[114th Congress Public Law 10]
[From the U.S. Government Publishing Office]



[[Page 129 STAT. 87]]

Public Law 114-10
114th Congress

                                 An Act


 
 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. <<NOTE: Apr. 16, 2015 -  [H.R. 2]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Medicare Access 
and CHIP Reauthorization Act of 2015. 42 USC 1305 note.>> 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare Access and 
CHIP Reauthorization Act of 2015''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.

     TITLE I--SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION

Sec. 101. Repealing the sustainable growth rate (SGR) and improving 
           Medicare payment for physicians' services.
Sec. 102. Priorities and funding for measure development.
Sec. 103. Encouraging care management for individuals with chronic care 
           needs.
Sec. 104. Empowering beneficiary choices through continued access to 
           information on physicians' services.
Sec. 105. Expanding availability of Medicare data.
Sec. 106. Reducing administrative burden and other provisions.

              TITLE II--MEDICARE AND OTHER HEALTH EXTENDERS

                     Subtitle A--Medicare Extenders

Sec. 201. Extension of work GPCI floor.
Sec. 202. Extension of therapy cap exceptions process.
Sec. 203. Extension of ambulance add-ons.
Sec. 204. Extension of increased inpatient hospital payment adjustment 
           for certain low-volume hospitals.
Sec. 205. Extension of the Medicare-dependent hospital (MDH) program.
Sec. 206. Extension for specialized Medicare Advantage plans for special 
           needs individuals.
Sec. 207. Extension of funding for quality measure endorsement, input, 
           and selection.
Sec. 208. Extension of funding outreach and assistance for low-income 
           programs.
Sec. 209. Extension and transition of reasonable cost reimbursement 
           contracts.
Sec. 210. Extension of home health rural add-on.

                   Subtitle B--Other Health Extenders

Sec. 211. Permanent extension of the qualifying individual (QI) program.
Sec. 212. Permanent extension of transitional medical assistance (TMA).
Sec. 213. Extension of special diabetes program for type I diabetes and 
           for Indians.
Sec. 214. Extension of abstinence education.
Sec. 215. Extension of personal responsibility education program (PREP).
Sec. 216. Extension of funding for family-to-family health information 
           centers.
Sec. 217. Extension of health workforce demonstration project for low-
           income individuals.

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Sec. 218. Extension of maternal, infant, and early childhood home 
           visiting programs.
Sec. 219. Tennessee DSH allotment for fiscal years 2015 through 2025.
Sec. 220. Delay in effective date for Medicaid amendments relating to 
           beneficiary liability settlements.
Sec. 221. Extension of funding for community health centers, the 
           National Health Service Corps, and teaching health centers.

                             TITLE III--CHIP

Sec. 301. 2-year extension of the Children's Health Insurance Program.
Sec. 302. Extension of express lane eligibility.
Sec. 303. Extension of outreach and enrollment program.
Sec. 304. Extension of certain programs and demonstration projects.
Sec. 305. Report of Inspector General of HHS on use of express lane 
           option under Medicaid and CHIP.

                            TITLE IV--OFFSETS

                Subtitle A--Medicare Beneficiary Reforms

Sec. 401. Limitation on certain medigap policies for newly eligible 
           Medicare beneficiaries.
Sec. 402. Income-related premium adjustment for parts B and D.

                        Subtitle B--Other Offsets

Sec. 411. Medicare payment updates for post-acute providers.
Sec. 412. Delay of reduction to Medicaid DSH allotments.
Sec. 413. Levy on delinquent providers.
Sec. 414. Adjustments to inpatient hospital payment rates.

                         TITLE V--MISCELLANEOUS

            Subtitle A--Protecting the Integrity of Medicare

Sec. 501. Prohibition of inclusion of Social Security account numbers on 
           Medicare cards.
Sec. 502. Preventing wrongful Medicare payments for items and services 
           furnished to incarcerated individuals, individuals not 
           lawfully present, and deceased individuals.
Sec. 503. Consideration of measures regarding Medicare beneficiary smart 
           cards.
Sec. 504. Modifying Medicare durable medical equipment face-to-face 
           encounter documentation requirement.
Sec. 505. Reducing improper Medicare payments.
Sec. 506. Improving senior Medicare patrol and fraud reporting rewards.
Sec. 507. Requiring valid prescriber National Provider Identifiers on 
           pharmacy claims.
Sec. 508. Option to receive Medicare Summary Notice electronically.
Sec. 509. Renewal of MAC contracts.
Sec. 510. Study on pathway for incentives to States for State 
           participation in medicaid data match program.
Sec. 511. Guidance on application of Common Rule to clinical data 
           registries.
Sec. 512. Eliminating certain civil money penalties; gainsharing study 
           and report.
Sec. 513. Modification of Medicare home health surety bond condition of 
           participation requirement.
Sec. 514. Oversight of Medicare coverage of manual manipulation of the 
           spine to correct subluxation.
Sec. 515. National expansion of prior authorization model for repetitive 
           scheduled non-emergent ambulance transport.
Sec. 516. Repealing duplicative Medicare secondary payor provision.
Sec. 517. Plan for expanding data in annual CERT report.
Sec. 518. Removing funds for Medicare Improvement Fund added by IMPACT 
           Act of 2014.
Sec. 519. Rule of construction.

                      Subtitle B--Other Provisions

Sec. 521. Extension of two-midnight PAMA rules on certain medical review 
           activities.
Sec. 522. Requiring bid surety bonds and State licensure for entities 
           submitting bids under the Medicare DMEPOS competitive 
           acquisition program.
Sec. 523. Payment for global surgical packages.
Sec. 524. Extension of Secure Rural Schools and Community Self-
           Determination Act of 2000.
Sec. 525. Exclusion from PAYGO scorecards.

[[Page 129 STAT. 89]]

     TITLE I--SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION

SEC. 101. REPEALING THE SUSTAINABLE GROWTH RATE (SGR) AND 
                        IMPROVING MEDICARE PAYMENT FOR PHYSICIANS' 
                        SERVICES.

    (a) Stabilizing Fee Updates.--
            (1) Repeal of sgr payment methodology.--Section 1848 of the 
        Social Security Act (42 U.S.C. 1395w-4) is amended--
                    (A) in subsection (d)--
                          (i) in paragraph (1)(A)--
                                    (I) by inserting ``and ending with 
                                2025'' after ``beginning with 2001''; 
                                and
                                    (II) by inserting ``or a subsequent 
                                paragraph'' after ``paragraph (4)''; and
                          (ii) in paragraph (4)--
                                    (I) in the heading, by inserting 
                                ``and ending with 2014'' after ``years 
                                beginning with 2001''; and
                                    (II) in subparagraph (A), by 
                                inserting ``and ending with 2014'' after 
                                ``a year beginning with 2001''; and
                    (B) in subsection (f)--
                          (i) in paragraph (1)(B), by inserting 
                      ``through 2014'' after ``of each succeeding 
                      year''; and
                          (ii) in paragraph (2), in the matter preceding 
                      subparagraph (A), by inserting ``and ending with 
                      2014'' after ``beginning with 2000''.
            (2) Update of rates for 2015 and subsequent years.--
        Subsection (d) of section 1848 of the Social Security Act (42 
        U.S.C. 1395w-4) is amended--
                    (A) <<NOTE: Effective date.>>  in paragraph (1)(A), 
                by adding at the end the following: ``There shall be two 
                separate conversion factors for each year beginning with 
                2026, one for items and services furnished by a 
                qualifying APM participant (as defined in section 
                1833(z)(2)) (referred to in this subsection as the 
                `qualifying APM conversion factor') and the other for 
                other items and services (referred to in this subsection 
                as the `nonqualifying APM conversion factor'), equal to 
                the respective conversion factor for the previous year 
                (or, in the case of 2026, equal to the single conversion 
                factor for 2025) multiplied by the update established 
                under paragraph (20) for such respective conversion 
                factor for such year.'';
                    (B) in paragraph (1)(D), by inserting ``(or, 
                beginning with 2026, applicable conversion factor)'' 
                after ``single conversion factor''; and
                    (C) by striking paragraph (16) and inserting the 
                following new paragraphs:
            ``(16) Update for january through june of 2015.--Subject to 
        paragraphs (7)(B), (8)(B), (9)(B), (10)(B), (11)(B), (12)(B), 
        (13)(B), (14)(B), and (15)(B), in lieu of the update to the 
        single conversion factor established in paragraph (1)(C) that 
        would otherwise apply for 2015 for the period beginning on 
        January 1, 2015, and ending on June 30, 2015, the update to the 
        single conversion factor shall be 0.0 percent.

[[Page 129 STAT. 90]]

            ``(17) Update for july through december of 2015.--The update 
        to the single conversion factor established in paragraph (1)(C) 
        for the period beginning on July 1, 2015, and ending on December 
        31, 2015, shall be 0.5 percent.
            ``(18) Update for 2016 through 2019.--The update to the 
        single conversion factor established in paragraph (1)(C) for 
        2016 and each subsequent year through 2019 shall be 0.5 percent.
            ``(19) Update for 2020 through 2025.--The update to the 
        single conversion factor established in paragraph (1)(C) for 
        2020 and each subsequent year through 2025 shall be 0.0 percent.
            ``(20) Update for 2026 and subsequent years.--For 2026 and 
        each subsequent year, the update to the qualifying APM 
        conversion factor established under paragraph (1)(A) is 0.75 
        percent, and the update to the nonqualifying APM conversion 
        factor established under such paragraph is 0.25 percent.''.
            (3) MedPAC reports.--
                    (A) Initial report.--Not later than July 1, 2017, 
                the Medicare Payment Advisory Commission shall submit to 
                Congress a report on the relationship between--
                          (i) physician and other health professional 
                      utilization and expenditures (and the rate of 
                      increase of such utilization and expenditures) of 
                      items and services for which payment is made under 
                      section 1848 of the Social Security Act (42 U.S.C. 
                      1395w-4); and
                          (ii) total utilization and expenditures (and 
                      the rate of increase of such utilization and 
                      expenditures) under parts A, B, and D of title 
                      XVIII of such Act.
                Such report shall include a methodology to describe such 
                relationship and the impact of changes in such physician 
                and other health professional practice and service 
                ordering patterns on total utilization and expenditures 
                under parts A, B, and D of such title.
                    (B) Final report.--Not later than July 1, 2021, the 
                Medicare Payment Advisory Commission shall submit to 
                Congress a report on the relationship described in 
                subparagraph (A), including the results determined from 
                applying the methodology included in the report 
                submitted under such subparagraph.
                    (C) Report on update to physicians' services under 
                medicare.--Not later than July 1, 2019, the Medicare 
                Payment Advisory Commission shall submit to Congress a 
                report on--
                          (i) the payment update for professional 
                      services applied under the Medicare program under 
                      title XVIII of the Social Security Act for the 
                      period of years 2015 through 2019;
                          (ii) the effect of such update on the 
                      efficiency, economy, and quality of care provided 
                      under such program;
                          (iii) the effect of such update on ensuring a 
                      sufficient number of providers to maintain access 
                      to care by Medicare beneficiaries; and
                          (iv) recommendations for any future payment 
                      updates for professional services under such 
                      program

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                      to ensure adequate access to care is maintained 
                      for Medicare beneficiaries.

    (b) Consolidation of Certain Current Law Performance Programs With 
New Merit-Based Incentive Payment System.--
            (1) EHR meaningful use incentive program.--
                    (A) Sunsetting separate meaningful use payment 
                adjustments.--Section 1848(a)(7)(A) of the Social 
                Security Act (42 U.S.C. 1395w-4(a)(7)(A)) is amended--
                          (i) in clause (i), by striking ``2015 or any 
                      subsequent payment year'' and inserting ``each of 
                      2015 through 2018'';
                          (ii) in clause (ii)(III), by striking ``each 
                      subsequent year'' and inserting ``2018''; and
                          (iii) in clause (iii)--
                                    (I) in the heading, by striking 
                                ``and subsequent years'';
                                    (II) by striking ``and each 
                                subsequent year''; and
                                    (III) by striking ``, but in no case 
                                shall the applicable percent be less 
                                than 95 percent''.
                    (B) Continuation of meaningful use determinations 
                for mips.--Section 1848(o)(2) of the Social Security Act 
                (42 U.S.C. 1395w-4(o)(2)) is amended--
                          (i) in subparagraph (A), in the matter 
                      preceding clause (i)--
                                    (I) by striking ``For purposes of 
                                paragraph (1), an'' and inserting 
                                ``An''; and
                                    (II) by inserting ``, or pursuant to 
                                subparagraph (D) for purposes of 
                                subsection (q), for a performance period 
                                under such subsection for a year'' after 
                                ``under such subsection for a year''; 
                                and
                          (ii) by adding at the end the following new 
                      subparagraph:
                    ``(D) Continued application for purposes of mips.--
                With respect to 2019 and each subsequent payment year, 
                the Secretary shall, for purposes of subsection (q) and 
                in accordance with paragraph (1)(F) of such subsection, 
                determine whether an eligible professional who is a MIPS 
                eligible professional (as defined in subsection 
                (q)(1)(C)) for such year is a meaningful EHR user under 
                this paragraph for the performance period under 
                subsection (q) for such year.''.
            (2) Quality reporting.--
                    (A) Sunsetting separate quality reporting 
                incentives.--Section 1848(a)(8)(A) of the Social 
                Security Act (42 U.S.C. 1395w-4(a)(8)(A)) is amended--
                          (i) in clause (i), by striking ``2015 or any 
                      subsequent year'' and inserting ``each of 2015 
                      through 2018''; and
                          (ii) in clause (ii)(II), by striking ``and 
                      each subsequent year'' and inserting ``, 2017, and 
                      2018''.
                    (B) Continuation of quality measures and processes 
                for mips.--Section 1848 of the Social Security Act (42 
                U.S.C. 1395w-4) is amended--
                          (i) in subsection (k), by adding at the end 
                      the following new paragraph:

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            ``(9) Continued application for purposes of mips and for 
        certain professionals volunteering to report.--The Secretary 
        shall, in accordance with subsection (q)(1)(F), carry out the 
        provisions of this subsection--
                    ``(A) for purposes of subsection (q); and
                    ``(B) for eligible professionals who are not MIPS 
                eligible professionals (as defined in subsection 
                (q)(1)(C)) for the year involved.''; and
                          (ii) in subsection (m)--
                                    (I) by redesignating paragraph (7) 
                                added by section 10327(a) of Public Law 
                                111-148 as paragraph (8); and
                                    (II) by adding at the end the 
                                following new paragraph:
            ``(9) Continued application for purposes of mips and for 
        certain professionals volunteering to report.--The Secretary 
        shall, in accordance with subsection (q)(1)(F), carry out the 
        processes under this subsection--
                    ``(A) for purposes of subsection (q); and
                    ``(B) for eligible professionals who are not MIPS 
                eligible professionals (as defined in subsection 
                (q)(1)(C)) for the year involved.''.
            (3) Value-based payments.--
                    (A) Sunsetting separate value-based payments.--
                Clause (iii) of section 1848(p)(4)(B) of the Social 
                Security Act (42 U.S.C. 1395w-4(p)(4)(B)) is amended to 
                read as follows:
                          ``(iii) Application.--The Secretary shall 
                      apply the payment modifier established under this 
                      subsection for items and services furnished on or 
                      after January 1, 2015, with respect to specific 
                      physicians and groups of physicians the Secretary 
                      determines appropriate, and for services furnished 
                      on or after January 1, 2017, with respect to all 
                      physicians and groups of physicians. Such payment 
                      modifier shall not be applied for items and 
                      services furnished on or after January 1, 2019.''.
                    (B) Continuation of value-based payment modifier 
                measures for mips.--Section 1848(p) of the Social 
                Security Act (42 U.S.C. 1395w-4(p)) is amended--
                          (i) in paragraph (2), by adding at the end the 
                      following new subparagraph:
                    ``(C) Continued application for purposes of mips.--
                The Secretary shall, in accordance with subsection 
                (q)(1)(F), carry out subparagraph (B) for purposes of 
                subsection (q).''; and
                          (ii) in paragraph (3), by adding at the end 
                      the following: ``With respect to 2019 and each 
                      subsequent year, the Secretary shall, in 
                      accordance with subsection (q)(1)(F), carry out 
                      this paragraph for purposes of subsection (q).''.

    (c) Merit-Based Incentive Payment System.--
            (1) In general.--Section 1848 of the Social Security Act (42 
        U.S.C. 1395w-4) is amended by adding at the end the following 
        new subsection:

    ``(q) Merit-Based Incentive Payment System.--
            ``(1) Establishment.--

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                    ``(A) In general.--Subject to the succeeding 
                provisions of this subsection, the Secretary shall 
                establish an eligible professional Merit-based Incentive 
                Payment System (in this subsection referred to as the 
                `MIPS') under which the Secretary shall--
                          ``(i) develop a methodology for assessing the 
                      total performance of each MIPS eligible 
                      professional according to performance standards 
                      under paragraph (3) for a performance period (as 
                      established under paragraph (4)) for a year;
                          ``(ii) using such methodology, provide for a 
                      composite performance score in accordance with 
                      paragraph (5) for each such professional for each 
                      performance period; and
                          ``(iii) use such composite performance score 
                      of the MIPS eligible professional for a 
                      performance period for a year to determine and 
                      apply a MIPS adjustment factor (and, as 
                      applicable, an additional MIPS adjustment factor) 
                      under paragraph (6) to the professional for the 
                      year.
                Notwithstanding subparagraph (C)(ii), under the MIPS, 
                the Secretary shall permit any eligible professional (as 
                defined in subsection (k)(3)(B)) to report on applicable 
                measures and activities described in paragraph (2)(B).
                    ``(B) <<NOTE: Applicability. Effective date.>>  
                Program implementation.--The MIPS shall apply to 
                payments for items and services furnished on or after 
                January 1, 2019.
                    ``(C) MIPS eligible professional defined.--
                          ``(i) In general.--For purposes of this 
                      subsection, subject to clauses (ii) and (iv), the 
                      term `MIPS eligible professional' means--
                                    ``(I) for the first and second years 
                                for which the MIPS applies to payments 
                                (and for the performance period for such 
                                first and second year), a physician (as 
                                defined in section 1861(r)), a physician 
                                assistant, nurse practitioner, and 
                                clinical nurse specialist (as such terms 
                                are defined in section 1861(aa)(5)), a 
                                certified registered nurse anesthetist 
                                (as defined in section 1861(bb)(2)), and 
                                a group that includes such 
                                professionals; and
                                    ``(II) for the third year for which 
                                the MIPS applies to payments (and for 
                                the performance period for such third 
                                year) and for each succeeding year (and 
                                for the performance period for each such 
                                year), the professionals described in 
                                subclause (I), such other eligible 
                                professionals (as defined in subsection 
                                (k)(3)(B)) as specified by the 
                                Secretary, and a group that includes 
                                such professionals.
                          ``(ii) Exclusions.--For purposes of clause 
                      (i), the term `MIPS eligible professional' does 
                      not include, with respect to a year, an eligible 
                      professional (as defined in subsection (k)(3)(B)) 
                      who--
                                    ``(I) is a qualifying APM 
                                participant (as defined in section 
                                1833(z)(2));
                                    ``(II) subject to clause (vii), is a 
                                partial qualifying APM participant (as 
                                defined in clause (iii))

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                                for the most recent period for which 
                                data are available and who, for the 
                                performance period with respect to such 
                                year, does not report on applicable 
                                measures and activities described in 
                                paragraph (2)(B) that are required to be 
                                reported by such a professional under 
                                the MIPS; or
                                    ``(III) for the performance period 
                                with respect to such year, does not 
                                exceed the low-volume threshold 
                                measurement selected under clause (iv).
                          ``(iii) <<NOTE: Definition.>>  Partial 
                      qualifying apm participant.--For purposes of this 
                      subparagraph, the term `partial qualifying APM 
                      participant' means, with respect to a year, an 
                      eligible professional for whom the Secretary 
                      determines the minimum payment percentage (or 
                      percentages), as applicable, described in 
                      paragraph (2) of section 1833(z) for such year 
                      have not been satisfied, but who would be 
                      considered a qualifying APM participant (as 
                      defined in such paragraph) for such year if--
                                    ``(I) with respect to 2019 and 2020, 
                                the reference in subparagraph (A) of 
                                such paragraph to 25 percent was instead 
                                a reference to 20 percent;
                                    ``(II) with respect to 2021 and 
                                2022--
                                            ``(aa) the reference in 
                                        subparagraph (B)(i) of such 
                                        paragraph to 50 percent was 
                                        instead a reference to 40 
                                        percent; and
                                            ``(bb) the references in 
                                        subparagraph (B)(ii) of such 
                                        paragraph to 50 percent and 25 
                                        percent of such paragraph were 
                                        instead references to 40 percent 
                                        and 20 percent, respectively; 
                                        and
                                    ``(III) with respect to 2023 and 
                                subsequent years--
                                            ``(aa) the reference in 
                                        subparagraph (C)(i) of such 
                                        paragraph to 75 percent was 
                                        instead a reference to 50 
                                        percent; and
                                            ``(bb) the references in 
                                        subparagraph (C)(ii) of such 
                                        paragraph to 75 percent and 25 
                                        percent of such paragraph were 
                                        instead references to 50 percent 
                                        and 20 percent, respectively.
                          ``(iv) Selection of low-volume threshold 
                      measurement.--The Secretary shall select a low-
                      volume threshold to apply for purposes of clause 
                      (ii)(III), which may include one or more or a 
                      combination of the following:
                                    ``(I) The minimum number (as 
                                determined by the Secretary) of 
                                individuals enrolled under this part who 
                                are treated by the eligible professional 
                                for the performance period involved.
                                    ``(II) The minimum number (as 
                                determined by the Secretary) of items 
                                and services furnished to individuals 
                                enrolled under this part by such 
                                professional for such performance 
                                period.
                                    ``(III) The minimum amount (as 
                                determined by the Secretary) of allowed 
                                charges billed by such

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                                professional under this part for such 
                                performance period.
                          ``(v) Treatment of new medicare enrolled 
                      eligible professionals.--In the case of a 
                      professional who first becomes a Medicare enrolled 
                      eligible professional during the performance 
                      period for a year (and had not previously 
                      submitted claims under this title such as a 
                      person, an entity, or a part of a physician group 
                      or under a different billing number or tax 
                      identifier), such professional shall not be 
                      treated under this subsection as a MIPS eligible 
                      professional until the subsequent year and 
                      performance period for such subsequent year.
                          ``(vi) Clarification.--In the case of items 
                      and services furnished during a year by an 
                      individual who is not a MIPS eligible professional 
                      (including pursuant to clauses (ii) and (v)) with 
                      respect to a year, in no case shall a MIPS 
                      adjustment factor (or additional MIPS adjustment 
                      factor) under paragraph (6) apply to such 
                      individual for such year.
                          ``(vii) Partial qualifying apm participant 
                      clarifications.--
                                    ``(I) Treatment as mips eligible 
                                professional.--In the case of an 
                                eligible professional who is a partial 
                                qualifying APM participant, with respect 
                                to a year, and who, for the performance 
                                period for such year, reports on 
                                applicable measures and activities 
                                described in paragraph (2)(B) that are 
                                required to be reported by such a 
                                professional under the MIPS, such 
                                eligible professional is considered to 
                                be a MIPS eligible professional with 
                                respect to such year.
                                    ``(II) Not eligible for qualifying 
                                apm participant payments.--In no case 
                                shall an eligible professional who is a 
                                partial qualifying APM participant, with 
                                respect to a year, be considered a 
                                qualifying APM participant (as defined 
                                in paragraph (2) of section 1833(z)) for 
                                such year or be eligible for the 
                                additional payment under paragraph (1) 
                                of such section for such year.
                    ``(D) Application to group practices.--
                          ``(i) In general.--Under the MIPS:
                                    ``(I) Quality performance 
                                category.--The Secretary shall establish 
                                and apply a process that includes 
                                features of the provisions of subsection 
                                (m)(3)(C) for MIPS eligible 
                                professionals in a group practice with 
                                respect to assessing performance of such 
                                group with respect to the performance 
                                category described in clause (i) of 
                                paragraph (2)(A).
                                    ``(II) Other performance 
                                categories.--The Secretary may establish 
                                and apply a process that includes 
                                features of the provisions of subsection 
                                (m)(3)(C) for MIPS eligible 
                                professionals in a group practice with 
                                respect to assessing the performance of 
                                such group with respect to the 
                                performance categories described in 
                                clauses (ii) through (iv) of such 
                                paragraph.

[[Page 129 STAT. 96]]

                          ``(ii) Ensuring comprehensiveness of group 
                      practice assessment.--The process established 
                      under clause (i) shall to the extent practicable 
                      reflect the range of items and services furnished 
                      by the MIPS eligible professionals in the group 
                      practice involved.
                    ``(E) Use of registries.--Under the MIPS, the 
                Secretary shall encourage the use of qualified clinical 
                data registries pursuant to subsection (m)(3)(E) in 
                carrying out this subsection.
                    ``(F) Application of certain provisions.--In 
                applying a provision of subsection (k), (m), (o), or (p) 
                for purposes of this subsection, the Secretary shall--
                          ``(i) adjust the application of such provision 
                      to ensure the provision is consistent with the 
                      provisions of this subsection; and
                          ``(ii) not apply such provision to the extent 
                      that the provision is duplicative with a provision 
                      of this subsection.
                    ``(G) Accounting for risk factors.--
                          ``(i) Risk factors.--Taking into account the 
                      relevant studies conducted and recommendations 
                      made in reports under section 2(d) of the 
                      Improving Medicare Post-Acute Care Transformation 
                      Act of 2014, and, as appropriate, other 
                      information, including information collected 
                      before completion of such studies and 
                      recommendations, the Secretary, on an ongoing 
                      basis, shall, as the Secretary determines 
                      appropriate and based on an individual's health 
                      status and other risk factors--
                                    ``(I) assess appropriate adjustments 
                                to quality measures, resource use 
                                measures, and other measures used under 
                                the MIPS; and
                                    ``(II) assess and implement 
                                appropriate adjustments to payment 
                                adjustments, composite performance 
                                scores, scores for performance 
                                categories, or scores for measures or 
                                activities under the MIPS.
            ``(2) Measures and activities under performance 
        categories.--
                    ``(A) Performance categories.--Under the MIPS, the 
                Secretary shall use the following performance categories 
                (each of which is referred to in this subsection as a 
                performance category) in determining the composite 
                performance score under paragraph (5):
                          ``(i) Quality.
                          ``(ii) Resource use.
                          ``(iii) Clinical practice improvement 
                      activities.
                          ``(iv) Meaningful use of certified EHR 
                      technology.
                    ``(B) Measures and activities specified for each 
                category.--For purposes of paragraph (3)(A) and subject 
                to subparagraph (C), measures and activities specified 
                for a performance period (as established under paragraph 
                (4)) for a year are as follows:
                          ``(i) Quality.--For the performance category 
                      described in subparagraph (A)(i), the quality 
                      measures included in the final measures list 
                      published under subparagraph (D)(i) for such year 
                      and the list of quality measures described in 
                      subparagraph (D)(vi) used by

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                      qualified clinical data registries under 
                      subsection (m)(3)(E).
                          ``(ii) Resource use.--For the performance 
                      category described in subparagraph (A)(ii), the 
                      measurement of resource use for such period under 
                      subsection (p)(3), using the methodology under 
                      subsection (r) as appropriate, and, as feasible 
                      and applicable, accounting for the cost of drugs 
                      under part D.
                          ``(iii) Clinical practice improvement 
                      activities.--For the performance category 
                      described in subparagraph (A)(iii), clinical 
                      practice improvement activities (as defined in 
                      subparagraph (C)(v)(III)) under subcategories 
                      specified by the Secretary for such period, which 
                      shall include at least the following:
                                    ``(I) The subcategory of expanded 
                                practice access, such as same day 
                                appointments for urgent needs and after 
                                hours access to clinician advice.
                                    ``(II) The subcategory of population 
                                management, such as monitoring health 
                                conditions of individuals to provide 
                                timely health care interventions or 
                                participation in a qualified clinical 
                                data registry.
                                    ``(III) The subcategory of care 
                                coordination, such as timely 
                                communication of test results, timely 
                                exchange of clinical information to 
                                patients and other providers, and use of 
                                remote monitoring or telehealth.
                                    ``(IV) The subcategory of 
                                beneficiary engagement, such as the 
                                establishment of care plans for 
                                individuals with complex care needs, 
                                beneficiary self-management assessment 
                                and training, and using shared decision-
                                making mechanisms.
                                    ``(V) The subcategory of patient 
                                safety and practice assessment, such as 
                                through use of clinical or surgical 
                                checklists and practice assessments 
                                related to maintaining certification.
                                    ``(VI) The subcategory of 
                                participation in an alternative payment 
                                model (as defined in section 
                                1833(z)(3)(C)).
                      In establishing activities under this clause, the 
                      Secretary shall give consideration to the 
                      circumstances of small practices (consisting of 15 
                      or fewer professionals) and practices located in 
                      rural areas and in health professional shortage 
                      areas (as designated under section 332(a)(1)(A) of 
                      the Public Health Service Act).
                          ``(iv) Meaningful ehr use.--For the 
                      performance category described in subparagraph 
                      (A)(iv), the requirements established for such 
                      period under subsection (o)(2) for determining 
                      whether an eligible professional is a meaningful 
                      EHR user.
                    ``(C) Additional provisions.--
                          ``(i) Emphasizing outcome measures under the 
                      quality performance category.--
                      In <<NOTE: Applicability.>>  applying subparagraph 
                      (B)(i), the Secretary shall, as feasible, 
                      emphasize the application of outcome measures.

[[Page 129 STAT. 98]]

                          ``(ii) Application of additional system 
                      measures.--The Secretary may use measures used for 
                      a payment system other than for physicians, such 
                      as measures for inpatient hospitals, for purposes 
                      of the performance categories described in clauses 
                      (i) and (ii) of subparagraph (A). For purposes of 
                      the previous sentence, the Secretary may not use 
                      measures for hospital outpatient departments, 
                      except in the case of items and services furnished 
                      by emergency physicians, radiologists, and 
                      anesthesiologists.
                          ``(iii) Global and population-based 
                      measures.--The Secretary may use global measures, 
                      such as global outcome measures, and population-
                      based measures for purposes of the performance 
                      category described in subparagraph (A)(i).
                          ``(iv) Application of measures and activities 
                      to non-patient-facing professionals.--In carrying 
                      out this paragraph, with respect to measures and 
                      activities specified in subparagraph (B) for 
                      performance categories described in subparagraph 
                      (A), the Secretary--
                                    ``(I) shall give consideration to 
                                the circumstances of professional types 
                                (or subcategories of those types 
                                determined by practice characteristics) 
                                who typically furnish services that do 
                                not involve face-to-face interaction 
                                with a patient; and
                                    ``(II) may, to the extent feasible 
                                and appropriate, take into account such 
                                circumstances and apply under this 
                                subsection with respect to MIPS eligible 
                                professionals of such professional types 
                                or subcategories, alternative measures 
                                or activities that fulfill the goals of 
                                the applicable performance category.
                      In <<NOTE: Consultation.>>  carrying out the 
                      previous sentence, the Secretary shall consult 
                      with professionals of such professional types or 
                      subcategories.
                          ``(v) Clinical practice improvement 
                      activities.--
                                    ``(I) Request for information.--In 
                                initially applying subparagraph 
                                (B)(iii), the Secretary shall use a 
                                request for information to solicit 
                                recommendations from stakeholders to 
                                identify activities described in such 
                                subparagraph and specifying criteria for 
                                such activities.
                                    ``(II) Contract authority for 
                                clinical practice improvement activities 
                                performance category.--
                                In <<NOTE: Applicability.>> applying 
                                subparagraph (B)(iii), the Secretary may 
                                contract with entities to assist the 
                                Secretary in--
                                            ``(aa) identifying 
                                        activities described in 
                                        subparagraph (B)(iii);
                                            ``(bb) specifying criteria 
                                        for such activities; and
                                            ``(cc) determining whether a 
                                        MIPS eligible professional meets 
                                        such criteria.
                                    ``(III) Clinical practice 
                                improvement activities defined.--For 
                                purposes of this subsection, the term 
                                `clinical practice improvement activity'

[[Page 129 STAT. 99]]

                                means an activity that relevant eligible 
                                professional organizations and other 
                                relevant stakeholders identify as 
                                improving clinical practice or care 
                                delivery and that the Secretary 
                                determines, when effectively executed, 
                                is likely to result in improved 
                                outcomes.
                    ``(D) Annual list of quality measures available for 
                mips assessment.--
                          
                      ``(i) <<NOTE: Notice. Regulations. Deadlines.>>  
                      In general.--Under the MIPS, the Secretary, 
                      through notice and comment rulemaking and subject 
                      to the succeeding clauses of this subparagraph, 
                      shall, with respect to the performance period for 
                      a year, establish an annual final list of quality 
                      measures from which MIPS eligible professionals 
                      may choose for purposes of assessment under this 
                      subsection for such performance period. Pursuant 
                      to the previous sentence, the Secretary shall--
                                    ``(I) not later than November 1 of 
                                the year prior to the first day of the 
                                first performance period under the MIPS, 
                                establish and publish in the Federal 
                                Register a final list of quality 
                                measures; and
                                    ``(II) not later than November 1 of 
                                the year prior to the first day of each 
                                subsequent performance period, update 
                                the final list of quality measures from 
                                the previous year (and publish such 
                                updated final list in the Federal 
                                Register), by--
                                            ``(aa) removing from such 
                                        list, as appropriate, quality 
                                        measures, which may include the 
                                        removal of measures that are no 
                                        longer meaningful (such as 
                                        measures that are topped out);
                                            ``(bb) adding to such list, 
                                        as appropriate, new quality 
                                        measures; and
                                            ``(cc) determining whether 
                                        or not quality measures on such 
                                        list that have undergone 
                                        substantive changes should be 
                                        included in the updated list.
                          ``(ii) Call for quality measures.--
                                    ``(I) In general.--Eligible 
                                professional organizations and other 
                                relevant stakeholders shall be requested 
                                to identify and submit quality measures 
                                to be considered for selection under 
                                this subparagraph in the annual list of 
                                quality measures published under clause 
                                (i) and to identify and submit updates 
                                to the measures on such list. For 
                                purposes of the previous sentence, 
                                measures may be submitted regardless of 
                                whether such measures were previously 
                                published in a proposed rule or endorsed 
                                by an entity with a contract under 
                                section 1890(a).
                                    ``(II) Eligible professional 
                                organization defined.--In this 
                                subparagraph, the term `eligible 
                                professional organization' means a 
                                professional organization as defined by 
                                nationally recognized specialty boards 
                                of certification or equivalent 
                                certification boards.

