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Title IV — Other Provisions

S. 2157 · 113th Congress · Mar 25, 2014 · Lineage

IV Other Provisions

Sec. 401 Commission on Improving Patient Directed Health Care

(a)
Findings— Congress finds the following:
(1)
In order to elevate the role of patient choices in the health care system, the American public must engage in an informed, national, public debate on how the current health care system empowers and informs health care decision-making, and what can be done to improve the likelihood patients receive the care they want and need.
(2)
Research suggests that patients often do not receive the care they want. As a result, the end of life is associated with a substantial burden of suffering by the patient and negative health and financial consequences that extend to family members and society.
(3)
Patients face a complex and fragmented health care system that may decrease the likelihood that health care choices are known and carried out. The health care system should embed principles that take into account patient wishes.
(4)
Decisions concerning health care, including end-of-life issues, affect an increasing number of Americans.
(5)
Medical advances are prolonging life expectancy in the United States both in acute life-threatening situations and protracted battles with illness. These advances raise new challenges surrounding health care decision-making.
(6)
The United States health care system should promote consideration of a person’s preference in health care decision-making and end-of-life choices.
(b)
Commission— The Social Security Act is amended by inserting after section 1150B (42 U.S.C. 1320b–24) the following new section:

“1150C. Commission on Improving Patient Directed Health Care

“(a) Purposes—The purposes of this section are to—

“(1) provide a forum for a nationwide public debate on improving patient self-determination in health care decision-making;

“(2) identify strategies that ensure every American has the health care they want; and

“(3) provide recommendations to Congress that result from the debate.

“(b) Establishment—The Secretary shall establish an entity to be known as the Commission on Improving Patient Directed Health Care (referred to in this section as the “Commission”).

“(c) Membership

“(1) Number and appointment—The Commission shall be composed of 15 members. One member shall be the Secretary. The Comptroller General of the United States shall appoint 14 members.

“(2) Qualifications—The membership of the Commission shall include—

“(A) health care consumers impacted by decision-making in advance of a health care crisis, such as individuals of advanced age, individuals with chronic, terminal and mental illnesses, family care givers, and individuals with disabilities;

“(B) providers in settings where crucial health care decision-making occurs, such as those working in intensive care settings, emergency room departments, primary care settings, nursing homes, hospice, or palliative care settings;

“(C) payors ensuring patients get the level of care they want;

“(D) experts in advance care planning, hospice, palliative care, information technology, bioethics, aging policy, disability policy, pediatric ethics, cultural sensitivity, psychology, and health care financing;

“(E) individuals who represent culturally diverse perspectives on patient self-determination and end-of-life issues; and

“(F) members of the faith community.

“(d) Period of appointment—Members of the Commission shall be appointed for the life of the Commission. Any vacancies shall not affect the power and duties of the Commission but shall be filled in the same manner as the original appointment.

“(e) Designation of the chairperson—Not later than 15 days after the date on which all members of the Commission have been appointed, the Comptroller General shall designate the chairperson of the Commission.

“(f) Subcommittees—The Commission may establish subcommittees if doing so increases the efficiency of the Commission in completing tasks.

“(g) Duties

“(1) Hearings—Not later than 90 days after the date of designation of the chairperson under subsection (e), the Commission shall hold no fewer than 8 hearings to examine—

“(A) the current state of health care decision-making and advance care planning laws in the United States at the Federal level and across the States, as well as options for improving advance care planning tools, especially with regard to use, portability, and storage;

“(B) consumer-focused approaches that educate the American public about patient choices, care planning, and other end-of-life issues;

“(C) the use of comprehensive, patient-centered care plans by providers, the impact care plans have on health care delivery and spending, and methods to expand the use of high quality care planning tools in both public and private health care systems;

“(D) the role of electronic medical records and other technologies in improving patient-directed health care;

“(E) innovative tools for improving patient experience with advanced illness, such as palliative care, hospice, and other models;

“(F) the role social determinants of health, such as socio-economic status, play in patient self-direction in health care;

“(G) the use of culturally-competent tools for health care decision-making;

“(H) strategies for educating providers and increasing provider engagement on care planning, palliative care, hospice care, and other issues surrounding honoring patient choices;

“(I) the sociological and psychological factors that influence health care decision-making and end-of-life choices; and

“(J) the role of spirituality and religion in patient self-determination in health care.

“(2) Additional hearings—The Commission may hold additional hearings on subjects other than those listed in paragraph (1) so long as such hearings are determined necessary by the Commission in carrying out the purposes of this section. Such additional hearings do not have to be completed within the time period specified but shall not delay the other activities of the Commission under this section.

