 hour,
equally divided among and controlled by the chair and ranking minority
member of the Committee on Energy and Commerce and the chair and
ranking minority member of the Committee on Ways and Means.
The gentleman from Pennsylvania (Mr. Pitts), the gentleman from New
Jersey (Mr. Pallone), the gentleman from Texas (Mr. Brady), and the
gentleman from Michigan (Mr. Levin) each will control 15 minutes.
The Chair recognizes the gentleman from Pennsylvania.
General Leave
Mr. PITTS. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days to revise and extend their remarks and to
include extraneous material on H.R. 2.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Pennsylvania?
There was no objection.
{time} 1015
Mr. PITTS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in support of H.R. 2, the Medicare Access
and CHIP Reauthorization Act of 2015, sponsored by Congressman Burgess
of Texas.
Mr. Speaker, I rise in support of H.R. 2, the bill I just referenced.
Four years ago, upon taking leadership of the Energy and Commerce
Health Subcommittee, I made it one of my goals to end the patchwork of
doc fixes and repeal the sustainable growth rate.
Now, we are here on the floor of the House with a bipartisan policy
and a bipartisan set of pay-fors. There are many who thought that this
day would never come.
We are replacing the SGR, once and for all, with a system that allows
greater freedom for physicians to practice medicine. We do this without
threatening access to health care for seniors. Instead of unrealistic
price controls, we are instituting a cooperative process to make our
healthcare dollars go farther.
We are also replacing a portion of the projected savings with real
entitlement reforms, reforms that could reduce spending by $295 billion
in the coming decades.
Let's not make the mistake of saying that this is saving Medicare.
The bill makes important reforms that put the program on a better path,
but there is much work to do before we achieve that goal.
Future generations of Americans have understandable doubts about
whether Medicare will be there when they retire. They pay into the
program just as my generation did, but the current system of funding
the program will not deliver on that promise for them. The
extraordinary progress represented by the bill before us today is the
result of a vision for the future and years of hard work.
That vision was wholeheartedly supported by Speaker Boehner, and
there are many more to thank: Chairman Upton, for his persistence in
leadership; current Ranking Member Pallone and former Ranking Member
Waxman for working with us to get a policy we could all agree on; also
Dr. Burgess, the primary sponsor of today's bill and the vice chairman
of the Health Subcommittee in the two past Congresses.
I would especially like to thank the dedicated staff that spent
countless hours and sacrificed weekends to make this happen: Dr. John
O'Shea, Robert Horne, Josh Trent, Clay Alspach, Michelle Rosenberg,
Heidi Stirrup, and Monica Volente, on my personal staff.
Finally, we should see this bill as a first step toward strengthening
and saving Medicare. This can't be the end of the road.
Mr. Speaker, I reserve the balance of my time.
Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in strong support of H.R. 2, the Medicare
Access and CHIP Reauthorization Act of 2015.
For more than 10 years, Congress has had to temporarily fix the
flawed sustainable growth rate, SGR, nearly 20 times since it was
enacted. Well, today is the last time I will have to talk about the
broken SGR. The House has come together to fix it once and for all.
This bill is the result of a lot of hard work by the House Energy and
Commerce Committee, Ways and Means and Senate Finance Committees and
our leadership. Many of our Members have made important contributions
to this bill, and I want to thank them all for being so diligent.
This bill not only repeals the SGR, it replaces it with a reformed
system that pays providers based on quality and value. It rewards
health outcomes. It allows providers to give more focus to their
patients, and most importantly, it provides stability and
predictability to the Medicare Program for years to come. This is good
for doctors, and it is good for seniors.
This bill also extends critical funding for programs that improve the
health and welfare of millions of children, families, and seniors. It
makes permanent the qualified individual program which helps low-income
seniors pay their Medicare part B premiums.
It makes permanent the Transitional Medical Assistance program, which
allows low-income families to maintain their Medicaid coverage for up
to 1 year as they transition from welfare to work.
It includes $8 billion in funding for community health centers, the
National Health Service Corps, and teaching health centers. This
funding will help serve 28 million patients, and all three, together,
strengthen access to primary and preventative health care in
communities throughout America.
The bill includes a fully funded 2-year extension of CHIP,
maintaining all of the improvements in the Affordable Care Act, but
this is not just a 2-year extension; it is a robust extension. It keeps
the promise made to States by maintaining the 23 percent bump in
Federal matching rates and ensures that States, in turn, keep their
promise to CHIP kids by leaving maintenance of effort requirements for
child enrollment through 2019 untouched.
This bill is not perfect. I wish my Republican colleagues would have
agreed to fund CHIP for 4 years. I also remain concerned about the
provisions that affect Medicare beneficiaries, but such is the nature
of compromise.
Mr. Speaker, I am proud of the work of my committee and of both of
our leaderships. This agreement took courage from both sides, but what
we have accomplished is truly significant. It is balanced and a
thoughtful product, and I urge Members to support it.
I reserve the balance of my time.
Mr. PITTS. Mr. Speaker, I am pleased to yield 1 minute to the
gentleman from Mississippi (Mr. Harper), an outstanding member of the
Energy and Commerce Committee and a good advocate on health issues.
Mr. HARPER. Mr. Speaker, the Medicare Access and CHIP Reauthorization
Act represents years of bipartisan effort to eliminate the fatally
flawed sustainable growth rate formula and implement new payment and
delivery models that will promote higher-quality care while reducing
costs.
In addition to stabilizing the Medicare Program for our Nation's
seniors, the bill addresses the healthcare needs of children and low-
income Americans, while promoting the long-term sustainability of the
Medicare Program through significant structural reforms to the Medicare
Program.
There is no question, Medicare must be modernized in order to avoid
the program's projected financial shortfalls. Republicans and Democrats
have worked together to advance a blueprint to begin to place Medicare
programs on a sound financial footing for both today's and future
retirees.
Now is the time to end this failed policy once and for all and
protect access to care for seniors. I urge my colleagues to support
this legislation.
Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentleman from
Texas (Mr. Gene Green), the ranking member of our House Subcommittee.
Mr. GENE GREEN of Texas. Mr. Speaker, I thank my colleague for
yielding to me, and I appreciate his leadership on this issue and many
others in our committee.
I rise in support of H.R. 2, the Medicare Access and CHIP
Reauthorization Act. As an original cosponsor of this landmark
legislation, I urge my colleagues to support the bill.
H.R. 2 will reform the flawed Medicare physician payment system that
will reward quality and value over volume, make reforms to slow the
growth of healthcare costs, and extend other critical programs,
including the Children's Health Insurance Program and
[[Page H2072]]
the funding for community health centers.
Since 2003, Congress has intervened 17 times to prevent steep payment
cuts caused by the flawed SGR formula in order to preserve seniors'
access to care.
Repealing the SGR is the responsible choice, both fiscally and
logically. More money has now been spent on short-term patches than the
full cost of the permanent repealing of the SGR.
We are closer than we have ever come to repealing the flawed SGR
formula and enacting meaningful reform that will strengthen the
Medicare system for generations to come.
I want to highlight the additional 2 years of funding for the
community health centers program included in the package. These
dedicated mandatory funds will avert an impending fiscal cliff set to
take place in September. Without this extension, funding for health
centers would be slashed by 70 percent, and 7.4 million patients would
lose access to care.
Also included in the agreement are funding for the National Health
Service Corps and the teaching health center program. Both programs
further the goals of improving and strengthening access to primary and
preventative care in our communities.
Like any good bipartisan compromise, the legislation strikes a
balance and offers a set of viable solutions that should have broad
bipartisan support.
I want to thank Speaker Boehner, Leader Pelosi, and my colleagues on
the Energy and Commerce Committee and Ways and Means Committee for
their leadership in working across the aisle to craft this commonsense,
landmark legislation.
Mr. PITTS. Mr. Speaker, I am pleased to yield 1 minute to the
gentleman from Indiana (Mr. Bucshon), a member of the Health
Subcommittee.
Mr. BUCSHON. Mr. Speaker, today is a great day for America's seniors.
After years of flawed Medicare policy, we are finally creating a stable
system that ensures Medicare patients will have access to their
doctors.
This new policy will move our Medicare system to one that is based on
quality of care that is provided to our Nation's seniors. In fact, for
the first time in decades, we actually achieve real structural reforms
in the program that will help save this critical program for future
seniors.
I would also like to highlight that this legislation repeals CMS'
policy to eliminate bundled surgical payments. Eliminating surgical
payment bundles would force doctors to spend more time billing CMS that
could be used for caring for patients.
I would like to thank Chairman Pitts, and I would also like to
congratulate Speaker Boehner, Minority Leader Pelosi, Chairman Upton,
and Ranking Member Pallone for putting politics aside and putting
America's seniors first.
Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentleman from
Oregon (Mr. Schrader).
Mr. SCHRADER. Mr. Speaker, I thank the gentleman for yielding.
I am proud to be here today to support real bipartisan compromise to
finally repeal and replace this flawed SGR formula.
I would like to give my congratulations to Congressman Burgess and,
frankly, former Congresswoman Allyson Schwartz also worked very hard
for many years to make this thing a reality.
This long-term solution is going to bring stability to Medicare, so
seniors will actually be able to continue to see their doctors.
Meanwhile, the bill also allows physicians to focus on value and
quality of care rather than quantity of care and extends, of course,
the vital CHIP program aiding so many children in this country.
Now, though I would prefer to see this bill completely paid for, like
many others in this Chamber, I recognize the nature of compromise means
you don't get everything you want, whether you are a House Member or a
Senate Member.
I am glad, however, that it has been pointed out that at least part
of the cost of this bill is covered by implementing crucial reforms to
Medicare that will help improve its solvency for future generations,
certainly compared to our current policy.
I congratulate my colleagues on the both sides of the aisle for
coming together on this agreement. It is long overdue and will greatly
improve our system. I hope we vote for this bill.
Mr. PITTS. Mr. Speaker, I am pleased to yield 1 minute to the
gentlewoman from Tennessee (Mrs. Blackburn), the vice chair of the
Energy and Commerce Committee.
Mrs. BLACKBURN. Mr. Speaker, I want to thank Chairman Pitts for the
work that he has done on this, as well as the other members of our
committee.
I do rise today in support of H.R. 2.
I think every one of us have constituents who are Medicare enrollees
who tell us the stories and the stress that comes with not being able
to see a doctor because they are no longer taking Medicare patients.
What this does is go to the heart of the problem, the SGR, the
sustainable growth rate. It was a big part of the problem--the sword of
Damocles, if you will--because doctors never knew if they were going to
get paid or what they were going to get paid or if it was going to be a
double-digit or a single-digit cut. Let's get that off the table and
provide some certainty.
H.R. 2 is finally going to eliminate the flawed SGR. It will be
replaced with commonsense legislation which will provide healthcare
providers with the predictability that is necessary to meet the needs
of Medicare enrollees.
In addition, H.R. 2 takes an important step to rein in healthcare
spending, incentivizing doctors on quality, as opposed to quantity,
getting at part of the problem of our entitlement programs.
I congratulate all involved. I encourage a ``yes'' vote.
Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentleman from New
York (Mr. Engel).
{time} 1030
Mr. ENGEL. Mr. Speaker, I rise in strong support of H.R. 2.
I have always believed that our physician workforce deserves to be
fairly compensated. The flawed SGR formula has failed to do this for
over a decade, and it isn't right that physicians have faced looming
Medicare cuts year after year. Therefore, I am pleased that House
Democrats and Republicans have come together to craft a fair,
bipartisan compromise to this longstanding and expensive problem.