[[Page 129 STAT. 100]]

                          ``(iii) Requirements.--In selecting quality 
                      measures for inclusion in the annual final list 
                      under clause (i), the Secretary shall--
                                    ``(I) provide that, to the extent 
                                practicable, all quality domains (as 
                                defined in subsection (s)(1)(B)) are 
                                addressed by such measures; and
                                    ``(II) ensure that such selection is 
                                consistent with the process for 
                                selection of measures under subsections 
                                (k), (m), and (p)(2).
                          ``(iv) <<NOTE: Publication.>>  Peer review.--
                      Before including a new measure in the final list 
                      of measures published under clause (i) for a year, 
                      the Secretary shall submit for publication in 
                      applicable specialty-appropriate, peer-reviewed 
                      journals such measure and the method for 
                      developing and selecting such measure, including 
                      clinical and other data supporting such measure.
                          ``(v) Measures for inclusion.--The final list 
                      of quality measures published under clause (i) 
                      shall include, as applicable, measures under 
                      subsections (k), (m), and (p)(2), including 
                      quality measures from among--
                                    ``(I) measures endorsed by a 
                                consensus-based entity;
                                    ``(II) measures developed under 
                                subsection (s); and
                                    ``(III) measures submitted under 
                                clause (ii)(I).
                      Any measure selected for inclusion in such list 
                      that is not endorsed by a consensus-based entity 
                      shall have a focus that is evidence-based.
                          ``(vi) Exception for qualified clinical data 
                      registry measures.--Measures used by a qualified 
                      clinical data registry under subsection (m)(3)(E) 
                      shall not be subject to the requirements under 
                      clauses (i), (iv), and (v). <<NOTE: Web 
                      posting.>>  The Secretary shall publish the list 
                      of measures used by such qualified clinical data 
                      registries on the Internet website of the Centers 
                      for Medicare & Medicaid Services.
                          ``(vii) Exception for existing quality 
                      measures.--Any quality measure specified by the 
                      Secretary under subsection (k) or (m), including 
                      under subsection (m)(3)(E), and any measure of 
                      quality of care established under subsection 
                      (p)(2) for the reporting period or performance 
                      period under the respective subsection beginning 
                      before the first performance period under the 
                      MIPS--
                                    ``(I) shall not be subject to the 
                                requirements under clause (i) (except 
                                under items (aa) and (cc) of subclause 
                                (II) of such clause) or to the 
                                requirement under clause (iv); and
                                    ``(II) shall be included in the 
                                final list of quality measures published 
                                under clause (i) unless removed under 
                                clause (i)(II)(aa).
                          ``(viii) Consultation with relevant eligible 
                      professional organizations and other relevant 
                      stakeholders.--Relevant eligible professional 
                      organizations and other relevant stakeholders,

[[Page 129 STAT. 101]]

                      including State and national medical societies, 
                      shall be consulted in carrying out this 
                      subparagraph.
                          ``(ix) Optional application.--The process 
                      under section 1890A is not required to apply to 
                      the selection of measures under this subparagraph.
            ``(3) Performance standards.--
                    ``(A) Establishment.--Under the MIPS, the Secretary 
                shall establish performance standards with respect to 
                measures and activities specified under paragraph (2)(B) 
                for a performance period (as established under paragraph 
                (4)) for a year.
                    ``(B) Considerations in establishing standards.--In 
                establishing such performance standards with respect to 
                measures and activities specified under paragraph 
                (2)(B), the Secretary shall consider the following:
                          ``(i) Historical performance standards.
                          ``(ii) Improvement.
                          ``(iii) The opportunity for continued 
                      improvement.
            ``(4) Performance period.--The Secretary shall establish a 
        performance period (or periods) for a year (beginning with 
        2019). Such performance period (or periods) shall begin and end 
        prior to the beginning of such year and be as close as possible 
        to such year. In this subsection, such performance period (or 
        periods) for a year shall be referred to as the performance 
        period for the year.
            ``(5) Composite performance score.--
                    ``(A) In general.--Subject to the succeeding 
                provisions of this paragraph and taking into account, as 
                available and applicable, paragraph (1)(G), the 
                Secretary shall develop a methodology for assessing the 
                total performance of each MIPS eligible professional 
                according to performance standards under paragraph (3) 
                with respect to applicable measures and activities 
                specified in paragraph (2)(B) with respect to each 
                performance category applicable to such professional for 
                a performance period (as established under paragraph 
                (4)) for a year. Using such methodology, the Secretary 
                shall provide for a composite assessment (using a 
                scoring scale of 0 to 100) for each such professional 
                for the performance period for such year. In this 
                subsection such a composite assessment for such a 
                professional with respect to a performance period shall 
                be referred to as the `composite performance score' for 
                such professional for such performance period.
                    ``(B) Incentive to report; encouraging use of 
                certified ehr technology for reporting quality 
                measures.--
                          ``(i) Incentive to report.--Under the 
                      methodology established under subparagraph (A), 
                      the Secretary shall provide that in the case of a 
                      MIPS eligible professional who fails to report on 
                      an applicable measure or activity that is required 
                      to be reported by the professional, the 
                      professional shall be treated as achieving the 
                      lowest potential score applicable to such measure 
                      or activity.
                          ``(ii) Encouraging use of certified ehr 
                      technology and qualified clinical data registries 
                      for

[[Page 129 STAT. 102]]

                      reporting quality measures.--Under the methodology 
                      established under subparagraph (A), the Secretary 
                      shall--
                                    ``(I) encourage MIPS eligible 
                                professionals to report on applicable 
                                measures with respect to the performance 
                                category described in paragraph 
                                (2)(A)(i) through the use of certified 
                                EHR technology and qualified clinical 
                                data registries; and
                                    ``(II) with respect to a performance 
                                period, with respect to a year, for 
                                which a MIPS eligible professional 
                                reports such measures through the use of 
                                such EHR technology, treat such 
                                professional as satisfying the clinical 
                                quality measures reporting requirement 
                                described in subsection (o)(2)(A)(iii) 
                                for such year.
                    ``(C) Clinical practice improvement activities 
                performance score.--
                          ``(i) Rule for certification.--A MIPS eligible 
                      professional who is in a practice that is 
                      certified as a patient-centered medical home or 
                      comparable specialty practice, as determined by 
                      the Secretary, with respect to a performance 
                      period shall be given the highest potential score 
                      for the performance category described in 
                      paragraph (2)(A)(iii) for such period.
                          ``(ii) APM participation.--Participation by a 
                      MIPS eligible professional in an alternative 
                      payment model (as defined in section 
                      1833(z)(3)(C)) with respect to a performance 
                      period shall earn such eligible professional a 
                      minimum score of one-half of the highest potential 
                      score for the performance category described in 
                      paragraph (2)(A)(iii) for such performance period.
                          ``(iii) Subcategories.--A MIPS eligible 
                      professional shall not be required to perform 
                      activities in each subcategory under paragraph 
                      (2)(B)(iii) or participate in an alternative 
                      payment model in order to achieve the highest 
                      potential score for the performance category 
                      described in paragraph (2)(A)(iii).
                    ``(D) Achievement and improvement.--
                          ``(i) Taking into account improvement.--
                      Beginning with the second year to which the MIPS 
                      applies, in addition to the achievement of a MIPS 
                      eligible professional, if data sufficient to 
                      measure improvement is available, the methodology 
                      developed under subparagraph (A)--
                                    ``(I) in the case of the performance 
                                score for the performance category 
                                described in clauses (i) and (ii) of 
                                paragraph (2)(A), shall take into 
                                account the improvement of the 
                                professional; and
                                    ``(II) in the case of performance 
                                scores for other performance categories, 
                                may take into account the improvement of 
                                the professional.
                          ``(ii) Assigning higher weight for 
                      achievement.--Subject to clause (i), under the 
                      methodology developed under subparagraph (A), the 
                      Secretary may assign a higher scoring weight under 
                      subparagraph (F) with respect to the achievement 
                      of a MIPS eligible professional than with respect 
                      to any improvement

[[Page 129 STAT. 103]]

                      of such professional applied under clause (i) with 
                      respect to a measure, activity, or category 
                      described in paragraph (2).
                    ``(E) Weights for the performance categories.--
                          ``(i) In general.--Under the methodology 
                      developed under subparagraph (A), subject to 
                      subparagraph (F)(i) and clause (ii), the composite 
                      performance score shall be determined as follows:
                                    ``(I) Quality.--
                                            ``(aa) In general.--Subject 
                                        to item (bb), thirty percent of 
                                        such score shall be based on 
                                        performance with respect to the 
                                        category described in clause (i) 
                                        of paragraph (2)(A). In applying 
                                        the previous sentence, the 
                                        Secretary shall, as feasible, 
                                        encourage the application of 
                                        outcome measures within such 
                                        category.
                                            ``(bb) First 2 years.--For 
                                        the first and second years for 
                                        which the MIPS applies to 
                                        payments, the percentage 
                                        applicable under item (aa) shall 
                                        be increased in a manner such 
                                        that the total percentage points 
                                        of the increase under this item 
                                        for the respective year equals 
                                        the total number of percentage 
                                        points by which the percentage 
                                        applied under subclause (II)(bb) 
                                        for the respective year is less 
                                        than 30 percent.
                                    ``(II) Resource use.--
                                            ``(aa) In general.--Subject 
                                        to item (bb), thirty percent of 
                                        such score shall be based on 
                                        performance with respect to the 
                                        category described in clause 
                                        (ii) of paragraph (2)(A).
                                            ``(bb) First 2 years.--For 
                                        the first year for which the 
                                        MIPS applies to payments, not 
                                        more than 10 percent of such 
                                        score shall be based on 
                                        performance with respect to the 
                                        category described in clause 
                                        (ii) of paragraph (2)(A). For 
                                        the second year for which the 
                                        MIPS applies to payments, not 
                                        more than 15 percent of such 
                                        score shall be based on 
                                        performance with respect to the 
                                        category described in clause 
                                        (ii) of paragraph (2)(A).
                                    ``(III) Clinical practice 
                                improvement activities.--Fifteen percent 
                                of such score shall be based on 
                                performance with respect to the category 
                                described in clause (iii) of paragraph 
                                (2)(A).
                                    ``(IV) Meaningful use of certified 
                                ehr technology.--Twenty-five percent of 
                                such score shall be based on performance 
                                with respect to the category described 
                                in clause (iv) of paragraph (2)(A).
                          ``(ii) Authority to adjust percentages in case 
                      of high ehr meaningful use adoption.--In any year 
                      in which the Secretary estimates that the 
                      proportion of eligible professionals (as defined 
                      in subsection (o)(5)) who are meaningful EHR users 
                      (as determined under subsection (o)(2)) is 75 
                      percent or greater, the Secretary may reduce the 
                      percent applicable under clause (i)(IV),

[[Page 129 STAT. 104]]

                      but not below 15 percent. If the Secretary makes 
                      such reduction for a year, subject to subclauses 
                      (I)(bb) and (II)(bb) of clause (i), the 
                      percentages applicable under one or more of 
                      subclauses (I), (II), and (III) of clause (i) for 
                      such year shall be increased in a manner such that 
                      the total percentage points of the increase under 
                      this clause for such year equals the total number 
                      of percentage points reduced under the preceding 
                      sentence for such year.
                    ``(F) Certain flexibility for weighting performance 
                categories, measures, and activities.--Under the 
                methodology under subparagraph (A), if there are not 
                sufficient measures and activities (described in 
                paragraph (2)(B)) applicable and available to each type 
                of eligible professional involved, the Secretary shall 
                assign different scoring weights (including a weight of 
                0)--
                          ``(i) which may vary from the scoring weights 
                      specified in subparagraph (E), for each 
                      performance category based on the extent to which 
                      the category is applicable to the type of eligible 
                      professional involved; and
                          ``(ii) for each measure and activity specified 
                      under paragraph (2)(B) with respect to each such 
                      category based on the extent to which the measure 
                      or activity is applicable and available to the 
                      type of eligible professional involved.
                    ``(G) Resource use.--Analysis of the performance 
                category described in paragraph (2)(A)(ii) shall include 
                results from the methodology described in subsection 
                (r)(5), as appropriate.
                    ``(H) Inclusion of quality measure data from other 
                payers.--In applying subsections (k), (m), and (p) with 
                respect to measures described in paragraph (2)(B)(i), 
                analysis of the performance category described in 
                paragraph (2)(A)(i) may include data submitted by MIPS 
                eligible professionals with respect to items and 
                services furnished to individuals who are not 
                individuals entitled to benefits under part A or 
                enrolled under part B.
                    ``(I) Use of voluntary virtual groups for certain 
                assessment purposes.--
                          ``(i) In general.--In the case of MIPS 
                      eligible professionals electing to be a virtual 
                      group under clause (ii) with respect to a 
                      performance period for a year, for purposes of 
                      applying the methodology under subparagraph (A) 
                      with respect to the performance categories 
                      described in clauses (i) and (ii) of paragraph 
                      (2)(A)--
                                    ``(I) the assessment of performance 
                                provided under such methodology with 
                                respect to such performance categories 
                                that is to be applied to each such 
                                professional in such group for such 
                                performance period shall be with respect 
                                to the combined performance of all such 
                                professionals in such group for such 
                                period; and
                                    ``(II) with respect to the composite 
                                performance score provided under this 
                                paragraph for such performance period 
                                for each such MIPS eligible professional 
                                in such virtual group, the components

[[Page 129 STAT. 105]]

                                of the composite performance score that 
                                assess performance with respect to such 
                                performance categories shall be based on 
                                the assessment of the combined 
                                performance under subclause (I) for such 
                                performance categories and performance 
                                period.
                          ``(ii) Election of practices to be a virtual 
                      group.--The Secretary shall, in accordance with 
                      the requirements under clause (iii), establish and 
                      have in place a process to allow an individual 
                      MIPS eligible professional or a group practice 
                      consisting of not more than 10 MIPS eligible 
                      professionals to elect, with respect to a 
                      performance period for a year to be a virtual 
                      group under this subparagraph with at least one 
                      other such individual MIPS eligible professional 
                      or group practice. Such a virtual group may be 
                      based on appropriate classifications of providers, 
                      such as by geographic areas or by provider 
                      specialties defined by nationally recognized 
                      specialty boards of certification or equivalent 
                      certification boards.
                          ``(iii) Requirements.--The requirements for 
                      the process under clause (ii) shall--
                                    ``(I) provide that an election under 
                                such clause, with respect to a 
                                performance period, shall be made before 
                                the beginning of such performance period 
                                and may not be changed during such 
                                performance period;
                                    ``(II) provide that an individual 
                                MIPS eligible professional and a group 
                                practice described in clause (ii) may 
                                elect to be in no more than one virtual 
                                group for a performance period and that, 
                                in the case of such a group practice 
                                that elects to be in such virtual group 
                                for such performance period, such 
                                election applies to all MIPS eligible 
                                professionals in such group practice;
                                    ``(III) provide that a virtual group 
                                be a combination of tax identification 
                                numbers;
                                    ``(IV) provide for formal written 
                                agreements among MIPS eligible 
                                professionals electing to be a virtual 
                                group under this subparagraph; and
                                    ``(V) include such other 
                                requirements as the Secretary determines 
                                appropriate.
            ``(6) MIPS payments.--
                    ``(A) MIPS adjustment factor.--Taking into account 
                paragraph (1)(G), the Secretary shall specify a MIPS 
                adjustment factor for each MIPS eligible professional 
                for a year. Such MIPS adjustment factor for a MIPS 
                eligible professional for a year shall be in the form of 
                a percent and shall be determined--
                          ``(i) by comparing the composite performance 
                      score of the eligible professional for such year 
                      to the performance threshold established under 
                      subparagraph (D)(i) for such year;
                          ``(ii) in a manner such that the adjustment 
                      factors specified under this subparagraph for a 
                      year result in differential payments under this 
                      paragraph reflecting that--

[[Page 129 STAT. 106]]

                                    ``(I) MIPS eligible professionals 
                                with composite performance scores for 
                                such year at or above such performance 
                                threshold for such year receive zero or 
                                positive payment adjustment factors for 
                                such year in accordance with clause 
                                (iii), with such professionals having 
                                higher composite performance scores 
                                receiving higher adjustment factors; and
                                    ``(II) MIPS eligible professionals 
                                with composite performance scores for 
                                such year below such performance 
                                threshold for such year receive negative 
                                payment adjustment factors for such year 
                                in accordance with clause (iv), with 
                                such professionals having lower 
                                composite performance scores receiving 
                                lower adjustment factors;
                          ``(iii) in a manner such that MIPS eligible 
                      professionals with composite scores described in 
                      clause (ii)(I) for such year, subject to clauses 
                      (i) and (ii) of subparagraph (F), receive a zero 
                      or positive adjustment factor on a linear sliding 
                      scale such that an adjustment factor of 0 percent 
                      is assigned for a score at the performance 
                      threshold and an adjustment factor of the 
                      applicable percent specified in subparagraph (B) 
                      is assigned for a score of 100; and
                          ``(iv) in a manner such that--
                                    ``(I) subject to subclause (II), 
                                MIPS eligible professionals with 
                                composite performance scores described 
                                in clause (ii)(II) for such year receive 
                                a negative payment adjustment factor on 
                                a linear sliding scale such that an 
                                adjustment factor of 0 percent is 
                                assigned for a score at the performance 
                                threshold and an adjustment factor of 
                                the negative of the applicable percent 
                                specified in subparagraph (B) is 
                                assigned for a score of 0; and
                                    ``(II) MIPS eligible professionals 
                                with composite performance scores that 
                                are equal to or greater than 0, but not 
                                greater than \1/4\ of the performance 
                                threshold specified under subparagraph 
                                (D)(i) for such year, receive a negative 
                                payment adjustment factor that is equal 
                                to the negative of the applicable 
                                percent specified in subparagraph (B) 
                                for such year.
                    ``(B) Applicable percent defined.--For purposes of 
                this paragraph, the term `applicable percent' means--
                          ``(i) for 2019, 4 percent;
                          ``(ii) for 2020, 5 percent;
                          ``(iii) for 2021, 7 percent; and
                          ``(iv) for 2022 and subsequent years, 9 
                      percent.
                    ``(C) Additional mips adjustment factors for 
                exceptional performance.--For 2019 and each subsequent 
                year through 2024, in the case of a MIPS eligible 
                professional with a composite performance score for a 
                year at or above the additional performance threshold 
                under subparagraph (D)(ii) for such year, in addition to 
                the MIPS adjustment factor under subparagraph (A) for 
                the eligible professional for such year, subject to 
                subparagraph (F)(iv), the Secretary shall specify an 
                additional positive MIPS adjustment factor for such 
                professional and year. Such additional MIPS

[[Page 129 STAT. 107]]

                adjustment factors shall be in the form of a percent and 
                determined by the Secretary in a manner such that 
                professionals having higher composite performance scores 
                above the additional performance threshold receive 
                higher additional MIPS adjustment factors.
                    ``(D) Establishment of performance thresholds.--
                          ``(i) Performance threshold.--For each year of 
                      the MIPS, the Secretary shall compute a 
                      performance threshold with respect to which the 
                      composite performance score of MIPS eligible 
                      professionals shall be compared for purposes of 
                      determining adjustment factors under subparagraph 
                      (A) that are positive, negative, and zero. Such 
                      performance threshold for a year shall be the mean 
                      or median (as selected by the Secretary) of the 
                      composite performance scores for all MIPS eligible 
                      professionals with respect to a prior period 
                      specified by the Secretary. The Secretary may 
                      reassess the selection of the mean or median under 
                      the previous sentence every 3 years.
                          ``(ii) Additional performance threshold for 
                      exceptional performance.--In addition to the 
                      performance threshold under clause (i), for each 
                      year of the MIPS, the Secretary shall compute an 
                      additional performance threshold for purposes of 
                      determining the additional MIPS adjustment factors 
                      under subparagraph (C). For each such year, the 
                      Secretary shall apply either of the following 
                      methods for computing such additional performance 
                      threshold for such a year:
                                    ``(I) The threshold shall be the 
                                score that is equal to the 25th 
                                percentile of the range of possible 
                                composite performance scores above the 
                                performance threshold determined under 
                                clause (i).
                                    ``(II) The threshold shall be the 
                                score that is equal to the 25th 
                                percentile of the actual composite 
                                performance scores for MIPS eligible 
                                professionals with composite performance 
                                scores at or above the performance 
                                threshold with respect to the prior 
                                period described in clause (i).
                          ``(iii) Special rule for initial 2 years.--
                      With respect to each of the first two years to 
                      which the MIPS applies, the Secretary shall, prior 
                      to the performance period for such years, 
                      establish a performance threshold for purposes of 
                      determining MIPS adjustment factors under 
                      subparagraph (A) and a threshold for purposes of 
                      determining additional MIPS adjustment factors 
                      under subparagraph (C). Each such performance 
                      threshold shall--
                                    ``(I) be based on a period prior to 
                                such performance periods; and
                                    ``(II) take into account--
                                            ``(aa) data available with 
                                        respect to performance on 
                                        measures and activities that may 
                                        be used under the performance 
                                        categories under subparagraph 
                                        (2)(B); and
                                            ``(bb) other factors 
                                        determined appropriate by the 
                                        Secretary.

[[Page 129 STAT. 108]]

                    ``(E) Application of mips adjustment factors.--In 
                the case of items and services furnished by a MIPS 
                eligible professional during a year (beginning with 
                2019), the amount otherwise paid under this part with 
                respect to such items and services and MIPS eligible 
                professional for such year, shall be multiplied by--
                          ``(i) 1, plus
                          ``(ii) the sum of--
                                    ``(I) the MIPS adjustment factor 
                                determined under subparagraph (A) 
                                divided by 100, and
                                    ``(II) as applicable, the additional 
                                MIPS adjustment factor determined under 
                                subparagraph (C) divided by 100.
                    ``(F) Aggregate application of mips adjustment 
                factors.--
                          ``(i) Application of scaling factor.--
                                    ``(I) In general.--With respect to 
                                positive MIPS adjustment factors under 
                                subparagraph (A)(ii)(I) for eligible 
                                professionals whose composite 
                                performance score is above the 
                                performance threshold under subparagraph 
                                (D)(i) for such year, subject to 
                                subclause (II), the Secretary shall 
                                increase or decrease such adjustment 
                                factors by a scaling factor in order to 
                                ensure that the budget neutrality 
                                requirement of clause (ii) is met.
                                    ``(II) Scaling factor limit.--In no 
                                case may the scaling factor applied 
                                under this clause exceed 3.0.
                          ``(ii) Budget neutrality requirement.--
                                    ``(I) In general.--Subject to clause 
                                (iii), the Secretary shall ensure that 
                                the estimated amount described in 
                                subclause (II) for a year is equal to 
                                the estimated amount described in 
                                subclause (III) for such year.
                                    ``(II) Aggregate increases.--The 
                                amount described in this subclause is 
                                the estimated increase in the aggregate 
                                allowed charges resulting from the 
                                application of positive MIPS adjustment 
                                factors under subparagraph (A) (after 
                                application of the scaling factor 
                                described in clause (i)) to MIPS 
                                eligible professionals whose composite 
                                performance score for a year is above 
                                the performance threshold under 
                                subparagraph (D)(i) for such year.
                                    ``(III) Aggregate decreases.--The 
                                amount described in this subclause is 
                                the estimated decrease in the aggregate 
                                allowed charges resulting from the 
                                application of negative MIPS adjustment 
                                factors under subparagraph (A) to MIPS 
                                eligible professionals whose composite 
                                performance score for a year is below 
                                the performance threshold under 
                                subparagraph (D)(i) for such year.
                          ``(iii) Exceptions.--
                                    ``(I) <<NOTE: Applicability.>>  In 
                                the case that all MIPS eligible 
                                professionals receive composite 
                                performance scores for a year that are 
                                below the performance threshold

[[Page 129 STAT. 109]]

                                under subparagraph (D)(i) for such year, 
                                the negative MIPS adjustment factors 
                                under subparagraph (A) shall apply with 
                                respect to such MIPS eligible 
                                professionals and the budget neutrality 
                                requirement of clause (ii) and the 
                                additional adjustment factors under 
                                clause (iv) shall not apply for such 
                                year.
                                    ``(II) In the case that, with 
                                respect to a year, the application of 
                                clause (i) results in a scaling factor 
                                equal to the maximum scaling factor 
                                specified in clause (i)(II), such 
                                scaling factor shall apply and the 
                                budget neutrality requirement of clause 
                                (ii) shall not apply for such year.
                          ``(iv) Additional incentive payment 
                      adjustments.--
                                    ``(I) <<NOTE: Time period.>>  In 
                                general.--Subject to subclause (II), in 
                                specifying the MIPS additional 
                                adjustment factors under subparagraph 
                                (C) for each applicable MIPS eligible 
                                professional for a year, the Secretary 
                                shall ensure that the estimated 
                                aggregate increase in payments under 
                                this part resulting from the application 
                                of such additional adjustment factors 
                                for MIPS eligible professionals in a 
                                year shall be equal (as estimated by the 
                                Secretary) to $500,000,000 for each year 
                                beginning with 2019 and ending with 
                                2024.
                                    ``(II) Limitation on additional 
                                incentive payment adjustments.--The MIPS 
                                additional adjustment factor under 
                                subparagraph (C) for a year for an 
                                applicable MIPS eligible professional 
                                whose composite performance score is 
                                above the additional performance 
                                threshold under subparagraph (D)(ii) for 
                                such year shall not exceed 10 percent. 
                                The application of the previous sentence 
                                may result in an aggregate amount of 
                                additional incentive payments that are 
                                less than the amount specified in 
                                subclause (I).
            ``(7) <<NOTE: Deadline.>>  Announcement of result of 
        adjustments.--Under the MIPS, the Secretary shall, not later 
        than 30 days prior to January 1 of the year involved, make 
        available to MIPS eligible professionals the MIPS adjustment 
        factor (and, as applicable, the additional MIPS adjustment 
        factor) under paragraph (6) applicable to the eligible 
        professional for items and services furnished by the 
        professional for such year. The Secretary may include such 
        information in the confidential feedback under paragraph (12).
            ``(8) No effect in subsequent years.--The MIPS adjustment 
        factors and additional MIPS adjustment factors under paragraph 
        (6) shall apply only with respect to the year involved, and the 
        Secretary shall not take into account such adjustment factors in 
        making payments to a MIPS eligible professional under this part 
        in a subsequent year.
            ``(9) Public reporting.--
                    ``(A) <<NOTE: Web posting.>>  In general.--The 
                Secretary shall, in an easily understandable format, 
                make available on the Physician Compare Internet website 
                of the Centers for Medicare & Medicaid Services the 
                following:

[[Page 129 STAT. 110]]

                          ``(i) Information regarding the performance of 
                      MIPS eligible professionals under the MIPS, 
                      which--
                                    ``(I) shall include the composite 
                                score for each such MIPS eligible 
                                professional and the performance of each 
                                such MIPS eligible professional with 
                                respect to each performance category; 
                                and
                                    ``(II) may include the performance 
                                of each such MIPS eligible professional 
                                with respect to each measure or activity 
                                specified in paragraph (2)(B).
                          ``(ii) The names of eligible professionals in 
                      eligible alternative payment models (as defined in 
                      section 1833(z)(3)(D)) and, to the extent 
                      feasible, the names of such eligible alternative 
                      payment models and performance of such models.
                    ``(B) Disclosure.--The information made available 
                under this paragraph shall indicate, where appropriate, 
                that publicized information may not be representative of 
                the eligible professional's entire patient population, 
                the variety of services furnished by the eligible 
                professional, or the health conditions of individuals 
                treated.
                    ``(C) Opportunity to review and submit 
                corrections.--The Secretary shall provide for an 
                opportunity for a professional described in subparagraph 
                (A) to review, and submit corrections for, the 
                information to be made public with respect to the 
                professional under such subparagraph prior to such 
                information being made public.
                    ``(D) <<NOTE: Web posting.>>  Aggregate 
                information.--The Secretary shall periodically post on 
                the Physician Compare Internet website aggregate 
                information on the MIPS, including the range of 
                composite scores for all MIPS eligible professionals and 
                the range of the performance of all MIPS eligible 
                professionals with respect to each performance category.
            ``(10) Consultation.--The Secretary shall consult with 
        stakeholders in carrying out the MIPS, including for the 
        identification of measures and activities under paragraph (2)(B) 
        and the methodologies developed under paragraphs (5)(A) and (6) 
        and regarding the use of qualified clinical data registries. 
        Such consultation shall include the use of a request for 
        information or other mechanisms determined appropriate.
            ``(11) Technical assistance to small practices and practices 
        in health professional shortage areas.--
                    ``(A) <<NOTE: Contracts.>>  In general.--The 
                Secretary shall enter into contracts or agreements with 
                appropriate entities (such as quality improvement 
                organizations, regional extension centers (as described 
                in section 3012(c) of the Public Health Service Act), or 
                regional health collaboratives) to offer guidance and 
                assistance to MIPS eligible professionals in practices 
                of 15 or fewer professionals (with priority given to 
                such practices located in rural areas, health 
                professional shortage areas (as designated under in 
                section 332(a)(1)(A) of such Act), and medically 
                underserved areas, and practices with low composite 
                scores) with respect to--
                          ``(i) the performance categories described in 
                      clauses (i) through (iv) of paragraph (2)(A); or
                          ``(ii) how to transition to the implementation 
                      of and participation in an alternative payment 
                      model as described in section 1833(z)(3)(C).