“(3) Number and location of hearings and additional hearings—The Commission shall hold no fewer than 8 hearings as indicated in paragraph (1) and in sufficient number in order to receive information that reflects—

“(A) the geographic differences throughout the United States;

“(B) diverse populations; and

“(C) a balance among urban and rural populations.

“(4) Interactive technology—The Commission may encourage public participation in hearings through interactive technology and other means as determined appropriate by the Commission.

“(5) Report to the american people on patient directed health care—Not later than 90 days after the hearings described in paragraphs (1) and (2) are completed, the Commission shall prepare and make available to health care consumers through the Internet and other appropriate public channels, a report to be entitled, “Report to the American People on Patient Directed Health Care”. Such a report shall be understandable to the general public and include—

“(A) a summary of—

“(i) the hearings described in such paragraphs;

“(ii) how the current health care system empowers and informs decision-making in advance of a health care crisis;

“(iii) factors that contribute to the provision of health care that does not adhere to patient wishes;

“(iv) the impact of care that does not follow patient choices, particularly at the end-of-life, on patients, families, providers, spending, and the health care system;

“(v) the laws surrounding advance care planning and health care decision-making including issues of portability, use, and storage;

“(vi) consumer-focused approaches to education of the American public about patient choices, care planning, and other end-of-life issues;

“(vii) the role of care plans in health care decision-making;

“(viii) the role of providers in ensuring patients receive the care they want;

“(ix) the role of electronic medical records and other technologies in improving patient directed health care;

“(x) the impact of social determinants on patient self-direction in health care services;

“(xi) the use of culturally competent methods for health care decision-making;

“(xii) the sociological and psychological factors that influence patient self-determination; and

“(xiii) the role of spirituality and religion in health care decision-making and end-of-life care;

“(B) best practices from communities, providers, and payors that document patient wishes and provide health care that adheres to those wishes; and

“(C) information on educating providers about health care decision-making and end-of-life issues.

“(6) Interim requirements—Not later than 180 days after the date of completion of the hearings, the Commission shall prepare and make available to the public through the Internet and other appropriate public channels, an interim set of recommendations on patient self-determination in health care and ways to improve and strengthen the health care system based on the information and preferences expressed at the community meetings. There shall be a 90-day public comment period on such recommendations.

“(h) Recommendations—Not later than 120 days after the expiration of the public comment period described in subsection (g)(6), the Commission shall submit to Congress and the President a final set of recommendations. The recommendations must be comprehensive and detailed. The recommendations must contain recommendations or proposals for legislative or administrative action as the Commission deems appropriate, including proposed legislative language to carry out the recommendations or proposals.

“(i) Administration

“(1) Executive director—There shall be an Executive Director of the Commission who shall be appointed by the chairperson of the Commission in consultation with the members of the Commission.

“(2) Compensation—While serving on the business of the Commission (including travel time), a member of the Commission shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5, United States Code, and while so serving away from home and the member’s regular place of business, a member may be allowed travel expenses, as authorized by the chairperson of the Commission. For purposes of pay and employment benefits, rights, and privileges, all personnel of the Commission shall be treated as if they were employees of the Senate.

“(3) Information from federal agencies—The Commission may secure directly from any Federal department or agency such information as the Commission considers necessary to carry out this section. Upon request of the Commission the head of such department or agency shall furnish such information.

“(4) Postal services—The Commission may use the United States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government.

“(j) Detail—Not more than 4 Federal Government employees employed by the Department of Labor, 4 Federal Government employees employed by the Social Security Administration, and 8 Federal Government employees employed by the Department of Health and Human Services may be detailed to the Commission under this section without further reimbursement. Any detail of an employee shall be without interruption or loss of civil service status or privilege.

“(k) Temporary and intermittent services—The chairperson of the Commission may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title.

“(l) Annual report—Not later than 1 year after the date of enactment of this Act, and annually thereafter during the existence of the Commission, the Commission shall report to Congress and make public a detailed description of the expenditures of the Commission used to carry out its duties under this section.

“(m) Sunset of commission—The Commission shall terminate on the date that is 3 years after the date on which all the members of the Commission have been appointed under subsection (c)(1) and appropriations are first made available to carry out this section.

“(n) Administration review and comments—Not later than 45 days after receiving the final recommendations of the Commission under subsection (h), the President shall submit a report to Congress which shall contain—

“(1) additional views and comments on such recommendations; and

“(2) recommendations for such legislation and administrative action as the President considers appropriate.

“(o) Authorization of appropriations

“(1) In general—There are authorized to be appropriated to carry out this section, $3,000,000 for each of fiscal years 2014 and 2015.

