[Congressional Record (Bound Edition), Volume 162 (2016), Part 6]
[House]
[Pages 7902-7907]
[From the U.S. Government Publishing Office, www.gpo.gov]




           HELPING HOSPITALS IMPROVE PATIENT CARE ACT OF 2016

  Mr. TIBERI. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 5273) to amend title XVIII of the Social Security Act to 
provide for regulatory relief under the Medicare program for certain 
providers of services and suppliers and increased transparency in 
hospital coding and enrollment data, and for other purposes, as 
amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                H.R. 5273

       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 ``Helping 
     Hospitals Improve Patient Care Act of 2016''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.

            TITLE I--PROVISIONS RELATING TO MEDICARE PART A

Sec. 101. Development of Medicare study for HCPCS version of MS-DRG 
              codes for similar hospital services.
Sec. 102. Establishing beneficiary equity in the Medicare hospital 
              readmission program.
Sec. 103. Five-year extension of the rural community hospital 
              demonstration program.
Sec. 104. Regulatory relief for LTCHs.
Sec. 105. Savings from IPPS MACRA pay-for through not applying 
              documentation and coding adjustments.

            TITLE II--PROVISIONS RELATING TO MEDICARE PART B

Sec. 201. Continuing Medicare payment under HOPD prospective payment 
              system for services furnished by mid-build off-campus 
              outpatient departments of providers.
Sec. 202. Treatment of cancer hospitals in off-campus outpatient 
              department of a provider policy.
Sec. 203. Treatment of eligible professionals in ambulatory surgical 
              centers for meaningful use and MIPS.

                  TITLE III--OTHER MEDICARE PROVISIONS

Sec. 301. Delay in authority to terminate contracts for Medicare 
              Advantage plans failing to achieve minimum quality 
              ratings.
Sec. 302. Requirement for enrollment data reporting for Medicare.
Sec. 303. Updating the Welcome to Medicare package.

            TITLE I--PROVISIONS RELATING TO MEDICARE PART A

     SEC. 101. DEVELOPMENT OF MEDICARE STUDY FOR HCPCS VERSION OF 
                   MS-DRG CODES FOR SIMILAR HOSPITAL SERVICES.

       Section 1886 of the Social Security Act (42 U.S.C. 1395ww) 
     is amended by adding at the end the following new subsection:
       ``(t) Relating Similar Inpatient and Outpatient Hospital 
     Services.--
       ``(1) Development of hcpcs version of ms-drg codes.--
       ``(A) In general.--Not later than January 1, 2018, the 
     Secretary shall develop HCPCS versions for MS-DRGs that is 
     similar to the ICD-10-PCS for such MS-DRGs such that, to the 
     extent possible, the MS-DRG assignment shall be similar for a 
     claim coded with the HCPCS version as an identical claim 
     coded with a ICD-10-PCS code.
       ``(B) Coverage of surgical ms-drgs.--In carrying out 
     subparagraph (A), the Secretary shall develop HCPCS versions 
     of MS-DRG codes for not fewer than 10 surgical MS-DRGs.
       ``(C) Publication and dissemination of the hcpcs versions 
     of ms-drgs.--
       ``(i) In general.--The Secretary shall develop a HCPCS MS-
     DRG definitions manual and software that is similar to the 
     definitions manual and software for ICD-10-PCS codes for such 
     MS-DRGs. The Secretary shall post the HCPCS MS-DRG 
     definitions manual and software on the Internet website of 
     the Centers for Medicare & Medicaid Services. The HCPCS MS-
     DRG definitions manual and software shall be in the public 
     domain and available for use and redistribution without 
     charge.
       ``(ii) Use of previous analysis done by medpac.--In 
     developing the HCPCS MS-DRG definitions manual and software 
     under clause (i), the Secretary shall consult with the 
     Medicare Payment Advisory Commission and shall consider the 
     analysis done by such Commission in translating outpatient 
     surgical claims into inpatient surgical MS-DRGs in preparing 
     chapter 7 (relating to hospital short-stay policy issues) of 
     its `Medicare and the Health Care Delivery System' report 
     submitted to Congress in June 2015.
       ``(D) Definition and reference.--In this paragraph:
       ``(i) HCPCS.--The term `HCPCS' means, with respect to 
     hospital items and services, the code under the Healthcare 
     Common Procedure Coding System (HCPCS) (or a successor code) 
     for such items and services.
       ``(ii) ICD-10-PCS.--The term `ICD-10-PCS' means the 
     International Classification of Diseases, 10th Revision, 
     Procedure Coding System, and includes a subsequent revision 
     of such International Classification of Diseases, Procedure 
     Coding System.''.

     SEC. 102. ESTABLISHING BENEFICIARY EQUITY IN THE MEDICARE 
                   HOSPITAL READMISSION PROGRAM.

       (a) Transitional Adjustment for Dual Eligible Population.--
     Section 1886(q)(3) of the Social Security Act (42 U.S.C. 
     1395ww(q)(3)) is amended--
       (1) in subparagraph (A), by inserting ``subject to 
     subparagraph (D),'' after ``purposes of paragraph (1),''; and
       (2) by adding at the end the following new subparagraph:
       ``(D) Transitional adjustment for dual eligibles.--
       ``(i) In general.--In determining a hospital's adjustment 
     factor under this paragraph for purposes of making payments 
     for discharges occurring during and after fiscal year 2019, 
     and before the application of