[[Page 129 STAT. 111]]

                    ``(B) Funding for technical assistance.--For 
                purposes of implementing subparagraph (A), the Secretary 
                shall provide for the transfer from the Federal 
                Supplementary Medical Insurance Trust Fund established 
                under section 1841 to the Centers for Medicare & 
                Medicaid Services Program Management Account of 
                $20,000,000 for each of fiscal years 2016 through 2020. 
                Amounts transferred under this subparagraph for a fiscal 
                year shall be available until expended.
            ``(12) Feedback and information to improve performance.--
                    ``(A) Performance feedback.--
                          ``(i) <<NOTE: Effective date.>>  In general.--
                      Beginning July 1, 2017, the Secretary--
                                    ``(I) shall make available timely 
                                (such as quarterly) confidential 
                                feedback to MIPS eligible professionals 
                                on the performance of such professionals 
                                with respect to the performance 
                                categories under clauses (i) and (ii) of 
                                paragraph (2)(A); and
                                    ``(II) may make available 
                                confidential feedback to such 
                                professionals on the performance of such 
                                professionals with respect to the 
                                performance categories under clauses 
                                (iii) and (iv) of such paragraph.
                          ``(ii) Mechanisms.--The Secretary may use one 
                      or more mechanisms to make feedback available 
                      under clause (i), which may include use of a web-
                      based portal or other mechanisms determined 
                      appropriate by the Secretary. With respect to the 
                      performance category described in paragraph 
                      (2)(A)(i), feedback under this subparagraph shall, 
                      to the extent an eligible professional chooses to 
                      participate in a data registry for purposes of 
                      this subsection (including registries under 
                      subsections (k) and (m)), be provided based on 
                      performance on quality measures reported through 
                      the use of such registries. With respect to any 
                      other performance category described in paragraph 
                      (2)(A), the Secretary shall encourage provision of 
                      feedback through qualified clinical data 
                      registries as described in subsection (m)(3)(E)).
                          ``(iii) Use of data.--For purposes of clause 
                      (i), the Secretary may use data, with respect to a 
                      MIPS eligible professional, from periods prior to 
                      the current performance period and may use rolling 
                      periods in order to make illustrative calculations 
                      about the performance of such professional.
                          ``(iv) Disclosure exemption.--Feedback made 
                      available under this subparagraph shall be exempt 
                      from disclosure under section 552 of title 5, 
                      United States Code.
                          ``(v) Receipt of information.--The Secretary 
                      may use the mechanisms established under clause 
                      (ii) to receive information from professionals, 
                      such as information with respect to this 
                      subsection.
                    ``(B) Additional information.--

[[Page 129 STAT. 112]]

                          ``(i) <<NOTE: Effective date.>>  In general.--
                      Beginning July 1, 2018, the Secretary shall make 
                      available to MIPS eligible professionals 
                      information, with respect to individuals who are 
                      patients of such MIPS eligible professionals, 
                      about items and services for which payment is made 
                      under this title that are furnished to such 
                      individuals by other suppliers and providers of 
                      services, which may include information described 
                      in clause (ii). Such information may be made 
                      available under the previous sentence to such MIPS 
                      eligible professionals by mechanisms determined 
                      appropriate by the Secretary, which may include 
                      use of a web-based portal. Such information may be 
                      made available in accordance with the same or 
                      similar terms as data are made available to 
                      accountable care organizations participating in 
                      the shared savings program under section 1899.
                          ``(ii) Type of information.--For purposes of 
                      clause (i), the information described in this 
                      clause, is the following:
                                    ``(I) With respect to selected items 
                                and services (as determined appropriate 
                                by the Secretary) for which payment is 
                                made under this title and that are 
                                furnished to individuals, who are 
                                patients of a MIPS eligible 
                                professional, by another supplier or 
                                provider of services during the most 
                                recent period for which data are 
                                available (such as the most recent 
                                three-month period), such as the name of 
                                such providers furnishing such items and 
                                services to such patients during such 
                                period, the types of such items and 
                                services so furnished, and the dates 
                                such items and services were so 
                                furnished.
                                    ``(II) Historical data, such as 
                                averages and other measures of the 
                                distribution if appropriate, of the 
                                total, and components of, allowed 
                                charges (and other figures as determined 
                                appropriate by the Secretary).
            ``(13) Review.--
                    ``(A) Targeted review.--The Secretary shall 
                establish a process under which a MIPS eligible 
                professional may seek an informal review of the 
                calculation of the MIPS adjustment factor (or factors) 
                applicable to such eligible professional under this 
                subsection for a year. The results of a review conducted 
                pursuant to the previous sentence shall not be taken 
                into account for purposes of paragraph (6) with respect 
                to a year (other than with respect to the calculation of 
                such eligible professional's MIPS adjustment factor for 
                such year or additional MIPS adjustment factor for such 
                year) after the factors determined in subparagraph (A) 
                and subparagraph (C) of such paragraph have been 
                determined for such year.
                    ``(B) Limitation.--Except as provided for in 
                subparagraph (A), there shall be no administrative or 
                judicial review under section 1869, section 1878, or 
                otherwise of the following:
                          ``(i) The methodology used to determine the 
                      amount of the MIPS adjustment factor under 
                      paragraph (6)(A) and the amount of the additional 
                      MIPS adjustment

[[Page 129 STAT. 113]]

                      factor under paragraph (6)(C) and the 
                      determination of such amounts.
                          ``(ii) The establishment of the performance 
                      standards under paragraph (3) and the performance 
                      period under paragraph (4).
                          ``(iii) The identification of measures and 
                      activities specified under paragraph (2)(B) and 
                      information made public or posted on the Physician 
                      Compare Internet website of the Centers for 
                      Medicare & Medicaid Services under paragraph (9).
                          ``(iv) The methodology developed under 
                      paragraph (5) that is used to calculate 
                      performance scores and the calculation of such 
                      scores, including the weighting of measures and 
                      activities under such methodology.''.
            (2) GAO reports.--
                    (A) Evaluation of eligible professional mips.--Not 
                later than October 1, 2021, the Comptroller General of 
                the United States shall submit to Congress a report 
                evaluating the eligible professional Merit-based 
                Incentive Payment System under subsection (q) of section 
                1848 of the Social Security Act (42 U.S.C. 1395w-4), as 
                added by paragraph (1). Such report shall--
                          (i) examine the distribution of the composite 
                      performance scores and MIPS adjustment factors 
                      (and additional MIPS adjustment factors) for MIPS 
                      eligible professionals (as defined in subsection 
                      (q)(1)(c) of such section) under such program, and 
                      patterns relating to such scores and adjustment 
                      factors, including based on type of provider, 
                      practice size, geographic location, and patient 
                      mix;
                          (ii) provide recommendations for improving 
                      such program;
                          (iii) evaluate the impact of technical 
                      assistance funding under section 1848(q)(11) of 
                      the Social Security Act, as added by paragraph 
                      (1), on the ability of professionals to improve 
                      within such program or successfully transition to 
                      an alternative payment model (as defined in 
                      section 1833(z)(3) of the Social Security Act, as 
                      added by subsection (e)), with priority for such 
                      evaluation given to practices located in rural 
                      areas, health professional shortage areas (as 
                      designated in section 332(a)(1)(A) of the Public 
                      Health Service Act), and medically underserved 
                      areas; and
                          (iv) provide recommendations for optimizing 
                      the use of such technical assistance funds.
                    (B) Study to examine alignment of quality measures 
                used in public and private programs.--
                          (i) In general.--Not later than 18 months 
                      after the date of the enactment of this Act, the 
                      Comptroller General of the United States shall 
                      submit to Congress a report that--
                                    (I) compares the similarities and 
                                differences in the use of quality 
                                measures under the original Medicare 
                                fee-for-service program under parts A 
                                and B of title XVIII of the Social 
                                Security Act, the Medicare Advantage 
                                program under part C of such title, 
                                selected State Medicaid programs

[[Page 129 STAT. 114]]

                                under title XIX of such Act, and private 
                                payer arrangements; and
                                    (II) makes recommendations on how to 
                                reduce the administrative burden 
                                involved in applying such quality 
                                measures.
                          (ii) Requirements.--The report under clause 
                      (i) shall--
                                    (I) consider those measures 
                                applicable to individuals entitled to, 
                                or enrolled for, benefits under such 
                                part A, or enrolled under such part B 
                                and individuals under the age of 65; and
                                    (II) focus on those measures that 
                                comprise the most significant component 
                                of the quality performance category of 
                                the eligible professional MIPS incentive 
                                program under subsection (q) of section 
                                1848 of the Social Security Act (42 
                                U.S.C. 1395w-4), as added by paragraph 
                                (1).
                    (C) Study on role of independent risk managers.--Not 
                later than January 1, 2017, the Comptroller General of 
                the United States shall submit to Congress a report 
                examining whether entities that pool financial risk for 
                physician practices, such as independent risk managers, 
                can play a role in supporting physician practices, 
                particularly small physician practices, in assuming 
                financial risk for the treatment of patients. Such 
                report shall examine barriers that small physician 
                practices currently face in assuming financial risk for 
                treating patients, the types of risk management entities 
                that could assist physician practices in participating 
                in two-sided risk payment models, and how such entities 
                could assist with risk management and with quality 
                improvement activities. Such report shall also include 
                an analysis of any existing legal barriers to such 
                arrangements.
                    (D) Study to examine rural and health professional 
                shortage area alternative payment models.--Not later 
                than October 1, 2021, the Comptroller General of the 
                United States shall submit to Congress a report that 
                examines the transition of professionals in rural areas, 
                health professional shortage areas (as designated in 
                section 332(a)(1)(A) of the Public Health Service Act), 
                or medically underserved areas to an alternative payment 
                model (as defined in section 1833(z)(3) of the Social 
                Security Act, as added by subsection (e)). Such report 
                shall make recommendations for removing administrative 
                barriers to practices, including small practices 
                consisting of 15 or fewer professionals, in rural areas, 
                health professional shortage areas, and medically 
                underserved areas to participation in such models.
            (3) Funding for implementation.--For purposes of 
        implementing the provisions of and the amendments made by this 
        section, the Secretary of Health and Human Services shall 
        provide for the transfer of $80,000,000 from the Supplementary 
        Medical Insurance Trust Fund established under section 1841 of 
        the Social Security Act (42 U.S.C. 1395t) to the Centers for 
        Medicare & Medicaid Program Management Account for each of the 
        fiscal years 2015 through 2019. Amounts transferred under this 
        paragraph shall be available until expended.

[[Page 129 STAT. 115]]

    (d) Improving Quality Reporting for Composite Scores.--
            (1) Changes for group reporting option.--
                    (A) In general.--Section 1848(m)(3)(C)(ii) of the 
                Social Security Act (42 U.S.C. 1395w-4(m)(3)(C)(ii)) is 
                amended by inserting ``and, for 2016 and subsequent 
                years, may provide'' after ``shall provide''.
                    (B) Clarification of qualified clinical data 
                registry reporting to group practices.--Section 
                1848(m)(3)(D) of the Social Security Act (42 U.S.C. 
                1395w-4(m)(3)(D)) is amended by inserting ``and, for 
                2016 and subsequent years, subparagraph (A) or (C)'' 
                after ``subparagraph (A)''.
            (2) Changes for multiple reporting periods and alternative 
        criteria for satisfactory reporting.--Section 1848(m)(5)(F) of 
        the Social Security Act (42 U.S.C. 1395w-4(m)(5)(F)) is 
        amended--
                    (A) by striking ``and subsequent years'' and 
                inserting ``through reporting periods occurring in 
                2015''; and
                    (B) by inserting ``and, for reporting periods 
                occurring in 2016 and subsequent years, the Secretary 
                may establish'' after ``shall establish''.
            (3) Physician feedback program reports succeeded by reports 
        under mips.--Section 1848(n) of the Social Security Act (42 
        U.S.C. 1395w-4(n)) is amended by adding at the end the following 
        new paragraph:
            ``(11) Reports ending with 2017.--Reports under the Program 
        shall not be provided after December 31, 2017. See subsection 
        (q)(12) for reports under the eligible professionals Merit-based 
        Incentive Payment System.''.
            (4) Coordination with satisfying meaningful ehr use clinical 
        quality measure reporting requirement.--Section 
        1848(o)(2)(A)(iii) of the Social Security Act (42 U.S.C. 1395w-
        4(o)(2)(A)(iii)) is amended by inserting ``and subsection 
        (q)(5)(B)(ii)(II)'' after ``Subject to subparagraph (B)(ii)''.

    (e) Promoting Alternative Payment Models.--
            (1) Increasing transparency of physician-focused payment 
        models.--Section 1868 of the Social Security Act (42 U.S.C. 
        1395ee) is amended by adding at the end the following new 
        subsection:

    ``(c) Physician-Focused Payment Models.--
            ``(1) Technical advisory committee.--
                    ``(A) Establishment.--There is established an ad hoc 
                committee to be known as the `Physician-Focused Payment 
                Model Technical Advisory Committee' (referred to in this 
                subsection as the `Committee').
                    ``(B) Membership.--
                          ``(i) Number and appointment.--The Committee 
                      shall be composed of 11 members appointed by the 
                      Comptroller General of the United States.
                          ``(ii) Qualifications.--The membership of the 
                      Committee shall include individuals with national 
                      recognition for their expertise in physician-
                      focused payment models and related delivery of 
                      care. No more than 5 members of the Committee 
                      shall be providers of services or suppliers, or 
                      representatives of providers of services or 
                      suppliers.

[[Page 129 STAT. 116]]

                          ``(iii) Prohibition on federal employment.--A 
                      member of the Committee shall not be an employee 
                      of the Federal Government.
                          ``(iv) Ethics disclosure.--The Comptroller 
                      General shall establish a system for public 
                      disclosure by members of the Committee of 
                      financial and other potential conflicts of 
                      interest relating to such members. Members of the 
                      Committee shall be treated as employees of 
                      Congress for purposes of applying title I of the 
                      Ethics in Government Act of 1978 (Public Law 95-
                      521).
                          ``(v) <<NOTE: Deadline.>>  Date of initial 
                      appointments.--The initial appointments of members 
                      of the Committee shall be made by not later than 
                      180 days after the date of enactment of this 
                      subsection.
                    ``(C) Term; vacancies.--
                          ``(i) Term.--The terms of members of the 
                      Committee shall be for 3 years except that the 
                      Comptroller General shall designate staggered 
                      terms for the members first appointed.
                          ``(ii) Vacancies.--Any member appointed to 
                      fill a vacancy occurring before the expiration of 
                      the term for which the member's predecessor was 
                      appointed shall be appointed only for the 
                      remainder of that term. A member may serve after 
                      the expiration of that member's term until a 
                      successor has taken office. A vacancy in the 
                      Committee shall be filled in the manner in which 
                      the original appointment was made.
                    ``(D) Duties.--The Committee shall meet, as needed, 
                to provide comments and recommendations to the 
                Secretary, as described in paragraph (2)(C), on 
                physician-focused payment models.
                    ``(E) Compensation of members.--
                          ``(i) In general.--Except as provided in 
                      clause (ii), a member of the Committee shall serve 
                      without compensation.
                          ``(ii) Travel expenses.--A member of the 
                      Committee shall be allowed travel expenses, 
                      including per diem in lieu of subsistence, at 
                      rates authorized for an employee of an agency 
                      under subchapter I of chapter 57 of title 5, 
                      United States Code, while away from the home or 
                      regular place of business of the member in the 
                      performance of the duties of the Committee.
                    ``(F) Operational and technical support.--
                          ``(i) In general.--The Assistant Secretary for 
                      Planning and Evaluation shall provide technical 
                      and operational support for the Committee, which 
                      may be by use of a contractor. The Office of the 
                      Actuary of the Centers for Medicare & Medicaid 
                      Services shall provide to the Committee actuarial 
                      assistance as needed.
                          ``(ii) Funding.--The Secretary shall provide 
                      for the transfer, from the Federal Supplementary 
                      Medical Insurance Trust Fund under section 1841, 
                      such amounts as are necessary to carry out this 
                      paragraph (not to exceed $5,000,000) for fiscal 
                      year 2015 and each subsequent fiscal year. Any 
                      amounts transferred

[[Page 129 STAT. 117]]

                      under the preceding sentence for a fiscal year 
                      shall remain available until expended.
                    ``(G) Application.--Section 14 of the Federal 
                Advisory Committee Act (5 U.S.C. App.) shall not apply 
                to the Committee.
            ``(2) Criteria and process for submission and review of 
        physician-focused payment models.--
                    ``(A) Criteria for assessing physician-focused 
                payment models.--
                          ``(i) <<NOTE: Deadline.>>  Rulemaking.--Not 
                      later than November 1, 2016, the Secretary shall, 
                      through notice and comment rulemaking, following a 
                      request for information, establish criteria for 
                      physician-focused payment models, including models 
                      for specialist physicians, that could be used by 
                      the Committee for making comments and 
                      recommendations pursuant to paragraph (1)(D).
                          ``(ii) MedPAC submission of comments.--During 
                      the comment period for the proposed rule described 
                      in clause (i), the Medicare Payment Advisory 
                      Commission may submit comments to the Secretary on 
                      the proposed criteria under such clause.
                          ``(iii) Updating.--The Secretary may update 
                      the criteria established under this subparagraph 
                      through rulemaking.
                    ``(B) Stakeholder submission of physician-focused 
                payment models.--On an ongoing basis, individuals and 
                stakeholder entities may submit to the Committee 
                proposals for physician-focused payment models that such 
                individuals and entities believe meet the criteria 
                described in subparagraph (A).
                    ``(C) Committee review of models submitted.--The 
                Committee shall, on a periodic basis, review models 
                submitted under subparagraph (B), prepare comments and 
                recommendations regarding whether such models meet the 
                criteria described in subparagraph (A), and submit such 
                comments and recommendations to the Secretary.
                    ``(D) Secretary review and response.--The Secretary 
                shall review the comments and recommendations submitted 
                by the Committee under subparagraph (C) and post a 
                detailed response to such comments and recommendations 
                on the Internet website of the Centers for Medicare & 
                Medicaid Services.
            ``(3) Rule of construction.--Nothing in this subsection 
        shall be construed to impact the development or testing of 
        models under this title or titles XI, XIX, or XXI.''.
            (2) Incentive payments for participation in eligible 
        alternative payment models.--Section 1833 of the Social Security 
        Act (42 U.S.C. 1395l) is amended by adding at the end the 
        following new subsection:

    ``(z) Incentive Payments for Participation in Eligible Alternative 
Payment Models.--
            ``(1) Payment incentive.--
                    ``(A) <<NOTE: Time period.>>  In general.--In the 
                case of covered professional services furnished by an 
                eligible professional during a year that is in the 
                period beginning with 2019 and ending with 2024 and for 
                which the professional is a qualifying APM participant 
                with respect to such year, in addition to the

[[Page 129 STAT. 118]]

                amount of payment that would otherwise be made for such 
                covered professional services under this part for such 
                year, there also shall be paid to such professional an 
                amount equal to 5 percent of the estimated aggregate 
                payment amounts for such covered professional services 
                under this part for the preceding year. For purposes of 
                the previous sentence, the payment amount for the 
                preceding year may be an estimation for the full 
                preceding year based on a period of such preceding year 
                that is less than the full year. 
                The <<NOTE: Policies.>> Secretary shall establish 
                policies to implement this subparagraph in cases in 
                which payment for covered professional services 
                furnished by a qualifying APM participant in an 
                alternative payment model--
                          ``(i) is made to an eligible alternative 
                      payment entity rather than directly to the 
                      qualifying APM participant; or
                          ``(ii) is made on a basis other than a fee-
                      for-service basis (such as payment on a capitated 
                      basis).
                    ``(B) Form of payment.--Payments under this 
                subsection shall be made in a lump sum, on an annual 
                basis, as soon as practicable.
                    ``(C) Treatment of payment incentive.--Payments 
                under this subsection shall not be taken into account 
                for purposes of determining actual expenditures under an 
                alternative payment model and for purposes of 
                determining or rebasing any benchmarks used under the 
                alternative payment model.
                    ``(D) Coordination.--The amount of the additional 
                payment under this subsection or subsection (m) shall be 
                determined without regard to any additional payment 
                under subsection (m) and this subsection, respectively. 
                The amount of the additional payment under this 
                subsection or subsection (x) shall be determined without 
                regard to any additional payment under subsection (x) 
                and this subsection, respectively. The amount of the 
                additional payment under this subsection or subsection 
                (y) shall be determined without regard to any additional 
                payment under subsection (y) and this subsection, 
                respectively.
            ``(2) <<NOTE: Definition.>>  Qualifying apm participant.--
        For purposes of this subsection, the term `qualifying APM 
        participant' means the following:
                    ``(A) 2019 and 2020.--With respect to 2019 and 2020, 
                an eligible professional for whom the Secretary 
                determines that at least 25 percent of payments under 
                this part for covered professional services furnished by 
                such professional during the most recent period for 
                which data are available (which may be less than a year) 
                were attributable to such services furnished under this 
                part through an eligible alternative payment entity.
                    ``(B) 2021 and 2022.--With respect to 2021 and 2022, 
                an eligible professional described in either of the 
                following clauses:
                          ``(i) Medicare payment threshold option.--An 
                      eligible professional for whom the Secretary 
                      determines that at least 50 percent of payments 
                      under this part for covered professional services 
                      furnished by such professional during the most 
                      recent period for which

[[Page 129 STAT. 119]]

                      data are available (which may be less than a year) 
                      were attributable to such services furnished under 
                      this part through an eligible alternative payment 
                      entity.
                          ``(ii) Combination all-payer and medicare 
                      payment threshold option.--An eligible 
                      professional--
                                    ``(I) for whom the Secretary 
                                determines, with respect to items and 
                                services furnished by such professional 
                                during the most recent period for which 
                                data are available (which may be less 
                                than a year), that at least 50 percent 
                                of the sum of--
                                            ``(aa) payments described in 
                                        clause (i); and
                                            ``(bb) all other payments, 
                                        regardless of payer (other than 
                                        payments made by the Secretary 
                                        of Defense or the Secretary of 
                                        Veterans Affairs and other than 
                                        payments made under title XIX in 
                                        a State in which no medical home 
                                        or alternative payment model is 
                                        available under the State 
                                        program under that title),
                                meet the requirement described in clause 
                                (iii)(I) with respect to payments 
                                described in item (aa) and meet the 
                                requirement described in clause 
                                (iii)(II) with respect to payments 
                                described in item (bb);
                                    ``(II) for whom the Secretary 
                                determines at least 25 percent of 
                                payments under this part for covered 
                                professional services furnished by such 
                                professional during the most recent 
                                period for which data are available 
                                (which may be less than a year) were 
                                attributable to such services furnished 
                                under this part through an eligible 
                                alternative payment entity; and
                                    ``(III) who provides to the 
                                Secretary such information as is 
                                necessary for the Secretary to make a 
                                determination under subclause (I), with 
                                respect to such professional.
                          ``(iii) Requirement.--For purposes of clause 
                      (ii)(I)--
                                    ``(I) the requirement described in 
                                this subclause, with respect to payments 
                                described in item (aa) of such clause, 
                                is that such payments are made to an 
                                eligible alternative payment entity; and
                                    ``(II) the requirement described in 
                                this subclause, with respect to payments 
                                described in item (bb) of such clause, 
                                is that such payments are made under 
                                arrangements in which--
                                            ``(aa) quality measures 
                                        comparable to measures under the 
                                        performance category described 
                                        in section 1848(q)(2)(B)(i) 
                                        apply;
                                            ``(bb) certified EHR 
                                        technology is used; and
                                            ``(cc) the eligible 
                                        professional participates in an 
                                        entity that--
                                                ``(AA) bears more than 
                                            nominal financial risk if 
                                            actual aggregate 
                                            expenditures exceeds 
                                            expected aggregate 
                                            expenditures; or

[[Page 129 STAT. 120]]

                                                ``(BB) with respect to 
                                            beneficiaries under title 
                                            XIX, is a medical home that 
                                            meets criteria comparable to 
                                            medical homes expanded under 
                                            section 1115A(c).
                    ``(C) <<NOTE: Effective date.>>  Beginning in 
                2023.--With respect to 2023 and each subsequent year, an 
                eligible professional described in either of the 
                following clauses:
                          ``(i) Medicare payment threshold option.--An 
                      eligible professional for whom the Secretary 
                      determines that at least 75 percent of payments 
                      under this part for covered professional services 
                      furnished by such professional during the most 
                      recent period for which data are available (which 
                      may be less than a year) were attributable to such 
                      services furnished under this part through an 
                      eligible alternative payment entity.
                          ``(ii) Combination all-payer and medicare 
                      payment threshold option.--An eligible 
                      professional--
                                    ``(I) for whom the Secretary 
                                determines, with respect to items and 
                                services furnished by such professional 
                                during the most recent period for which 
                                data are available (which may be less 
                                than a year), that at least 75 percent 
                                of the sum of--
                                            ``(aa) payments described in 
                                        clause (i); and
                                            ``(bb) all other payments, 
                                        regardless of payer (other than 
                                        payments made by the Secretary 
                                        of Defense or the Secretary of 
                                        Veterans Affairs and other than 
                                        payments made under title XIX in 
                                        a State in which no medical home 
                                        or alternative payment model is 
                                        available under the State 
                                        program under that title),
                                meet the requirement described in clause 
                                (iii)(I) with respect to payments 
                                described in item (aa) and meet the 
                                requirement described in clause 
                                (iii)(II) with respect to payments 
                                described in item (bb);
                                    ``(II) for whom the Secretary 
                                determines at least 25 percent of 
                                payments under this part for covered 
                                professional services furnished by such 
                                professional during the most recent 
                                period for which data are available 
                                (which may be less than a year) were 
                                attributable to such services furnished 
                                under this part through an eligible 
                                alternative payment entity; and
                                    ``(III) who provides to the 
                                Secretary such information as is 
                                necessary for the Secretary to make a 
                                determination under subclause (I), with 
                                respect to such professional.
                          ``(iii) Requirement.--For purposes of clause 
                      (ii)(I)--
                                    ``(I) the requirement described in 
                                this subclause, with respect to payments 
                                described in item (aa) of such clause, 
                                is that such payments are made to an 
                                eligible alternative payment entity; and
                                    ``(II) the requirement described in 
                                this subclause, with respect to payments 
                                described in item

[[Page 129 STAT. 121]]

                                (bb) of such clause, is that such 
                                payments are made under arrangements in 
                                which--
                                            
                                        ``(aa) <<NOTE: Applicability.>>  
                                        quality measures comparable to 
                                        measures under the performance 
                                        category described in section 
                                        1848(q)(2)(B)(i) apply;
                                            ``(bb) certified EHR 
                                        technology is used; and
                                            ``(cc) the eligible 
                                        professional participates in an 
                                        entity that--
                                                ``(AA) bears more than 
                                            nominal financial risk if 
                                            actual aggregate 
                                            expenditures exceeds 
                                            expected aggregate 
                                            expenditures; or
                                                ``(BB) with respect to 
                                            beneficiaries under title 
                                            XIX, is a medical home that 
                                            meets criteria comparable to 
                                            medical homes expanded under 
                                            section 1115A(c).
                    ``(D) Use of patient approach.--The Secretary may 
                base the determination of whether an eligible 
                professional is a qualifying APM participant under this 
                subsection and the determination of whether an eligible 
                professional is a partial qualifying APM participant 
                under section 1848(q)(1)(C)(iii) by using counts of 
                patients in lieu of using payments and using the same or 
                similar percentage criteria (as specified in this 
                subsection and such section, respectively), as the 
                Secretary determines appropriate.
            ``(3) Additional definitions.--In this subsection:
                    ``(A) Covered professional services.--The term 
                `covered professional services' has the meaning given 
                that term in section 1848(k)(3)(A).
                    ``(B) Eligible professional.--The term `eligible 
                professional' has the meaning given that term in section 
                1848(k)(3)(B) and includes a group that includes such 
                professionals.
                    ``(C) Alternative payment model (apm).--The term 
                `alternative payment model' means, other than for 
                purposes of subparagraphs (B)(ii)(I)(bb) and 
                (C)(ii)(I)(bb) of paragraph (2), any of the following:
                          ``(i) A model under section 1115A (other than 
                      a health care innovation award).
                          ``(ii) The shared savings program under 
                      section 1899.
                          ``(iii) A demonstration under section 1866C.
                          ``(iv) A demonstration required by Federal 
                      law.
                    ``(D) Eligible alternative payment entity.--The term 
                `eligible alternative payment entity' means, with 
                respect to a year, an entity that--
                          ``(i) participates in an alternative payment 
                      model that--
                                    ``(I) requires participants in such 
                                model to use certified EHR technology 
                                (as defined in subsection (o)(4)); and
                                    ``(II) provides for payment for 
                                covered professional services based on 
                                quality measures comparable to measures 
                                under the performance category described 
                                in section 1848(q)(2)(B)(i); and

[[Page 129 STAT. 122]]

                          ``(ii)(I) bears financial risk for monetary 
                      losses under such alternative payment model that 
                      are in excess of a nominal amount; or
                          ``(II) is a medical home expanded under 
                      section 1115A(c).
            ``(4) Limitation.--There shall be no administrative or 
        judicial review under section 1869, 1878, or otherwise, of the 
        following:
                    ``(A) The determination that an eligible 
                professional is a qualifying APM participant under 
                paragraph (2) and the determination that an entity is an 
                eligible alternative payment entity under paragraph 
                (3)(D).
                    ``(B) The determination of the amount of the 5 
                percent payment incentive under paragraph (1)(A), 
                including any estimation as part of such 
                determination.''.
            (3) Coordination conforming amendments.--Section 1833 of the 
        Social Security Act (42 U.S.C. 1395l) is further amended--
                    (A) in subsection (x)(3), by adding at the end the 
                following new sentence: ``The amount of the additional 
                payment for a service under this subsection and 
                subsection (z) shall be determined without regard to any 
                additional payment for the service under subsection (z) 
                and this subsection, respectively.''; and
                    (B) in subsection (y)(3), by adding at the end the 
                following new sentence: ``The amount of the additional 
                payment for a service under this subsection and 
                subsection (z) shall be determined without regard to any 
                additional payment for the service under subsection (z) 
                and this subsection, respectively.''.
            (4) Encouraging development and testing of certain models.--
        Section 1115A(b)(2) of the Social Security Act (42 U.S.C. 
        1315a(b)(2)) is amended--
                    (A) in subparagraph (B), by adding at the end the 
                following new clauses:
                          ``(xxi) Focusing primarily on physicians' 
                      services (as defined in section 1848(j)(3)) 
                      furnished by physicians who are not primary care 
                      practitioners.
                          ``(xxii) Focusing on practices of 15 or fewer 
                      professionals.
                          ``(xxiii) Focusing on risk-based models for 
                      small physician practices which may involve two-
                      sided risk and prospective patient assignment, and 
                      which examine risk-adjusted decreases in mortality 
                      rates, hospital readmissions rates, and other 
                      relevant and appropriate clinical measures.
                          ``(xxiv) Focusing primarily on title XIX, 
                      working in conjunction with the Center for 
                      Medicaid and CHIP Services.''; and
                    (B) in subparagraph (C)(viii), by striking ``other 
                public sector or private sector payers'' and inserting 
                ``other public sector payers, private sector payers, or 
                statewide payment models''.
            (5) <<NOTE: 42 USC 1315a note.>>  Construction regarding 
        telehealth services.--Nothing in the provisions of, or 
        amendments made by, this title shall be construed as precluding 
        an alternative payment model or a qualifying APM participant (as 
        those terms are

[[Page 129 STAT. 123]]

        defined in section 1833(z) of the Social Security Act, as added 
        by paragraph (1)) from furnishing a telehealth service for which 
        payment is not made under section 1834(m) of the Social Security 
        Act (42 U.S.C. 1395m(m)).
            (6) <<NOTE: Deadline. Study.>>  Integrating medicare 
        advantage alternative payment models.--Not later than July 1, 
        2016, the Secretary of Health and Human Services shall submit to 
        Congress a study that examines the feasibility of integrating 
        alternative payment models in the Medicare Advantage payment 
        system. The study shall include the feasibility of including a 
        value-based modifier and whether such modifier should be budget 
        neutral.
            (7) Study and report on fraud related to alternative payment 
        models under the medicare program.--
                    (A) <<NOTE: Consultation.>>  Study.--The Secretary 
                of Health and Human Services, in consultation with the 
                Inspector General of the Department of Health and Human 
                Services, shall conduct a study that--
                          (i) examines the applicability of the Federal 
                      fraud prevention laws to items and services 
                      furnished under title XVIII of the Social Security 
                      Act for which payment is made under an alternative 
                      payment model (as defined in section 1833(z)(3)(C) 
                      of such Act (42 U.S.C. 1395l(z)(3)(C)));
                          (ii) identifies aspects of such alternative 
                      payment models that are vulnerable to fraudulent 
                      activity; and
                          (iii) examines the implications of waivers to 
                      such laws granted in support of such alternative 
                      payment models, including under any potential 
                      expansion of such models.
                    (B) Report.--Not later than 2 years after the date 
                of the enactment of this Act, the Secretary shall submit 
                to Congress a report containing the results of the study 
                conducted under subparagraph (A). <<NOTE: Recommenda- 
                tions.>> Such report shall include recommendations for 
                actions to be taken to reduce the vulnerability of such 
                alternative payment models to fraudulent activity. Such 
                report also shall include, as appropriate, 
                recommendations of the Inspector General for changes in 
                Federal fraud prevention laws to reduce such 
                vulnerability.

