[113th Congress Public Law 185]
[From the U.S. Government Printing Office]



[[Page 1951]]

      IMPROVING MEDICARE POST-ACUTE CARE TRANSFORMATION ACT OF 2014

[[Page 128 STAT. 1952]]

Public Law 113-185
113th Congress

                                 An Act


 
     To amend title XVIII of the Social Security Act to provide for 
 standardized post-acute care assessment data for quality, payment, and 
      discharge planning, and for other purposes. <<NOTE: Oct. 6, 
                         2014 -  [H.R. 4994]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Improving 
Medicare Post-Acute Care Transformation Act of 2014.>> 
SECTION 1. <<NOTE: 42 USC 1305 note.>>  SHORT TITLE.

    This Act may be cited as the ``Improving Medicare Post-Acute Care 
Transformation Act of 2014'' or the ``IMPACT Act of 2014''.
SEC. 2. STANDARDIZATION OF POST-ACUTE CARE DATA.

    (a) In General.--Title XVIII of the Social Security Act is amended 
by adding at the end the following new section:
``SEC. 1899B. <<NOTE: 42 USC 1395lll.>>  STANDARDIZED POST-ACUTE 
                            CARE (PAC) ASSESSMENT DATA FOR 
                            QUALITY, PAYMENT, AND DISCHARGE 
                            PLANNING.

    ``(a) Requirement for Standardized Assessment Data.--
            ``(1) In general.--The Secretary shall--
                    ``(A) require under the applicable reporting 
                provisions post-acute care providers (as defined in 
                paragraph (2)(A)) to report--
                          ``(i) standardized patient assessment data in 
                      accordance with subsection (b);
                          ``(ii) data on quality measures under 
                      subsection (c)(1); and
                          ``(iii) data on resource use and other 
                      measures under subsection (d)(1);
                    ``(B) require data described in subparagraph (A) to 
                be standardized and interoperable so as to allow for the 
                exchange of such data among such post-acute care 
                providers and other providers and the use by such 
                providers of such data that has been so exchanged, 
                including by using common standards and definitions, in 
                order to provide access to longitudinal information for 
                such providers to facilitate coordinated care and 
                improved Medicare beneficiary outcomes; and
                    ``(C) in accordance with subsections (b)(1) and 
                (c)(2), modify PAC assessment instruments (as defined in 
                paragraph (2)(B)) applicable to post-acute care 
                providers to--
                          ``(i) provide for the submission of 
                      standardized patient assessment data under this 
                      title with respect to such providers; and

[[Page 128 STAT. 1953]]

                          ``(ii) enable comparison of such assessment 
                      data across all such providers to whom such data 
                      are applicable.
            ``(2) Definitions.--For purposes of this section:
                    ``(A) Post-acute care (pac) provider.--The terms 
                `post-acute care provider' and `PAC provider' mean--
                          ``(i) a home health agency;
                          ``(ii) a skilled nursing facility;
                          ``(iii) an inpatient rehabilitation facility; 
                      and
                          ``(iv) a long-term care hospital (other than a 
                      hospital classified under section 
                      1886(d)(1)(B)(iv)(II)).
                    ``(B) PAC assessment instrument.--The term `PAC 
                assessment instrument' means--
                          ``(i) in the case of home health agencies, the 
                      instrument used for purposes of reporting and 
                      assessment with respect to the Outcome and 
                      Assessment Information Set (OASIS), as described 
                      in sections 484.55 and 484.250 of title 42, the 
                      Code of Federal Regulations, or any successor 
                      regulation, or any other instrument used with 
                      respect to home health agencies for such purposes;
                          ``(ii) in the case of skilled nursing 
                      facilities, the resident's assessment under 
                      section 1819(b)(3);
                          ``(iii) in the case of inpatient 
                      rehabilitation facilities, any Medicare 
                      beneficiary assessment instrument established by 
                      the Secretary for purposes of section 1886(j); and
                          ``(iv) in the case of long-term care 
                      hospitals, the Medicare beneficiary assessment 
                      instrument used with respect to such hospitals for 
                      the collection of data elements necessary to 
                      calculate quality measures as described in the 
                      August 18, 2011, Federal Register (76 Fed. Reg. 
                      51754-51755), including for purposes of section 
                      1886(m)(5)(C), or any other instrument used with 
                      respect to such hospitals for assessment purposes.
                    ``(C) Applicable reporting provision.--The term 
                `applicable reporting provision' means--
                          ``(i) for home health agencies, section 
                      1895(b)(3)(B)(v);
                          ``(ii) for skilled nursing facilities, section 
                      1888(e)(6);
                          ``(iii) for inpatient rehabilitation 
                      facilities, section 1886(j)(7); and
                          ``(iv) for long-term care hospitals, section 
                      1886(m)(5).
                    ``(D) PAC payment system.--The term `PAC payment 
                system' means--
                          ``(i) with respect to a home health agency, 
                      the prospective payment system under section 1895;
                          ``(ii) with respect to a skilled nursing 
                      facility, the prospective payment system under 
                      section 1888(e);
                          ``(iii) with respect to an inpatient 
                      rehabilitation facility, the prospective payment 
                      system under section 1886(j); and
                          ``(iv) with respect to a long-term care 
                      hospital, the prospective payment system under 
                      section 1886(m).
                    ``(E) Specified application date.--The term 
                `specified application date' means the following:

[[Page 128 STAT. 1954]]