“(2) Report to the American people on patient directed health care—There are authorized to be appropriated for the preparation and dissemination of the Report to the American People on Patient Directed Health Care described in subsection (g)(5), $1,000,000 for the fiscal year in which the report is required to be submitted.”

Sec. 402 Expansion of the definition of inpatient hospital services for certain cancer hospitals

Section 1861(b) of the Social Security Act (42 U.S.C. 1395x(b)) is amended—
(1)
in paragraph (3)—
(A)
by inserting “(A)” after “(3)”;
(B)
by adding “and” after the semicolon at the end; and
(C)
by adding at the end the following new subparagraph:

“(B) subject to the third sentence of this subsection, with respect to a hospital that—

“(i) is described in section 1886(d)(1)(B)(v); and

“(ii) as of the date of the enactment of the Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014, is located in the same building, or on the same campus, as another hospital (as described in sections 412.22(e) and 412.22(f) of title 42, Code of Federal Regulations, as in effect on such date of enactment );”

(2)
by adding at the end the following new flush sentence:

Sec. 403 Quality measures for certain post-acute care providers relating to notice and transfer of patient health information and patient care preferences

(a)
Development— The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall provide for the development of one or more quality measures under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) to accurately communicate the existence and provide for the transfer of patient health information and patient care preferences when an individual transitions from a hospital to return home or move to other post-acute care settings.
(b)
Use of measure developers— The Secretary shall arrange for the development of such measures by appropriate measure developers.
(c)
Endorsement— The Secretary shall arrange for such developed measures to be submitted for endorsement to a consensus-based entity as described in section 1890(a) of the Social Security Act (42 U.S.C. 1395aaa(a)).
(d)
Use of measures— The Secretary shall, through notice and comment rulemaking, use such measures under the quality reporting programs with respect to—
(1)
inpatient hospitals under section 1886(b)(3)(B)(viii) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(viii));
(2)
skilled nursing facilities under section 1888(e) of such Act (42 U.S.C. 1395yy(e));
(3)
home health services under section 1895(b)(3)(B)(v) of such Act (42 U.S.C. 1395fff(b)(3)(B)(v)); and
(4)
other providers of services (as defined in section 1861(u) of such Act) and suppliers (as defined in section 1861(d) of such Act) that the Secretary determines appropriate.

Sec. 404 Criteria for medically necessary, short inpatient hospital stays

(a)
In general— The Secretary of Health and Human Services shall consult with, and seek input from, interested stakeholders to determine appropriate criteria for payment under the Medicare program under title XVIII of the Social Security Act of an inpatient hospital admission that—
(1)
is medically necessary; and
(2)
is an inpatient hospital stay that is less than two midnights, as described in section 412.3 of title 42, Code of Federal Regulation, as finalized in the final rule published by the Centers for Medicare & Medicaid Services in the Federal Register on August 19, 2013 (78 Federal Register 50496) entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2014 Rates; Quality Reporting Requirements for Specific Providers; Hospital Conditions of Participation; Payment Policies Related to Patient Status”.
(b)
Interested stakeholders— In subsection (a), the term “interested stakeholders” means the following:
(1)
Hospitals.
(2)
Physicians
(3)
Medicare administrative contractors under section 1874A of the Social Security Act (42 U.S.C. 1395kk–1).
(4)
Recovery audit contractors under section 1893(h) of such Act (42 U.S.C. 1395ddd(h)).
(5)
Other parties determined appropriate by the Secretary.

Sec. 405 Transparency of reasons for excluding additional procedures from the Medicare ambulatory surgical center (ASC) approved list

Section 1833(i)(1) of the Social Security Act (42 U.S.C. 1395l(i)(1)) is amended by adding at the end the following: “In updating such lists for application in years beginning after December 31, 2014, for each procedure that was not proposed but was requested to be included on such lists during the public comment where the Secretary does not finalize (in the final rule updating such lists) to so include, the Secretary shall describe in such final rule the specific safety criteria for not including such requested procedure on such lists.”.

Sec. 406 Supervision in critical access hospitals

(a)
General supervision in critical access hospitals— Section 1834(g) of the Social Security Act (42 U.S.C. 1395m(g)) is amended by adding at the end the following new paragraph:

“(6) Supervision—In the case of services furnished on or after the date of the enactment of this paragraph, the level of supervision with respect to outpatient therapeutic critical access hospital services shall be general supervision (as defined by the Secretary) unless the Secretary specifies otherwise for a particular service.”

(b)
Supervision of cardiac and pulmonary rehabilitation programs in critical access hospitals— Section 1861(eee)(2)(B) of the Social Security Act (42 U.S.C. 1395x(eee)(2)(B)) is amended by inserting “(or, in the case of a critical access hospital, a physician, or (beginning on the date of enactment of the Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014) a nurse practitioner, clinical nurse specialist, or physician assistant (as such terms are defined in subsection (aa)(5)))” after “a physician”.