    (f) Collaborating With the Physician, Practitioner, and Other 
Stakeholder Communities To Improve Resource Use Measurement.--Section 
1848 of the Social Security Act (42 U.S.C. 1395w-4), as amended by 
subsection (c), is further amended by adding at the end the following 
new subsection:
    ``(r) Collaborating With the Physician, Practitioner, and Other 
Stakeholder Communities To Improve Resource Use Measurement.--
            ``(1) In general.--In order to involve the physician, 
        practitioner, and other stakeholder communities in enhancing the 
        infrastructure for resource use measurement, including for 
        purposes of the Merit-based Incentive Payment System under 
        subsection (q) and alternative payment models under section 
        1833(z), the Secretary shall undertake the steps described in 
        the succeeding provisions of this subsection.
            ``(2) Development of care episode and patient condition 
        groups and classification codes.--

[[Page 129 STAT. 124]]

                    ``(A) In general.--In order to classify similar 
                patients into care episode groups and patient condition 
                groups, the Secretary shall undertake the steps 
                described in the succeeding provisions of this 
                paragraph.
                    ``(B) Public availability of existing efforts to 
                design an episode grouper.--Not <<NOTE: Deadline. Web 
                posting.>> later than 180 days after the date of the 
                enactment of this subsection, the Secretary shall post 
                on the Internet website of the Centers for Medicare & 
                Medicaid Services a list of the episode groups developed 
                pursuant to subsection (n)(9)(A) and related descriptive 
                information.
                    ``(C) <<NOTE: Comment period.>>  Stakeholder 
                input.--The Secretary shall accept, through the date 
                that is 120 days after the day the Secretary posts the 
                list pursuant to subparagraph (B), suggestions from 
                physician specialty societies, applicable practitioner 
                organizations, and other stakeholders for episode groups 
                in addition to those posted pursuant to such 
                subparagraph, and specific clinical criteria and patient 
                characteristics to classify patients into--
                          ``(i) care episode groups; and
                          ``(ii) patient condition groups.
                    ``(D) Development of proposed classification 
                codes.--
                          ``(i) In general.--Taking into account the 
                      information described in subparagraph (B) and the 
                      information received under subparagraph (C), the 
                      Secretary shall--
                                    ``(I) establish care episode groups 
                                and patient condition groups, which 
                                account for a target of an estimated \1/
                                2\ of expenditures under parts A and B 
                                (with such target increasing over time 
                                as appropriate); and
                                    ``(II) assign codes to such groups.
                          ``(ii) Care episode groups.--In establishing 
                      the care episode groups under clause (i), the 
                      Secretary shall take into account--
                                    ``(I) the patient's clinical 
                                problems at the time items and services 
                                are furnished during an episode of care, 
                                such as the clinical conditions or 
                                diagnoses, whether or not inpatient 
                                hospitalization occurs, and the 
                                principal procedures or services 
                                furnished; and
                                    ``(II) other factors determined 
                                appropriate by the Secretary.
                          ``(iii) Patient condition groups.--In 
                      establishing the patient condition groups under 
                      clause (i), the Secretary shall take into 
                      account--
                                    ``(I) the patient's clinical history 
                                at the time of a medical visit, such as 
                                the patient's combination of chronic 
                                conditions, current health status, and 
                                recent significant history (such as 
                                hospitalization and major surgery during 
                                a previous period, such as 3 months); 
                                and
                                    ``(II) other factors determined 
                                appropriate by the Secretary, such as 
                                eligibility status under this title 
                                (including eligibility under section 
                                226(a), 226(b), or 226A, and dual 
                                eligibility under this title and title 
                                XIX).

[[Page 129 STAT. 125]]

                    ``(E) Draft care episode and patient condition 
                groups and classification codes.--
                Not <<NOTE: Deadline. Web posting.>> later than 270 days 
                after the end of the comment period described in 
                subparagraph (C), the Secretary shall post on the 
                Internet website of the Centers for Medicare & Medicaid 
                Services a draft list of the care episode and patient 
                condition codes established under subparagraph (D) (and 
                the criteria and characteristics assigned to such code).
                    ``(F) <<NOTE: Comment period.>>  Solicitation of 
                input.--The Secretary shall seek, through the date that 
                is 120 days after the Secretary posts the list pursuant 
                to subparagraph (E), comments from physician specialty 
                societies, applicable practitioner organizations, and 
                other stakeholders, including representatives of 
                individuals entitled to benefits under part A or 
                enrolled under this part, regarding the care episode and 
                patient condition groups (and codes) posted under 
                subparagraph (E). In seeking such comments, the 
                Secretary shall use one or more mechanisms (other than 
                notice and comment rulemaking) that may include use of 
                open door forums, town hall meetings, or other 
                appropriate mechanisms.
                    ``(G) Operational list of care episode and patient 
                condition groups and codes.--Not <<NOTE: Deadline. Web 
                posting.>> later than 270 days after the end of the 
                comment period described in subparagraph (F), taking 
                into account the comments received under such 
                subparagraph, the Secretary shall post on the Internet 
                website of the Centers for Medicare & Medicaid Services 
                an operational list of care episode and patient 
                condition codes (and the criteria and characteristics 
                assigned to such code).
                    ``(H) <<NOTE: Deadline. Effective 
                date. Regulations.>>  Subsequent revisions.--Not later 
                than November 1 of each year (beginning with 2018), the 
                Secretary shall, through rulemaking, make revisions to 
                the operational lists of care episode and patient 
                condition codes as the Secretary determines may be 
                appropriate. Such revisions may be based on experience, 
                new information developed pursuant to subsection 
                (n)(9)(A), and input from the physician specialty 
                societies, applicable practitioner organizations, and 
                other stakeholders, including representatives of 
                individuals entitled to benefits under part A or 
                enrolled under this part.
            ``(3) Attribution of patients to physicians or 
        practitioners.--
                    ``(A) In general.--In order to facilitate the 
                attribution of patients and episodes (in whole or in 
                part) to one or more physicians or applicable 
                practitioners furnishing items and services, the 
                Secretary shall undertake the steps described in the 
                succeeding provisions of this paragraph.
                    ``(B) Development of patient relationship categories 
                and codes.--The Secretary shall develop patient 
                relationship categories and codes that define and 
                distinguish the relationship and responsibility of a 
                physician or applicable practitioner with a patient at 
                the time of furnishing an item or service. Such patient 
                relationship categories shall include different 
                relationships of the physician or applicable 
                practitioner to the patient (and the codes

[[Page 129 STAT. 126]]

                may reflect combinations of such categories), such as a 
                physician or applicable practitioner who--
                          ``(i) considers themself to have the primary 
                      responsibility for the general and ongoing care 
                      for the patient over extended periods of time;
                          ``(ii) considers themself to be the lead 
                      physician or practitioner and who furnishes items 
                      and services and coordinates care furnished by 
                      other physicians or practitioners for the patient 
                      during an acute episode;
                          ``(iii) furnishes items and services to the 
                      patient on a continuing basis during an acute 
                      episode of care, but in a supportive rather than a 
                      lead role;
                          ``(iv) furnishes items and services to the 
                      patient on an occasional basis, usually at the 
                      request of another physician or practitioner; or
                          ``(v) furnishes items and services only as 
                      ordered by another physician or practitioner.
                    ``(C) <<NOTE: Deadline. Web posting.>>  Draft list 
                of patient relationship categories and codes.--Not later 
                than one year after the date of the enactment of this 
                subsection, the Secretary shall post on the Internet 
                website of the Centers for Medicare & Medicaid Services 
                a draft list of the patient relationship categories and 
                codes developed under subparagraph (B).
                    ``(D) <<NOTE: Comment period.>>  Stakeholder 
                input.--The Secretary shall seek, through the date that 
                is 120 days after the Secretary posts the list pursuant 
                to subparagraph (C), comments from physician specialty 
                societies, applicable practitioner organizations, and 
                other stakeholders, including representatives of 
                individuals entitled to benefits under part A or 
                enrolled under this part, regarding the patient 
                relationship categories and codes posted under 
                subparagraph (C). In seeking such comments, the 
                Secretary shall use one or more mechanisms (other than 
                notice and comment rulemaking) that may include open 
                door forums, town hall meetings, web-based forums, or 
                other appropriate mechanisms.
                    ``(E) Operational list of patient relationship 
                categories and codes.--Not <<NOTE: Deadline. Web 
                posting.>> later than 240 days after the end of the 
                comment period described in subparagraph (D), taking 
                into account the comments received under such 
                subparagraph, the Secretary shall post on the Internet 
                website of the Centers for Medicare & Medicaid Services 
                an operational list of patient relationship categories 
                and codes.
                    ``(F) <<NOTE: Deadline. Effective 
                date. Regulations.>>  Subsequent revisions.--Not later 
                than November 1 of each year (beginning with 2018), the 
                Secretary shall, through rulemaking, make revisions to 
                the operational list of patient relationship categories 
                and codes as the Secretary determines appropriate. Such 
                revisions may be based on experience, new information 
                developed pursuant to subsection (n)(9)(A), and input 
                from the physician specialty societies, applicable 
                practitioner organizations, and other stakeholders, 
                including representatives of individuals entitled to 
                benefits under part A or enrolled under this part.

[[Page 129 STAT. 127]]

            ``(4) Reporting of information for resource use 
        measurement.--Claims <<NOTE: Claims. Effective date.>> submitted 
        for items and services furnished by a physician or applicable 
        practitioner on or after January 1, 2018, shall, as determined 
        appropriate by the Secretary, include--
                    ``(A) applicable codes established under paragraphs 
                (2) and (3); and
                    ``(B) the national provider identifier of the 
                ordering physician or applicable practitioner (if 
                different from the billing physician or applicable 
                practitioner).
            ``(5) Methodology for resource use analysis.--
                    ``(A) In general.--In order to evaluate the 
                resources used to treat patients (with respect to care 
                episode and patient condition groups), the Secretary 
                shall, as the Secretary determines appropriate--
                          ``(i) use the patient relationship codes 
                      reported on claims pursuant to paragraph (4) to 
                      attribute patients (in whole or in part) to one or 
                      more physicians and applicable practitioners;
                          ``(ii) use the care episode and patient 
                      condition codes reported on claims pursuant to 
                      paragraph (4) as a basis to compare similar 
                      patients and care episodes and patient condition 
                      groups; and
                          ``(iii) conduct an analysis of resource use 
                      (with respect to care episodes and patient 
                      condition groups of such patients).
                    ``(B) Analysis of patients of physicians and 
                practitioners.--In conducting the analysis described in 
                subparagraph (A)(iii) with respect to patients 
                attributed to physicians and applicable practitioners, 
                the Secretary shall, as feasible--
                          ``(i) <<NOTE: Time period.>>  use the claims 
                      data experience of such patients by patient 
                      condition codes during a common period, such as 12 
                      months; and
                          ``(ii) use the claims data experience of such 
                      patients by care episode codes--
                                    ``(I) in the case of episodes 
                                without a hospitalization, during 
                                periods of time (such as the number of 
                                days) determined appropriate by the 
                                Secretary; and
                                    ``(II) in the case of episodes with 
                                a hospitalization, during periods of 
                                time (such as the number of days) 
                                before, during, and after the 
                                hospitalization.
                    ``(C) Measurement of resource use.--In measuring 
                such resource use, the Secretary--
                          ``(i) shall use per patient total allowed 
                      charges for all services under part A and this 
                      part (and, if the Secretary determines 
                      appropriate, part D) for the analysis of patient 
                      resource use, by care episode codes and by patient 
                      condition codes; and
                          ``(ii) may, as determined appropriate, use 
                      other measures of allowed charges (such as 
                      subtotals for categories of items and services) 
                      and measures of utilization of items and services 
                      (such as frequency of specific items and services 
                      and the ratio of specific items and services among 
                      attributed patients or episodes).

[[Page 129 STAT. 128]]

                    ``(D) Stakeholder input.--The Secretary shall seek 
                comments from the physician specialty societies, 
                applicable practitioner organizations, and other 
                stakeholders, including representatives of individuals 
                entitled to benefits under part A or enrolled under this 
                part, regarding the resource use methodology established 
                pursuant to this paragraph. In seeking comments the 
                Secretary shall use one or more mechanisms (other than 
                notice and comment rulemaking) that may include open 
                door forums, town hall meetings, web-based forums, or 
                other appropriate mechanisms.
            ``(6) <<NOTE: Contracts.>>  Implementation.--To the extent 
        that the Secretary contracts with an entity to carry out any 
        part of the provisions of this subsection, the Secretary may not 
        contract with an entity or an entity with a subcontract if the 
        entity or subcontracting entity currently makes recommendations 
        to the Secretary on relative values for services under the fee 
        schedule for physicians' services under this section.
            ``(7) Limitation.--There shall be no administrative or 
        judicial review under section 1869, section 1878, or otherwise 
        of--
                    ``(A) care episode and patient condition groups and 
                codes established under paragraph (2);
                    ``(B) patient relationship categories and codes 
                established under paragraph (3); and
                    ``(C) measurement of, and analyses of resource use 
                with respect to, care episode and patient condition 
                codes and patient relationship codes pursuant to 
                paragraph (5).
            ``(8) Administration.--Chapter 35 of title 44, United States 
        Code, shall not apply to this section.
            ``(9) Definitions.--In this subsection:
                    ``(A) Physician.--The term `physician' has the 
                meaning given such term in section 1861(r)(1).
                    ``(B) Applicable practitioner.--The term `applicable 
                practitioner' means--
                          ``(i) a physician assistant, nurse 
                      practitioner, and clinical nurse specialist (as 
                      such terms are defined in section 1861(aa)(5)), 
                      and a certified registered nurse anesthetist (as 
                      defined in section 1861(bb)(2)); and
                          ``(ii) <<NOTE: Effective date.>>  beginning 
                      January 1, 2019, such other eligible professionals 
                      (as defined in subsection (k)(3)(B)) as specified 
                      by the Secretary.
            ``(10) Clarification.--The provisions of sections 1890(b)(7) 
        and 1890A shall not apply to this subsection.''.
SEC. 102. PRIORITIES AND FUNDING FOR MEASURE DEVELOPMENT.

    Section 1848 of the Social Security Act (42 U.S.C. 1395w-4), as 
amended by subsections (c) and (f) of section 101, is further amended by 
inserting at the end the following new subsection:
    ``(s) Priorities and Funding for Measure Development.--
            ``(1) Plan identifying measure development priorities and 
        timelines.--
                    ``(A) <<NOTE: Deadline. Plans.>>  Draft measure 
                development plan.--Not later than January 1, 2016, the 
                Secretary shall develop, and post on the Internet 
                website of the Centers for Medicare & Medicaid Services, 
                a draft plan for the development of quality measures for 
                application under the applicable

[[Page 129 STAT. 129]]

                provisions (as defined in paragraph (5)). Under such 
                plan the Secretary shall--
                          ``(i) address how measures used by private 
                      payers and integrated delivery systems could be 
                      incorporated under title XVIII;
                          ``(ii) describe how coordination, to the 
                      extent possible, will occur across organizations 
                      developing such measures; and
                          ``(iii) take into account how clinical best 
                      practices and clinical practice guidelines should 
                      be used in the development of quality measures.
                    ``(B) <<NOTE: Definitions.>>  Quality domains.--For 
                purposes of this subsection, the term `quality domains' 
                means at least the following domains:
                          ``(i) Clinical care.
                          ``(ii) Safety.
                          ``(iii) Care coordination.
                          ``(iv) Patient and caregiver experience.
                          ``(v) Population health and prevention.
                    ``(C) <<NOTE: Plans.>>  Consideration.--In 
                developing the draft plan under this paragraph, the 
                Secretary shall consider--
                          ``(i) gap analyses conducted by the entity 
                      with a contract under section 1890(a) or other 
                      contractors or entities;
                          ``(ii) whether measures are applicable across 
                      health care settings;
                          ``(iii) clinical practice improvement 
                      activities submitted under subsection 
                      (q)(2)(C)(iv) for identifying possible areas for 
                      future measure development and identifying 
                      existing gaps with respect to such measures; and
                          ``(iv) the quality domains applied under this 
                      subsection.
                    ``(D) <<NOTE: Plans.>>  Priorities.--In developing 
                the draft plan under this paragraph, the Secretary shall 
                give priority to the following types of measures:
                          ``(i) Outcome measures, including patient 
                      reported outcome and functional status measures.
                          ``(ii) Patient experience measures.
                          ``(iii) Care coordination measures.
                          ``(iv) Measures of appropriate use of 
                      services, including measures of over use.
                    ``(E) <<NOTE: Deadline. Comment period.>>  
                Stakeholder input.--The Secretary shall accept through 
                March 1, 2016, comments on the draft plan posted under 
                paragraph (1)(A) from the public, including health care 
                providers, payers, consumers, and other stakeholders.
                    ``(F) <<NOTE: Deadline. Web posting.>>  Final 
                measure development plan.--Not later than May 1, 2016, 
                taking into account the comments received under this 
                subparagraph, the Secretary shall finalize the plan and 
                post on the Internet website of the Centers for Medicare 
                & Medicaid Services an operational plan for the 
                development of quality measures for use under the 
                applicable provisions. Such plan shall be updated as 
                appropriate.
            ``(2) Contracts and other arrangements for quality measure 
        development.--

[[Page 129 STAT. 130]]

                    ``(A) In general.--The Secretary shall enter into 
                contracts or other arrangements with entities for the 
                purpose of developing, improving, updating, or expanding 
                in accordance with the plan under paragraph (1) quality 
                measures for application under the applicable 
                provisions. Such entities shall include organizations 
                with quality measure development expertise.
                    ``(B) Prioritization.--
                          ``(i) In general.--In entering into contracts 
                      or other arrangements under subparagraph (A), the 
                      Secretary shall give priority to the development 
                      of the types of measures described in paragraph 
                      (1)(D).
                          ``(ii) Consideration.--In selecting measures 
                      for development under this subsection, the 
                      Secretary shall consider--
                                    ``(I) whether such measures would be 
                                electronically specified; and
                                    ``(II) clinical practice guidelines 
                                to the extent that such guidelines 
                                exist.
            ``(3) Annual report by the secretary.--
                    ``(A) <<NOTE: Web posting.>>  In general.--Not later 
                than May 1, 2017, and annually thereafter, the Secretary 
                shall post on the Internet website of the Centers for 
                Medicare & Medicaid Services a report on the progress 
                made in developing quality measures for application 
                under the applicable provisions.
                    ``(B) Requirements.--Each report submitted pursuant 
                to subparagraph (A) shall include the following:
                          ``(i) A description of the Secretary's efforts 
                      to implement this paragraph.
                          ``(ii) With respect to the measures developed 
                      during the previous year--
                                    ``(I) a description of the total 
                                number of quality measures developed and 
                                the types of such measures, such as an 
                                outcome or patient experience measure;
                                    ``(II) the name of each measure 
                                developed;
                                    ``(III) the name of the developer 
                                and steward of each measure;
                                    ``(IV) with respect to each type of 
                                measure, an estimate of the total amount 
                                expended under this title to develop all 
                                measures of such type; and
                                    ``(V) whether the measure would be 
                                electronically specified.
                          ``(iii) With respect to measures in 
                      development at the time of the report--
                                    ``(I) the information described in 
                                clause (ii), if available; and
                                    ``(II) a timeline for completion of 
                                the development of such measures.
                          ``(iv) A description of any updates to the 
                      plan under paragraph (1) (including newly 
                      identified gaps and the status of previously 
                      identified gaps) and the inventory of measures 
                      applicable under the applicable provisions.
                          ``(v) Other information the Secretary 
                      determines to be appropriate.

[[Page 129 STAT. 131]]

            ``(4) Stakeholder input.--With respect to paragraph (1), the 
        Secretary shall seek stakeholder input with respect to--
                    ``(A) the identification of gaps where no quality 
                measures exist, particularly with respect to the types 
                of measures described in paragraph (1)(D);
                    ``(B) prioritizing quality measure development to 
                address such gaps; and
                    ``(C) other areas related to quality measure 
                development determined appropriate by the Secretary.
            ``(5) Definition of applicable provisions.--In this 
        subsection, the term `applicable provisions' means the following 
        provisions:
                    ``(A) Subsection (q)(2)(B)(i).
                    ``(B) Section 1833(z)(2)(C).
            ``(6) Funding.--For purposes of carrying out this 
        subsection, the Secretary shall provide for the transfer, from 
        the Federal Supplementary Medical Insurance Trust Fund under 
        section 1841, of $15,000,000 to the Centers for Medicare & 
        Medicaid Services Program Management Account for each of fiscal 
        years 2015 through 2019. Amounts transferred under this 
        paragraph shall remain available through the end of fiscal year 
        2022.
            ``(7) Administration.--Chapter 35 of title 44, United States 
        Code, shall not apply to the collection of information for the 
        development of quality measures.''.
SEC. 103. ENCOURAGING CARE MANAGEMENT FOR INDIVIDUALS WITH CHRONIC 
                        CARE NEEDS.

    (a) In General.--Section 1848(b) of the Social Security Act (42 
U.S.C. 1395w-4(b)) is amended by adding at the end the following new 
paragraph:
            ``(8) Encouraging care management for individuals with 
        chronic care needs.--
                    ``(A) <<NOTE: Effective date.>>  In general.--In 
                order to encourage the management of care for 
                individuals with chronic care needs the Secretary shall, 
                subject to subparagraph (B), make payment (as the 
                Secretary determines to be appropriate) under this 
                section for chronic care management services furnished 
                on or after January 1, 2015, by a physician (as defined 
                in section 1861(r)(1)), physician assistant or nurse 
                practitioner (as defined in section 1861(aa)(5)(A)), 
                clinical nurse specialist (as defined in section 
                1861(aa)(5)(B)), or certified nurse midwife (as defined 
                in section 1861(gg)(2)).
                    ``(B) Policies relating to payment.--In carrying out 
                this paragraph, with respect to chronic care management 
                services, the Secretary shall--
                          ``(i) make payment to only one applicable 
                      provider for such services furnished to an 
                      individual during a period;
                          ``(ii) not make payment under subparagraph (A) 
                      if such payment would be duplicative of payment 
                      that is otherwise made under this title for such 
                      services; and
                          ``(iii) not require that an annual wellness 
                      visit (as defined in section 1861(hhh)) or an 
                      initial preventive physical examination (as 
                      defined in section

[[Page 129 STAT. 132]]

                      1861(ww)) be furnished as a condition of payment 
                      for such management services.''.

    (b) Education and Outreach.--
            (1) <<NOTE: 42 USC 1395w-4 note.>>  Campaign.--
                    (A) In general.--The Secretary of Health and Human 
                Services (in this subsection referred to as the 
                ``Secretary'') shall conduct an education and outreach 
                campaign to inform professionals who furnish items and 
                services under part B of title XVIII of the Social 
                Security Act and individuals enrolled under such part of 
                the benefits of chronic care management services 
                described in section 1848(b)(8) of the Social Security 
                Act, as added by subsection (a), and encourage such 
                individuals with chronic care needs to receive such 
                services.
                    (B) Requirements.--Such campaign shall--
                          (i) be directed by the Office of Rural Health 
                      Policy of the Department of Health and Human 
                      Services and the Office of Minority Health of the 
                      Centers for Medicare & Medicaid Services; and
                          (ii) focus on encouraging participation by 
                      underserved rural populations and racial and 
                      ethnic minority populations.
            (2) Report.--Not later than December 31, 2017, the Secretary 
        shall submit to Congress a report on the use of chronic care 
        management services described in such section 1848(b)(8) by 
        individuals living in rural areas and by racial and ethnic 
        minority populations. Such report shall--
                    (A) identify barriers to receiving chronic care 
                management services; and
                    (B) <<NOTE: Recommenda- tions.>>  make 
                recommendations for increasing the appropriate use of 
                chronic care management services.
SEC. 104. <<NOTE: 42 USC 1395w-6.>>  EMPOWERING BENEFICIARY 
                        CHOICES THROUGH CONTINUED ACCESS TO 
                        INFORMATION ON PHYSICIANS' SERVICES.

    (a) <<NOTE: Deadlines. Effective date. Public information.>>  In 
General.--On an annual basis (beginning with 2015), the Secretary shall 
make publicly available, in an easily understandable format, information 
with respect to physicians and, as appropriate, other eligible 
professionals on items and services furnished to Medicare beneficiaries 
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).

    (b) Type and Manner of Information.--The information made available 
under this section shall be similar to the type of information in the 
Medicare Provider Utilization and Payment Data: Physician and Other 
Supplier Public Use File released by the Secretary with respect to 2012 
and shall be made available in a manner similar to the manner in which 
the information in such file is made available.
    (c) Requirements.--The information made available under this section 
shall include, at a minimum, the following:
            (1) Information on the number of services furnished by the 
        physician or other eligible professional under part B of title 
        XVIII of the Social Security Act (42 U.S.C. 1395j et seq.), 
        which may include information on the most frequent services 
        furnished or groupings of services.
            (2) Information on submitted charges and payments for 
        services under such part.

[[Page 129 STAT. 133]]

            (3) A unique identifier for the physician or other eligible 
        professional that is available to the public, such as a national 
        provider identifier.

    (d) Searchability.--The information made available under this 
section shall be searchable by at least the following:
            (1) The specialty or type of the physician or other eligible 
        professional.
            (2) Characteristics of the services furnished, such as 
        volume or groupings of services.
            (3) The location of the physician or other eligible 
        professional.

    (e) <<NOTE: Effective date.>>  Integration on Physician Compare.--
Beginning with 2016, the Secretary shall integrate the information made 
available under this section on Physician Compare.

    (f) Definitions.--In this section:
            (1) Eligible professional; physician; secretary.--The terms 
        ``eligible professional'', ``physician'', and ``Secretary'' have 
        the meaning given such terms in section 10331(i) of Public Law 
        111-148.
            (2) Physician compare.--The term ``Physician Compare'' means 
        the Physician Compare Internet website of the Centers for 
        Medicare & Medicaid Services (or a successor website).
SEC. 105. <<NOTE: 42 USC 1395kk-2.>>  EXPANDING AVAILABILITY OF 
                        MEDICARE DATA.

    (a) Expanding Uses of Medicare Data by Qualified Entities.--
            (1) Additional analyses.--
                    (A) <<NOTE: Effective date.>>  In general.--Subject 
                to subparagraph (B), to the extent consistent with 
                applicable information, privacy, security, and 
                disclosure laws (including paragraph (3)), 
                notwithstanding paragraph (4)(B) of section 1874(e) of 
                the Social Security Act (42 U.S.C. 1395kk(e)) and the 
                second sentence of paragraph (4)(D) of such section, 
                beginning July 1, 2016, a qualified entity may use the 
                combined data described in paragraph (4)(B)(iii) of such 
                section received by such entity under such section, and 
                information derived from the evaluation described in 
                such paragraph (4)(D), to conduct additional non-public 
                analyses (as determined appropriate by the Secretary) 
                and provide or sell such analyses to authorized users 
                for non-public use (including for the purposes of 
                assisting providers of services and suppliers to develop 
                and participate in quality and patient care improvement 
                activities, including developing new models of care).
                    (B) Limitations with respect to analyses.--
                          (i) Employers.--Any analyses provided or sold 
                      under subparagraph (A) to an employer described in 
                      paragraph (9)(A)(iii) may only be used by such 
                      employer for purposes of providing health 
                      insurance to employees and retirees of the 
                      employer.
                          (ii) Health insurance issuers.--A qualified 
                      entity may not provide or sell an analysis to a 
                      health insurance issuer described in paragraph 
                      (9)(A)(iv) unless the issuer is providing the 
                      qualified entity with data under section 
                      1874(e)(4)(B)(iii) of the Social Security Act (42 
                      U.S.C. 1395kk(e)(4)(B)(iii)).
            (2) Access to certain data.--

[[Page 129 STAT. 134]]

                    (A) <<NOTE: Effective date.>>  Access.--To the 
                extent consistent with applicable information, privacy, 
                security, and disclosure laws (including paragraph (3)), 
                notwithstanding paragraph (4)(B) of section 1874(e) of 
                the Social Security Act (42 U.S.C. 1395kk(e)) and the 
                second sentence of paragraph (4)(D) of such section, 
                beginning July 1, 2016, a qualified entity may--
                          (i) provide or sell the combined data 
                      described in paragraph (4)(B)(iii) of such section 
                      to authorized users described in clauses (i), 
                      (ii), and (v) of paragraph (9)(A) for non-public 
                      use, including for the purposes described in 
                      subparagraph (B); or
                          (ii) subject to subparagraph (C), provide 
                      Medicare claims data to authorized users described 
                      in clauses (i), (ii), and (v), of paragraph (9)(A) 
                      for non-public use, including for the purposes 
                      described in subparagraph (B).
                    (B) Purposes described.--The purposes described in 
                this subparagraph are assisting providers of services 
                and suppliers in developing and participating in quality 
                and patient care improvement activities, including 
                developing new models of care.
                    (C) Medicare claims data must be provided at no 
                cost.--A qualified entity may not charge a fee for 
                providing the data under subparagraph (A)(ii).
            (3) Protection of information.--
                    (A) In general.--Except as provided in subparagraph 
                (B), an analysis or data that is provided or sold under 
                paragraph (1) or (2) shall not contain information that 
                individually identifies a patient.
                    (B) Information on patients of the provider of 
                services or supplier.--To the extent consistent with 
                applicable information, privacy, security, and 
                disclosure laws, an analysis or data that is provided or 
                sold to a provider of services or supplier under 
                paragraph (1) or (2) may contain information that 
                individually identifies a patient of such provider or 
                supplier, including with respect to items and services 
                furnished to the patient by other providers of services 
                or suppliers.
                    (C) Prohibition on using analyses or data for 
                marketing purposes.--An authorized user shall not use an 
                analysis or data provided or sold under paragraph (1) or 
                (2) for marketing purposes.
            (4) Data use agreement.--A qualified entity and an 
        authorized user described in clauses (i), (ii), and (v) of 
        paragraph (9)(A) shall enter into an agreement regarding the use 
        of any data that the qualified entity is providing or selling to 
        the authorized user under paragraph (2). Such agreement shall 
        describe the requirements for privacy and security of the data 
        and, as determined appropriate by the Secretary, any 
        prohibitions on using such data to link to other individually 
        identifiable sources of information. If the authorized user is 
        not a covered entity under the rules promulgated pursuant to the 
        Health Insurance Portability and Accountability Act of 1996, the 
        agreement shall identify the relevant regulations, as determined 
        by the Secretary, that the user shall comply

[[Page 129 STAT. 135]]

        with as if it were acting in the capacity of such a covered 
        entity.
            (5) No redisclosure of analyses or data.--
                    (A) In general.--Except as provided in subparagraph 
                (B), an authorized user that is provided or sold an 
                analysis or data under paragraph (1) or (2) shall not 
                redisclose or make public such analysis or data or any 
                analysis using such data.
                    (B) Permitted redisclosure.--A provider of services 
                or supplier that is provided or sold an analysis or data 
                under paragraph (1) or (2) may, as determined by the 
                Secretary, redisclose such analysis or data for the 
                purposes of performance improvement and care 
                coordination activities but shall not make public such 
                analysis or data or any analysis using such data.
            (6) Opportunity for providers of services and suppliers to 
        review.--Prior to a qualified entity providing or selling an 
        analysis to an authorized user under paragraph (1), to the 
        extent that such analysis would individually identify a provider 
        of services or supplier who is not being provided or sold such 
        analysis, such qualified entity shall provide such provider or 
        supplier with the opportunity to appeal and correct errors in 
        the manner described in section 1874(e)(4)(C)(ii) of the Social 
        Security Act (42 U.S.C. 1395kk(e)(4)(C)(ii)).
            (7) Assessment for a breach.--
                    (A) In general.--In the case of a breach of a data 
                use agreement under this section or section 1874(e) of 
                the Social Security Act (42 U.S.C. 1395kk(e)), the 
                Secretary shall impose an assessment on the qualified 
                entity both in the case of--
                          (i) an agreement between the Secretary and a 
                      qualified entity; and
                          (ii) an agreement between a qualified entity 
                      and an authorized user.
                    (B) Assessment.--The assessment under subparagraph 
                (A) shall be an amount up to $100 for each individual 
                entitled to, or enrolled for, benefits under part A of 
                title XVIII of the Social Security Act or enrolled for 
                benefits under part B of such title--
                          (i) in the case of an agreement described in 
                      subparagraph (A)(i), for whom the Secretary 
                      provided data on to the qualified entity under 
                      paragraph (2); and
                          (ii) in the case of an agreement described in 
                      subparagraph (A)(ii), for whom the qualified 
                      entity provided data on to the authorized user 
                      under paragraph (2).
                    (C) Deposit of amounts collected.--Any amounts 
                collected pursuant to this paragraph shall be deposited 
                in Federal Supplementary Medical Insurance Trust Fund 
                under section 1841 of the Social Security Act (42 U.S.C. 
                1395t).
            (8) Annual reports.--Any qualified entity that provides or 
        sells an analysis or data under paragraph (1) or (2) shall 
        annually submit to the Secretary a report that includes--
                    (A) a summary of the analyses provided or sold, 
                including the number of such analyses, the number of

[[Page 129 STAT. 136]]

                purchasers of such analyses, and the total amount of 
                fees received for such analyses;
                    (B) a description of the topics and purposes of such 
                analyses;
                    (C) information on the entities who received the 
                data under paragraph (2), the uses of the data, and the 
                total amount of fees received for providing, selling, or 
                sharing the data; and
                    (D) other information determined appropriate by the 
                Secretary.
            (9) Definitions.--In this subsection and subsection (b):
                    (A) Authorized user.--The term ``authorized user'' 
                means the following:
                          (i) A provider of services.
                          (ii) A supplier.
                          (iii) An employer (as defined in section 3(5) 
                      of the Employee Retirement Insurance Security Act 
                      of 1974).
                          (iv) A health insurance issuer (as defined in 
                      section 2791 of the Public Health Service Act).
                          (v) A medical society or hospital association.
                          (vi) Any entity not described in clauses (i) 
                      through (v) that is approved by the Secretary 
                      (other than an employer or health insurance issuer 
                      not described in clauses (iii) and (iv), 
                      respectively, as determined by the Secretary).
                    (B) Provider of services.--The term ``provider of 
                services'' has the meaning given such term in section 
                1861(u) of the Social Security Act (42 U.S.C. 1395x(u)).
                    (C) Qualified entity.--The term ``qualified entity'' 
                has the meaning given such term in section 1874(e)(2) of 
                the Social Security Act (42 U.S.C. 1395kk(e)).
                    (D) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services.
                    (E) Supplier.--The term ``supplier'' has the meaning 
                given such term in section 1861(d) of the Social 
                Security Act (42 U.S.C. 1395x(d)).

