[Congressional Record (Bound Edition), Volume 161 (2015), Part 4]
[Senate]
[Pages 4964-4971]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 1114. Mr. CORNYN proposed an amendment to 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; as 
follows:

       At the appropriate place, insert the following:

     SEC. __. RESTORING INDIVIDUAL LIBERTY.

       Sections 1501 and 1502 and subsections (a), (b), (c), and 
     (d) of section 10106 of the Patient Protection and Affordable 
     Care Act (and the amendments made by such sections and 
     subsections) are repealed and the Internal Revenue Code of 
     1986 shall be applied and administered as if such provisions 
     and amendments had never been enacted.
                                 ______
                                 
  SA 1115. Mr. BENNET (for himself, Ms. Warren, Mr. Menendez, Mr. Reed, 
Mrs. Shaheen, Mr. Whitehouse, Ms. Baldwin, Mr. Blumenthal, and Ms. 
Mikulski) proposed an amendment to 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; as follows:

       Strike sections 301 through 304, and insert the following:

     SEC. 301. 4-YEAR EXTENSION OF THE CHILDREN'S HEALTH INSURANCE 
                   PROGRAM.

       (a) Funding.--
       (1) In general.--Section 2104(a) of the Social Security Act 
     (42 U.S.C. 1397dd(a)) is amended--
       (A) in paragraph (17), by striking ``and'' at the end; and
       (B) by striking paragraph (18) and inserting the following 
     new paragraphs:
       ``(18) for fiscal year 2015, $21,061,000,000;
       ``(19) for fiscal year 2016, $19,300,000,000;
       ``(20) for fiscal year 2017, $20,300,000,000;
       ``(21) for fiscal year 2018, $21,300,000,000; and
       ``(22) for fiscal year 2019, for purposes of making 2 semi-
     annual allotments--
       ``(A) $2,850,000,000 for the period beginning on October 1, 
     2018, and ending on March 31, 2019; and
       ``(B) $2,850,000,000 for the period beginning on April 1, 
     2019, and ending on September 30, 2019.''.
       (2) Prevention of duplicate appropriations for fiscal year 
     2015.--Notwithstanding any other provision of law, insofar as 
     funds have been appropriated under subsection (a)(18) or (m) 
     of section 2104 of the Social Security Act (42 U.S.C. 
     1397dd), or under section 108 of the Children's Health 
     Insurance Program Reauthorization Act of 2009 (Public Law 
     111-3), as such subsections and section are in effect on the 
     day before the date of the enactment of this Act, to provide 
     allotments to States under the State Children's Health 
     Insurance Program established under title XXI of the Social 
     Security Act (42 U.S.C. 1397aa et seq.) (whether implemented 
     under title XIX, XXI, or both, of the Social Security Act) 
     for fiscal year 2015--
       (A) any amounts that are so appropriated that are not so 
     allotted and obligated before the date of the enactment of 
     this Act, are rescinded; and
       (B) any amount provided for CHIP allotments to a State 
     under this section (and the amendments made by this section) 
     for such fiscal year shall be reduced by the amount of such 
     appropriations so allotted and obligated before such date.
       (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 ``2018''; and
       (ii) by striking subparagraph (B) and inserting the 
     following new subparagraph:
       ``(B) Fiscal year 2013 through 2018.--Subject to paragraphs 
     (4) and (6), from the amount made available under paragraphs 
     (16) through (21) of subsection (a) for each of fiscal years 
     2013 through 2018, 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, 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 (5) 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 
     clause (iii), 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 
     (5) for such even-numbered fiscal year.
       ``(iii) Special rule for fiscal year 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 (5) for fiscal 
     year 2016.'';
       (C) in paragraph (3)--
       (i) in the heading, by striking ``2015''and inserting 
     ``2019'';
       (ii) in subparagraph (A)--

       (I) by striking ``paragraph (18)'' and inserting 
     ``paragraph (22)''; and
       (II) by striking ``section 108 of the Children's Health 
     Insurance Program Reauthorization Act of 2009'' and inserting 
     ``section 301(b)(2) of the Medicare Access and CHIP 
     Reauthorization Act of 2015'';

       (iii) in subparagraph (B), by striking ``paragraph (18)'' 
     and inserting ``paragraph (22)'';
       (iv) in subparagraph (C)--

       (I) by striking ``2014'' each place it appears and 
     inserting ``2018''; and
       (II) by striking ``2015'' and inserting ``2019''; and

       (v) in subparagraph (D)--

       (I) in clause (i)--

       (aa) in subclause (I), by striking ``subsection 
     (a)(18)(A)'' and inserting ``subsection (a)(22)(A)''; and
       (bb) in subclause (II), by striking ``section 108 of the 
     Children's Health Insurance Program Reauthorization Act of 
     2009'' and inserting ``section 301(b)(2) of the Medicare 
     Access and CHIP Reauthorization Act of 2015''; and

       (II) in clause (ii)(II), by striking ``subsection 
     (a)(18)(B)'' and inserting ``subsection (a)(22)(B)'';

       (D) in paragraph (4), by striking ``2015'' and inserting 
     ``2019'';
       (E) in paragraph (6)--
       (i) in subparagraph (A), by striking ``2015'' and inserting 
     ``2019''; and
       (ii) in the second sentence, by striking ``or fiscal year 
     2014'' and inserting ``fiscal year 2014, fiscal year 2016, or 
     fiscal year 2018''; and
       (F) in paragraph (8)--
       (i) in the paragraph heading, by striking ``2015'' and 
     inserting ``2019''; and
       (ii) by striking ``for a period in fiscal year 2015'' and 
     inserting ``for a period in fiscal year 2019''.
       (2) One-time appropriation for fiscal year 2019.--There is 
     appropriated to the Secretary of Health and Human Services, 
     out of any money in the Treasury not otherwise appropriated, 
     $16,700,000,000 to accompany the allotment made for the 
     period beginning on October 1, 2018, and ending on March 31, 
     2019, under section 2104(a)(22)(A) of the Social Security Act 
     (42 U.S.C. 1397dd(a)(22)(A)) (as added by subsection (a)(1)), 
     to remain available until expended. Such amount shall be used 
     to provide allotments to States under paragraph (3) of 
     section 2104(m) of such Act (42 U.S.C. 1397dd(m)) (as amended 
     by paragraph (1)(C)) for the first 6 months of fiscal year 
     2019 in the same manner as allotments are provided under 
     subsection (a)(22)(A) of such section 2104 and subject to the 
     same terms and conditions as apply to the allotments provided 
     from such subsection (a)(22)(A).