                          ``(i) Quality measures.--In the case of 
                      quality measures under subsection (c)(1)--
                                    ``(I) with respect to the domain 
                                described in subsection (c)(1)(A) 
                                (relating to functional status, 
                                cognitive function, and changes in 
                                function and cognitive function)--
                                            ``(aa) for PAC providers 
                                        described in clauses (ii) and 
                                        (iii) of paragraph (2)(A), 
                                        October 1, 2016;
                                            ``(bb) for PAC providers 
                                        described in clause (iv) of such 
                                        paragraph, October 1, 2018; and
                                            ``(cc) for PAC providers 
                                        described in clause (i) of such 
                                        paragraph, January 1, 2019;
                                    ``(II) with respect to the domain 
                                described in subsection (c)(1)(B) 
                                (relating to skin integrity and changes 
                                in skin integrity)--
                                            ``(aa) for PAC providers 
                                        described in clauses (ii), 
                                        (iii), and (iv) of paragraph 
                                        (2)(A), October 1, 2016; and
                                            ``(bb) for PAC providers 
                                        described in clause (i) of such 
                                        paragraph, January 1, 2017;
                                    ``(III) with respect to the domain 
                                described in subsection (c)(1)(C) 
                                (relating to medication 
                                reconciliation)--
                                            ``(aa) for PAC providers 
                                        described in clause (i) of such 
                                        paragraph, January 1, 2017; and
                                            ``(bb) for PAC providers 
                                        described in clauses (ii), 
                                        (iii), and (iv) of such 
                                        paragraph, October 1, 2018;
                                    ``(IV) with respect to the domain 
                                described in subsection (c)(1)(D) 
                                (relating to incidence of major falls)--
                                            ``(aa) for PAC providers 
                                        described in clauses (ii), 
                                        (iii), and (iv) of paragraph 
                                        (2)(A), October 1, 2016; and
                                            ``(bb) for PAC providers 
                                        described in clause (i) of such 
                                        paragraph, January 1, 2019; and
                                    ``(V) with respect to the domain 
                                described in subsection (c)(1)(E) 
                                (relating to accurately communicating 
                                the existence of and providing for the 
                                transfer of health information and care 
                                preferences)--
                                            ``(aa) for PAC providers 
                                        described in clauses (ii), 
                                        (iii), and (iv) of paragraph 
                                        (2)(A), October 1, 2018; and
                                            ``(bb) for PAC providers 
                                        described in clause (i) of such 
                                        paragraph, January 1, 2019.
                          ``(ii) Resource use and other measures.--In 
                      the case of resource use and other measures under 
                      subsection (d)(1)--
                                    ``(I) for PAC providers described in 
                                clauses (ii), (iii), and (iv) of 
                                paragraph (2)(A), October 1, 2016; and
                                    ``(II) for PAC providers described 
                                in clause (i) of such paragraph, January 
                                1, 2017.
                    ``(F) Medicare beneficiary.--The term `Medicare 
                beneficiary' means an individual entitled to benefits 
                under

[[Page 128 STAT. 1955]]

                part A or, as appropriate, enrolled for benefits under 
                part B.

    ``(b) Standardized Patient Assessment Data.--
            ``(1) Requirement for reporting assessment data.--
                    ``(A) <<NOTE: Deadlines.>>  In general.--Beginning 
                not later than October 1, 2018, for PAC providers 
                described in clauses (ii), (iii), and (iv) of subsection 
                (a)(2)(A) and January 1, 2019, for PAC providers 
                described in clause (i) of such subsection, the 
                Secretary shall require PAC providers to submit to the 
                Secretary, under the applicable reporting provisions and 
                through the use of PAC assessment instruments, the 
                standardized patient assessment data described in 
                subparagraph (B). The Secretary shall require such data 
                be submitted with respect to admission and discharge of 
                an individual (and may be submitted more frequently as 
                the Secretary deems appropriate).
                    ``(B) Standardized patient assessment data 
                described.--For purposes of subparagraph (A), the 
                standardized patient assessment data described in this 
                subparagraph is data required for at least the quality 
                measures described in subsection (c)(1) and that is with 
                respect to the following categories:
                          ``(i) Functional status, such as mobility and 
                      self care at admission to a PAC provider and 
                      before discharge from a PAC provider.
                          ``(ii) Cognitive function, such as ability to 
                      express ideas and to understand, and mental 
                      status, such as depression and dementia.
                          ``(iii) Special services, treatments, and 
                      interventions, such as need for ventilator use, 
                      dialysis, chemotherapy, central line placement, 
                      and total parenteral nutrition.
                          ``(iv) Medical conditions and co-morbidities, 
                      such as diabetes, congestive heart failure, and 
                      pressure ulcers.
                          ``(v) Impairments, such as incontinence and an 
                      impaired ability to hear, see, or swallow.
                          ``(vi) Other categories deemed necessary and 
                      appropriate by the Secretary.
            ``(2) Alignment of claims data with standardized patient 
        assessment data. <<NOTE: Deadlines.>> --To the extent 
        practicable, not later than October 1, 2018, for PAC providers 
        described in clauses (ii), (iii), and (iv) of subsection 
        (a)(2)(A), and January 1, 2019, for PAC providers described in 
        clause (i) of such subsection, the Secretary shall match claims 
        data with assessment data pursuant to this section for purposes 
        of assessing prior service use and concurrent service use, such 
        as antecedent hospital or PAC provider use, and may use such 
        matched data for such other uses as the Secretary determines 
        appropriate.
            ``(3) Replacement of certain existing data.--In the case of 
        patient assessment data being used with respect to a PAC 
        assessment instrument that duplicates or overlaps with 
        standardized patient assessment data within a category described 
        in paragraph (1), the Secretary shall, as soon as practicable, 
        revise or replace such existing data with the standardized data.

[[Page 128 STAT. 1956]]

            ``(4) Clarification.--Standardized patient assessment data 
        submitted pursuant to this subsection shall not be used to 
        require individuals to be provided post-acute care by a specific 
        type of PAC provider in order for such care to be eligible for 
        payment under this title.

    ``(c) Quality Measures.--
            ``(1) <<NOTE: Deadline. Applicability.>>  Requirement for 
        reporting quality measures.--Not later than the specified 
        application date, as applicable to measures and PAC providers, 
        the Secretary shall specify quality measures on which PAC 
        providers are required under the applicable reporting provisions 
        to submit standardized patient assessment data described in 
        subsection (b)(1) and other necessary data specified by the 
        Secretary. Such measures shall be with respect to at least the 
        following domains:
                    ``(A) Functional status, cognitive function, and 
                changes in function and cognitive function.
                    ``(B) Skin integrity and changes in skin integrity.
                    ``(C) Medication reconciliation.
                    ``(D) Incidence of major falls.
                    ``(E) Accurately communicating the existence of and 
                providing for the transfer of health information and 
                care preferences of an individual to the individual, 
                family caregiver of the individual, and providers of 
                services furnishing items and services to the 
                individual, when the individual transitions--
                          ``(i) from a hospital or critical access 
                      hospital to another applicable setting, including 
                      a PAC provider or the home of the individual; or
                          ``(ii) from a PAC provider to another 
                      applicable setting, including a different PAC 
                      provider, a hospital, a critical access hospital, 
                      or the home of the individual.
            ``(2) Reporting through pac assessment instruments.--
                    ``(A) In general. <<NOTE: Modification.>> --To the 
                extent possible, the Secretary shall require such 
                reporting by a PAC provider of quality measures under 
                paragraph (1) through the use of a PAC assessment 
                instrument and shall modify such PAC assessment 
                instrument as necessary to enable the use of such 
                instrument with respect to such quality measures.
                    ``(B) <<NOTE: Federal Register, publication.>>  
                Limitation.--The Secretary may not make significant 
                modifications to a PAC assessment instrument more than 
                once per calendar year or fiscal year, as applicable, 
                unless the Secretary publishes in the Federal Register a 
                justification for such significant modification.
            ``(3) Adjustments.--
                    ``(A) In general.--The Secretary shall consider 
                applying adjustments to the quality measures under this 
                subsection taking into consideration the studies under 
                section 2(d) of the IMPACT Act of 2014.
                    ``(B) Risk adjustment.--Such quality measures shall 
                be risk adjusted, as determined appropriate by the 
                Secretary.