    (b) Access to Medicare Data by Qualified Clinical Data Registries To 
Facilitate Quality Improvement.--
            (1) Access.--
                    (A) <<NOTE: Effective date.>>  In general.--To the 
                extent consistent with applicable information, privacy, 
                security, and disclosure laws, beginning July 1, 2016, 
                the Secretary shall, at the request of a qualified 
                clinical data registry under section 1848(m)(3)(E) of 
                the Social Security Act (42 U.S.C. 1395w-4(m)(3)(E)), 
                provide the data described in subparagraph (B) (in a 
                form and manner determined to be appropriate) to such 
                qualified clinical data registry for purposes of linking 
                such data with clinical outcomes data and performing 
                risk-adjusted, scientifically valid analyses and 
                research to support quality improvement or patient 
                safety, provided that any public reporting of such 
                analyses or research that identifies a provider of 
                services or supplier shall only be conducted with the 
                opportunity of such provider or supplier to appeal and 
                correct errors in the manner described in subsection 
                (a)(6).

[[Page 129 STAT. 137]]

                    (B) Data described.--The data described in this 
                subparagraph is--
                          (i) claims data under the Medicare program 
                      under title XVIII of the Social Security Act; and
                          (ii) if the Secretary determines appropriate, 
                      claims data under the Medicaid program under title 
                      XIX of such Act and the State Children's Health 
                      Insurance Program under title XXI of such Act.
            (2) Fee.--Data described in paragraph (1)(B) shall be 
        provided to a qualified clinical data registry under paragraph 
        (1) at a fee equal to the cost of providing such data. Any fee 
        collected pursuant to the preceding sentence shall be deposited 
        in the Centers for Medicare & Medicaid Services Program 
        Management Account.

    (c) Expansion of Data Available to Qualified Entities.--Section 
1874(e) of the Social Security Act (42 U.S.C. 1395kk(e)) is amended--
            (1) in the subsection heading, by striking ``Medicare''; and
            (2) in paragraph (3)--
                    (A) <<NOTE: Effective date.>>  by inserting after 
                the first sentence the following new sentence: 
                ``Beginning July 1, 2016, if the Secretary determines 
                appropriate, the data described in this paragraph may 
                also include standardized extracts (as determined by the 
                Secretary) of claims data under titles XIX and XXI for 
                assistance provided under such titles for one or more 
                specified geographic areas and time periods requested by 
                a qualified entity.''; and
                    (B) in the last sentence, by inserting ``or under 
                titles XIX or XXI'' before the period at the end.

    (d) Revision of Placement of Fees.--Section 1874(e)(4)(A) of the 
Social Security Act (42 U.S.C. 1395kk(e)(4)(A)) is amended, in the 
second sentence--
            (1) by inserting ``, for periods prior to July 1, 2016,'' 
        after ``deposited''; and
            (2) by inserting the following before the period at the end: 
        ``, and, beginning July 1, 2016, into the Centers for Medicare & 
        Medicaid Services Program Management Account''.
SEC. 106. REDUCING ADMINISTRATIVE BURDEN AND OTHER PROVISIONS.

    (a) Medicare Physician and Practitioner Opt-Out to Private 
Contract.--
            (1) Indefinite, continuing automatic extension of opt out 
        election.--
                    (A) <<NOTE: Time periods.>>  In general.--Section 
                1802(b)(3) of the Social Security Act (42 U.S.C. 
                1395a(b)(3)) is amended--
                          (i) in subparagraph (B)(ii), by striking 
                      ``during the 2-year period beginning on the date 
                      the affidavit is signed'' and inserting ``during 
                      the applicable 2-year period (as defined in 
                      subparagraph (D))'';
                          (ii) in subparagraph (C), by striking ``during 
                      the 2-year period described in subparagraph 
                      (B)(ii)'' and inserting ``during the applicable 2-
                      year period''; and
                          (iii) by adding at the end the following new 
                      subparagraph:
                    ``(D) Applicable 2-year periods for effectiveness of 
                affidavits.--In <<NOTE: Definition.>> this subsection, 
                the term `applicable

[[Page 129 STAT. 138]]

                2-year period' means, with respect to an affidavit of a 
                physician or practitioner under subparagraph (B), the 2-
                year period beginning on the date the affidavit is 
                signed and includes each subsequent 2-year period unless 
                the physician or practitioner involved provides notice 
                to the Secretary (in a form and manner specified by the 
                Secretary), not later than 30 days before the end of the 
                previous 2-year period, that the physician or 
                practitioner does not want to extend the application of 
                the affidavit for such subsequent 2-year period.''.
                    (B) <<NOTE: Applicability. 42 USC 1395a note.>>  
                Effective date.--The amendments made by subparagraph (A) 
                shall apply to affidavits entered into on or after the 
                date that is 60 days after the date of the enactment of 
                this Act.
            (2) Public availability of information on opt-out physicians 
        and practitioners.--Section 1802(b) of the Social Security Act 
        (42 U.S.C. 1395a(b)) is amended--
                    (A) in paragraph (5), by adding at the end the 
                following new subparagraph:
            ``(D) <<NOTE: Definition.>>  Opt-out physician or 
        practitioner.--The term `opt-out physician or practitioner' 
        means a physician or practitioner who has in effect an affidavit 
        under paragraph (3)(B).'';
                    (B) by redesignating paragraph (5) as paragraph (6); 
                and
                    (C) by inserting after paragraph (4) the following 
                new paragraph:
            ``(5) Posting of information on opt-out physicians and 
        practitioners.--
                    ``(A) <<NOTE: Effective date. Public information.>>  
                In general.--Beginning not later than February 1, 2016, 
                the Secretary shall make publicly available through an 
                appropriate publicly accessible website of the 
                Department of Health and Human Services information on 
                the number and characteristics of opt-out physicians and 
                practitioners and shall update such information on such 
                website not less often than annually.
                    ``(B) Information to be included.--The information 
                to be made available under subparagraph (A) shall 
                include at least the following with respect to opt-out 
                physicians and practitioners:
                          ``(i) Their number.
                          ``(ii) Their physician or professional 
                      specialty or other designation.
                          ``(iii) Their geographic distribution.
                          ``(iv) <<NOTE: Time period.>>  The timing of 
                      their becoming opt-out physicians and 
                      practitioners, relative, to the extent feasible, 
                      to when they first enrolled in the program under 
                      this title and with respect to applicable 2-year 
                      periods.
                          ``(v) The proportion of such physicians and 
                      practitioners who billed for emergency or urgent 
                      care services.''.

    (b) Promoting Interoperability of Electronic Health Record 
Systems.--
            (1) Recommendations for achieving widespread ehr 
        interoperability.--
                    (A) <<NOTE: Deadline.>>  Objective.--As a 
                consequence of a significant Federal investment in the 
                implementation of health information technology through 
                the Medicare and Medicaid EHR

[[Page 129 STAT. 139]]

                incentive programs, Congress declares it a national 
                objective to achieve widespread exchange of health 
                information through interoperable certified EHR 
                technology nationwide by December 31, 2018.
                    (B) Definitions.--In this paragraph:
                          (i) Widespread interoperability.--The term 
                      ``widespread interoperability'' means 
                      interoperability between certified EHR technology 
                      systems employed by meaningful EHR users under the 
                      Medicare and Medicaid EHR incentive programs and 
                      other clinicians and health care providers on a 
                      nationwide basis.
                          (ii) Interoperability.--The term 
                      ``interoperability'' means the ability of two or 
                      more health information systems or components to 
                      exchange clinical and other information and to use 
                      the information that has been exchanged using 
                      common standards as to provide access to 
                      longitudinal information for health care providers 
                      in order to facilitate coordinated care and 
                      improved patient outcomes.
                    (C) <<NOTE: Deadline. Consultation.>>  Establishment 
                of metrics.--Not later than July 1, 2016, and in 
                consultation with stakeholders, the Secretary shall 
                establish metrics to be used to determine if and to the 
                extent that the objective described in subparagraph (A) 
                has been achieved.
                    (D) <<NOTE: Determination. Deadlines. Reports.>>  
                Recommendations if objective not achieved.--If the 
                Secretary of Health and Human Services determines that 
                the objective described in subparagraph (A) has not been 
                achieved by December 31, 2018, then the Secretary shall 
                submit to Congress a report, by not later than December 
                31, 2019, that identifies barriers to such objective and 
                recommends actions that the Federal Government can take 
                to achieve such objective. Such recommended actions may 
                include recommendations--
                          (i) to adjust payments for not being 
                      meaningful EHR users under the Medicare EHR 
                      incentive programs; and
                          (ii) for criteria for decertifying certified 
                      EHR technology products.
            (2) Preventing blocking the sharing of information.--
                    (A) For meaningful use ehr professionals.--Section 
                1848(o)(2)(A)(ii) of the Social Security Act (42 U.S.C. 
                1395w-4(o)(2)(A)(ii)) is amended by inserting before the 
                period at the end the following: ``, and the 
                professional demonstrates (through a process specified 
                by the Secretary, such as the use of an attestation) 
                that the professional has not knowingly and willfully 
                taken action (such as to disable functionality) to limit 
                or restrict the compatibility or interoperability of the 
                certified EHR technology''.
                    (B) For meaningful use ehr hospitals.--Section 
                1886(n)(3)(A)(ii) of the Social Security Act (42 U.S.C. 
                1395ww(n)(3)(A)(ii)) is amended by inserting before the 
                period at the end the following: ``, and the hospital 
                demonstrates (through a process specified by the 
                Secretary, such as the use of an attestation) that the 
                hospital has not knowingly and willfully taken action 
                (such as to disable functionality) to limit or restrict 
                the compatibility or interoperability of the certified 
                EHR technology''.

[[Page 129 STAT. 140]]

                    (C) <<NOTE: Applicability. 42 USC 1395w-4 note.>>  
                Effective date.--The amendments made by this subsection 
                shall apply to meaningful EHR users as of the date that 
                is one year after the date of the enactment of this Act.
            (3) Study and report on the feasibility of establishing a 
        mechanism to compare certified ehr technology products.--
                    (A) Study.--The Secretary shall conduct a study to 
                examine the feasibility of establishing one or more 
                mechanisms to assist providers in comparing and 
                selecting certified EHR technology products. Such 
                mechanisms may include--
                          (i) a website with aggregated results of 
                      surveys of meaningful EHR users on the 
                      functionality of certified EHR technology products 
                      to enable such users to directly compare the 
                      functionality and other features of such products; 
                      and
                          (ii) information from vendors of certified 
                      products that is made publicly available in a 
                      standardized format.
                The aggregated results of the surveys described in 
                clause (i) may be made available through contracts with 
                physicians, hospitals, or other organizations that 
                maintain such comparative information described in such 
                clause.
                    (B) Report.--Not later than 1 year after the date of 
                the enactment of this Act, the Secretary shall submit to 
                Congress a report on mechanisms that would assist 
                providers in comparing and selecting certified EHR 
                technology products. The report shall include 
                information on the benefits of, and resources needed to 
                develop and maintain, such mechanisms.
            (4) Definitions.--In this subsection:
                    (A) The term ``certified EHR technology'' has the 
                meaning given such term in section 1848(o)(4) of the 
                Social Security Act (42 U.S.C. 1395w-4(o)(4)).
                    (B) The term ``meaningful EHR user'' has the meaning 
                given such term under the Medicare EHR incentive 
                programs.
                    (C) The term ``Medicare and Medicaid EHR incentive 
                programs'' means--
                          (i) in the case of the Medicare program under 
                      title XVIII of the Social Security Act, the 
                      incentive programs under section 1814(l)(3), 
                      section 1848(o), subsections (l) and (m) of 
                      section 1853, and section 1886(n) of the Social 
                      Security Act (42 U.S.C. 1395f(l)(3), 1395w-4(o), 
                      1395w-23, 1395ww(n)); and
                          (ii) in the case of the Medicaid program under 
                      title XIX of such Act, the incentive program under 
                      subsections (a)(3)(F) and (t) of section 1903 of 
                      such Act (42 U.S.C. 1396b).
                    (D) The term ``Secretary'' means the Secretary of 
                Health and Human Services.

    (c) GAO Studies and Reports on the Use of Telehealth Under Federal 
Programs and on Remote Patient Monitoring Services.--

[[Page 129 STAT. 141]]

            (1) Study on telehealth services.--The Comptroller General 
        of the United States shall conduct a study on the following:
                    (A) How the definition of telehealth across various 
                Federal programs and Federal efforts can inform the use 
                of telehealth in the Medicare program under title XVIII 
                of the Social Security Act (42 U.S.C. 1395 et seq.).
                    (B) Issues that can facilitate or inhibit the use of 
                telehealth under the Medicare program under such title, 
                including oversight and professional licensure, changing 
                technology, privacy and security, infrastructure 
                requirements, and varying needs across urban and rural 
                areas.
                    (C) Potential implications of greater use of 
                telehealth with respect to payment and delivery system 
                transformations under the Medicare program under such 
                title XVIII and the Medicaid program under title XIX of 
                such Act (42 U.S.C. 1396 et seq.).
                    (D) How the Centers for Medicare & Medicaid Services 
                monitors payments made under the Medicare program under 
                such title XVIII to providers for telehealth services.
            (2) Study on remote patient monitoring services.--
                    (A) In general.--The Comptroller General of the 
                United States shall conduct a study--
                          (i) of the dissemination of remote patient 
                      monitoring technology in the private health 
                      insurance market;
                          (ii) of the financial incentives in the 
                      private health insurance market relating to 
                      adoption of such technology;
                          (iii) of the barriers to adoption of such 
                      services under the Medicare program under title 
                      XVIII of the Social Security Act;
                          (iv) that evaluates the patients, conditions, 
                      and clinical circumstances that could most benefit 
                      from remote patient monitoring services; and
                          (v) that evaluates the challenges related to 
                      establishing appropriate valuation for remote 
                      patient monitoring services under the Medicare 
                      physician fee schedule under section 1848 of the 
                      Social Security Act (42 U.S.C. 1395w-4) in order 
                      to accurately reflect the resources involved in 
                      furnishing such services.
                    (B) Definitions.--For purposes of this paragraph:
                          (i) Remote patient monitoring services.--The 
                      term ``remote patient monitoring services'' means 
                      services furnished through remote patient 
                      monitoring technology.
                          (ii) Remote patient monitoring technology.--
                      The term ``remote patient monitoring technology'' 
                      means a coordinated system that uses one or more 
                      home-based or mobile monitoring devices that 
                      automatically transmit vital sign data or 
                      information on activities of daily living and may 
                      include responses to assessment questions 
                      collected on the devices wirelessly or through a 
                      telecommunications connection to a server that 
                      complies with the Federal regulations (concerning 
                      the privacy of individually identifiable health 
                      information) promulgated under section 264(c)

[[Page 129 STAT. 142]]

                      of the Health Insurance Portability and 
                      Accountability Act of 1996, as part of an 
                      established plan of care for that patient that 
                      includes the review and interpretation of that 
                      data by a health care professional.
            (3) Reports.--Not later than 24 months after the date of the 
        enactment of this Act, the Comptroller General shall submit to 
        Congress--
                    (A) a report containing the results of the study 
                conducted under paragraph (1); and
                    (B) a report containing the results of the study 
                conducted under paragraph (2).
        A report <<NOTE: Recommenda- tions.>>  required under this 
        paragraph shall be submitted together with recommendations for 
        such legislation and administrative action as the Comptroller 
        General determines appropriate. The Comptroller General may 
        submit one report containing the results described in 
        subparagraphs (A) and (B) and the recommendations described in 
        the previous sentence.

    (d) <<NOTE: 42 USC 18122 note.>>  Rule of Construction Regarding 
Health Care Providers.--
            (1) In general.--Subject to paragraph (3), the development, 
        recognition, or implementation of any guideline or other 
        standard under any Federal health care provision shall not be 
        construed to establish the standard of care or duty of care owed 
        by a health care provider to a patient in any medical 
        malpractice or medical product liability action or claim.
            (2) Definitions.--For purposes of this subsection:
                    (A) Federal health care provision.--The term 
                ``Federal health care provision'' means any provision of 
                the Patient Protection and Affordable Care Act (Public 
                Law 111-148), title I or subtitle B of title II of the 
                Health Care and Education Reconciliation Act of 2010 
                (Public Law 111-152), or title XVIII or XIX of the 
                Social Security Act (42 U.S.C. 1395 et seq., 42 U.S.C. 
                1396 et seq.).
                    (B) Health care provider.--The term ``health care 
                provider'' means any individual, group practice, 
                corporation of health care professionals, or hospital--
                          (i) licensed, registered, or certified under 
                      Federal or State laws or regulations to provide 
                      health care services; or
                          (ii) required to be so licensed, registered, 
                      or certified but that is exempted by other statute 
                      or regulation.
                    (C) Medical malpractice or medical product liability 
                action or claim.--The term ``medical malpractice or 
                medical product liability action or claim'' means a 
                medical malpractice action or claim (as defined in 
                section 431(7) of the Health Care Quality Improvement 
                Act of 1986 (42 U.S.C. 11151(7))) and includes a 
                liability action or claim relating to a health care 
                provider's prescription or provision of a drug, device, 
                or biological product (as such terms are defined in 
                section 201 of the Federal Food, Drug, and Cosmetic Act 
                (21 U.S.C. 321) or section 351 of the Public Health 
                Service Act (42 U.S.C. 262)).
                    (D) State.--The term ``State'' includes the District 
                of Columbia, Puerto Rico, and any other commonwealth, 
                possession, or territory of the United States.

[[Page 129 STAT. 143]]

            (3) <<NOTE: 42 USC 18122 note.>>  No preemption.--Nothing in 
        paragraph (1) or any provision of the Patient Protection and 
        Affordable Care Act (Public Law 111-148), title I or subtitle B 
        of title II of the Health Care and Education Reconciliation Act 
        of 2010 (Public Law 111-152), or title XVIII or XIX of the 
        Social Security Act (42 U.S.C. 1395 et seq., 42 U.S.C. 1396 et 
        seq.) shall be construed to preempt any State or common law 
        governing medical professional or medical product liability 
        actions or claims.

              TITLE II--MEDICARE AND OTHER HEALTH EXTENDERS

                     Subtitle A--Medicare Extenders

SEC. 201. EXTENSION OF WORK GPCI FLOOR.

    Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``April 1, 2015'' and inserting 
``January 1, 2018''.
SEC. 202. EXTENSION OF THERAPY CAP EXCEPTIONS PROCESS.

    (a) In General.--Section 1833(g) of the Social Security Act (42 
U.S.C. 1395l(g)) is amended--
            (1) in paragraph (5)(A), in the first sentence, by striking 
        ``March 31, 2015'' and inserting ``December 31, 2017''; and
            (2) in paragraph (6)(A)--
                    (A) by striking ``March 31, 2015'' and inserting 
                ``December 31, 2017''; and
                    (B) by striking ``2012, 2013, 2014, or the first 
                three months of 2015'' and inserting ``2012 through 
                2017''.

    (b) Targeted Reviews Under Manual Medical Review Process for 
Outpatient Therapy Services.--
            (1) In general.--Section 1833(g)(5) of the Social Security 
        Act (42 U.S.C. 1395l(g)(5)) is amended--
                    (A) in subparagraph (C)(i), by inserting ``, subject 
                to subparagraph (E),'' after ``manual medical review 
                process that''; and
                    (B) by adding at the end the following new 
                subparagraph:

    ``(E)(i) In place of the manual medical review process under 
subparagraph (C)(i), the Secretary shall implement a process for medical 
review under this subparagraph under which the Secretary shall identify 
and conduct medical review for services described in subparagraph (C)(i) 
furnished by a provider of services or supplier (in this subparagraph 
referred to as a `therapy provider') using such factors as the Secretary 
determines to be appropriate.
    ``(ii) Such factors may include the following:
            ``(I) The therapy provider has had a high claims denial 
        percentage for therapy services under this part or is less 
        compliant with applicable requirements under this title.
            ``(II) The therapy provider has a pattern of billing for 
        therapy services under this part that is aberrant compared to 
        peers or otherwise has questionable billing practices for such 
        services, such as billing medically unlikely units of services 
        in a day.

[[Page 129 STAT. 144]]

            ``(III) The therapy provider is newly enrolled under this 
        title or has not previously furnished therapy services under 
        this part.
            ``(IV) The services are furnished to treat a type of medical 
        condition.
            ``(V) The therapy provider is part of group that includes 
        another therapy provider identified using the factors determined 
        under this subparagraph.

    ``(iii) For purposes of carrying out this subparagraph, the 
Secretary shall provide for the transfer, from the Federal Supplementary 
Medical Insurance Trust Fund under section 1841, of $5,000,000 to the 
Centers for Medicare & Medicaid Services Program Management Account for 
fiscal years 2015 and 2016, to remain available until expended. Such 
funds may not be used by a contractor under section 1893(h) for medical 
reviews under this subparagraph.
    ``(iv) The targeted review process under this subparagraph shall not 
apply to services for which expenses are incurred beyond the period for 
which the exceptions process under subparagraph (A) is implemented.''.
            (2) <<NOTE: Applicability. Deadline. 42 USC 1395l note.>>  
        Effective date.--The amendments made by this subsection shall 
        apply with respect to requests described in section 
        1833(g)(5)(C)(i) of the Social Security Act (42 U.S.C. 
        1395l(g)(5)(C)(i)) with respect to which the Secretary of Health 
        and Human Services has not conducted medical review under such 
        section by a date (not later than 90 days after the date of the 
        enactment of this Act) specified by the Secretary.
SEC. 203. EXTENSION OF AMBULANCE ADD-ONS.

    (a) Ground Ambulance.--Section 1834(l)(13)(A) of the Social Security 
Act (42 U.S.C. 1395m(l)(13)(A)) is amended by striking ``April 1, 2015'' 
and inserting ``January 1, 2018'' each place it appears.
    (b) Super Rural Ground Ambulance.--Section 1834(l)(12)(A) of the 
Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended, in the first 
sentence, by striking ``April 1, 2015'' and inserting ``January 1, 
2018''.
SEC. 204. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT 
                        ADJUSTMENT FOR CERTAIN LOW-VOLUME 
                        HOSPITALS.

    Section 1886(d)(12) of the Social Security Act (42 U.S.C. 
1395ww(d)(12)) is amended--
            (1) in subparagraph (B), in the matter preceding clause (i), 
        by striking ``in fiscal year 2015 (beginning on April 1, 2015), 
        fiscal year 2016, and subsequent fiscal years'' and inserting 
        ``in fiscal year 2018 and subsequent fiscal years'';
            (2) in subparagraph (C)(i), by striking ``fiscal years 2011 
        through 2014 and fiscal year 2015 (before April 1, 2015),'' and 
        inserting ``fiscal years 2011 through 2017,'' each place it 
        appears; and
            (3) in subparagraph (D), by striking ``fiscal years 2011 
        through 2014 and fiscal year 2015 (before April 1, 2015),'' and 
        inserting ``fiscal years 2011 through 2017,''.
SEC. 205. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL (MDH) 
                        PROGRAM.

    (a) In General.--Section 1886(d)(5)(G) of the Social Security Act 
(42 U.S.C. 1395ww(d)(5)(G)) is amended--

[[Page 129 STAT. 145]]

            (1) in clause (i), by striking ``April 1, 2015'' and 
        inserting ``October 1, 2017''; and
            (2) in clause (ii)(II), by striking ``April 1, 2015'' and 
        inserting ``October 1, 2017''.

    (b) Conforming Amendments.--
            (1) Extension of target amount.--Section 1886(b)(3)(D) of 
        the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is amended--
                    (A) in the matter preceding clause (i), by striking 
                ``April 1, 2015'' and inserting ``October 1, 2017''; and
                    (B) in clause (iv), by striking ``through fiscal 
                year 2014 and the portion of fiscal year 2015 before 
                April 1, 2015'' and inserting ``through fiscal year 
                2017''.
            (2) Permitting hospitals to decline reclassification.--
        Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 
        1993 (42 U.S.C. 1395ww note) is amended by striking ``through 
        the first 2 quarters of fiscal year 2015'' and inserting 
        ``through fiscal year 2017''.
SEC. 206. EXTENSION FOR SPECIALIZED MEDICARE ADVANTAGE PLANS FOR 
                        SPECIAL NEEDS INDIVIDUALS.

    Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w-
28(f)(1)) is amended by striking ``2017'' and inserting ``2019''.
SEC. 207. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSEMENT, 
                        INPUT, AND SELECTION.

    Section 1890(d)(2) of the Social Security Act (42 U.S.C. 
1395aaa(d)(2)) is amended by striking ``and $15,000,000 for the first 6 
months of fiscal year 2015'' and inserting ``and $30,000,000 for each of 
fiscal years 2015 through 2017''.
SEC. 208. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR LOW-
                        INCOME PROGRAMS.

    (a) Additional Funding for State Health Insurance Programs.--
Subsection (a)(1)(B) of section 119 of the Medicare Improvements for 
Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note), as amended 
by section 3306 of the Patient Protection and Affordable Care Act 
(Public Law 111-148), section 610 of the American Taxpayer Relief Act of 
2012 (Public Law 112-240), section 1110 of the Pathway for SGR Reform 
Act of 2013 (Public Law 113-67), and section 110 of the Protecting 
Access to Medicare Act of 2014 (Public Law 113-93), is amended--
            (1) in clause (iv), by striking ``and'' at the end;
            (2) by striking clause (v); and
            (3) by adding at the end the following new clauses:
                          ``(v) for fiscal year 2015, of $7,500,000;
                          ``(vi) for fiscal year 2016, of $13,000,000; 
                      and
                          ``(vii) for fiscal year 2017, of 
                      $13,000,000.''.

    (b) Additional Funding for Area Agencies on Aging.--Subsection 
(b)(1)(B) of such section 119, as so amended, is amended--
            (1) in clause (iv), by striking ``and'' at the end;
            (2) by striking clause (v); and
            (3) by inserting after clause (iv) the following new 
        clauses:
                          ``(v) for fiscal year 2015, of $7,500,000;
                          ``(vi) for fiscal year 2016, of $7,500,000; 
                      and
                          ``(vii) for fiscal year 2017, of 
                      $7,500,000.''.

[[Page 129 STAT. 146]]

    (c) Additional Funding for Aging and Disability Resource Centers.--
Subsection (c)(1)(B) of such section 119, as so amended, is amended--
            (1) in clause (iv), by striking ``and'' at the end;
            (2) by striking clause (v); and
            (3) by inserting after clause (iv) the following new 
        clauses:
                          ``(v) for fiscal year 2015, of $5,000,000;
                          ``(vi) for fiscal year 2016, of $5,000,000; 
                      and
                          ``(vii) for fiscal year 2017, of 
                      $5,000,000.''.

    (d) Additional Funding for Contract With the National Center for 
Benefits and Outreach Enrollment.--Subsection (d)(2) of such section 
119, as so amended, is amended--
            (1) in clause (iv), by striking ``and'' at the end;
            (2) by striking clause (v); and
            (3) by inserting after clause (iv) the following new 
        clauses:
                          ``(v) for fiscal year 2015, of $5,000,000;
                          ``(vi) for fiscal year 2016, of $12,000,000; 
                      and
                          ``(vii) for fiscal year 2017, of 
                      $12,000,000.''.
SEC. 209. EXTENSION AND TRANSITION OF REASONABLE COST 
                        REIMBURSEMENT CONTRACTS.

    (a) One-Year Transition and Notice Regarding Transition.--Section 
1876(h)(5)(C) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)) is 
amended--
            (1) in clause (ii), in the matter preceding subclause (I), 
        by striking ``For any'' and inserting ``Subject to clause (iv), 
        for any'';
            (2) in clause (iii)(I), by inserting ``cost plan service'' 
        after ``With respect to any portion of the'';
            (3) in clause (iii)(II), by inserting ``cost plan service'' 
        after ``With respect to any other portion of such''; and
            (4) by adding at the end the following new clauses:

    ``(iv) <<NOTE: Deadline. Applicability.>>  In the case of an 
eligible organization that is offering a reasonable cost reimbursement 
contract that may no longer be extended or renewed because of the 
application of clause (ii), or where such contract has been extended or 
renewed but the eligible organization has informed the Secretary in 
writing not later than a date determined appropriate by the Secretary 
that such organization voluntarily plans not to seek renewal of the 
reasonable cost reimbursement contract, the following shall apply:
            ``(I) Notwithstanding such clause, such contract may be 
        extended or renewed for the two years subsequent to 2016. The 
        final year in which such contract is extended or renewed is 
        referred to in this subsection as the `last reasonable cost 
        reimbursement contract year for the contract'.
            ``(II) The organization may not enroll a new enrollee under 
        such contract during the last reasonable cost reimbursement 
        contract year for the contract (but may continue to enroll new 
        enrollees through the end of the year immediately preceding such 
        year) unless such enrollee is any of the following:
                    ``(aa) An individual who chooses enrollment in the 
                reasonable cost contract during the annual election 
                period with respect to such last year.
                    ``(bb) An individual whose spouse, at the time of 
                the individual's enrollment is an enrollee under the 
                reasonable cost reimbursement contract.

[[Page 129 STAT. 147]]

                    ``(cc) An individual who is covered under an 
                employer group health plan that offers coverage through 
                the reasonable cost reimbursement contract.
                    ``(dd) An individual who becomes entitled to 
                benefits under part A, or enrolled under part B, and was 
                enrolled in a plan offered by the eligible organization 
                immediately prior to the individual's enrollment under 
                the reasonable cost reimbursement contract.
            ``(III) <<NOTE: Deadline. Notification.>>  Not later than a 
        date determined appropriate by the Secretary prior to the 
        beginning of the last reasonable cost reimbursement contract 
        year for the contract, the organization shall provide notice to 
        the Secretary as to whether the organization will apply to have 
        the contract converted over, in whole or in part, and offered as 
        a Medicare Advantage plan under part C for the year following 
        the last reasonable cost reimbursement contract year for the 
        contract.
            ``(IV) <<NOTE: Deadline.>>  If the organization provides the 
        notice described in subclause (III) that the contract will be 
        converted, in whole or in part, the organization shall, not 
        later than a date determined appropriate by the Secretary, 
        provide the Secretary with such information as the Secretary 
        determines appropriate in order to carry out section 1851(c)(4) 
        and to carry out section 1854(a)(5), including subparagraph 
        (C)(ii) of such section.
            ``(V) <<NOTE: Notification.>>  In the case that the 
        organization enrolls a new enrollee under such contract during 
        the last reasonable cost reimbursement contract year for the 
        contract, the organization shall provide the individual with a 
        notification that such year is the last year for such contract.

