Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019
This bill extends funding for, and makes a series of changes to, Medicare enrollment, payment, and prescription drug programs.
Among other things, the bill
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3417 Introduced in House (IH)]
<DOC>
116th CONGRESS
1st Session
H. R. 3417
To amend title XVIII of the Social Security Act to provide for patient
improvements and rural and quality improvements under the Medicare
program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 21, 2019
Mr. Neal (for himself and Mr. Brady) introduced the following bill;
which was referred to the Committee on Ways and Means, and in addition
to the Committee on Energy and Commerce, 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 patient
improvements and rural and quality improvements under the Medicare
program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Beneficiary
Education Tools, Telehealth, and Extenders Reauthorization Act of
2019'' or the ``BETTER Act of 2019''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--PATIENT IMPROVEMENTS
Sec. 101. Beneficiary enrollment notification and eligibility
simplification.
Sec. 102. Extension of funding outreach and assistance for low-income
programs.
Sec. 103. Medicare coverage of certain mental health telehealth
services.
Sec. 104. Requiring prescription drug plan sponsors to include real-
time benefit information as part of such
sponsor's electronic prescription program
under the Medicare program.
Sec. 105. Transitional coverage and retroactive Medicare part D
coverage for certain low-income
beneficiaries.
TITLE II--RURAL AND QUALITY IMPROVEMENTS
Sec. 201. Medicare GME treatment of hospitals establishing new medical
residency training programs after hosting
medical resident rotators for short
durations.
Sec. 202. Extension of the work geographic index floor under the
Medicare program.
Sec. 203. Extension of funding for quality measure endorsement, input,
and selection under Medicare program.
Sec. 204. Improving measurements under the skilled nursing facility
value-based purchasing program under the
Medicare program.
TITLE I--PATIENT IMPROVEMENTS
SEC. 101. BENEFICIARY ENROLLMENT NOTIFICATION AND ELIGIBILITY
SIMPLIFICATION.
(a) Eligibility and Enrollment Notices.--
(1) As part of social security account statement for
individuals attaining ages 63 to 65.--Section 1143(a) of the
Social Security Act (42 U.S.C. 1320b-13(a)) is amended by
adding at the end the following new paragraph:
``(4) Medicare Eligibility Information.--
``(A) In general.--In the case of statements provided on or
after the date that is 2 years after the date of the enactment
of this paragraph to individuals who are attaining ages 63, 64,
and 65, the statement shall also include a notice containing
the information described in subparagraph (B).
``(B) Contents of notice.--The notice required under
subparagraph (A) shall include a clear, simple explanation of--
``(i) eligibility for benefits under the Medicare
program under title XVIII, and in particular benefits
under part B of such title;
``(ii) the reasons a late enrollment penalty for
failure to timely enroll could be assessed and how such
late enrollment penalty is calculated, in particular
for benefits under part B;
``(iii) the availability of relief from the late
enrollment penalty and retroactive enrollment under
section 1837(h) (including as such section is applied
under sections 1818(c) and 1818A(c)(3)), with examples
of circumstances under which such relief may be granted
and examples of circumstances under which such relief
would not be granted;
``(iv) the need for coordination of benefits
(including primary and secondary coverage scenarios)
pursuant to section 1862, in particular for benefits
under part B of such title; and
``(v) populations, such as residents of Puerto Rico
and veterans, for whom there are special considerations
with respect to enrollment under title XVIII.
``(C) Development of notice.--
``(i) In general.--The Secretary, in coordination
with the Commissioner of Social Security, and taking
into consideration information collected pursuant to
clause (ii), shall, not later than 12 months after the
last day of the period for the request of information
described in clause (ii), develop the notice to be
provided pursuant to subparagraph (A).
``(ii) Request for information.--Not later than 6
months after the date of the enactment of this
paragraph, the Secretary shall request written
information, including recommendations, from
stakeholders (including the groups described in
subparagraph (D)) on the information to be included in
the notice.
``(iii) Notice improvement.--Beginning 4 years
after the date of enactment of this paragraph, and not
less than once every two years thereafter, the
Secretary, in coordination with the Commissioner of
Social Security, shall--
``(I) review the content of the notice to
be provided under subparagraph (A);
``(II) solicit recommendations on the
notice through a request for information
process as described in clause (ii); and
``(III) update and revise such notice as
the Secretary deems appropriate.