[[Page 4965]]

       (c) 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)--

       (I) in the matter preceding clause (i), by striking ``and 
     (D)'' and inserting ``, (D), and (E)''; and
       (II) by striking clause (ii) and inserting the following:

       ``(ii) for each of--

       ``(I) fiscal years 2010 through 2014, such sums as are 
     necessary for making payments to eligible States for such 
     fiscal year, but not in excess of the aggregate cap described 
     in subparagraph (B); and
       ``(II) fiscal years 2015 through 2018 (and for each of the 
     semi-annual allotment periods for fiscal year 2019), such 
     sums as are necessary for making payments to eligible States 
     for such fiscal year or period.''; and

       (ii) by striking subparagraph (B) and inserting the 
     following:
       ``(B) Aggregate cap.--The total amount available for 
     payment from the Fund for each of fiscal years 2010 through 
     2014, taking into account deposits made under subparagraph 
     (C), shall not exceed 20 percent of the amount made available 
     under subsection (a) for the fiscal year. In the case of 
     fiscal years 2015 through 2018 (and for each of the semi-
     annual allotment periods for fiscal year 2019), there shall 
     be no limit on the amount available for payment from the 
     Fund.'';
       (iii) in subparagraph (D)--

       (I) by inserting ``before fiscal year 2015'' after ``fiscal 
     year or period''; and
       (II) by striking ``for any succeeding fiscal year''; and

       (iv) by adding at the end the following subparagraph:
       ``(E) Transfers.--Notwithstanding any other provision of 
     this title, the following amounts shall also be available, 
     without fiscal year limitation, for making payments from the 
     Fund:
       ``(i) Unobligated national allotment for fiscal years 
     beginning with fiscal year 2014.--

       ``(I) Fiscal year 2014 allotment.--As of December 31 of 
     fiscal year 2015, the portion, if any, of the amount 
     appropriated under subsection (a) for fiscal year 2014 that 
     is unobligated for allotment to a State under subsection (m) 
     for such fiscal year.
       ``(II) Succeeding fiscal year allotments.--As of December 
     31 of fiscal year 2016, and each succeeding fiscal year, the 
     portion, if any, of the amount appropriated under subsection 
     (a) for the preceding fiscal year that is unobligated for 
     allotment to a State under subsection (m) for such preceding 
     fiscal year.

       ``(ii) Unexpended allotments not used for redistribution.--
     As of December 31 of fiscal year 2015, and as of November 15 
     of each succeeding fiscal year, the total amount of 
     allotments made to States under subsection (a) for the second 
     preceding fiscal year that is not expended or redistributed 
     under subsection (f) during the period in which such 
     allotments are available for obligation.
       ``(iii) Unexpended performance incentive funds.--As of 
     January 1, 2016, and as of January 1 of each succeeding 
     calendar year, the portion, if any, of the amount 
     appropriated under section 2105(a)(3)(E)(iii) for the 
     preceding fiscal year that is not expended or obligated under 
     such section.''; and
       (B) in paragraph (3)--
       (i) in subparagraph (A)--

       (I) by redesignating clauses (i) and (ii) as subclauses (I) 
     and (II), respectively, and realigning the left margins 
     accordingly;
       (II) by striking ``If a State's'' and all that follows 
     through ``2015,'' and inserting the following:

       ``(i) For fiscal years 2009 through 2014.--If a State's 
     expenditures under this title in fiscal year 2009, fiscal 
     year 2010, fiscal year 2011, fiscal year 2012, fiscal year 
     2013, or fiscal year 2014'';

       (III) by striking ``or period'' each place it appears;
       (IV) in subclause (II) (as so redesignated), by striking 
     ``(or in which the period occurs)''; and
       (V) by adding at the end the following clause:

       ``(ii) For fiscal years after 2014.--

       ``(I) In general.--For each of fiscal years 2015 through 
     2018 (and for each of the semi-annual allotment periods for 
     fiscal year 2019), if the Secretary determines that a State 
     is a shortfall State described in subclause (II) for that 
     fiscal year or period, the Secretary shall pay to the State 
     from the Fund, in addition to any other payments made to the 
     State under this title for the fiscal year or period, an 
     amount equal to the amount described in subclause (III).
       ``(II) Shortfall states described.--For purposes of this 
     clause, with respect to a fiscal year or semi-annual 
     allotment period, a shortfall State is a State for which the 
     Secretary estimates, on the basis of the most recent data 
     available to the Secretary, that the projected expenditures 
     for the State and fiscal year or period under this title 
     (including in the form of coverage described in paragraph (1) 
     or (2) of section 2101, or both) will exceed the sum of--

       ``(aa) the amount of the State's allotments for any 
     preceding fiscal year that remains available for expenditure 
     and that will not be expended by the end of the immediately 
     preceding fiscal year;
       ``(bb) the amount (if any) that will be redistributed to 
     the State under subsection (f) for the fiscal year or period;
       ``(cc) the amount (if any) to be paid to the State in the 
     first quarter of the fiscal year under section 2105(a)(3); 
     and
       ``(dd) the amount of the State's allotment for the fiscal 
     year or period.

       ``(III) Amount described.--With respect to a State and 
     fiscal year or period, the amount described in this subclause 
     is equal to the amount by which the projected expenditures 
     for the State under this title for the fiscal year or period 
     (estimated by the Secretary on the basis of the most recent 
     data available to the Secretary) exceed the sum determined 
     under subclause (II) for the State and fiscal year or period.
       ``(IV) Retrospective adjustment.--The Secretary may adjust 
     the determinations made under this clause with respect to a 
     State and fiscal year or period as necessary on the basis of 
     the amounts reported by States not later than November 30 of 
     the succeeding fiscal year, as approved by the Secretary.'';

       (ii) in subparagraph (B)(ii), by striking ``(or semi-annual 
     period occurring in a fiscal year)'';
       (iii) in subparagraph (C)--

       (I) in the matter preceding clause (i), by striking 
     ``subparagraph (A)(ii)'' and inserting ``subparagraph 
     (A)(i)(II)''; and
       (II) in clause (ii), by striking ``(or semi-annual period 
     occurring in a fiscal year)''; and

       (iv) in subparagraph (G), by inserting ``the expenditures 
     under the State child health plan and'' after ``regarding''.
       (2) Conforming amendment.--Section 2104(f)(2)(A)(ii) of the 
     Social Security Act (42 U.S.C. 13957dd(f)(2)(A)(ii)) is 
     amended by inserting ``only in the case of a fiscal year 
     before fiscal year 2015,'' before ``the amount''.
       (d) Extension and Update of Performance Incentive 
     Payments.--
       (1) Extension through fiscal year 2019.--Section 2105(a)(3) 
     of the Social Security Act (42 U.S.C. 1397ee(a)(3)) is 
     amended--
       (A) in subparagraph (A)--
       (i) by striking ``2013'' and inserting ``2019''; and
       (ii) in the second sentence, by inserting ``, except that 
     payment under this paragraph may be made to a State for 
     fiscal year 2014 as a single payment not later than December 
     31, 2015'' before the period;
       (B) in subparagraph (E)--
       (i) in clause (ii)--

       (I) by striking subclause (I) and inserting the following:
       ``(I) Unobligated national allotment for fiscal years 2009 
     through 2013.--As of December 31 of fiscal year 2009, and as 
     of December 31 of each succeeding fiscal year through fiscal 
     year 2013, the portion, if any, of the amount appropriated 
     under section 2104(a) for such fiscal year that is 
     unobligated for allotment to a State under section 2104(m) 
     for such fiscal year or set aside under subsection (a)(3) or 
     (b)(2) of section 2111 for such fiscal year.'';
       (II) in subclause (III), by striking ``2013'' and inserting 
     ``2014'';

