[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4987 Introduced in House (IH)]
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115th CONGRESS
2d Session
H. R. 4987
To amend title XVIII of the Social Security Act to provide for
technical amendments to the Merit-based Incentive Payment System under
Medicare.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 8, 2018
Mr. Burgess (for himself, Mr. Gene Green of Texas, Mr. Roskam, and Mr.
Levin) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for
technical amendments to the Merit-based Incentive Payment System under
Medicare.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. TECHNICAL AMENDMENTS TO PUBLIC LAW 114-10.
(a) MIPS Transition.--Section 1848 of the Social Security Act (42
U.S.C. 1395w-4) is amended--
(1) in subsection (q)--
(A) in paragraph (1)--
(i) in subparagraph (B), by striking
``items and services'' and inserting ``covered
professional services (as defined in subsection
(k)(3)(A))''; and
(ii) in subparagraph (C)(iv)--
(I) by amending subclause (I) to
read as follows:
``(I) The minimum number (as
determined by the Secretary) of--
``(aa) for performance
periods beginning before
January 1, 2018, individuals
enrolled under this part who
are treated by the eligible
professional for the
performance period involved;
and
``(bb) for performance
periods beginning on or after
January 1, 2018, individuals
enrolled under this part who
are furnished covered
professional services (as
defined in subsection
(k)(3)(A)) by the eligible
professional for the
performance period involved.'';
(II) in subclause (II), by striking
``items and services'' and inserting
``covered professional services (as
defined in subsection (k)(3)(A))''; and
(III) by amending subclause (III)
to read as follows:
``(III) The minimum amount (as
determined by the Secretary) of--
``(aa) for performance
periods beginning before
January 1, 2018, allowed
charges billed by such
professional under this part
for such performance period;
and
``(bb) for performance
periods beginning on or after
January 1, 2018, allowed
charges for covered
professional services (as
defined in subsection
(k)(3)(A)) billed by such
professional for such
performance period.'';
(B) in paragraph (5)(D)--
(i) in clause (i)(I), by inserting
``subject to clause (iii),'' after ``clauses
(i) and (ii) of paragraph (2)(A),''; and
(ii) by adding at the end the following new
clause:
``(iii) Transition years.--For each of the
second, third, fourth, and fifth years for
which the MIPS applies to payments, the
performance score for the performance category
described in paragraph (2)(A)(ii) shall not
take into account the improvement of the
professional involved.'';
(C) in paragraph (5)(E)--
(i) in clause (i)(I)(bb)--
(I) in the heading by striking
``First 2 years'' and inserting ``First
5 years''; and
(II) by striking ``the first and
second years'' and inserting ``each of
the first through fifth years''; and
(ii) in clause (i)(II)(bb)--
(I) in the heading, by striking ``2
years'' and inserting ``5 years''; and
(II) by striking the second
sentence and inserting the following
new sentences: ``For each of the
second, third, fourth, and fifth years
for which the MIPS applies to payments,
not less than 10 percent and not more
than 30 percent of such score shall be
based on performance with respect to
the category described in clause (ii)
of paragraph (2)(A). Nothing in the
previous sentence shall be construed,
with respect to a performance period
for a year described in the previous
sentence, as preventing the Secretary
from basing 30 percent of such score
for such year with respect to the
category described in such clause (ii),
if the Secretary determines, based on
information posted under subsection
(r)(2)(I) that sufficient resource use
measures are ready for adoption for use
under the performance category under
paragraph (2)(A)(ii) for such
performance period.'';
(D) in paragraph (6)(D)--
(i) in clause (i), in the second sentence,
by striking ``Such performance threshold'' and
inserting ``Subject to clauses (iii) and (iv),
such performance threshold'';
(ii) in clause (ii)--
(I) in the first sentence, by
inserting ``(beginning with 2019 and
ending with 2024)'' after ``for each
year of the MIPS''; and
(II) in the second sentence, by
inserting ``subject to clause (iii),''
after ``For each such year,'';
(iii) in clause (iii)--
(I) in the heading, by striking
``2'' and inserting ``5''; and
(II) in the first sentence, by
striking ``two years'' and inserting
``five years''; and
(iv) by adding at the end the following new
clause:
``(iv) Additional special rule for third,
fourth and fifth years of mips.--For purposes
of determining MIPS adjustment factors under
subparagraph (A), in addition to the
requirements specified in clause (iii), the
Secretary shall increase the performance
threshold with respect to each of the third,
fourth, and fifth years to which the MIPS
applies to ensure a gradual and incremental
transition to the performance threshold
described in clause (i) (as estimated by the
Secretary) with respect to the sixth year to
which the MIPS applies.'';
(E) in paragraph (6)(E)--
(i) by striking ``In the case of items and
services'' and inserting ``In the case of
covered professional services (as defined in
subsection (k)(3)(A))''; and
(ii) by striking ``under this part with
respect to such items and services'' and
inserting ``under this part with respect to
such covered professional services''; and
(F) in paragraph (7), in the first sentence, by
striking ``items and services'' and inserting ``covered
professional services (as defined in subsection
(k)(3)(A))'';
(2) in subsection (r)(2), by adding at the end the
following new subparagraph:
``(I) Information.--The Secretary shall, not later
than December 31st of each year (beginning with 2018),
post on the Internet website of the Centers for
Medicare & Medicaid Services information on resource
use measures in use under subsection (q), resource use
measures under development and the time-frame for such
development, potential future resource use measure
topics, a description of stakeholder engagement, and
the percent of expenditures under part A and this part
that are covered by resource use measures.''; and
(3) in subsection (s)(5)(B), by striking ``section
1833(z)(2)(C)'' and inserting ``section 1833(z)(3)(D)''.
(b) Physician-Focused Payment Model Technical Advisory Committee
Provision of Initial Proposal Feedback.--Section 1868(c)(2)(C) of the
Social Security Act (42 U.S.C. 1395ee(c)(2)(C)) is amended to read as
follows:
``(C) Committee review of models submitted.--The
Committee, on a periodic basis--
``(i) shall review models submitted under
subparagraph (B);
``(ii) may provide individuals and
stakeholder entities who submitted such models
with--
``(I) initial feedback on such
models regarding the extent to which
such models meet the criteria described
in subparagraph (A); and
``(II) an explanation of the basis
for the feedback provided under
subclause (I); and
``(iii) shall prepare comments and
recommendations regarding whether such models
meet the criteria described in subparagraph (A)
and submit such comments and recommendations to
the Secretary.''.
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