[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2 Enrolled Bill (ENR)]
H.R.2
One Hundred Fourteenth Congress
of the
United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Tuesday,
the sixth day of January, two thousand and fifteen
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

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(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:

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Medicare payment for physicians' services.

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TITLE I

-SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION

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1141d35687339e552db2dcebc42e7a03e3a53f7503d214cb2e80d93df289abd7

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TITLE II

-MEDICARE AND OTHER HEALTH EXTENDERS

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National Health Service Corps, and teaching health centers.

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option under Medicaid and CHIP.
Subtitle A--Medicare Beneficiary Reforms

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TITLE III

-CHIP

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TITLE IV

-OFFSETS

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Subtitle A--Protecting the Integrity of Medicare

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TITLE V

-MISCELLANEOUS

furnished to incarcerated individuals, individuals not
lawfully present, and deceased individuals.

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participation in medicaid data match program.

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scheduled non-emergent ambulance transport.

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submitting bids under the Medicare DMEPOS competitive
acquisition program.

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Section 1848 of the Social Security Act (42 U.S.C. 1395w-4), as
amended by subsections (c) and (f) of section 101, is further amended
by inserting at the end the following new subsection:
``(s) Priorities and Funding for Measure Development.--
``(1) Plan identifying measure development priorities and
timelines.--
``(A) Draft measure development plan.--Not later than
January 1, 2016, the Secretary shall develop, and post on the
Internet website of the Centers for Medicare & Medicaid
Services, a draft plan for the development of quality measures
for application under the applicable provisions (as defined in
paragraph (5)). Under such plan the Secretary shall--
``(i) address how measures used by private payers and
integrated delivery systems could be incorporated under
title XVIII;
``(ii) describe how coordination, to the extent
possible, will occur across organizations developing such
measures; and
``(iii) take into account how clinical best practices
and clinical practice guidelines should be used in the
development of quality measures.
``(B) Quality domains.--For purposes of this subsection,
the term `quality domains' means at least the following
domains:
``(i) Clinical care.
``(ii) Safety.
``(iii) Care coordination.
``(iv) Patient and caregiver experience.
``(v) Population health and prevention.
``(C) Consideration.--In developing the draft plan under
this paragraph, the Secretary shall consider--
``(i) gap analyses conducted by the entity with a
contract under section 1890(a) or other contractors or
entities;
``(ii) whether measures are applicable across health
care settings;
``(iii) clinical practice improvement activities
submitted under subsection (q)(2)(C)(iv) for identifying
possible areas for future measure development and
identifying existing gaps with respect to such measures;
and
``(iv) the quality domains applied under this
subsection.
``(D) Priorities.--In developing the draft plan under this
paragraph, the Secretary shall give priority to the following
types of measures:
``(i) Outcome measures, including patient reported
outcome and functional status measures.
``(ii) Patient experience measures.
``(iii) Care coordination measures.
``(iv) Measures of appropriate use of services,
including measures of over use.
``(E) Stakeholder input.--The Secretary shall accept
through March 1, 2016, comments on the draft plan posted under
paragraph (1)(A) from the public, including health care
providers, payers, consumers, and other stakeholders.
``(F) Final measure development plan.--Not later than May
1, 2016, taking into account the comments received under this
subparagraph, the Secretary shall finalize the plan and post on
the Internet website of the Centers for Medicare & Medicaid
Services an operational plan for the development of quality
measures for use under the applicable provisions. Such plan
shall be updated as appropriate.
``(2) Contracts and other arrangements for quality measure
development.--
``(A) In general.--The Secretary shall enter into contracts
or other arrangements with entities for the purpose of
developing, improving, updating, or expanding in accordance
with the plan under paragraph (1) quality measures for
application under the applicable provisions. Such entities
shall include organizations with quality measure development
expertise.
``(B) Prioritization.--
``(i) In general.--In entering into contracts or other
arrangements under subparagraph (A), the Secretary shall
give priority to the development of the types of measures
described in paragraph (1)(D).
``(ii) Consideration.--In selecting measures for
development under this subsection, the Secretary shall
consider--
``(I) whether such measures would be electronically
specified; and
``(II) clinical practice guidelines to the extent
that such guidelines exist.
``(3) Annual report by the secretary.--
``(A) In general.--Not later than May 1, 2017, and annually
thereafter, the Secretary shall post on the Internet website of
the Centers for Medicare & Medicaid Services a report on the
progress made in developing quality measures for application
under the applicable provisions.
``(B) Requirements.--Each report submitted pursuant to
subparagraph (A) shall include the following:
``(i) A description of the Secretary's efforts to
implement this paragraph.
``(ii) With respect to the measures developed during
the previous year--
``(I) a description of the total number of quality
measures developed and the types of such measures, such
as an outcome or patient experience measure;
``(II) the name of each measure developed;
``(III) the name of the developer and steward of
each measure;
``(IV) with respect to each type of measure, an
estimate of the total amount expended under this title
to develop all measures of such type; and
``(V) whether the measure would be electronically
specified.
``(iii) With respect to measures in development at the
time of the report--
``(I) the information described in clause (ii), if
available; and
``(II) a timeline for completion of the development
of such measures.
``(iv) A description of any updates to the plan under
paragraph (1) (including newly identified gaps and the
status of previously identified gaps) and the inventory of
measures applicable under the applicable provisions.
``(v) Other information the Secretary determines to be
appropriate.
``(4) Stakeholder input.--With respect to paragraph (1), the
Secretary shall seek stakeholder input with respect to--
``(A) the identification of gaps where no quality measures
exist, particularly with respect to the types of measures
described in paragraph (1)(D);
``(B) prioritizing quality measure development to address
such gaps; and
``(C) other areas related to quality measure development
determined appropriate by the Secretary.
``(5) Definition of applicable provisions.--In this subsection,
the term `applicable provisions' means the following provisions:
``(A) Subsection (q)(2)(B)(i).
``(B) Section 1833(z)(2)(C).
``(6) Funding.--For purposes of carrying out this subsection,
the Secretary shall provide for the transfer, from the Federal
Supplementary Medical Insurance Trust Fund under section 1841, of
$15,000,000 to the Centers for Medicare & Medicaid Services Program
Management Account for each of fiscal years 2015 through 2019.
Amounts transferred under this paragraph shall remain available
through the end of fiscal year 2022.
``(7) Administration.--Chapter 35 of title 44, United States
Code, shall not apply to the collection of information for the
development of quality measures.''.

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CARE NEEDS.
(a) In General.--Section 1848(b) of the Social Security Act (42
U.S.C. 1395w-4(b)) is amended by adding at the end the following new
paragraph:
``(8) Encouraging care management for individuals with chronic
care needs.--
``(A) In general.--In order to encourage the management of
care for individuals with chronic care needs the Secretary
shall, subject to subparagraph (B), make payment (as the
Secretary determines to be appropriate) under this section for
chronic care management services furnished on or after January
1, 2015, by a physician (as defined in section 1861(r)(1)),
physician assistant or nurse practitioner (as defined in
section 1861(aa)(5)(A)), clinical nurse specialist (as defined
in section 1861(aa)(5)(B)), or certified nurse midwife (as
defined in section 1861(gg)(2)).
``(B) Policies relating to payment.--In carrying out this
paragraph, with respect to chronic care management services,
the Secretary shall--
``(i) make payment to only one applicable provider for
such services furnished to an individual during a period;
``(ii) not make payment under subparagraph (A) if such
payment would be duplicative of payment that is otherwise
made under this title for such services; and
``(iii) not require that an annual wellness visit (as
defined in section 1861(hhh)) or an initial preventive
physical examination (as defined in section 1861(ww)) be
furnished as a condition of payment for such management
services.''.
(b) Education and Outreach.--
(1) Campaign.--
(A) In general.--The Secretary of Health and Human Services
(in this subsection referred to as the ``Secretary'') shall
conduct an education and outreach campaign to inform
professionals who furnish items and services under part B of
title XVIII of the Social Security Act and individuals enrolled
under such part of the benefits of chronic care management
services described in section 1848(b)(8) of the Social Security
Act, as added by subsection (a), and encourage such individuals
with chronic care needs to receive such services.
(B) Requirements.--Such campaign shall--
(i) be directed by the Office of Rural Health Policy of
the Department of Health and Human Services and the Office
of Minority Health of the Centers for Medicare & Medicaid
Services; and
(ii) focus on encouraging participation by underserved
rural populations and racial and ethnic minority
populations.
(2) Report.--Not later than December 31, 2017, the Secretary
shall submit to Congress a report on the use of chronic care
management services described in such section 1848(b)(8) by
individuals living in rural areas and by racial and ethnic minority
populations. Such report shall--
(A) identify barriers to receiving chronic care management
services; and
(B) make recommendations for increasing the appropriate use
of chronic care management services.

6799d5effc8c1c8d62a8f436d722c792c65c1d3591ad9b8eb96d31146f4afde1

TO INFORMATION ON PHYSICIANS' SERVICES.
(a) In General.--On an annual basis (beginning with 2015), the
Secretary shall make publicly available, in an easily understandable
format, information with respect to physicians and, as appropriate,
other eligible professionals on items and services furnished to
Medicare beneficiaries under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.).
(b) Type and Manner of Information.--The information made available
under this section shall be similar to the type of information in the
Medicare Provider Utilization and Payment Data: Physician and Other
Supplier Public Use File released by the Secretary with respect to 2012
and shall be made available in a manner similar to the manner in which
the information in such file is made available.
(c) Requirements.--The information made available under this
section shall include, at a minimum, the following:
(1) Information on the number of services furnished by the
physician or other eligible professional under part B of title
XVIII of the Social Security Act (42 U.S.C. 1395j et seq.), which
may include information on the most frequent services furnished or
groupings of services.
(2) Information on submitted charges and payments for services
under such part.
(3) A unique identifier for the physician or other eligible
professional that is available to the public, such as a national
provider identifier.
(d) Searchability.--The information made available under this
section shall be searchable by at least the following:
(1) The specialty or type of the physician or other eligible
professional.
(2) Characteristics of the services furnished, such as volume
or groupings of services.
(3) The location of the physician or other eligible
professional.
(e) Integration on Physician Compare.--Beginning with 2016, the
Secretary shall integrate the information made available under this
section on Physician Compare.
(f) Definitions.--In this section:
(1) Eligible professional; physician; secretary.--The terms
``eligible professional'', ``physician'', and ``Secretary'' have
the meaning given such terms in section 10331(i) of Public Law 111-
148.
(2) Physician compare.--The term ``Physician Compare'' means
the Physician Compare Internet website of the Centers for Medicare
& Medicaid Services (or a successor website).