``(D) Groups for consultation.--For purposes of
subparagraph (C)(ii), the groups described in this clause
include the following:
``(i) Individuals who are 60 years of age or older.
``(ii) Veterans.
``(iii) Individuals with disabilities.
``(iv) Individuals with end stage renal disease.
``(v) Low-income individuals and families.
``(vi) Employers (including human resources
professionals).
``(vii) States (including representatives of State-
run Health Insurance Exchanges, Medicaid offices, and
Departments of Insurance).
``(viii) State Health Insurance Assistance
Programs.
``(ix) Health insurers.
``(x) Health insurance agents and brokers.
``(xi) Such other groups as specified by the
Secretary.
``(E) Posting of notice on websites.--The Commissioner of
Social Security and the Secretary shall ensure that the notice
being used under subparagraph (A) is posted in a prominent
location on the public Internet website of the Social Security
Administration and on the public Internet website of the
Centers for Medicare & Medicaid Services, respectively.
``(F) Reimbursement of costs.--
``(i) In general.--Effective for fiscal years
beginning in the year in which the date of enactment of
this paragraph occurs, the Commissioner of Social
Security and the Secretary shall enter into an
agreement which shall provide funding to cover the
administrative costs of the Commissioner's activities
under this paragraph. Such agreement shall--
``(I) provide funds to the Commissioner for
the full cost of the Social Security
Administration's work related to the
implementation of this paragraph, including any
initial costs incurred prior to the
finalization of such agreement;
``(II) provide such funding quarterly in
advance of the applicable quarter based on
estimating methodology agreed to by the
Commissioner and the Secretary; and
``(III) require an annual accounting and
reconciliation of the actual costs incurred and
funds provided under this paragraph.
``(ii) Limitation.--In no case shall funds from the
Social Security Administration's Limitation on
Administrative Expenses be used to carry out activities
related to the implementation of this paragraph.
``(G) No effect on obligation to mail statements.--Nothing
in this paragraph shall be construed to relieve the
Commissioner of Social Security from any requirement under
subsection (c), including the requirement to mail a statement
on an annual basis to each eligible individual who is not
receiving benefits under title II and for whom a mailing
address can be determined through such methods as the
Commissioner determines to be appropriate.''.
(2) Individuals in medicare waiting period.--Title XI of
the Social Security Act (42 U.S.C. 1301 et seq.) is amended by
inserting after section 1144 the following new section:
``medicare enrollment notification and eligibility notices for
individuals in medicare waiting period
``Notices
``Sec. 1144A. (a)
``(1) In General.--The Commissioner of Social Security
shall distribute the notice to be provided pursuant to section
1143(a)(4), as may be modified under paragraph (2), to
individuals in the 24-month waiting period under section
226(b).
``(2) Authority To Modify Notice.--The Secretary, in
coordination with the Commissioner of Social Security, may
modify the notice to be distributed under paragraph (1) as
necessary to take into account the individuals described in
such paragraph.
``(3) Posting of Notice on Websites.--The Commissioner of
Social Security and the Secretary shall ensure that the notice
being used under paragraph (1) is posted in a prominent
location on the public Internet website of the Social Security
Administration and on the public Internet website of the
Centers for Medicare & Medicaid Services, respectively.
``Timing
``(b) Beginning not later than 2 years after the date of the
enactment of this section, a notice required under subsection (a)(1)
shall be mailed to an individual no less than two times in accordance
with the following:
``(1) The notice shall be provided to such individual not
later than 3 months prior to the date on which such
individual's enrollment period begins as provided under section
1837.
``(2) The notice shall subsequently be provided to such
individual not later than one month prior to such date.
``Reimbursement of Costs
``(c)
``(1) In General.--Effective for fiscal years beginning in
the year in which the date of enactment of this section occurs,
the Commissioner of Social Security and the Secretary shall
enter into an agreement which shall provide funding to cover
the administrative costs of the Commissioner's activities under
this section. Such agreement shall--
``(A) provide funds to the Commissioner for the
full cost of the Social Security Administration's work
related to the implementation of this section,
including any initial costs incurred prior to the
finalization of such agreement;
``(B) provide such funding quarterly in advance of
the applicable quarter based on estimating methodology
agreed to by the Commissioner and the Secretary; and
``(C) require an annual accounting and
reconciliation of the actual costs incurred and funds
provided under this section.