       (ii) by redesignating clause (iii) as clause (iv); and
       (iii) by inserting after clause (ii) the following new 
     clause:
       ``(iii) Appropriation for fiscal years 2015 through 2019.--
     Out of any money in the Treasury not otherwise appropriated, 
     there are appropriated $500,000,000 for each of fiscal years 
     2015 through 2019 for making payments under this paragraph. 
     Amounts appropriated for a fiscal year under this clause 
     shall remain available for making payments under this 
     paragraph until January 1 of the following fiscal year. Any 
     amounts of such appropriations that remain unexpended or 
     unobligated as of such date shall be transferred and made 
     available for making payments under section 2104(n).''; and
       (C) in subparagraph (F)(iii), by striking ``2013'' and 
     inserting ``2019''.
       (2) Updated performance incentive criteria for fiscal years 
     2015 through 2019.--Section 2105(a) of the Social Security 
     Act (42 U.S.C. 1397ee(a)) is amended--
       (A) in paragraph (3)(A), by inserting ``or (5)'' after 
     ``paragraph (4)'';
       (B) in paragraph (4)--
       (i) in the heading, by inserting ``fiscal years 2009 
     through 2014'' after ``for children''; and
       (ii) in the matter preceding subparagraph (A), by striking 
     ``for a fiscal year if'' and inserting ``for fiscal years 
     2009 through 2014 if''; and
       (C) by adding at the end the following new paragraph:
       ``(5) Enrollment and retention provisions for children for 
     fiscal year 2015 and succeeding fiscal years.--
       ``(A) In general.--For purposes of paragraph (3)(A), a 
     State meets the condition of this paragraph for fiscal year 
     2015 and any succeeding fiscal year if it is implementing at 
     least 4 of the enrollment and retention provisions specified 
     in subparagraph (B) (treating each clause as a separate 
     enrollment and retention provision) throughout the entire 
     fiscal year.

[[Page 4966]]

       ``(B) Enrollment and retention provisions.--The enrollment 
     and retention provisions specified in this subparagraph are 
     the following:
       ``(i) Continuous eligibility.--The State has elected the 
     option of continuous eligibility for a full 12 months for all 
     children described in section 1902(e)(12) under title XIX 
     under 19 years of age, as well as applying such policy under 
     its State child health plan under this title.
       ``(ii) Express lane eligibility.--The State is implementing 
     the option described in section 1902(e)(13) under title XIX 
     as well as, pursuant to section 2107(e)(1), under this title.
       ``(iii) Presumptive eligibility.--The State provides 
     medical assistance to children during a presumptive 
     eligibility period by implementing section 1920A under title 
     XIX as well as, pursuant to section 2107(e)(1), under this 
     title, and ensures that such period begins with the 
     determination by any qualified entity that the family income 
     of the child does not exceed the applicable level of income 
     eligibility under the State plan. A State shall not satisfy 
     this provision if the only type of entity recognized by the 
     State as a qualified entity is a hospital that has elected to 
     be a qualified entity under section 1902(a)(47)(B).
       ``(iv) Premium assistance for employer-sponsored plans.--
     The State has opted to offer a premium assistance subsidy for 
     qualified employer-sponsored coverage by implementing section 
     1906A under title XIX or the option described in section 
     2105(c)(10) under this title.
       ``(v) Elimination of waiting periods.--The State does not 
     impose a waiting period for coverage of any individual under 
     the State child health plan and ensures that no waiting 
     period applies in the case of coverage provided to any 
     individual eligible for coverage under the State child health 
     plan through coverage purchased by the State under section 
     2105(c)(3) or employer-sponsored coverage subsidized by the 
     State under section 1906A of title XIX or section 2105(c)(10) 
     of this title.
       ``(vi) Automated tracking of cost sharing or lower cap on 
     cost sharing.--In the case of a State child health plan that 
     imposes premiums, deductibles, cost sharing, or similar 
     charges that could (as determined by the Secretary) cause 
     families that include an individual receiving assistance 
     under the plan to have out-of-pocket expenses that exceed the 
     limit imposed under section 2103(e)(3)(B), the State has 
     either--

       ``(I) established, or, in the case of a State child health 
     plan that provides child health assistance through managed 
     care entities or organizations, required such entities or 
     organizations to coordinate with the State agency responsible 
     for implementing the State child health plan under this title 
     in establishing--

       ``(aa) an electronic process for tracking such expenses 
     that does not rely on documentation provided by the 
     individual or the family; and
       ``(bb) a system for notifying each such family of the 
     aggregate monthly or quarterly limits on out-of-pocket 
     expenses applicable to the family under section 2103(e)(3)(B) 
     and explaining to each such family that no such expenses 
     shall be imposed on any individual in the family for the 
     remainder of any month or quarter with respect to which the 
     family has reached the applicable aggregate monthly or 
     quarterly family limit imposed under such section; or

       ``(II) elected to eliminate deductibles, copayments, 
     coinsurance, or other forms of cost-sharing (other than 
     premiums) imposed under this title with respect to any 
     individual receiving coverage under the State child health 
     plan.

       ``(vii) Real-time eligibility determinations through the 
     use of enhanced data sources.--With respect to applications 
     and renewals for medical assistance under title XIX or child 
     health assistance under this title for a fiscal year, the 
     State meets the following criteria for all income 
     determinations made using modified adjusted gross income 
     under section 1902(e)(14)(A):

       ``(I) The State relies on enhanced data sources (which may 
     include, but shall not be limited to, the data sources 
     available under section 1137 or the federal Data Services 
     Hub) to make the determinations.
       ``(II) In the case of initial applications, the State makes 
     at least 50 percent of the determinations within 24 hours of 
     receiving the application. If a State successfully makes the 
     required minimum percentage of timely determinations for a 
     fiscal year, such State shall not receive credit for meeting 
     this provision in any subsequent fiscal year unless the State 
     makes a percentage of timely income determinations that is at 
     least 5 percentage points higher (or, if at least 75 percent 
     of the State's determinations in a previous fiscal year were 
     timely, 1 percentage point higher) than the percentage that 
     the State achieved in the last fiscal year in which the State 
     received credit for meeting this provision.
       ``(III) In the case of renewals, the State makes at least 
     50 percent of the determinations within 24 hours of receiving 
     the renewal. If a State successfully makes the required 
     minimum percentage of timely determinations for a fiscal 
     year, such State shall not receive credit for meeting this 
     provision in any subsequent fiscal year unless the State 
     makes a percentage of timely income determinations that is at 
     least 5 percentage points higher (or, if at least 75 percent 
     of the State's determinations in a previous fiscal year were 
     timely, 1 percentage point higher) than the percentage that 
     the State achieved in the last fiscal year in which the State 
     received credit for meeting this provision.