47f4d93588f39c77c52f2fb2600d3956dbd938546e4bb73471121f894f2ed56d

(a) Expanding Uses of Medicare Data by Qualified Entities.--
(1) Additional analyses.--
(A) In general.--Subject to subparagraph (B), to the extent
consistent with applicable information, privacy, security, and
disclosure laws (including paragraph (3)), notwithstanding
paragraph (4)(B) of section 1874(e) of the Social Security Act
(42 U.S.C. 1395kk(e)) and the second sentence of paragraph
(4)(D) of such section, beginning July 1, 2016, a qualified
entity may use the combined data described in paragraph
(4)(B)(iii) of such section received by such entity under such
section, and information derived from the evaluation described
in such paragraph (4)(D), to conduct additional non-public
analyses (as determined appropriate by the Secretary) and
provide or sell such analyses to authorized users for non-
public use (including for the purposes of assisting providers
of services and suppliers to develop and participate in quality
and patient care improvement activities, including developing
new models of care).
(B) Limitations with respect to analyses.--
(i) Employers.--Any analyses provided or sold under
subparagraph (A) to an employer described in paragraph
(9)(A)(iii) may only be used by such employer for purposes
of providing health insurance to employees and retirees of
the employer.
(ii) Health insurance issuers.--A qualified entity may
not provide or sell an analysis to a health insurance
issuer described in paragraph (9)(A)(iv) unless the issuer
is providing the qualified entity with data under section
1874(e)(4)(B)(iii) of the Social Security Act (42 U.S.C.
1395kk(e)(4)(B)(iii)).
(2) Access to certain data.--
(A) Access.--To the extent consistent with applicable
information, privacy, security, and disclosure laws (including
paragraph (3)), notwithstanding paragraph (4)(B) of section
1874(e) of the Social Security Act (42 U.S.C. 1395kk(e)) and
the second sentence of paragraph (4)(D) of such section,
beginning July 1, 2016, a qualified entity may--
(i) provide or sell the combined data described in
paragraph (4)(B)(iii) of such section to authorized users
described in clauses (i), (ii), and (v) of paragraph (9)(A)
for non-public use, including for the purposes described in
subparagraph (B); or
(ii) subject to subparagraph (C), provide Medicare
claims data to authorized users described in clauses (i),
(ii), and (v), of paragraph (9)(A) for non-public use,
including for the purposes described in subparagraph (B).
(B) Purposes described.--The purposes described in this
subparagraph are assisting providers of services and suppliers
in developing and participating in quality and patient care
improvement activities, including developing new models of
care.
(C) Medicare claims data must be provided at no cost.--A
qualified entity may not charge a fee for providing the data
under subparagraph (A)(ii).
(3) Protection of information.--
(A) In general.--Except as provided in subparagraph (B), an
analysis or data that is provided or sold under paragraph (1)
or (2) shall not contain information that individually
identifies a patient.
(B) Information on patients of the provider of services or
supplier.--To the extent consistent with applicable
information, privacy, security, and disclosure laws, an
analysis or data that is provided or sold to a provider of
services or supplier under paragraph (1) or (2) may contain
information that individually identifies a patient of such
provider or supplier, including with respect to items and
services furnished to the patient by other providers of
services or suppliers.
(C) Prohibition on using analyses or data for marketing
purposes.--An authorized user shall not use an analysis or data
provided or sold under paragraph (1) or (2) for marketing
purposes.
(4) Data use agreement.--A qualified entity and an authorized
user described in clauses (i), (ii), and (v) of paragraph (9)(A)
shall enter into an agreement regarding the use of any data that
the qualified entity is providing or selling to the authorized user
under paragraph (2). Such agreement shall describe the requirements
for privacy and security of the data and, as determined appropriate
by the Secretary, any prohibitions on using such data to link to
other individually identifiable sources of information. If the
authorized user is not a covered entity under the rules promulgated
pursuant to the Health Insurance Portability and Accountability Act
of 1996, the agreement shall identify the relevant regulations, as
determined by the Secretary, that the user shall comply with as if
it were acting in the capacity of such a covered entity.
(5) No redisclosure of analyses or data.--
(A) In general.--Except as provided in subparagraph (B), an
authorized user that is provided or sold an analysis or data
under paragraph (1) or (2) shall not redisclose or make public
such analysis or data or any analysis using such data.
(B) Permitted redisclosure.--A provider of services or
supplier that is provided or sold an analysis or data under
paragraph (1) or (2) may, as determined by the Secretary,
redisclose such analysis or data for the purposes of
performance improvement and care coordination activities but
shall not make public such analysis or data or any analysis
using such data.
(6) Opportunity for providers of services and suppliers to
review.--Prior to a qualified entity providing or selling an
analysis to an authorized user under paragraph (1), to the extent
that such analysis would individually identify a provider of
services or supplier who is not being provided or sold such
analysis, such qualified entity shall provide such provider or
supplier with the opportunity to appeal and correct errors in the
manner described in section 1874(e)(4)(C)(ii) of the Social
Security Act (42 U.S.C. 1395kk(e)(4)(C)(ii)).
(7) Assessment for a breach.--
(A) In general.--In the case of a breach of a data use
agreement under this section or section 1874(e) of the Social
Security Act (42 U.S.C. 1395kk(e)), the Secretary shall impose
an assessment on the qualified entity both in the case of--
(i) an agreement between the Secretary and a qualified
entity; and
(ii) an agreement between a qualified entity and an
authorized user.
(B) Assessment.--The assessment under subparagraph (A)
shall be an amount up to $100 for each individual entitled to,
or enrolled for, benefits under part A of title XVIII of the
Social Security Act or enrolled for benefits under part B of
such title--
(i) in the case of an agreement described in
subparagraph (A)(i), for whom the Secretary provided data
on to the qualified entity under paragraph (2); and
(ii) in the case of an agreement described in
subparagraph (A)(ii), for whom the qualified entity
provided data on to the authorized user under paragraph
(2).
(C) Deposit of amounts collected.--Any amounts collected
pursuant to this paragraph shall be deposited in Federal
Supplementary Medical Insurance Trust Fund under section 1841
of the Social Security Act (42 U.S.C. 1395t).
(8) Annual reports.--Any qualified entity that provides or
sells an analysis or data under paragraph (1) or (2) shall annually
submit to the Secretary a report that includes--
(A) a summary of the analyses provided or sold, including
the number of such analyses, the number of purchasers of such
analyses, and the total amount of fees received for such
analyses;
(B) a description of the topics and purposes of such
analyses;
(C) information on the entities who received the data under
paragraph (2), the uses of the data, and the total amount of
fees received for providing, selling, or sharing the data; and
(D) other information determined appropriate by the
Secretary.
(9) Definitions.--In this subsection and subsection (b):
(A) Authorized user.--The term ``authorized user'' means
the following:
(i) A provider of services.
(ii) A supplier.
(iii) An employer (as defined in section 3(5) of the
Employee Retirement Insurance Security Act of 1974).
(iv) A health insurance issuer (as defined in section
2791 of the Public Health Service Act).
(v) A medical society or hospital association.
(vi) Any entity not described in clauses (i) through
(v) that is approved by the Secretary (other than an
employer or health insurance issuer not described in
clauses (iii) and (iv), respectively, as determined by the
Secretary).
(B) Provider of services.--The term ``provider of
services'' has the meaning given such term in section 1861(u)
of the Social Security Act (42 U.S.C. 1395x(u)).
(C) Qualified entity.--The term ``qualified entity'' has
the meaning given such term in section 1874(e)(2) of the Social
Security Act (42 U.S.C. 1395kk(e)).
(D) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(E) Supplier.--The term ``supplier'' has the meaning given
such term in section 1861(d) of the Social Security Act (42
U.S.C. 1395x(d)).
(b) Access to Medicare Data by Qualified Clinical Data Registries
To Facilitate Quality Improvement.--
(1) Access.--
(A) In general.--To the extent consistent with applicable
information, privacy, security, and disclosure laws, beginning
July 1, 2016, the Secretary shall, at the request of a
qualified clinical data registry under section 1848(m)(3)(E) of
the Social Security Act (42 U.S.C. 1395w-4(m)(3)(E)), provide
the data described in subparagraph (B) (in a form and manner
determined to be appropriate) to such qualified clinical data
registry for purposes of linking such data with clinical
outcomes data and performing risk-adjusted, scientifically
valid analyses and research to support quality improvement or
patient safety, provided that any public reporting of such
analyses or research that identifies a provider of services or
supplier shall only be conducted with the opportunity of such
provider or supplier to appeal and correct errors in the manner
described in subsection (a)(6).
(B) Data described.--The data described in this
subparagraph is--
(i) claims data under the Medicare program under title
XVIII of the Social Security Act; and
(ii) if the Secretary determines appropriate, claims
data under the Medicaid program under title XIX of such Act
and the State Children's Health Insurance Program under
title XXI of such Act.
(2) Fee.--Data described in paragraph (1)(B) shall be provided
to a qualified clinical data registry under paragraph (1) at a fee
equal to the cost of providing such data. Any fee collected
pursuant to the preceding sentence shall be deposited in the
Centers for Medicare & Medicaid Services Program Management
Account.
(c) Expansion of Data Available to Qualified Entities.--Section
1874(e) of the Social Security Act (42 U.S.C. 1395kk(e)) is amended--
(1) in the subsection heading, by striking ``Medicare''; and
(2) in paragraph (3)--
(A) by inserting after the first sentence the following new
sentence: ``Beginning July 1, 2016, if the Secretary determines
appropriate, the data described in this paragraph may also
include standardized extracts (as determined by the Secretary)
of claims data under titles XIX and XXI for assistance provided
under such titles for one or more specified geographic areas
and time periods requested by a qualified entity.''; and
(B) in the last sentence, by inserting ``or under titles
XIX or XXI'' before the period at the end.
(d) Revision of Placement of Fees.--Section 1874(e)(4)(A) of the
Social Security Act (42 U.S.C. 1395kk(e)(4)(A)) is amended, in the
second sentence--
(1) by inserting ``, for periods prior to July 1, 2016,'' after
``deposited''; and
(2) by inserting the following before the period at the end:
``, and, beginning July 1, 2016, into the Centers for Medicare &
Medicaid Services Program Management Account''.

d1597b3a6690f32cfbbc0ed5432d813bab9ee7e257301a1c0258857a7c284707

(a) Medicare Physician and Practitioner Opt-Out to Private
Contract.--
(1) Indefinite, continuing automatic extension of opt out
election.--
(A) In general.--Section 1802(b)(3) of the Social Security
Act (42 U.S.C. 1395a(b)(3)) is amended--
(i) in subparagraph (B)(ii), by striking ``during the
2-year period beginning on the date the affidavit is
signed'' and inserting ``during the applicable 2-year
period (as defined in subparagraph (D))'';
(ii) in subparagraph (C), by striking ``during the 2-
year period described in subparagraph (B)(ii)'' and
inserting ``during the applicable 2-year period''; and
(iii) by adding at the end the following new
subparagraph:
``(D) Applicable 2-year periods for effectiveness of
affidavits.--In this subsection, the term `applicable 2-year
period' means, with respect to an affidavit of a physician or
practitioner under subparagraph (B), the 2-year period
beginning on the date the affidavit is signed and includes each
subsequent 2-year period unless the physician or practitioner
involved provides notice to the Secretary (in a form and manner
specified by the Secretary), not later than 30 days before the
end of the previous 2-year period, that the physician or
practitioner does not want to extend the application of the
affidavit for such subsequent 2-year period.''.
(B) Effective date.--The amendments made by subparagraph
(A) shall apply to affidavits entered into on or after the date
that is 60 days after the date of the enactment of this Act.
(2) Public availability of information on opt-out physicians
and practitioners.--Section 1802(b) of the Social Security Act (42
U.S.C. 1395a(b)) is amended--
(A) in paragraph (5), by adding at the end the following
new subparagraph:
``(D) Opt-out physician or practitioner.--The term `opt-out
physician or practitioner' means a physician or practitioner who
has in effect an affidavit under paragraph (3)(B).'';
(B) by redesignating paragraph (5) as paragraph (6); and
(C) by inserting after paragraph (4) the following new
paragraph:
``(5) Posting of information on opt-out physicians and
practitioners.--
``(A) In general.--Beginning not later than February 1,
2016, the Secretary shall make publicly available through an
appropriate publicly accessible website of the Department of
Health and Human Services information on the number and
characteristics of opt-out physicians and practitioners and
shall update such information on such website not less often
than annually.
``(B) Information to be included.--The information to be
made available under subparagraph (A) shall include at least
the following with respect to opt-out physicians and
practitioners:
``(i) Their number.
``(ii) Their physician or professional specialty or
other designation.
``(iii) Their geographic distribution.
``(iv) The timing of their becoming opt-out physicians
and practitioners, relative, to the extent feasible, to
when they first enrolled in the program under this title
and with respect to applicable 2-year periods.
``(v) The proportion of such physicians and
practitioners who billed for emergency or urgent care
services.''.
(b) Promoting Interoperability of Electronic Health Record
Systems.--
(1) Recommendations for achieving widespread ehr
interoperability.--
(A) Objective.--As a consequence of a significant Federal
investment in the implementation of health information
technology through the Medicare and Medicaid EHR incentive
programs, Congress declares it a national objective to achieve
widespread exchange of health information through interoperable
certified EHR technology nationwide by December 31, 2018.
(B) Definitions.--In this paragraph:
(i) Widespread interoperability.--The term ``widespread
interoperability'' means interoperability between certified
EHR technology systems employed by meaningful EHR users
under the Medicare and Medicaid EHR incentive programs and
other clinicians and health care providers on a nationwide
basis.
(ii) Interoperability.--The term ``interoperability''
means the ability of two or more health information systems
or components to exchange clinical and other information
and to use the information that has been exchanged using
common standards as to provide access to longitudinal
information for health care providers in order to
facilitate coordinated care and improved patient outcomes.
(C) Establishment of metrics.--Not later than July 1, 2016,
and in consultation with stakeholders, the Secretary shall
establish metrics to be used to determine if and to the extent
that the objective described in subparagraph (A) has been
achieved.
(D) Recommendations if objective not achieved.--If the
Secretary of Health and Human Services determines that the
objective described in subparagraph (A) has not been achieved
by December 31, 2018, then the Secretary shall submit to
Congress a report, by not later than December 31, 2019, that
identifies barriers to such objective and recommends actions
that the Federal Government can take to achieve such objective.
Such recommended actions may include recommendations--
(i) to adjust payments for not being meaningful EHR
users under the Medicare EHR incentive programs; and
(ii) for criteria for decertifying certified EHR
technology products.
(2) Preventing blocking the sharing of information.--
(A) For meaningful use ehr professionals.--Section
1848(o)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395w-
4(o)(2)(A)(ii)) is amended by inserting before the period at
the end the following: ``, and the professional demonstrates
(through a process specified by the Secretary, such as the use
of an attestation) that the professional has not knowingly and
willfully taken action (such as to disable functionality) to
limit or restrict the compatibility or interoperability of the
certified EHR technology''.
(B) For meaningful use ehr hospitals.--Section
1886(n)(3)(A)(ii) of the Social Security Act (42 U.S.C.
1395ww(n)(3)(A)(ii)) is amended by inserting before the period
at the end the following: ``, and the hospital demonstrates
(through a process specified by the Secretary, such as the use
of an attestation) that the hospital has not knowingly and
willfully taken action (such as to disable functionality) to
limit or restrict the compatibility or interoperability of the
certified EHR technology''.
(C) Effective date.--The amendments made by this subsection
shall apply to meaningful EHR users as of the date that is one
year after the date of the enactment of this Act.
(3) Study and report on the feasibility of establishing a
mechanism to compare certified ehr technology products.--
(A) Study.--The Secretary shall conduct a study to examine
the feasibility of establishing one or more mechanisms to
assist providers in comparing and selecting certified EHR
technology products. Such mechanisms may include--
(i) a website with aggregated results of surveys of
meaningful EHR users on the functionality of certified EHR
technology products to enable such users to directly
compare the functionality and other features of such
products; and
(ii) information from vendors of certified products
that is made publicly available in a standardized format.
The aggregated results of the surveys described in clause (i)
may be made available through contracts with physicians,
hospitals, or other organizations that maintain such
comparative information described in such clause.
(B) Report.--Not later than 1 year after the date of the
enactment of this Act, the Secretary shall submit to Congress a
report on mechanisms that would assist providers in comparing
and selecting certified EHR technology products. The report
shall include information on the benefits of, and resources
needed to develop and maintain, such mechanisms.
(4) Definitions.--In this subsection:
(A) The term ``certified EHR technology'' has the meaning
given such term in section 1848(o)(4) of the Social Security
Act (42 U.S.C. 1395w-4(o)(4)).
(B) The term ``meaningful EHR user'' has the meaning given
such term under the Medicare EHR incentive programs.
(C) The term ``Medicare and Medicaid EHR incentive
programs'' means--
(i) in the case of the Medicare program under title
XVIII of the Social Security Act, the incentive programs
under section 1814(l)(3), section 1848(o), subsections (l)
and (m) of section 1853, and section 1886(n) of the Social
Security Act (42 U.S.C. 1395f(l)(3), 1395w-4(o), 1395w-23,
1395ww(n)); and
(ii) in the case of the Medicaid program under title
XIX of such Act, the incentive program under subsections
(a)(3)(F) and (t) of section 1903 of such Act (42 U.S.C.
1396b).
(D) The term ``Secretary'' means the Secretary of Health
and Human Services.
(c) GAO Studies and Reports on the Use of Telehealth Under Federal
Programs and on Remote Patient Monitoring Services.--
(1) Study on telehealth services.--The Comptroller General of
the United States shall conduct a study on the following:
(A) How the definition of telehealth across various Federal
programs and Federal efforts can inform the use of telehealth
in the Medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(B) Issues that can facilitate or inhibit the use of
telehealth under the Medicare program under such title,
including oversight and professional licensure, changing
technology, privacy and security, infrastructure requirements,
and varying needs across urban and rural areas.
(C) Potential implications of greater use of telehealth
with respect to payment and delivery system transformations
under the Medicare program under such title XVIII and the
Medicaid program under title XIX of such Act (42 U.S.C. 1396 et
seq.).
(D) How the Centers for Medicare & Medicaid Services
monitors payments made under the Medicare program under such
title XVIII to providers for telehealth services.
(2) Study on remote patient monitoring services.--
(A) In general.--The Comptroller General of the United
States shall conduct a study--
(i) of the dissemination of remote patient monitoring
technology in the private health insurance market;
(ii) of the financial incentives in the private health
insurance market relating to adoption of such technology;
(iii) of the barriers to adoption of such services
under the Medicare program under title XVIII of the Social
Security Act;
(iv) that evaluates the patients, conditions, and
clinical circumstances that could most benefit from remote
patient monitoring services; and
(v) that evaluates the challenges related to
establishing appropriate valuation for remote patient
monitoring services under the Medicare physician fee
schedule under section 1848 of the Social Security Act (42
U.S.C. 1395w-4) in order to accurately reflect the
resources involved in furnishing such services.
(B) Definitions.--For purposes of this paragraph:
(i) Remote patient monitoring services.--The term
``remote patient monitoring services'' means services
furnished through remote patient monitoring technology.
(ii) Remote patient monitoring technology.--The term
``remote patient monitoring technology'' means a
coordinated system that uses one or more home-based or
mobile monitoring devices that automatically transmit vital
sign data or information on activities of daily living and
may include responses to assessment questions collected on
the devices wirelessly or through a telecommunications
connection to a server that complies with the Federal
regulations (concerning the privacy of individually
identifiable health information) promulgated under section
264(c) of the Health Insurance Portability and
Accountability Act of 1996, as part of an established plan
of care for that patient that includes the review and
interpretation of that data by a health care professional.
(3) Reports.--Not later than 24 months after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress--
(A) a report containing the results of the study conducted
under paragraph (1); and
(B) a report containing the results of the study conducted
under paragraph (2).
A report required under this paragraph shall be submitted together
with recommendations for such legislation and administrative action
as the Comptroller General determines appropriate. The Comptroller
General may submit one report containing the results described in
subparagraphs (A) and (B) and the recommendations described in the
previous sentence.
(d) Rule of Construction Regarding Health Care Providers.--
(1) In general.--Subject to paragraph (3), the development,
recognition, or implementation of any guideline or other standard
under any Federal health care provision shall not be construed to
establish the standard of care or duty of care owed by a health
care provider to a patient in any medical malpractice or medical
product liability action or claim.
(2) Definitions.--For purposes of this subsection:
(A) Federal health care provision.--The term ``Federal
health care provision'' means any provision of the Patient
Protection and Affordable Care Act (Public Law 111-148), title
I or subtitle B of title II of the Health Care and Education
Reconciliation Act of 2010 (Public Law 111-152), or title XVIII
or XIX of the Social Security Act (42 U.S.C. 1395 et seq., 42
U.S.C. 1396 et seq.).
(B) Health care provider.--The term ``health care
provider'' means any individual, group practice, corporation of
health care professionals, or hospital--
(i) licensed, registered, or certified under Federal or
State laws or regulations to provide health care services;
or
(ii) required to be so licensed, registered, or
certified but that is exempted by other statute or
regulation.
(C) Medical malpractice or medical product liability action
or claim.--The term ``medical malpractice or medical product
liability action or claim'' means a medical malpractice action
or claim (as defined in section 431(7) of the Health Care
Quality Improvement Act of 1986 (42 U.S.C. 11151(7))) and
includes a liability action or claim relating to a health care
provider's prescription or provision of a drug, device, or
biological product (as such terms are defined in section 201 of
the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321) or
section 351 of the Public Health Service Act (42 U.S.C. 262)).
(D) State.--The term ``State'' includes the District of
Columbia, Puerto Rico, and any other commonwealth, possession,
or territory of the United States.
(3) No preemption.--Nothing in paragraph (1) or any provision
of the Patient Protection and Affordable Care Act (Public Law 111-
148), title I or subtitle B of title II of the Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152), or title
XVIII or XIX of the Social Security Act (42 U.S.C. 1395 et seq., 42
U.S.C. 1396 et seq.) shall be construed to preempt any State or
common law governing medical professional or medical product
liability actions or claims.
Subtitle A--Medicare Extenders