[[Page 7903]]

     clause (i) of subparagraph (E), the Secretary shall assign 
     hospitals to groups (as defined by the Secretary under clause 
     (ii)) and apply the applicable provisions of this subsection 
     using a methodology in a manner that allows for separate 
     comparison of hospitals within each such group, as determined 
     by the Secretary.
       ``(ii) Defining groups.--For purposes of this subparagraph, 
     the Secretary shall define groups of hospitals based on their 
     overall proportion, of the inpatients who are entitled to, or 
     enrolled for, benefits under part A, who are full-benefit 
     dual eligible individuals (as defined in section 1935(c)(6)). 
     In defining groups, the Secretary shall consult the Medicare 
     Payment Advisory Commission and may consider the analysis 
     done by such Commission in preparing the portion of its 
     report submitted to Congress in June 2013 relating to 
     readmissions.
       ``(iii) Minimizing reporting burden on hospitals.--In 
     carrying out this subparagraph, the Secretary shall not 
     impose any additional reporting requirements on hospitals.
       ``(iv) Budget neutral design methodology.--The Secretary 
     shall design the methodology to implement this subparagraph 
     so that the estimated total amount of reductions in payments 
     under this subsection equals the estimated total amount of 
     reductions in payments that would otherwise occur under this 
     subsection if this subparagraph did not apply.''.
       (b) Subsequent Adjustments Based on IMPACT Reports.--
     Section 1886(q)(3) of the Social Security Act (42 U.S.C. 
     1395ww(q)(3)), as amended by subsection (a), is further 
     amended by adding at the end the following new subparagraph:
       ``(E) Changes in risk adjustment.--
       ``(i) Consideration of recommendations in impact reports.--
     The Secretary may take into account the studies conducted and 
     the recommendations made by the Secretary under section 
     2(d)(1) of the IMPACT Act of 2014 (Public Law 113-185; 42 
     U.S.C. 1395lll note) with respect to the application under 
     this subsection of risk adjustment methodologies. Nothing in 
     this clause shall be construed as precluding consideration of 
     the use of groupings of hospitals.''.
       (c) MedPAC Study on Readmissions Program.--The Medicare 
     Payment Advisory Commission shall conduct a study to review 
     overall hospital readmissions described in section 
     1886(q)(5)(E) of the Social Security Act (42 U.S.C. 
     1395ww(q)(5)(E)) and whether such readmissions are related to 
     any changes in outpatient and emergency services furnished. 
     The Commission shall submit to Congress a report on such 
     study in its report to Congress in June 2017.
       (d) Addressing Issue of Certain Patients.--Subparagraph (E) 
     of section 1886(q)(3) of the Social Security Act (42 U.S.C. 
     1395ww(q)(3)), as added by subsection (b), is further amended 
     by adding at the end the following new clause:
       ``(ii) Consideration of exclusion of patient cases based on 
     v or other appropriate codes.--In promulgating regulations to 
     carry out this subsection with respect to discharges 
     occurring after fiscal year 2018, the Secretary may consider 
     the use of V or other ICD-related codes for removal of a 
     readmission. The Secretary may consider modifying measures 
     under this subsection to incorporate V or other ICD-related 
     codes at the same time as other changes are being made under 
     this subparagraph.''.
       (e) Removal of Certain Readmissions.--Subparagraph (E) of 
     section 1886(q)(3) of the Social Security Act (42 U.S.C. 
     1395ww(q)(3)), as added by subsection (b) and amended by 
     subsection (d), is further amended by adding at the end the 
     following new clause:
       ``(iii) Removal of certain readmissions.--In promulgating 
     regulations to carry out this subsection, with respect to 
     discharges occurring after fiscal year 2018, the Secretary 
     may consider removal as a readmission of an admission that is 
     classified within one or more of the following: transplants, 
     end-stage renal disease, burns, trauma, psychosis, or 
     substance abuse. The Secretary may consider modifying 
     measures under this subsection to remove readmissions at the 
     same time as other changes are being made under this 
     subparagraph.''.

     SEC. 103. FIVE-YEAR EXTENSION OF THE RURAL COMMUNITY HOSPITAL 
                   DEMONSTRATION PROGRAM.

       (a) Extension.--Section 410A of the Medicare Prescription 
     Drug, Improvement, and Modernization Act of 2003 (Public Law 
     108-173; 42 U.S.C. 1395ww note), as amended by sections 3123 
     and 10313 of the Patient Protection and Affordable Care Act 
     (Public Law 111-148), is amended--
       (1) in subsection (a)(5), by striking ``5-year extension 
     period'' and inserting ``10-year extension period''; and
       (2) in subsection (g)--
       (A) in the subsection heading, by striking ``Five-Year'' 
     and inserting ``Ten-Year'';
       (B) in paragraph (1), by striking ``additional 5-year'' and 
     inserting ``additional 10-year'';
       (C) by striking ``5-year extension period'' and inserting 
     ``10-year extension period'' each place it appears;
       (D) in paragraph (4)(B)--
       (i) in the matter preceding clause (i), by inserting ``each 
     5-year period in'' after ``hospital during''; and
       (ii) in clause (i), by inserting ``each applicable 5-year 
     period in'' after ``the first day of''; and
       (E) by adding at the end the following new paragraphs:
       ``(5) Other hospitals in demonstration program.--During the 
     second 5 years of the 10-year extension period, the Secretary 
     shall apply the provisions of paragraph (4) to rural 
     community hospitals that are not described in paragraph (4) 
     but are participating in the demonstration program under this 
     section as of December 30, 2014, in a similar manner as such 
     provisions apply to rural community hospitals described in 
     paragraph (4).
       ``(6) Expansion of demonstration program to rural areas in 
     any state.--
       ``(A) In general.--The Secretary shall, notwithstanding 
     subsection (a)(2) or paragraph (2) of this subsection, not 
     later than 120 days after the date of the enactment of this 
     paragraph, issue a solicitation for applications to select up 
     to the maximum number of additional rural community hospitals 
     located in any State to participate in the demonstration 
     program under this section for the second 5 years of the 10-
     year extension period without exceeding the limitation under 
     paragraph (3) of this subsection.
       ``(B) Priority.--In determining which rural community 
     hospitals that submitted an application pursuant to the 
     solicitation under subparagraph (A) to select for 
     participation in the demonstration program, the Secretary--
       ``(i) shall give priority to rural community hospitals 
     located in one of the 20 States with the lowest population 
     densities (as determined by the Secretary using the 2015 
     Statistical Abstract of the United States); and
       ``(ii) may consider--

       ``(I) closures of hospitals located in rural areas in the 
     State in which the rural community hospital is located during 
     the 5-year period immediately preceding the date of the 
     enactment of this paragraph; and
       ``(II) the population density of the State in which the 
     rural community hospital is located.''.