       ``(viii) Elimination of premiums or retroactive 
     reinstatement upon premium payment.--The State has elected to 
     either--

       ``(I) impose no premiums for coverage under the State child 
     health plan; or
       ``(II) in the case of an individual whose coverage under 
     the State child health plan has been terminated for failure 
     to make premium payments, provide assistance to such 
     individual for purposes of immediate reenrollment of the 
     individual upon payment of outstanding premiums, with 
     coverage retroactive to the beginning of the most recent 
     month for which an outstanding premium has been paid, and 
     shall not impose any waiting period or fee as a condition of 
     such reenrollment.''.

       (e) 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 ``2019''; and
       (2) in subparagraph (A), by striking ``2015'' and inserting 
     ``2019''.
       (f) Extension of Certain Programs and Demonstration 
     Projects.--
       (1) Quality care for children demonstration project.--
     Section 1139A(d)(1) of the Social Security Act (42 U.S.C. 
     1320b-9a(d)(1)) is amended in the matter before subparagraph 
     (A) by inserting ``, and during the period of fiscal years 
     2016 through 2019, the Secretary shall award not more than 10 
     grants,'' before ``to States''.
       (2) 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 $25,000,000 for the 
     period of fiscal years 2015 though 2019'' after ``2014''.
       (3) 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 each of 
     fiscal years 2016 through 2019, $45,000,000 for the purpose 
     of carrying out this section (other than subsections (e), 
     (f), and (g)).''.
       (4) Outreach and enrollment grants; national campaign.--
     Section 2113 of the Social Security Act (42 U.S.C. 1397mm) is 
     amended--
       (A) in subsection (a)(1), by striking ``2015'' and 
     inserting ``2019''; and
       (B) in subsection (g), by inserting ``, and $80,000,000 for 
     the period of fiscal years 2016 through 2019, to remain 
     available until expended,'' after ``2015''.
       (g) 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 ``September 30, 2015'' and inserting 
     ``September 30, 2019''.
       (h) Authority To Use Income Determination Made Under 
     Certain Programs.--Section 1902(e)(14) of the Social Security 
     Act (42 U.S.C. 1396a(e)(14)) is amended--
       (1) in subparagraph (A), in the first sentence, by striking 
     ``subparagraph (D)'' and inserting ``subparagraphs (D) and 
     (J)''; and
       (2) by adding at the end the following new subparagraph:
       ``(J) Use of income determination made under certain other 
     programs.--
       ``(i) In general.--For purposes of determining income 
     eligibility for medical assistance under the State plan or 
     under any waiver of such plan, a State may use a 
     determination of income made by--

       ``(I) the State program funded under part A of title IV; or
       ``(II) the supplemental nutrition assistance program 
     established under the Food and Nutrition Act of 2008.

       ``(ii) Sunset.--Clause (i) shall not apply after September 
     30, 2019.''.
                                 ______
                                 
  SA 1116. Mr. LEE (for himself, Mr. Sessions, Mr. Cruz, Mr. Crapo, and 
Mr. Sasse) proposed an amendment to 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; as follows:

       On page 261, strike line 21 and all that follows through 
     page 262, line 4.
                                 ______
                                 
  SA 1117. Mrs. MURRAY (for herself, Mr. Wyden, Mr. Brown, Ms. Baldwin, 
Mr. Bennet, Mr. Blumenthal, Mrs. Boxer, Ms. Hirono, Ms. Mikulski, Mr. 
Menendez, Mr. Murphy, Mr. Sanders, Ms. Stabenow, Mrs. Shaheen, Mr. 
Franken, Mr. Reid, Mr. Whitehouse, Ms. Cantwell, Ms. Warren, and Mr. 
Booker) proposed an amendment to 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

[[Page 4967]]

other improvements, to reauthorize the Children's Health Insurance 
Program, and for other purposes; as follows:

       At the appropriate place, insert the following:

            TITLE __--WOMEN'S ACCESS TO QUALITY HEALTH CARE

     SEC. _01. SHORT TITLE.

       This title may be cited as the ``Women's Access to Quality 
     Health Care Act''.

     SEC. _02. RENEWAL OF APPLICATION OF MEDICARE PAYMENT RATE 
                   FLOOR TO PRIMARY CARE SERVICES FURNISHED UNDER 
                   MEDICAID AND INCLUSION OF ADDITIONAL PROVIDERS.

       (a) Renewal of Payment Floor; Additional Providers.--
       (1) In general.--Section 1902(a)(13) of the Social Security 
     Act (42 U.S.C. 1396a(a)(13)) is amended by striking 
     subparagraph (C) and inserting the following:
       ``(C) payment for primary care services (as defined in 
     subsection (jj)) at a rate that is not less than 100 percent 
     of the payment rate that applies to such services and 
     physician under part B of title XVIII (or, if greater, the 
     payment rate that would be applicable under such part if the 
     conversion factor under section 1848(d) for the year involved 
     were the conversion factor under such section for 2009), and 
     that is not less than the rate that would otherwise apply to 
     such services under this title if the rate were determined 
     without regard to this subparagraph, and that are--
       ``(i) furnished on or after January 1, 2013, and before 
     January 1, 2015, by a physician with a primary specialty 
     designation of family medicine, general internal medicine, or 
     pediatric medicine; or
       ``(ii) furnished on or after January 1, 2015, and before 
     January 1, 2017--

       ``(I) by a physician with a primary specialty designation 
     of family medicine, general internal medicine, or pediatric 
     medicine, but only if the physician self-attests that the 
     physician is Board certified in family medicine, general 
     internal medicine, or pediatric medicine;
       ``(II) by a physician with a primary specialty designation 
     of obstetrics and gynecology, but only if the physician self-
     attests that the physician is Board certified in obstetrics 
     and gynecology;
       ``(III) by an advanced practice clinician, as defined by 
     the Secretary, that works under the supervision of--

       ``(aa) a physician that satisfies the criteria specified in 
     subclause (I) or (II); or
       ``(bb) a nurse practitioner or a physician assistant (as 
     such terms are defined in section 1861(aa)(5)(A)) who is 
     working in accordance with State law, or a certified nurse-
     midwife (as defined in section 1861(gg)) who is working in 
     accordance with State law;

       ``(IV) by a rural health clinic, Federally-qualified health 
     center, or other health clinic that receives reimbursement on 
     a fee schedule applicable to a physician, a nurse 
     practitioner or a physician assistant (as such terms are 
     defined in section 1861(aa)(5)(A)) who is working in 
     accordance with State law, or a certified nurse-midwife (as 
     defined in section 1861(gg)) who is working in accordance 
     with State law, for services furnished by a physician, nurse 
     practitioner, physician assistant, or certified nurse-
     midwife, or services furnished by an advanced practice 
     clinician supervised by a physician described in subclause 
     (I)(aa) or (II)(aa), another advanced practice clinician, or 
     a certified nurse-midwife; or
       ``(V) by a nurse practitioner or a physician assistant (as 
     such terms are defined in section 1861(aa)(5)(A)) who is 
     working in accordance with State law, or a certified nurse-
     midwife (as defined in section 1861(gg)) who is working in 
     accordance with State law, in accordance with procedures that 
     ensure that the portion of the payment for such services that 
     the nurse practitioner, physician assistant, or certified 
     nurse-midwife is paid is not less than the amount that the 
     nurse practitioner, physician assistant, or certified nurse-
     midwife would be paid if the services were provided under 
     part B of title XVIII;''.