46c790ef32622dc5c69e485409df0e217f9015115fea971de7bb17a41b8f9061

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''.

eeb034958dd6c410025ee4fc87ce74f00dbb01ffddc22874f24c7d2deeef1183

(a) In General.--Section 1833(g) of the Social Security Act (42
U.S.C. 1395l(g)) is amended--
(1) in paragraph (5)(A), in the first sentence, by striking
``March 31, 2015'' and inserting ``December 31, 2017''; and
(2) in paragraph (6)(A)--
(A) by striking ``March 31, 2015'' and inserting ``December
31, 2017''; and
(B) by striking ``2012, 2013, 2014, or the first three
months of 2015'' and inserting ``2012 through 2017''.
(b) Targeted Reviews Under Manual Medical Review Process for
Outpatient Therapy Services.--
(1) In general.--Section 1833(g)(5) of the Social Security Act
(42 U.S.C. 1395l(g)(5)) is amended--
(A) in subparagraph (C)(i), by inserting ``, subject to
subparagraph (E),'' after ``manual medical review process
that''; and
(B) by adding at the end the following new subparagraph:
``(E)(i) In place of the manual medical review process under
subparagraph (C)(i), the Secretary shall implement a process for
medical review under this subparagraph under which the Secretary shall
identify and conduct medical review for services described in
subparagraph (C)(i) furnished by a provider of services or supplier (in
this subparagraph referred to as a `therapy provider') using such
factors as the Secretary determines to be appropriate.
``(ii) Such factors may include the following:
``(I) The therapy provider has had a high claims denial
percentage for therapy services under this part or is less
compliant with applicable requirements under this title.
``(II) The therapy provider has a pattern of billing for
therapy services under this part that is aberrant compared to peers
or otherwise has questionable billing practices for such services,
such as billing medically unlikely units of services in a day.
``(III) The therapy provider is newly enrolled under this title
or has not previously furnished therapy services under this part.
``(IV) The services are furnished to treat a type of medical
condition.
``(V) The therapy provider is part of group that includes
another therapy provider identified using the factors determined
under this subparagraph.
``(iii) For purposes of carrying out this subparagraph, the
Secretary shall provide for the transfer, from the Federal
Supplementary Medical Insurance Trust Fund under section 1841, of
$5,000,000 to the Centers for Medicare & Medicaid Services Program
Management Account for fiscal years 2015 and 2016, to remain available
until expended. Such funds may not be used by a contractor under
section 1893(h) for medical reviews under this subparagraph.
``(iv) The targeted review process under this subparagraph shall
not apply to services for which expenses are incurred beyond the period
for which the exceptions process under subparagraph (A) is
implemented.''.
(2) Effective date.--The amendments made by this subsection
shall apply with respect to requests described in section
1833(g)(5)(C)(i) of the Social Security Act (42 U.S.C.
1395l(g)(5)(C)(i)) with respect to which the Secretary of Health
and Human Services has not conducted medical review under such
section by a date (not later than 90 days after the date of the
enactment of this Act) specified by the Secretary.

d14a17bb3cf83afefbe824000c05e4db581132dfcf9ea63a256e4be41b66a9fc

(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''.

2e90dd4b2b4c3a31c789548736e744b12e547c9d2ed75d0f50d1bfac34fd3f58

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,''.

a94999aa74177eae47a7d45330fe201e6b40e304e24b912f259d175935842e8b

PROGRAM.
(a) In General.--Section 1886(d)(5)(G) of the Social Security Act
(42 U.S.C. 1395ww(d)(5)(G)) is amended--
(1) in clause (i), by striking ``April 1, 2015'' and inserting
``October 1, 2017''; and
(2) in clause (ii)(II), by striking ``April 1, 2015'' and
inserting ``October 1, 2017''.
(b) Conforming Amendments.--
(1) Extension of target amount.--Section 1886(b)(3)(D) of the
Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is amended--
(A) in the matter preceding clause (i), by striking ``April
1, 2015'' and inserting ``October 1, 2017''; and
(B) in clause (iv), by striking ``through fiscal year 2014
and the portion of fiscal year 2015 before April 1, 2015'' and
inserting ``through fiscal year 2017''.
(2) Permitting hospitals to decline reclassification.--Section
13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 (42
U.S.C. 1395ww note) is amended by striking ``through the first 2
quarters of fiscal year 2015'' and inserting ``through fiscal year
2017''.

698866d8db25d9c620a55ae6188659dcf6ab030b0a0e0096d9b2f850a67f6cd9

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''.

13d2cf66337b68183e786606fcf77020fc66c1a1827a274421b18f679c7697d6

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''.

7fd861155685ea70032314541c14f0612055dcc903020b4db321bcc418ef5020

INCOME PROGRAMS.
(a) Additional Funding for State Health Insurance Programs.--
Subsection (a)(1)(B) of section 119 of the Medicare Improvements for
Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note), as amended
by section 3306 of the Patient Protection and Affordable Care Act
(Public Law 111-148), section 610 of the American Taxpayer Relief Act
of 2012 (Public Law 112-240), section 1110 of the Pathway for SGR
Reform Act of 2013 (Public Law 113-67), and section 110 of the
Protecting Access to Medicare Act of 2014 (Public Law 113-93), is
amended--
(1) in clause (iv), by striking ``and'' at the end;
(2) by striking clause (v); and
(3) by adding at the end the following new clauses:
``(v) for fiscal year 2015, of $7,500,000;
``(vi) for fiscal year 2016, of $13,000,000; and
``(vii) for fiscal year 2017, of $13,000,000.''.
(b) Additional Funding for Area Agencies on Aging.--Subsection
(b)(1)(B) of such section 119, as so amended, is amended--
(1) in clause (iv), by striking ``and'' at the end;
(2) by striking clause (v); and
(3) by inserting after clause (iv) the following new clauses:
``(v) for fiscal year 2015, of $7,500,000;
``(vi) for fiscal year 2016, of $7,500,000; and
``(vii) for fiscal year 2017, of $7,500,000.''.
(c) Additional Funding for Aging and Disability Resource Centers.--
Subsection (c)(1)(B) of such section 119, as so amended, is amended--
(1) in clause (iv), by striking ``and'' at the end;
(2) by striking clause (v); and
(3) by inserting after clause (iv) the following new clauses:
``(v) for fiscal year 2015, of $5,000,000;
``(vi) for fiscal year 2016, of $5,000,000; and
``(vii) for fiscal year 2017, of $5,000,000.''.
(d) Additional Funding for Contract With the National Center for
Benefits and Outreach Enrollment.--Subsection (d)(2) of such section
119, as so amended, is amended--
(1) in clause (iv), by striking ``and'' at the end;
(2) by striking clause (v); and
(3) by inserting after clause (iv) the following new clauses:
``(v) for fiscal year 2015, of $5,000,000;
``(vi) for fiscal year 2016, of $12,000,000; and
``(vii) for fiscal year 2017, of $12,000,000.''.