Mr. Speaker, the American people want us to end gridlock. They want
us to meet in the middle, and we are doing that today. I want to
commend Speaker Boehner and Leader Pelosi. And while I would have liked
to have seen a 4-year extension of CHIP funding and I am upset that
unnecessary Hyde language has been attached to much-needed community
health center funding, overall, this is a good agreement.
Medicare beneficiaries, their physicians, children, and our entire
health care system will benefit from seeing CHIP and health center
funding extended, SGR repealed, and quality-based physician
reimbursement incentivized.
So I urge my colleagues both here in the House and in the Senate to
support this compromise legislation, the Medicare Access and CHIP
Reauthorization Act of 2015.
Mr. PITTS. Mr. Speaker, I am pleased to yield 1 minute to the
gentleman from Tennessee (Mr. Roe), the chairman of the Doctors Caucus,
who should be recognized for his tireless efforts to build support for
this bill.
Mr. ROE of Tennessee. Mr. Speaker, today I rise in strong support of
H.R. 2, which will permanently repeal the flawed SGR formula and
replace it with meaningful reform that will ensure seniors' access to
Medicare.
This agreement is one of the most important things we have
accomplished since I have been in Congress, and I couldn't be prouder
of the work done by the House Energy and Commerce and Ways and Means
Committees, along with the GOP Doctors Caucus.
I want to give a special thank-you to Speaker John Boehner and Leader
Nancy Pelosi, without whose leadership this agreement would never have
happened.
This bill will ensure Medicare recipients have access to quality care
and helps pave the way for entitlement reform by making important
structural changes to the program. That is an important point. People
over the years
[[Page H2073]]
have referred to this as the ``doc fix,'' but it really should be
called the ``senior fix.'' The cuts required by SGR were so severe
that, had they been allowed to go into effect, seniors' access to a
Medicare physician almost assuredly would have been curtailed.
After 12 years, 17 patches, and $170 billion spent to keep a flawed
formula from doing lasting damage to Medicare, we are finally acting in
a responsible manner, in a way that should give the American people
renewed confidence in Congress' ability to act on important matters.
I thank all involved.
Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentlewoman from
California (Ms. Pelosi), our Democratic leader, and I thank her for
what she accomplished here today working with the Speaker.
Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding.
I thank Mr. Pallone and Mr. Levin, our ranking members on the Energy
and Commerce Committee and the Ways and Means Committee, for their
leadership and cooperation on this issue, as well as Chairman Ryan of
the Ways and Means Committee and Chairman Upton of the Energy and
Commerce Committee.
This is a day that we really have to salute our staff. They have
worked so hard. It was my honor to work with Speaker Boehner on this
important issue to do what we came here to do--to legislate. We are the
legislative branch. We are legislating. We are working together to get
the job done for the American people.
From Speaker Boehner's staff, I especially want to thank Charlotte
Ivancic, who was extremely knowledgeable about health policy and was
smart and fair about all of this. Wendell Primus of my staff was a
strong voice for the concerns of seniors and children and the rest in
those discussions.
Ed Grossman and his team at House Legislative Counsel--for all the
ideas that Members churned up, Legislative Counsel had to translate
that into what the possibility was for legislative language. They
worked 24/7, weekends included.
Megan O'Reilly, Bridget Taylor, and the technical teams at CMS and
HHS worked 24/7 for many days.
Holly Harvey and Tom Bradley and the team at the Congressional Budget
Office, having to score every change of idea that we may have had.
Again, the staff both at the Ways and Means Committee and the Energy
and Commerce Committee on both sides of the aisle, I take the time to
recognize them because in recognizing them, I really want to recognize
the work that is done by staff on all that we do here.
All of these individuals, again, have been working 18-hour days for
the past few weeks, and we thank them for their tireless hard work.
This package includes many important victories for low-income
seniors, children, and families. There are many reasons to support this
bill, four of which I would like to point out:
We are strengthening the quality of care for many older Americans
with additional funding for initiatives that help low-income seniors
pay their Medicare part B premiums.
We have added almost $750 million for training more urgently needed
nurses and physicians.
We have secured the health care of poor children with a 2-year
extension of the Children's Health Insurance Program at the same rates
set by the Affordable Care Act. Many people wanted more, as did I. That
does not diminish the importance of the 2-year extension.
Lastly, we have secured critical funding for community health centers
over the next 2 years, expanding a vital investment in underserved
communities.
I am proud to rise in support of this historic, bipartisan package.
It represents bold, necessary progress for our country. And it is not
just about enabling our seniors to see their doctors, which was the
original purpose of the bill. It is about how we can increase
performance and lower cost; it is about value, not volume of service;
it is about quality, not quantity of procedures; and this legislation
is transformative in how it rewards the value, not the volume. So I am
proud to support it.
At long last, we will replace the broken SGR formula and transition
Medicare away from a volume-based system toward one that rewards
values, ensures the accuracy of payments, and improves the quality of
care.
With this legislation, we give America's seniors confidence that they
will be able to see the doctors they need and the doctors they like,
liberating them and their families from the shadow of needless, annual
crises.
And as a woman, during Women's History Month, I am very proud of what
the legislation means to women and their health issues.
So for these and other reasons, I urge my colleagues to vote ``aye.''
It was my privilege to work with the Speaker in a bipartisan way on
this legislation. I hope it will be a model of things to come.
Mr. PITTS. Mr. Speaker, I join in thanking the minority leader for
her role in achieving this bipartisan compromise. It is really
historic. I think it is appropriate that this is happening on her
birthday, and I join my colleagues in wishing her a happy birthday
today.
Mr. Speaker, could I inquire of the time remaining.
The SPEAKER pro tempore. The gentleman from Pennsylvania has 8
minutes remaining. The gentleman from New Jersey has 7\1/2\ minutes
remaining.
Mr. PITTS. Mr. Speaker, I yield 1 minute to the gentleman from
Florida (Mr. Bilirakis), another member of the Health Subcommittee.
Mr. BILIRAKIS. Mr. Speaker, I rise today to support H.R. 2, to repeal
and replace the SGR.
This bill will replace the SGR with the Merit-Based Incentive Payment
System, or MIPS. MIPS means physicians are practicing better medicine
to keep their patients healthier. Healthier people utilize less health
care, which means a lower cost to the taxpayer.
Nearly 150,000 seniors live in my district. This bill gives them
certainty that their doctor will see them. It provides seniors with
better care.
H.R. 2 includes a 2-year extension for community health centers
funding, which is very important to my constituents. This bill is pro-
senior, pro-doctor, and pro-patient.
This is a historic moment, nearly 20 years in the making. We have a
chance to make a huge difference for seniors. The benefits of repealing
the SGR are clear. Support this bill.
Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentlewoman from
Florida (Ms. Castor).
Ms. CASTOR of Florida. I thank the gentleman from New Jersey for
yielding the time.
Mr. Speaker, I rise in support of this important, bipartisan,
landmark bill.
Our parents and grandparents who rely on Medicare and the doctors
that take care of them can breathe easier today because of this bill.
Medicare will be stronger, and it will be more efficient. We are going
to put ``modern'' into modern medicine by transitioning the Medicare
health system into one that focuses on quality rather than quantity.
I would like to thank my colleagues on the Energy and Commerce
Committee, Chairman Upton and Ranking Member Pallone, Mr. Pitts and Mr.
Green, and Speaker Boehner and Minority Leader Pelosi for also adding
into this important package new assurance for children across America,
for our community health centers. The State Children's Health Insurance
Program now gets a very significant boost, along with our health
centers that take care of so many of our neighbors.
Thanks again to the professional staff, to the great public servants
in the Obama administration.
I urge a ``yes'' vote on this important, landmark bill.
Mr. PITTS. Mr. Speaker, I am pleased to yield at this time 1 minute
to the gentlelady from North Carolina (Mrs. Ellmers), another valued
member of the Health Subcommittee.
Mrs. ELLMERS of North Carolina. Mr. Speaker, I just want to extend my
thanks to all of the members who have worked so hard, both on the
Energy and Commerce Committee, but my Democratic colleagues across the
aisle, those who we are working with in the Senate.
I just want to say to the American people, don't look now, but we are
actually governing. And this is what the American people want to see.
I have a speech here to read, but I am actually going to go offline
and tell you from my heart what this means for our seniors.
This is about certainty. This is about governing. This is about
giving solutions to a problem. Yes, it comes with
[[Page H2074]]
a price tag. But when we continuously look at things from a one-
dimensional perspective on something so important as health care--it is
so multidimensional--we can't stop ourselves from moving forward.
Imagine a year from now where we will be when we are not trying to
come up with another billion-dollar bandaid to continue the SGR failed
formula, when we can actually be looking forward for solutions in
health care, continuing our work on 21st century cures, and showing our
seniors and every American family in this country how important it is
in the work that we are doing.
Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentleman from
North Carolina (Mr. Butterfield).
Mr. BUTTERFIELD. I thank the gentleman from New Jersey (Mr. Pallone).
Mr. Speaker, this is a good day for medical providers and for our
seniors. This is also a good day for the House of Representatives. This
is bipartisanship at its best.
With the passage of H.R. 2, seniors will no longer have to worry
about losing their physicians. Providers will have the certainty to
continue to serve their Medicare patients.
But this bill, Mr. Speaker, is about more than fixing Medicare. It
also includes a 2-year extension of the CHIP program, which is
children's health insurance, and funding for community health centers
that is set to expire this fall. Both programs are vital to the low-
income vulnerable and rural communities that I represent in North
Carolina.
The CHIP program covers more than 8 million children across the
country, including many in my State. It helps provide health coverage
to children who are not eligible for Medicaid but cannot afford other
insurance.
The community health center program funds 1,300 health centers across
the country. Without this extension, the program would expire, and care
for 7.4 million patients would be jeopardized.
Supporting this bill is about providing access to care for the most
vulnerable Americans. I urge my colleagues in the House and the Senate
to vote ``yes'' on H.R. 2.
Mr. PITTS. Mr. Speaker, I am very pleased at this time to yield 1
minute to the gentleman from Ohio (Mr. Boehner), our Speaker, who
deserves a lot of credit in coming up with this bipartisan compromise.
Mr. BOEHNER. I thank my colleague from Pennsylvania for yielding.
Let me say a big thank you to Chairman Upton, Chairman Ryan, Mr.
Pallone, Mr. Levin, and their staffs for all of the work that has gone
into this product. Also, I want to thank Wendell Primus with Leader
Pelosi's staff; Charlene MacDonald with Mr. Hoyer's staff; and, of
course, Charlotte Ivancic on my team, all who have worked together to
create this product that we have today. Thanks to their hard work and
the work of this House, we expect to end the so-called doc fix once and
for all.
Many of you know that we have patched this problem 17 times over the
last 11 years, and I decided about a year ago that I had had enough of
it. In its place, we will deliver for the American people the first
real entitlement reform in nearly two decades. I think this is good
news for America's seniors, who will benefit from a more stable and
reliable system for seeing their doctor.
{time} 1045
It is good news for hard-working families who will benefit from a
stronger Medicare program to help care for their elderly parents. It is
good news for the taxpayers who, according to the CBO and a number of
other fiscal experts, will save money now and well into the future.
That means it is especially good news for our kids and grandkids,
because today it is about a problem much bigger than any doc fix or any
deadline. It is about beginning the process of solving our spending
problem, and it is about strengthening and saving Medicare, which is at
the heart of that problem.
Normally, we would be here to admit that we are just going to kick
the can down the road one more time. But today, because of what we are
doing here, we are going to save money 20, 30, and 40 years down the
road. Not only that, we are strengthening Medicare's ability to fight
fraud, waste, and abuse.