    ``(d) Resource Use and Other Measures.--
            ``(1) Requirement for resource use and other 
        measures. <<NOTE: Deadline. Applicability.>> --Not later than 
        the specified application date, as applicable to measures and 
        PAC providers, the Secretary shall specify resource use and 
        other measures on which PAC providers are required under the 
        applicable reporting provisions

[[Page 128 STAT. 1957]]

        to submit any necessary data specified by the Secretary, which 
        may include standardized assessment data in addition to claims 
        data. Such measures shall be with respect to at least the 
        following domains:
                    ``(A) Resource use measures, including total 
                estimated Medicare spending per beneficiary.
                    ``(B) Discharge to community.
                    ``(C) Measures to reflect all-condition risk-
                adjusted potentially preventable hospital readmission 
                rates.
            ``(2) Aligning methodology adjustments for resource use 
        measures.--
                    ``(A) Period of time.--With respect to the period of 
                time used for calculating measures under paragraph 
                (1)(A), the Secretary shall, to the extent the Secretary 
                determines appropriate, align resource use with the 
                methodology used for purposes of section 
                1886(o)(2)(B)(ii).
                    ``(B) Geographic and other adjustments.--The 
                Secretary shall standardize measures with respect to the 
                domain described in paragraph (1)(A) for geographic 
                payment rate differences and payment differentials (and 
                other adjustments, as applicable) consistent with the 
                methodology published in the Federal Register on August 
                18, 2011 (76 Fed. Reg. 51624 through 51626), or any 
                subsequent modifications made to the methodology.
                    ``(C) Medicare spending per beneficiary.--The 
                Secretary shall adjust, as appropriate, measures with 
                respect to the domain described in paragraph (1)(A) for 
                the factors applied under section 1886(o)(2)(B)(ii).
            ``(3) Adjustments.--
                    ``(A) In general.--The Secretary shall consider 
                applying adjustments to the resource use and other 
                measures specified under this subsection with respect to 
                the domain described in paragraph (1)(A), taking into 
                consideration the studies under section 2(d) of the 
                IMPACT Act of 2014.
                    ``(B) Risk adjustment.--Such resource use and other 
                measures shall be risk adjusted, as determined 
                appropriate by the Secretary.

    ``(e) Measurement Implementation Phases; Selection of Quality 
Measures and Resource Use and Other Measures.--
            ``(1) Measurement implementation phases.--In the case of 
        quality measures specified under subsection (c)(1) and resource 
        use and other measures specified under subsection (d)(1), the 
        provisions of this section shall be implemented in accordance 
        with the following phases:
                    ``(A) Initial implementation phase.--The initial 
                implementation phase, with respect to such a measure, 
                shall, in accordance with subsections (c) and (d), as 
                applicable, consist of--
                          ``(i) <<NOTE: Public information.>>  measure 
                      specification, including informing the public of 
                      the measure's numerator, denominator, exclusions, 
                      and any other aspects the Secretary determines 
                      necessary;
                          ``(ii) <<NOTE: Reports.>>  data collection, 
                      including, in the case of quality measures, 
                      requiring PAC providers to report data elements 
                      needed to calculate such a measure; and

[[Page 128 STAT. 1958]]

                          ``(iii) data analysis, including, in the case 
                      of resource use and other measures, the use of 
                      claims data to calculate such a measure.
                    ``(B) <<NOTE: Reports.>>  Second implementation 
                phase.--The second implementation phase, with respect to 
                such a measure, shall consist of the provision of 
                feedback reports to PAC providers, in accordance with 
                subsection (f).
                    ``(C) <<NOTE: Public information.>>  Third 
                implementation phase.--The third implementation phase, 
                with respect to such a measure, shall consist of public 
                reporting of PAC providers' performance on such measure 
                in accordance with subsection (g).
            ``(2) Consensus-based entity.--
                    ``(A) <<NOTE: Contracts.>>  In general.--Subject to 
                subparagraph (B), each measure specified by the 
                Secretary under this section shall be endorsed by the 
                entity with a contract under section 1890(a).
                    ``(B) Exception.--In the case of a specified area or 
                medical topic determined appropriate by the Secretary 
                for which a feasible and practical measure has not been 
                endorsed by the entity with a contract under section 
                1890(a), the Secretary may specify a measure that is not 
                so endorsed as long as due consideration is given to 
                measures that have been endorsed or adopted by a 
                consensus organization identified by the Secretary.
            ``(3) Treatment of application of pre-rulemaking process 
        (measure applications partnership process).--
                    ``(A) In general.--Subject to subparagraph (B), the 
                provisions of section 1890A shall apply in the case of a 
                quality measure specified under subsection (c) or a 
                resource use or other measure specified under subsection 
                (d).
                    ``(B) Exceptions.--
                          ``(i) Expedited procedures.--For purposes of 
                      satisfying subparagraph (A), the Secretary may use 
                      expedited procedures, such as ad-hoc reviews, as 
                      necessary, in the case of a quality measure 
                      specified under subsection (c) or a resource use 
                      or other measure specified in subsection (d) 
                      required with respect to data submissions under 
                      the applicable reporting provisions during the 1-
                      year period before the specified application date 
                      applicable to such a measure and provider 
                      involved.
                          ``(ii) Option to waive provisions.--The 
                      Secretary may waive the application of the 
                      provisions of section 1890A in the case of a 
                      quality measure or resource use or other measure 
                      described in clause (i), if the application of 
                      such provisions (including through the use of an 
                      expedited procedure described in such clause) 
                      would result in the inability of the Secretary to 
                      satisfy any deadline specified in this section 
                      with respect to such measure.

    ``(f) Feedback Reports to PAC Providers.--
            ``(1) <<NOTE: Effective date.>>  In general.--Beginning one 
        year after the specified application date, as applicable to PAC 
        providers and quality measures and resource use and other 
        measures under this section, the Secretary shall provide 
        confidential feedback reports to such PAC providers on the 
        performance of such

[[Page 128 STAT. 1959]]

        providers with respect to such measures required under the 
        applicable provisions.
            ``(2) Frequency.--To the extent feasible, the Secretary 
        shall provide feedback reports described in paragraph (1) not 
        less frequently than on a quarterly basis. Notwithstanding the 
        previous sentence, with respect to measures described in such 
        paragraph that are reported on an annual basis, the Secretary 
        may provide such feedback reports on an annual basis.