Sec. 407 Requiring State licensure of bidding entities under the competitive acquisition program for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)

Section 1847(a)(1) of the Social Security Act (42 U.S.C. 1395w–3(a)(1)) is amended by adding at the end the following new subparagraph:

“(G) Requiring State licensure of bidding entities—With respect to rounds of competitions beginning on or after the date of enactment of this subparagraph, the Secretary may only accept a bid from an entity for an area if the entity meets applicable State licensure requirements for such area for all items in such bid for a product category.”

Sec. 408 Recognition of attending physician assistants as attending physicians To serve hospice patients

(a)
Recognition of attending physician assistants as attending physicians To serve hospice patients—
(1)
In general— Section 1861(dd)(3)(B) of the Social Security Act (42 U.S.C. 1395x(dd)(3)(B)) is amended—
(A)
by striking “or nurse” and inserting “, the nurse”; and
(B)
by inserting “, or the physician assistant (as defined in such subsection)” after “subsection (aa)(5))”.
(2)
Clarification of hospice role of physician assistants— Section 1814(a)(7)(A)(i)(I) of the Social Security Act (42 U.S.C. 1395f(a)(7)(A)(i)(I)) is amended by inserting “or a physician assistant” after “a nurse practitioner”.
(b)
Effective date— The amendments made by this section shall apply to items and services furnished on or after October 1, 2015.