As was mentioned earlier, this bill also extends the Children's
Health Insurance Program for another 2 years and extends the
authorization for community health centers for another 2 years.
My colleagues, this is what we can accomplish when we are focused on
finding common ground. But we can't become complacent. We know more
serious entitlement reform is needed. It shouldn't take another two
decades to do it, and, frankly, I don't think we have got that much
time. But I am here today to urge all of our Members to begin that
process, and the process begins by voting ``yes'' on H.R. 2 today.
Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Colorado (Ms. DeGette).
Ms. DeGETTE. Mr. Speaker, I rise today to support H.R. 2, the
Medicare Access and CHIP Reauthorization Act.
As this legislation was under negotiation, several of our colleagues
tried to add unnecessary language that would have expanded the Hyde
amendment to embed this harmful policy into the Affordable Care Act and
the Public Health Services Act. Thanks to the commitment of leaders for
women's health care rights, we secured important changes to this
language. Current appropriation policies concerning the use of funds at
community health centers will not change, and when the funding in this
bill for community health centers, the National Health Service Corps,
and teaching health centers expires, so will the funding restrictions.
Also, this language is freestanding, and it does not amend the
Affordable Care Act or the Public Health Services Act.
Let me be clear. I oppose the Hyde amendment. It is backwards policy
because it denies full reproductive coverage to poor women who need it
the most of everybody in this society; but this bill does not restrict
their access any further than current law, and the Pro-Choice Caucus
will continue to fight for health parity in this country for all women.
In the meantime, we have a bill here that has real advances in
finally fixing the physician reimbursement, extending the important
Children's Health program, extending the special diabetes fund that
helps so many Americans, and gives $7 billion to extend the important
community health centers for the next 2 years.
Mr. Speaker, I am proud of the work we did in a bipartisan way. I
want to thank the majority, and I want to thank my colleagues on my
side of the aisle for working together and only showing, as the Speaker
just said, what we can do when we really do the job that Congress is
supposed to do. I urge support of this legislation.
Mr. PITTS. Mr. Speaker, I am pleased to yield 2 minutes to the
gentleman from Texas (Mr. Burgess), the prime sponsor of the
legislation, who deserves a great deal of credit for where we are
today.
Mr. BURGESS. Mr. Speaker, I want to thank the chairman of the
Subcommittee on Health on Energy and Commerce. Mr. Speaker, I omitted
one of the people that should have been thanked earlier in my remarks
from the House Legislative Counsel, Michelle Vanek, who worked so hard
on the language that is before us today.
Mr. Speaker, a year ago I came to this floor, we had a similar vote,
and I talked about how important it was to send a positive message,
because last year it was the key that would get us through the door.
Well, guess what, Mr. Speaker. This year, not only will the key get us
through the door; we are going to knock the darned door down.
We do need a strong vote today. We saw it evidenced on the rule. I
urge all of my colleagues to get behind this legislation. It may not
have been everything you want, it may not have been what you would have
done if you had done it by yourself, but this is a collaborative body.
This is the work of a collaborative body. Now we need to send it over
to the world's greatest deliberative body. Let them deliberate for only
a short period of time because of the thunderous approval that has come
from the people's House.
Mr. Speaker, it is time to end the SGR. Let us never speak of this
issue again.
[[Page H2075]]
Mr. PALLONE. Mr. Speaker, I yield 3 minutes to the gentleman from
Maryland (Mr. Hoyer), our Democratic whip.
Mr. HOYER. Mr. Speaker, as an aside, I was inclined to get up and ask
that the gentleman's words be taken down. Of course, when we do that,
we do it in a different context. With those words, we ought to all be
happy today. Whether we are for or against, the Congress is working
today as the American people would have the Congress work.
Speaker Boehner, Leader Pelosi, our extraordinary staffs on both
sides of the aisle, and Members have come together and dealt with some
difficult issues. As the gentleman, Dr. Burgess indicated--and I have
worked with him on SCHIP for a very, very long period of time as I
recall--we are making progress. We are not where we all want to be, but
we are making progress.
Mr. Speaker, I rise in support of this bill and thank the Democratic
leader as well as Speaker Boehner, Ranking Members Pallone and Levin,
and the chairman of the committee, Mr. Pitts, and others for getting us
to where we are today.
This bill will permanently replace the broken Medicare sustainable
growth rate formula that, frankly, I have been working to get rid of
for almost a decade, if not longer, which has created uncertainty and
instability in the Medicare program for over a decade. I am pleased
that the parties were able to come together and craft a bipartisan bill
that will ensure seniors' access to their doctors and incentivize high-
quality, high-value care.
I am also glad that this bill includes a robust reauthorization of
the Children's Health Insurance Program, known as CHIP, which has been
a bipartisan success story. This is an issue, Mr. Speaker, I worked
hard on when I was majority leader, and I am glad that we are moving
forward today in a bipartisan way that recognizes how important the
CHIP program is for children and for families.
Another major component of this bipartisan compromise is the $7.2
billion in funding for community health centers. These centers serve
some of our most needy citizens. These centers, in my home State of
Maryland and throughout our country, provide essential health services
for millions of underserved families. That is good for all of us.
This, of course, as I said, is not a perfect bill. No compromise is
ever perfect from everybody's perspective. There are some parts I and
other Democrats would have liked to see improved, just as there are
some parts my colleagues on the other side of the aisle would change,
but this compromise will provide much-needed relief and certainty to
seniors, children, and families.
Mr. Speaker, I urge all of my colleagues to support this effort. It
will be a good day for the Congress of the United States, and it will
be a good day for America. I thank all of those whose leadership--
Members and staff--who got us to this point for the work that they have
done.
Mr PITT. Mr. Speaker, I reserve the balance of my time.
Mr. PALLONE. Mr. Speaker, I yield myself my 30 seconds remaining.
I want to recognize one person in particular, Ira Burney, a career
civil servant who, for more than 30 years, has worked tirelessly on
Medicare issues at CMS. There is not one Medicare bill in this time
that he has not been a part of. His hard work and technical knowledge
have been instrumental in supporting our work here in Congress.
So I want to thank Ira and all those on both sides of the aisle who
worked so hard to make this day possible. This is an important and
incredibly significant bill, and I urge my colleagues to support it.
I yield back the balance of my time.
Mr. PITTS. Mr. Speaker, I yield 1 minute to the gentleman from
California (Mr. McCarthy), the distinguished majority leader.
Mr. McCARTHY. I thank the gentleman, and I yield to my friend on the
other side of the aisle, Mr. Hoyer.
Mr. HOYER. I thank my friend, who has a magic minute that I dearly
miss. I forgot to articulate, and I should have articulated, I want to
congratulate Fred Upton.
Fred Upton is my friend. Fred Upton is the chairman of the Energy and
Commerce Committee. Fred Upton is one of those Members in this House
who represents this institution so well because he is committed to
working in a bipartisan fashion. We find ourselves sometimes not able
to do that. But I want to say thank you to Mr. Upton from Michigan for
his leadership and his commitment to making sure this institution works
as the American people want it to work.
I thank my friend, the majority leader, for yielding.
Mr. McCARTHY. Mr. Speaker, I thank the gentleman for his words, and I
hope all that are watching today see that this is a pattern of what
works inside Washington.
In Washington, Mr. Speaker, there is a common cycle: you have a
problem, you kick the can down the road; you hit a cliff, then you rush
to a short-term fix that doesn't actually fix the problem; then the
cycle starts all over again.
This isn't a good way to govern. With this cycle, problems usually
get worse, and a lot of times the short-term fixes get packed with add-
ons that increase the size of government and cost people more and more.
We have seen this with this doc fix again and again, 17 times over the
last decade. Every single year I have served in this body, less than a
decade, that has been the solution, to kick the can down the road. But
today the House will vote on a bipartisan bill to end the cliff for
good, stop the cycle, and, most importantly, provide stability to the
Medicare program for the seniors and their doctors.
Mr. Speaker, this is a big moment for Congress, and I think we should
all realize it. The bill before us today will, once and for all, repeal
and replace the flawed Medicare physician payment system. It will move
us away from volume-based care to care based on quality, value, and
accountability.
Everyone knows that we need to reform programs like Medicare to save
it for the future, but for so long, nothing has been done in this
House--that is until today. Today marks the first step of what I hope
will be many more to save our safety nets from collapse and to ensure
it for a future generation. These reforms are permanent, they are
bipartisan, and they lay the foundation for a Medicare that lasts.
We wouldn't be here to make all these big reforms without a lot of
hard work.
First, I want to thank the Doctors Caucus. There are many times I was
in a meeting with frustration wanting to find a solution, and the first
place to find a solution is policy. They spent their time together to
find that policy. Then it was: How are we going to pay for it and how
are we going to move forward? That is where the leadership of chairmen
come through in Fred Upton and Paul Ryan. They not only helped build
with the Doctors Caucus, they led their own committees.
Today, when this vote is taking place, it is going to be different
from others. People aren't going to sit and watch the sides to wonder
whether it gets there and how close does it pass? People are going to
watch how big the overall vote is going to be.
After this vote today, we will go back to our districts. We will go
back to our districts, hopefully in a different thought and a different
time, that yes, we can solve a problem; yes, we can pick a problem that
has lasted over a decade, that every Congress before it has kicked it
down the road, but no, we found common ground. We found the ability to
come together to solve something that many believed we could not.
We hope the Senate will see the same value. Today is a good day, but
today should not be the last day. We should look for the other
problems--and there are many--and ways that we can solve them
permanently like we will do today.
{time} 1100
Mr. PITTS. Mr. Speaker, I am very pleased at this time to yield such
time as he may consume to close to the gentleman from Michigan (Mr.
Upton), the chair of the Energy and Commerce, a master of bipartisan
compromise who deserves a great deal of credit for being here today.
Mr. UPTON. Mr. Speaker, it couldn't be bipartisan if we didn't have
good people on both sides of the aisle to get things done. I appreciate
all the leadership on this side and this side to really get this to a
finish point today.
Today, we do come together, we really do--Republicans and Democrats--
to
[[Page H2076]]
finally, finally fix Medicare's broken payment system, protect seniors'
access to care, and, yes, strengthen Medicare and extend the Children's
Health Insurance Program.
For way too long, the so-called SGR has been an axe over Medicare
physicians and the seniors that they care for. It has sparked crisis
after crisis for nearly 20 years, forcing this Congress to pass some 17
temporary measures to undo its faulty math and protect seniors' access
to their trusted doctors. Those 17 patches also served as a ready-made
vehicle for bigger government. Today, we put a stop to that gravy
train, leave the SGR in the past, and begin to put Medicare on the
right track.
This bill is good for seniors and for doctors who treat them. We
repeal the flawed SGR formula and replace it with a bipartisan,
bicameral agreement on a new system that promotes innovation and higher
quality care. It removes the hassle and worry that so many seniors and
physicians face from the cycle of repeated patches.
We also take steps to strengthen Medicare for current and future
seniors with structural reforms, which will not only provide cost
savings today, but the CBO has confirmed those savings will grow over
time. And the budget that we passed last night fully accounts for the
cost of those permanent reforms.
This package also extends benefits for millions of low-income
families and children by extending the Children's Health Insurance
Program for 2 years. This program provides high-quality, affordable
coverage for roughly 8 million children and pregnant women and has been
an example of sound bipartisan success.
I want to thank the bill's sponsor, Dr. Burgess, for his leadership
on this issue from day one. He came to Congress to solve this problem
and, today, we have a bill with his name on it to do just that.