``(2) Limitation.--In no case shall funds from the Social
Security Administration's Limitation on Administrative Expenses
be used to carry out activities related to the implementation
of this section.''.
(b) Beneficiary Enrollment Simplification.--
(1) Effective date of coverage.--Section 1838(a) of the
Social Security Act (42 U.S.C. 1395q(a)) is amended--
(A) by amending paragraph (2) to read as follows:
``(2)(A) in the case of an individual who enrolls pursuant
to subsection (d) of section 1837 before the month in which he
first satisfies paragraph (1) or (2) of section 1836, the first
day of such month,
``(B) in the case of an individual who first satisfies such
paragraph in a month beginning before January 2021 and who
enrolls pursuant to such subsection (d)--
``(i) in such month in which he first satisfies
such paragraph, the first day of the month following
the month in which he so enrolls,
``(ii) in the month following such month in which
he first satisfies such paragraph, the first day of the
second month following the month in which he so
enrolls, or
``(iii) more than one month following such month in
which he satisfies such paragraph, the first day of the
third month following the month in which he so enrolls,
``(C) in the case of an individual who first satisfies such
paragraph in a month beginning on or after January 1, 2021, and
who enrolls pursuant to such subsection (d) in such month in
which he first satisfies such paragraph or in any subsequent
month of his initial enrollment period, the first day of the
month following the month in which he so enrolls, or
``(D) in the case of an individual who enrolls pursuant to
subsection (e) of section 1837 in a month beginning--
``(i) before January 1, 2021, the July 1 following
the month in which he so enrolls, or
``(ii) on or after January 1, 2021, the first day
of the month following the month in which he so
enrolls, or''; and
(B) by amending paragraph (3) to read as follows:
``(3) in the case of an individual who is deemed to have
enrolled--
``(A) on or before the last day of the third month
of his initial enrollment period, the first day of the
month in which he first meets the applicable
requirements of section 1836 or July 1, 1973, whichever
is later, or
``(B) on or after the first day of the fourth month
of his initial enrollment period, and where such month
begins--
``(i) before January 1, 2021, as prescribed
under subparagraphs (B)(i), (B)(ii), (B)(iii),
and (D) of paragraph (2), or
``(ii) on or after January 1, 2021, as
prescribed under paragraph (2)(C).''.
(2) Special enrollment periods for exceptional
circumstances.--
(A) Enrollment.--Section 1837 of the Social
Security Act (42 U.S.C. 1395p) is amended by adding at
the end the following new subsection:
``(m) Beginning January 1, 2021, the Secretary may establish
special enrollment periods in the case of individuals who meet such
exceptional conditions as the Secretary may provide, such as
individuals who reside in an area with an emergency or disaster as
determined by the Secretary.''.
(B) Coverage period.--Section 1838 of the Social
Security Act (42 U.S.C. 1395q) is amended by adding at
the end the following new subsection:
``(g) Notwithstanding subsection (a), in the case of an individual
who enrolls during a special enrollment period pursuant to section
1837(m), the coverage period shall begin on a date the Secretary
provides in a manner consistent (to the extent practicable) with
protecting continuity of health benefit coverage.''.
(C) Conforming amendment.--Section 1839(b) of the
Social Security Act (42 U.S.C. 1395r(b)) is amended, in
the first sentence, by striking ``or (l)'' and
inserting ``, (l), or (m)''.
(3) Technical correction.--Section 1839(b) of the Social
Security Act (42 U.S.C. 1395r(b)) is amended by adding at the
end the following new sentence: ``For purposes of determining
any increase under this subsection for individuals whose
enrollment occurs on or after January 1, 2021, the second
sentence of this subsection shall be applied by substituting
`close of the month' for `close of the enrollment period' each
place it appears.''.
(4) Report.--Not later than January 1, 2021, the Secretary
of Health and Human Services shall submit to the Committee on
Ways and Means and Committee on Energy and Commerce of the
House of Representatives and the Committee on Finance and
Special Committee on Aging of the Senate a report including
recommendations on how to align existing Medicare enrollment
periods under title XVIII of the Social Security Act, including
the general enrollment period under part B of such title and
the annual election period under the Medicare Advantage program
under part C of such title and under the prescription drug
program under part D of such title. Such recommendations shall
be consistent with the goals of maximizing coverage continuity
and choice and easing beneficiary transition.
