[Congressional Record (Bound Edition), Volume 161 (2015), Part 4]
[House]
[Pages 4514-4553]
[From the U.S. 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''.
       (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.--

[[Page 4515]]

       (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.
       ``(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

[[Page 4516]]

     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- 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):

[[Page 4517]]

       ``(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 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).

[[Page 4518]]

     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
       ``(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

[[Page 4519]]

       ``(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 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--

[[Page 4520]]

       ``(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--

       ``(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

[[Page 4521]]

     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, 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

[[Page 4522]]

     (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 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.

[[Page 4523]]

       ``(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 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

[[Page 4524]]

     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 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

[[Page 4525]]

     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;
       ``(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).

[[Page 4526]]

       ``(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.
       (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

[[Page 4527]]

     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.--
       (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

[[Page 4528]]

     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.
       (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

[[Page 4529]]

     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 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''.

[[Page 4530]]



     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.''.
       (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

[[Page 4531]]

     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 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--

[[Page 4532]]

       (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

[[Page 4533]]

     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 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

[[Page 4534]]

       (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 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:

[[Page 4535]]

       ``(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

       (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

[[Page 4536]]

     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''.
       (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.

[[Page 4537]]

       ``(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 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.

[[Page 4538]]

       ``(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 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'';

[[Page 4539]]

       (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:
       ``(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

[[Page 4540]]

     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).

  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

[[Page 4541]]

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 Health 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 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-

[[Page 4542]]

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 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

[[Page 4543]]

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 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

[[Page 4544]]

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.
  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. PITTS. 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

[[Page 4545]]

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 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

[[Page 4546]]

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 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

[[Page 4547]]

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. 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.
  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-

[[Page 4548]]

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.
  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

[[Page 4549]]

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 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

[[Page 4550]]

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 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

[[Page 4551]]

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 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

[[Page 4552]]

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.
  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.
  Mr. HONDA. Mr. Speaker, H.R. 2 will repeal the flawed Sustainable 
Growth Rate (SGR) formula and replace it with a bipartisan agreement to 
improve the Medicare payment system and return stability to physician 
payments.
  The Balanced Budget Act of 1997 created SGR in an attempt to control 
spending in the Medicare program, and it was adopted for TRICARE as 
well. For years, this methodology has consistently produced unrealistic 
expenditure targets that trigger untenable reductions in payment rates 
to doctors providing services to Medicare patients.
  Congress has repeatedly buried the true cost of this policy through 
annual Congressional overrides of these scheduled cuts. Each of these 
short-term ``doc fixes'' has achieved the important goal of averting an 
immediate crisis in access to physicians for Medicare beneficiaries, 
but has exacerbated a longer-term crisis in Medicare financing.

[[Page 4553]]

  Continued reliance on short-term patches creates instability in the 
health care system and the economy as a whole. Doctors have been 
hamstrung by yearly doubt about what reimbursement rates will be, and 
patients have had to pay the eventual price in uneven, substandard 
quality of care. Enactment of H.R. 2 will bring stability back to our 
health care system.
  I voted for H.R. 2 because this legislation not only repeals the SGR, 
but also preserves and extends the Children's Health Insurance Program 
and provides funding for Community Health Centers through 2017. These 
programs are important in ensuring that those who need it most have 
access to health care. I remain concerned that the bill included an 
unnecessary provision restating current law on abortion coverage 
restrictions. The Hyde Amendment language, which has been included in 
annual appropriations bills since 1976, restricts women's access to 
health care and disproportionately discriminates against women of 
color, immigrants, and young people. Moving forward, we must work to 
ensure that women get access to health care, not continue policies that 
limit it.
  Medicare has guaranteed essential health protections to seniors and 
certain disabled persons for nearly four decades. Fixing the physician 
Medicare reimbursement system is important to ensuring continued high 
quality care for Americans. I believe Medicare is more than just a 
program; it is a covenant that exists between the government and the 
American people, and I supported H.R. 2 to keep that covenant.
  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.

                          ____________________