586ec05914d5e59a2f2979a94b665af546a13f2843efa84677ea884e012bcc53

CONTRACTS.
(a) One-Year Transition and Notice Regarding Transition.--Section
1876(h)(5)(C) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)) is
amended--
(1) in clause (ii), in the matter preceding subclause (I), by
striking ``For any'' and inserting ``Subject to clause (iv), for
any'';
(2) in clause (iii)(I), by inserting ``cost plan service''
after ``With respect to any portion of the'';
(3) in clause (iii)(II), by inserting ``cost plan service''
after ``With respect to any other portion of such''; and
(4) by adding at the end the following new clauses:
``(iv) In the case of an eligible organization that is offering a
reasonable cost reimbursement contract that may no longer be extended
or renewed because of the application of clause (ii), or where such
contract has been extended or renewed but the eligible organization has
informed the Secretary in writing not later than a date determined
appropriate by the Secretary that such organization voluntarily plans
not to seek renewal of the reasonable cost reimbursement contract, the
following shall apply:
``(I) Notwithstanding such clause, such contract may be
extended or renewed for the two years subsequent to 2016. The final
year in which such contract is extended or renewed is referred to
in this subsection as the `last reasonable cost reimbursement
contract year for the contract'.
``(II) The organization may not enroll a new enrollee under
such contract during the last reasonable cost reimbursement
contract year for the contract (but may continue to enroll new
enrollees through the end of the year immediately preceding such
year) unless such enrollee is any of the following:
``(aa) An individual who chooses enrollment in the
reasonable cost contract during the annual election period with
respect to such last year.
``(bb) An individual whose spouse, at the time of the
individual's enrollment is an enrollee under the reasonable
cost reimbursement contract.
``(cc) An individual who is covered under an employer group
health plan that offers coverage through the reasonable cost
reimbursement contract.
``(dd) An individual who becomes entitled to benefits under
part A, or enrolled under part B, and was enrolled in a plan
offered by the eligible organization immediately prior to the
individual's enrollment under the reasonable cost reimbursement
contract.
``(III) Not later than a date determined appropriate by the
Secretary prior to the beginning of the last reasonable cost
reimbursement contract year for the contract, the organization
shall provide notice to the Secretary as to whether the
organization will apply to have the contract converted over, in
whole or in part, and offered as a Medicare Advantage plan under
part C for the year following the last reasonable cost
reimbursement contract year for the contract.
``(IV) If the organization provides the notice described in
subclause (III) that the contract will be converted, in whole or in
part, the organization shall, not later than a date determined
appropriate by the Secretary, provide the Secretary with such
information as the Secretary determines appropriate in order to
carry out section 1851(c)(4) and to carry out section 1854(a)(5),
including subparagraph (C)(ii) of such section.
``(V) In the case that the organization enrolls a new enrollee
under such contract during the last reasonable cost reimbursement
contract year for the contract, the organization shall provide the
individual with a notification that such year is the last year for
such contract.
``(v) If an eligible organization that is offering a reasonable
cost reimbursement contract that is extended or renewed pursuant to
clause (iv) provides the notice described in clause (iv)(III) that the
contract will be converted, in whole or in part, the following shall
apply:
``(I) The deemed enrollment under section 1851(c)(4).
``(II) The special rule for quality increase under section
1853(o)(4)(C).
``(III) During the last reasonable cost reimbursement contract
year for the contract and the year immediately preceding such year,
the eligible organization, or the corporate parent organization of
the eligible organization, shall be permitted to offer an MA plan
in the area that such contract is being offered and enroll Medicare
Advantage eligible individuals in such MA plan and such cost
plan.''.
(b) Deemed Enrollment From Reasonable Cost Reimbursement Contracts
Converted to Medicare Advantage Plans.--
(1) In general.--Section 1851(c) of the Social Security Act (42
U.S.C. 1395w-21(c)) is amended--
(A) in paragraph (1), by striking ``Such elections'' and
inserting ``Subject to paragraph (4), such elections''; and
(B) by adding at the end the following:
``(4) Deemed enrollment relating to converted reasonable cost
reimbursement contracts.--
``(A) In general.--On the first day of the annual,
coordinated election period under subsection (e)(3) for plan
years beginning on or after January 1, 2017, an MA eligible
individual described in clause (i) or (ii) of subparagraph (B)
is deemed, unless the individual elects otherwise, to have
elected to receive benefits under this title through an
applicable MA plan (and shall be enrolled in such plan)
beginning with such plan year, if--
``(i) the individual is enrolled in a reasonable cost
reimbursement contract under section 1876(h) in the
previous plan year;
``(ii) such reasonable cost reimbursement contract was
extended or renewed for the last reasonable cost
reimbursement contract year of the contract (as described
in subclause (I) of section 1876(h)(5)(C)(iv)) pursuant to
such section;
``(iii) the eligible organization that is offering such
reasonable cost reimbursement contract provided the notice
described in subclause (III) of such section that the
contract was to be converted;
``(iv) the applicable MA plan--
``(I) is the plan that was converted from the
reasonable cost reimbursement contract described in
clause (iii);
``(II) is offered by the same entity (or an
organization affiliated with such entity that has a
common ownership interest of control) that entered into
such contract; and
``(III) is offered in the service area where the
individual resides;
``(v) in the case of reasonable cost reimbursement
contracts that provide coverage under parts A and B (and,
to the extent the Secretary determines it to be feasible,
contracts that provide only part B coverage), the
difference between the estimated individual costs (as
determined applicable by the Secretary) for the applicable
MA plan and such costs for the predecessor cost plan does
not exceed a threshold established by the Secretary; and
``(vi) the applicable MA plan--
``(I) provides coverage for enrollees transitioning
from the converted reasonable cost reimbursement
contract to such plan to maintain current providers of
services and suppliers and course of treatment at the
time of enrollment for a period of at least 90 days
after enrollment; and
``(II) during such period, pays such providers of
services and suppliers for items and services furnished
to the enrollee an amount that is not less than the
amount of payment applicable for such items and
services under the original Medicare fee-for-service
program under parts A and B.
``(B) MA eligible individuals described.--
``(i) Without prescription drug coverage.--An MA
eligible individual described in this clause, with respect
to a plan year, is an MA eligible individual who is
enrolled in a reasonable cost reimbursement contract under
section 1876(h) in the previous plan year and who is not,
for such previous plan year, enrolled in a prescription
drug plan under part D, including coverage under section
1860D-22.
``(ii) With prescription drug coverage.--An MA eligible
individual described in this clause, with respect to a plan
year, is an MA eligible individual who is enrolled in a
reasonable cost reimbursement contract under section
1876(h) in the previous plan year and who, for such
previous plan year, is enrolled in a prescription drug plan
under part D--
``(I) through such contract; or
``(II) through a prescription drug plan, if the
sponsor of such plan is the same entity (or an
organization affiliated with such entity) that entered
into such contract.
``(C) Applicable ma plan defined.--In this paragraph, the
term `applicable MA plan' means, in the case of an individual
described in--
``(i) subparagraph (B)(i), an MA plan that is not an
MA-PD plan; and
``(ii) subparagraph (B)(ii), an MA-PD plan.
``(D) Identification and notification of deemed
individuals.--Not later than 45 days before the first day of
the annual, coordinated election period under subsection (e)(3)
for plan years beginning on or after January 1, 2017, the
Secretary shall identify and notify the individuals who will be
subject to deemed elections under subparagraph (A) on the first
day of such period.''.
(2) Beneficiary option to discontinue or change ma plan or ma-
pd plan after deemed enrollment.--
(A) In general.--Section 1851(e)(2) of the Social Security
Act (42 U.S.C. 1395w-21(e)(4)) is amended by adding at the end
the following:
``(F) Special period for certain deemed elections.--
``(i) In general.--At any time during the period
beginning after the last day of the annual, coordinated
election period under paragraph (3) in which an individual
is deemed to have elected to enroll in an MA plan or MA-PD
plan under subsection (c)(4) and ending on the last day of
February of the first plan year for which the individual is
enrolled in such plan, such individual may change the
election under subsection (a)(1) (including changing the MA
plan or MA-PD plan in which the individual is enrolled).
``(ii) Limitation of one change.--An individual may
exercise the right under clause (i) only once during the
applicable period described in such clause. The limitation
under this clause shall not apply to changes in elections
effected during an annual, coordinated election period
under paragraph (3) or during a special enrollment period
under paragraph (4).''.
(B) Conforming amendments.--
(i) Plan requirement for open enrollment.--Section
1851(e)(6)(A) of the Social Security Act (42 U.S.C. 1395w-
21(e)(6)(A)) is amended by striking ``paragraph (1),'' and
inserting ``paragraph (1), during the period described in
paragraph (2)(F),''.
(ii) Part d.--Section 1860D-1(b)(1)(B) of such Act (42
U.S.C. 1395w-101(b)(1)(B)) is amended--
(I) in clause (ii), by adding ``and paragraph (4)''
after ``paragraph (3)(A)''; and
(II) in clause (iii) by striking ``and (E)'' and
inserting ``(E), and (F)''.
(3) Treatment of esrd for deemed enrollment.--Section
1851(a)(3)(B) of the Social Security Act (42 U.S.C. 1395w-
21(a)(3)(B)) is amended by adding at the end the following flush
sentence: ``An individual who develops end-stage renal disease
while enrolled in a reasonable cost reimbursement contract under
section 1876(h) shall be treated as an MA eligible individual for
purposes of applying the deemed enrollment under subsection
(c)(4).''.
(c) Information Requirements.--Section 1851(d)(2)(B) of the Social
Security Act (42 U.S.C. 1395w-21(d)(2)(B)) is amended--
(1) in the heading, by striking ``Notification to newly
eligible medicare advantage eligible individuals'' and inserting
the following: ``Notifications required.--
``(i) Notification to newly eligible medicare advantage
eligible individuals.--''; and
(2) by adding at the end the following new clause:
``(ii) Notification related to certain deemed
elections.--The Secretary shall require a Medicare
Advantage organization that is offering a Medicare
Advantage plan that has been converted from a reasonable
cost reimbursement contract pursuant to section
1876(h)(5)(C)(iv) to mail, not later than 30 days prior to
the first day of the annual, coordinated election period
under subsection (e)(3) of a year, to any individual
enrolled under such contract and identified by the
Secretary under subsection (c)(4)(D) for such year--
``(I) a notification that such individual will, on
such day, be deemed to have made an election with
respect to such plan to receive benefits under this
title through an MA plan or MA-PD plan (and shall be
enrolled in such plan) for the next plan year under
subsection (c)(4)(A), but that the individual may make
a different election during the annual, coordinated
election period for such year;
``(II) the information described in subparagraph
(A);
``(III) a description of the differences between
such MA plan or MA-PD plan and the reasonable cost
reimbursement contract in which the individual was most
recently enrolled with respect to benefits covered
under such plans, including cost-sharing, premiums,
drug coverage, and provider networks;
``(IV) information about the special period for
elections under subsection (e)(2)(F); and
``(V) other information the Secretary may
specify.''.
(d) Treatment of Transition Plan for Quality Rating for Payment
Purposes.--Section 1853(o)(4) of the Social Security Act (42 U.S.C.
1395w-23(o)(4)) is amended by adding at the end the following new
subparagraph:
``(C) Special rule for first 3 plan years for plans that
were converted from a reasonable cost reimbursement contract.--
For purposes of applying paragraph (1) and section
1854(b)(1)(C) for the first 3 plan years under this part in the
case of an MA plan to which deemed enrollment applies under
section 1851(c)(4)--
``(i) such plan shall not be treated as a new MA plan
(as defined in paragraph (3)(A)(iii)(II)); and
``(ii) in determining the star rating of the plan under
subparagraph (A), to the extent that Medicare Advantage
data for such plan is not available for a measure used to
determine such star rating, the Secretary shall use data
from the period in which such plan was a reasonable cost
reimbursement contract.''.

4253b8139971242a5a90c2c40639bc123f0f17f174ab04e7b043886dddc59216

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

c0dd8ddc176cd6e0bb7db8ac582aad4dd3221c0fbc46d35f85d2d4fc8dcdd853

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) for the period that begins on April 1, 2015, and ends
on December 31, 2015, the total allocation amount is
$535,000,000; and
``(Q) for 2016 and, subject to paragraph (4), for each
subsequent year, the total allocation amount is
$980,000,000.'';
(2) in paragraph (3), by striking ``(P), (R), (T), or (V)'' and
inserting ``or (P)''; and
(3) by adding at the end the following new paragraph:
``(4) Adjustment to allocations.--The Secretary may increase
the allocation amount under paragraph (2)(Q) for a year (beginning
with 2017) up to an amount that does not exceed the product of the
following:
``(A) Maximum allocation amount for previous year.--In the
case of 2017, the allocation amount for 2016, or in the case of
a subsequent year, the maximum allocation amount allowed under
this paragraph for the previous year.
``(B) Increase in part b premium.--The monthly premium rate
determined under section 1839 for the year divided by the
monthly premium rate determined under such section for the
previous year.
``(C) Increase in part b enrollment.--The average number of
individuals (as estimated by the Chief Actuary of the Centers
for Medicare & Medicaid Services in September of the previous
year) to be enrolled under part B of title XVIII for months in
the year divided by the average number of such individuals (as
so estimated) under this subparagraph with respect to
enrollments in months in the previous year.''.

5924decb16597cd98bdb19e2ecf8d181e5f477b6120a0b47e770c2f3c7a81572

(TMA).
(a) In General.--Section 1925 of the Social Security Act (42 U.S.C.
1396r-6) is amended--
(1) by striking subsection (f); and
(2) by redesignating subsection (g) as subsection (f).
(b) Conforming Amendment.--Section 1902(e)(1) of the Social
Security Act (42 U.S.C. 1396a(e)(1)) is amended to read as follows:
``(1) Beginning April 1, 1990, for provisions relating to the
extension of eligibility for medical assistance for certain families
who have received aid pursuant to a State plan approved under part A of
title IV and have earned income, see section 1925.''.

62e29b634e24a73a5f015c20ce6958a489717213fb0636712a31e0d37663480b

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''.

0f56c6500a523d66cd9c51ec095893186a26cc87c46a23e43f20039d6cf80f21

(a) In General.--Section 510 of the Social Security Act (42 U.S.C.
710) is amended--
(1) in subsection (a), striking ``2015'' and inserting
``2017''; and
(2) in subsection (d), by inserting ``and an additional
$75,000,000 for each of fiscal years 2016 and 2017'' after
``2015''.
(b) Budget Scoring.--Notwithstanding section 257(b)(2) of the
Balanced Budget and Emergency Deficit Control Act of 1985, the baseline
shall be calculated assuming that no grant shall be made under section
510 of the Social Security Act (42 U.S.C. 710) after fiscal year 2017.
(c) Reallocation of Unused Funding.--The remaining unobligated
balances of the amount appropriated for fiscal years 2016 and 2017 by
section 510(d) of the Social Security Act (42 U.S.C. 710(d)) for which
no application has been received by the Funding Opportunity
Announcement deadline, shall be made available to States that require
the implementation of each element described in subparagraphs (A)
through (H) of the definition of abstinence education in section
510(b)(2). The remaining unobligated balances shall be reallocated to
such States that submit a valid application consistent with the
original formula for this funding.

2e5feaea388c3e25ce50b6b2bfc5762af26ad7f6a2171da2bc0016d40fbc59de

(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''.

b827fcb5b0ff7d7686e9a9845e5bc50a8bfd066a132143d25302728aacd65fc9

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.''.

47a05e816211f7c899519d9b9ffe80959cfc4a1751438ffa22828b34bdc757aa

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''.

5933a067ee842fd78c31e335982d40d60a42297ccd02099d7aa8957412863dc6

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.''.

22f52b96577435639516bfc34713e9fc605a1fe63a0a869b12893e19b1adff4d

2025.
Section 1923(f)(6)(A) of the Social Security Act (42 U.S.C. 1396r-
4(f)(6)(A)) is amended by adding at the end the following:
``(vi) Allotment for fiscal years 2015 through 2025.--
Notwithstanding any other provision of this subsection, any
other provision of law, or the terms of the TennCare
Demonstration Project in effect for the State, the DSH
allotment for Tennessee for fiscal year 2015, and for each
fiscal year thereafter through fiscal year 2025, shall be
$53,100,000 for each such fiscal year.''.