SEC. 102. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR LOW-INCOME
PROGRAMS.
(a) Additional Funding for State Health Insurance Programs.--
Subsection (a)(1)(B) of section 119 of the Medicare Improvements for
Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note), as amended
by section 3306 of the Patient Protection and Affordable Care Act
(Public Law 111-148), section 610 of the American Taxpayer Relief Act
of 2012 (Public Law 112-240), section 1110 of the Pathway for SGR
Reform Act of 2013 (Public Law 113-67), section 110 of the Protecting
Access to Medicare Act of 2014 (Public Law 113-93), section 208 of the
Medicare Access and CHIP Reauthorization Act of 2015 (Public Law 114-
10), and section 50207 of the Bipartisan Budget Act of 2018 (Public Law
115-123), is amended--
(1) in clause (vii), by striking ``and'' at the end;
(2) in clause (viii), by striking ``and'' at the end;
(3) in clause (ix), by striking the period at the end and
inserting ``; and''; and
(4) by inserting after clause (ix) the following new
clause:
``(x) for each of fiscal years 2020 through
2022, of $15,000,000.''.
(b) Additional Funding for Area Agencies on Aging.--Subsection
(b)(1)(B) of such section 119, as so amended, is amended--
(1) in clause (vii), by striking ``and'' at the end;
(2) in clause (viii), by striking ``and'' at the end;
(3) in clause (ix), by striking the period at the end and
inserting ``; and''; and
(4) by inserting after clause (ix) the following new
clause:
``(x) for each of fiscal years 2020 through
2022, of $15,000,000.''.
(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 (vii), by striking ``and'' at the end;
(2) in clause (viii), by striking ``and'' at the end;
(3) in clause (ix), by striking the period at the end and
inserting ``; and''; and
(4) by inserting after clause (ix) the following new
clause:
``(x) for each of fiscal years 2020 through
2022, 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 (vii), by striking ``and'' at the end;
(2) in clause (viii), by striking ``and'' at the end;
(3) in clause (ix), by striking the period at the end and
inserting ``; and''; and
(4) by inserting after clause (ix) the following new
clause:
``(x) for each of fiscal years 2020 through
2022, of $15,000,000.''.
SEC. 103. MEDICARE COVERAGE OF CERTAIN MENTAL HEALTH TELEHEALTH
SERVICES.
Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is
amended--
(1) in paragraph (2)(B)(i), by striking ``and paragraph
(6)(C)'' and inserting ``, paragraph (6)(C), and paragraph
(8)(C)'';
(2) in paragraph (4)(C)(i), by striking ``and (7)'' and
inserting ``(7), and (8)'';
(3) in paragraph (4)(F)(i), by inserting ``services
identified by CPT codes 90834 and 90837 (and as subsequently
modified by the Secretary),'' before ``and any additional
service'';
(4) in paragraph (6)(A), by striking ``paragraph (4)(C)''
and inserting ``paragraph (4)(C)(i)'';
(5) in paragraph (7), by striking ``The geographic
requirements'' and inserting ``Subject to paragraph (8)(D), the
geographic requirements''; and
(6) by adding at the end the following new paragraph:
``(8) Treatment of mental health telehealth services.--
``(A) Non-application of originating site
requirements.--The requirements described in paragraph
(4)(C)(i) shall not apply with respect to telehealth
services furnished on or after January 1, 2020, that
are mental health telehealth services. Nothing in the
previous sentence shall waive any applicable State law
requirements.
``(B) Inclusion of certain sites.--With respect to
telehealth services described in subparagraph (A), the
term `originating site' shall include the home of the
eligible telehealth individual at which the individual
is located at the time the service is furnished via a
telecommunications system.
``(C) No originating site facility fee.--No
facility fee shall be paid under paragraph (2)(B) to an
originating site with respect to a telehealth service
described in subparagraph (A) if the originating site
does not otherwise meet the requirements for an
originating site under paragraph (4)(C).