Sec. 409 Remote patient monitoring pilot projects

(a)
Pilot projects—
(1)
In general— Not later than 9 months after the date of the enactment of this Act, the Secretary shall conduct pilot projects under title XVIII of the Social Security Act for the purpose of providing incentives to home health agencies to furnish remote patient monitoring services that reduce expenditures under such title.
(2)
Site requirements—
(A)
Urban and Rural— The Secretary shall conduct the pilot projects under this section in both urban and rural areas.
(B)
Site in a small state— The Secretary shall conduct at least 1 of the pilot projects in a State with a population of less than 1,000,000.
(b)
Medicare beneficiaries within the scope of projects—
(1)
In general— The Secretary shall specify the criteria for identifying those Medicare beneficiaries who shall be considered within the scope of the pilot projects under this section for purposes of the application of subsection (c) and for the assessment of the effectiveness of the home health agency in achieving the objectives of this section.
(2)
Criteria— The criteria specified under paragraph (1)—
(A)
shall include conditions and clinical circumstances, including congestive heart failure, diabetes, and chronic pulmonary obstructive disease, and other conditions determined appropriate by the Secretary; and
(B)
may provide for the inclusion in the projects of Medicare beneficiaries who begin receiving home health services under title XVIII of the Social Security Act after the date of the implementation of the projects.
(c)
Incentives—
(1)
Performance targets— The Secretary shall establish for each home health agency participating in a pilot project under this section a performance target using one of the following methodologies, as determined appropriate by the Secretary:
(A)
Adjusted historical performance target— The Secretary shall establish for the agency—
(i)
a base expenditure amount equal to the average total payments made under parts A, B, and D of title XVIII of the Social Security Act for Medicare beneficiaries determined to be within the scope of the pilot project in a base period determined by the Secretary; and
(ii)
an annual per capita expenditure target for such beneficiaries, reflecting the base expenditure amount adjusted for risk, changes in costs, and growth rates.
(B)
Comparative performance target— The Secretary shall establish for the agency a comparative performance target equal to the average total payments made under such parts A, B, and D during the pilot project for comparable individuals in the same geographic area that are not determined to be within the scope of the pilot project.
(2)
Payment— Subject to paragraph (3), the Secretary shall pay to each home health agency participating in a pilot project a payment for each year under the pilot project equal to a 75 percent share of the total Medicare cost savings realized for such year relative to the performance target under paragraph (1).
(3)
Limitation on expenditures— The Secretary shall limit payments under this section in order to ensure that the aggregate expenditures under title XVIII of the Social Security Act (including payments under this subsection) do not exceed the amount that the Secretary estimates would have been expended if the pilot projects under this section had not been implemented, including any reasonable costs incurred by the Secretary in the administration of the pilot projects.
(4)
No duplication in participation in shared savings programs— A home health agency that participates in any of the following shall not be eligible to participate in the pilot projects under this section:
(A)
A model tested or expanded under section 1115A of the Social Security Act (42 U.S.C. 1315a) that involves shared savings under title XVIII of such Act or any other program or demonstration project that involves such shared savings.
(B)
The independence at home medical practice demonstration program under section 1866E of such Act (42 U.S.C. 1395cc–5).
(d)
Waiver authority— The Secretary may waive such provisions of titles XI and XVIII of the Social Security Act as the Secretary determines to be appropriate for the conduct of the pilot projects under this section.
(e)
Report to Congress— Not later than 3 years after the date that the first pilot project under this section is implemented, the Secretary shall submit to Congress a report on the projects. Such report shall contain—
(1)
a detailed description of the projects, including any changes in clinical outcomes for Medicare beneficiaries under the projects, Medicare beneficiary satisfaction under the projects, utilization of items and services under parts A, B, and D of title XVIII of the Social Security Act by Medicare beneficiaries under the projects, and Medicare per-beneficiary and Medicare aggregate spending under the projects;
(2)
a detailed description of issues related to the expansion of the projects under subsection (f);
(3)
recommendations for such legislation and administrative actions as the Secretary considers appropriate; and
(4)
other items considered appropriate by the Secretary.
(f)
Expansion— If the Secretary determines that any of the pilot projects under this section enhance health outcomes for Medicare beneficiaries and reduce expenditures under title XVIII of the Social Security Act, the Secretary shall initiate comparable projects in additional areas.
(g)
Payments have no effect on other Medicare payments to home health agencies— A payment under this section shall have no effect on the amount of payments that a home health agency would otherwise receive under title XVIII of the Social Security Act for the provision of home health services.
(h)
Study and report on the appropriate valuation for remote patient monitoring services under the Medicare physician fee schedule—
(1)
Study— The Secretary shall conduct a study on the appropriate valuation for remote patient monitoring services under the Medicare physician fee schedule under section 1848 of the Social Security Act (42 U.S.C. 1395w–4) in order to accurately reflect the resources involved in furnishing such services.
(2)
Report— Not later than 6 months after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under paragraph (1), together with such recommendations as the Secretary determines appropriate.
(i)
Definitions— In this section:
(1)
Home health agency— The term “home health agency” has the meaning given that term in section 1861(o) of the Social Security Act (42 U.S.C. 1395x(o)).
(2)
Remote patient monitoring services—
(A)
In general— The term remote patient monitoring services means services furnished in the home using remote patient monitoring technology which—
(i)
shall include patient monitoring or patient assessment; and
(ii)
may include in-home technology-based professional consultations, patient training services, clinical observation, treatment, and any additional services that utilize technologies specified by the Secretary.
(B)
Limitation— The term “remote patient monitoring services” shall not include a telecommunication that consists solely of a telephone audio conversation, facsimile, or electronic text mail between a health care professional and a patient.
(3)
Remote patient monitoring technology— The term remote patient monitoring technology means a coordinated system that uses one or more home-based or mobile monitoring devices that automatically transmit vital sign data or information on activities of daily living and may include responses to assessment questions collected on the devices wirelessly or through a telecommunications connection to a server that complies with the Federal regulations (concerning the privacy of individually identifiable health information) promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996, as part of an established plan of care for that patient that includes the review and interpretation of that data by a health care professional.
(4)
Secretary— The term “Secretary” means the Secretary of Health and Human Services.