    ``(g) Public Reporting of PAC Provider Performance.--
            ``(1) <<NOTE: Procedures.>>  In general.--Subject to the 
        succeeding paragraphs of this subsection, the Secretary shall 
        provide for public reporting of PAC provider performance on 
        quality measures under subsection (c)(1) and the resource use 
        and other measures under subsection (d)(1), including by 
        establishing procedures for making available to the public 
        information regarding the performance of individual PAC 
        providers with respect to such measures.
            ``(2) Opportunity to review.--The procedures under paragraph 
        (1) shall ensure, including through a process consistent with 
        the process applied under section 1886(b)(3)(B)(viii)(VII) for 
        similar purposes, that a PAC provider has the opportunity to 
        review and submit corrections to the data and information that 
        is to be made public with respect to the provider prior to such 
        data being made public.
            ``(3) Timing.--Such procedures shall provide that the data 
        and information described in paragraph (1), with respect to a 
        measure and PAC provider, is made publicly available beginning 
        not later than two years after the specified application date 
        applicable to such a measure and provider.
            ``(4) Coordination with existing programs.--Such procedures 
        shall provide that data and information described in paragraph 
        (1) with respect to quality measures and resource use and other 
        measures under subsections (c)(1) and (d)(1) shall be made 
        publicly available consistent with the following provisions:
                    ``(A) In the case of home health agencies, section 
                1895(b)(3)(B)(v)(III).
                    ``(B) In the case of skilled nursing facilities, 
                sections 1819(i) and 1919(i).
                    ``(C) In the case of inpatient rehabilitation 
                facilities, section 1886(j)(7)(E).
                    ``(D) In the case of long-term care hospitals, 
                section 1886(m)(5)(E).

    ``(h) <<NOTE: Federal Register, publication.>>  Removing, 
Suspending, or Adding Measures.--
            ``(1) In general.--The Secretary may remove, suspend, or add 
        a quality measure or resource use or other measure described in 
        subsection (c)(1) or (d)(1), so long as, subject to paragraph 
        (2), the Secretary publishes in the Federal Register (with a 
        notice and comment period) a justification for such removal, 
        suspension, or addition.
            ``(2) Exception.--In the case of such a quality measure or 
        resource use or other measure for which there is a reason to 
        believe that the continued collection of such measure raises 
        potential safety concerns or would cause other unintended 
        consequences, the Secretary may promptly suspend or remove such 
        measure and satisfy paragraph (1) by publishing in the

[[Page 128 STAT. 1960]]

        Federal Register a justification for such suspension or removal 
        in the next rulemaking cycle following such suspension or 
        removal.

    ``(i) Use of Standardized Assessment Data, Quality Measures, and 
Resource Use and Other Measures To Inform Discharge Planning and 
Incorporate Patient Preference.--
            ``(1) <<NOTE: Deadlines. Regulations.>>  In general.--Not 
        later than January 1, 2016, and periodically thereafter (but not 
        less frequently than once every 5 years), the Secretary shall 
        promulgate regulations to modify conditions of participation and 
        subsequent interpretive guidance applicable to PAC providers, 
        hospitals, and critical access hospitals. Such regulations and 
        interpretive guidance shall require such providers to take into 
        account quality, resource use, and other measures under the 
        applicable reporting provisions (which, as available, shall 
        include measures specified under subsections (c) and (d), and 
        other relevant measures) in the discharge planning process. 
        Specifically, such regulations and interpretive guidance shall 
        address the settings to which a patient may be discharged in 
        order to assist subsection (d) hospitals, critical access 
        hospitals, hospitals described in section 1886(d)(1)(B)(v), PAC 
        providers, patients, and families of such patients with 
        discharge planning from inpatient settings, including such 
        hospitals, and from PAC provider 
        settings. <<NOTE: Procedures.>>  In addition, such regulations 
        and interpretive guidance shall include procedures to address--
                    ``(A) treatment preferences of patients; and
                    ``(B) goals of care of patients.
            ``(2) Discharge planning.--All requirements applied pursuant 
        to paragraph (1) shall be used to help inform and mandate the 
        discharge planning process.
            ``(3) Clarification.--Such regulations shall not require an 
        individual to be provided post-acute care by a specific type of 
        PAC provider in order for such care to be eligible for payment 
        under this title.

    ``(j) Stakeholder Input.--Before the initial rulemaking process to 
implement this section, the Secretary shall allow for stakeholder input, 
such as through town halls, open door forums, and mail-box submissions.
    ``(k) Funding.--For purposes of carrying out this section, the 
Secretary shall provide for the transfer to the Centers for Medicare & 
Medicaid Services Program Management Account, from the Federal Hospital 
Insurance Trust Fund under section 1817 and the Federal Supplementary 
Medical Insurance Trust Fund under section 1841, in such proportion as 
the Secretary determines appropriate, of $130,000,000. Fifty percent of 
such amount shall be available on the date of the enactment of this 
section and fifty percent of such amount shall be equally proportioned 
for each of fiscal years 2015 through 2019. Such sums shall remain 
available until expended.
    ``(l) Limitation.--There shall be no administrative or judicial 
review under sections 1869 and 1878 or otherwise of the specification of 
standardized patient assessment data required, the determination of 
measures, and the systems to report such standardized data under this 
section.
    ``(m) Non-Application of Paperwork Reduction Act.--Chapter 35 of 
title 44, United States Code (commonly referred to as the `Paperwork 
Reduction Act of 1995') shall not apply to

[[Page 128 STAT. 1961]]