    ``(v) <<NOTE: Applicability.>>  If an eligible organization that is 
offering a reasonable cost reimbursement contract that is extended or 
renewed pursuant to clause (iv) provides the notice described in clause 
(iv)(III) that the contract will be converted, in whole or in part, the 
following shall apply:
            ``(I) The deemed enrollment under section 1851(c)(4).
            ``(II) The special rule for quality increase under section 
        1853(o)(4)(C).
            ``(III) During the last reasonable cost reimbursement 
        contract year for the contract and the year immediately 
        preceding such year, the eligible organization, or the corporate 
        parent organization of the eligible organization, shall be 
        permitted to offer an MA plan in the area that such contract is 
        being offered and enroll Medicare Advantage eligible individuals 
        in such MA plan and such cost plan.''.

    (b) Deemed Enrollment From Reasonable Cost Reimbursement Contracts 
Converted to Medicare Advantage Plans.--
            (1) In general.--Section 1851(c) of the Social Security Act 
        (42 U.S.C. 1395w-21(c)) is amended--
                    (A) in paragraph (1), by striking ``Such elections'' 
                and inserting ``Subject to paragraph (4), such 
                elections''; and
                    (B) by adding at the end the following:
            ``(4) Deemed enrollment relating to converted reasonable 
        cost reimbursement contracts.--
                    ``(A) <<NOTE: Effective date.>>  In general.--On the 
                first day of the annual, coordinated election period 
                under subsection (e)(3) for plan years beginning on or 
                after January 1, 2017, an MA eligible individual 
                described in clause (i) or (ii) of subparagraph (B) is 
                deemed, unless the individual elects otherwise, to

[[Page 129 STAT. 148]]

                have elected to receive benefits under this title 
                through an applicable MA plan (and shall be enrolled in 
                such plan) beginning with such plan year, if--
                          ``(i) the individual is enrolled in a 
                      reasonable cost reimbursement contract under 
                      section 1876(h) in the previous plan year;
                          ``(ii) such reasonable cost reimbursement 
                      contract was extended or renewed for the last 
                      reasonable cost reimbursement contract year of the 
                      contract (as described in subclause (I) of section 
                      1876(h)(5)(C)(iv)) pursuant to such section;
                          ``(iii) the eligible organization that is 
                      offering such reasonable cost reimbursement 
                      contract provided the notice described in 
                      subclause (III) of such section that the contract 
                      was to be converted;
                          ``(iv) the applicable MA plan--
                                    ``(I) is the plan that was converted 
                                from the reasonable cost reimbursement 
                                contract described in clause (iii);
                                    ``(II) is offered by the same entity 
                                (or an organization affiliated with such 
                                entity that has a common ownership 
                                interest of control) that entered into 
                                such contract; and
                                    ``(III) is offered in the service 
                                area where the individual resides;
                          ``(v) in the case of reasonable cost 
                      reimbursement contracts that provide coverage 
                      under parts A and B (and, to the extent the 
                      Secretary determines it to be feasible, contracts 
                      that provide only part B coverage), the difference 
                      between the estimated individual costs (as 
                      determined applicable by the Secretary) for the 
                      applicable MA plan and such costs for the 
                      predecessor cost plan does not exceed a threshold 
                      established by the Secretary; and
                          ``(vi) the applicable MA plan--
                                    ``(I) <<NOTE: Time period.>>  
                                provides coverage for enrollees 
                                transitioning from the converted 
                                reasonable cost reimbursement contract 
                                to such plan to maintain current 
                                providers of services and suppliers and 
                                course of treatment at the time of 
                                enrollment for a period of at least 90 
                                days after enrollment; and
                                    ``(II) during such period, pays such 
                                providers of services and suppliers for 
                                items and services furnished to the 
                                enrollee an amount that is not less than 
                                the amount of payment applicable for 
                                such items and services under the 
                                original Medicare fee-for-service 
                                program under parts A and B.
                    ``(B) MA eligible individuals described.--
                          ``(i) Without prescription drug coverage.--An 
                      MA eligible individual described in this clause, 
                      with respect to a plan year, is an MA eligible 
                      individual who is enrolled in a reasonable cost 
                      reimbursement contract under section 1876(h) in 
                      the previous plan year and who is not, for such 
                      previous plan year, enrolled in a prescription 
                      drug plan under part D, including coverage under 
                      section 1860D-22.

[[Page 129 STAT. 149]]

                          ``(ii) With prescription drug coverage.--An MA 
                      eligible individual described in this clause, with 
                      respect to a plan year, is an MA eligible 
                      individual who is enrolled in a reasonable cost 
                      reimbursement contract under section 1876(h) in 
                      the previous plan year and who, for such previous 
                      plan year, is enrolled in a prescription drug plan 
                      under part D--
                                    ``(I) through such contract; or
                                    ``(II) through a prescription drug 
                                plan, if the sponsor of such plan is the 
                                same entity (or an organization 
                                affiliated with such entity) that 
                                entered into such contract.
                    ``(C) Applicable ma plan defined.--In this 
                paragraph, the term `applicable MA plan' means, in the 
                case of an individual described in--
                          ``(i) subparagraph (B)(i), an MA plan that is 
                      not an MA-PD plan; and
                          ``(ii) subparagraph (B)(ii), an MA-PD plan.
                    ``(D) Identification and notification of deemed 
                individuals.--Not <<NOTE: Deadline. Effective 
                date.>> later than 45 days before the first day of the 
                annual, coordinated election period under subsection 
                (e)(3) for plan years beginning on or after January 1, 
                2017, the Secretary shall identify and notify the 
                individuals who will be subject to deemed elections 
                under subparagraph (A) on the first day of such 
                period.''.
            (2) Beneficiary option to discontinue or change ma plan or 
        ma-pd plan after deemed enrollment.--
                    (A) In general.--Section 1851(e)(2) of the Social 
                Security Act (42 U.S.C. 1395w-21(e)(4)) is amended by 
                adding at the end the following:
                    ``(F) Special period for certain deemed elections.--
                          ``(i) In general.--At any time during the 
                      period beginning after the last day of the annual, 
                      coordinated election period under paragraph (3) in 
                      which an individual is deemed to have elected to 
                      enroll in an MA plan or MA-PD plan under 
                      subsection (c)(4) and ending on the last day of 
                      February of the first plan year for which the 
                      individual is enrolled in such plan, such 
                      individual may change the election under 
                      subsection (a)(1) (including changing the MA plan 
                      or MA-PD plan in which the individual is 
                      enrolled).
                          ``(ii) Limitation of one change.--An 
                      individual may exercise the right under clause (i) 
                      only once during the applicable period described 
                      in such clause. The limitation under this clause 
                      shall not apply to changes in elections effected 
                      during an annual, coordinated election period 
                      under paragraph (3) or during a special enrollment 
                      period under paragraph (4).''.
                    (B) Conforming amendments.--
                          (i) Plan requirement for open enrollment.--
                      Section 1851(e)(6)(A) of the Social Security Act 
                      (42 U.S.C. 1395w-21(e)(6)(A)) is amended by 
                      striking ``paragraph (1),'' and inserting 
                      ``paragraph (1), during the period described in 
                      paragraph (2)(F),''.
                          (ii) Part d.--Section 1860D-1(b)(1)(B) of such 
                      Act (42 U.S.C. 1395w-101(b)(1)(B)) is amended--

[[Page 129 STAT. 150]]

                                    (I) in clause (ii), by adding ``and 
                                paragraph (4)'' after ``paragraph 
                                (3)(A)''; and
                                    (II) in clause (iii) by striking 
                                ``and (E)'' and inserting ``(E), and 
                                (F)''.
            (3) <<NOTE: Applicability.>>  Treatment of esrd for deemed 
        enrollment.--Section 1851(a)(3)(B) of the Social Security Act 
        (42 U.S.C. 1395w-21(a)(3)(B)) is amended by adding at the end 
        the following flush sentence: ``An individual who develops end-
        stage renal disease while enrolled in a reasonable cost 
        reimbursement contract under section 1876(h) shall be treated as 
        an MA eligible individual for purposes of applying the deemed 
        enrollment under subsection (c)(4).''.

    (c) Information Requirements.--Section 1851(d)(2)(B) of the Social 
Security Act (42 U.S.C. 1395w-21(d)(2)(B)) is amended--
            (1) in the heading, by striking ``Notification to newly 
        eligible medicare advantage eligible individuals'' and inserting 
        the following: ``Notifications required.--
                          ``(i) Notification to newly eligible medicare 
                      advantage eligible individuals.--''; and
            (2) by adding at the end the following new clause:
                          ``(ii) Notification related to certain deemed 
                      elections.--The <<NOTE: Deadline.>> Secretary 
                      shall require a Medicare Advantage organization 
                      that is offering a Medicare Advantage plan that 
                      has been converted from a reasonable cost 
                      reimbursement contract pursuant to section 
                      1876(h)(5)(C)(iv) to mail, not later than 30 days 
                      prior to the first day of the annual, coordinated 
                      election period under subsection (e)(3) of a year, 
                      to any individual enrolled under such contract and 
                      identified by the Secretary under subsection 
                      (c)(4)(D) for such year--
                                    ``(I) a notification that such 
                                individual will, on such day, be deemed 
                                to have made an election with respect to 
                                such plan to receive benefits under this 
                                title through an MA plan or MA-PD plan 
                                (and shall be enrolled in such plan) for 
                                the next plan year under subsection 
                                (c)(4)(A), but that the individual may 
                                make a different election during the 
                                annual, coordinated election period for 
                                such year;
                                    ``(II) the information described in 
                                subparagraph (A);
                                    ``(III) a description of the 
                                differences between such MA plan or MA-
                                PD plan and the reasonable cost 
                                reimbursement contract in which the 
                                individual was most recently enrolled 
                                with respect to benefits covered under 
                                such plans, including cost-sharing, 
                                premiums, drug coverage, and provider 
                                networks;
                                    ``(IV) information about the special 
                                period for elections under subsection 
                                (e)(2)(F); and
                                    ``(V) other information the 
                                Secretary may specify.''.

    (d) Treatment of Transition Plan for Quality Rating for Payment 
Purposes.--Section 1853(o)(4) of the Social Security Act (42 U.S.C. 
1395w-23(o)(4)) is amended by adding at the end the following new 
subparagraph:

[[Page 129 STAT. 151]]

                    ``(C) Special rule for first 3 plan years for plans 
                that were converted from a reasonable cost reimbursement 
                contract.--For <<NOTE: Applicability.>> purposes of 
                applying paragraph (1) and section 1854(b)(1)(C) for the 
                first 3 plan years under this part in the case of an MA 
                plan to which deemed enrollment applies under section 
                1851(c)(4)--
                          ``(i) such plan shall not be treated as a new 
                      MA plan (as defined in paragraph (3)(A)(iii)(II)); 
                      and
                          ``(ii) in determining the star rating of the 
                      plan under subparagraph (A), to the extent that 
                      Medicare Advantage data for such plan is not 
                      available for a measure used to determine such 
                      star rating, the Secretary shall use data from the 
                      period in which such plan was a reasonable cost 
                      reimbursement contract.''.
SEC. 210. EXTENSION OF HOME HEALTH RURAL ADD-ON.

    Section 421(a) of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2283; 42 U.S.C. 
1395fff note), as amended by section 5201(b) of the Deficit Reduction 
Act of 2005 (Public Law 109-171; 120 Stat. 46) and by section 3131(c) of 
the Patient Protection and Affordable Care Act (Public Law 111-148; 124 
Stat. 428), is amended by striking ``January 1, 2016'' and inserting 
``January 1, 2018'' each place it appears.

                   Subtitle B--Other Health Extenders

SEC. 211. PERMANENT EXTENSION OF THE QUALIFYING INDIVIDUAL (QI) 
                        PROGRAM.

    (a) Permanent Extension.--Section 1902(a)(10)(E)(iv) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by striking 
``(but only for premiums payable with respect to months during the 
period beginning with January 1998, and ending with March 2015)''.
    (b) Allocations.--Section 1933(g) of the Social Security Act (42 
U.S.C. 1396u-3(g)) is amended--
            (1) in paragraph (2)--
                    (A) by striking subparagraphs (A) through (H);
                    (B) in subparagraph (V), by striking ``and'' at the 
                end;
                    (C) in subparagraph (W), by striking the period at 
                the end and inserting a semicolon;
                    (D) by redesignating subparagraphs (I) through (W) 
                as subparagraphs (A) through (O), respectively; and
                    (E) by adding at the end the following new 
                subparagraphs:
                    ``(P) <<NOTE: Time period.>>  for the period that 
                begins on April 1, 2015, and ends on December 31, 2015, 
                the total allocation amount is $535,000,000; and
                    ``(Q) for 2016 and, subject to paragraph (4), for 
                each subsequent year, the total allocation amount is 
                $980,000,000.'';
            (2) in paragraph (3), by striking ``(P), (R), (T), or (V)'' 
        and inserting ``or (P)''; and
            (3) by adding at the end the following new paragraph:
            ``(4) Adjustment to allocations.--The Secretary may increase 
        the allocation amount under paragraph (2)(Q) for a

[[Page 129 STAT. 152]]

        year (beginning with 2017) up to an amount that does not exceed 
        the product of the following:
                    ``(A) Maximum allocation amount for previous year.--
                In the case of 2017, the allocation amount for 2016, or 
                in the case of a subsequent year, the maximum allocation 
                amount allowed under this paragraph for the previous 
                year.
                    ``(B) Increase in part b premium.--The monthly 
                premium rate determined under section 1839 for the year 
                divided by the monthly premium rate determined under 
                such section for the previous year.
                    ``(C) Increase in part b enrollment.--The average 
                number of individuals (as estimated by the Chief Actuary 
                of the Centers for Medicare & Medicaid Services in 
                September of the previous year) to be enrolled under 
                part B of title XVIII for months in the year divided by 
                the average number of such individuals (as so estimated) 
                under this subparagraph with respect to enrollments in 
                months in the previous year.''.
SEC. 212. PERMANENT EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE 
                        (TMA).

    (a) In General.--Section 1925 of the Social Security Act (42 U.S.C. 
1396r-6) is amended--
            (1) by striking subsection (f); and
            (2) by redesignating subsection (g) as subsection (f).

    (b) Conforming Amendment.--Section 1902(e)(1) of the Social Security 
Act (42 U.S.C. 1396a(e)(1)) is amended to read as follows:
    ``(1) <<NOTE: Effective date.>>  Beginning April 1, 1990, for 
provisions relating to the extension of eligibility for medical 
assistance for certain families who have received aid pursuant to a 
State plan approved under part A of title IV and have earned income, see 
section 1925.''.
SEC. 213. EXTENSION OF SPECIAL DIABETES PROGRAM FOR TYPE I 
                        DIABETES AND FOR INDIANS.

    (a) Special Diabetes Programs for Type I Diabetes.--Section 
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-
2(b)(2)(C)) is amended by striking ``2015'' and inserting ``2017''.
    (b) Special Diabetes Programs for Indians.--Section 330C(c)(2)(C) of 
the Public Health Service Act (42 U.S.C. 254c-3(c)(2)(C)) is amended by 
striking ``2015'' and inserting ``2017''.
SEC. 214. EXTENSION OF ABSTINENCE EDUCATION.

    (a) In General.--Section 510 of the Social Security Act (42 U.S.C. 
710) is amended--
            (1) in subsection (a), striking ``2015'' and inserting 
        ``2017''; and
            (2) in subsection (d), by inserting ``and an additional 
        $75,000,000 for each of fiscal years 2016 and 2017'' after 
        ``2015''.

    (b) Budget Scoring.--Notwithstanding section 257(b)(2) of the 
Balanced Budget and Emergency Deficit Control Act of 1985, the baseline 
shall be calculated assuming that no grant shall be made under section 
510 of the Social Security Act (42 U.S.C. 710) after fiscal year 2017.
    (c) Reallocation of Unused Funding.--The remaining unobligated 
balances of the amount appropriated for fiscal years 2016 and 2017 by 
section 510(d) of the Social Security Act (42 U.S.C. 710(d)) for which 
no application has been received by the

[[Page 129 STAT. 153]]

Funding Opportunity Announcement deadline, shall be made available to 
States that require the implementation of each element described in 
subparagraphs (A) through (H) of the definition of abstinence education 
in section 510(b)(2). The remaining unobligated balances shall be 
reallocated to such States that submit a valid application consistent 
with the original formula for this funding.
SEC. 215. EXTENSION OF PERSONAL RESPONSIBILITY EDUCATION PROGRAM 
                        (PREP).

    Section 513 of the Social Security Act (42 U.S.C. 713) is amended--
            (1) in paragraphs (1)(A) and (4)(A) of subsection (a), by 
        striking ``2015'' and inserting ``2017'' each place it appears;
            (2) in subsection (a)(4)(B)(i), by striking ``, 2013, 2014, 
        and 2015'' and inserting ``through 2017''; and
            (3) in subsection (f), by striking ``2015'' and inserting 
        ``2017''.
SEC. 216. EXTENSION OF FUNDING FOR FAMILY-TO-FAMILY HEALTH 
                        INFORMATION CENTERS.

     Section 501(c)(1)(A) of the Social Security Act (42 U.S.C. 
701(c)(1)(A)) is amended--
            (1) by striking clause (vi); and
            (2) by adding after clause (v) the following new clause:
            ``(vi) $5,000,000 for each of fiscal years 2015 through 
        2017.''.
SEC. 217. EXTENSION OF HEALTH WORKFORCE DEMONSTRATION PROJECT FOR 
                        LOW-INCOME INDIVIDUALS.

    Section 2008(c)(1) of the Social Security Act (42 U.S.C. 
1397g(c)(1)) is amended by striking ``2015'' and inserting ``2017''.
SEC. 218. EXTENSION OF MATERNAL, INFANT, AND EARLY CHILDHOOD HOME 
                        VISITING PROGRAMS.

    Section 511(j)(1) of the Social Security Act (42 U.S.C. 711(j)) is 
amended--
            (1) by striking ``and'' at the end of subparagraph (E);
            (2) in subparagraph (F)--
                    (A) by striking ``for the period beginning on 
                October 1, 2014, and ending on March 31, 2015'' and 
                inserting ``for fiscal year 2015'';
                    (B) by striking ``an amount equal to the amount 
                provided in subparagraph (E)'' and inserting 
                ``$400,000,000''; and
                    (C) by striking the period at the end and inserting 
                a semicolon; and
            (3) by adding at the end the following new subparagraphs:
                    ``(G) for fiscal year 2016, $400,000,000; and
                    ``(H) for fiscal year 2017, $400,000,000.''.
SEC. 219. TENNESSEE DSH ALLOTMENT FOR FISCAL YEARS 2015 THROUGH 
                        2025.

    Section 1923(f)(6)(A) of the Social Security Act (42 U.S.C. 1396r-
4(f)(6)(A)) is amended by adding at the end the following:
                          ``(vi) Allotment for fiscal years 2015 through 
                      2025.--Notwithstanding any other provision of this 
                      subsection, any other provision of law, or the 
                      terms of the TennCare Demonstration Project in 
                      effect for the State, the DSH allotment for 
                      Tennessee for fiscal year

[[Page 129 STAT. 154]]

                      2015, and for each fiscal year thereafter through 
                      fiscal year 2025, shall be $53,100,000 for each 
                      such fiscal year.''.
SEC. 220. DELAY IN EFFECTIVE DATE FOR MEDICAID AMENDMENTS RELATING 
                        TO BENEFICIARY LIABILITY SETTLEMENTS.

    Section 202(c) of the Bipartisan Budget Act of 2013 (division A of 
Public Law 113-67; 42 U.S.C. 1396a note), as amended by section 211 of 
the Protecting Access to Medicare Act of 2014 (Public Law 113-93; 128 
Stat. 1047) is amended by striking ``October 1, 2016'' and inserting 
``October 1, 2017''.
SEC. 221. EXTENSION OF FUNDING FOR COMMUNITY HEALTH CENTERS, THE 
                        NATIONAL HEALTH SERVICE CORPS, AND 
                        TEACHING HEALTH CENTERS.

    (a) Funding for Community Health Centers and the National Health 
Service Corps.--
            (1) Community health centers.--Section 10503(b)(1)(E) of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 254b-
        2(b)(1)(E)) is amended by striking ``for fiscal year 2015'' and 
        inserting ``for each of fiscal years 2015 through 2017''.
            (2) National health service corps.--Section 10503(b)(2)(E) 
        of the Patient Protection and Affordable Care Act (42 U.S.C. 
        254b-2(b)(2)(E)) is amended by striking ``for fiscal year 2015'' 
        and inserting ``for each of fiscal years 2015 through 2017''.

    (b) Extension of Teaching Health Centers Program.--Section 340H(g) 
of the Public Health Service Act (42 U.S.C. 256h(g)) is amended by 
inserting ``and $60,000,000 for each of fiscal years 2016 and 2017'' 
before the period at the end.
    (c) Application.--Amounts appropriated pursuant to this section for 
fiscal year 2016 and fiscal year 2017 are subject to the requirements 
contained in Public Law 113-235 for funds for programs authorized under 
sections 330 through 340 of the Public Health Service Act (42 U.S.C. 
254b-256).

                             TITLE III--CHIP

SEC. 301. 2-YEAR EXTENSION OF THE CHILDREN'S HEALTH INSURANCE 
                        PROGRAM.

    (a) Funding.--Section 2104(a) of the Social Security Act (42 U.S.C. 
1397dd(a)) is amended--
            (1) in paragraph (17), by striking ``and'' at the end;
            (2) in paragraph (18)(B), by striking the period at the end 
        and inserting a semicolon; and
            (3) by adding at the end the following new paragraphs:
            ``(19) for fiscal year 2016, $19,300,000,000; and
            ``(20) <<NOTE: Time periods.>>  for fiscal year 2017, for 
        purposes of making 2 semi-annual allotments--
                    ``(A) $2,850,000,000 for the period beginning on 
                October 1, 2016, and ending on March 31, 2017; and
                    ``(B) $2,850,000,000 for the period beginning on 
                April 1, 2017, and ending on September 30, 2017.''.

    (b) Allotments.--
            (1) In general.--Section 2104(m) of the Social Security Act 
        (42 U.S.C. 1397dd(m)) is amended--

[[Page 129 STAT. 155]]

                    (A) in the subsection heading, by striking ``Through 
                2015'' and inserting ``and Thereafter'';
                    (B) in paragraph (2)--
                          (i) in the paragraph heading, by striking 
                      ``2014'' and inserting ``2016''; and
                          (ii) by striking subparagraph (B) and 
                      inserting the following new subparagraph:
                    ``(B) Fiscal year 2013 and each succeeding fiscal 
                year.--Subject to paragraphs (5) and (7), from the 
                amount made available under paragraphs (16) through (19) 
                of subsection (a) for fiscal year 2013 and each 
                succeeding fiscal year, respectively, the Secretary 
                shall compute a State allotment for each State 
                (including the District of Columbia and each 
                commonwealth and territory) for each such fiscal year as 
                follows:
                          ``(i) Rebasing in fiscal year 2013 and each 
                      succeeding odd-numbered fiscal year.--For fiscal 
                      year 2013 and each succeeding odd-numbered fiscal 
                      year (other than fiscal years 2015 and 2017), the 
                      allotment of the State is equal to the Federal 
                      payments to the State that are attributable to 
                      (and countable toward) the total amount of 
                      allotments available under this section to the 
                      State in the preceding fiscal year (including 
                      payments made to the State under subsection (n) 
                      for such preceding fiscal year as well as amounts 
                      redistributed to the State in such preceding 
                      fiscal year), multiplied by the allotment increase 
                      factor under paragraph (6) for such odd-numbered 
                      fiscal year.
                          ``(ii) Growth factor update for fiscal year 
                      2014 and each succeeding even-numbered fiscal 
                      year.--Except as provided in clauses (iii) and 
                      (iv), for fiscal year 2014 and each succeeding 
                      even-numbered fiscal year, the allotment of the 
                      State is equal to the sum of--
                                    ``(I) the amount of the State 
                                allotment under clause (i) for the 
                                preceding fiscal year; and
                                    ``(II) the amount of any payments 
                                made to the State under subsection (n) 
                                for such preceding fiscal year,
                      multiplied by the allotment increase factor under 
                      paragraph (6) for such even-numbered fiscal year.
                          ``(iii) Special rule for 2016.--For fiscal 
                      year 2016, the allotment of the State is equal to 
                      the Federal payments to the State that are 
                      attributable to (and countable toward) the total 
                      amount of allotments available under this section 
                      to the State in the preceding fiscal year 
                      (including payments made to the State under 
                      subsection (n) for such preceding fiscal year as 
                      well as amounts redistributed to the State in such 
                      preceding fiscal year), but determined as if the 
                      last two sentences of section 2105(b) were in 
                      effect in such preceding fiscal year and then 
                      multiplying the result by the allotment increase 
                      factor under paragraph (6) for fiscal year 2016.
                          ``(iv) Reduction in 2018.--For fiscal year 
                      2018, with respect to the allotment of the State 
                      for fiscal year 2017, any amounts of such 
                      allotment that remain

[[Page 129 STAT. 156]]

                      available for expenditure by the State in fiscal 
                      year 2018 shall be reduced by one-third.'';
                    (C) in paragraph (4), by inserting ``or 2017'' after 
                ``2015'';
                    (D) in paragraph (6)--
                          (i) in subparagraph (A), by striking ``2015'' 
                      and inserting ``2017''; and
                          (ii) in the second sentence, by striking ``or 
                      fiscal year 2014'' and inserting ``fiscal year 
                      2014, or fiscal year 2016'';
                    (E) in paragraph (8)--
                          (i) in the paragraph heading, by striking 
                      ``fiscal year 2015'' and inserting ``fiscal years 
                      2015 and 2017''; and
                          (ii) by inserting ``or fiscal year 2017'' 
                      after ``2015'';
                    (F) by redesignating paragraphs (4) through (8) as 
                paragraphs (5) through (9), respectively; and
                    (G) by inserting after paragraph (3) the following 
                new paragraph:
            ``(4) For fiscal year 2017.--
                    ``(A) First half.--Subject to paragraphs (5) and 
                (7), from the amount made available under subparagraph 
                (A) of paragraph (20) of subsection (a) for the semi-
                annual period described in such paragraph, increased by 
                the amount of the appropriation for such period under 
                section 301(b)(3) of the Medicare Access and CHIP 
                Reauthorization Act of 2015, the Secretary shall compute 
                a State allotment for each State (including the District 
                of Columbia and each commonwealth and territory) for 
                such semi-annual period in an amount equal to the first 
                half ratio (described in subparagraph (D)) of the amount 
                described in subparagraph (C).
                    ``(B) Second half.--Subject to paragraphs (5) and 
                (7), from the amount made available under subparagraph 
                (B) of paragraph (20) of subsection (a) for the semi-
                annual period described in such paragraph, the Secretary 
                shall compute a State allotment for each State 
                (including the District of Columbia and each 
                commonwealth and territory) for such semi-annual period 
                in an amount equal to the amount made available under 
                such subparagraph, multiplied by the ratio of--
                          ``(i) the amount of the allotment to such 
                      State under subparagraph (A); to
                          ``(ii) the total of the amount of all of the 
                      allotments made available under such subparagraph.
                    ``(C) Full year amount based on rebased amount.--The 
                amount described in this subparagraph for a State is 
                equal to the Federal payments to the State that are 
                attributable to (and countable towards) the total amount 
                of allotments available under this section to the State 
                in fiscal year 2016 (including payments made to the 
                State under subsection (n) for fiscal year 2016 as well 
                as amounts redistributed to the State in fiscal year 
                2016), multiplied by the allotment increase factor under 
                paragraph (6) for fiscal year 2017.
                    ``(D) First half ratio.--The first half ratio 
                described in this subparagraph is the ratio of--

[[Page 129 STAT. 157]]

                          ``(i) the sum of--
                                    ``(I) the amount made available 
                                under subsection (a)(20)(A); and
                                    ``(II) the amount of the 
                                appropriation for such period under 
                                section 301(b)(3) of the Medicare Access 
                                and CHIP Reauthorization Act of 2015; to
                          ``(ii) the sum of the--
                                    ``(I) amount described in clause 
                                (i); and
                                    ``(II) the amount made available 
                                under subsection (a)(20)(B).''.
            (2) Conforming amendments.--
                    (A) Section 2104(c)(1) of the Social Security Act 
                (42 U.S.C. 1397dd(c)(1)) is amended by striking 
                ``(m)(4)'' and inserting ``(m)(5)''.
                    (B) Section 2104(m) of such Act (42 U.S.C. 
                1397dd(m)), as amended by paragraph (1), is further 
                amended--
                          (i) in paragraph (1)--
                                    (I) by striking ``paragraph (4)'' 
                                each place it appears in subparagraphs 
                                (A) and (B) and inserting ``paragraph 
                                (5)''; and
                                    (II) by striking ``the allotment 
                                increase factor determined under 
                                paragraph (5)'' each place it appears 
                                and inserting ``the allotment increase 
                                factor determined under paragraph (6)'';
                          (ii) in paragraph (2)(A), by striking ``the 
                      allotment increase factor under paragraph (5)'' 
                      and inserting ``the allotment increase factor 
                      under paragraph (6)'';
                          (iii) in paragraph (3)--
                                    (I) by striking ``paragraphs (4) and 
                                (6)'' and inserting ``paragraphs (5) and 
                                (7)'' each place it appears; and
                                    (II) by striking ``the allotment 
                                increase factor under paragraph (5)'' 
                                and inserting ``the allotment increase 
                                factor under paragraph (6)'';
                          (iv) in paragraph (5) (as redesignated by 
                      paragraph (1)(F)), by striking ``paragraph (1), 
                      (2), or (3)'' and inserting ``paragraph (1), (2), 
                      (3), or (4)'';
                          (v) in paragraph (7) (as redesignated by 
                      paragraph (1)(F)), by striking ``subject to 
                      paragraph (4)'' and inserting ``subject to 
                      paragraph (5)''; and
                          (vi) in paragraph (9), (as redesignated by 
                      paragraph (1)(F)), by striking ``paragraph (3)'' 
                      and inserting ``paragraph (3) or (4)''.
                    (C) Section 2104(n)(3)(B)(ii) of such Act (42 U.S.C. 
                1397dd(n)(3)(B)(ii)) is amended by striking ``subsection 
                (m)(5)(B)'' and inserting ``subsection (m)(6)(B)''.
                    (D) Section 2111(b)(2)(B)(i) of such Act (42 U.S.C. 
                1397kk(b)(2)(B)(i)) is amended by striking ``section 
                2104(m)(4)'' and inserting ``section 2104(m)(5)''.
            (3) One-time appropriation for fiscal year 2017.--There is 
        appropriated to the Secretary of Health and Human Services, out 
        of any money in the Treasury not otherwise appropriated, 
        $14,700,000,000 to accompany the allotment made for the period 
        beginning on October 1, 2016, and ending on March 31, 2017, 
        under paragraph (20)(A) of section 2104(a) of the Social 
        Security Act (42 U.S.C. 1397dd(a)) (as added by subsection 
        (a)(1)), to remain available until expended. Such amount

[[Page 129 STAT. 158]]

        shall be used to provide allotments to States under paragraph 
        (4) of section 2104(m) of such Act (42 U.S.C. 1397dd(m)) (as 
        amended by paragraph(1)(G)) for the first 6 months of fiscal 
        year 2017 in the same manner as allotments are provided under 
        subsection (a)(20)(A) of such section 2104 and subject to the 
        same terms and conditions as apply to the allotments provided 
        from such subsection (a)(20)(A).

    (c) Extension of Qualifying States Option.--Section 2105(g)(4) of 
the Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended--
            (1) in the paragraph heading, by striking ``2015'' and 
        inserting ``2017''; and
            (2) in subparagraph (A), by striking ``2015'' and inserting 
        ``2017''.