       (2) Conforming amendment.--Section 1905(dd) of the Social 
     Security Act (42 U.S.C. 1396d(dd)) is amended by striking 
     ``January 1, 2015'' and inserting ``January 1, 2017''.
       (b) Ensuring Payment by Managed Care Entities.--
       (1) In general.--Section 1903(m)(2)(A) of the Social 
     Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended--
       (A) in clause (xii), by striking ``and'' after the 
     semicolon;
       (B) by realigning the left margin of clause (xiii) so as to 
     align with the left margin of clause (xii) and by striking 
     the period at the end of clause (xiii) and inserting ``; 
     and''; and
       (C) by inserting after clause (xiii) the following:
       ``(xiv) such contract provides that (I) payments to 
     providers specified in section 1902(a)(13)(C) for primary 
     care services defined in section 1902(jj) that are furnished 
     during a period specified in section 1902(a)(13)(C) and 
     section 1905(dd) are at least equal to the amounts set forth 
     and required by the Secretary by regulation, (II) the entity 
     shall, upon request, provide documentation to the State, 
     sufficient to enable the State and the Secretary to ensure 
     compliance with subclause (I), and (III) the Secretary shall 
     approve payments described in subclause (I) that are 
     furnished through an agreed upon capitation, partial 
     capitation, or other value-based payment arrangement if the 
     capitation, partial capitation, or other value-based payment 
     arrangement is based on a reasonable methodology and the 
     entity provides documentation to the State sufficient to 
     enable the State and the Secretary to ensure compliance with 
     subclause (I).''.
       (2) Conforming amendment.--Section 1932(f) of the Social 
     Security Act (42 U.S.C. 1396u-2(f)) is amended by inserting 
     ``and clause (xiv) of section 1903(m)(2)(A)'' before the 
     period.

     SEC. _03. INCREASING ACCESS TO SAFETY-NET PROVIDERS.

       Title X of the Public Health Service Act (42 U.S.C. 300 et 
     seq.) is amended by inserting after section 1003 the 
     following:

     ``SEC. 1003A. GRANTS FOR FACILITIES IMPROVEMENTS.

       ``(a) In General.--The Secretary is authorized to award 
     grants to, and enter into contracts with, public or nonprofit 
     private entities to plan, develop, or make improvements to 
     facilities carrying out family planning service projects, and 
     to expand preventive health services, under section 1001.
       ``(b) Funding.--There is authorized to be appropriated, and 
     there is appropriated, out of any monies in the Treasury not 
     otherwise appropriated, $500,000,000 for each of fiscal years 
     2016 through 2019, to enable the Secretary to expand access 
     to family planning services and to provide enhanced funding 
     for the family planning program under section 1001.''.

     SEC. _04. STRENGTHENING AND IMPROVING COMMUNITY HEALTH 
                   CENTERS, THE NATIONAL HEALTH SERVICE CORPS, AND 
                   TEACHING HEALTH CENTERS.

       (a) In General.--The Medicare Access and CHIP 
     Reauthorization Act of 2015 is amended by striking section 
     221.
       (b) 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 
     2019''.
       (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 
     2019''.
       (c) 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 $100,000,000 for each of 
     fiscal years 2016 through 2019'' before the period.

     SEC. _05. INVESTING IN PRIMARY CARE, NURSE PRACTITIONERS.

       Part B of title VIII of the Public Health Service Act (42 
     U.S.C. 296j et seq.) is amended by adding at the end the 
     following:

     ``SEC. 812. DEMONSTRATION GRANTS FOR NURSE PRACTITIONER 
                   TRAINING PROGRAM.

       ``(a) Establishment of Program.--The Secretary shall 
     establish a demonstration program (referred to in this 
     section as the `program') to award grants to eligible 
     entities for the training of nurse practitioners specializing 
     in women's health care for careers as providers in health 
     centers that receive assistance under title X (referred to in 
     this section as `health centers').
       ``(b) Purpose.--The purpose of the program is to enable 
     each grant recipient to--
       ``(1) provide new nurse practitioners with clinical 
     training to enable such practitioners to serve as providers 
     in health centers;
       ``(2) train new nurse practitioners to work under a model 
     of care that is consistent with the principles set forth by 
     the Report Providing Quality Family Planning Services of the 
     Centers for Disease Control and Prevention; and
       ``(3) establish a model of training for nurse practitioners 
     that specialize in women's health care that may be replicated 
     nationwide.
       ``(c) Grants.--Under the program, the Secretary shall award 
     3-year grants to eligible entities that meet the requirements 
     established by the Secretary, for the purpose of operating 
     the nurse practitioner programs described in subsection (a) 
     at such entities.
       ``(d) Eligible Entities.--To be eligible to receive a grant 
     under this section, an entity shall be--
       ``(1) a health center that receives funding under section 
     1001; and
       ``(2) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require.
       ``(e) Eligibility of Nurse Practitioners.--
       ``(1) In general.--To be eligible for acceptance into a 
     training program carried out by an eligible entity under a 
     grant under this section, an individual shall--
       ``(A) be licensed, or eligible for licensure, in the State 
     in which the program is being carried out as an advanced 
     practice registered nurse or advanced practice nurse and

[[Page 4968]]

     be eligible or board-certified as a nurse practitioner; and
       ``(B) demonstrate commitment to a career as a provider in a 
     health center.
       ``(2) Preference.--In accepting individuals into a training 
     program under this section, a grant recipient shall give 
     preference to bilingual applicants that meet the requirements 
     described in paragraph (1).
       ``(f) Grant Amount.--Each grant awarded under this section 
     shall be in an amount not to exceed $600,000 per year. A 
     grant recipient may carry over funds from 1 fiscal year to 
     another without obtaining approval from the Secretary.
       ``(g) Technical Assistance Grants.--The Secretary may award 
     technical assistance grants to 1 or more health centers that 
     have demonstrated expertise in establishing a nurse 
     practitioner residency training program. Such technical 
     assistance grants shall be for the purpose of providing 
     technical assistance to other recipients of grants under 
     subsection (c).
       ``(h) Authorization of Appropriations.--To carry out this 
     section, there is authorized to be appropriated $10,000,000 
     for each of fiscal years 2016 through 2019.''.
                                 ______
                                 
  SA 1118. Mr. COTTON proposed an amendment to 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; as 
follows:

       Beginning on page 5, strike line 22 and all that follows 
     through page 127, line 6, and insert the following:
       (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 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 and subsequent years.--The update to 
     the single conversion factor established in paragraph (1)(C) 
     for 2016 and each subsequent year shall be 0.5 percent.''.
                                 ______
                                 
  SA 1119. Mr. CARDIN (for himself, Mr. Vitter, Mr. Reid, Mr. 
Whitehouse, Ms. Hirono, Mr. Casey, Mrs. Shaheen, Mr. Menendez, Ms. 
Mikulski, Mr. Brown, Ms. Stabenow, Mr. Reed, Mr. Leahy, Ms. Cantwell, 
Mr. Bennet, Mr. Booker, Ms. Warren, and Ms. Klobuchar) proposed an 
amendment to 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; as follows:

       Strike section 202 and insert the following:

     SEC. __. MEDICARE PAYMENT FOR THERAPY SERVICES.