Sec. 410 Community-Based Institutional Special Needs Plan Demonstration Program

(a)
In general— The Secretary of Health and Human Services (referred to in this section as the “Secretary”) shall establish a Community-Based Institutional Special Needs Plan (CBI-SNP) demonstration program to prevent and delay institutionalization under Medicaid among targeted low-income Medicare beneficiaries.
(b)
Establishment— The Secretary shall enter into agreements with not more than 5 specialized MA plans for special needs individuals, as defined in section 1859(b)(6)(B)(i) of the Social Security Act (42 U.S.C. 1395w–28(b)(6)(B)(i)), to conduct the CBI-SNP demonstration program. Under the CBI-SNP demonstration program, a targeted low-income Medicare beneficiary shall receive, as supplemental benefits under section 1852(a)(3) of such Act (42 U.S.C. 1395w-22(a)(3)), long-term care services or supports that—
(1)
the Secretary determines appropriate for the purposes of the CBI-SNP demonstration program; and
(2)
for which payment may be made under the State plan under title XIX of such Act (42 U.S.C. 1396 et seq.) of the State in which the targeted low-income Medicare beneficiary is located.
(c)
Eligible plans— To be eligible to participate in the CBI-SNP demonstration program, a specialized MA plan for special needs individuals must—
(1)
serve special needs individuals (as defined in section 1859(b)(6)(B)(i) of the Social Security Act (42 U.S.C. 1395w–28(b)(6)(B)(i));
(2)
have experience in offering special needs plans for nursing home-eligible, non-institutionalized Medicare beneficiaries who live in the community;
(3)
be located in a State that the Secretary has determined will participate in the CBI-SNP demonstration program by agreeing to make available data necessary for purposes of conducting the independent evaluation required under subsection (f); and
(4)
meet such other criteria as the Secretary may require.
(d)
Targeted low-income Medicare beneficiary defined— In this section, the term targeted low-income Medicare beneficiary means a Medicare beneficiary who—
(1)
is enrolled in a specialized MA plan for special needs individuals that has been selected to participate in the CBI-SNP demonstration program;
(2)
is a subsidy eligible individual (as defined in section 1860D–14(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)(A)); and
(3)
is unable to perform 2 or more activities of daily living (as defined in section 7702B(c)(2)(B) of the Internal Revenue Code of 1986).
(e)
Implementation deadline; duration— The CBI-SNP demonstration program shall be implemented not later than January 1, 2016, and shall be conducted for a period of 3 years.
(f)
Independent evaluation and reports—
(1)
Independent evaluation— Not later than 2 years after the completion of the CBI-SNP demonstration program, the Secretary shall provide for the evaluation of the CBI-SNP demonstration program by an independent third party. The evaluation shall determine whether the CBI-SNP demonstration program has improved patient care and quality of life for the targeted low-income Medicare beneficiaries participating in the CBI-SNP demonstration program. Specifically, the evaluation shall determine if the CBI-SNP demonstration program has—
(A)
reduced hospitalizations or re-hospitalizations;
(B)
reduced Medicaid nursing home facility stays; and
(C)
reduced spenddown of income and assets for purposes of becoming eligible for Medicaid.
(2)
Reports— Not later than 3 years after the completion of the CBI-SNP demonstration program, the Secretary shall submit to Congress a report containing the results of the evaluation conducted under paragraph (1), together with such recommendations for legislative or administrative action as the Secretary determines appropriate.
(g)
Funding—
(1)
Funding for implementation— For purposes of carrying out the demonstration program under this section (other than the evaluation and report under subsection (f)), the Secretary shall provide for the transfer 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 such proportion as the Secretary determines appropriate, of $3,000,000 to the Centers for Medicare & Medicaid Services Program Management Account.
(2)
Funding for evaluation and report— For purposes of carrying out the evaluation and report under subsection (f), the Secretary shall provide for the transfer from the Federal Hospital Insurance Trust Fund under such section 1817 and the Federal Supplementary Medical Insurance Trust Fund under such section 1841, in such proportion as the Secretary determines appropriate, of $500,000.
(3)
Availability— Amounts transferred under paragraph (1) or (2) shall remain available until expended.
(h)
Budget neutrality— In conducting the CBI-SNP demonstration program, the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary estimates would have been expended under titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq., 1396 et seq.) if the CBI-SNP demonstration program had not been implemented.
(i)
Paperwork Reduction Act— Chapter 35 of title 44, United States Code, shall not apply to the testing and evaluation of the CBI-SNP demonstration program under this section.

Sec. 411 Applying CMMI waiver authority to PACE in order to foster innovations

(a)
CMMI waiver authority— Subsection (d)(1) of section 1115A of the Social Security Act (42 U.S.C. 1315a) is amended—
(1)
by inserting “(other than subsections (b)(1)(A) and (c)(5) of section 1894)” after “XVIII”; and
(2)
by striking “and 1903(m)(2)(A)(iii)” and inserting “1903(m)(2)(A)(iii), and 1934 (other than subsections (b)(1)(A) and (c)(5) of such section)”.
(b)
Sense of the Senate— It is the sense of the Senate that the Secretary of Health and Human Services should use the waiver authority provided under the amendments made by this section to provide, in a budget neutral manner, programs of all-inclusive care for the elderly (PACE programs) with increased operational flexibility to support the ability of such programs to improve and innovate and to reduce technical and administrative barriers that have hindered enrollment in such programs.

Sec. 412 Improve and modernize Medicaid data systems and reporting

(a)
In general— The Secretary of Health and Human Services shall implement a strategic plan to increase the usefulness of data about State Medicaid programs reported by States to the Centers for Medicare & Medicaid Services. The strategic plan shall address redundancies and gaps in Medicaid data systems and reporting through improvements to, and modernization of, computer and data systems. Areas for improvement under the plan shall include (but not be limited to) the following:
(1)
The reporting of encounter data by managed care plans.
(2)
The timeliness and quality of reported data, including enrollment data.
(3)
The consistency of data reported from multiple sources.
(4)
Information about State program policies.
(b)
Implementation status report— Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall submit a report to Congress on the status of the implementation of the strategic plan required under subsection (a).
(c)
Authorization of appropriations— There is authorized to be appropriated to the Secretary of Health and Human Services for the period of fiscal years 2015 through 2019, such sums as may be necessary to carry out this section.