I also commend the great subcommittee chair, Joe Pitts. Four years
ago, we embarked together on this effort to end the SGR, and that hard
work has brought us to this point.
I want to thank the full committee and the Health Subcommittee
ranking members, Mr. Pallone, my good friend, and Mr. Green, for
working, again, across the aisle from day one. We wouldn't be standing
here together if we hadn't started together.
Also, a big thanks to the folks at the House Legislative Counsel,
CBO, and the committee staff: Clay Alspach, Robert Horne, Josh Trent,
Paul Edattel, and Noelle Clemente.
Finally, I want to thank my friends on the Ways and Means Committee
and our leadership on both sides, from John Boehner and Kevin McCarthy
to Nancy Pelosi and Steny Hoyer. We are, together, getting this done.
This is a long time coming. Most of us came to Congress to fight for
our Nation's kids, seniors, and their families. Today's vote is a
defining moment for this Congress and for Medicare. Those who vote
``no'' are not only voting against seniors but against the future of
the critical safety net. That is why we all need to vote ``yes.''
Mr. PITTS. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. The Chair recognizes the gentleman from
Texas.
Mr. BRADY of Texas. Mr. Speaker, I yield myself such time as I may
consume.
I rise on behalf of Chairman Paul Ryan, chairman of the Ways and
Means Committee, in support of H.R. 2, a bill led by Dr. Michael
Burgess, and I am joined by many of our colleagues, both here in the
House and throughout the country.
This bill is critical because of this problem. Imagine you are a
senior. You desperately need to see a doctor, but you learn that there
are no local doctors who can treat you because they simply can't afford
to treat Medicare patients. Or they have been throughout the years
faced each year with a 10, 20, 30 percent cut in their reimbursements
and, as the sole practitioner or as a small business, have rethought
their relationship with Medicare and are no longer, frankly, able to do
that. That scenario has been played out across this country for far too
long. If there is any group in America who needs to see doctors they
know and who know them, it is our seniors.
This bill takes the first real permanent step to ensuring our seniors
can see local doctors when they need to see them, and it takes the
first real step in saving Medicare not just for these seniors, not just
for the next generation, but for generations to come.
I commend the work that has been done by the leaders of the Ways and
Means Committee; Chairman Ryan; Chairman Fred Upton of the Energy and
Commerce Committee; our physicians caucus, led by Dr. Phil Roe and Dr.
John Fleming; as well as those in this Chamber who have come together
to make this historic step today.
So this is about helping our seniors. This is about taking those
first reforms permanently to save Medicare. And it really is about
ending a formula and a reimbursement that simply works against our
seniors.
The flawed--they call it the ``sustainable growth rate,'' it dictates
huge cuts to our physicians through Medicare. Congress had to intervene
17 times in recent years to stave off these cuts with short-term fixes.
This flawed formula regularly threatens access to care for seniors and
really distracts Congress from making real reforms that are needed.
The bipartisan agreement that we face today would repeal that SGR
once and for all and replace it with a value-based system that provides
certainty to our seniors and, really, finally reimburses doctors not on
the number of procedures but on the quality they provide, and
determined not by Washington but by our local physicians and
practitioners themselves.
This reform alone, if that was the only thing this did, is
significant. It begins to move its way from that flawed fee-for-service
system. And it does in a way. The sole practitioner in rural
Pennsylvania, as well as a doctor in a major institution in downtown
Houston, can both practice to their highest capability and continue to
practice until they decide to retire, not until Medicare or some flawed
formula encourages them to retire early.
In addition, this bill has two important reforms, and I think
critical reforms, to strengthen the Medicare Program and offset the
costs of this measure. Similar reforms have been included in the House
Republican budget for years. This is a bipartisan effort to work
together with absolute dedication to make sure Medicare is around for
our seniors.
First, it restricts first dollar coverage in Medigap plans. These are
bipartisan recommendations experts believe will help reduce unnecessary
costs and really strengthen programs over the years.
Second, the agreement includes increased means testing for premiums
in Medicare parts B and D, our doctors, and our medicines, with the
wealthiest seniors paying higher premiums. And then there are savings
from a broad range of other healthcare providers.
I want to make clear, this bipartisan reform alone will not save
Medicare, but it takes us in the right direction for the very important
first step, and the savings from this will grow over the long term.
The alternative we refuse to pass is yet another cycle of short-term
fixes, leaving behind bipartisan structural reforms to Medicare and
delaying the opportunity to actually save this program for our seniors.
So, today, we end the SGR, we begin the important reform, and we
stand up for seniors who need to see doctors.
With that, Mr. Speaker, I reserve the balance of my time.
Mr. LEVIN. Mr. Speaker, I yield myself such time as I may consume.
Well, this is, indeed, a rare event. It was an event really waiting
to happen because, a year ago, our committee, Ways and Means, chaired
by Dave Camp, alongside the Energy and Commerce and Senate Finance
Committees, reached a bipartisan, bicameral agreement to move the
physician reimbursement system to one based more on quality, not
quantity. This helped pave the way for the package in front of us
today, negotiated with the key help of the Speaker and our Leader.
The SGR has been hanging over our heads for more than a decade. We
have paid close to $170 billion in short-term patches. With each patch,
it becomes harder to find offsets, putting seniors in our healthcare
system increasingly at risk. This is being done--and I emphasize that--
while maintaining the
[[Page H2077]]
basic structure of Medicare. Talk otherwise is mistaken.
Our approach to paying for this reform is a reasonable one. We are
paying for additional benefits, but not to dig out of the hole created
by the flawed budget formula.
This package includes a number of improvements across the healthcare
landscape. It fully funds a 2-year extension of CHIP at the increased
level of funding that we included in the Affordable Care Act. It
permanently extends the qualifying individual program that pays
Medicare premiums for low-income seniors. It permanently extends the
transitional Medicare Medical Assistance Program, which helps Medicaid
beneficiaries transitioning back to work to keep their insurance. It
secures $7.2 billion in funding for community health centers, ensuring
that 7 million Americans who depend on these establishments for care
can get it. And it makes progress in fighting fraud and abuse in
Medicare.
What I would like to do--it will take a little more time--is to thank
the staff. We don't do that enough. So I want to thank Wendell Primus,
Charlene MacDonald, Clay Alspach, and Matt Hoffmann. And, of course,
the Ways and Means Committee health staff, particularly Amy Hall and
Erin Richardson.
And we need to thank the excellent drafters from the House
Legislative Counsel Office, led by Ed Grossman, who I think is here
today, along with the Centers for Medicare and Medicaid Services Office
of Legislation, particularly Ira Burney, who is known for his deep
knowledge of Medicare and who helped put the package together in a
technically sound manner. And the CBO health team led by Tom Bradley,
who worked expeditiously to meet our timetable.
And I want to close my remarks by paying tribute to a Member who is
not with us today, who worked for years on these issues, John Dingell
of Michigan, for the years he put in protecting and strengthening
Medicare, Medicaid, and CHIP, including trying to fix SGR.
We are fixing SGR today, and we are strengthening Medicare, Medicaid,
and CHIP. This is a day where there was common ground, and today we
stand on it.
I reserve the balance of my time.
Mr. BRADY of Texas. Mr. Speaker, I yield 2 minutes to the gentleman
from Pennsylvania (Mr. Kelly), a successful small business person who
has provided health care to his more than 100 employees for years, a
key leader of the Ways and Means Committee.
Mr. KELLY of Pennsylvania. Mr. Speaker, I thank the gentleman.
We rise today. Really, this is not so much a doc fix as a senior fix.
And while our lives are usually defined by wins and losses, I would
think that really in our lives we remember the losses far more than we
remember the wins. And the reason I say that is, I have been there for
the birth of my four children, and I have celebrated the birth of our
10 grandchildren. Those are great moments. But I have also sat by the
bedside of my mother, my sister, and my father as they lay dying and
were transitioning.
{time} 1115
Those losses are things that you can never truly regain. Those are
the times when, if you just had 1 minute left with those folks,
wouldn't you love to have that? Wouldn't you love to be there with them
to give them peace of mind? This bill gives them peace of mind, Mr.
Speaker. That is what this bill does. This is a senior fix.
I will tell you, when I have watched people as they have passed--both
friends and family--what they have wanted at their bedsides at that
time is to have their faith with them so that they know they are
surrounded by their God, so that they know that where they are going is
best, and so that they know that somehow their futures are going to be
okay.
They also want the comfort of knowing that their families are there
with them, helping them to get through the toughest parts of their
lives, when they are at their most vulnerable, whenever they need the
most help.
Lastly, they want their doctors. They want to know that that person
who has guided them through the last several months and through their
lives--the person they have always gone to for their health care--is
going to be there and is not going to be taken away because of some
government program that didn't work.
I would say, as we sit in America's House, whether we are Republicans
or Democrats--and our gallery is filled with people--we are people who
are representing people and the best interests of people.
This piece of legislation today is truly a senior fix, but it is a
fix for the most vulnerable. I can think of nothing that we could do
that is more important than giving peace of mind to those who have
given so much to us as families, as States, and as a country. This is a
brilliant piece of legislation.
While it may not satisfy all, it serves the needs of so many.
Mr. LEVIN. Mr. Speaker, I yield 3 minutes to the gentleman from
Washington (Mr. McDermott), who is the ranking member on the Health
Subcommittee.
(Mr. McDERMOTT asked and was given permission to revise and extend
his remarks.)
Mr. McDERMOTT. Mr. Speaker, today is, in a sense, an historic event.
We are finally putting to rest a problem that has festered around here
for as long as I have been here.
Every year, as the deadline approached, providers faced draconian
cuts, and Congress passed an eleventh hour patch that delayed the
implementation of SGR. Doctors, patients, Congress--nobody--liked it.
Nevertheless, 17 times, we have made temporary fixes. We have spent
$174 billion in inadequate ways in dealing with the real problem that
SGR was all about, which is cost control.
This is a first step today. We can celebrate, but we have to go on
because cost control is still a question, and we have replaced SGR with
a system that we hope will make Medicare pay for value rather than for
volume. That is not an issue that is for sure. We know that we are
trying it.
I thought of Franklin Delano Roosevelt, who once said:
I will try something. If it doesn't work, I will stop it
and try something else.
That is really where we are today, looking at the future of cost
control in health care.
The most important thing today, though, is that we have gotten back
to regular order. The Republicans put this in 16 years ago. Some of us
voted ``no'' because we knew it wouldn't work, but we had all of our 17
years. Now, we come together to fix it together, and we have to fix
things together in this House. Compromise is the essence of what we
have here.
For my friends on the other side, just so you understand, I have
already had a phone call from a group in Washington State who told me
they are going to take me off the board if I vote for this.
It isn't as though this is a nice thing for one side or the other
side. It is a compromise, where some people get what they want and
where some people don't get what they want. Some people think it is not
enough, and some think it is too much.
That is the essence of compromise, and that is how the Congress has
to work. It is what is going to have to work with the ACA, the
Affordable Care Act. It is going to have to work on transportation. It
is going to have to work on a whole series of issues if we, as a
Congress, are going to function on behalf of the American people.
This is a great day. This ought to be a unanimous vote today. When
you look at all of the things that are in it and at all of the things
we have dealt with, it ought to be unanimous. My view is that, when you
reach a compromise, that is the kind of thing you can expect because
nobody in this House ever gets all he wants. Nobody has the right to
say: it is my way or the highway.
When we do that, we damage the American people. We have been damaging
the healthcare system with these patches, spending all of that money,
and not getting what we want. We hope this is the start of a better day
for cost control in health care. Everyone should vote for this.