       (a) Repeal of Therapy Cap and 1-year Extension of Threshold 
     for Manual Medical Review.--Section 1833(g) of the Social 
     Security Act (42 U.S.C. 1395l(g)) is amended--
       (1) in paragraph (4)--
       (A) by striking ``This subsection'' and inserting ``Except 
     as provided in paragraph (5)(C)(iii), this subsection''; and
       (B) by inserting the following before the period at the 
     end: ``or with respect to services furnished on or after the 
     date of enactment of subsection (aa)''; and
       (2) in paragraph (5)--
       (A) in subparagraph (A), in the first sentence, by striking 
     ``March 31, 2015'' and inserting ``the date of enactment of 
     the Medicare Access and CHIP Reauthorization Act of 2015''; 
     and
       (B) in subparagraph (C), by adding at the end the following 
     new clause:
       ``(iii) Beginning on the date of enactment of subsection 
     (aa) and ending on the day before the date of the 
     implementation of such subsection, the manual medical review 
     process described in clause (i), subject to subparagraph (E), 
     shall apply with respect to expenses incurred in a year for 
     services described in paragraphs (1) and (3) (including 
     services described in subsection (a)(8)(B)) that exceed the 
     threshold described in clause (ii) for the year.''; and
       (3) in paragraph (6)(A)--
       (A) by striking ``March 31, 2015'' and inserting ``the date 
     of enactment of the Medicare Access and CHIP Reauthorization 
     Act of 2015''; and
       (B) by striking ``the first three months of 2015'' and 
     inserting ``the period beginning on January 1, 2015, and 
     ending on such date of enactment''.
       (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 a 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.''.
       (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.
       (c) Medical Review of Outpatient Therapy Services.--
       (1) Medical review of outpatient therapy services.--Section 
     1833 of the Social Security Act (42 U.S.C. 1395l) is amended 
     by adding at the end the following new subsection:
       ``(aa) Medical Review of Outpatient Therapy Services.--
       ``(1) In general.--
       ``(A) Process for medical review.--The Secretary shall 
     implement a process for the medical review (as described in 
     paragraph (2)) of outpatient therapy services (as defined in 
     paragraph (10)) and, subject to paragraph (12), apply such 
     process to such services furnished on or after the date that 
     is 12 months after the date of enactment of this subsection, 
     focusing on services identified under subparagraph (B).
       ``(B) Identification of services for review.--Under the 
     process, the Secretary shall identify services for medical 
     review, using such factors as the Secretary determines 
     appropriate, which may include the following:
       ``(i) Services furnished by a therapy provider (as defined 
     in paragraph (10)) who, in a prior period, has had a high 
     claims denial percentage or is less compliant with other 
     applicable requirements under this title.
       ``(ii) Services furnished by a therapy provider whose 
     pattern of billing is aberrant compared to peers or otherwise 
     has questionable billing practices, such as billing medically 
     unlikely units of services in a day.
       ``(iii) Services furnished by a therapy provider that is 
     newly enrolled under this title or has not previously 
     furnished therapy services under this part.
       ``(iv) Services furnished to treat a type of medical 
     condition.
       ``(v) Services identified by use of the standardized data 
     elements required to be reported under section 1834(r).
       ``(vi) Services furnished by a therapy provider who is part 
     of a group that includes a therapy provider identified by 
     factors described in this subparagraph.
       ``(vii) Other services as determined appropriate by the 
     Secretary.
       ``(2) Medical review.--
       ``(A) Prior authorization medical review.--
       ``(i) In general.--Subject to the succeeding provisions of 
     this subparagraph, the Secretary shall use prior 
     authorization medical review for outpatient therapy services 
     furnished to an individual above one or more

[[Page 4969]]

     thresholds established by the Secretary, such as a dollar 
     threshold or a threshold based on other factors.
       ``(ii) Ending application of prior authorization for a 
     therapy provider.--The Secretary shall end the application of 
     prior authorization medical review to outpatient therapy 
     services furnished by a therapy provider if the Secretary 
     determines that the provider has a low denial rate under such 
     prior authorization. The Secretary may subsequently reapply 
     prior authorization medical review to such therapy provider 
     if the Secretary determines it to be appropriate.
       ``(iii) Prior authorization of multiple services.--The 
     Secretary shall, where practicable, provide for prior 
     authorization medical review for multiple services at a 
     single time, such as services in a therapy plan of care 
     described in section 1861(p)(2).
       ``(B) Other types of medical review.--The Secretary may use 
     pre-payment review or post-payment review for services 
     identified under paragraph (1)(B) 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) Review contractors.--The Secretary shall conduct 
     prior authorization medical review of outpatient therapy 
     services under this subsection using medicare administrative 
     contractors (as described in section 1874A) or other review 
     contractors (other than contractors under section 1893(h) or 
     other contractors paid on a contingent basis).
       ``(4) No payment without prior authorization.--With respect 
     to an outpatient therapy service 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 (6), no 
     payment shall 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.
       ``(5) Submission of information.--A therapy provider 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, but not later than 24 months 
     after the date of enactment of this subsection.
       ``(6) Timeliness.--If the Secretary does not make a prior 
     authorization determination under paragraph (4)(A) within 10 
     business days of the date of the Secretary's receipt of 
     medical documentation needed to make such determination, 
     paragraph (4)(B) shall not apply.
       ``(7) Construction.--With respect to an outpatient therapy 
     service 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 or any other provision of law.
       ``(8) Beneficiary protections.--In the case where payment 
     may not be made as a result of application of medical review 
     under this subsection, 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).
       ``(9) 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.
       ``(C) Limitation.--There shall be no administrative or 
     judicial review under section 1869, section 1878, or 
     otherwise of the identification of services for medical 
     review or the process for medical review under this 
     subsection.
       ``(10) Definitions.--For purposes of this subsection:
       ``(A) Outpatient therapy services.--The term `outpatient 
     therapy services' means the following services for which 
     payment is made under section 1848, 1834(g), or 1834(k):
       ``(i) Physical therapy services of the type described in 
     section 1861(p).
       ``(ii) Speech-language pathology services of the type 
     described in such section though the application of section 
     1861(ll)(2).
       ``(iii) Occupational therapy services of the type described 
     in section 1861(p) through the operation of section 1861(g).
       ``(B) Therapy provider.--The term `therapy provider' means 
     a provider of services (as defined in section 1861(u)) or a 
     supplier (as defined in section 1861(d)) who submits a claim 
     for outpatient therapy services.
       ``(11) Funding.--For purposes of implementing this 
     subsection, the Secretary shall provide for the transfer, 
     from the Federal Supplementary Medical Insurance Trust Fund 
     under section 1841, of $35,000,000 to the Centers for 
     Medicare & Medicaid Services Program Management Account for 
     each fiscal year (beginning with fiscal year 2015). Amounts 
     transferred under this paragraph shall remain available until 
     expended.
       ``(12) Scaling back.--
       ``(A) Periodic determinations.--Beginning with 2019, and 
     every two years thereafter, the Secretary shall--
       ``(i) make a determination of the improper payment rate for 
     outpatient therapy services for a 12-month period; and
       ``(ii) make such determination publicly available.
       ``(B) Scaling back.--If the improper payment rate for 
     outpatient therapy services determined for a 12-month period 
     under subparagraph (A) is 50 percent or less of the Medicare 
     fee-for-service improper payment rate for such period, the 
     Secretary shall--
       ``(i) reduce the amount and extent of medical review 
     conducted for a prospective year under the process 
     established in this subsection; and
       ``(ii) return an appropriate portion of the funding 
     provided for such year under paragraph (11).''.
       (2) GAO study and report.--
       (A) Study.--The Comptroller General of the United States 
     shall conduct a study on the effectiveness of medical review 
     of outpatient therapy services under section 1833(aa) of the 
     Social Security Act, as added by paragraph (1). Such study 
     shall include an analysis of--
       (i) aggregate data on--