this section and the sections referenced in subsection (a)(2)(B) that 
require modification in order to achieve the standardization of patient 
assessment data.''.
    (b) Studies of Alternative PAC Payment Models.--
            (1) <<NOTE: Deadline. Reports.>>  MedPAC.--Using data from 
        the Post-Acute Payment Reform Demonstration authorized under 
        section 5008 of the Deficit Reduction Act of 2005 (Public Law 
        109-171) or other data, as available, not later than June 30, 
        2016, the Medicare Payment Advisory Commission shall submit to 
        Congress a report that evaluates and recommends features of PAC 
        payment systems (as defined in section 1899B(a)(2)(D) of the 
        Social Security Act, as added by subsection (a)) that establish, 
        or a unified post-acute care payment system under title XVIII of 
        the Social Security Act that establishes, payment rates 
        according to characteristics of individuals (such as cognitive 
        ability, functional status, and impairments) instead of 
        according to the post-acute care setting where the Medicare 
        beneficiary involved is treated. To the extent feasible, such 
        report shall consider the impacts of moving from PAC payment 
        systems (as defined in subsection (a)(2)(D) of such section 
        1899B) in existence as of the date of the enactment of this Act 
        to new post-acute care payment systems under title XVIII of the 
        Social Security Act.
            (2) Recommendations for pac prospective payment.--
                    (A) <<NOTE: Consultation.>>  Report by secretary.--
                Not later than 2 years after the date by which the 
                Secretary of Health and Human Services has collected 2 
                years of data on quality measures under subsection (c) 
                of section 1899B, as added by subsection (a), the 
                Secretary shall, in consultation with the Medicare 
                Payment Advisory Commission and appropriate 
                stakeholders, submit to Congress a report, including--
                          (i) recommendations and a technical prototype, 
                      on a post-acute care prospective payment system 
                      under title XVIII of the Social Security Act that 
                      would--
                                    (I) in lieu of the rates that would 
                                otherwise apply under PAC payment 
                                systems (as defined in subsection 
                                (a)(2)(D) of such section 1899B), base 
                                payments under such title, with respect 
                                to items and services furnished to an 
                                individual by a PAC provider (as defined 
                                in subsection (a)(2)(A) of such 
                                section), according to individual 
                                characteristics (such as cognitive 
                                ability, functional status, and 
                                impairments) of such individual instead 
                                of the post-acute care setting in which 
                                the individual is furnished such items 
                                and services;
                                    (II) account for the clinical 
                                appropriateness of items and services so 
                                furnished and Medicare beneficiary 
                                outcomes;
                                    (III) be designed to incorporate (or 
                                otherwise account for) standardized 
                                patient assessment data under section 
                                1899B; and
                                    (IV) further clinical integration, 
                                such as by motivating greater 
                                coordination around a single condition 
                                or procedure to integrate hospital 
                                systems with PAC providers (as so 
                                defined).

[[Page 128 STAT. 1962]]

                          (ii) recommendations on which Medicare fee-
                      for-service regulations for post-acute care 
                      payment systems under title XVIII of the Social 
                      Security Act should be altered (such as the 
                      skilled nursing facility 3-day stay and inpatient 
                      rehabilitation facility 60 percent rule);
                          (iii) an analysis of the impact of the 
                      recommended payment system described in clause (i) 
                      on Medicare beneficiary cost-sharing, access to 
                      care, and choice of setting;
                          (iv) a projection of any potential reduction 
                      in expenditures under title XVIII of the Social 
                      Security Act that may be attributable to the 
                      application of the recommended payment system 
                      described in clause (i); and
                          (v) a review of the value of subsection (d) 
                      hospitals (as defined in section 1886(d)(1)(B) of 
                      the Social Security Act (42 U.S.C. 
                      1395ww(d)(1)(B)), hospitals described in section 
                      1886(d)(1)(B)(v) of such Act (42 U.S.C. 
                      1395ww(d)(1)(B)(v)), and critical access hospitals 
                      described in section 1820(c)(2)(B) of such Act (42 
                      U.S.C. 1395i-4(c)(2)(B)) collecting and reporting 
                      to the Secretary standardized patient assessment 
                      data with respect to inpatient hospital services 
                      furnished by such a hospital or critical access 
                      hospital to individuals who are entitled to 
                      benefits under part A of title XVIII of such Act 
                      or, as appropriate, enrolled for benefits under 
                      part B of such title.
                    (B) <<NOTE: Recommenda- tions.>>  Report by 
                medpac.--Not later than the first June 30th following 
                the date on which the report is required under 
                subparagraph (A), the Medicare Payment Advisory 
                Commission shall submit to Congress a report, including 
                recommendations and a technical prototype, on a post-
                acute care prospective payment system under title XVIII 
                of the Social Security Act that would satisfy the 
                criteria described in subparagraph (A).
            (3) Medicare beneficiary defined.--For purposes of this 
        subsection, the term ``Medicare beneficiary'' has the meaning 
        given such term in section 1899B(a)(2) of the Social Security 
        Act, as added by subsection (a).

    (c) Payment Consequences Under the Applicable Reporting 
Provisions.--
            (1) Home health agencies.--Section 1895(b)(3)(B)(v) of the 
        Social Security Act (42 U.S.C. 1395fff(b)(3)(B)(v)) is amended--
                    (A) in subclause (I), by striking ``subclause (II)'' 
                and inserting ``subclauses (II) and (IV)'';
                    (B) in subclause (II), by striking ``For 2007'' and 
                inserting ``Subject to subclause (V), for 2007'';
                    (C) in subclause (III), by inserting ``and subclause 
                (IV)(aa)'' after ``subclause (II)''; and
                    (D) by adding at the end the following new 
                subclauses:
                                    ``(IV) Submission of additional 
                                data.--
                                            ``(aa) In general.--For the 
                                        year beginning on the specified 
                                        application date (as defined in 
                                        subsection (a)(2)(E) of section 
                                        1899B), as

[[Page 128 STAT. 1963]]

                                        applicable with respect to home 
                                        health agencies and quality 
                                        measures under subsection (c)(1) 
                                        of such section and measures 
                                        under subsection (d)(1) of such 
                                        section, and each subsequent 
                                        year, in addition to the data 
                                        described in subclause (II), 
                                        each home health agency shall 
                                        submit to the Secretary data on 
                                        such quality measures and any 
                                        necessary data specified by the 
                                        Secretary under such subsection 
                                        (d)(1).
                                            ``(bb) Standardized patient 
                                        assessment data.--For 2019 and 
                                        each subsequent year, in 
                                        addition to such data described 
                                        in item (aa), each home health 
                                        agency shall submit to the 
                                        Secretary standardized patient 
                                        assessment data required under 
                                        subsection (b)(1) of section 
                                        1899B.
                                            ``(cc) Submission.--Data 
                                        shall be submitted under items 
                                        (aa) and (bb) in the form and 
                                        manner, and at the time, 
                                        specified by the Secretary for 
                                        purposes of this clause.
                                    ``(V) Non-duplication.--To the 
                                extent data submitted under subclause 
                                (IV) duplicates other data required to 
                                be submitted under subclause (II), the 
                                submission of such data under subclause 
                                (IV) shall be in lieu of the submission 
                                of such data under subclause (II). The 
                                previous sentence shall not apply 
                                insofar as the Secretary determines it 
                                is necessary to avoid a delay in the 
                                implementation of section 1899B, taking 
                                into account the different specified 
                                application dates under subsection 
                                (a)(2)(E) of such section.''.
            (2) Inpatient rehabilitation facilities.--Section 1886(j)(7) 
        of the Social Security Act (42 U.S.C. 1395ww(j)(7)) is amended--
                    (A) in subparagraph (A)(i), by striking 
                ``subparagraph (C)'' and inserting ``subparagraphs (C) 
                and (F)'';
                    (B) in subparagraph (C), by striking ``For fiscal 
                year 2014 and each subsequent rate year'' and inserting 
                ``Subject to subparagraph (G), for fiscal year 2014 and 
                each subsequent fiscal year'';
                    (C) in subparagraph (E), by inserting ``and 
                subparagraph (F)(i)'' after ``subparagraph (C)''; and
                    (D) by adding at the end the following new 
                subparagraphs:
                    ``(F) Submission of additional data.--
                          ``(i) <<NOTE: Effective date.>>  In general.--
                      For the fiscal year beginning on the specified 
                      application date (as defined in subsection 
                      (a)(2)(E) of section 1899B), as applicable with 
                      respect to inpatient rehabilitation facilities and 
                      quality measures under subsection (c)(1) of such 
                      section and measures under subsection (d)(1) of 
                      such section, and each subsequent fiscal year, in 
                      addition to such data on the quality measures 
                      described in subparagraph (C), each rehabilitation 
                      facility shall submit to the Secretary data on the 
                      quality measures under such