Mr. BRADY of Texas. Mr. Speaker, I am proud to yield 2 minutes to the
gentleman from Pennsylvania (Mr. Meehan), who is a champion in health
care and whose district has a large number of seniors.
[[Page H2078]]
Mr. MEEHAN. Mr. Speaker, I rise today in strong support of the
Medicare Access and CHIP Reauthorization Act of 2015.
This is the product of several years of sustained bipartisan work,
and, today, we can finish the job. This is a critically important piece
of legislation for seniors because it is going to strengthen and
preserve the Medicare Program, and it is going to put an end to the
perennial drills that threaten seniors' access to high-quality care,
the care that they deserve.
H.R. 2 is a result of bipartisan compromise. I am sure my friends on
both sides of the aisle can agree, as my good friend from Oregon
identified, that it isn't perfect, but I am pleased that they will also
extend funding for the Children's Health Insurance Program. Just like
our seniors, we need to make sure that our kids have access to high-
quality, affordable care. We also continue to support community health
centers, which provide quality care for those of lesser means.
Since 2002, Congress has passed 17 patches to avert the SGR's
draconian cuts. These patches avoid crisis, but they don't do anything
to preserve or improve the Medicare Program for current and future
seniors, so I am delighted that, together, we can finally forge a
lasting solution.
This isn't just good for seniors' care and for our healthcare
workforce; it is a sign that partisan differences in Washington can be
bridged to address our biggest challenges. I urge my colleagues to
support this legislation, and I hope the Senate will send it to the
President and get it signed quickly.
Mr. LEVIN. Mr. Speaker, how much time is there, please, on both
sides?
The SPEAKER pro tempore. The gentleman from Michigan has 8 minutes
remaining, and the gentleman from Texas has 7 minutes remaining.
Mr. LEVIN. Mr. Speaker, it is now my pleasure to yield 2 minutes to
the gentleman from Oregon (Mr. Blumenauer), a distinguished member of
our committee.
Mr. BLUMENAUER. I appreciate the gentleman's courtesy, as I
appreciate his leadership on this.
Mr. Speaker, I have sat on the floor for the entire debate--of both
the Commerce and Ways and Means Committees--and it is really exciting.
I was one of those people who didn't vote for the balanced budget
agreement back in the day, but I have been frustrated by this as much
as anybody. I had legislation that would just simply reset the
baseline, but, actually, this is better.
It is better because we have had Ways and Means, Commerce, and
Finance Committees come together for several years and develop a reform
that will strengthen opportunities for better payment. It is better
because we have seen the minority leader and the Speaker of the House
come together to empower the committees to do their job.
I was struck by the words of Majority Leader McCarthy when he said
this was a good day, and he thinks that this will not be the last such
day. I sincerely hope that that is the case, that it signals
opportunities for us all to go forward.
I like the fact that we have added things in here like the SCHIP. We
have even gotten Secure Rural Schools, funding extended which makes a
big difference for people in the West, especially Oregon.
I am hopeful that we can step forward. We have got another cliff that
is facing us in 2 months: the transportation cliff. People are talking
about 17 SGR fixes here when we have had 23 short term extensions for
the transportation system.
I would hope that we could take the same spirit of cooperation and
bipartisanship and listen to people in the outside world--organized
labor, the AFL-CIO, the U.S. chamber, contractors, local government,
environmentalists--who are all speaking with one voice: Congress, get
your act together; give us funding to be able to fund the
transportation bill for the first time in years and rebuild and renew
America, to put people to work--and to show the same sort of bipartisan
cooperation that I find really invigorating today.
I hope the next thing we do is have the Ways and Means Committee, the
committee of jurisdiction, step forward to solve the transportation
problem. It is even easier than the SGR.
Mr. BRADY of Texas. Mr. Speaker, I am proud to yield 1\1/2\ minutes
to the gentlewoman from Tennessee (Mrs. Black), who has spent more than
40 years in health care as a nurse and as a small-business owner.
She is a member of the Doctors Caucus here and is a key leader in
health care on the Ways and Means Committee.
Mrs. BLACK. I thank my colleague, who is someone who has worked
tirelessly on this issue and who is a leader on our healthcare
committee.
Mr. Speaker, I rise in strong support of the Medicare Access and CHIP
Reauthorization Act of 2015.
This bipartisan legislation offers a permanent solution to strengthen
the Medicare Program that our Nation's seniors and their doctors rely
on. It would repeal the flawed SGR formula that dictates draconian cuts
to Medicare reimbursements, and it would do so in a fiscally
responsible way that would provide important offset savings.
Since 2003, Congress has spent $170 billion on short-term fixes that
has staved off these cuts without making the real reforms that are
needed, and this cycle has done nothing to address the real problems of
our entitlement spending.
I have been a nurse for more than 40 years, as has been said, and I
know that you can't put a bandaid on a problem that needs to be
corrected by surgery. The problems impacted and affected by these
looming cuts were my patients and my colleagues.
I urge this body to end the SGR crisis once and for all. Adopt these
structural reforms, and help us move forward together to strengthen
Medicare for today's seniors and tomorrow's retirees.
Mr. LEVIN. Mr. Speaker, I yield 2 minutes to the gentleman from New
Jersey (Mr. Pascrell), a very vocal member of our committee.
Mr. PASCRELL. I have got to say this to Chairman Brady and to our
leader, Mr. Levin: you guys did a great job in keeping us together, and
I think the words that I will take away are what Dr. Burgess said about
this being a collaborative effort.
Mr. Speaker, if someone came down from Mars today into this Chamber,
he would be shocked by the camaraderie. This is great. This is a good
feeling. You have got to admit it is a good feeling. I know it is
before Palm Sunday, but I have got a good feeling today, on Thursday.
This effort, I think, establishes a very good precedent for
revitalizing the integrity of this Congress, of this institution. We
here, Mr. Brady and Mr. Levin, got out of our echo chambers. We love to
hear ourselves. You know that. It is part of the DNA of being a
Congressperson.
We got out of those echo chambers, and we actually listened to each
other. That is shocking. If we can rise above our own attempts to be
ideologues, we can accomplish a hell of a lot here for the people of
the United States. They deserve no less.
The repeal and the replacement of SGR ends the constant looming of
deep payment cuts to Medicare physicians, which, as we have heard,
jeopardizes the participation in the program and jeopardizes seniors'
access to their doctors. As a result of this law, our Medicare payment
system will finally be rooted in the quality of services provided as
opposed to the quantity, results rather than fee for service.
I must say, Mr. Speaker, that I urge my colleagues to vote for this
legislation. It is good for America.
Mr. BRADY of Texas. Mr. Speaker, I am proud to yield 1 minute to the
gentleman from Florida (Mr. Curbelo), a new Member of Congress who is
passionate about health care, reforming Medicare, and helping seniors.
{time} 1130
Mr. CURBELO of Florida. Mr. Speaker, I rise today in strong support
of H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015,
and I would like to thank the Committee on Ways and Means and Committee
on Energy and Commerce for taking bold leadership on such a critical
issue.
Sustainable growth rate is a budget cap on physician services passed
into law in 1997 to control spending. Unfortunately, the SGR formula is
fundamentally broken. Since 2003, Congress has spent nearly $150
billion in 17 separate short-term patches to prevent significant
Medicare reimbursement rate cuts. This uncertainty is detrimental to
providing our seniors and our doctors with the confidence that they
deserve.
[[Page H2079]]
This bill before us today repeals the outdated SGR formula and
replaces it with a new permanent system that rewards quality and value
and guarantees stability to Medicare beneficiaries and the physicians
providing their treatment.
Most of all, Mr. Speaker, I want to thank our leaders for allowing us
to have this special moment. Today, the American people have the
Congress that they deserve, a Congress that is focused on advancing an
agenda that can make the American people proud. Let us continue walking
down this path together.
Mr. LEVIN. I yield 2 minutes to the gentleman from Illinois (Mr.
Danny K. Davis), another active member of our committee.
Mr. DANNY K. DAVIS of Illinois. Mr. Speaker, it takes a lot of time,
energy, effort, hard work, and study to become a physician. I think
they ought to be adequately compensated for the services they provide,
especially when they serve the most needy health population in our
country--our senior citizens.
We call this the doctor fix, but it is really not about the doctor
fix. It is about fixing health care. It is about CHIP. It is about
community health centers that serve more than 23 million low- and
moderate-income citizens each and every year. It is about the National
Health Service Corps training physicians. It is about the home visiting
program.
I represent a district that has 24 hospitals, four outstanding
medical schools, and so we train and educate many doctors, nurses, and
other health personnel.
This is not just a good day for the doctors; it is a good day for
health care, and it is a good day for America.
Mr. Speaker, H.R. 2, the Medicare Access and CHIP Reauthorization Act
of 2015 is a bill that determines how doctors get adequate pay for
providing medical services to Medicare recipients. For the past 12
years, the Medicare sustainable growth rate (SGR) formula has impeded
stability in the Medicare program for providers and beneficiaries.
Seventeen times Congress have done short term fixes, known as patches,
that range from 3 to 12 months. Physicians should and deserve equitable
reimbursement and not a lower reimbursement rate for the services they
provide to our seniors. This is one of the leading reasons why
physicians are leaving their practice or not accepting Medicare
patients. We should repeal SGR and establish a legislative long-term
fix that offers payment stability for our doctors. H.R. 2 will do just
that and allow doctors to develop long-term strategic planning for
their practice and time to invest in electronic health information
technology and other medical systems to improve access and quality care
for their patients.
Now is the time to capitalize on the lower offset now projected for
the permanent repeal of the SGR formula otherwise failure to do so may
cause problems for many providers to see Medicare patients. Ten
thousand new enrollees enter Medicare each day. Access to physicians
will suffer for the Medicare population as the gap between payments and
practice costs continue to grow.
H.R. 2 fully fund the Children's Health Insurance Program (CHIP) for
two years. CHIP is a partnership between the federal government and the
States to provide healthcare coverage for over eight million children.
Also, this legislation extends funding for two years to Community
Health Centers to avoid draconian cuts to their services and operations
in their communities. Community health centers play a critical role in
the delivery of care to our most financially and medically vulnerable
populations, and thus play an instrumental role in efforts to achieve
health equity. Health centers serve one in seven Medicaid
beneficiaries, one in seven uninsured, and one in three individuals
living below poverty. African Americans, Asians/Hawaiians/Pacific
Islanders, American Indians/Alaskan Natives, and persons with multi-
racial and ethnic backgrounds account for 36 percent of all health
center patients. Approximately 34 percent of health center patients are
Hispanic/Latino, and health centers serve one in four racial and ethnic
minorities living in poverty.
Community health centers are a local solution to the delivery of
primary care--which is precisely how care works best--and services that
are tailored to meet local needs, specific to each community. Health
centers save the health care system money by keeping patients out of
costlier health care settings, coordinating care amongst providers of
different health disciplines, and effectively managing chronic
conditions. Recent independent research shows that health centers
currently save the health care system $24 billion annually in reduced
emergency, hospital, and specialty care costs, including an estimated
$6 billion annually in combined state and federal Medicaid savings.
Despite serving traditionally at-risk populations, community health
centers meet or exceed national practice standards for chronic
condition treatment and ensure that their patients receive more
recommended screening and health promotion services than patients of
other providers. Health centers also have a substantial and positive
economic impact on their communities. In 2009 alone, health centers
across the country generated $20 billion in total economic benefit and
produced 189,158 jobs in the nation's most economically challenged
neighborhoods.