       (I) the number of individuals, therapy providers, and 
     claims subject to such review; and
       (II) the number of reviews conducted under such section; 
     and

       (ii) the outcomes of such reviews.
       (B) Report.--Not later than 3 years after the date of 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report containing the results of the study 
     under subparagraph (A), together with recommendations for 
     such legislation and administrative action as the Comptroller 
     General determines appropriate.
       (d) Collection of Standardized Data Elements for Outpatient 
     Therapy Services.--
       (1) Collection of standardized data elements for outpatient 
     therapy services.--Section 1834 of the Social Security Act 
     (42 U.S.C. 1395m) is amended by adding at the end the 
     following new subsection:
       ``(r) Collection of Standardized Data Elements for 
     Outpatient Therapy Services.--
       ``(1) Standardized data elements.--
       ``(A) In general.--Not later than 6 months after the date 
     of enactment of this subsection, the Secretary shall post on 
     the Internet website of the Centers for Medicare & Medicaid 
     Services a draft list of standardized data elements for 
     individuals receiving outpatient therapy services.
       ``(B) Categories.--
       ``(i) In general.--Such standardized data elements shall 
     include information with respect to the following categories, 
     as determined appropriate by the Secretary:

       ``(I) Functional status.
       ``(II) Demographic information.
       ``(III) Diagnosis.
       ``(IV) Severity.
       ``(V) Affected body structures and functions.
       ``(VI) Limitations with activities of daily living and 
     participation.
       ``(VII) Other categories determined to be appropriate by 
     the Secretary.

       ``(ii) Alignment with categories for reporting of 
     assessment data under impact.--The Secretary shall, as 
     appropriate, align the functional status category under 
     subclause (I) of clause (i) and the other categories under 
     subclauses (II) through (VII) of such clause with the 
     categories described
     in clauses (i) through (vi) of section 1899B(b)(1)(B).
       ``(C) Solicitation of input.--The Secretary shall accept 
     input from stakeholders through the date that is 60 days 
     after the date the Secretary posts the draft list of 
     standardized data elements pursuant to subparagraph (A). In 
     seeking such input, the Secretary shall use one or more 
     mechanisms to solicit input from stakeholders that may 
     include use of open door forums, town hall meetings, requests 
     for information, or other mechanisms determined appropriate 
     by the Secretary.
       ``(D) Operational list of standardized data elements.--Not 
     later than 120 days after the end of the period for accepting 
     input described in subparagraph (C), the Secretary, taking 
     into account such input, shall post on the Internet website 
     of the Centers for Medicare & Medicaid Services an 
     operational list of standardized data elements.
       ``(E) Subsequent revisions.--Subsequent revisions to the 
     operational list of standardized data elements shall be made 
     through rulemaking. Such revisions may be based on experience 
     and input from stakeholders.
       ``(2) System to report standardized data elements.--
       ``(A) In general.--Not later than 18 months after the date 
     the Secretary posts the operational list of standardized data 
     elements pursuant to paragraph (1)(D), the Secretary shall 
     develop and implement an electronic system (which may be a 
     web portal) for therapy providers to report the standardized 
     data elements for individuals with respect to outpatient 
     therapy services.

[[Page 4970]]

       ``(B) Stakeholder input.--The Secretary shall seek input 
     from stakeholders regarding the best way to report the 
     standardized data elements under this subsection.
       ``(3) Reporting.--
       ``(A) Frequency of reporting.--
       ``(i) In general.--Subject to clauses (ii) and (iii), the 
     Secretary shall specify the frequency of reporting 
     standardized data elements under this subsection.
       ``(ii) Stakeholder input.--The Secretary shall seek input 
     from stakeholders regarding the frequency of the reporting of 
     such data elements.
       ``(iii) Alignment with frequency for reporting of 
     assessment data under impact.--The Secretary shall, as 
     appropriate, align the frequency of the reporting of such 
     data elements with respect to an individual under this 
     subsection with the frequency in which data is required to be 
     submitted with respect to an individual under the second 
     sentence of section 1899B(b)(1)(A).
       ``(B) Reporting requirement.--Beginning on the date the 
     system to report standardized data elements under this 
     subsection is operational, no payment shall be made under 
     this part for outpatient therapy services furnished to an 
     individual unless a therapy provider reports the standardized 
     data elements for such individual.
       ``(4) Report on new payment system for outpatient therapy 
     services.--
       ``(A) In general.--Not later than 24 months after the date 
     described in paragraph (3)(B), the Secretary shall submit to 
     Congress a report on the design of a new payment system for 
     outpatient therapy services. The report shall include an 
     analysis of the standardized data elements collected and 
     other appropriate data and information.
       ``(B) Features.--Such report shall consider--
       ``(i) appropriate adjustments to payment (such as case mix 
     and outliers);
       ``(ii) payments on an episode of care basis; and
       ``(iii) reduced payment for multiple episodes.
       ``(C) Consultation.--The Secretary shall consult with 
     stakeholders regarding the design of such a new payment 
     system.
       ``(5) Implementation.--
       ``(A) Funding.--For purposes of implementing this 
     subsection, the Secretary shall provide for the transfer, 
     from the Federal Supplementary Medical Insurance Trust Fund 
     under section 1841, of $7,000,000 to the Centers for Medicare 
     & Medicaid Services Program Management Account for each of 
     fiscal years 2015 through 2019. Amounts transferred under 
     this subparagraph shall remain available until expended.
       ``(B) Administration.--Chapter 35 of title 44, United 
     States Code, shall not apply to specification of the 
     standardized data elements and implementation of the system 
     to report such standardized data elements under this 
     subsection.
       ``(C) Limitation.--There shall be no administrative or 
     judicial review under section 1869, section 1878, or 
     otherwise of the specification of standardized data elements 
     required under this subsection or the system to report such 
     standardized data elements.
       ``(D) Definition of outpatient therapy services and therapy 
     provider.--In this subsection, the terms `outpatient therapy 
     services' and `therapy provider' have the meaning given those 
     term in section 1833(aa).''.
       (2) Sunset of current claims-based collection of therapy 
     data.--Section 3005(g)(1) of the Middle Class Tax Extension 
     and Job Creation Act of 2012 (42 U.S.C. 1395l note) is 
     amended, in the first sentence, by inserting ``and ending on 
     the date the system to report standardized data elements 
     under section 1834(r) of the Social Security Act (42 U.S.C. 
     1395m(r)) is implemented,'' after ``January 1, 2013,''.
       (e) Reporting of Certain Information.--Section 1842(t) of 
     the Social Security Act (42 U.S.C. 1395u(t)) is amended by 
     adding at the end the following new paragraph:
       ``(3) Each request for payment, or bill submitted, by a 
     therapy provider (as defined in section 1833(aa)(10)) for an 
     outpatient therapy service (as defined in such section) 
     furnished by a therapy assistant on or after January 1, 2017, 
     shall include (in a form and manner specified by the 
     Secretary) an indication that the service was furnished by a 
     therapy assistant.''.
                                 ______
                                 