[[Page 128 STAT. 1964]]

                      subsection (c)(1) and any necessary data specified 
                      by the Secretary under such subsection (d)(1).
                          ``(ii) Standardized patient assessment data.--
                      For fiscal year 2019 and each subsequent fiscal 
                      year, in addition to such data described in clause 
                      (i), each rehabilitation facility shall submit to 
                      the Secretary standardized patient assessment data 
                      required under subsection (b)(1) of section 1899B.
                          ``(iii) Submission.--Such data shall be 
                      submitted in the form and manner, and at the time, 
                      specified by the Secretary for purposes of this 
                      subparagraph.
                    ``(G) Non-duplication.--To the extent data submitted 
                under subparagraph (F) duplicates other data required to 
                be submitted under subparagraph (C), the submission of 
                such data under subparagraph (F) shall be in lieu of the 
                submission of such data under subparagraph (C). The 
                previous sentence shall not apply insofar as the 
                Secretary determines it is necessary to avoid a delay in 
                the implementation of section 1899B, taking into account 
                the different specified application dates under 
                subsection (a)(2)(E) of such section.''.
            (3) Long-term care hospitals.--Section 1886(m)(5) of the 
        Social Security Act (42 U.S.C. 1395ww(m)(5)) is amended--
                    (A) in subparagraph (A)(i), by striking 
                ``subparagraph (C)'' and inserting ``subparagraphs (C) 
                and (F)'';
                    (B) in subparagraph (C), by striking ``For rate 
                year'' and inserting ``Subject to subparagraph (G), for 
                rate year'';
                    (C) in subparagraph (E), by inserting ``and 
                subparagraph (F)(i)'' after ``subparagraph (C)''; and
                    (D) by adding at the end the following new 
                subparagraphs:
                    ``(F) Submission of additional data.--
                          ``(i) <<NOTE: Effective date.>>  In general.--
                      For the rate year beginning on the specified 
                      application date (as defined in subsection 
                      (a)(2)(E) of section 1899B), as applicable with 
                      respect to long-term care hospitals and quality 
                      measures under subsection (c)(1) of such section 
                      and measures under subsection (d)(1) of such 
                      section, and each subsequent rate year, in 
                      addition to the data on the quality measures 
                      described in subparagraph (C), each long-term care 
                      hospital (other than a hospital classified under 
                      subsection (d)(1)(B)(iv)(II)) shall submit to the 
                      Secretary data on the quality measures under such 
                      subsection (c)(1) and any necessary data specified 
                      by the Secretary under such subsection (d)(1).
                          ``(ii) Standardized patient assessment data.--
                      For rate year 2019 and each subsequent rate year, 
                      in addition to such data described in clause (i), 
                      each long-term care hospital (other than a 
                      hospital classified under subsection 
                      (d)(1)(B)(iv)(II)) shall submit to the Secretary 
                      standardized patient assessment data required 
                      under subsection (b)(1) of section 1899B.
                          ``(iii) Submission.--Such data shall be 
                      submitted in the form and manner, and at the time, 
                      specified by the Secretary for purposes of this 
                      subparagraph.
                    ``(G) Non-duplication.--To the extent data submitted 
                under subparagraph (F) duplicates other data required to

[[Page 128 STAT. 1965]]

                be submitted under subparagraph (C), the submission of 
                such data under subparagraph (F) shall be in lieu of the 
                submission of such data under subparagraph (C). The 
                previous sentence shall not apply insofar as the 
                Secretary determines it is necessary to avoid a delay in 
                the implementation of section 1899B, taking into account 
                the different specified application dates under 
                subsection (a)(2)(E) of such section.''.
            (4) Skilled nursing facilities.--
                    (A) In general.--Paragraph (6) of section 1888(e) of 
                the Social Security Act (42 U.S.C. 1395yy(e)) is amended 
                to read as follows:
            ``(6) Reporting of assessment and quality data.--
                    ``(A) Reduction in update for failure to report.--
                          ``(i) <<NOTE: Effective date.>>  In general.--
                      For fiscal years beginning with fiscal year 2018, 
                      in the case of a skilled nursing facility that 
                      does not submit data, as applicable, in accordance 
                      with subclauses (II) and (III) of subparagraph 
                      (B)(i) with respect to such a fiscal year, after 
                      determining the percentage described in paragraph 
                      (5)(B)(i), and after application of paragraph 
                      (5)(B)(ii), the Secretary shall reduce such 
                      percentage for payment rates during such fiscal 
                      year by 2 percentage points.
                          ``(ii) Special rule.--The application of this 
                      subparagraph may result in the percentage 
                      described in paragraph (5)(B)(i), after 
                      application of paragraph (5)(B)(ii), being less 
                      than 0.0 for a fiscal year, and may result in 
                      payment rates under this subsection for a fiscal 
                      year being less than such payment rates for the 
                      preceding fiscal year.
                          ``(iii) Noncumulative application.--Any 
                      reduction under clause (i) shall apply only with 
                      respect to the fiscal year involved and the 
                      Secretary shall not take into account such 
                      reduction in computing the payment amount under 
                      this subsection for a subsequent fiscal year.
                    ``(B) Assessment and measure data.--
                          ``(i) In general.--A skilled nursing facility, 
                      or a facility (other than a critical access 
                      hospital) described in paragraph (7)(B), shall 
                      submit to the Secretary, in a manner and within 
                      the timeframes prescribed by the Secretary--
                                    ``(I) subject to clause (iii), the 
                                resident assessment data necessary to 
                                develop and implement the rates under 
                                this subsection;
                                    ``(II) for fiscal years beginning on 
                                or after the specified application date 
                                (as defined in subsection (a)(2)(E) of 
                                section 1899B), as applicable with 
                                respect to skilled nursing facilities 
                                and quality measures under subsection 
                                (c)(1) of such section and measures 
                                under subsection (d)(1) of such section, 
                                data on such quality measures under such 
                                subsection (c)(1) and any necessary data 
                                specified by the Secretary under such 
                                subsection (d)(1); and
                                    ``(III) <<NOTE: Effective date.>>  
                                for fiscal years beginning on or after 
                                October 1, 2018, standardized patient 
                                assessment