       (b) Change in Timing for Report.--Subsection (e) of such 
     section 410A is amended--
       (1) by striking ``Not later than 6 months after the 
     completion of the demonstration program under this section'' 
     and inserting ``Not later than August 1, 2018''; and
       (2) by striking ``such program'' and inserting ``the 
     demonstration program under this section''.

     SEC. 104. REGULATORY RELIEF FOR LTCHS.

       (a) Technical Change to the Medicare Long-term Care 
     Hospital Moratorium Exception.--
       (1) In general.--Section 114(d)(7) of the Medicare, 
     Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 1395ww 
     note), as amended by sections 3106(b) and 10312(b) of Public 
     Law 111-148, section 1206(b)(2) of the Pathway for SGR Reform 
     Act of 2013 (division B of Public Law 113-67), and section 
     112 of the Protecting Access to Medicare Act of 2014, is 
     amended by striking ``The moratorium under paragraph (1)(A)'' 
     and inserting ``Any moratorium under paragraph (1)''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall take effect as if included in the enactment of section 
     112 of the Protecting Access to Medicare Act of 2014.
       (b) Modification to Medicare Long-term Care Hospital High 
     Cost Outlier Payments.--Section 1886(m) of the Social 
     Security Act (42 U.S.C. 1395ww(m)) is amended by adding at 
     the end the following new paragraph:
       ``(7) Treatment of high cost outlier payments.--
       ``(A) Adjustment to the standard federal payment rate for 
     estimated high cost outlier payments.--Under the system 
     described in paragraph (1), for fiscal years beginning on or 
     after October 1, 2017, the Secretary shall reduce the 
     standard Federal payment rate as if the estimated aggregate 
     amount of high cost outlier payments for standard Federal 
     payment rate discharges for each such fiscal year would be 
     equal to 8 percent of estimated aggregate payments for 
     standard Federal payment rate discharges for each such fiscal 
     year.
       ``(B) Limitation on high cost outlier payment amounts.--
     Notwithstanding subparagraph (A), the Secretary shall set the 
     fixed loss amount for high cost outlier payments such that 
     the estimated aggregate amount of high cost outlier payments 
     made for standard Federal payment rate discharges for fiscal 
     years beginning on or after October 1, 2017, shall be equal 
     to 99.6875 percent of 8 percent of estimated aggregate 
     payments for standard Federal payment rate discharges for 
     each such fiscal year.
       ``(C) Waiver of budget neutrality.--Any reduction in 
     payments resulting from the application of subparagraph (B) 
     shall not be taken into account in applying any budget 
     neutrality provision under such system.
       ``(D) No effect on site neutral high cost outlier payment 
     rate.--This paragraph shall not apply with respect to the 
     computation of the applicable site neutral payment rate under 
     paragraph (6).''.

[[Page 7904]]



     SEC. 105. SAVINGS FROM IPPS MACRA PAY-FOR THROUGH NOT 
                   APPLYING DOCUMENTATION AND CODING ADJUSTMENTS.

       Section 7(b)(1)(B)(iii) 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 122-240) and section 414(1)(B)(iii) of 
     the Medicare Access and CHIP Reauthorization Act of 2015 
     (Public Law 114-10), is amended by striking ``an increase of 
     0.5 percentage points for discharges occurring during each of 
     fiscal years 2018 through 2023'' and inserting ``an increase 
     of 0.4590 percentage points for discharges occurring during 
     fiscal year 2018 and 0.5 percentage points for discharges 
     occurring during each of fiscal years 2019 through 2023''.

            TITLE II--PROVISIONS RELATING TO MEDICARE PART B

     SEC. 201. CONTINUING MEDICARE PAYMENT UNDER HOPD PROSPECTIVE 
                   PAYMENT SYSTEM FOR SERVICES FURNISHED BY MID-
                   BUILD OFF-CAMPUS OUTPATIENT DEPARTMENTS OF 
                   PROVIDERS.

       (a) In General.--Section 1833(t)(21) of the Social Security 
     Act (42 U.S.C. 1395l(t)(21)) is amended--
       (1) in subparagraph (B)--
       (A) in clause (i), by striking ``clause (ii)'' and 
     inserting ``the subsequent provisions of this subparagraph''; 
     and
       (B) by adding at the end the following new clauses:
       ``(iii) Deemed treatment for 2017.--For purposes of 
     applying clause (ii) with respect to applicable items and 
     services furnished during 2017, a department of a provider 
     (as so defined) not described in such clause is deemed to be 
     billing under this subsection with respect to covered OPD 
     services furnished prior to November 2, 2015, if the 
     Secretary received from the provider prior to December 2, 
     2015, an attestation (pursuant to section 413.65(b)(3) of 
     title 42 of the Code of Federal Regulations) that such 
     department was a department of a provider (as so defined).
       ``(iv) Alternative exception beginning with 2018.--For 
     purposes of paragraph (1)(B)(v) and this paragraph with 
     respect to applicable items and services furnished during 
     2018 or a subsequent year, the term `off-campus outpatient 
     department of a provider' also shall not include a department 
     of a provider (as so defined) that is not described in clause 
     (ii) if--

       ``(I) the Secretary receives from the provider an 
     attestation (pursuant to such section 413.65(b)(3)) not later 
     than December 31, 2016 (or, if later, 60 days after the date 
     of the enactment of this clause), that such department met 
     the requirements of a department of a provider specified in 
     section 413.65 of title 42 of the Code of Federal 
     Regulations;
       ``(II) the provider includes such department as part of the 
     provider on its enrollment form in accordance with the 
     enrollment process under section 1866(j); and
       ``(III) the department met the mid-build requirement of 
     clause (v) and the Secretary receives, not later than 60 days 
     after the date of the enactment of this clause, from the 
     chief executive officer or chief operating officer of the 
     provider a written certification that the department met such 
     requirement.