  SA 1120. Mr. McCONNELL (for Mr. Cornyn) proposed an amendment to the 
bill S. 178, to provide justice for the victims of trafficking; as 
follows:

       Strike section 101 and insert the following:

     SEC. 101. DOMESTIC TRAFFICKING VICTIMS' FUND.

       (a) In General.--Chapter 201 of title 18, United States 
     Code, is amended by adding at the end the following:

     ``Sec. 3014. Additional special assessment

       ``(a) In General.--Beginning on the date of enactment of 
     the Justice for Victims of Trafficking Act of 2015 and ending 
     on September, 30 2019, in addition to the assessment imposed 
     under section 3013, the court shall assess an amount of 
     $5,000 on any non-indigent person or entity convicted of an 
     offense under--
       ``(1) chapter 77 (relating to peonage, slavery, and 
     trafficking in persons);
       ``(2) chapter 109A (relating to sexual abuse);
       ``(3) chapter 110 (relating to sexual exploitation and 
     other abuse of children);
       ``(4) chapter 117 (relating to transportation for illegal 
     sexual activity and related crimes); or
       ``(5) section 274 of the Immigration and Nationality Act (8 
     U.S.C. 1324) (relating to human smuggling), unless the person 
     induced, assisted, abetted, or aided only an individual who 
     at the time of such action was the alien's spouse, parent, 
     son, or daughter (and no other individual) to enter the 
     United States in violation of law.
       ``(b) Satisfaction of Other Court-Ordered Obligations.--An 
     assessment under subsection (a) shall not be payable until 
     the person subject to the assessment has satisfied all 
     outstanding court-ordered fines and orders of restitution 
     arising from the criminal convictions on which the special 
     assessment is based.
       ``(c) Establishment of Domestic Trafficking Victims' 
     Fund.--There is established in the Treasury of the United 
     States a fund, to be known as the `Domestic Trafficking 
     Victims' Fund' (referred to in this section as the `Fund'), 
     to be administered by the Attorney General, in consultation 
     with the Secretary of Homeland Security and the Secretary of 
     Health and Human Services.
       ``(d) Transfers.--In a manner consistent with section 
     3302(b) of title 31, there shall be transferred to the Fund 
     from the General Fund of the Treasury an amount equal to the 
     amount of the assessments collected under this section, which 
     shall remain available until expended.
       ``(e) Use of Funds.--
       ``(1) In general.--From amounts in the Fund, in addition to 
     any other amounts available, and without further 
     appropriation, the Attorney General, in coordination with the 
     Secretary of Health and Human Services shall, for each of 
     fiscal years 2016 through 2019, use amounts available in the 
     Fund to award grants or enhance victims' programming under--
       ``(A) sections 202, 203, and 204 of the Trafficking Victims 
     Protection Reauthorization Act of 2005 (42 U.S.C. 14044a, 
     14044b, and 14044c);
       ``(B) subsections (b)(2) and (f) of section 107 of the 
     Trafficking Victims Protection Act of 2000 (22 U.S.C. 7105); 
     and
       ``(C) section 214(b) of the Victims of Child Abuse Act of 
     1990 (42 U.S.C. 13002(b)).
       ``(2) Grants.--Of the amounts in the Fund used under 
     paragraph (1), not less than $2,000,000, if such amounts are 
     available in the Fund during the relevant fiscal year, shall 
     be used for grants to provide services for child pornography 
     victims under section 214(b) of the Victims of Child Abuse 
     Act of 1990 (42 U.S.C. 13002(b)).
       ``(3) Application.--Amounts transferred from the Fund 
     pursuant to this section for each of fiscal years 2016 
     through 2019 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).
       ``(f) Transfers.--
       ``(1) In general.--Effective on the day after the date of 
     enactment of the Justice for Victims of Trafficking Act of 
     2015, on September 30 of each fiscal year, all unobligated 
     balances in the Fund shall be transferred to the Crime 
     Victims Fund established under section 1402 of the Victims of 
     Crime Act of 1984 (42 U.S.C. 10601).
       ``(2) Availability.--Amounts transferred under paragraph 
     (1)--
       ``(A) shall be available for any authorized purpose of the 
     Crime Victims Fund; and
       ``(B) shall remain available until expended.
       ``(g) Collection Method.--The amount assessed under 
     subsection (a) shall, subject to subsection (b), be collected 
     in the manner that fines are collected in criminal cases.
       ``(h) Duration of Obligation.--Subject to section 3613(b), 
     the obligation to pay an assessment imposed on or after the 
     date of enactment of the Justice for Victims of Trafficking 
     Act of 2015 shall not cease until the assessment is paid in 
     full.
       ``(i) Authorization of Appropriations.--
       ``(1) Written certification.--Not later than September 30, 
     2016, and each September 30 thereafter, the Attorney General 
     shall submit to Congress a written certification as to the 
     total amount in the Fund.
       ``(2) Authorization of appropriations.--In any fiscal year 
     for which a written certification submitted under paragraph 
     (1) indicates the total amount in the Fund is less than 
     $30,000,000, there is authorized to be appropriated to the 
     Fund an amount equal to $30,000,000 minus the total amount 
     indicated in the certification.''.
       (b) Technical and Conforming Amendment.--The table of 
     sections for chapter 201 of title 18, United States Code, is 
     amended by inserting after the item relating to section 3013 
     the following:

``3014. Additional special assessment.''.

[[Page 4971]]



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