``(D) Face-to-face initial assessment;
reassessments.--Payment may not be made for mental
health telehealth services under this paragraph (if
such payment would not otherwise be allowed under this
subsection without application of this paragraph or
paragraph (7)) furnished to an eligible telehealth
individual unless--
``(i) within the 6-month period prior to
the provision of such mental health telehealth
services, the individual receives a face-to-
face clinical assessment, without the use of
telehealth, by a physician described in
subparagraph (F)(i) or a practitioner described
in subparagraph (F)(ii) of the needs of such
individual for such services; and
``(ii) the individual receives a
reassessment (at a frequency specified by the
Secretary) by a physician so described or a
practitioner so described of the needs of such
individual for such services.
``(E) Mental health telehealth services defined.--
For purposes of this paragraph, the term `mental health
telehealth service' means services identified by CPT
codes 90834 and 90837 (and as subsequently modified by
the Secretary).
``(F) Physician and practitioner described.--For
purposes of subparagraph (D):
``(i) Physician.--A physician described in
this clause is a physician, as defined in
section 1861(r)(1).
``(ii) Practitioner.--A practitioner
described in this clause is a practitioner
described in any of clauses (i), (iv), or (v)
of section 1842(b)(18)(C).''.
SEC. 104. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS TO INCLUDE REAL-
TIME BENEFIT INFORMATION AS PART OF SUCH SPONSOR'S
ELECTRONIC PRESCRIPTION PROGRAM UNDER THE MEDICARE
PROGRAM.
Section 1860D-4(e)(2) of the Social Security Act (42 U.S.C. 1395w-
104(e)(2)) is amended--
(1) in subparagraph (D), by striking ``To the extent'' and
inserting ``Except as provided in subparagraph (F), to the
extent''; and
(2) by adding at the end the following new subparagraph:
``(F) Real-time benefit information.--
``(i) In general.--Not later than January
1, 2021, the program shall provide for the
real-time electronic transmission to
prescribing health care professionals, using
technology capable of integrating with such
professionals' electronic prescribing and
electronic health record systems, of
individual-specific formulary and benefit
information under a prescription drug plan with
respect to an individual enrolled in such plan.
Such information shall include, with respect to
the prescribing of a covered part D drug to
such individual, the following:
``(I) A description of any
clinically-appropriate alternatives to
such drug included in the formulary of
such plan.
``(II) Information relating to
applicable cost-sharing requirements
for such drug and such alternatives,
including a description of any variance
in such requirements based on the
pharmacy dispensing such drug or such
alternatives.
``(III) Information relating to any
prior authorization or other
utilization management requirements
applicable to such drug and such
alternatives within the formulary of
such plan.
``(ii) Special rule for 2021.--The program
shall be deemed to be in compliance with clause
(i) for 2021 if the program complies with the
provisions of section 423.160(b)(7) of title
42, Code of Federal Regulations (or a successor
regulation), for such year.''.
SEC. 105. TRANSITIONAL COVERAGE AND RETROACTIVE MEDICARE PART D
COVERAGE FOR CERTAIN LOW-INCOME BENEFICIARIES.
Section 1860D-14 of the Social Security Act (42 U.S.C. 1395w-114)
is amended--
(1) by redesignating subsection (e) as subsection (f); and
(2) by adding after subsection (d) the following new
subsection:
``(e) Limited Income Newly Eligible Transition Program.--
``(1) In general.--Beginning not later than January 1,
2021, the Secretary shall carry out a program to provide
transitional coverage for covered part D drugs for LI NET
eligible individuals in accordance with this subsection.
``(2) LI net eligible individual defined.--For purposes of
this subsection, the term `LI NET eligible individual' means a
part D eligible individual who--
``(A) meets the requirements of clauses (ii) and
(iii) of subsection (a)(3)(A); and
``(B) has not yet enrolled in a prescription drug
plan or an MA-PD plan, or, who has so enrolled, but
with respect to whom coverage under such plan has not
yet taken effect.