       ``(v) Mid-build requirement described.--The mid-build 
     requirement of this clause is, with respect to a department 
     of a provider, that before November 2, 2015, the provider had 
     a binding written agreement with an outside unrelated party 
     for the actual construction of such department.
       ``(vii) Audit.--Not later than December 31, 2018, the 
     Secretary shall audit the compliance with requirements of 
     clause (iv) with respect to each department of a provider to 
     which such clause applies. If the Secretary finds as a result 
     of an audit under this clause that the applicable 
     requirements were not met with respect to such department, 
     the department shall not be excluded from the term `off-
     campus outpatient department of a provider' under such 
     clause.
       ``(viii) Implementation.--For purposes of implementing 
     clauses (iii) through (vii):

       ``(I) Notwithstanding any other provision of law, the 
     Secretary may implement such clauses by program instruction 
     or otherwise.
       ``(II) Subchapter I of chapter 35 of title 44, United 
     States Code, shall not apply.
       ``(III) For purposes of carrying out this subparagraph with 
     respect to clauses (iii) and (iv) (and clause (vii) insofar 
     as it relates to clause (iv)), $10,000,000 shall be available 
     from the Federal Supplementary Medical Insurance Trust Fund 
     under section 1841, to remain available until December 31, 
     2018.''; and

       (2) in subparagraph (E), by adding at the end the following 
     new clause:
       ``(iv) The determination of an audit under subparagraph 
     (B)(vii).''.
       (b) Effective Date.--The amendments made by this section 
     shall be effective as if included in the enactment of section 
     603 of the Bipartisan Budget Act of 2015 (Public Law 114-74).

     SEC. 202. TREATMENT OF CANCER HOSPITALS IN OFF-CAMPUS 
                   OUTPATIENT DEPARTMENT OF A PROVIDER POLICY.

       (a) In General.--Section 1833(t)(21)(B) of the Social 
     Security Act (42 U.S.C. 1395l(t)(21)(B)), as amended by 
     section 201(a), is amended--
       (1) by inserting after clause (v) the following new clause:
       ``(vi) Exclusion for certain cancer hospitals.--For 
     purposes of paragraph (1)(B)(v) and this paragraph with 
     respect to applicable items and services furnished during 
     2017 or a subsequent year, the term `off-campus outpatient 
     department of a provider' also shall not include a department 
     of a provider (as so defined) that is not described in clause 
     (ii) if the provider is a hospital described in section 
     1886(d)(1)(B)(v) and--

       ``(I) in the case of a department that met the requirements 
     of section 413.65 of title 42 of the Code of Federal 
     Regulations after November 1, 2015, and before the date of 
     the enactment of this clause, the Secretary receives from the 
     provider an attestation that such department met such 
     requirements not later than 60 days after such date of 
     enactment; or
       ``(II) in the case of a department that meets such 
     requirements after such date of enactment, the Secretary 
     receives from the provider an attestation that such 
     department meets such requirements not later than 60 days 
     after the date such requirements are first met with respect 
     to such department.'';

       (2) in clause (vii), by inserting after the first sentence 
     the following: ``Not later than 2 years after the date the 
     Secretary receives an attestation under clause (vi) relating 
     to compliance of a department of a provider with requirements 
     referred to in such clause, the Secretary shall audit the 
     compliance with such requirements with respect to the 
     department.''; and
       (3) in clause (viii)(III), by adding at the end the 
     following: ``For purposes of carrying out this subparagraph 
     with respect to clause (vi) (and clause (vii) insofar as it 
     relates to such clause), $2,000,000 shall be available from 
     the Federal Supplementary Medical Insurance Trust Fund under 
     section 1841, to remain available until expended.''.
       (b) Offsetting Savings.--Section 1833(t)(18) of the Social 
     Security Act (42 U.S.C. 1395l(t)(18)) is amended--
       (1) in subparagraph (B), by inserting ``, subject to 
     subparagraph (C),'' after ``shall''; and
       (2) by adding at the end the following new subparagraph:
       ``(C) Target pcr adjustment.--In applying section 419.43(i) 
     of title 42 of the Code of Federal Regulations to implement 
     the appropriate adjustment under this paragraph for services 
     furnished on or after January 1, 2018, the Secretary shall 
     use a target PCR that is 1.0 percentage points less than the 
     target PCR that would otherwise apply. In addition to the 
     percentage point reduction under the previous sentence, the 
     Secretary may consider making an additional percentage point 
     reduction to such target PCR that takes into account payment 
     rates for applicable items and services described in 
     paragraph (21)(C) other than for services furnished by 
     hospitals described in section 1886(d)(1)(B)(v). In making 
     any budget neutrality adjustments under this subsection for 
     2018 or a subsequent year, the Secretary shall not take into 
     account the reduced expenditures that result from the 
     application of this subparagraph.''.
       (c) Effective Date.--The amendments made by this section 
     shall be effective as if included in the enactment of section 
     603 of the Bipartisan Budget Act of 2015 (Public Law 114-74).

     SEC. 203. TREATMENT OF ELIGIBLE PROFESSIONALS IN AMBULATORY 
                   SURGICAL CENTERS FOR MEANINGFUL USE AND MIPS.