    (d) Extension of the Child Enrollment Contingency Fund.--
            (1) In general.--Section 2104(n) of the Social Security Act 
        (42 U.S.C. 1397dd(n)) is amended--
                    (A) in paragraph (2)--
                          (i) in subparagraph (A)(ii)--
                                    (I) by striking ``2010 through 
                                2014'' and inserting ``2010, 2011, 2012, 
                                2013, 2014, and 2016''; and
                                    (II) by inserting ``and fiscal year 
                                2017'' after ``2015''; and
                          (ii) in subparagraph (B)--
                                    (I) by striking ``2010 through 
                                2014'' and inserting ``2010, 2011, 2012, 
                                2013, 2014, and 2016''; and
                                    (II) by inserting ``and fiscal year 
                                2017'' after ``2015''; and
                    (B) in paragraph (3)(A), in the matter preceding 
                clause (i), by striking ``fiscal year 2009, fiscal year 
                2010, fiscal year 2011, fiscal year 2012, fiscal year 
                2013, fiscal year 2014, or a semi-annual allotment 
                period for fiscal year 2015'' and inserting ``any of 
                fiscal years 2009 through 2014, fiscal year 2016, or a 
                semi-annual allotment period for fiscal year 2015 or 
                2017''.
SEC. 302. EXTENSION OF EXPRESS LANE ELIGIBILITY.

    Section 1902(e)(13)(I) of the Social Security Act (42 U.S.C. 
1396a(e)(13)(I)) is amended by striking ``2015'' and inserting ``2017''.
SEC. 303. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM.

    Section 2113 of the Social Security Act (42 U.S.C. 1397mm) is 
amended--
            (1) in subsection (a)(1), by striking ``2015'' and inserting 
        ``2017''; and
            (2) in subsection (g), by inserting ``and $40,000,000 for 
        the period of fiscal years 2016 and 2017'' after ``2015''.
SEC. 304. EXTENSION OF CERTAIN PROGRAMS AND DEMONSTRATION 
                        PROJECTS.

    (a) Childhood Obesity Demonstration Project.--Section 1139A(e)(8) of 
the Social Security Act (42 U.S.C. 1320b-9a(e)(8)) is amended by 
inserting ``, and $10,000,000 for the period of fiscal years 2016 and 
2017'' after ``2014''.

[[Page 129 STAT. 159]]

    (b) Pediatric Quality Measures Program.--Section 1139A(i) of the 
Social Security Act (42 U.S.C. 1320b-9a(i)) is amended in the first 
sentence by inserting before the period at the end the following: ``, 
and there is appropriated for the period of fiscal years 2016 and 2017, 
$20,000,000 for the purpose of carrying out this section (other than 
subsections (e), (f), and (g))''.
SEC. 305. REPORT OF INSPECTOR GENERAL OF HHS ON USE OF EXPRESS 
                        LANE OPTION UNDER MEDICAID AND CHIP.

    Not later than 18 months after the date of the enactment of this 
Act, the Inspector General of the Department of Health and Human 
Services shall submit to the Committee on Energy and Commerce of the 
House of Representatives and the Committee on Finance of the Senate a 
report that--
            (1) provides data on the number of individuals enrolled in 
        the Medicaid program under title XIX of the Social Security Act 
        (referred to in this section as ``Medicaid'') and the Children's 
        Health Insurance Program under title XXI of such Act (referred 
        to in this section as ``CHIP'') through the use of the Express 
        Lane option under section 1902(e)(13) of the Social Security Act 
        (42 U.S.C. 1396a(e)(13));
            (2) assesses the extent to which individuals so enrolled 
        meet the eligibility requirements under Medicaid or CHIP (as 
        applicable); and
            (3) provides data on Federal and State expenditures under 
        Medicaid and CHIP for individuals so enrolled and disaggregates 
        such data between expenditures made for individuals who meet the 
        eligibility requirements under Medicaid or CHIP (as applicable) 
        and expenditures made for individuals who do not meet such 
        requirements.

                            TITLE IV--OFFSETS

                Subtitle A--Medicare Beneficiary Reforms

SEC. 401. LIMITATION ON CERTAIN MEDIGAP POLICIES FOR NEWLY 
                        ELIGIBLE MEDICARE BENEFICIARIES.

    Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is 
amended by adding at the end the following new subsection:
    ``(z) Limitation on Certain Medigap Policies for Newly Eligible 
Medicare Beneficiaries.--
            ``(1) <<NOTE: Effective date.>>  In general.--
        Notwithstanding any other provision of this section, on or after 
        January 1, 2020, a medicare supplemental policy that provides 
        coverage of the part B deductible, including any such policy (or 
        rider to such a policy) issued under a waiver granted under 
        subsection (p)(6), may not be sold or issued to a newly eligible 
        Medicare beneficiary.
            ``(2) Newly eligible medicare beneficiary defined.--In this 
        subsection, the term `newly eligible Medicare beneficiary' means 
        an individual who is neither of the following:
                    ``(A) An individual who has attained age 65 before 
                January 1, 2020.
                    ``(B) An individual who was entitled to benefits 
                under part A pursuant to section 226(b) or 226A, or 
                deemed to be eligible for benefits under section 226(a), 
                before January 1, 2020.

[[Page 129 STAT. 160]]

            ``(3) Treatment of waivered states.--In the case of a State 
        described in subsection (p)(6), nothing in this section shall be 
        construed as preventing the State from modifying its alternative 
        simplification program under such subsection so as to eliminate 
        the coverage of the part B deductible for any medical 
        supplemental policy sold or issued under such program to a newly 
        eligible Medicare beneficiary on or after January 1, 2020.
            ``(4) Treatment of references to certain policies.--In the 
        case of a newly eligible Medicare beneficiary, except as the 
        Secretary may otherwise provide, any reference in this section 
        to a medicare supplemental policy which has a benefit package 
        classified as `C' or `F' shall be deemed, as of January 1, 2020, 
        to be a reference to a medicare supplemental policy which has a 
        benefit package classified as `D' or `G', respectively.
            ``(5) <<NOTE: Applicability.>>  Enforcement.--The penalties 
        described in clause (ii) of subsection (d)(3)(A) shall apply 
        with respect to a violation of paragraph (1) in the same manner 
        as it applies to a violation of clause (i) of such 
        subsection.''.
SEC. 402. INCOME-RELATED PREMIUM ADJUSTMENT FOR PARTS B AND D.

    (a) In General.--Section 1839(i)(3)(C)(i) of the Social Security Act 
(42 U.S.C. 1395r(i)(3)(C)(i)) is amended--
            (1) by inserting after ``In general.--'' the following:
                                    ``(I) Subject to paragraphs (5) and 
                                (6), for years before 2018:''; and
            (2) by adding at the end the following:
                                    ``(II) Subject to paragraph (5), for 
                                years beginning with 2018:

``If the modified adjusted gross income is:              The applicable
                                                                  percentage is:
  More than $85,000 but not more than $107,000.....            35 percent
  More than $107,000 but not more than $133,500....            50 percent
  More than $133,500 but not more than $160,000....            65 percent
  More than $160,000...............................            80 percent.''.
 


    (b) Conforming Amendments.--Section 1839(i) of the Social Security 
Act (42 U.S.C. 1395r(i)) is amended--
            (1) in paragraph (2)(A), by inserting ``(or, beginning with 
        2018, $85,000)'' after ``$80,000'';
            (2) in paragraph (3)(A)(i), by inserting ``applicable'' 
        before ``table'';
            (3) in paragraph (5)(A)--
                    (A) in the matter before clause (i), by inserting 
                ``(other than 2018 and 2019)'' after ``2007''; and
                    (B) in clause (ii), by inserting ``(or, in the case 
                of a calendar year beginning with 2020, August 2018)'' 
                after ``August 2006''; and
            (4) in paragraph (6), in the matter before subparagraph (A), 
        by striking ``2019'' and inserting ``2017''.

[[Page 129 STAT. 161]]

                        Subtitle B--Other Offsets

SEC. 411. MEDICARE PAYMENT UPDATES FOR POST-ACUTE PROVIDERS.

    (a) SNFs.--Section 1888(e) of the Social Security Act (42 U.S.C. 
1395yy(e))--
            (1) in paragraph (5)(B)--
                    (A) in clause (i), by striking ``clause (ii)'' and 
                inserting ``clauses (ii) and (iii)'';
                    (B) in clause (ii), by inserting ``subject to clause 
                (iii),'' after ``each subsequent fiscal year,''; and
                    (C) by adding at the end the following new clause:
                          ``(iii) Special rule for fiscal year 2018.--
                      For fiscal year 2018 (or other similar annual 
                      period specified in clause (i)), the skilled 
                      nursing facility market basket percentage, after 
                      application of clause (ii), is equal to 1 
                      percent.''; and
            (2) in paragraph (6)(A), by striking ``paragraph 
        (5)(B)(ii)'' and inserting ``clauses (ii) and (iii) of paragraph 
        (5)(B)'' each place it appears.

    (b) IRFs.--Section 1886(j) of the Social Security Act (42 U.S.C. 
1395ww(j)) is amended--
            (1) in paragraph (3)(C)--
                    (A) in clause (i), by striking ``clause (ii)'' and 
                inserting ``clauses (ii) and (iii)'';
                    (B) in clause (ii), by striking ``After'' and 
                inserting ``Subject to clause (iii), after''; and
                    (C) by adding at the end the following new clause:
                          ``(iii) <<NOTE: Applicability.>>  Special rule 
                      for fiscal year 2018.--The increase factor to be 
                      applied under this subparagraph for fiscal year 
                      2018, after the application of clause (ii), shall 
                      be 1 percent.''; and
            (2) in paragraph (7)(A)(i), by striking ``paragraph (3)(D)'' 
        and inserting ``subparagraphs (C)(iii) and (D) of paragraph 
        (3)''.

    (c) HHAs.--Section 1895(b)(3)(B) of the Social Security Act (42 
U.S.C. 1395fff(b)(3)(B)) is amended--
            (1) in clause (iii), by adding at the end the following: 
        ``Notwithstanding the previous sentence, the home health market 
        basket percentage increase for 2018 shall be 1 percent.''; and
            (2) in clause (vi)(I), by inserting ``(except 2018)'' after 
        ``each subsequent year''.

    (d) Hospice.--Section 1814(i) of the Social Security Act (42 U.S.C. 
1395f(i)) is amended--
            (1) in paragraph (1)(C)--
                    (A) in clause (ii)(VII), by striking ``clause 
                (iv),,'' and inserting ``clauses (iv) and (vi),'';
                    (B) in clause (iii), by striking ``clause (iv),'' 
                and inserting ``clauses (iv) and (vi),'';
                    (C) in clause (iv), by striking ``After 
                determining'' and inserting ``Subject to clause (vi), 
                after determining''; and
                    (D) by adding at the end the following new clause:

    ``(vi) For fiscal year 2018, the market basket percentage increase 
under clause (ii)(VII) or (iii), as applicable, after application of 
clause (iv), shall be 1 percent.''; and

[[Page 129 STAT. 162]]

            (2) in paragraph (5)(A)(i), by striking ``paragraph 
        (1)(C)(iv)'' and inserting ``clauses (iv) and (vi) of paragraph 
        (1)(C)''.

    (e) LTCHs.--Section 1886(m)(3) of the Social Security Act (42 U.S.C. 
1395ww(m)(3)) is amended--
            (1) in subparagraph (A), in the matter preceding clause (i), 
        by striking ``In implementing'' and inserting ``Subject to 
        subparagraph (C), in implementing''; and
            (2) by adding at the end the following new subparagraph:
                    ``(C) Additional special rule.--For fiscal year 
                2018, the annual update under subparagraph (A) for the 
                fiscal year, after application of clauses (i) and (ii) 
                of subparagraph (A), shall be 1 percent.''.
SEC. 412. DELAY OF REDUCTION TO MEDICAID DSH ALLOTMENTS.

    Section 1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f)) is 
amended--
            (1) in paragraph (7)(A)--
                    (A) in clause (i), by striking ``2017 through 2024'' 
                and inserting ``2018 through 2025'';
                    (B) by striking clause (ii) and inserting the 
                following new clause:
                          ``(ii) Aggregate reductions.--The aggregate 
                      reductions in DSH allotments for all States under 
                      clause (i)(I) shall be equal to--
                                    ``(I) $2,000,000,000 for fiscal year 
                                2018;
                                    ``(II) $3,000,000,000 for fiscal 
                                year 2019;
                                    ``(III) $4,000,000,000 for fiscal 
                                year 2020;
                                    ``(IV) $5,000,000,000 for fiscal 
                                year 2021;
                                    ``(V) $6,000,000,000 for fiscal year 
                                2022;
                                    ``(VI) $7,000,000,000 for fiscal 
                                year 2023;
                                    ``(VII) $8,000,000,000 for fiscal 
                                year 2024; and
                                    ``(VIII) $8,000,000,000 for fiscal 
                                year 2025.''; and
                    (C) by adding at the end the following new clause:
                          ``(v) Distribution of aggregate reductions.--
                      The Secretary shall distribute the aggregate 
                      reductions under clause (ii) among States in 
                      accordance with subparagraph (B).''; and
            (2) in paragraph (8), by striking ``2024'' and inserting 
        ``2025''.
SEC. 413. LEVY ON DELINQUENT PROVIDERS.

    (a) In General.--Paragraph (3) of section 6331(h) of the Internal 
Revenue Code of 1986 <<NOTE: 26 USC 6331.>>  is amended by striking ``30 
percent'' and inserting ``100 percent''.

    (b) <<NOTE: Applicability. 26 USC 6331 note.>>  Effective Date.--The 
amendment made by this section shall apply to payments made after 180 
days after the date of the enactment of this Act.
SEC. 414. ADJUSTMENTS TO INPATIENT HOSPITAL PAYMENT RATES.

    Section 7(b) of the TMA, Abstinence Education, and QI Programs 
Extension Act of 2007 (Public Law 110-90), as amended by section 631(b) 
of the American Taxpayer Relief Act of 2012 (Public Law 112-
240), <<NOTE: 121 Stat. 986.>> is amended--
            (1) in paragraph (1)--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``, 2009, or 2010'' and inserting ``or 2009''; 
                and
                    (B) in subparagraph (B)--

[[Page 129 STAT. 163]]

                          (i) in clause (i), by striking ``and'' at the 
                      end;
                          (ii) in clause (ii), by striking the period at 
                      the end and inserting ``; and''; and
                          (iii) by adding at the end the following new 
                      clause:
                    ``(iii) make an additional adjustment to the 
                standardized amounts under such section 1886(d) of an 
                increase of 0.5 percentage points for discharges 
                occurring during each of fiscal years 2018 through 2023 
                and not make the adjustment (estimated to be an increase 
                of 3.2 percent) that would otherwise apply for 
                discharges occurring during fiscal year 2018 by reason 
                of the completion of the adjustments required under 
                clause (ii).'';
            (2) in paragraph (3)--
                    (A) by striking ``shall be construed'' and all that 
                follows through ``providing authority'' and inserting 
                ``shall be construed as providing authority''; and
                    (B) by inserting ``and each succeeding fiscal year 
                through fiscal year 2023'' after ``2017'';
            (3) by redesignating paragraphs (3) and (4) as paragraphs 
        (4) and (5), respectively; and
            (4) by inserting after paragraph (2) the following new 
        paragraph:
            ``(3) Prohibition.--The Secretary shall not make an 
        additional prospective adjustment (estimated to be a decrease of 
        0.55 percent) to the standardized amounts under such section 
        1886(d) to offset the amount of the increase in aggregate 
        payments related to documentation and coding changes for 
        discharges occurring during fiscal year 2010.''.

                         TITLE V--MISCELLANEOUS

            Subtitle A--Protecting the Integrity of Medicare

SEC. 501. PROHIBITION OF INCLUSION OF SOCIAL SECURITY ACCOUNT 
                        NUMBERS ON MEDICARE CARDS.

    (a) In General.--Section 205(c)(2)(C) of the Social Security Act (42 
U.S.C. 405(c)(2)(C)) is amended--
            (1) by moving clause (x), as added by section 1414(a)(2) of 
        the Patient Protection and Affordable Care Act, 6 ems to the 
        left;
            (2) by redesignating clause (x), as added by section 2(a)(1) 
        of the Social Security Number Protection Act of 2010, and clause 
        (xi) as clauses (xi) and (xii), respectively; and
            (3) by adding at the end the following new clause:

    ``(xiii) <<NOTE: Consultation. Procedures.>>  The Secretary of 
Health and Human Services, in consultation with the Commissioner of 
Social Security, shall establish cost-effective procedures to ensure 
that a Social Security account number (or derivative thereof) is not 
displayed, coded, or embedded on the Medicare card issued to an 
individual who is entitled to benefits under part A of title XVIII or 
enrolled under part B of title XVIII and that any other identifier 
displayed on such card is not identifiable as a Social Security account 
number (or derivative thereof).''.

    (b) <<NOTE: 42 USC 405 note.>>  Implementation.--In implementing 
clause (xiii) of section 205(c)(2)(C) of the Social Security Act (42 
U.S.C. 405(c)(2)(C)), as

[[Page 129 STAT. 164]]

added by subsection (a)(3), the Secretary of Health and Human Services 
shall do the following:
            (1) In general.--Establish a cost-effective process that 
        involves the least amount of disruption to, as well as necessary 
        assistance for, Medicare beneficiaries and health care 
        providers, such as a process that provides such beneficiaries 
        with access to assistance through a toll-free telephone number 
        and provides outreach to providers.
            (2) Consideration of medicare beneficiary identified.--
        Consider implementing a process, similar to the process 
        involving Railroad Retirement Board beneficiaries, under which a 
        Medicare beneficiary identifier which is not a Social Security 
        account number (or derivative thereof) is used external to the 
        Department of Health and Human Services and is convertible over 
        to a Social Security account number (or derivative thereof) for 
        use internal to such Department and the Social Security 
        Administration.

    (c) Funding for Implementation.--For purposes of implementing the 
provisions of and the amendments made by this section, the Secretary of 
Health and Human Services shall provide for the following transfers from 
the Federal Hospital Insurance Trust Fund under section 1817 of the 
Social Security Act (42 U.S.C. 1395i) and from the Federal Supplementary 
Medical Insurance Trust Fund established under section 1841 of such Act 
(42 U.S.C. 1395t), in such proportions as the Secretary determines 
appropriate:
            (1) To the Centers for Medicare & Medicaid Program 
        Management Account, transfers of the following amounts:
                    (A) For fiscal year 2015, $65,000,000, to be made 
                available through fiscal year 2018.
                    (B) For each of fiscal years 2016 and 2017, 
                $53,000,000, to be made available through fiscal year 
                2018.
                    (C) For fiscal year 2018, $48,000,000, to be made 
                available until expended.
            (2) To the Social Security Administration Limitation on 
        Administration Account, transfers of the following amounts:
                    (A) For fiscal year 2015, $27,000,000, to be made 
                available through fiscal year 2018.
                    (B) For each of fiscal years 2016 and 2017, 
                $22,000,000, to be made available through fiscal year 
                2018.
                    (C) For fiscal year 2018, $27,000,000, to be made 
                available until expended.
            (3) To the Railroad Retirement Board Limitation on 
        Administration Account, the following amount:
                    (A) For fiscal year 2015, $3,000,000, to be made 
                available until expended.

    (d) <<NOTE: Deadlines.>>  Effective Date.--
            (1) In general.--Clause (xiii) of section 205(c)(2)(C) of 
        the Social Security Act (42 U.S.C. 405(c)(2)(C)), as added by 
        subsection (a)(3), shall apply with respect to Medicare cards 
        issued on and after an effective date specified by the Secretary 
        of Health and Human Services, but in no case shall such 
        effective date be later than the date that is four years after 
        the date of the enactment of this Act.
            (2) Reissuance.--The Secretary shall provide for the 
        reissuance of Medicare cards that comply with the requirements 
        of such clause not later than four years after the effective 
        date specified by the Secretary under paragraph (1).

[[Page 129 STAT. 165]]

SEC. 502. PREVENTING WRONGFUL MEDICARE PAYMENTS FOR ITEMS AND 
                        SERVICES FURNISHED TO INCARCERATED 
                        INDIVIDUALS, INDIVIDUALS NOT LAWFULLY 
                        PRESENT, AND DECEASED INDIVIDUALS.

    (a) Requirement for the Secretary To Establish Policies and Claims 
Edits Relating to Incarcerated Individuals, Individuals Not Lawfully 
Present, and Deceased Individuals.--Section 1874 of the Social Security 
Act (42 U.S.C. 1395kk) is amended by adding at the end the following new 
subsection:
    ``(f) Requirement for the Secretary To Establish Policies and Claims 
Edits Relating to Incarcerated Individuals, Individuals Not Lawfully 
Present, and Deceased Individuals.--
The <<NOTE: Procedures. Audits.>> Secretary shall establish and maintain 
procedures, including procedures for using claims processing edits, 
updating eligibility information to improve provider accessibility, and 
conducting recoupment activities such as through recovery audit 
contractors, in order to ensure that payment is not made under this 
title for items and services furnished to an individual who is one of 
the following:
            ``(1) An individual who is incarcerated.
            ``(2) An individual who is not lawfully present in the 
        United States and who is not eligible for coverage under this 
        title.
            ``(3) A deceased individual.''.

    (b) <<NOTE: 42 USC 1395kk note.>>  Report.--Not later than 18 months 
after the date of the enactment of this section, and periodically 
thereafter as determined necessary by the Office of Inspector General of 
the Department of Health and Human Services, such Office shall submit to 
Congress a report on the activities described in subsection (f) of 
section 1874 of the Social Security Act (42 U.S.C. 1395kk), as added by 
subsection (a), that have been conducted since such date of enactment.
SEC. 503. CONSIDERATION OF MEASURES REGARDING MEDICARE BENEFICIARY 
                        SMART CARDS.

    To the extent the Secretary of Health and Human Services determines 
that it is cost effective and technologically viable to use electronic 
Medicare beneficiary and provider cards (such as cards that use smart 
card technology, including an embedded and secure integrated circuit 
chip), as presented in the Government Accountability Office report 
required by the conference report accompanying the Consolidated 
Appropriations Act, 2014 (Public Law 113-76), the Secretary shall 
consider such measures as determined appropriate by the Secretary to 
implement such use of such cards for beneficiary and provider use under 
title XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.). <<NOTE: Reports.>> In the case that the Secretary considers 
measures under the preceding sentence, the Secretary shall submit to the 
Committees on Ways and Means and Energy and Commerce of the House of 
Representatives, and to the Committee on Finance of the Senate, a report 
outlining the considerations undertaken by the Secretary under such 
sentence.
SEC. 504. MODIFYING MEDICARE DURABLE MEDICAL EQUIPMENT FACE-TO-
                        FACE ENCOUNTER DOCUMENTATION REQUIREMENT.

    (a) In General.--Section 1834(a)(11)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395m(a)(11)(B)(ii)) is amended--

[[Page 129 STAT. 166]]

            (1) by striking ``the physician documenting that''; and
            (2) by striking ``has had a face-to-face encounter'' and 
        inserting ``documenting such physician, physician assistant, 
        practitioner, or specialist has had a face-to-face encounter''.

    (b) Implementation.--Notwithstanding any other provision of law, the 
Secretary of Health and Human Services may implement the amendments made 
by subsection (a) by program instruction or otherwise.
SEC. 505. REDUCING IMPROPER MEDICARE PAYMENTS.

    (a) Medicare Administrative Contractor Improper Payment Outreach and 
Education Program.--Section 1874A of the Social Security Act (42 U.S.C. 
1395kk-1) is amended--
            (1) in subsection (a)(4)--
                    (A) by redesignating subparagraph (G) as 
                subparagraph (H); and
                    (B) by inserting after subparagraph (F) the 
                following new subparagraph:
                    ``(G) Improper payment outreach and education 
                program.--Having in place an improper payment outreach 
                and education program described in subsection (h).''; 
                and
            (2) by adding at the end the following new subsection:

    ``(h) Improper Payment Outreach and Education Program.--
            ``(1) In general.--In order to reduce improper payments 
        under this title, each medicare administrative contractor shall 
        establish and have in place an improper payment outreach and 
        education program under which the contractor, through outreach, 
        education, training, and technical assistance or other 
        activities, shall provide providers of services and suppliers 
        located in the region covered by the contract under this section 
        with the information described in paragraph (2). The activities 
        described in the preceding sentence shall be conducted on a 
        regular basis.
            ``(2) Information to be provided through activities.--The 
        information to be provided under such payment outreach and 
        education program shall include information the Secretary 
        determines to be appropriate, which may include the following 
        information:
                    ``(A) A list of the providers' or suppliers' most 
                frequent and expensive payment errors over the last 
                quarter.
                    ``(B) Specific instructions regarding how to correct 
                or avoid such errors in the future.
                    ``(C) A notice of new topics that have been approved 
                by the Secretary for audits conducted by recovery audit 
                contractors under section 1893(h).
                    ``(D) Specific instructions to prevent future issues 
                related to such new audits.
                    ``(E) Other information determined appropriate by 
                the Secretary.
            ``(3) Priority.--A medicare administrative contractor shall 
        give priority to activities under such program that will reduce 
        improper payments that are one or more of the following:
                    ``(A) Are for items and services that have the 
                highest rate of improper payment.
                    ``(B) Are for items and service that have the 
                greatest total dollar amount of improper payments.

[[Page 129 STAT. 167]]

                    ``(C) Are due to clear misapplication or 
                misinterpretation of Medicare policies.
                    ``(D) Are clearly due to common and inadvertent 
                clerical or administrative errors.
                    ``(E) Are due to other types of errors that the 
                Secretary determines could be prevented through 
                activities under the program.
            ``(4) Information on improper payments from recovery audit 
        contractors.--
                    ``(A) In general.--In order to assist medicare 
                administrative contractors in carrying out improper 
                payment outreach and education programs, the Secretary 
                shall provide each contractor with a complete list of 
                the types of improper payments identified by recovery 
                audit contractors under section 1893(h) with respect to 
                providers of services and suppliers located in the 
                region covered by the contract under this section. Such 
                information shall be provided on a time frame the 
                Secretary determines appropriate which may be on a 
                quarterly basis.
                    ``(B) Information.--The information described in 
                subparagraph (A) shall include information such as the 
                following:
                          ``(i) Providers of services and suppliers that 
                      have the highest rate of improper payments.
                          ``(ii) Providers of services and suppliers 
                      that have the greatest total dollar amounts of 
                      improper payments.
                          ``(iii) Items and services furnished in the 
                      region that have the highest rates of improper 
                      payments.
                          ``(iv) Items and services furnished in the 
                      region that are responsible for the greatest total 
                      dollar amount of improper payments.
                          ``(v) Other information the Secretary 
                      determines would assist the contractor in carrying 
                      out the program.
            ``(5) Communications.--Communications with providers of 
        services and suppliers under an improper payment outreach and 
        education program are subject to the standards and requirements 
        of subsection (g).''.

    (b) Use of Certain Funds Recovered by RACs.--Section 1893(h) of the 
Social Security Act (42 U.S.C. 1395ddd(h)) is amended--
            (1) in paragraph (2), by inserting ``or paragraph (10)'' 
        after ``paragraph (1)(C)''; and
            (2) by adding at the end the following new paragraph:
            ``(10) Use of certain recovered funds.--
                    ``(A) In general.--After application of paragraph 
                (1)(C), the Secretary shall retain a portion of the 
                amounts recovered by recovery audit contractors for each 
                year under this section which shall be available to the 
                program management account of the Centers for Medicare & 
                Medicaid Services for purposes of, subject to 
                subparagraph (B), carrying out sections 1833(z), 
                1834(l)(16), and 1874A(a)(4)(G), carrying out section 
                514(b) of the Medicare Access and CHIP Reauthorization 
                Act of 2015, and implementing strategies (such as claims 
                processing edits) to help reduce the error rate of 
                payments under this title.

[[Page 129 STAT. 168]]

                The amounts retained under the preceding sentence shall 
                not exceed an amount equal to 15 percent of the amounts 
                recovered under this subsection, and shall remain 
                available until expended.
                    ``(B) Limitation.--Except for uses that support 
                claims processing (including edits) or system 
                functionality for detecting fraud, amounts retained 
                under subparagraph (A) may not be used for 
                technological-related infrastructure, capital 
                investments, or information systems.
                    ``(C) No reduction in payments to recovery audit 
                contractors.--Nothing in subparagraph (A) shall reduce 
                amounts available for payments to recovery audit 
                contractors under this subsection.''.
SEC. 506. IMPROVING SENIOR MEDICARE PATROL AND FRAUD REPORTING 
                        REWARDS.

    (a) <<NOTE: Plans. Recommenda- tions.>>  In General.--The Secretary 
of Health and Human Services (in this section referred to as the 
``Secretary'') shall develop a plan to revise the incentive program 
under section 203(b) of the Health Insurance Portability and 
Accountability Act of 1996 (42 U.S.C. 1395b-5(b)) to encourage greater 
participation by individuals to report fraud and abuse in the Medicare 
program. Such plan shall include recommendations for--
            (1) ways to enhance rewards for individuals reporting under 
        the incentive program, including rewards based on information 
        that leads to an administrative action; and
            (2) extending the incentive program to the Medicaid program.

    (b) Public Awareness and Education Campaign.--The plan developed 
under subsection (a) shall also include recommendations for the use of 
the Senior Medicare Patrols authorized under section 411 of the Older 
Americans Act of 1965 (42 U.S.C. 3032) to conduct a public awareness and 
education campaign to encourage participation in the revised incentive 
program under subsection (a).
    (c) <<NOTE: Deadline.>>  Submission of Plan.--Not later than 180 
days after the date of enactment of this Act, the Secretary shall submit 
to Congress the plan developed under subsection (a).
SEC. 507. REQUIRING VALID PRESCRIBER NATIONAL PROVIDER IDENTIFIERS 
                        ON PHARMACY CLAIMS.

    Section 1860D-4(c) of the Social Security Act (42 U.S.C. 1395w-
104(c)) is amended by adding at the end the following new paragraph:
            ``(4) Requiring valid prescriber national provider 
        identifiers on pharmacy claims.--
                    ``(A) In general.--For plan year 2016 and subsequent 
                plan years, the Secretary shall require a claim for a 
                covered part D drug for a part D eligible individual 
                enrolled in a prescription drug plan under this part or 
                an MA-PD plan under part C to include a prescriber 
                National Provider Identifier that is determined to be 
                valid under the procedures established under 
                subparagraph (B)(i).
                    ``(B) Procedures.--
                          ``(i) Validity of prescriber national provider 
                      identifiers.--
                      The <<NOTE: Consultation.>> Secretary, in 
                      consultation with appropriate stakeholders, shall 
                      establish procedures for determining the validity 
                      of prescriber National Provider Identifiers under 
                      subparagraph (A).

[[Page 129 STAT. 169]]

                          ``(ii) Informing beneficiaries of reason for 
                      denial.--The Secretary shall establish procedures 
                      to ensure that, in the case that a claim for a 
                      covered part D drug of an individual described in 
                      subparagraph (A) is denied because the claim does 
                      not meet the requirements of this paragraph, the 
                      individual is properly informed at the point of 
                      service of the reason for the denial.
                    ``(C) Report.--Not later than January 1, 2018, the 
                Inspector General of the Department of Health and Human 
                Services shall submit to Congress a report on the 
                effectiveness of the procedures established under 
                subparagraph (B)(i).''.
SEC. 508. OPTION TO RECEIVE MEDICARE SUMMARY NOTICE 
                        ELECTRONICALLY.

    (a) In General.--Section 1806 of the Social Security Act (42 U.S.C. 
1395b-7) is amended by adding at the end the following new subsection:
    ``(c) Format of Statements From Secretary.--
            ``(1) Electronic option beginning in 2016.--Subject to 
        paragraph (2), for statements described in subsection (a) that 
        are furnished for a period in 2016 or a subsequent year, in the 
        case that an individual described in subsection (a) elects, in 
        accordance with such form, manner, and time specified by the 
        Secretary, to receive such statement in an electronic format, 
        such statement shall be furnished to such individual for each 
        period subsequent to such election in such a format and shall 
        not be mailed to the individual.
            ``(2) Limitation on revocation option.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                Secretary may determine a maximum number of elections 
                described in paragraph (1) by an individual that may be 
                revoked by the individual.
                    ``(B) Minimum of one revocation option.--In no case 
                may the Secretary determine a maximum number under 
                subparagraph (A) that is less than one.
            ``(3) <<NOTE: Effective date.>>  Notification.--The 
        Secretary shall ensure that, in the most cost effective manner 
        and beginning January 1, 2017, a clear notification of the 
        option to elect to receive statements described in subsection 
        (a) in an electronic format is made available, such as through 
        the notices distributed under section 1804, to individuals 
        described in subsection (a).''.