55f50ee4bbd82ad6b45e7624aa0a8b7f91cc5530efa3e1338d3f3924a0746912

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''.

4302bb70b3431568be2a11c3847739f619862bb02a27a20a2042dcf2dd2c7321

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).

963da1586aa55f5af8e2c7c314c3feb16b80f7e625e7bc85e154f07455af3cf2

PROGRAM.
(a) Funding.--Section 2104(a) of the Social Security Act (42 U.S.C.
1397dd(a)) is amended--
(1) in paragraph (17), by striking ``and'' at the end;
(2) in paragraph (18)(B), by striking the period at the end and
inserting a semicolon; and
(3) by adding at the end the following new paragraphs:
``(19) for fiscal year 2016, $19,300,000,000; and
``(20) for fiscal year 2017, for purposes of making 2 semi-
annual allotments--
``(A) $2,850,000,000 for the period beginning on October 1,
2016, and ending on March 31, 2017; and
``(B) $2,850,000,000 for the period beginning on April 1,
2017, and ending on September 30, 2017.''.
(b) Allotments.--
(1) In general.--Section 2104(m) of the Social Security Act (42
U.S.C. 1397dd(m)) is amended--
(A) in the subsection heading, by striking ``Through 2015''
and inserting ``and Thereafter'';
(B) in paragraph (2)--
(i) in the paragraph heading, by striking ``2014'' and
inserting ``2016''; and
(ii) by striking subparagraph (B) and inserting the
following new subparagraph:
``(B) Fiscal year 2013 and each succeeding fiscal year.--
Subject to paragraphs (5) and (7), from the amount made
available under paragraphs (16) through (19) of subsection (a)
for fiscal year 2013 and each succeeding fiscal year,
respectively, the Secretary shall compute a State allotment for
each State (including the District of Columbia and each
commonwealth and territory) for each such fiscal year as
follows:
``(i) Rebasing in fiscal year 2013 and each succeeding
odd-numbered fiscal year.--For fiscal year 2013 and each
succeeding odd-numbered fiscal year (other than fiscal
years 2015 and 2017), the allotment of the State is equal
to the Federal payments to the State that are attributable
to (and countable toward) the total amount of allotments
available under this section to the State in the preceding
fiscal year (including payments made to the State under
subsection (n) for such preceding fiscal year as well as
amounts redistributed to the State in such preceding fiscal
year), multiplied by the allotment increase factor under
paragraph (6) for such odd-numbered fiscal year.
``(ii) Growth factor update for fiscal year 2014 and
each succeeding even-numbered fiscal year.--Except as
provided in clauses (iii) and (iv), for fiscal year 2014
and each succeeding even-numbered fiscal year, the
allotment of the State is equal to the sum of--
``(I) the amount of the State allotment under
clause (i) for the preceding fiscal year; and
``(II) the amount of any payments made to the State
under subsection (n) for such preceding fiscal year,
multiplied by the allotment increase factor under paragraph
(6) for such even-numbered fiscal year.
``(iii) Special rule for 2016.--For fiscal year 2016,
the allotment of the State is equal to the Federal payments
to the State that are attributable to (and countable
toward) the total amount of allotments available under this
section to the State in the preceding fiscal year
(including payments made to the State under subsection (n)
for such preceding fiscal year as well as amounts
redistributed to the State in such preceding fiscal year),
but determined as if the last two sentences of section
2105(b) were in effect in such preceding fiscal year and
then multiplying the result by the allotment increase
factor under paragraph (6) for fiscal year 2016.
``(iv) Reduction in 2018.--For fiscal year 2018, with
respect to the allotment of the State for fiscal year 2017,
any amounts of such allotment that remain available for
expenditure by the State in fiscal year 2018 shall be
reduced by one-third.'';
(C) in paragraph (4), by inserting ``or 2017'' after
``2015'';
(D) in paragraph (6)--
(i) in subparagraph (A), by striking ``2015'' and
inserting ``2017''; and
(ii) in the second sentence, by striking ``or fiscal
year 2014'' and inserting ``fiscal year 2014, or fiscal
year 2016'';
(E) in paragraph (8)--
(i) in the paragraph heading, by striking ``fiscal year
2015'' and inserting ``fiscal years 2015 and 2017''; and
(ii) by inserting ``or fiscal year 2017'' after
``2015'';
(F) by redesignating paragraphs (4) through (8) as
paragraphs (5) through (9), respectively; and
(G) by inserting after paragraph (3) the following new
paragraph:
``(4) For fiscal year 2017.--
``(A) First half.--Subject to paragraphs (5) and (7), from
the amount made available under subparagraph (A) of paragraph
(20) of subsection (a) for the semi-annual period described in
such paragraph, increased by the amount of the appropriation
for such period under section 301(b)(3) of the Medicare Access
and CHIP Reauthorization Act of 2015, the Secretary shall
compute a State allotment for each State (including the
District of Columbia and each commonwealth and territory) for
such semi-annual period in an amount equal to the first half
ratio (described in subparagraph (D)) of the amount described
in subparagraph (C).
``(B) Second half.--Subject to paragraphs (5) and (7), from
the amount made available under subparagraph (B) of paragraph
(20) of subsection (a) for the semi-annual period described in
such paragraph, the Secretary shall compute a State allotment
for each State (including the District of Columbia and each
commonwealth and territory) for such semi-annual period in an
amount equal to the amount made available under such
subparagraph, multiplied by the ratio of--
``(i) the amount of the allotment to such State under
subparagraph (A); to
``(ii) the total of the amount of all of the allotments
made available under such subparagraph.
``(C) Full year amount based on rebased amount.--The amount
described in this subparagraph for a State is equal to the
Federal payments to the State that are attributable to (and
countable towards) the total amount of allotments available
under this section to the State in fiscal year 2016 (including
payments made to the State under subsection (n) for fiscal year
2016 as well as amounts redistributed to the State in fiscal
year 2016), multiplied by the allotment increase factor under
paragraph (6) for fiscal year 2017.
``(D) First half ratio.--The first half ratio described in
this subparagraph is the ratio of--
``(i) the sum of--
``(I) the amount made available under subsection
(a)(20)(A); and
``(II) the amount of the appropriation for such
period under section 301(b)(3) of the Medicare Access
and CHIP Reauthorization Act of 2015; to
``(ii) the sum of the--
``(I) amount described in clause (i); and
``(II) the amount made available under subsection
(a)(20)(B).''.
(2) Conforming amendments.--
(A) Section 2104(c)(1) of the Social Security Act (42
U.S.C. 1397dd(c)(1)) is amended by striking ``(m)(4)'' and
inserting ``(m)(5)''.
(B) Section 2104(m) of such Act (42 U.S.C. 1397dd(m)), as
amended by paragraph (1), is further amended--
(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 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''.

763484c5adc3ceaca31e41942093f59bb399c89a214c0750bacf873a507a6aec

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''.

99ab545fdfccda9b1fc47ec84cfef1f56896ba9aa8bc3e586b87fc7acb621158

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''.

1d2e0a87cef0814d454e552c5857514bcbff4a2973dcc9fd57079ffaa04c9af0

(a) Childhood Obesity Demonstration Project.--Section 1139A(e)(8)
of the Social Security Act (42 U.S.C. 1320b-9a(e)(8)) is amended by
inserting ``, and $10,000,000 for the period of fiscal years 2016 and
2017'' after ``2014''.
(b) Pediatric Quality Measures Program.--Section 1139A(i) of the
Social Security Act (42 U.S.C. 1320b-9a(i)) is amended in the first
sentence by inserting before the period at the end the following: ``,
and there is appropriated for the period of fiscal years 2016 and 2017,
$20,000,000 for the purpose of carrying out this section (other than
subsections (e), (f), and (g))''.

e06307f4adf2b6ed5b73ba020e461fb02ff662aeb551871f7408294fe2eb33ed

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.
Subtitle A--Medicare Beneficiary Reforms

bcaa22830f621444eb2140dc644fe6a0c79020db596fbde5ec07621732ca1da0

MEDICARE BENEFICIARIES.
Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is
amended by adding at the end the following new subsection:
``(z) Limitation on Certain Medigap Policies for Newly Eligible
Medicare Beneficiaries.--
``(1) In general.--Notwithstanding any other provision of this
section, on or after January 1, 2020, a medicare supplemental
policy that provides coverage of the part B deductible, including
any such policy (or rider to such a policy) issued under a waiver
granted under subsection (p)(6), may not be sold or issued to a
newly eligible Medicare beneficiary.
``(2) Newly eligible medicare beneficiary defined.--In this
subsection, the term `newly eligible Medicare beneficiary' means an
individual who is neither of the following:
``(A) An individual who has attained age 65 before January
1, 2020.
``(B) An individual who was entitled to benefits under part
A pursuant to section 226(b) or 226A, or deemed to be eligible
for benefits under section 226(a), before January 1, 2020.
``(3) Treatment of waivered states.--In the case of a State
described in subsection (p)(6), nothing in this section shall be
construed as preventing the State from modifying its alternative
simplification program under such subsection so as to eliminate the
coverage of the part B deductible for any medical supplemental
policy sold or issued under such program to a newly eligible
Medicare beneficiary on or after January 1, 2020.
``(4) Treatment of references to certain policies.--In the case
of a newly eligible Medicare beneficiary, except as the Secretary
may otherwise provide, any reference in this section to a medicare
supplemental policy which has a benefit package classified as `C'
or `F' shall be deemed, as of January 1, 2020, to be a reference to
a medicare supplemental policy which has a benefit package
classified as `D' or `G', respectively.
``(5) Enforcement.--The penalties described in clause (ii) of
subsection (d)(3)(A) shall apply with respect to a violation of
paragraph (1) in the same manner as it applies to a violation of
clause (i) of such subsection.''.

ae03ac0d5d3643d0014a7b8bc1babd7bdc545f6a608ae2248995cbb7ace8b3fa

(a) In General.--Section 1839(i)(3)(C)(i) of the Social Security
Act (42 U.S.C. 1395r(i)(3)(C)(i)) is amended--
(1) by inserting after ``In general.--'' the following:
``(I) Subject to paragraphs (5) and (6), for years
before 2018:''; and
(2) by adding at the end the following:
``(II) Subject to paragraph (5), for years
beginning with 2018:
``If the modified adjusted gross income is:              The applicable
percentage is:
More than $85,000 but not more than $107,000.....            35 percent
More than $107,000 but not more than $133,500....            50 percent
More than $133,500 but not more than $160,000....            65 percent
More than $160,000...............................            80 percent.''.
''.    (b) Conforming Amendments.--Section 1839(i) of the Social
Security Act (42 U.S.C. 1395r(i)) is amended--
(1) in paragraph (2)(A), by inserting ``(or, beginning with
2018, $85,000)'' after ``$80,000'';
(2) in paragraph (3)(A)(i), by inserting ``applicable'' before
``table'';
(3) in paragraph (5)(A)--
(A) in the matter before clause (i), by inserting ``(other
than 2018 and 2019)'' after ``2007''; and
(B) in clause (ii), by inserting ``(or, in the case of a
calendar year beginning with 2020, August 2018)'' after
``August 2006''; and
(4) in paragraph (6), in the matter before subparagraph (A), by
striking ``2019'' and inserting ``2017''.
Subtitle B--Other Offsets

bbd0477a4bd72cea3068defe468ef0e4af72efc7933926bf83adbbaa88c7d81d

(a) SNFs.--Section 1888(e) of the Social Security Act (42 U.S.C.
1395yy(e))--
(1) in paragraph (5)(B)--
(A) in clause (i), by striking ``clause (ii)'' and
inserting ``clauses (ii) and (iii)'';
(B) in clause (ii), by inserting ``subject to clause
(iii),'' after ``each subsequent fiscal year,''; and
(C) by adding at the end the following new clause:
``(iii) Special rule for fiscal year 2018.--For fiscal
year 2018 (or other similar annual period specified in
clause (i)), the skilled nursing facility market basket
percentage, after application of clause (ii), is equal to 1
percent.''; and
(2) in paragraph (6)(A), by striking ``paragraph (5)(B)(ii)''
and inserting ``clauses (ii) and (iii) of paragraph (5)(B)'' each
place it appears.
(b) IRFs.--Section 1886(j) of the Social Security Act (42 U.S.C.
1395ww(j)) is amended--
(1) in paragraph (3)(C)--
(A) in clause (i), by striking ``clause (ii)'' and
inserting ``clauses (ii) and (iii)'';
(B) in clause (ii), by striking ``After'' and inserting
``Subject to clause (iii), after''; and
(C) by adding at the end the following new clause:
``(iii) Special rule for fiscal year 2018.--The
increase factor to be applied under this subparagraph for
fiscal year 2018, after the application of clause (ii),
shall be 1 percent.''; and
(2) in paragraph (7)(A)(i), by striking ``paragraph (3)(D)''
and inserting ``subparagraphs (C)(iii) and (D) of paragraph (3)''.
(c) HHAs.--Section 1895(b)(3)(B) of the Social Security Act (42
U.S.C. 1395fff(b)(3)(B)) is amended--
(1) in clause (iii), by adding at the end the following:
``Notwithstanding the previous sentence, the home health market
basket percentage increase for 2018 shall be 1 percent.''; and
(2) in clause (vi)(I), by inserting ``(except 2018)'' after
``each subsequent year''.
(d) Hospice.--Section 1814(i) of the Social Security Act (42 U.S.C.
1395f(i)) is amended--
(1) in paragraph (1)(C)--
(A) in clause (ii)(VII), by striking ``clause (iv),,'' and
inserting ``clauses (iv) and (vi),'';
(B) in clause (iii), by striking ``clause (iv),'' and
inserting ``clauses (iv) and (vi),'';
(C) in clause (iv), by striking ``After determining'' and
inserting ``Subject to clause (vi), after determining''; and
(D) by adding at the end the following new clause:
``(vi) For fiscal year 2018, the market basket percentage increase
under clause (ii)(VII) or (iii), as applicable, after application of
clause (iv), shall be 1 percent.''; and
(2) in paragraph (5)(A)(i), by striking ``paragraph
(1)(C)(iv)'' and inserting ``clauses (iv) and (vi) of paragraph
(1)(C)''.
(e) LTCHs.--Section 1886(m)(3) of the Social Security Act (42
U.S.C. 1395ww(m)(3)) is amended--
(1) in subparagraph (A), in the matter preceding clause (i), by
striking ``In implementing'' and inserting ``Subject to
subparagraph (C), in implementing''; and
(2) by adding at the end the following new subparagraph:
``(C) Additional special rule.--For fiscal year 2018, the
annual update under subparagraph (A) for the fiscal year, after
application of clauses (i) and (ii) of subparagraph (A), shall
be 1 percent.''.