       (a) In General.--Section 1848(a)(7)(D) of the Social 
     Security Act (42 U.S.C. 1395w-4(a)(7)(D)) is amended--
       (1) by striking ``hospital-based eligible professionals'' 
     and all that follows through ``No payment'' and inserting the 
     following: ``hospital-based and ambulatory surgical center-
     based eligible professionals.--
       ``(i) Hospital-based.--No payment''; and
       (2) by adding at the end the following new clauses:
       ``(ii) Ambulatory surgical center-based.--Subject to clause 
     (iv), no payment adjustment may be made under subparagraph 
     (A) for 2017 and 2018 in the case of an eligible professional 
     with respect to whom substantially all of the covered 
     professional services furnished by such professional are 
     furnished in an ambulatory surgical center.
       ``(iii) Determination.--The determination of whether an 
     eligible professional is an eligible professional described 
     in clause (ii) may be made on the basis of--

       ``(I) the site of service (as defined by the Secretary); or
       ``(II) an attestation submitted by the eligible 
     professional.

     Determinations made under subclauses (I) and (II) shall be 
     made without regard to any employment or billing arrangement 
     between the eligible professional and any other supplier or 
     provider of services.
       ``(iv) Sunset.--Clause (ii) shall no longer apply as of the 
     first year that begins more than 3 years after the date on 
     which the Secretary determines, through notice and comment 
     rulemaking, that certified EHR technology applicable to the 
     ambulatory surgical center setting is available.''.
       (b) Continued Application of Certain Provisions Under 
     MIPS.--Section 1848(o)(2)(D) of the Social Security Act (42 
     U.S.C. 1395w-4(o)(2)(D)) is amended by adding at the end the 
     following new sentence: ``The provisions of subparagraphs (B) 
     and (D) of

[[Page 7905]]

     subsection (a)(7), including the application of clause (iv) 
     of such subparagraph (D), shall apply to assessments of MIPS 
     eligible professionals under subsection (q) with respect to 
     the performance category described in subsection 
     (q)(2)(A)(iv) in a manner similar to the manner in which such 
     provisions apply with respect to payment adjustments made 
     under subsection (a)(7)(A).''.

                  TITLE III--OTHER MEDICARE PROVISIONS

     SEC. 301. DELAY IN AUTHORITY TO TERMINATE CONTRACTS FOR 
                   MEDICARE ADVANTAGE PLANS FAILING TO ACHIEVE 
                   MINIMUM QUALITY RATINGS.

       (a) Findings.--Consistent with the studies provided under 
     the IMPACT Act of 2014 (Public Law 113-185), it is the intent 
     of Congress--
       (1) to continue to study and request input on the effects 
     of socioeconomic status and dual-eligible populations on the 
     Medicare Advantage STARS rating system before reforming such 
     system with the input of stakeholders; and
       (2) pending the results of such studies and input, to 
     provide for a temporary delay in authority of the Centers for 
     Medicare & Medicaid Services (CMS) to terminate Medicare 
     Advantage plan contracts solely on the basis of performance 
     of plans under the STARS rating system.
       (b) Delay in MA Contract Termination Authority for Plans 
     Failing To Achieve Minimum Quality Ratings.--Section 1857(h) 
     of the Social Security Act (42 U.S.C. 1395w-27(h)) is amended 
     by adding at the end the following new paragraph:
       ``(3) Delay in contract termination authority for plans 
     failing to achieve minimum quality rating.--During the period 
     beginning on the date of the enactment of this paragraph and 
     through the end of plan year 2018, the Secretary may not 
     terminate a contract under this section with respect to the 
     offering of an MA plan by a Medicare Advantage organization 
     solely because the MA plan has failed to achieve a minimum 
     quality rating under the 5-star rating system under section 
     1853(o)(4).''.

     SEC. 302. REQUIREMENT FOR ENROLLMENT DATA REPORTING FOR 
                   MEDICARE.

       Section 1874 of the Social Security Act (42 U.S.C. 1395kk) 
     is amended by adding at the end the following new subsection:
       ``(g) Requirement for Enrollment Data Reporting.--
       ``(1) In general.--Each year (beginning with 2016), the 
     Secretary shall submit to the Committees on Ways and Means 
     and Energy and Commerce of the House of Representatives and 
     the Committee on Finance of the Senate a report on Medicare 
     enrollment data (and, in the case of part A, on data on 
     individuals receiving benefits under such part) as of a date 
     in such year specified by the Secretary. Such data shall be 
     presented--
       ``(A) by Congressional district and State; and
       ``(B) in a manner that provides for such data based on--
       ``(i) fee-for-service enrollment (as defined in paragraph 
     (2));
       ``(ii) enrollment under part C (including separate for 
     aggregate enrollment in MA-PD plans and aggregate enrollment 
     in MA plans that are not MA-PD plans); and
       ``(iii) enrollment under part D.
       ``(2) Fee-for-service enrollment defined.--For purpose of 
     paragraph (1)(B)(i), the term `fee-for-service enrollment' 
     means aggregate enrollment (including receipt of benefits 
     other than through enrollment) under--
       ``(A) part A only;
       ``(B) part B only; and
       ``(C) both part A and part B.''.

     SEC. 303. UPDATING THE WELCOME TO MEDICARE PACKAGE.

       (a) In General.--Not later than 12 months after the last 
     day of the period for the request of information described in 
     subsection (b), the Secretary of Health and Human Services 
     shall, taking into consideration information collected 
     pursuant to subsection (b), update the information included 
     in the Welcome to Medicare package to include information, 
     presented in a clear and simple manner, about options for 
     receiving benefits under the Medicare program under title 
     XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), 
     including through the original medicare fee-for-service 
     program under parts A and B of such title (42 U.S.C. 1395c et 
     seq., 42 U.S.C. 1395j et seq.), Medicare Advantage plans 
     under part C of such title (42 U.S.C. 1395w-21 et seq.), and 
     prescription drug plans under part D of such title (42 U.S.C. 
     1395w-101 et seq.)). The Secretary shall make subsequent 
     updates to the information included in the Welcome to 
     Medicare package as appropriate.
       (b) Request for Information.--Not later than six months 
     after the date of the enactment of this Act, the Secretary of 
     Health and Human Services shall request information, 
     including recommendations, from stakeholders (including 
     patient advocates, issuers, and employers) on information 
     included in the Welcome to Medicare package, including 
     pertinent data and information regarding enrollment and 
     coverage for Medicare eligible individuals.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Ohio (Mr. Tiberi) and the gentleman from Washington (Mr. McDermott) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Ohio.