``(3) Transitional coverage.--For purposes of this
subsection, the term `transitional coverage' means with respect
to an LI NET eligible individual--
``(A) immediate access to covered part D drugs at
the point of sale during the period that begins on the
first day of the month such individual is determined to
meet the requirements of clauses (ii) and (iii) of
subsection (a)(3)(A) and ends on the date that coverage
under a prescription drug plan or MA-PD plan takes
effect with respect to such individual; and
``(B) in the case of an LI NET eligible individual
who is a full-benefit dual eligible individual (as
defined in section 1935(c)(6)) or a recipient of
supplemental security income benefits under title XVI,
retroactive coverage (in the form of reimbursement of
the amounts that would have been paid under this part
had such individual been enrolled in a prescription
drug plan or MA-PD plan) of covered part D drugs
purchased by such individual during the period that
begins on the date that is the later of--
``(i) the date that such individual was
first eligible for a low-income subsidy under
this part; or
``(ii) the date that is 36 months prior to
the date such individual enrolls in a
prescription drug plan or MA-PD plan,
and ends on the date that coverage under such plan
takes effect.
``(4) Program administration.--
``(A) Single point of contact.--The Secretary
shall, to the extent feasible, administer the program
under this subsection through a contract with a single
program administrator.
``(B) Benefit design.--The Secretary shall ensure
that the transitional coverage provided to LI NET
eligible individuals under this subsection--
``(i) provides access to all covered part D
drugs under an open formulary;
``(ii) permits all pharmacies determined by
the Secretary to be in good standing to process
claims under the program;
``(iii) is consistent with such
requirements as the Secretary considers
necessary to improve patient safety and ensure
appropriate dispensing of medication; and
``(iv) meets such other requirements as the
Secretary may establish.
``(5) Relationship to other provisions of this title;
waiver authority.--
``(A) In general.--The following provisions shall
not apply with respect to the program under this
subsection:
``(i) Paragraphs (1) and (3)(B) of section
1860D-4(a) (relating to dissemination of
general information; availability of
information on changes in formulary through the
Internet).
``(ii) Subparagraphs (A) and (B) of section
1860D-4(b)(3) (relating to requirements on
development and application of formularies;
formulary development).
``(iii) Paragraphs (1)(C) and (2) of
section 1860D-4(c) (relating to medication
therapy management program).
``(B) Waiver authority.--The Secretary may waive
such other requirements of title XI and this title as
may be necessary to carry out the purposes of the
program established under this subsection.''.
TITLE II--RURAL AND QUALITY IMPROVEMENTS
SEC. 201. MEDICARE GME TREATMENT OF HOSPITALS ESTABLISHING NEW MEDICAL
RESIDENCY TRAINING PROGRAMS AFTER HOSTING MEDICAL
RESIDENT ROTATORS FOR SHORT DURATIONS.
(a) Redetermination of Approved FTE Resident Amount.--Section
1886(h)(2)(F) of the Social Security Act (42 U.S.C. 1395ww(h)(2)(F)) is
amended--
(1) by inserting ``(i)'' before ``In the case of''; and
(2) by adding at the end the following:
``(ii) In applying this subparagraph in the case of
a hospital that, on or after the date of the enactment
of this clause, begins to train residents and has not
entered into a GME affiliation agreement (as defined by
the Secretary for purposes of paragraph (4)(H)(ii)),
the Secretary shall not establish an FTE resident
amount until such time as the Secretary determines that
the hospital has trained at least 1.0 full-time-
equivalent resident in an approved medical residency
training program in a cost reporting period.
``(iii) In applying this subparagraph for cost
reporting periods beginning on or after the date of
enactment of this clause, in the case of a hospital
that, as of such date of enactment, has an approved FTE
resident amount based on the training in an approved
medical residency program of--
``(I) less than 1.0 full-time-equivalent
resident in any cost reporting period beginning
before October 1, 1997, as determined by the
Secretary; or
``(II) no more than 3.0 full-time-
equivalent residents in any cost reporting
period beginning on or after October 1, 1997,
and before the date of the enactment of this
clause, as determined by the Secretary,
in lieu of such FTE resident amount the Secretary
shall, in accordance with the methodology described in
section 413.77(e) of title 42 of the Code of Federal
Regulations (or any successor regulation), establish a
new FTE resident amount if the hospital trains at least
1.0 full-time-equivalent resident (in the case of a
hospital described in subclause (I)) or more than 3.0
full-time-equivalent residents (in the case of a
hospital described in subclause (II)) in a cost
reporting period beginning on or after such date of
enactment and before the date that is 5 years after
such date of enactment.