1a08c4f35c9944026b03ff11761ec6cf693dc8ee173cd248e0e2eaf1b412bcac

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''.

d9d0523948b0ec4fd8c5f75f6d725e6807b56fcd5692a35e881b59a42723abb2

(a) In General.--Paragraph (3) of section 6331(h) of the Internal
Revenue Code of 1986 is amended by striking ``30 percent'' and
inserting ``100 percent''.
(b) Effective Date.--The amendment made by this section shall apply
to payments made after 180 days after the date of the enactment of this
Act.

4f848c3a55bd9bad31c0551dfd1586697a606349ff380cf1fefe7d0bf5952500

Section 7(b) of the TMA, Abstinence Education, and QI Programs
Extension Act of 2007 (Public Law 110-90), as amended by section 631(b)
of the American Taxpayer Relief Act of 2012 (Public Law 112-240), is
amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A), by striking
``, 2009, or 2010'' and inserting ``or 2009''; and
(B) in subparagraph (B)--
(i) in clause (i), by striking ``and'' at the end;
(ii) in clause (ii), by striking the period at the end
and inserting ``; and''; and
(iii) by adding at the end the following new clause:
``(iii) make an additional adjustment to the standardized
amounts under such section 1886(d) of an increase of 0.5
percentage points for discharges occurring during each of
fiscal years 2018 through 2023 and not make the adjustment
(estimated to be an increase of 3.2 percent) that would
otherwise apply for discharges occurring during fiscal year
2018 by reason of the completion of the adjustments required
under clause (ii).'';
(2) in paragraph (3)--
(A) by striking ``shall be construed'' and all that follows
through ``providing authority'' and inserting ``shall be
construed as providing authority''; and
(B) by inserting ``and each succeeding fiscal year through
fiscal year 2023'' after ``2017'';
(3) by redesignating paragraphs (3) and (4) as paragraphs (4)
and (5), respectively; and
(4) by inserting after paragraph (2) the following new
paragraph:
``(3) Prohibition.--The Secretary shall not make an additional
prospective adjustment (estimated to be a decrease of 0.55 percent)
to the standardized amounts under such section 1886(d) to offset
the amount of the increase in aggregate payments related to
documentation and coding changes for discharges occurring during
fiscal year 2010.''.
Subtitle A--Protecting the Integrity of Medicare

d13cc2a3dfa78deca0dd7887803f6917e79b2b5b4abe951614bc19d5d0d700be

NUMBERS ON MEDICARE CARDS.
(a) In General.--Section 205(c)(2)(C) of the Social Security Act
(42 U.S.C. 405(c)(2)(C)) is amended--
(1) by moving clause (x), as added by section 1414(a)(2) of the
Patient Protection and Affordable Care Act, 6 ems to the left;
(2) by redesignating clause (x), as added by section 2(a)(1) of
the Social Security Number Protection Act of 2010, and clause (xi)
as clauses (xi) and (xii), respectively; and
(3) by adding at the end the following new clause:
``(xiii) The Secretary of Health and Human Services, in
consultation with the Commissioner of Social Security, shall establish
cost-effective procedures to ensure that a Social Security account
number (or derivative thereof) is not displayed, coded, or embedded on
the Medicare card issued to an individual who is entitled to benefits
under part A of title XVIII or enrolled under part B of title XVIII and
that any other identifier displayed on such card is not identifiable as
a Social Security account number (or derivative thereof).''.
(b) Implementation.--In implementing clause (xiii) of section
205(c)(2)(C) of the Social Security Act (42 U.S.C. 405(c)(2)(C)), as
added by subsection (a)(3), the Secretary of Health and Human Services
shall do the following:
(1) In general.--Establish a cost-effective process that
involves the least amount of disruption to, as well as necessary
assistance for, Medicare beneficiaries and health care providers,
such as a process that provides such beneficiaries with access to
assistance through a toll-free telephone number and provides
outreach to providers.
(2) Consideration of medicare beneficiary identified.--Consider
implementing a process, similar to the process involving Railroad
Retirement Board beneficiaries, under which a Medicare beneficiary
identifier which is not a Social Security account number (or
derivative thereof) is used external to the Department of Health
and Human Services and is convertible over to a Social Security
account number (or derivative thereof) for use internal to such
Department and the Social Security Administration.
(c) Funding for Implementation.--For purposes of implementing the
provisions of and the amendments made by this section, the Secretary of
Health and Human Services shall provide for the following transfers
from the Federal Hospital Insurance Trust Fund under section 1817 of
the Social Security Act (42 U.S.C. 1395i) and from the Federal
Supplementary Medical Insurance Trust Fund established under section
1841 of such Act (42 U.S.C. 1395t), in such proportions as the
Secretary determines appropriate:
(1) To the Centers for Medicare & Medicaid Program Management
Account, transfers of the following amounts:
(A) For fiscal year 2015, $65,000,000, to be made available
through fiscal year 2018.
(B) For each of fiscal years 2016 and 2017, $53,000,000, to
be made available through fiscal year 2018.
(C) For fiscal year 2018, $48,000,000, to be made available
until expended.
(2) To the Social Security Administration Limitation on
Administration Account, transfers of the following amounts:
(A) For fiscal year 2015, $27,000,000, to be made available
through fiscal year 2018.
(B) For each of fiscal years 2016 and 2017, $22,000,000, to
be made available through fiscal year 2018.
(C) For fiscal year 2018, $27,000,000, to be made available
until expended.
(3) To the Railroad Retirement Board Limitation on
Administration Account, the following amount:
(A) For fiscal year 2015, $3,000,000, to be made available
until expended.
(d) Effective Date.--
(1) In general.--Clause (xiii) of section 205(c)(2)(C) of the
Social Security Act (42 U.S.C. 405(c)(2)(C)), as added by
subsection (a)(3), shall apply with respect to Medicare cards
issued on and after an effective date specified by the Secretary of
Health and Human Services, but in no case shall such effective date
be later than the date that is four years after the date of the
enactment of this Act.
(2) Reissuance.--The Secretary shall provide for the reissuance
of Medicare cards that comply with the requirements of such clause
not later than four years after the effective date specified by the
Secretary under paragraph (1).

665ebaf6e7fd784c61507b42ef4419c2b3431720ccb62c0528eea7d2437d293c

SERVICES FURNISHED TO INCARCERATED INDIVIDUALS, INDIVIDUALS NOT
LAWFULLY PRESENT, AND DECEASED INDIVIDUALS.
(a) Requirement for the Secretary To Establish Policies and Claims
Edits Relating to Incarcerated Individuals, Individuals Not Lawfully
Present, and Deceased Individuals.--Section 1874 of the Social Security
Act (42 U.S.C. 1395kk) is amended by adding at the end the following
new subsection:
``(f) Requirement for the Secretary To Establish Policies and
Claims Edits Relating to Incarcerated Individuals, Individuals Not
Lawfully Present, and Deceased Individuals.--The Secretary shall
establish and maintain procedures, including procedures for using
claims processing edits, updating eligibility information to improve
provider accessibility, and conducting recoupment activities such as
through recovery audit contractors, in order to ensure that payment is
not made under this title for items and services furnished to an
individual who is one of the following:
``(1) An individual who is incarcerated.
``(2) An individual who is not lawfully present in the United
States and who is not eligible for coverage under this title.
``(3) A deceased individual.''.
(b) Report.--Not later than 18 months after the date of the
enactment of this section, and periodically thereafter as determined
necessary by the Office of Inspector General of the Department of
Health and Human Services, such Office shall submit to Congress a
report on the activities described in subsection (f) of section 1874 of
the Social Security Act (42 U.S.C. 1395kk), as added by subsection (a),
that have been conducted since such date of enactment.

d99d44b7378b04f43f793101d2434ca0f40e546c3ce0d607a5445406ab69737c

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

2fa308d4b5eb2cda808612541695e59ec37cf36839ba14f24097ff08cf3ca06a

ENCOUNTER DOCUMENTATION REQUIREMENT.
(a) In General.--Section 1834(a)(11)(B)(ii) of the Social Security
Act (42 U.S.C. 1395m(a)(11)(B)(ii)) is amended--
(1) by striking ``the physician documenting that''; and
(2) by striking ``has had a face-to-face encounter'' and
inserting ``documenting such physician, physician assistant,
practitioner, or specialist has had a face-to-face encounter''.
(b) Implementation.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services may implement the amendments
made by subsection (a) by program instruction or otherwise.

1f83f2e50d824f4bea980cc11af5f573ff47b714f947e202cd09501b914c3255

(a) Medicare Administrative Contractor Improper Payment Outreach
and Education Program.--Section 1874A of the Social Security Act (42
U.S.C. 1395kk-1) is amended--
(1) in subsection (a)(4)--
(A) by redesignating subparagraph (G) as subparagraph (H);
and
(B) by inserting after subparagraph (F) the following new
subparagraph:
``(G) Improper payment outreach and education program.--
Having in place an improper payment outreach and education
program described in subsection (h).''; and
(2) by adding at the end the following new subsection:
``(h) Improper Payment Outreach and Education Program.--
``(1) In general.--In order to reduce improper payments under
this title, each medicare administrative contractor shall establish
and have in place an improper payment outreach and education
program under which the contractor, through outreach, education,
training, and technical assistance or other activities, shall
provide providers of services and suppliers located in the region
covered by the contract under this section with the information
described in paragraph (2). The activities described in the
preceding sentence shall be conducted on a regular basis.
``(2) Information to be provided through activities.--The
information to be provided under such payment outreach and
education program shall include information the Secretary
determines to be appropriate, which may include the following
information:
``(A) A list of the providers' or suppliers' most frequent
and expensive payment errors over the last quarter.
``(B) Specific instructions regarding how to correct or
avoid such errors in the future.
``(C) A notice of new topics that have been approved by the
Secretary for audits conducted by recovery audit contractors
under section 1893(h).
``(D) Specific instructions to prevent future issues
related to such new audits.
``(E) Other information determined appropriate by the
Secretary.
``(3) Priority.--A medicare administrative contractor shall
give priority to activities under such program that will reduce
improper payments that are one or more of the following:
``(A) Are for items and services that have the highest rate
of improper payment.
``(B) Are for items and service that have the greatest
total dollar amount of improper payments.
``(C) Are due to clear misapplication or misinterpretation
of Medicare policies.
``(D) Are clearly due to common and inadvertent clerical or
administrative errors.
``(E) Are due to other types of errors that the Secretary
determines could be prevented through activities under the
program.
``(4) Information on improper payments from recovery audit
contractors.--
``(A) In general.--In order to assist medicare
administrative contractors in carrying out improper payment
outreach and education programs, the Secretary shall provide
each contractor with a complete list of the types of improper
payments identified by recovery audit contractors under section
1893(h) with respect to providers of services and suppliers
located in the region covered by the contract under this
section. Such information shall be provided on a time frame the
Secretary determines appropriate which may be on a quarterly
basis.
``(B) Information.--The information described in
subparagraph (A) shall include information such as the
following:
``(i) Providers of services and suppliers that have the
highest rate of improper payments.
``(ii) Providers of services and suppliers that have
the greatest total dollar amounts of improper payments.
``(iii) Items and services furnished in the region that
have the highest rates of improper payments.
``(iv) Items and services furnished in the region that
are responsible for the greatest total dollar amount of
improper payments.
``(v) Other information the Secretary determines would
assist the contractor in carrying out the program.
``(5) Communications.--Communications with providers of
services and suppliers under an improper payment outreach and
education program are subject to the standards and requirements of
subsection (g).''.
(b) Use of Certain Funds Recovered by RACs.--Section 1893(h) of the
Social Security Act (42 U.S.C. 1395ddd(h)) is amended--
(1) in paragraph (2), by inserting ``or paragraph (10)'' after
``paragraph (1)(C)''; and
(2) by adding at the end the following new paragraph:
``(10) Use of certain recovered funds.--
``(A) In general.--After application of paragraph (1)(C),
the Secretary shall retain a portion of the amounts recovered
by recovery audit contractors for each year under this section
which shall be available to the program management account of
the Centers for Medicare & Medicaid Services for purposes of,
subject to subparagraph (B), carrying out sections 1833(z),
1834(l)(16), and 1874A(a)(4)(G), carrying out section 514(b) of
the Medicare Access and CHIP Reauthorization Act of 2015, and
implementing strategies (such as claims processing edits) to
help reduce the error rate of payments under this title. The
amounts retained under the preceding sentence shall not exceed
an amount equal to 15 percent of the amounts recovered under
this subsection, and shall remain available until expended.
``(B) Limitation.--Except for uses that support claims
processing (including edits) or system functionality for
detecting fraud, amounts retained under subparagraph (A) may
not be used for technological-related infrastructure, capital
investments, or information systems.
``(C) No reduction in payments to recovery audit
contractors.--Nothing in subparagraph (A) shall reduce amounts
available for payments to recovery audit contractors under this
subsection.''.