                             General Leave

  Mr. TIBERI. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days within which to revise and extend their remarks 
and include extraneous material on H.R. 5273.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Ohio?
  There was no objection.
  Mr. TIBERI. Mr. Speaker, I yield myself such time as I may consume.
  Today I rise in support of H.R. 5273, the Helping Hospitals Improve 
Patient Care Act, or ``HIP-C'' Act. This bill truly represents a 
bipartisan effort, and I want to thank the distinguished gentleman from 
Washington State (Mr. McDermott) for working with me on this bill. The 
bill also fully represents what the Speaker has often called true 
regular order.
  Prior to introducing H.R. 5273, the Ways and Means Committee held 
three hearings on topics included in the bill during the 114th 
Congress, and the committee recently marked up the bill in a unanimous 
way.
  H.R. 5273 strikes the right balance of preserving site-neutral 
payment policy, which I support, and providing essential relief for 
hospitals that were caught up in this policy change from last year's 
budget deal. Specifically, this bill helps many hospitals around the 
country and in my State of Ohio, including a facility by OhioHealth and 
Nationwide Children's Hospital that was started a year ago, last 
summer, and will benefit from full outpatient payments under the bill, 
as they had planned to when they dug the hole for their facility.
  Further, the James Cancer Hospital, part of my alma mater at Ohio 
State University, will have their cancer designation protected under 
the bill, along with other designated cancer centers.
  The bill also touches on three very important themes in the Medicare 
program: One, giving providers regulatory relief; two, ensuring access 
in rural areas; and three, protecting Medicare beneficiaries' access to 
that important service that people like my mom and dad count on.
  Under the topic of regulatory relief, we have included three Ways and 
Means member priorities:
  Representative Diane Black's bill that provides physicians who 
primarily practice medicine in ambulatory surgical centers relief in 
the electronic health records program; Representative Vern Buchanan's 
bill, ensuring full access to Medicare advantage plans; and finally, 
Representative Mike Kelly's bill requiring fair and transparent 
reporting by congressional district on the enrollment of beneficiaries 
in both the traditional fee-for-service Medicare and Medicare Advantage 
programs. All of these priorities have previously passed the House 
during the 114th Session.
  Under the topic of access in rural areas, the bill allows for 
continuation and expansion of participation in the Rural Community 
Hospital Demonstration Program. Championed by my colleagues, Senator 
Grassley in the Senate and Chairman Don Young in the House, this policy 
is a continuation from the Medicare Modernization Act of 2003.
  Under the topic of beneficiary access in Medicare, the bill requires 
the Secretary to revise the pre-Medicare eligibility notification, 
adding greater transparency for beneficiaries, which was led by my 
colleagues, Dr. McDermott and Representative Pat Meehan.
  Finally, the bill includes two important Member priorities that 
advance important Medicare hospital issues. The first requires the 
Secretary to ensure there is proper adjustment for socioeconomic 
factors. The gentleman from Ohio (Mr. Renacci) has championed this 
issue for some time. Representative Jim Renacci's policy ensures that 
the hospital readmissions program provides an apples-to-apples 
comparison based on the specific patient population a hospital treats.
  The second priority, led by our Speaker, Paul Ryan, is the 
establishment of a crosswalk of hospital codes.

[[Page 7906]]