``(iv) For purposes of carrying out this
subparagraph for cost reporting periods beginning on or
after the date of the enactment of this clause, a
hospital shall report full-time-equivalent residents on
its cost report for a cost reporting period if the
hospital trains at least 1.0 full-time-equivalent
resident in an approved medical residency training
program in such period.
``(v) As appropriate, the Secretary may consider
information from any cost reporting period necessary to
establish a new FTE resident amount as described in
clause (iii).''.
(b) Redetermination of FTE Resident Limitation.--Section
1886(h)(4)(H)(i) of the Social Security Act (42 U.S.C.
1395ww(h)(4)(H)(i)) is amended--
(1) by inserting ``(I)'' before ``The Secretary''; and
(2) by adding at the end the following:
``(II) In applying this clause in the case
of a hospital that, on or after the date of the
enactment of this subclause, begins to train
residents in a new approved medical residency
training program (as defined by the Secretary),
the Secretary shall not determine a limitation
applicable to the hospital under subparagraph
(F) until such time as the Secretary determines
that the hospital has trained at least 1.0
full-time-equivalent resident in such new
approved medical residency training program in
a cost reporting period.
``(III) In applying this clause in the case
of a hospital that, as of the date of the
enactment of this subclause, has a limitation
under subparagraph (F), based on a cost
reporting period beginning before October 1,
1997, of less than 1.0 full-time-equivalent
resident, the Secretary shall adjust the
limitation in the manner applicable to a new
approved medical residency training program if
the Secretary determines the hospital trains at
least 1.0 full-time-equivalent resident in a
program year beginning on or after such date of
enactment and before the date that is 5 years
after such date of enactment.
``(IV) In applying this clause in the case
of a hospital that, as of the date of the
enactment of this subclause, has a limitation
under subparagraph (F), based on a cost
reporting period beginning on or after October
1, 1997, and before such date of enactment, of
no more than 3.0 full-time-equivalent
residents, the Secretary shall adjust the
limitation in the manner applicable to a new
approved medical residency training program if
the Secretary determines the hospital begins
training more than 3.0 full-time-equivalent
residents in a program year beginning on or
after such date of enactment and before the
date that is 5 years after such date of
enactment.
``(V) An adjustment to the limitation
applicable to a hospital made pursuant to
subclause (III) or (IV) shall be made in a
manner consistent with the methodology, as
appropriate, in section 413.79(e) of title 42,
Code of Federal Regulations (or any successor
regulation). As appropriate, the Secretary may
consider information from any cost reporting
periods necessary to make such an adjustment to
the limitation.''.
(c) Technical and Conforming Amendments.--Section 1886 of the
Social Security Act (42 U.S.C. 1395ww) is amended--
(1) in subsection (d)(5)(B)(viii), by striking ``subsection
(h)(4)(H)'' and inserting ``paragraphs (2)(F)(iv) and (4)(H) of
subsection (h)''; and
(2) in subsection (h)--
(A) in paragraph (4)(H)(iv), by striking ``an rural
area'' and inserting ``a rural area''; and
(B) in paragraph (7)(E), by striking ``under this''
and all that follows through the period at the end and
inserting the following: ``under this paragraph,
paragraph (8), clause (i), (ii), (iii), or (v) of
paragraph (2)(F), or clause (i) or (vi) of paragraph
(4)(H).''.
(d) Effective Date.--The amendments made by this section shall
apply to payment under section 1886 of the Social Security Act (42
U.S.C. 1395ww) for cost reporting periods beginning on or after the
date of the enactment of this Act.
SEC. 202. EXTENSION OF THE WORK GEOGRAPHIC INDEX FLOOR UNDER THE
MEDICARE PROGRAM.
Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``2020'' and inserting ``2023''.
SEC. 203. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSEMENT, INPUT,
AND SELECTION UNDER MEDICARE PROGRAM.
(a) In General.--Section 1890(d)(2) of the Social Security Act (42
U.S.C. 1395aaa(d)(2)) is amended--
(1) by striking ``and $7,500,000'' and inserting
``$7,500,000''; and
(2) by striking ``and 2019.'' and inserting ``and 2019, and
$30,000,000 for each of fiscal years 2020 through 2022.''.
(b) Input for Removal of Measures.--Section 1890(b) of the Social
Security Act (42 U.S.C. 1395aaa(b)) is amended by inserting after
paragraph (3) the following:
``(4) Removal of measures.--The entity may provide input to
the Secretary on quality and efficiency measures described in
paragraph (7)(B) that could be considered for removal.''.