144e88ca2cb2a9fbcb6482f8e832fe1c90d7f1040d93411dc956950cd4632ce1

REWARDS.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall develop a plan to
revise the incentive program under section 203(b) of the Health
Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1395b-
5(b)) to encourage greater participation by individuals to report fraud
and abuse in the Medicare program. Such plan shall include
recommendations for--
(1) ways to enhance rewards for individuals reporting under the
incentive program, including rewards based on information that
leads to an administrative action; and
(2) extending the incentive program to the Medicaid program.
(b) Public Awareness and Education Campaign.--The plan developed
under subsection (a) shall also include recommendations for the use of
the Senior Medicare Patrols authorized under section 411 of the Older
Americans Act of 1965 (42 U.S.C. 3032) to conduct a public awareness
and education campaign to encourage participation in the revised
incentive program under subsection (a).
(c) Submission of Plan.--Not later than 180 days after the date of
enactment of this Act, the Secretary shall submit to Congress the plan
developed under subsection (a).

b1a6cb2327c73f314c9383ee43aa37b8c102dcd1f032fad106259a67640b03ed

ON PHARMACY CLAIMS.
Section 1860D-4(c) of the Social Security Act (42 U.S.C. 1395w-
104(c)) is amended by adding at the end the following new paragraph:
``(4) Requiring valid prescriber national provider identifiers
on pharmacy claims.--
``(A) In general.--For plan year 2016 and subsequent plan
years, the Secretary shall require a claim for a covered part D
drug for a part D eligible individual enrolled in a
prescription drug plan under this part or an MA-PD plan under
part C to include a prescriber National Provider Identifier
that is determined to be valid under the procedures established
under subparagraph (B)(i).
``(B) Procedures.--
``(i) Validity of prescriber national provider
identifiers.--The Secretary, in consultation with
appropriate stakeholders, shall establish procedures for
determining the validity of prescriber National Provider
Identifiers under subparagraph (A).
``(ii) Informing beneficiaries of reason for denial.--
The Secretary shall establish procedures to ensure that, in
the case that a claim for a covered part D drug of an
individual described in subparagraph (A) is denied because
the claim does not meet the requirements of this paragraph,
the individual is properly informed at the point of service
of the reason for the denial.
``(C) Report.--Not later than January 1, 2018, the
Inspector General of the Department of Health and Human
Services shall submit to Congress a report on the effectiveness
of the procedures established under subparagraph (B)(i).''.

42e41afcee01df37b1ff2d0f56019dd73e3172f7a3a6d03d1c60699ef3b9d0b6

(a) In General.--Section 1806 of the Social Security Act (42 U.S.C.
1395b-7) is amended by adding at the end the following new subsection:
``(c) Format of Statements From Secretary.--
``(1) Electronic option beginning in 2016.--Subject to
paragraph (2), for statements described in subsection (a) that are
furnished for a period in 2016 or a subsequent year, in the case
that an individual described in subsection (a) elects, in
accordance with such form, manner, and time specified by the
Secretary, to receive such statement in an electronic format, such
statement shall be furnished to such individual for each period
subsequent to such election in such a format and shall not be
mailed to the individual.
``(2) Limitation on revocation option.--
``(A) In general.--Subject to subparagraph (B), the
Secretary may determine a maximum number of elections described
in paragraph (1) by an individual that may be revoked by the
individual.
``(B) Minimum of one revocation option.--In no case may the
Secretary determine a maximum number under subparagraph (A)
that is less than one.
``(3) Notification.--The Secretary shall ensure that, in the
most cost effective manner and beginning January 1, 2017, a clear
notification of the option to elect to receive statements described
in subsection (a) in an electronic format is made available, such
as through the notices distributed under section 1804, to
individuals described in subsection (a).''.
(b) Encouraged Expansion of Electronic Statements.--To the extent
to which the Secretary of Health and Human Services determines
appropriate, the Secretary shall--
(1) apply an option similar to the option described in
subsection (c)(1) of section 1806 of the Social Security Act (42
U.S.C. 1395b-7) (relating to the provision of the Medicare Summary
Notice in an electronic format), as added by subsection (a), to
other statements and notifications under title XVIII of such Act
(42 U.S.C. 1395 et seq.); and
(2) provide such Medicare Summary Notice and any such other
statements and notifications on a more frequent basis than is
otherwise required under such title.

620aac0cfdaeadf501d0d30916adda3f0f06028d3d7d260969dfb5efea6dbfec

(a) In General.--Section 1874A(b)(1)(B) of the Social Security Act
(42 U.S.C. 1395kk-1(b)(1)(B)) is amended by striking ``5 years'' and
inserting ``10 years''.
(b) Application.--The amendments made by subsection (a) shall apply
to contracts entered into on or after, and to contracts in effect as
of, the date of the enactment of this Act.
(c) Contractor Performance Transparency.--Section 1874A(b)(3)(A) of
the Social Security Act (42 U.S.C. 1395kk-1(b)(3)(A)) is amended by
adding at the end the following new clause:
``(iv) Contractor performance transparency.--To the
extent possible without compromising the process for
entering into and renewing contracts with medicare
administrative contractors under this section, the
Secretary shall make available to the public the
performance of each medicare administrative contractor with
respect to such performance requirements and measurement
standards.''.

7d8b278b4536a200cfa2706053b29abd197b918b44c2698de7ab65f658919e67

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).''.

24e0af8afb6487b98d72437403c2a1cf1e86d3749c7899ed705ebd3d852819a1

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

c3eba7b1e40b26c7b895bbac47027f5e56259648b08d77fdd6a52c7b21dc7093

STUDY AND REPORT.
(a) Eliminating Civil Money Penalties for Inducements to Physicians
To Limit Services That Are Not Medically Necessary.--
(1) In general.--Section 1128A(b)(1) of the Social Security Act
(42 U.S.C. 1320a-7a(b)(1)) is amended by inserting ``medically
necessary'' after ``reduce or limit''.
(2) Effective date.--The amendment made by paragraph (1) shall
apply to payments made on or after the date of the enactment of
this Act.
(b) Gainsharing Study and Report.--Not later than 12 months after
the date of the enactment of this Act, the Secretary of Health and
Human Services, in consultation with the Inspector General of the
Department of Health and Human Services, shall submit to Congress a
report with options for amending existing fraud and abuse laws in, and
regulations related to, titles XI and XVIII of the Social Security Act
(42 U.S.C. 301 et seq.), through exceptions, safe harbors, or other
narrowly targeted provisions, to permit gainsharing arrangements that
otherwise would be subject to the civil money penalties described in
paragraphs (1) and (2) of section 1128A(b) of such Act (42 U.S.C.
1320a-7a(b)), or similar arrangements between physicians and hospitals,
and that improve care while reducing waste and increasing efficiency.
The report shall--
(1) consider whether such provisions should apply to ownership
interests, compensation arrangements, or other relationships;
(2) describe how the recommendations address accountability,
transparency, and quality, including how best to limit inducements
to stint on care, discharge patients prematurely, or otherwise
reduce or limit medically necessary care; and
(3) consider whether a portion of any savings generated by such
arrangements (as compared to an historical benchmark or other
metric specified by the Secretary to determine the impact of
delivery and payment system changes under such title XVIII on
expenditures made under such title) should accrue to the Medicare
program under title XVIII of the Social Security Act.

75baf63fc98352bfb2111c22aa32a0a2cd09c745559d29e894fc43c23be18f83

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''.

47a7a6f5220eddc0b8d5c6a2713cf73d2ba1f15be6ca7289140f94a136fa9437

THE SPINE TO CORRECT SUBLUXATION.
(a) In General.--Section 1833 of the Social Security Act (42 U.S.C.
1395l) is amended by adding at the end the following new subsection:
``(z) Medical Review of Spinal Subluxation Services.--
``(1) In general.--The Secretary shall implement a process for
the medical review (as described in paragraph (2)) of treatment by
a chiropractor described in section 1861(r)(5) by means of manual
manipulation of the spine to correct a subluxation (as described in
such section) of an individual who is enrolled under this part and
apply such process to such services furnished on or after January
1, 2017, focusing on services such as--
``(A) services furnished by a such a chiropractor whose
pattern of billing is aberrant compared to peers; and
``(B) services furnished by such a chiropractor who, in a
prior period, has a services denial percentage in the 85th
percentile or greater, taking into consideration the extent
that service denials are overturned on appeal.
``(2) Medical review.--
``(A) Prior authorization medical review.--
``(i) In general.--Subject to clause (ii), the
Secretary shall use prior authorization medical review for
services described in paragraph (1) that are furnished to
an individual by a chiropractor described in section
1861(r)(5) that are part of an episode of treatment that
includes more than 12 services. For purposes of the
preceding sentence, an episode of treatment shall be
determined by the underlying cause that justifies the need
for services, such as a diagnosis code.
``(ii) Ending application of prior authorization
medical review.--The Secretary shall end the application of
prior authorization medical review under clause (i) to
services described in paragraph (1) by such a chiropractor
if the Secretary determines that the chiropractor has a low
denial rate under such prior authorization medical review.
The Secretary may subsequently reapply prior authorization
medical review to such chiropractor if the Secretary
determines it to be appropriate and the chiropractor has,
in the time period subsequent to the determination by the
Secretary of a low denial rate with respect to the
chiropractor, furnished such services described in
paragraph (1).
``(iii) Early request for prior authorization review
permitted.--Nothing in this subsection shall be construed
to prevent such a chiropractor from requesting prior
authorization for services described in paragraph (1) that
are to be furnished to an individual before the
chiropractor furnishes the twelfth such service to such
individual for an episode of treatment.
``(B) Type of review.--The Secretary may use pre-payment
review or post-payment review of services described in section
1861(r)(5) that are not subject to prior authorization medical
review under subparagraph (A).
``(C) Relationship to law enforcement activities.--The
Secretary may determine that medical review under this
subsection does not apply in the case where potential fraud may
be involved.
``(3) No payment without prior authorization.--With respect to
a service described in paragraph (1) for which prior authorization
medical review under this subsection applies, the following shall
apply:
``(A) Prior authorization determination.--The Secretary
shall make a determination, prior to the service being
furnished, of whether the service would or would not meet the
applicable requirements of section 1862(a)(1)(A).
``(B) Denial of payment.--Subject to paragraph (5), no
payment may be made under this part for the service unless the
Secretary determines pursuant to subparagraph (A) that the
service would meet the applicable requirements of such section
1862(a)(1)(A).
``(4) Submission of information.--A chiropractor described in
section 1861(r)(5) may submit the information necessary for medical
review by fax, by mail, or by electronic means. The Secretary shall
make available the electronic means described in the preceding
sentence as soon as practicable.
``(5) Timeliness.--If the Secretary does not make a prior
authorization determination under paragraph (3)(A) within 14
business days of the date of the receipt of medical documentation
needed to make such determination, paragraph (3)(B) shall not
apply.
``(6) Application of limitation on beneficiary liability.--
Where payment may not be made as a result of the application of
paragraph (2)(B), section 1879 shall apply in the same manner as
such section applies to a denial that is made by reason of section
1862(a)(1).
``(7) Review by contractors.--The medical review described in
paragraph (2) may be conducted by medicare administrative
contractors pursuant to section 1874A(a)(4)(G) or by any other
contractor determined appropriate by the Secretary that is not a
recovery audit contractor.
``(8) Multiple services.--The Secretary shall, where
practicable, apply the medical review under this subsection in a
manner so as to allow an individual described in paragraph (1) to
obtain, at a single time rather than on a service-by-service basis,
an authorization in accordance with paragraph (3)(A) for multiple
services.
``(9) Construction.--With respect to a service described in
paragraph (1) that has been affirmed by medical review under this
subsection, nothing in this subsection shall be construed to
preclude the subsequent denial of a claim for such service that
does not meet other applicable requirements under this Act.
``(10) Implementation.--
``(A) Authority.--The Secretary may implement the
provisions of this subsection by interim final rule with
comment period.
``(B) Administration.--Chapter 35 of title 44, United
States Code, shall not apply to medical review under this
subsection.''.
(b) Improving Documentation of Services.--
(1) In general.--The Secretary of Health and Human Services
shall, in consultation with stakeholders (including the American
Chiropractic Association) and representatives of medicare
administrative contractors (as defined in section 1874A(a)(3)(A) of
the Social Security Act (42 U.S.C. 1395kk-1(a)(3)(A))), develop
educational and training programs to improve the ability of
chiropractors to provide documentation to the Secretary of services
described in section 1861(r)(5) in a manner that demonstrates that
such services are, in accordance with section 1862(a)(1) of such
Act (42 U.S.C. 1395y(a)(1)), reasonable and necessary for the
diagnosis or treatment of illness or injury or to improve the
functioning of a malformed body member.
(2) Timing.--The Secretary shall make the educational and
training programs described in paragraph (1) publicly available not
later than January 1, 2016.
(3) Funding.--The Secretary shall use funds made available
under paragraph (10) of section 1893(h) of the Social Security Act
(42 U.S.C. 1395ddd(h)), as added by section 505, to carry out this
subsection.
(c) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States shall
conduct a study on the effectiveness of the process for medical
review of services furnished as part of a treatment by means of
manual manipulation of the spine to correct a subluxation
implemented under subsection (z) of section 1833 of the Social
Security Act (42 U.S.C. 1395l), as added by subsection (a). Such
study shall include an analysis of--
(A) aggregate data on--
(i) the number of individuals, chiropractors, and
claims for services subject to such review; and
(ii) the number of reviews conducted under such
section; and
(B) the outcomes of such reviews.
(2) Report.--Not later than four years after the date of
enactment of this Act, the Comptroller General shall submit to
Congress a report containing the results of the study conducted
under paragraph (1), including recommendations for such legislation
and administrative action with respect to the process for medical
review implemented under subsection (z) of section 1833 of the
Social Security Act (42 U.S.C. 1395l) as the Comptroller General
determines appropriate.