H.R. 2 includes the MIECHV home visiting program, which I worked in a
bipartisan and bicameral way in Congress to establish a national
program that serves approximately 115,000 parents and children. Under
this legislation this program will be extended to improve child health,
child development, and readiness to learn.
Mr. Speaker, I rise in full support of H.R. 2 and encourage all my
colleagues to vote for this bill.
Mr. BRADY of Texas. Mr. Speaker, I yield myself 30 seconds.
I include in the Record a list of over 100 healthcare organizations
throughout America--and growing--who support the passage of this
legislation today. I would like to point out that these represent
physicians and healthcare providers who truly want to treat our
seniors, to see them when they need to see them, but can't today
because of the way Medicare pays them.
So we start with a fresh start, and I enter into the Record this
list.
Alliance for Academic Internal Medicine (AAIM); AMDA The
Society for Post-Acute and Long-Term Care Medicine American
Academy of Allergy, Asthma, and Immunology (AAAAI); American
Academy of Dermatology Association; American Academy of
Family Physicians; American Academy of Neurology (AAN);
American Academy of Ophthalmology; American Academy of
Pediatrics; American Action Forum; American Association for
the Study of Liver Diseases (AASLD); American Association of
Clinical Endocrinologists (AACE); American Association of
Neurological Surgeons/Congress of Neurological Surgeons;
American Association of Nurse Anesthetists; American
Association of Nurse Practitioners (AANP); American
Association of Orthopedic Surgeons; American College of
Allergy, Asthma and Immunology (ACAAI); American College of
Cardiology (ACC); American College of Chest Physicians
(CHEST); American College of Physicians (ACP); American
College of Radiology.
American College of Rheumatology (ACR); American College of
Surgeons; American Congress of Obstetricians and
Gynecologists; American Gastroenterological Association
(AGA); American Geriatrics Society (AGS); American Health
Care Association; American Hospital Association; American
Medical Association; American Medical Society for Sports
Medicine (AMSSM); American Osteopathic Association (AOA);
American Society for Blood and Marrow Transplantation
(ASBMT); American Society for Gastrointestinal Endoscopy
(ASGE); American Society for Radiation. Oncology (ASTRO);
American Society of Clinical Oncology; American Society of
Hematology (ASH); American Society of Nephrology (ASN);
American Thoracic Society (ATS); Americans for Tax Reform;
Association of Departments of Family Medicine; Association of
Family Medicine Residency Directors.
Aurora Health Care; Billings Clinic; Bipartisan Policy
Center; California Medical Association; Center for Law and
Social Policy (CLASP); College of American Pathologists;
Digestive Health Physicians Association; Endocrine Society
(ES); Essentia Health; Federation of American Hospitals;
Grace Marie Turner for the Galen Institute; Greater New York
Hospital Association; Gundersen Health System; HealthCare
Association of New York State; Healthcare Leadership Council;
Healthcare Quality Coalition; HealthPartners; HealthSouth;
Hospital Sisters Health System; Infectious Diseases Society
of America (IDSA).
Iowa Medical Society; Let Freedom Ring; Louisiana Rural
Health Association; LUGPA; March of Dimes; Marshfield Clinic
Health System; Mayo Clinic; McFarland Clinic PC; Medical
Group Management Association; Mercy Health; Military Officers
Association of America (MOAA); Minnesota Hospital
Association; Minnesota Medical Association; National
Association of Community Health Centers; National Association
of Spine Specialists; National Association of Urban
Hospitals; National Coalition on Health Care; National Retail
Federation; North American Primary Care Research Group; Novo
Nordisk.
Oregon Association of Hospitals and Health Systems; PhRMA;
Premier Inc.; Renal Physicians Association; Rural Wisconsin
Health Cooperative; Society for Adolescent Health and
Medicine (SAHM); Society of Critical Care Medicine (SCCM);
Society of General Internal Medicine (SGIM); Society of
Teachers of Family Medicine; Tennessee Medical Association;
Texas Medical Association; The 60 Plus Association; The
American College of Gastroenterology; The Hospital &
Healthsystem Association of Pennsylvania; The Iowa Clinic;
The Society
[[Page H2080]]
of Interventional Radiology; ThedaCare; Wisconsin
Collaborative for Healthcare Quality; Wisconsin Health and
Educational Facilities Authority; Wisconsin Hospital
Association; Wisconsin Medical Society.
Mr. BRADY of Texas. Mr. Speaker, I reserve the balance of my time.
Mr. LEVIN. Mr. Speaker, I yield 1 minute to the distinguished
gentlewoman from Texas (Ms. Jackson Lee).
Ms. JACKSON LEE. Mr. Speaker, I thank the distinguished gentleman
from Michigan and my friend from Texas, and what a celebration of
Members coming together, Republicans and Democrats.
Mr. Speaker, I stand on this floor to ensure and insist that I am
here to protect seniors and to ensure that the vote taken today does
not undermine the protection of Medicaid and Medicare, in particular
Medicare for our seniors, and that any vote does not in any way hinder
those and provide a burden for those who cannot pay.
This provides a pathway for providing for our medical providers with
the SGR fix; it provides seniors with quality healthcare services so
they can go to the doctor they want; and, yes, it provides quality
funding for our children and for our low-income families.
It supports our federally qualified health clinics, and coming from
the city of Houston with the Texas Medical Center, there are a lot of
doctors. Those doctors serve the poor and they serve seniors, and I
want to make sure they are able to do so. The CHIP program will be
protected that has been a vital program to provide for those families
for our children to be healthy.
Let me agree with my colleague, brother Pascrell, this is good for
America. I am delighted to support this, and we are going to help
physician-owned hospitals and look forward to a better day.
Mr. Speaker, I rise in support of H.R. 2, the ``Medicare Access and
CHIP Reauthorization Act of 2015,'' and the underlying bill.
H.R. 2 repeals and replaces the Medicare Physician Payment System and
incentivizes quality care for seniors, children and low income-
families.
I thank Chairman Ryan and Ranking Member Levin for their work in
shepherding this legislation, which enjoys bipartisan support to the
floor.
I support the bill before us because it protects our seniors, our
children, low-income families, and equitably compensates physicians who
provide critically needed health services.
This bipartisan legislation represents a significant achievement
because it reforms Medicare's payment system and maintains critical
funding for health care for millions of seniors, low-income children,
and families.
Compensating our medical providers adequately to enable them to
continue providing much needed services to our seniors is a moral
imperative.
Assuring that our seniors receive quality health services is a moral
imperative.
Providing critical healthcare funding for children and low income
families is also a moral imperative.
Physicians from my congressional district in Texas, and others across
the country, serve and provide remarkable healthcare to our seniors,
children, and low income families.
The 70,000 seniors in my congressional district are entitled to the
security that comes from knowing that healthcare will be available to
them when they need it the most.
The 4.4 million low income families and children in the state of
Texas and the 130,000 children in Harris County will benefit from this
bill because it provides the resources needed to improve their quality
of health.
It is important that physicians who are willing to serve our seniors,
children, and low income families not have to go broke doing so.
Mr. Speaker, let me briefly list several of the more important
aspects of this bill which I wholeheartedly support:
For our seniors, the bill repeals the sustainable growth rate (also
known as SGR) formula and phases in a value based payment system for
physicians serving Medicare patients for the quality of care they
provide.
For our seniors, children and low-income families, the new payment
incentives in the bill encourage physicians to move towards alternative
payment models such as bundled payment and shared savings which foster
alignment of high-quality and cost effective healthcare.
This bill extends the Children's Health Insurance Program, or CHIP,
for two years.
Over 928,000 children are in CHIP in Texas, and 130,000 in Harris
County, will benefit from this bill.
For our children, ``clean'' extensions in the bill maintain policies
and funding that does not include detrimental policies or cuts.
This funding supports evidence-based programs that have been proven
to reduce health care costs, improve school readiness, and increase
family self-sufficiency and economic security.
This bill extends the Maternal, Infant, and Early Childhood Home
Visiting Program for two years.
This bill extends funding for 1,300 federally funded community health
centers located in all 50 states, the District of Columbia, and six
U.S. territories, distributed evenly between urban and rural areas,
that serve 28 million patients.
A third of those patients are children, and 93 percent of patients
served have incomes below 200 percent of the federal poverty line.
The vast majority of the 90 million patient visits to community
health centers were for primary medical care.
Without the funding, 7.4 million low-income patients--including 4.3
million women provided by this bill would lose access to health care.
This bill extends the Qualifying Individual Program--which subsidizes
Medicare premiums for low-income beneficiaries--permanently.
This bill permanently corrects Medicare payments to physicians an
provides much-needed certainty and stability to the Medicare program.
Importantly, the bill provides financial incentives to reinforce the
country's path toward a health care system that rewards value and
quality of care.
Mr. Speaker, this bipartisan legislation is a step in the right
direction in Medicare payment reform and ensures continued funding that
improves the health and welfare of millions of seniors, children, and
families.
H.R. 2 is important because it reforms our flawed Medicare physician
payment system; incentivizes quality and value for our seniors; and
extends coverage for our children and low income families.
For all these reasons, I strongly support this bill and urge my
colleagues to likewise.
Mr. BRADY of Texas. Mr. Speaker, I know Mr. Levin has additional
speakers, so I will reserve the balance of my time.
Mr. LEVIN. I yield myself the balance of my time.
Mr. Speaker, this is an important moment. As I look back, it has been
decade after decade of a struggle for health care for all Americans, a
real struggle.
Today, we have legislation that covers kids from infancy through
seniors, for seniors throughout their years. That is the importance,
really, of these provisions. I simply want to express, I think, the
feeling of so many of us on this side. So we have this moment of coming
together, and I hope in the days ahead that these notes of harmony will
not be disturbed by notes of dissonance. We owe more, and all the
bodies, all the institutions owe it to the people of this country to
continue on this path so what should be a right is a reality.
I don't think anybody in this institution can imagine going to bed
any night worried about having health care, and the same for their
families, their kids, and their grandchildren. I hope we will take
these few minutes when we come together and reassert the importance in
this country of joining together so that everybody from birth until
their last days has the ability to have what is so precious--the
ability to have access to health care. I hope that is the significance
of this vote. I hope, as a result, it will be a very strong vote, and I
think it is a vote for health care for every American.
I yield back the balance of my time.
Mr. BRADY of Texas. I yield myself the balance of my time to close.
Mr. Speaker, there is nothing wrong with being passionate about your
ideas and principles, and nowhere is that more evident than in health
care. When you can find, though, common ground on those principles that
help our seniors, encourage our doctors to treat them, and make the
first reforms to really save Medicare for the long term, we ought to do
that. That is what this bill does.
But it just isn't a common ground as far as our lawmakers. We have
dedicated staff who came together to work out the tough issues for us
as well. On behalf of the Committee on Ways and Means Chairman Paul
Ryan and myself, I would like to thank our staff on the Ways and Means
Subcommittee on Health--Matt Hoffmann, Brett Baker, Amy Hall, and Erin
Richardson--for their tremendous work.
The Speaker and former Speaker Pelosi also led the effort to find
this
[[Page H2081]]
common ground, and for Speaker Boehner, Charlotte Ivancic, and for
Leader Pelosi, Wendell Primus, we thank you, as well as legislative
counsel; and for the Congressional Budget Office, Tom Bradley and Holly
Harvey contributed greatly to this day.
The other day, my neighbor, who has just retired from Continental,
now United, walked over to my front porch and told me that after years
of seeing his local doctor, his local doctor can't see him anymore
because he can't afford to treat Medicare patients.