[[Page 128 STAT. 1966]]

                                data required under subsection (b)(1) of 
                                section 1899B.
                          ``(ii) Use of standard instrument.--For 
                      purposes of meeting the requirement under clause 
                      (i), a skilled nursing facility, or a facility 
                      (other than a critical access hospital) described 
                      in paragraph (7)(B), may submit the resident 
                      assessment data required under section 1819(b)(3), 
                      using the standard instrument designated by the 
                      State under section 1819(e)(5).
                          ``(iii) Non-duplication.--To the extent data 
                      submitted under subclause (II) or (III) of clause 
                      (i) duplicates other data required to be submitted 
                      under clause (i)(I), the submission of such data 
                      under such a subclause shall be in lieu of the 
                      submission of such data under clause (i)(I). The 
                      previous sentence shall not apply insofar as the 
                      Secretary determines it is necessary to avoid a 
                      delay in the implementation of section 1899B, 
                      taking into account the different specified 
                      application dates under subsection (a)(2)(E) of 
                      such section.''.
                    (B) Funding for nursing home compare website.--
                Section 1819(i) of the Social Security Act (42 U.S.C. 
                1395i-3(i)) is amended by adding at the end the 
                following new paragraph:
            ``(3) Funding.--The Secretary shall transfer to the Centers 
        for Medicare & Medicaid Services Program Management Account, 
        from the Federal Hospital Insurance Trust Fund under section 
        1817 a one-time allocation of $11,000,000. <<NOTE: Availability 
        date.>>  The amount shall be available on the date of the 
        enactment of this paragraph. Such sums shall remain available 
        until expended. Such sums shall be used to implement section 
        1128I(g).''.

    (d) <<NOTE: 42 USC 1395lll note.>>  Improving Payment Accuracy Under 
the PAC Payment Systems and Other Medicare Payment Systems.--
            (1) Studies and reports of effect of certain information on 
        quality and resource use.--
                    (A) Study using existing medicare data.--
                          (i) Study.--The Secretary of Health and Human 
                      Services (in this subsection referred to as the 
                      ``Secretary'') shall conduct a study that examines 
                      the effect of individuals' socioeconomic status on 
                      quality measures and resource use and other 
                      measures for individuals under the Medicare 
                      program under title XVIII of the Social Security 
                      Act (42 U.S.C. 1395 et seq.) (such as to recognize 
                      that less healthy individuals may require more 
                      intensive interventions). The study shall use 
                      information collected on such individuals in 
                      carrying out such program, such as urban and rural 
                      location, eligibility for Medicaid under title XIX 
                      of such Act (42 U.S.C. 1396 et seq.) (recognizing 
                      and accounting for varying Medicaid eligibility 
                      across States), and eligibility for benefits under 
                      the supplemental security income (SSI) program. 
                      The Secretary shall carry out this paragraph 
                      acting through the Assistant Secretary for 
                      Planning and Evaluation.
                          (ii) Report.--Not later than 2 years after the 
                      date of the enactment of this Act, the Secretary 
                      shall submit

[[Page 128 STAT. 1967]]

                      to Congress a report on the study conducted under 
                      clause (i).
                    (B) Study using other data.--
                          (i) Study.--The Secretary shall conduct a 
                      study that examines the impact of risk factors, 
                      such as those described in section 1848(p)(3) of 
                      the Social Security Act (42 U.S.C. 1395w-4(p)(3)), 
                      race, health literacy, limited English proficiency 
                      (LEP), and Medicare beneficiary activation, on 
                      quality measures and resource use and other 
                      measures under the Medicare program (such as to 
                      recognize that less healthy individuals may 
                      require more intensive interventions). In 
                      conducting such study the Secretary may use 
                      existing Federal data and collect such additional 
                      data as may be necessary to complete the study.
                          (ii) Report.--Not later than 5 years after the 
                      date of the enactment of this Act, the Secretary 
                      shall submit to Congress a report on the study 
                      conducted under clause (i).
                    (C) Examination of data in conducting studies.--In 
                conducting the studies under subparagraphs (A) and (B), 
                the Secretary shall examine what non-Medicare data sets, 
                such as data from the American Community Survey (ACS), 
                can be useful in conducting the types of studies under 
                such paragraphs and how such data sets that are 
                identified as useful can be coordinated with Medicare 
                administrative data in order to improve the overall data 
                set available to do such studies and for the 
                administration of the Medicare program.
                    (D) Recommendations to account for information in 
                payment adjustment mechanisms.--If the studies conducted 
                under subparagraphs (A) and (B) find a relationship 
                between the factors examined in the studies and quality 
                measures and resource use and other measures, then the 
                Secretary shall also provide recommendations for how the 
                Centers for Medicare & Medicaid Services should--
                          (i) obtain access to the necessary data (if 
                      such data is not already being collected) on such 
                      factors, including recommendations on how to 
                      address barriers to the Centers in accessing such 
                      data; and
                          (ii) account for such factors--
                                    (I) in quality measures, resource 
                                use measures, and other measures under 
                                title XVIII of the Social Security Act 
                                (including such measures specified under 
                                subsections (c) and (d) of section 1899B 
                                of such Act, as added by subsection 
                                (a)); and
                                    (II) in determining payment 
                                adjustments based on such measures in 
                                other applicable provisions of such 
                                title.
                    (E) Funding.--There are hereby appropriated to the 
                Secretary from the Federal Hospital Insurance Trust Fund 
                under section 1817 of the Social Security Act (42 U.S.C. 
                1395i) and the Federal Supplementary Medical Insurance 
                Trust Fund under section 1841 of such Act (42 U.S.C. 
                1395t) (in proportions determined appropriate by the 
                Secretary) to carry out this paragraph $6,000,000, to 
                remain available until expended.