9def4aa4747a082fcb528e3a5ff2297dd8ce02c66c403d9f81113faeceb66f5a

REPETITIVE SCHEDULED NON-EMERGENT AMBULANCE TRANSPORT.
(a) Initial Expansion.--
(1) In general.--In implementing the model described in
paragraph (2) proposed to be tested under subsection (b) of section
1115A of the Social Security Act (42 U.S.C. 1315a), the Secretary
of Health and Human Services shall revise the testing under
subsection (b) of such section to cover, effective not later than
January 1, 2016, States located in medicare administrative
contractor (MAC) regions L and 11 (consisting of Delaware, the
District of Columbia, Maryland, New Jersey, Pennsylvania, North
Carolina, South Carolina, West Virginia, and Virginia).
(2) Model described.--The model described in this paragraph is
the testing of a model of prior authorization for repetitive
scheduled non-emergent ambulance transport proposed to be carried
out in New Jersey, Pennsylvania, and South Carolina.
(3) Funding.--The Secretary shall allocate funds made available
under section 1115A(f)(1)(B) of the Social Security Act (42 U.S.C.
1315a(f)(1)(B)) to carry out this subsection.
(b) National Expansion.--Section 1834(l) of the Social Security Act
(42 U.S.C. 1395m(l)) is amended by adding at the end the following new
paragraph:
``(16) Prior authorization for repetitive scheduled non-
emergent ambulance transports.--
``(A) In general.--Beginning January 1, 2017, if the
expansion to all States of the model of prior authorization
described in paragraph (2) of section 515(a) of the Medicare
Access and CHIP Reauthorization Act of 2015 meets the
requirements described in paragraphs (1) through (3) of section
1115A(c), then the Secretary shall expand such model to all
States.
``(B) Funding.--The Secretary shall use funds made
available under section 1893(h)(10) to carry out this
paragraph.
``(C) Clarification regarding budget neutrality.--Nothing
in this paragraph may be construed to limit or modify the
application of section 1115A(b)(3)(B) to models described in
such section, including with respect to the model described in
subparagraph (A) and expanded beginning on January 1, 2017,
under such subparagraph.''.

7231d9d156bfec72cd0db378d00e88b9517c167351cd32dc01c5d14fb3d10ae4

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

51bfced6a872956a8a5b208fc5122b74e4f253218050ce1af7d81b010a07b08c

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).

f296891da34d91ad6a917c67dc8e8ac886d922feaad4e84a9ba5a4d30e905940

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''.

69fc44cba2af28f67483bef77ca20aa1cbe56f10a9f64242be83798ee57a85a7

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

714524153527d870cfb1772b56acc8d5f7676eeb64aaa0df77f4a6c75a6b4d8f

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.''.

8313ae9cf9f3c434b6c24e31c89407bae1af994fac4e20911d13fd7e1b585838

ENTITIES SUBMITTING BIDS UNDER THE MEDICARE DMEPOS COMPETITIVE
ACQUISITION PROGRAM.
(a) Bid Surety Bonds.--Section 1847(a)(1) of the Social Security
Act (42 U.S.C. 1395w-3(a)(1)) is amended by adding at the end the
following new subparagraphs:
``(G) Requiring bid bonds for bidding entities.--With
respect to rounds of competitions beginning under this
subsection for contracts beginning not earlier than January 1,
2017, and not later than January 1, 2019, an entity may not
submit a bid for a competitive acquisition area unless, as of
the deadline for bid submission, the entity has obtained (and
provided the Secretary with proof of having obtained) a bid
surety bond (in this paragraph referred to as a `bid bond') in
a form specified by the Secretary consistent with subparagraph
(H) and in an amount that is not less than $50,000 and not more
than $100,000 for each competitive acquisition area in which
the entity submits the bid.
``(H) Treatment of bid bonds submitted.--
``(i) For bidders that submit bids at or below the
median and are offered but do not accept the contract.--In
the case of a bidding entity that is offered a contract for
any product category for a competitive acquisition area,
if--
``(I) the entity's composite bid for such product
category and area was at or below the median composite
bid rate for all bidding entities included in the
calculation of the single payment amounts for such
product category and area; and
``(II) the entity does not accept the contract
offered for such product category and area,
the bid bond submitted by such entity for such area shall
be forfeited by the entity and the Secretary shall collect
on it.
``(ii) Treatment of other bidders.--In the case of a
bidding entity for any product category for a competitive
acquisition area, if the entity does not meet the bid
forfeiture conditions in subclauses (I) and (II) of clause
(i) for any product category for such area, the bid bond
submitted by such entity for such area shall be returned
within 90 days of the public announcement of the contract
suppliers for such area.''.
(b) State Licensure.--
(1) In general.--Section 1847(b)(2)(A) of the Social Security
Act (42 U.S.C. 1395w-3(b)(2)(A)) is amended by adding at the end
the following new clause:
``(v) The entity meets applicable State licensure
requirements.''.
(2) Construction.--Nothing in the amendment made by paragraph
(1) shall be construed as affecting the authority of the Secretary
of Health and Human Services to require State licensure of an
entity under the Medicare competitive acquisition program under
section 1847 of the Social Security Act (42 U.S.C. 1395w-3) before
the date of the enactment of this Act.
(c) GAO Report on Bid Bond Impact on Small Suppliers.--
(1) Study.--The Comptroller General of the United States shall
conduct a study that evaluates the effect of the bid surety bond
requirement under the amendment made by subsection (a) on the
participation of small suppliers in the Medicare DMEPOS competitive
acquisition program under section 1847 of the Social Security Act
(42 U.S.C. 1395w-3).
(2) Report.--Not later than 6 months after the date contracts
are first awarded subject to such bid surety bond requirement, the
Comptroller General shall submit to Congress a report on the study
conducted under paragraph (1). Such report shall include
recommendations for changes in such requirement in order to ensure
robust participation by legitimate small suppliers in the Medicare
DMEPOS competition acquisition program.

d345cc427ef4dacdcbd9570c8674ac7d56dfb3c2ad400baeaf251f8d9e20b72e

(a) In General.--Section 1848(c) of the Social Security Act (42
U.S.C. 1395w-4(c)) is amended by adding at the end the following new
paragraph:
``(8) Global surgical packages.--
``(A) Prohibition of implementation of rule regarding
global surgical packages.--
``(i) In general.--The Secretary shall not implement
the policy established in the final rule published on
November 13, 2014 (79 Fed. Reg. 67548 et seq.), that
requires the transition of all 10-day and 90-day global
surgery packages to 0-day global periods.
``(ii) Construction.--Nothing in clause (i) shall be
construed to prevent the Secretary from revaluing misvalued
codes for specific surgical services or assigning values to
new or revised codes for surgical services.
``(B) Collection of data on services included in global
surgical packages.--
``(i) In general.--Subject to clause (ii), the
Secretary shall through rulemaking develop and implement a
process to gather, from a representative sample of
physicians, beginning not later than January 1, 2017,
information needed to value surgical services. Such
information shall include the number and level of medical
visits furnished during the global period and other items
and services related to the surgery and furnished during
the global period, as appropriate. Such information shall
be reported on claims at the end of the global period or in
another manner specified by the Secretary. For purposes of
carrying out this paragraph (other than clause (iii)), the
Secretary shall transfer from the Federal Supplemental
Medical Insurance Trust Fund under section 1841 $2,000,000
to the Center for Medicare & Medicaid Services Program
Management Account for fiscal year 2015. Amounts
transferred under the previous sentence shall remain
available until expended.
``(ii) Reassessment and potential sunset.--Every 4
years, the Secretary shall reassess the value of the
information collected pursuant to clause (i). Based on such
a reassessment and by regulation, the Secretary may
discontinue the requirement for collection of information
under such clause if the Secretary determines that the
Secretary has adequate information from other sources, such
as qualified clinical data registries, surgical logs,
billing systems or other practice or facility records, and
electronic health records, in order to accurately value
global surgical services under this section.
``(iii) Inspector general audit.--The Inspector General
of the Department of Health and Human Services shall audit
a sample of the information reported under clause (i) to
verify the accuracy of the information so reported.
``(C) Improving accuracy of pricing for surgical
services.--For years beginning with 2019, the Secretary shall
use the information reported under subparagraph (B)(i) as
appropriate and other available data for the purpose of
improving the accuracy of valuation of surgical services under
the physician fee schedule under this section.''.
(b) Incentive for Reporting Information on Global Surgical
Services.--Section 1848(a) of the Social Security Act (42 U.S.C. 1395w-
4(a)) is amended by adding at the end the following new paragraph:
``(9) Information reporting on services included in global
surgical packages.--With respect to services for which a physician
is required to report information in accordance with subsection
(c)(8)(B)(i), the Secretary may through rulemaking delay payment of
5 percent of the amount that would otherwise be payable under the
physician fee schedule under this section for such services until
the information so required is reported.''.

e68fed19b5ae38b207f7a298ef0bf05164e0c5de1fd002c0d739decd0128b989

DETERMINATION ACT OF 2000.
(a) Payments for Fiscal Years 2014 and 2015.--
(1) Payments required.--Section 101 of the Secure Rural Schools
and Community Self-Determination Act of 2000 (16 U.S.C. 7111) is
amended by striking ``2013'' both places it appears and inserting
``2015''.
(2) Prompt payment.--Payments for fiscal year 2014 under title
I of the Secure Rural Schools and Community Self-Determination Act
of 2000 (16 U.S.C. 7111 et seq.), as amended by this section, shall
be made not later than 45 days after the date of the enactment of
this Act.
(3) Reduction in fiscal year 2014 payments on account of
previous 25- and 50-percent payments.--Section 101 of the Secure
Rural Schools and Community Self-Determination Act of 2000 (16
U.S.C. 7111) is amended by adding at the end the following new
subsection:
``(c) Special Rule for Fiscal Year 2014 Payments.--
``(1) State payment.--If an eligible county in a State that
will receive a share of the State payment for fiscal year 2014 has
already received, or will receive, a share of the 25-percent
payment for fiscal year 2014 distributed to the State before the
date of the enactment of this subsection, the amount of the State
payment shall be reduced by the amount of that eligible county's
share of the 25-percent payment.
``(2) County payment.--If an eligible county that will receive
a county payment for fiscal year 2014 has already received a 50-
percent payment for that fiscal year, the amount of the county
payment shall be reduced by the amount of the 50-percent
payment.''.
(4) Shares of california state payment.--Section 103(d)(2) of
the Secure Rural Schools and Community Self-Determination Act of
2000 (16 U.S.C. 7113(d)(2)) is amended by striking ``2013'' and
inserting ``2015''.
(b) Use of Fiscal Year 2013 Elections and Reservations for Fiscal
Years 2014 and 2015.--Section 102 of the Secure Rural Schools and
Community Self-Determination Act of 2000 (16 U.S.C. 7112) is amended--
(1) in subsection (b)(1), by adding at the end the following
new subparagraph:
``(C) Effect of late payment for fiscal years 2014 and
2015.--The election otherwise required by subparagraph (A)
shall not apply for fiscal year 2014 or 2015.'';
(2) in subsection (b)(2)--
(A) in subparagraph (A), by adding at the end the following
new sentence: ``If such two-fiscal year period included fiscal
year 2013, the county election to receive a share of the 25-
percent payment or 50-percent payment, as applicable, also
shall be effective for fiscal years 2014 and 2015.''; and
(B) in subparagraph (B), by striking ``2013'' the second
place it appears and inserting ``2015''; and
(3) in subsection (d)--
(A) by adding at the end of paragraph (1) the following new
subparagraph:
``(E) Effect of late payment for fiscal year 2014.--The
election made by an eligible county under subparagraph (B),
(C), or (D) for fiscal year 2013, or deemed to be made by the
county under paragraph (3)(B) for that fiscal year, shall be
effective for fiscal years 2014 and 2015.''; and
(B) by adding at the end of paragraph (3) the following new
subparagraph:
``(C) Effect of late payment for fiscal year 2014.--This
paragraph does not apply for fiscal years 2014 and 2015.''.
(c) Special Projects on Federal Land.--Title II of the Secure Rural
Schools and Community Self-Determination Act of 2000 (16 U.S.C. 7121 et
seq.) is amended--
(1) in section 203(a)(1) (16 U.S.C. 7123(a)(1)), by striking
``September 30 for fiscal year 2008 (or as soon thereafter as the
Secretary concerned determines is practicable), and each September
30 thereafter for each succeeding fiscal year through fiscal year
2013'' and inserting ``September 30 of each fiscal year (or a later
date specified by the Secretary concerned for the fiscal year)'';
(2) in section 204(e)(3)(B)(iii) (16 U.S.C.
7124(e)(3)(B)(iii)), by striking ``each of fiscal years 2010
through 2013'' and inserting ``fiscal year 2010 and fiscal years
thereafter'';
(3) in section 207(a) (16 U.S.C. 7127(a)), by striking
``September 30, 2008 (or as soon thereafter as the Secretary
concerned determines is practicable), and each September 30
thereafter for each succeeding fiscal year through fiscal year
2013'' and inserting ``September 30 of each fiscal year (or a later
date specified by the Secretary concerned for the fiscal year)'';
and
(4) in section 208 (16 U.S.C. 7128)--
(A) in subsection (a), by striking ``2013'' and inserting
``2017''; and
(B) in subsection (b), by striking ``2014'' and inserting
``2018''.
(d) County Funds.--Section 304 of the Secure Rural Schools and
Community Self-Determination Act of 2000 (16 U.S.C. 7144) is amended--
(1) in subsection (a), by striking ``2013'' and inserting
``2017''; and
(2) in subsection (b), by striking ``2014'' and inserting
``2018''.
(e) Authorization of Appropriations.--Section 402 of the Secure
Rural Schools and Community Self-Determination Act of 2000 (16 U.S.C.
7152) is amended by striking ``for each of fiscal years 2008 through
2013''.

aba81bc7bc28a97ab606ed1a6c53d1bc2ec035392bfa549477a785499bb62755

(a) Statutory Pay-As-You-Go Scorecards.--The budgetary effects of
this Act shall not be entered on either PAYGO scorecard maintained
pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.
(b) Senate PAYGO Scorecards.--The budgetary effects of this Act
shall not be entered on any PAYGO scorecard maintained for purposes of
section 201 of S. Con. Res. 21 (110th Congress).
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.

ba0bc0a448122bdf79366e1aab65903908ec5b3adc090cf59fd23f44e4a126c8

Medicare Access and CHIP Reauthorization Act of 2015

Other Sections

TITLE I

TITLE II

TITLE III

TITLE IV

TITLE V

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