The other day--it was a tough winter for illnesses--I had an ear
infection, and my local doctor I have known since he started his
practice snuck me in at 6 at night. His staff had been there since 8 in
the morning working and just looked frazzled. He just said, look, he
doesn't drive a fancy car, doesn't live in a fancy home; he doesn't
have a fancy office; he just wants to help treat patients. But this
formula just makes it harder and harder for him. My main physician, who
is 66, told me the other day that he would like to practice for 5 more
years. He said: I think probably just 1 more year. He said: I can't
handle the way Medicare pays today.
Look, we can't allow that to continue. Today, a simple question on
this bill: Will you stand with our seniors, who need to see a local
doctor and a doctor they know? Will you stand with our doctors, who
want to treat our seniors, who don't want to retire early or sell out
to larger institutions? Will you take the first real step to save
Medicare for the long term? That is the question we face today.
On behalf of Chairman Ryan and those who have come together on this
bill, I urge a ``yes'' vote on this measure.
Mr. Speaker, I yield back the balance of my time.
Mr. RYAN of Wisconsin. Mr. Speaker, here's what it all comes down to:
This is a step toward patient-centered health care.
And what that means is, we're starting to focus on what's best for
patients.
Medicare is supposed to help seniors get the best health care
possible.
And the way to do that is to reward what works.
Reward the doctors who help you recover faster and live longer.
Reward the doctors who put seniors and their health first.
That's what it means to have a patient-centered system. That's how
you strengthen Medicare.
And that's what this bill does. This bill changes how Medicare pays
doctors.
Right now, you get paid for every single treatment you perform--no
matter how effective you are.
So what we say to doctors is, ``From now on, we're going to reward
quality work. Do a good job, make people better, keep them out of the
hospital, and you'll get paid more.''
I think we all can agree that's better than just paying for the
amount of care.
And we can all agree that's better than one more year of a
manufactured crisis.
Now I want to add that we make a couple of other good reforms in this
bill.
These reforms will save money. And those savings will build up over
time.
We ask the wealthy to contribute more to their care.
We discourage unnecessary doctor visits with some insurance reforms.
And we tell Medicare to share data with experts to help providers
figure out what works.
You all know I think we have a long way to go to save Medicare.
I think this is just a start.
But this is a firm step in the right direction.
It's a firm step toward a patient-centered system.
And I ask all my colleagues to support it.
Committee on Ways and Means,
House of Representatives,
Washington, DC, March 20, 2015.
Hon. Fred Upton,
Chairman, Committee on Energy and Commerce, Rayburn House
Office Building, Washington, DC.
Dear Chairman Upton: Thank you for your letter regarding
H.R. 1021, Protecting the Integrity of Medicare Act of 2015,
which was ordered reported by the Committee on Ways and Means
on February 26, 2015. I appreciate your decision to
facilitate prompt consideration of the bill by the full
House. I understand that by foregoing a mark-up of the bill,
the Committee on Energy and Commerce is not waiving its
interest in the provisions within its jurisdiction.
Per your request, I will include a copy of our exchange of
letters with respect to H.R. 1021 in the Congressional Record
during House consideration of this bill. We appreciate your
cooperation and look forward to working with you as this bill
moves through the Congress.
Sincerely,
Paul Ryan,
Chairman.
Ms. FRANKEL of Florida. Mr. Speaker, I rise today to express my
disappointment that Hyde Amendment language was included in H.R. 2, the
Medicare Access and CHIP Reauthorization Act of 2015.
The Hyde Amendment, which prohibits federal funding for abortion, has
prevented women from accessing needed reproductive health care for
decades. While the Hyde Amendment remains in law through the yearly
appropriations process, every attempt to insert Hyde Amendment language
into other legislation damages efforts to protect women's health.
It is unfortunate that today's historic bipartisan deal--which will
strengthen Medicare for millions of Floridians--was used as a vehicle
to chip away at women's access to reproductive health care. Every woman
deserves the right to make her own personal health decisions.
Mr. FARR. Mr. Speaker, I rise today to thank our leaders for working
so tirelessly to find a compromise to fix the SGR. For too many years
this arbitrary budget device has worked to up-end Medicare doctors and
patients alike, creating turmoil when what was needed was common sense.
Thankfully, today common sense wins out.
But I have to say as well that I am disappointed that the bill
includes unnecessary language on restricting women's reproductive
rights. The inclusion of a statutory reference to the Hyde amendment is
bothersome in the least and very possibly a dangerous precedent-setting
salvo by anti-choice opponents to codify the Hyde language.
Mr. Speaker, I don't understand why Hyde had to be referenced at all
in this bill. Everyone already knows that community health centers are
already subject to Hyde restrictions. Including it in this SGR bill is
redundant. Unfortunately, it is all too typical of this Tea Party-
infused Congress to sow discord rather than accommodation. Adding the
Hyde language to the bill only causes heartburn in a bill that could
much more easily have satisfied our hunger for bipartisanship.
Ms. BONAMICI. Mr. Speaker, I rise today in support of H.R. 2, the
Medicare Access and CHIP Reauthorization Act. This legislation is a
long overdue remedy to the flawed Medicare physician payment formula
known as the Sustainable Growth Rate, or SGR. I look forward to putting
an end to the temporary patches that Congress has repeatedly passed in
place of a permanent fix.
Replacing the SGR and bringing predictability to Medicare will
encourage more providers to enter and remain in the program, which in
turn will improve health care access and affordability for seniors.
Additionally, H.R. 2 marks an important shift from fee-for-service
payments to a system that rewards quality outcomes.
This bill also includes several important reauthorizations to
crucial programs, including the Children's Health Insurance Program,
the Qualifying Individual program, and the Maternal, Infant, and Early
Childhood Home Visiting Program. Although I would have supported a
longer authorization of CHIP, which would bring more certainty to our
states and the children and families they serve through the program, I
hope we can work together during the next two years to develop a strong
authorization before it expires in two years.
I am also very pleased that this legislation includes an extension
of the Secure Rural Schools and Community Self-Determination Act.
Hundreds of jurisdictions across the country--including timber-
dependent counties all across Oregon--rely on this essential funding
for their schools, government services, and law enforcement.
Lastly, H.R. 2 provides continued authorization for Community Health
Centers, which provide important services in underserved communities.
Although support for community health centers will prevent millions of
patients from losing access to primary care, the funding will
unfortunately remain subject to the Hyde Amendment--a harmful provision
that undermines women's health. I am deeply troubled with the
continuation of this public law.
I am also troubled by the precedent set in this bill where we will
begin charging some seniors more for their premiums. Medicare, like
Social Security, is an earned benefit paid for over a lifetime.
Despite these serious objections, I will support this bipartisan
legislation. Congress must preserve access to primary care for
vulnerable individuals
[[Page H2082]]
and bring long sought stability to Medicare for our seniors. I urge my
colleagues to join me in supporting this comprehensive legislation and
permanently fix the SGR.
Mr. BOUSTANY. Mr. Speaker, this week the House has an opportunity to
make historic reforms to Medicare that will provide certainty to
doctors and patients across the country.
I spent 30 years practicing as a heart surgeon, fighting to save
lives on the operating table every day.
I know firsthand that the cycle of temporary patches and extensions
injects tremendous uncertainty into the process, making it much more
difficult to run a successful practice.
Last week, I stood with a bipartisan group of Representatives and
Senators to introduce the replacement legislation under consideration.
This bill repeals the unworkable SGR, consolidates duplicative
programs, and improves transparency for patients and doctors. It is a
historic solution to a problem that has plagued doctors and providers
for over a decade.
But no solution is one hundred percent perfect.
I believe we must continue working toward full repeal of the
unworkable Medicare outpatient therapy cap, something I've introduced
legislation to address and will continue to work with my colleagues to
make this law.
That's something I'll continue to fight for.
But today, it's time for Congress to do what we are elected to do:
come together, find common ground, and pass a solution.
This is the first meaningful opportunity to fix this broken system in
years--let's not bypass this moment.
I encourage all of my colleagues to support this permanent doc fix.
Mr. LANGEVIN. Mr. Speaker, I rise today in support of the Medicare
Access and CHIP Reauthorization Act, which repeals once and for all the
flawed Medicare physician reimbursement formula, known as the SGR, and
replaces it with a payment system based on quality of care, value and
accountability.
Since 2003, Congress has spent nearly $170 billion on short-term
patches to temporarily avoid cuts under the SGR. This bipartisan,
bicameral agreement will finally stabilize payments for medical
providers and remove the persistent threat of rate cuts that have
jeopardized access to care for our seniors.
Also contained in this legislation is a crucial two-year extension of
the Children's Health Insurance Program. Although I would have
preferred to see CHIP extended for four years, this measure allows us
to take immediate action instead of waiting until the program expires
in September, providing certainty to states like Rhode Island that are
preparing their budgets for next year, while ensuring that over eight
million children continue receiving the health coverage they need at
increased funding levels set forth under the Affordable Care Act.
I am also pleased to see the inclusion of over $7 billion for
community health centers that provide front line care to millions of
families across the country, as well as $620 million for the National
Health Service Corps and $120 million for Teaching Health Centers.
Of course, this legislation is not perfect. It includes provisions I
do not support, such as reforms to Medigap deductibles for new Medicare
beneficiaries beginning in 2020. However, this measure seeks to protect
our most vulnerable citizens by permanently extending the Qualifying
Individual (QI) program that helps low-income seniors pay their
Medicare Part B premiums, and the Transitional Medical Assistance (TMA)
program that assists families on Medicaid maintain their coverage for
one year as they transition from welfare to work.
Mr. Speaker, this legislation will end the decade-long cycle of
annual SGR patches, restore certainty Medicare providers, and extend
vital health care programs our constituents depend on. I am pleased
that members on both sides of the aisle have come together to address
this issue, and I urge my colleagues to support this legislation and
provide continued health security for our seniors, children and
families
Mr. FLORES. Mr. Speaker, I rise in support of H.R. 2, the Medicare
Access and CHIP Reauthorization Act.
I came to Congress because Washington was in the midst of a culture
of excess--excessive spending, excessive regulation and excessive
government.
Today, we have the opportunity to repeal and replace Medicare's SGR,
an outdated reimbursement system that for over a decade Congress has
passed patch after patch to fix the flawed formula while hiding the
true state of Medicare.
Mr. Speaker, this legislation will take crucial steps to change
spending and improve health care for America.
Today, we are voting to enact policy and reforms that generate
savings and finally incentivize quality of care over quantity.
I urge my colleagues to support H.R. 2.
Mr. VAN HOLLEN. Mr. Speaker, I rise today in support of H.R. 2,
Medicare Access and CHIP Reauthorization Act. This bill is not perfect
but on its whole, it extends critical funding to ensure that kids in
the Children's Health Insurance Program (CHIP) don't lose access to
health insurance and to keep community health centers open to serve
hardworking American families. It funds the successful Home Visiting
Program, makes permanent a program to assist low-income seniors afford
their Medicare premiums, and supports families on Medicaid who are
transitioning to work. On top of preventing massive cuts to these
programs, the legislation replaces a flawed payment system that wasn't
working for people in Medicare, their physicians, or taxpayers.
In some areas--specifically in extending funding for CHIP for two
years--I don't think the bill goes far enough. As a longtime supporter
of CHIP, I advocated to extend funding for four years and included a
four-year extension in the budget I offered in the House. House
Democratic leadership fought for a four-year extension but was met with
resistance from Republicans who have made quite clear that they would
rather roll back coverage for kids in CHIP. Despite the two-year
compromise, I'm pleased that the legislation funds CHIP at current
levels and maintains the safeguards we set in the Affordable Care Act
(ACA) to ensure coverage for every eligible child in the nation.