[[Page 128 STAT. 1968]]

            (2) CMS activities.--
                    (A) In general.--Taking into account the relevant 
                studies conducted and recommendations made in reports 
                under paragraph (1) and, as appropriate, other 
                information, including information collected before 
                completion of such studies and recommendations, the 
                Secretary, on an ongoing basis, shall, as the Secretary 
                determines appropriate and based on an individual's 
                health status and other factors--
                          (i) assess appropriate adjustments to quality 
                      measures, resource use measures, and other 
                      measures under title XVIII of the Social Security 
                      Act (42 U.S.C. 1395 et seq.) (including measures 
                      specified in subsections (c) and (d) of section 
                      1899B of such Act, as added by subsection (a)); 
                      and
                          (ii) assess and implement appropriate 
                      adjustments to payments under such title based on 
                      measures described in clause (i).
                    (B) Accessing data.--The Secretary shall collect or 
                otherwise obtain access to the data necessary to carry 
                out this paragraph through existing and new data 
                sources.
                    (C) Periodic analyses.--The Secretary shall carry 
                out periodic analyses, at least every 3 years, based on 
                the factors referred to in subparagraph (A) so as to 
                monitor changes in possible relationships.
                    (D) Funding.--There are hereby appropriated to the 
                Secretary from the Federal Hospital Insurance Trust Fund 
                under section 1817 of the Social Security Act (42 U.S.C. 
                1395i) and the Federal Supplementary Medical Insurance 
                Trust Fund under section 1841 of such Act (42 U.S.C. 
                1395t) (in proportions determined appropriate by the 
                Secretary) to carry out this paragraph $10,000,000, to 
                remain available until expended.
            (3) Strategic plan for accessing race and ethnicity 
        data. <<NOTE: Deadline.>> --Not later than 18 months after the 
        date of the enactment of this Act, the Secretary shall develop 
        and report to Congress on a strategic plan for collecting or 
        otherwise accessing data on race and ethnicity for purposes of 
        specifying quality measures and resource use and other measures 
        under subsections (c) and (d) of section 1899B of the Social 
        Security Act, as added by subsection (a), and, as the Secretary 
        determines appropriate, other similar provisions of, including 
        payment adjustments under, title XVIII of such Act (42 U.S.C. 
        1395 et seq.).
SEC. 3. HOSPICE CARE.

    (a) Hospice Survey Requirement.--
            (1) In general.--Section 1861(dd)(4) of the Social Security 
        Act (42 U.S.C. 1395x(dd)(4)) is amended by adding at the end the 
        following new subparagraph:

    ``(C) <<NOTE: Effective date. Time period.>>  Any entity that is 
certified as a hospice program shall be subject to a standard survey by 
an appropriate State or local survey agency, or an approved 
accreditation agency, as determined by the Secretary, not less 
frequently than once every 36 months beginning 6 months after the date 
of the enactment of this subparagraph and ending September 30, 2025.''.
            (2) Funding.--For purposes of carrying out subparagraph (C) 
        of section 1861(dd)(4) of the Social Security Act (42 U.S.C.

[[Page 128 STAT. 1969]]

        1395x(dd)(4)), as added by paragraph (1), there shall be 
        transferred from the Federal Hospital Insurance Trust Fund under 
        section 1817 of such Act (42 U.S.C. 1395i) to the Centers for 
        Medicare & Medicaid Services Program Management Account--
                    (A) $25,000,000 for fiscal years 2015 through 2017, 
                to be made available for such purposes in equal parts 
                for each such fiscal year; and
                    (B) $45,000,000 for fiscal years 2018 through 2025, 
                to be made available for such purposes in equal parts 
                for each such fiscal year.

    (b) Hospice Program Eligibility Recertification Technical Correction 
to Apply Limitation on Liability of Beneficiary Rules.--Section 1879 of 
the Social Security Act (42 U.S.C. 1395pp) is amended by adding at the 
end the following new subsection:
    ``(i) The provisions of this section shall apply with respect to a 
denial of a payment under this title by reason of section 1814(a)(7)(E) 
in the same manner as such provisions apply with respect to a denial of 
a payment under this title by reason of section 1862(a)(1).''.
    (c) Revision to Requirement for Medical Review of Certain Hospice 
Care.--Section 1814(a)(7) of the Social Security Act (42 U.S.C. 
1395f(a)(7)) is amended--
            (1) in subparagraph (C), by striking ``and'' at the end;
            (2) in subparagraph (D), in the matter preceding clause (i), 
        by inserting ``(and, in the case of clause (ii), before the date 
        of enactment of subparagraph (E))'' after ``2011''; and
            (3) by adding at the end the following new subparagraph:
                    ``(E) on and after the date of enactment of this 
                subparagraph, in the case of hospice care provided an 
                individual for more than 180 days by a hospice program 
                for which the number of such cases for such program 
                comprises more than a percent (specified by the 
                Secretary) of the total number of all cases of 
                individuals provided hospice care by the program under 
                this title, the hospice care provided to such individual 
                is medically reviewed (in accordance with procedures 
                established by the Secretary); and''.

    (d) Update of Hospice Aggregate Payment Cap.--Section 1814(i)(2)(B) 
of the Social Security Act (42 U.S.C. 1395f(i)(2)(B)) is amended--
            (1) by striking ``(B) For purposes'' and inserting ``(B)(i) 
        Except as provided in clause (ii), for purposes''; and
            (2) by adding at the end the following:

    ``(ii) <<NOTE: Time period.>>  For purposes of subparagraph (A) for 
accounting years that end after September 30, 2016, and before October 
1, 2025, the `cap amount' is the cap amount under this subparagraph for 
the preceding accounting year updated by the percentage update to 
payment rates for hospice care under paragraph (1)(C) for services 
furnished during the fiscal year beginning on the October 1 preceding 
the beginning of the accounting year (including the application of any 
productivity or other adjustment under clause (iv) of that paragraph).

    ``(iii) For accounting years that end after September 30, 2025, the 
cap amount shall be computed under clause (i) as if clause (ii) had 
never applied.''.
    (e) Medicare Improvement Fund.--Section 1898 of the Social Security 
Act (42 U.S.C. 1395iii) is amended--

[[Page 128 STAT. 1970]]

            (1) by amending the heading to read as follows: ``medicare 
        improvement fund'';
            (2) by amending subsection (a) to read as follows:

    ``(a) Establishment.--The Secretary shall establish under this title 
a Medicare Improvement Fund (in this section referred to as the `Fund') 
which shall be available to the Secretary to make improvements under the 
original Medicare fee-for-service program under parts A and B for 
individuals entitled to, or enrolled for, benefits under part or 
enrolled under part B including adjustments to payments for items and 
services furnished by providers of services and suppliers under such 
original Medicare fee-for-service program.'';
            (3) in subsection (b)(1), by striking ``during'' and all 
        that follows and inserting ``during and after fiscal year 2020, 
        $195,000,000.''; and
            (4) in subsection (b)(2), by striking ``from the Federal'' 
        and all that follows and inserting ``from the Federal Hospital 
        Insurance Trust Fund and the Federal Supplementary Medical 
        Insurance Trust Fund in such proportion as the Secretary 
        determines appropriate.''.

    Approved October 6, 2014.

LEGISLATIVE HISTORY--H.R. 4994:
---------------------------------------------------------------------------

CONGRESSIONAL RECORD, Vol. 160 (2014):
            Sept. 16, considered and passed House.
            Sept. 18, considered and passed Senate.

                                  <all>