Back when Speaker Ryan was the chairman of the Ways and Means 
Committee, he actively pursued Medicare hospital issues. His crosswalk 
is an important building block of a future system that promises to 
streamline the operation of hospital services.
  I encourage my colleagues to pass this legislation, send it to the 
Senate, and let's get this to the President's desk.
  Mr. Speaker, I reserve the balance of my time.
  Mr. McDERMOTT. Mr. Speaker, I yield myself such time as I may 
consume.
  I rise today in support of the Helping Hospitals Improve Patient Care 
Act. This bill makes important changes that will help hospitals 
continue to provide high-quality care to patients as they implement the 
recent payment reforms. This is bipartisan legislation unique in itself 
that I am happy to have introduced with the gentleman from Ohio (Mr. 
Tiberi).
  I thank the chairman for his willingness to collaborate on this bill. 
I also thank the staff of the Ways and Means Committee for their hard 
work in helping us come to an agreement on language that Members of 
both parties can fully support. This final bill isn't perfect, but it 
is truly a bipartisan product that reflects the spirit of compromise.
  Whenever we head back to our districts, we all hear from our 
hospitals about the effects that our policies are having back home. 
Although we made a smart change to hospital payments when we passed the 
Bipartisan Budget Act last year, we are beginning to recognize the 
unintended consequences of the legislation. We did not really expect 
everything that is happening.
  Many hospitals that were in the process of constructing outpatient 
departments will be hit with unexpected payment cuts due to the BBA. In 
addition, many cancer hospitals would be harmed by the new payment 
rules. This bill fixes these problems in a narrowly tailored way that 
doesn't undermine the goals of the BBA.
  Moving forward, hospitals will no longer be encouraged to consolidate 
by buying up physician practices for the purpose of billing Medicare at 
an inflated rate. This is a good policy that is consistent with the 
recommendations of a GAO report that was released last year. But 
facilities that were under development when we passed the BBA, as well 
as cancer hospitals, will be protected from these changes. This isn't a 
giveaway to hospitals. The industry will pay the full cost.
  In addition, this bill makes refinements to the readmissions 
reduction program. To ensure that hospitals that serve a large number 
of low-income patients are not unfairly penalized, the bill will 
require CMS to make apples-to-apples comparisons between similar 
facilities. As we await additional data that will soon be available 
thanks to the IMPACT Act, this will ensure that the hospitals are not 
hit with undeserved penalties due to a flawed methodology.
  Finally, I am happy that we are also able to come to an agreement on 
a bipartisan improvement to the beneficiary enrollment process. Each 
year, thousands of people enroll in Medicare; and thanks to this bill, 
seniors will have more information about their benefit options when 
they become eligible for Medicare. Providing complete and easy-to-
understand information is critical. The decisions that beneficiaries 
make when they enroll in Medicare have serious, long-term implications, 
including a potential lifetime penalty if they fail to sign up for part 
B. This bill will also help beneficiaries make informed decisions by 
improving the Welcome to Medicare package.
  I, again, thank my colleagues on both sides of the aisle for working 
together on this bill. I am pleased we were able to craft a bipartisan 
compromise, and I look forward to continuing to work together on these 
and other important issues in the weeks ahead.
  I reserve the balance of my time.
  Mr. TIBERI. Mr. Speaker, I yield 2 minutes to the gentleman from 
Alaska (Mr. Young).
  Mr. YOUNG of Alaska. Mr. Speaker, first I want to thank Chairman 
Tiberi for his kind work. We will miss the gentleman from Washington 
(Mr. McDermott), and I thank him for this bipartisan effort because 
this is a good bill and I strongly support it.
  This measure includes many important provisions as you have spoken 
about. But especially important to Alaska is section 103 language from 
legislation, H.R. 672, a 5-year extension of the Rural Community 
Hospital Demonstration Program. This demonstration program has worked 
well and has come to the aid of seniors in Alaska and healthcare 
providers across rural America.
  Congress created the program to provide increased Medicare 
reimbursements for hospitals across the Nation that are too large to be 
considered Critical Access Hospitals, but too small to be supported by 
traditional low Medicare margins on inpatient services.

                              {time}  1615

  This program has helped three hospitals in Alaska: Central Peninsula 
of Soldotna, the Bartlett Regional Hospital in Juneau, and Mt. 
Edgecumbe in Sitka. These hospitals serve a wide variety of patients 
all across those vast areas.
  I do believe this is one of the better bipartisan efforts. Go back to 
the old days when we accomplished things together by talking with one 
another. It is vital we pass this bipartisan legislation and that the 
Senate act on it. I would suggest, respectfully, to both my chairman 
and ranking member, let's talk to the Senate and see if we can't get 
something done. Four hundred bills over there is wrong. This is one 
that shouldn't be hung up.
  I urge all my colleagues to support the passage of this legislation.
  Mr. McDERMOTT. Mr. Speaker, I yield 3 minutes to the gentleman from 
Illinois (Mr. Danny K. Davis).
  Mr. DANNY K. DAVIS of Illinois. Mr. Speaker, I want to commend and 
congratulate Chairman Tiberi and Ranking Member McDermott for having 
put together an outstanding piece of legislation. While we applaud it 
for being bipartisan, I applaud it because it is good. It actually 
helps to meet needs that exist. It protects hospitals and gives them 
the opportunity to provide a better level of patient care.
  I attended, just last week, the opening of an outpatient center that 
St. Bernard Hospital in the Englewood community of Chicago had put 
together. Of course, everybody in the community was there because 
everybody recognized that inner-city hospitals, disproportionate share 
hospitals, and medical centers that are complex need all of the 
protection that they can get, and we need to have a better 
understanding of readmission policies and practices and why some are 
different than others.
  These gentlemen have put together a piece of legislation that all of 
us can be proud of. I strongly support it and thank them for their 
diligence, for their cooperation, and for their tremendous efforts to 
do a good bill.
  Mr. TIBERI. Mr. Speaker, I yield 3 minutes to the gentleman from 
northeastern Ohio (Mr. Renacci), a good friend, an important member of 
the Committee on Ways and Means, and a leader on the readmission policy 
dealing with hospitalization.
  Mr. RENACCI. Mr. Speaker, I rise in support of H.R. 5273, the Helping 
Hospitals Improve Patient Care Act of 2016. I want to thank Chairman 
Brady and my good friend and colleague, Subcommittee Chairman Tiberi, 
for all their great work to advance this bill, which addresses many 
concerns in payments to hospitals, and especially outpatient 
departments.
  I heard from many of the hospitals in northeast Ohio, including 
MetroHealth, about the impact this payment policy had on their new 
facility. I am happy we are able to correct these issues for those 
facilities already under construction.
  I also want to thank my colleague from Ohio for including my bill, 
H.R. 1343--the Establishing Beneficiary Equity in Hospital Readmission 
Program--in the underlying legislation. The Hospital Readmission 
Program

[[Page 7907]]