    (b) <<NOTE: 7 USC 1395b-7 note.>>  Encouraged Expansion of 
Electronic Statements.--To the extent to which the Secretary of Health 
and Human Services determines appropriate, the Secretary shall--
            (1) <<NOTE: Applicability.>>  apply an option similar to the 
        option described in subsection (c)(1) of section 1806 of the 
        Social Security Act (42 U.S.C. 1395b-7) (relating to the 
        provision of the Medicare Summary Notice in an electronic 
        format), as added by subsection (a), to other statements and 
        notifications under title XVIII of such Act (42 U.S.C. 1395 et 
        seq.); and
            (2) provide such Medicare Summary Notice and any such other 
        statements and notifications on a more frequent basis than is 
        otherwise required under such title.

[[Page 129 STAT. 170]]

SEC. 509. RENEWAL OF MAC CONTRACTS.

    (a) In General.--Section 1874A(b)(1)(B) of the Social Security Act 
(42 U.S.C. 1395kk-1(b)(1)(B)) is amended by striking ``5 years'' and 
inserting ``10 years''.
    (b) <<NOTE: 42 USC 1395kk-1 note.>> Application.--The amendments 
made by subsection (a) shall apply to contracts entered into on or 
after, and to contracts in effect as of, the date of the enactment of 
this Act.

    (c) Contractor Performance Transparency.--Section 1874A(b)(3)(A) of 
the Social Security Act (42 U.S.C. 1395kk-1(b)(3)(A)) is amended by 
adding at the end the following new clause:
                          ``(iv) <<NOTE: Public information.>>  
                      Contractor performance transparency.--To the 
                      extent possible without compromising the process 
                      for entering into and renewing contracts with 
                      medicare administrative contractors under this 
                      section, the Secretary shall make available to the 
                      public the performance of each medicare 
                      administrative contractor with respect to such 
                      performance requirements and measurement 
                      standards.''.
SEC. 510. STUDY ON PATHWAY FOR INCENTIVES TO STATES FOR STATE 
                        PARTICIPATION IN MEDICAID DATA MATCH 
                        PROGRAM.

    Section 1893(g) of the Social Security Act (42 U.S.C. 1395ddd(g)) is 
amended by adding at the end the following new paragraph:
            ``(3) Incentives for states.--The Secretary shall study and, 
        as appropriate, may specify incentives for States to work with 
        the Secretary for the purposes described in paragraph 
        (1)(A)(ii). The application of the previous sentence may include 
        use of the waiver authority described in paragraph (2).''.
SEC. 511. GUIDANCE ON APPLICATION OF COMMON RULE TO CLINICAL DATA 
                        REGISTRIES.

    Not <<NOTE: Deadline.>>  later than one year after the date of the 
enactment of this section, the Secretary of Health and Human Services 
shall issue a clarification or modification with respect to the 
application of subpart A of part 46 of title 45, Code of Federal 
Regulations, governing the protection of human subjects in research (and 
commonly known as the ``Common Rule''), to activities, including quality 
improvement activities, involving clinical data registries, including 
entities that are qualified clinical data registries pursuant to section 
1848(m)(3)(E) of the Social Security Act (42 U.S.C. 1395w-4(m)(3)(E)).
SEC. 512. ELIMINATING CERTAIN CIVIL MONEY PENALTIES; GAINSHARING 
                        STUDY AND REPORT.

    (a) Eliminating Civil Money Penalties for Inducements to Physicians 
To Limit Services That Are Not Medically Necessary.--
            (1) In general.--Section 1128A(b)(1) of the Social Security 
        Act (42 U.S.C. 1320a-7a(b)(1)) is amended by inserting 
        ``medically necessary'' after ``reduce or limit''.
            (2) <<NOTE: Applicability. 42 USC 1320a-7a note.>>  
        Effective date.--The amendment made by paragraph (1) shall apply 
        to payments made on or after the date of the enactment of this 
        Act.

    (b) <<NOTE: Consultation.>>  Gainsharing Study and Report.--Not 
later than 12 months after the date of the enactment of this Act, the 
Secretary of Health and Human Services, in consultation with the 
Inspector General of the Department of Health and Human Services, shall

[[Page 129 STAT. 171]]

submit to Congress a report with options for amending existing fraud and 
abuse laws in, and regulations related to, titles XI and XVIII of the 
Social Security Act (42 U.S.C. 301 et seq.), through exceptions, safe 
harbors, or other narrowly targeted provisions, to permit gainsharing 
arrangements that otherwise would be subject to the civil money 
penalties described in paragraphs (1) and (2) of section 1128A(b) of 
such Act (42 U.S.C. 1320a-7a(b)), or similar arrangements between 
physicians and hospitals, and that improve care while reducing waste and 
increasing efficiency. The report shall--
            (1) consider whether such provisions should apply to 
        ownership interests, compensation arrangements, or other 
        relationships;
            (2) describe how the recommendations address accountability, 
        transparency, and quality, including how best to limit 
        inducements to stint on care, discharge patients prematurely, or 
        otherwise reduce or limit medically necessary care; and
            (3) consider whether a portion of any savings generated by 
        such arrangements (as compared to an historical benchmark or 
        other metric specified by the Secretary to determine the impact 
        of delivery and payment system changes under such title XVIII on 
        expenditures made under such title) should accrue to the 
        Medicare program under title XVIII of the Social Security Act.
SEC. 513. MODIFICATION OF MEDICARE HOME HEALTH SURETY BOND 
                        CONDITION OF PARTICIPATION REQUIREMENT.

    Section 1861(o)(7) of the Social Security Act (42 U.S.C. 
1395x(o)(7)) is amended to read as follows:
            ``(7) provides the Secretary with a surety bond--
                    ``(A) in a form specified by the Secretary and in an 
                amount that is not less than the minimum of $50,000; and
                    ``(B) that the Secretary determines is commensurate 
                with the volume of payments to the home health agency; 
                and''.
SEC. 514. OVERSIGHT OF MEDICARE COVERAGE OF MANUAL MANIPULATION OF 
                        THE SPINE TO CORRECT SUBLUXATION.

    (a) In General.--Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended by adding at the end the following new subsection:
    ``(z) Medical Review of Spinal Subluxation Services.--
            ``(1) <<NOTE: Applicability. Effective date.>>  In 
        general.--The Secretary shall implement a process for the 
        medical review (as described in paragraph (2)) of treatment by a 
        chiropractor described in section 1861(r)(5) by means of manual 
        manipulation of the spine to correct a subluxation (as described 
        in such section) of an individual who is enrolled under this 
        part and apply such process to such services furnished on or 
        after January 1, 2017, focusing on services such as--
                    ``(A) services furnished by a such a chiropractor 
                whose pattern of billing is aberrant compared to peers; 
                and
                    ``(B) services furnished by such a chiropractor who, 
                in a prior period, has a services denial percentage in 
                the 85th percentile or greater, taking into 
                consideration the extent that service denials are 
                overturned on appeal.
            ``(2) Medical review.--

[[Page 129 STAT. 172]]

                    ``(A) Prior authorization medical review.--
                          ``(i) In general.--Subject to clause (ii), the 
                      Secretary shall use prior authorization medical 
                      review for services described in paragraph (1) 
                      that are furnished to an individual by a 
                      chiropractor described in section 1861(r)(5) that 
                      are part of an episode of treatment that includes 
                      more than 12 services. For purposes of the 
                      preceding sentence, an episode of treatment shall 
                      be determined by the underlying cause that 
                      justifies the need for services, such as a 
                      diagnosis code.
                          ``(ii) Ending application of prior 
                      authorization medical review.--
                      The <<NOTE: Determination.>> Secretary shall end 
                      the application of prior authorization medical 
                      review under clause (i) to services described in 
                      paragraph (1) by such a chiropractor if the 
                      Secretary determines that the chiropractor has a 
                      low denial rate under such prior authorization 
                      medical review. The Secretary may subsequently 
                      reapply prior authorization medical review to such 
                      chiropractor if the Secretary determines it to be 
                      appropriate and the chiropractor has, in the time 
                      period subsequent to the determination by the 
                      Secretary of a low denial rate with respect to the 
                      chiropractor, furnished such services described in 
                      paragraph (1).
                          ``(iii) Early request for prior authorization 
                      review permitted.--Nothing in this subsection 
                      shall be construed to prevent such a chiropractor 
                      from requesting prior authorization for services 
                      described in paragraph (1) that are to be 
                      furnished to an individual before the chiropractor 
                      furnishes the twelfth such service to such 
                      individual for an episode of treatment.
                    ``(B) Type of review.--The Secretary may use pre-
                payment review or post-payment review of services 
                described in section 1861(r)(5) that are not subject to 
                prior authorization medical review under subparagraph 
                (A).
                    ``(C) Relationship to law enforcement activities.--
                The Secretary may determine that medical review under 
                this subsection does not apply in the case where 
                potential fraud may be involved.
            ``(3) <<NOTE: Applicability.>>  No payment without prior 
        authorization.--With respect to a service described in paragraph 
        (1) for which prior authorization medical review under this 
        subsection applies, the following shall apply:
                    ``(A) Prior authorization determination.--The 
                Secretary shall make a determination, prior to the 
                service being furnished, of whether the service would or 
                would not meet the applicable requirements of section 
                1862(a)(1)(A).
                    ``(B) Denial of payment.--Subject to paragraph (5), 
                no payment may be made under this part for the service 
                unless the Secretary determines pursuant to subparagraph 
                (A) that the service would meet the applicable 
                requirements of such section 1862(a)(1)(A).
            ``(4) Submission of information.--A chiropractor described 
        in section 1861(r)(5) may submit the information

[[Page 129 STAT. 173]]

        necessary for medical review by fax, by mail, or by electronic 
        means. The Secretary shall make available the electronic means 
        described in the preceding sentence as soon as practicable.
            ``(5) <<NOTE: Deadline.>>  Timeliness.--If the Secretary 
        does not make a prior authorization determination under 
        paragraph (3)(A) within 14 business days of the date of the 
        receipt of medical documentation needed to make such 
        determination, paragraph (3)(B) shall not apply.
            ``(6) Application of limitation on beneficiary liability.--
        Where payment may not be made as a result of the application of 
        paragraph (2)(B), section 1879 shall apply in the same manner as 
        such section applies to a denial that is made by reason of 
        section 1862(a)(1).
            ``(7) Review by contractors.--The medical review described 
        in paragraph (2) may be conducted by medicare administrative 
        contractors pursuant to section 1874A(a)(4)(G) or by any other 
        contractor determined appropriate by the Secretary that is not a 
        recovery audit contractor.
            ``(8) <<NOTE: Applicability.>>  Multiple services.--The 
        Secretary shall, where practicable, apply the medical review 
        under this subsection in a manner so as to allow an individual 
        described in paragraph (1) to obtain, at a single time rather 
        than on a service-by-service basis, an authorization in 
        accordance with paragraph (3)(A) for multiple services.
            ``(9) Construction.--With respect to a service described in 
        paragraph (1) that has been affirmed by medical review under 
        this subsection, nothing in this subsection shall be construed 
        to preclude the subsequent denial of a claim for such service 
        that does not meet other applicable requirements under this Act.
            ``(10) Implementation.--
                    ``(A) <<NOTE: Regulations. Comment period.>>  
                Authority.--The Secretary may implement the provisions 
                of this subsection by interim final rule with comment 
                period.
                    ``(B) Administration.--Chapter 35 of title 44, 
                United States Code, shall not apply to medical review 
                under this subsection.''.

    (b) <<NOTE: 42 USC 1395l note. Consultation.>>  Improving 
Documentation of Services.--
            (1) In general.--The Secretary of Health and Human Services 
        shall, in consultation with stakeholders (including the American 
        Chiropractic Association) and representatives of medicare 
        administrative contractors (as defined in section 1874A(a)(3)(A) 
        of the Social Security Act (42 U.S.C. 1395kk-1(a)(3)(A))), 
        develop educational and training programs to improve the ability 
        of chiropractors to provide documentation to the Secretary of 
        services described in section 1861(r)(5) in a manner that 
        demonstrates that such services are, in accordance with section 
        1862(a)(1) of such Act (42 U.S.C. 1395y(a)(1)), reasonable and 
        necessary for the diagnosis or treatment of illness or injury or 
        to improve the functioning of a malformed body member.
            (2) <<NOTE: Public information. Deadline.>>  Timing.--The 
        Secretary shall make the educational and training programs 
        described in paragraph (1) publicly available not later than 
        January 1, 2016.
            (3) Funding.--The Secretary shall use funds made available 
        under paragraph (10) of section 1893(h) of the Social

[[Page 129 STAT. 174]]

        Security Act (42 U.S.C. 1395ddd(h)), as added by section 505, to 
        carry out this subsection.

    (c) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct a study on the effectiveness of the process for 
        medical review of services furnished as part of a treatment by 
        means of manual manipulation of the spine to correct a 
        subluxation implemented under subsection (z) of section 1833 of 
        the Social Security Act (42 U.S.C. 1395l), as added by 
        subsection (a). Such study shall include an analysis of--
                    (A) aggregate data on--
                          (i) the number of individuals, chiropractors, 
                      and claims for services subject to such review; 
                      and
                          (ii) the number of reviews conducted under 
                      such section; and
                    (B) the outcomes of such reviews.
            (2) <<NOTE: Recommenda- tions.>>  Report.--Not later than 
        four years after the date of enactment of this Act, the 
        Comptroller General shall submit to Congress a report containing 
        the results of the study conducted under paragraph (1), 
        including recommendations for such legislation and 
        administrative action with respect to the process for medical 
        review implemented under subsection (z) of section 1833 of the 
        Social Security Act (42 U.S.C. 1395l) as the Comptroller General 
        determines appropriate.
SEC. 515. NATIONAL EXPANSION OF PRIOR AUTHORIZATION MODEL FOR 
                        REPETITIVE SCHEDULED NON-EMERGENT 
                        AMBULANCE TRANSPORT.

    (a) <<NOTE: State listing.>> Initial Expansion.--
            (1) <<NOTE: Effective date.>>  In general.--In implementing 
        the model described in paragraph (2) proposed to be tested under 
        subsection (b) of section 1115A of the Social Security Act (42 
        U.S.C. 1315a), the Secretary of Health and Human Services shall 
        revise the testing under subsection (b) of such section to 
        cover, effective not later than January 1, 2016, States located 
        in medicare administrative contractor (MAC) regions L and 11 
        (consisting of Delaware, the District of Columbia, Maryland, New 
        Jersey, Pennsylvania, North Carolina, South Carolina, West 
        Virginia, and Virginia).
            (2) Model described.--The model described in this paragraph 
        is the testing of a model of prior authorization for repetitive 
        scheduled non-emergent ambulance transport proposed to be 
        carried out in New Jersey, Pennsylvania, and South Carolina.
            (3) Funding.--The Secretary shall allocate funds made 
        available under section 1115A(f)(1)(B) of the Social Security 
        Act (42 U.S.C. 1315a(f)(1)(B)) to carry out this subsection.

    (b) National Expansion.--Section 1834(l) of the Social Security Act 
(42 U.S.C. 1395m(l)) is amended by adding at the end the following new 
paragraph:
            ``(16) Prior authorization for repetitive scheduled non-
        emergent ambulance transports.--
                    ``(A) <<NOTE: Effective date.>>  In general.--
                Beginning January 1, 2017, if the expansion to all 
                States of the model of prior authorization described in 
                paragraph (2) of section 515(a) of the Medicare Access 
                and CHIP Reauthorization Act of 2015 meets the 
                requirements described in paragraphs (1) through (3) of

[[Page 129 STAT. 175]]

                section 1115A(c), then the Secretary shall expand such 
                model to all States.
                    ``(B) Funding.--The Secretary shall use funds made 
                available under section 1893(h)(10) to carry out this 
                paragraph.
                    ``(C) Clarification regarding budget neutrality.--
                Nothing in this paragraph may be construed to limit or 
                modify the application of section 1115A(b)(3)(B) to 
                models described in such section, including with respect 
                to the model described in subparagraph (A) and expanded 
                beginning on January 1, 2017, under such 
                subparagraph.''.
SEC. 516. REPEALING DUPLICATIVE MEDICARE SECONDARY PAYOR 
                        PROVISION.

    (a) In General.--Section 1862(b)(5) of the Social Security Act (42 
U.S.C. 1395y(b)(5)) is amended by inserting at the end the following new 
subparagraph:
                    ``(E) End date.--The provisions of this paragraph 
                shall not apply to information required to be provided 
                on or after July 1, 2016.''.

    (b) <<NOTE: Applicability. 42 USC 1395y note.>>  Effective Date.--
The amendment made by subsection (a) shall take effect on the date of 
the enactment of this Act and shall apply to information required to be 
provided on or after January 1, 2016.
SEC. 517. PLAN FOR EXPANDING DATA IN ANNUAL CERT REPORT.

    Not later than June 30, 2015, the Secretary of Health and Human 
Services shall submit to the Committee on Finance of the Senate, and to 
the Committees on Energy and Commerce and Ways and Means of the House of 
Representatives--
            (1) a plan for including, in the annual report of the 
        Comprehensive Error Rate Testing (CERT) program, data on 
        services (or groupings of services) (other than medical visits) 
        paid under the physician fee schedule under section 1848 of the 
        Social Security Act (42 U.S.C. 1395w-4) where the fee schedule 
        amount is in excess of $250 and where the error rate is in 
        excess of 20 percent; and
            (2) to the extent practicable by such date, specific 
        examples of services described in paragraph (1).
SEC. 518. REMOVING FUNDS FOR MEDICARE IMPROVEMENT FUND ADDED BY 
                        IMPACT ACT OF 2014.

    Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)), as amended by section 3(e)(3) of the IMPACT Act of 2014 
(Public Law 113-185), is amended by striking ``$195,000,000'' and 
inserting ``$0''.
SEC. 519. <<NOTE: 42 USC 405 note.>>  RULE OF CONSTRUCTION.

    Except as explicitly provided in this subtitle, nothing in this 
subtitle, including the amendments made by this subtitle, shall be 
construed as preventing the use of notice and comment rulemaking in the 
implementation of the provisions of, and the amendments made by, this 
subtitle.

[[Page 129 STAT. 176]]

                      Subtitle B--Other Provisions

SEC. 521. EXTENSION OF TWO-MIDNIGHT PAMA RULES ON CERTAIN MEDICAL 
                        REVIEW ACTIVITIES.

    Section 111 of the Protecting Access to Medicare Act of 2014 (Public 
Law 113-93; 42 U.S.C. 1395ddd note) is amended--
            (1) in subsection (a), by striking ``the first 6 months of 
        fiscal year 2015'' and inserting ``through the end of fiscal 
        year 2015'';
            (2) in subsection (b), by striking ``March 31, 2015'' and 
        inserting ``September 30, 2015''; and
            (3) by adding at the end the following new subsection:

    ``(c) Construction.--Except as provided in subsections (a) and (b), 
nothing in this section shall be construed as limiting the Secretary's 
authority to pursue fraud and abuse activities under such section 
1893(h) or otherwise.''.
SEC. 522. REQUIRING BID SURETY BONDS AND STATE LICENSURE FOR 
                        ENTITIES SUBMITTING BIDS UNDER THE 
                        MEDICARE DMEPOS COMPETITIVE ACQUISITION 
                        PROGRAM.

    (a) Bid Surety Bonds.--Section 1847(a)(1) of the Social Security Act 
(42 U.S.C. 1395w-3(a)(1)) is amended by adding at the end the following 
new subparagraphs:
                    ``(G) <<NOTE: Time period.>>  Requiring bid bonds 
                for bidding entities.--With respect to rounds of 
                competitions beginning under this subsection for 
                contracts beginning not earlier than January 1, 2017, 
                and not later than January 1, 2019, an entity may not 
                submit a bid for a competitive acquisition area unless, 
                as of the deadline for bid submission, the entity has 
                obtained (and provided the Secretary with proof of 
                having obtained) a bid surety bond (in this paragraph 
                referred to as a `bid bond') in a form specified by the 
                Secretary consistent with subparagraph (H) and in an 
                amount that is not less than $50,000 and not more than 
                $100,000 for each competitive acquisition area in which 
                the entity submits the bid.
                    ``(H) Treatment of bid bonds submitted.--
                          ``(i) For bidders that submit bids at or below 
                      the median and are offered but do not accept the 
                      contract.--In the case of a bidding entity that is 
                      offered a contract for any product category for a 
                      competitive acquisition area, if--
                                    ``(I) the entity's composite bid for 
                                such product category and area was at or 
                                below the median composite bid rate for 
                                all bidding entities included in the 
                                calculation of the single payment 
                                amounts for such product category and 
                                area; and
                                    ``(II) the entity does not accept 
                                the contract offered for such product 
                                category and area,
                      the bid bond submitted by such entity for such 
                      area shall be forfeited by the entity and the 
                      Secretary shall collect on it.
                          ``(ii) <<NOTE: Deadline. Public 
                      information.>>  Treatment of other bidders.--In 
                      the case of a bidding entity for any product 
                      category for a competitive acquisition area, if 
                      the entity does not meet the bid forfeiture 
                      conditions in subclauses (I)

[[Page 129 STAT. 177]]

                      and (II) of clause (i) for any product category 
                      for such area, the bid bond submitted by such 
                      entity for such area shall be returned within 90 
                      days of the public announcement of the contract 
                      suppliers for such area.''.

    (b) State Licensure.--
            (1) In general.--Section 1847(b)(2)(A) of the Social 
        Security Act (42 U.S.C. 1395w-3(b)(2)(A)) is amended by adding 
        at the end the following new clause:
                          ``(v) The entity meets applicable State 
                      licensure requirements.''.
            (2) <<NOTE: 42 USC 1395w-3 note.>>  Construction.--Nothing 
        in the amendment made by paragraph (1) shall be construed as 
        affecting the authority of the Secretary of Health and Human 
        Services to require State licensure of an entity under the 
        Medicare competitive acquisition program under section 1847 of 
        the Social Security Act (42 U.S.C. 1395w-3) before the date of 
        the enactment of this Act.

    (c) GAO Report on Bid Bond Impact on Small Suppliers.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct a study that evaluates the effect of the bid 
        surety bond requirement under the amendment made by subsection 
        (a) on the participation of small suppliers in the Medicare 
        DMEPOS competitive acquisition program under section 1847 of the 
        Social Security Act (42 U.S.C. 1395w-3).
            (2) Report.--Not later than 6 months after the date 
        contracts are first awarded subject to such bid surety bond 
        requirement, the Comptroller General shall submit to Congress a 
        report on the study conducted under paragraph 
        (1). <<NOTE: Recommenda- tions.>> Such report shall include 
        recommendations for changes in such requirement in order to 
        ensure robust participation by legitimate small suppliers in the 
        Medicare DMEPOS competition acquisition program.
SEC. 523. PAYMENT FOR GLOBAL SURGICAL PACKAGES.

    (a) In General.--Section 1848(c) of the Social Security Act (42 
U.S.C. 1395w-4(c)) is amended by adding at the end the following new 
paragraph:
            ``(8) Global surgical packages.--
                    ``(A) Prohibition of implementation of rule 
                regarding global surgical packages.--
                          ``(i) In general.--The Secretary shall not 
                      implement the policy established in the final rule 
                      published on November 13, 2014 (79 Fed. Reg. 67548 
                      et seq.), that requires the transition of all 10-
                      day and 90-day global surgery packages to 0-day 
                      global periods.
                          ``(ii) Construction.--Nothing in clause (i) 
                      shall be construed to prevent the Secretary from 
                      revaluing misvalued codes for specific surgical 
                      services or assigning values to new or revised 
                      codes for surgical services.
                    ``(B) Collection of data on services included in 
                global surgical packages.--
                          ``(i) <<NOTE: Regulations. Deadline.>>  In 
                      general.--Subject to clause (ii), the Secretary 
                      shall through rulemaking develop and implement a 
                      process to gather, from a representative sample of 
                      physicians, beginning not later than January 1, 
                      2017, information needed to value surgical 
                      services.

[[Page 129 STAT. 178]]

                      Such information shall include the number and 
                      level of medical visits furnished during the 
                      global period and other items and services related 
                      to the surgery and furnished during the global 
                      period, as appropriate. Such information shall be 
                      reported on claims at the end of the global period 
                      or in another manner specified by the Secretary. 
                      For purposes of carrying out this paragraph (other 
                      than clause (iii)), the Secretary shall transfer 
                      from the Federal Supplemental Medical Insurance 
                      Trust Fund under section 1841 $2,000,000 to the 
                      Center for Medicare & Medicaid Services Program 
                      Management Account for fiscal year 2015. Amounts 
                      transferred under the previous sentence shall 
                      remain available until expended.
                          ``(ii) Reassessment and potential sunset.--
                      Every 
                      4 <<NOTE: Deadline. Regulation. Determination.>> ye
                      ars, the Secretary shall reassess the value of the 
                      information collected pursuant to clause (i). 
                      Based on such a reassessment and by regulation, 
                      the Secretary may discontinue the requirement for 
                      collection of information under such clause if the 
                      Secretary determines that the Secretary has 
                      adequate information from other sources, such as 
                      qualified clinical data registries, surgical logs, 
                      billing systems or other practice or facility 
                      records, and electronic health records, in order 
                      to accurately value global surgical services under 
                      this section.
                          ``(iii) Inspector general audit.--The 
                      Inspector General of the Department of Health and 
                      Human Services shall audit a sample of the 
                      information reported under clause (i) to verify 
                      the accuracy of the information so reported.
                    ``(C) Improving accuracy of pricing for surgical 
                services.--For <<NOTE: Effective date.>> years beginning 
                with 2019, the Secretary shall use the information 
                reported under subparagraph (B)(i) as appropriate and 
                other available data for the purpose of improving the 
                accuracy of valuation of surgical services under the 
                physician fee schedule under this section.''.

    (b) Incentive for Reporting Information on Global Surgical 
Services.--Section 1848(a) of the Social Security Act (42 U.S.C. 1395w-
4(a)) is amended by adding at the end the following new paragraph:
            ``(9) Information reporting on services included in global 
        surgical packages.--With <<NOTE: Regulations.>> respect to 
        services for which a physician is required to report information 
        in accordance with subsection (c)(8)(B)(i), the Secretary may 
        through rulemaking delay payment of 5 percent of the amount that 
        would otherwise be payable under the physician fee schedule 
        under this section for such services until the information so 
        required is reported.''.
SEC. 524. EXTENSION OF SECURE RURAL SCHOOLS AND COMMUNITY SELF-
                        DETERMINATION ACT OF 2000.

    (a) Payments for Fiscal Years 2014 and 2015.--
            (1) Payments required.--Section 101 of the Secure Rural 
        Schools and Community Self-Determination Act of 2000 (16

[[Page 129 STAT. 179]]

        U.S.C. 7111) is amended by striking ``2013'' both places it 
        appears and inserting ``2015''.
            (2) <<NOTE: Deadline.>>  Prompt payment.--Payments for 
        fiscal year 2014 under title I of the Secure Rural Schools and 
        Community Self-Determination Act of 2000 (16 U.S.C. 7111 et 
        seq.), as amended by this section, shall be made not later than 
        45 days after the date of the enactment of this Act.
            (3) Reduction in fiscal year 2014 payments on account of 
        previous 25- and 50-percent payments.--Section 101 of the Secure 
        Rural Schools and Community Self-Determination Act of 2000 (16 
        U.S.C. 7111) is amended by adding at the end the following new 
        subsection:

    ``(c) Special Rule for Fiscal Year 2014 Payments.--
            ``(1) State payment.--If an eligible county in a State that 
        will receive a share of the State payment for fiscal year 2014 
        has already received, or will receive, a share of the 25-percent 
        payment for fiscal year 2014 distributed to the State before the 
        date of the enactment of this subsection, the amount of the 
        State payment shall be reduced by the amount of that eligible 
        county's share of the 25-percent payment.
            ``(2) County payment.--If an eligible county that will 
        receive a county payment for fiscal year 2014 has already 
        received a 50-percent payment for that fiscal year, the amount 
        of the county payment shall be reduced by the amount of the 50-
        percent payment.''.
            (4) Shares of california state payment.--Section 103(d)(2) 
        of the Secure Rural Schools and Community Self-Determination Act 
        of 2000 (16 U.S.C. 7113(d)(2)) is amended by striking ``2013'' 
        and inserting ``2015''.

    (b) Use of Fiscal Year 2013 Elections and Reservations for Fiscal 
Years 2014 and 2015.--Section 102 of the Secure Rural Schools and 
Community Self-Determination Act of 2000 (16 U.S.C. 7112) is amended--
            (1) in subsection (b)(1), by adding at the end the following 
        new subparagraph:
                    ``(C) Effect of late payment for fiscal years 2014 
                and 2015.--The election otherwise required by 
                subparagraph (A) shall not apply for fiscal year 2014 or 
                2015.'';
            (2) in subsection (b)(2)--
                    (A) <<NOTE: Effective date.>>  in subparagraph (A), 
                by adding at the end the following new sentence: ``If 
                such two-fiscal year period included fiscal year 2013, 
                the county election to receive a share of the 25-percent 
                payment or 50-percent payment, as applicable, also shall 
                be effective for fiscal years 2014 and 2015.''; and
                    (B) in subparagraph (B), by striking ``2013'' the 
                second place it appears and inserting ``2015''; and
            (3) in subsection (d)--
                    (A) by adding at the end of paragraph (1) the 
                following new subparagraph:
                    ``(E) Effect of late payment for fiscal year 2014.--
                The <<NOTE: Effective date.>> election made by an 
                eligible county under subparagraph (B), (C), or (D) for 
                fiscal year 2013, or deemed to be made by the county 
                under paragraph (3)(B) for that fiscal year, shall be 
                effective for fiscal years 2014 and 2015.''; and

[[Page 129 STAT. 180]]

                    (B) by adding at the end of paragraph (3) the 
                following new subparagraph:
                    ``(C) Effect of late payment for fiscal year 2014.--
                This paragraph does not apply for fiscal years 2014 and 
                2015.''.

    (c) Special Projects on Federal Land.--Title II of the Secure Rural 
Schools and Community Self-Determination Act of 2000 (16 U.S.C. 7121 et 
seq.) is amended--
            (1) in section 203(a)(1) (16 U.S.C. 7123(a)(1)), by striking 
        ``September 30 for fiscal year 2008 (or as soon thereafter as 
        the Secretary concerned determines is practicable), and each 
        September 30 thereafter for each succeeding fiscal year through 
        fiscal year 2013'' and inserting ``September 30 of each fiscal 
        year (or a later date specified by the Secretary concerned for 
        the fiscal year)'';
            (2) in section 204(e)(3)(B)(iii) (16 U.S.C. 
        7124(e)(3)(B)(iii)), by striking ``each of fiscal years 2010 
        through 2013'' and inserting ``fiscal year 2010 and fiscal years 
        thereafter'';
            (3) in section 207(a) (16 U.S.C. 7127(a)), by striking 
        ``September 30, 2008 (or as soon thereafter as the Secretary 
        concerned determines is practicable), and each September 30 
        thereafter for each succeeding fiscal year through fiscal year 
        2013'' and inserting ``September 30 of each fiscal year (or a 
        later date specified by the Secretary concerned for the fiscal 
        year)''; and
            (4) in section 208 (16 U.S.C. 7128)--
                    (A) in subsection (a), by striking ``2013'' and 
                inserting ``2017''; and
                    (B) in subsection (b), by striking ``2014'' and 
                inserting ``2018''.

    (d) County Funds.--Section 304 of the Secure Rural Schools and 
Community Self-Determination Act of 2000 (16 U.S.C. 7144) is amended--
            (1) in subsection (a), by striking ``2013'' and inserting 
        ``2017''; and
            (2) in subsection (b), by striking ``2014'' and inserting 
        ``2018''.

    (e) Authorization of Appropriations.--Section 402 of the Secure 
Rural Schools and Community Self-Determination Act of 2000 (16 U.S.C. 
7152) is amended by striking ``for each of fiscal years 2008 through 
2013''.
SEC. 525. EXCLUSION FROM PAYGO SCORECARDS.

    (a) Statutory Pay-As-You-Go Scorecards.--The budgetary effects of 
this Act shall not be entered on either PAYGO scorecard maintained 
pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.

[[Page 129 STAT. 181]]

    (b) Senate PAYGO Scorecards.--The budgetary effects of this Act 
shall not be entered on any PAYGO scorecard maintained for purposes of 
section 201 of S. Con. Res. 21 (110th Congress).

    Approved April 16, 2015.

LEGISLATIVE HISTORY--H.R. 2:
---------------------------------------------------------------------------

CONGRESSIONAL RECORD, Vol. 161 (2015):
            Mar. 26, considered and passed House.
            Apr. 14, considered and passed Senate.

                                  <all>