(c) Prioritization of Measure Endorsement.--Section 1890(b) of the
Social Security Act (42 U.S.C. 1395aaa(b)) is amended by adding at the
end the following:
``(9) Prioritization of measure endorsement.--The
Secretary--
``(A) during the period beginning on the date of
the enactment of this paragraph and ending on December
31, 2023, shall prioritize the endorsement of measures
relating to maternal morbidity and mortality by the
entity with a contract under subsection (a) in
connection with endorsement of measures described in
paragraph (2); and
``(B) on and after January 1, 2024, may prioritize
the endorsement of such measures by such entity.''.
SEC. 204. IMPROVING MEASUREMENTS UNDER THE SKILLED NURSING FACILITY
VALUE-BASED PURCHASING PROGRAM UNDER THE MEDICARE
PROGRAM.
(a) In General.--Section 1888(h) of the Social Security Act (42
U.S.C. 1395yy(h)) is amended--
(1) in paragraph (1), by adding at the end the following
new subparagraph:
``(C) Exclusions.--With respect to payments for
services furnished on or after October 1, 2021, this
subsection shall not apply to a facility for which
there are not a minimum number (as determined by the
Secretary) of--
``(i) cases for the measures that apply to
the facility for the performance period for the
applicable fiscal year; or
``(ii) measures that apply to the facility
for the performance period for the applicable
fiscal year.'';
(2) in paragraph (2)(A)--
(A) by striking ``The Secretary shall apply'' and
inserting ``The Secretary--
``(i) shall apply'';
(B) by striking the period at the end and inserting
``; and''; and
(C) by adding at the end the following:
``(ii) may, with respect to payments for
services furnished on or after October 1, 2022,
apply additional measures determined
appropriate by the Secretary, which may include
measures of functional status, patient safety,
care coordination, or patient experience.
Subject to the succeeding sentence, in the case that
the Secretary applies additional measures under clause
(ii), the Secretary shall consider and apply, as
appropriate, quality measures specified under section
1899B(c)(1). In no case may the Secretary apply more
than 10 measures under this subparagraph.'';
(3) in subparagraph (A) of each of paragraphs (3) and (4),
by striking ``measure'' and inserting ``measures''; and
(4) by adding at the end the following new paragraph:
``(12) Validation.--
``(A) In general.--The Secretary shall apply to the
measures applied under this subsection and the data
submitted under subsection (e)(6) a process to validate
such measures and data, as appropriate, which may be
similar to the process specified in section
1886(b)(3)(B)(viii)(XI) for validating inpatient
hospital measures.
``(B) Funding.--For purposes of carrying out this
paragraph, the Secretary shall provide for the
transfer, from the Federal Hospital Insurance Trust
Fund established under section 1817, of $5,000,000 to
the Centers for Medicare & Medicaid Services Program
Management Account for each of fiscal years 2022
through 2024.''.
(b) Report by MedPAC.--Not later than March 15, 2021, the Medicare
Payment Advisory Commission shall submit to Congress a report on
establishing a prototype value-based payment program under a unified
prospective payment system for post-acute care services under the
Medicare program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.). Such report--
(1) shall--
(A) consider design elements such as--
(i) measures that are important to the
Medicare program and to beneficiaries under
such program;
(ii) methodologies for scoring provider
performance and effects on payment; and
(iii) other elements determined appropriate
by the Commission; and
(B) analyze the effects of implementing such
prototype program; and
(2) may--
(A) discuss the possible effects, with respect to
the Medicare program, on program spending, post-acute
care providers, patient outcomes, and other effects
determined appropriate by the Commission; and
(B) include recommendations with respect to such
prototype program, as determined appropriate by the
Commission, to Congress and the Secretary of Health and
Human Services.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
Referred to the Subcommittee on Health.
Committee Consideration and Mark-up Session Held.
Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 41 - 0.
Reported (Amended) by the Committee on Ways and Means. H. Rept. 116-691, Part I.
Reported (Amended) by the Committee on Ways and Means. H. Rept. 116-691, Part I.
Committee on Energy and Commerce discharged.
Committee on Energy and Commerce discharged.
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Placed on the Union Calendar, Calendar No. 574.