was created due to concerns that too few resources were being spent on 
reducing acute care hospital readmissions.
  While we do want to make sure hospitals are reducing acute care 
readmissions, we also want to make sure we are not disproportionately 
penalizing those who see a large number of our most vulnerable patient 
populations, especially those teaching hospitals who see a large number 
of dual-eligible beneficiaries, low-income seniors, or young people 
with disabilities who are eligible for both Medicare and Medicaid who 
would have been unintentionally hurt under the current program.
  Again, I want to thank the chairman for working with me on this 
readmission component of this bill, but also all of the other important 
provisions included in this legislation. These are commonsense, 
bipartisan reforms to improve our healthcare system.
  I urge all Members to support the Helping Hospitals Improve Patient 
Care Act of 2016.
  Mr. McDERMOTT. Mr. Speaker, I reserve the balance of my time.
  Mr. TIBERI. Mr. Speaker, I yield myself such time as I may consume to 
tell you a little bit about some of the hospital networks in my State 
of Ohio. Mr. Renacci talked about some in northeastern Ohio that 
support this legislation. Let me just name a few hospitals in my State 
of Ohio that are supportive of this legislation: Aultman, headquartered 
in his district in Canton; the Cleveland Clinic, Kettering Health 
Network in the Dayton area; Mercy Canton Sisters of Charity; 
MetroHealth System in Cleveland; OhioHealth, headquartered in Columbus; 
Ohio State University Wexner Medical Center in Columbus; the University 
of Cincinnati Health System in Cincinnati; and University Hospitals, 
headquartered in Cleveland. As was mentioned, this legislation passed 
the Committee on Ways and Means in a bipartisan manner.
  Mr. Speaker, I reserve the balance of my time.
  Mr. McDERMOTT. Mr. Speaker, occasionally we have an extra minute on 
the floor, and it makes sense to acknowledge some people that we trust 
and rely upon and we don't ever mention, so I would like to just say 
thank you to the Democratic staff: Sarah Levin, Melanie Egorin, Daniel 
Foster, JC Cannon, and Daniel Jackson; on the Republican side: Emily 
Murry, Lisa Grabert, Nick Uehlecke, Taylor Trott; to the staff at the 
CMS who helped put this bill together: Ira Burney, Anne Scott, Lisa 
Yen. And to the staff at legislative counsel: Ed Grossman--Ed has been 
there for as long as I have been here, so any bill that gets out of 
here without Ed looking at it is a pretty rare bill--and Jessica 
Shapiro is his assistant.
  The Congressional Budget Office gets in on these deals as well: Tom 
Bradley, Lori Housman, Kevin McNellis, and Jamease Kowalczyk. I am from 
Chicago. I should be able to pronounce a Polish name. We appreciate 
their hard work.
  Mr. Speaker, I yield back the balance of my time.
  Mr. TIBERI. Mr. Speaker, let me just close by saying thank you to Dr. 
McDermott. It has been enjoyable to work with his team, led by Amy, and 
we appreciate the bipartisanship. You mentioned all those names--stole 
my thunder--Emily and her team, and my staff, Whitney Koch Daffner and 
Abigail Finn, too, for yeoman's work.
  Mr. Speaker, I urge a unanimous vote.
  I yield back the balance of my time.
  Mr. BRADY of Texas. Mr. Speaker, I rise today in support of H.R. 
5273, the Helping Hospitals Improve Patient Care Act of 2016.
  First, I'd like to thank Chairman Tiberi and Ranking Member McDermott 
for their leadership on this important legislation.
  At the Ways and Means Committee, we are working to deliver health 
care solutions that will expand access, increase choices, and improve 
the quality of care for the American people.
  The Helping Hospitals Improve Patient Care Act helps advance all 
three of those goals. And the bill does so in a fiscally responsible 
manner that helps strengthen and preserve Medicare for the long-term.
  At its core, our bipartisan legislation is about supporting the 
delivery of high-quality, affordable care to families and seniors 
throughout the country. It will especially help people who live in low-
income and rural communities.
  Our bill includes straightforward solutions to help hospitals and 
health care providers transition to--and preserve--the new site-neutral 
payment policies. This will give providers the certainty they need to 
best serve their patients, now and into the future.
  This bill is an excellent illustration of what we can accomplish 
through regular order. It's the product of many innovative solutions, 
proposed by many members on both sides of the aisle.
  The solutions in this bill will make a real difference when it comes 
to the delivery of high-quality care for the people of our districts.
  In fact, the University of Texas' MD Anderson Cancer Center located 
in Houston has already embraced this bill. MD Anderson officials said, 
``This ensures our ability to continue providing the highest quality 
and level of cancer care to patients in the communities we serve.''
  And MD Anderson is just one of many hospitals and cancer treatment 
centers throughout the country that we help with H.R. 5273.
  This bill is particularly personal for me because it builds from the 
hospital discussion draft I released as Health Subcommittee Chairman 
back in November 2014.
  In the Helping Hospitals Improve Patient Care Act, we push forward 
two critical building blocks of that discussion draft.
  First, Speaker Ryan's crosswalk bill that better coordinates care 
between inpatient and outpatient settings.
  Second, Congressman Jim Renacci's readmission policy, which helps 
hospitals in low-income communities serve their patients.
  There are still many policies from our hospital discussion draft that 
are worthy of debate. We'll continue to work with Members and 
stakeholders to pursue additional reforms that make our health care 
system work better for patients and providers in our communities.
  I'm grateful to all the members--on and off our committee--who worked 
hard to craft and advance the Helping Hospitals Improve Patient Care 
Act.
  Mr. McDERMOTT. Mr. Speaker, I would like to acknowledge the staff who 
helped make the Helping Hospitals Improve Patient Care Act possible.
  First, I would like to thank the Democratic staff: Amy Hall, Sarah 
Levin, Melanie Egorin, Daniel Foster, JC Cannon, and Daniel Jackson. 
And on the Republican side: Emily Murry, Lisa Grabert, Nick Uehlecke, 
and Taylor Trott.
  I would also like to thank the staff at CMS: Ira Burney, Anne Scott, 
and Lisa Yen.
  And the staff at the House Office of Legislative Counsel: Ed 
Grossman--Ed has been there for as long as I have been here, so any 
bill that gets out of here without Ed looking at it is a pretty rare 
bill--and Jessica Shapiro, who was instrumental in drafting this 
legislation and for years has taken a leading role in drafting 
countless other Medicare bills in the House.
  Finally, I would like to thank the staff of the Congressional Budget 
Office who worked on this bill: Tom Bradley, Lori Housman, Kevin 
McNellis, and Jamease Kowalczyk.
  We appreciate their hard work.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Ohio (Mr. Tiberi) that the House suspend the rules and 
pass the bill, H.R. 5273, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________