Sec. 413 Fairness in Medicaid supplemental needs trusts

(a)
In general— Section 1917(d)(4)(A) of the Social Security Act (42 U.S.C. 1396p(d)(4)(A)) is amended by inserting “the individual,” after “for the benefit of such individual by”.
(b)
Effective date— The amendment made by subsection (a) shall apply to trusts established on or after the date of the enactment of this Act.

Sec. 414 Helping Ensure Life- and Limb-Saving Access to Podiatric Physicians

(a)
Including podiatrists as physicians under the Medicaid program—
(1)
In general— Section 1905(a)(5)(A) of the Social Security Act (42 U.S.C. 1396d(a)(5)(A)) is amended by striking “section 1861(r)(1)” and inserting “paragraphs (1) and (3) of section 1861(r)”.
(2)
Effective date—
(A)
In general— Except as provided in subparagraph (B), the amendment made by paragraph (1) shall apply to services furnished on or after the date of enactment of this Act.
(B)
Extension of effective date for State law amendment— In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet the additional requirement imposed by the amendment made by paragraph (1), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.
(b)
Modifications to requirements for diabetic shoes to be included under medical and other health services under Medicare—
(1)
In general— Section 1861(s)(12) of the Social Security Act (42 U.S.C. 1395x(s)(12)) is amended to read as follows:

“(12) subject to section 4072(e) of the Omnibus Budget Reconciliation Act of 1987, extra-depth shoes with inserts or custom molded shoes (in this paragraph referred to as “therapeutic shoes”) with inserts for an individual with diabetes, if—

“(A) the physician who is managing the individual’s diabetic condition—

“(i) documents that the individual has diabetes;

“(ii) certifies that the individual is under a comprehensive plan of care related to the individual’s diabetic condition; and

“(iii) documents agreement with the prescribing podiatrist or other qualified physician (as established by the Secretary) that it is medically necessary for the individual to have such extra-depth shoes with inserts or custom molded shoes with inserts;

“(B) the therapeutic shoes are prescribed by a podiatrist or other qualified physician (as established by the Secretary) who—

“(i) examines the individual and determines the medical necessity for the individual to receive the therapeutic shoes; and

“(ii) communicates in writing the medical necessity to the physician described in subparagraph (A) for the individual to have therapeutic shoes along with findings that the individual has peripheral neuropathy with evidence of callus formation, a history of pre-ulcerative calluses, a history of previous ulceration, foot deformity, previous amputation, or poor circulation; and

“(C) the therapeutic shoes are fitted and furnished by a podiatrist or other qualified supplier (as established by the Secretary), such as a pedorthist or orthotist, who is not the physician described in subparagraph (A) (unless the Secretary finds that the physician is the only such qualified individual in the area);”

(2)
Effective date— The amendment made by paragraph (1) shall apply with respect to items and services furnished on or after January 1, 2015.