Failure to pass this bill and fund CHIP would cause millions of kids to
become uninsured or lose access to services, or would cause their
parents to face higher out-of-pocket costs.
The bill also includes two years of additional funding for community
health centers which provide primary care to families, seniors, people
with disabilities, and veterans in Maryland and across the nation.
Health centers keep people healthy and working by responding to the
unique needs of their communities, create good-paying jobs, and train
the next generation of the health care workforce. Without this bill,
funding for health centers would be cut by 70 percent and over 7
million Americans could be at risk of losing critical health services.
Not funding very cost-effective health providers is irresponsible and
unfair to hardworking American families.
It comes as no surprise that my Republican colleagues would have
liked to hijack this bill for their arsenal in their unending assault
on women's health. If you need any evidence, just look at what
Republicans did in the Senate trying to use the human trafficking bill
to expand the Hyde amendment to permanent funds and non-taxpayer funds.
I applaud the Democratic Senators blocking that Republican anti-choice
effort. Let me be clear; this bill does not do that. I worked with
Leader Pelosi and the co-chairs of the House Pro-Choice Caucus, of
which I am a member, to counter attempts to codify the Hyde amendment.
As a result, this bill continues the current policy for funding for
community health centers. Just like the Hyde language included in
annual appropriations bills, the provision is limited to taxpayer funds
and temporary--terminating when the funding expires in 2017. I strongly
share the ongoing concerns of the reproductive health community and I
remain deeply committed to protecting a woman's fundamental right to
choose her health care.
Finally, the bill repeals and replaces a deeply flawed physician
payment system for paying physicians that basically penalizes doctors
for participating in Medicare. For more than ten years, doctors have
faced the threat of steep rate cuts required by a mindless formula in
the law. Congress has repeatedly adopted short-term patches to prevent
these cuts from taking effect. This crisis-driven approach to paying
physicians makes it difficult for doctors to participate in Medicare,
which ultimately is unfair to their patients--the seniors and disabled
workers who rely on Medicare for access to the health care services
they need. The bill rights this wrong with a smarter physician payment
system that improves quality of care for people with Medicare.
Mr. Speaker, today's bill is not perfect but Congress must move
forward with this bipartisan agreement to protect the health of
America's families, children and seniors. I urge support H.R. 2.
Mr. LYNCH. Mr. Speaker, I rise today in support of the Medicare and
CHIP Reauthorization Act, H.R. 2.
I commend Energy and Commerce Chairman Fred Upton and ranking member
Frank Pallone as well as Ways and Means Chairman Paul Ryan and ranking
member Sander Levin for their hard work in putting this bill together.
The sustainable growth rate (SGR) was part of the Balanced Budget Act
of 1997 but has proven to be far less than sustainable.
In fact, according to the Congressional Research Service, since 2003
Congress passed 17 laws overriding the SGR-mandated reductions in the
Medicare physician fee schedule.
This bill may not be perfect but it seems to strike enough
compromises that many of us are willing to support a good bill rather
than hold out for a perfect one.
[[Page H2083]]
I am particularly pleased that the bill includes a two year extension
of the Health Center Fund, which will provide an additional $3.6
billion per year to the nation's community health centers.
Created under the Affordable Care Act to expand the health centers
program and increase access to care, the fund is set to expire after
2015.
Should it expire, health centers would be facing a 70% cut in funding
which would force devastating reductions and closures at many of the
more than 9,000 health centers nationwide.
We simply cannot allow that to happen.
Community health centers are critical to the health care equation,
meeting the needs of approximately 23 million people every year. They
provide access to primary and preventative health services that keep
patients from seeking or eventually needing more costly care. And that
benefits all of us.
The 1,300 federally funded health centers are located in every corner
of our country and are distributed evenly between urban and rural
areas. I am fortunate in my own district to have 7 community health
centers treating more than one hundred thousand patients every year. In
fact, as we recognize the 50th anniversary of our health centers, I am
proud to acknowledge that the first community health center in the
United States, Geiger Gibson, is located in my district.
Health centers serve all our constituents, Democrat and Republican,
young and old, black, white or brown. they are vital to all our
communities, and that is why this program has strong bipartisan
support.
Whether you supported the Affordable Care Act or not, I think we all
can agree that access to affordable health care helps to keep health
costs down. Our community health centers provide that access. They are
doing a terrific job for people across the nation.
That is why I strongly support our health centers and I urge my
colleagues to join me in supporting this bill.
The SPEAKER pro tempore. All time for debate has expired.
Pursuant to House Resolution 173, the previous question is ordered on
the bill, as amended.
The question is on the engrossment and third reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. BRADY of Texas. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, this 15-
minute vote on passage of the bill will be followed by a 5-minute vote
on agreeing to the Speaker's approval of the Journal, if ordered.
The vote was taken by electronic device, and there were--yeas 392,
nays 37, not voting 4, as follows:
[Roll No. 144]
YEAS--392
Abraham
Adams
Aderholt
Aguilar
Allen
Amodei
Ashford
Babin
Barletta
Barr
Barton
Bass
Beatty
Becerra
Benishek
Bera
Beyer
Bilirakis
Bishop (GA)
Bishop (MI)
Bishop (UT)
Black
Blackburn
Blumenauer
Boehner
Bonamici
Bost
Boustany
Boyle, Brendan F.
Brady (PA)
Brady (TX)
Brooks (IN)
Brown (FL)
Brownley (CA)
Buchanan
Bucshon
Burgess
Bustos
Butterfield
Byrne
Calvert
Capps
Capuano
Cardenas
Carney
Carson (IN)
Carter (GA)
Carter (TX)
Cartwright
Castor (FL)
Castro (TX)
Chabot
Chaffetz
Chu, Judy
Cicilline
Clark (MA)
Clarke (NY)
Clawson (FL)
Clay
Cleaver
Clyburn
Coffman
Cohen
Cole
Collins (GA)
Collins (NY)
Comstock
Conaway
Connolly
Conyers
Cook
Costa
Costello (PA)
Courtney
Cramer
Crawford
Crenshaw
Crowley
Cuellar
Culberson
Cummings
Curbelo (FL)
Davis (CA)
Davis, Danny
Davis, Rodney
DeFazio
DeGette
Delaney
DeLauro
DelBene
Denham
Dent
DeSaulnier
Deutch
Diaz-Balart
Dingell
Doggett
Dold
Doyle, Michael F.
Duckworth
Duffy
Duncan (SC)
Duncan (TN)
Edwards
Ellison
Ellmers (NC)
Emmer (MN)
Engel
Eshoo
Esty
Farenthold
Farr
Fattah
Fincher
Fitzpatrick
Fleischmann
Fleming
Flores
Forbes
Fortenberry
Foster
Foxx
Frankel (FL)
Franks (AZ)
Frelinghuysen
Fudge
Gabbard
Gallego
Garamendi
Gibbs
Gibson
Goodlatte
Gosar
Gowdy
Graham
Granger
Graves (LA)
Graves (MO)
Grayson
Green, Al
Green, Gene
Griffith
Grijalva
Guinta
Guthrie
Gutierrez
Hahn
Hanna
Hardy
Harper
Harris
Hartzler
Hastings
Heck (NV)
Heck (WA)
Hensarling
Herrera Beutler
Hice, Jody B.
Higgins
Hill
Himes
Holding
Honda
Hoyer
Hudson
Huffman
Huizenga (MI)
Hunter
Hurd (TX)
Hurt (VA)
Israel
Jackson Lee
Jeffries
Jenkins (KS)
Jenkins (WV)
Johnson (GA)
Johnson (OH)
Johnson, E. B.
Joyce
Kaptur
Katko
Keating
Kelly (IL)
Kelly (PA)
Kennedy
Kildee
Kilmer
Kind
King (NY)
Kinzinger (IL)
Kirkpatrick
Kline
Knight
Kuster
LaMalfa
Lamborn
Lance
Langevin
Larsen (WA)
Larson (CT)
Latta
Lawrence
Lee
Levin
Lewis
Lieu, Ted
Lipinski
LoBiondo
Loebsack
Lofgren
Long
Love
Lowenthal
Lowey
Lucas
Luetkemeyer
Lujan Grisham (NM)
Lujan, Ben Ray (NM)
Lynch
MacArthur
Maloney, Carolyn
Maloney, Sean
Marino
Matsui
McCarthy
McCaul
McCollum
McDermott
McGovern
McHenry
McKinley
McMorris Rodgers
McNerney
McSally
Meehan
Meeks
Meng
Messer
Mica
Miller (FL)
Miller (MI)
Moolenaar
Mooney (WV)
Moore
Moulton
Mullin
Murphy (FL)
Murphy (PA)
Napolitano
Neal
Neugebauer
Newhouse
Noem
Nolan
Norcross
Nugent
Nunes
O'Rourke
Olson
Palazzo
Pallone
Pascrell
Paulsen
Pearce
Pelosi
Perlmutter
Perry
Peters
Peterson
Pingree
Pittenger
Pitts
Pocan
Poe (TX)
Poliquin
Polis
Pompeo
Posey
Price (NC)
Price, Tom
Quigley
Rangel
Reed
Reichert
Renacci
Ribble
Rice (NY)
Rice (SC)
Richmond
Rigell
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rohrabacher
Rokita
Rooney (FL)
Ros-Lehtinen
Roskam
Ross
Rothfus
Rouzer
Roybal-Allard
Royce
Ruppersberger
Rush
Russell
Ryan (OH)
Ryan (WI)
Salmon
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Scalise
Schiff
Schock
Schrader
Scott (VA)
Scott, Austin
Scott, David
Serrano
Sessions
Sewell (AL)
Sherman
Shimkus
Shuster
Simpson
Sinema
Sires
Slaughter
Smith (MO)
Smith (NE)
Smith (NJ)
Smith (TX)
Speier
Stefanik
Stewart
Stivers
Stutzman
Swalwell (CA)
Takai
Takano
Thompson (CA)
Thompson (MS)
Thompson (PA)
Thornberry
Tiberi
Tipton
Titus
Tonko
Torres
Trott
Tsongas
Turner
Upton
Valadao
Van Hollen
Vargas
Veasey
Vela
Velazquez
Wagner
Walberg
Walden
Walker
Walorski
Walters, Mimi
Walz
Wasserman Schultz
Waters, Maxine
Watson Coleman
Weber (TX)
Webster (FL)
Welch
Wenstrup
Westerman
Westmoreland
Whitfield
Williams
Wilson (FL)
Wilson (SC)
Wittman
Womack
Woodall
Yarmuth
Yoder
Yoho
Young (AK)
Young (IA)
Young (IN)
Zeldin
Zinke
NAYS--37
Amash
Blum
Brat
Bridenstine
Brooks (AL)
Buck
Cooper
DeSantis
DesJarlais
Garrett
Gohmert
Graves (GA)
Grothman
Huelskamp
Hultgren
Issa
Johnson, Sam
Jolly
Jones
Jordan
King (IA)
Labrador
Loudermilk
Lummis
Marchant
Massie
McClintock
Meadows
Mulvaney
Nadler
Palmer
Ratcliffe
Sanford
Schakowsky
Schweikert
Sensenbrenner
Visclosky
NOT VOTING--4
Hinojosa
Payne
Ruiz
Smith (WA)
{time} 1207
Messrs. MULVANEY and SCHWEIKERT changed their vote from ``yea'' to
``nay.''
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
____________________