Sec. 415 Demonstration programs to improve community mental health services

(a)
Criteria for certified community behavioral health clinics to participate in demonstration programs—
(1)
Publication— Not later than September 1, 2015, the Secretary shall publish criteria for a clinic to be certified by a State as a certified community behavioral health clinic for purposes of participating in a demonstration program conducted under subsection (d).
(2)
Requirements— The criteria published under this subsection shall include criteria with respect to the following:
(A)
Staffing— Staffing requirements, including criteria that staff have diverse disciplinary backgrounds, have necessary State-required license and accreditation, and are culturally and linguistically trained to serve the needs of the clinic's patient population.
(B)
Availability and accessibility of services— Availability and accessibility of services, including crisis management services that are available and accessible 24 hours a day, the use of a sliding scale for payment, and no rejection for services or limiting of services on the basis of a patient's ability to pay or a place of residence.
(C)
Care coordination— Care coordination, including requirements to coordinate care across settings and providers to ensure seamless transitions for patients across the full spectrum of health services including acute, chronic, and behavioral health needs. Care coordination requirements shall include partnerships or formal contracts with the following:
(i)
Federally-qualified health centers (and as applicable, rural health clinics) to provide Federally-qualified health center services (and as applicable, rural health clinic services) to the extent such services are not provided directly through the certified community behavioral health clinic.
(ii)
Inpatient psychiatric facilities and substance use detoxification, post-detoxification step-down services, and residential programs.
(iii)
Other community or regional services, supports, and providers, including schools, child welfare agencies, juvenile and criminal justice agencies and facilities, Indian Health Service youth regional treatment centers, State licensed and nationally accredited child placing agencies for therapeutic foster care service, and other social and human services.
(iv)
Department of Veterans Affairs medical centers, independent outpatient clinics, drop-in centers, and other facilities of the Department as defined in section 1801 of title 38, United States Code.
(v)
Inpatient acute care hospitals and hospital outpatient clinics.
(D)
Scope of services— Provision (in a manner reflecting person-centered care) of the following services which, if not available directly through the certified community behavioral health clinic, are provided or referred through formal relationships with other providers:
(i)
Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization.
(ii)
Screening, assessment, and diagnosis, including risk assessment.
(iii)
Patient-centered treatment planning or similar processes, including risk assessment and crisis planning.
(iv)
Outpatient mental health and substance use services.
(v)
Outpatient clinic primary care screening and monitoring of key health indicators and health risk.
(vi)
Targeted case management.
(vii)
Psychiatric rehabilitation services.
(viii)
Peer support and counselor services and family supports.
(ix)
Intensive, community-based mental health care for members of the armed forces and veterans, particularly those members and veterans located in rural areas, provided the care is consistent with minimum clinical mental health guidelines promulgated by the Veterans Health Administration including clinical guidelines contained in the Uniform Mental Health Services Handbook of such Administration.
(E)
Quality and other reporting— Reporting of encounter data, clinical outcomes data, quality data, and such other data as the Secretary requires.
(F)
Organizational authority— Criteria that a clinic be a non-profit or part of a local government behavioral health authority or operated under the authority of the Indian Health Service, an Indian tribe or tribal organization pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination Act (25 U.S.C. 450 et seq.), or an urban Indian organization pursuant to a grant or contract with the Indian Health Service under title V of the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.).
(b)
Guidance on development of prospective payment system for testing under demonstration programs—
(1)
In general— Not later than September 1, 2015, the Secretary, through the Administrator of the Centers for Medicare & Medicaid Services, shall issue guidance for the establishment of a prospective payment system that shall only apply to medical assistance for mental health services furnished by a certified community behavioral health clinic participating in a demonstration program under subsection (d).
(2)
Requirements— The guidance issued by the Secretary under paragraph (1) shall provide that—
(A)
no payment shall be made for inpatient care, residential treatment, room and board expenses, or any other non-ambulatory services, as determined by the Secretary; and
(B)
no payment shall be made to satellite facilities of certified community behavioral health clinics if such facilities are established after the date of enactment of this Act.
(c)
Planning grants—
(1)
In general— Not later than January 1, 2016, the Secretary shall award planning grants to States for the purpose of developing proposals to participate in time-limited demonstration programs described in subsection (d).
(2)
Use of funds— A State awarded a planning grant under this subsection shall—
(A)
solicit input with respect to the development of such a demonstration program from patients, providers, and other stakeholders;
(B)
certify clinics as certified community behavioral health clinics for purposes of participating in a demonstration program conducted under subsection (d); and
(C)
establish a prospective payment system for mental health services furnished by a certified community behavioral health clinic participating in a demonstration program under subsection (d) in accordance with the guidance issued under subsection (b).
(d)
Demonstration programs—
(1)
In general— Not later than September 1, 2017, the Secretary shall select States to participate in demonstration programs that are developed through planning grants awarded under subsection (c), meet the requirements of this subsection, and represent a diverse selection of geographic areas, including rural and underserved areas.
(2)
Application requirements—
(A)
In general— The Secretary shall solicit applications to participate in demonstration programs under this subsection solely from States awarded planning grants under subsection (c).
(B)
Required information— An application for a demonstration program under this subsection shall include the following:
(i)
The target Medicaid population to be served under the demonstration program.
(ii)
A list of participating certified community behavioral health clinics.
(iii)
Verification that the State has certified a participating clinic as a certified community behavioral health clinic in accordance with the requirements of subsection (b).
(iv)
A description of the scope of the mental health services available under the State Medicaid program that will be paid for under the prospective payment system tested in the demonstration program.
(v)
Verification that the State has agreed to pay for such services at the rate established under the prospective payment system.
(vi)
Such other information as the Secretary may require relating to the demonstration program including with respect to determining the soundness of the proposed prospective payment system.
(3)
Number and length of demonstration programs— Not more than 8 States shall be selected for 4-year demonstration programs under this subsection.
(4)
Requirements for selecting demonstration programs—
(A)
In general— The Secretary shall give preference to selecting demonstration programs where participating certified community behavioral health clinics—
(i)
provide the most complete scope of services described in subsection (a)(2)(D) to individuals eligible for medical assistance under the State Medicaid program;
(ii)
will improve availability of, access to, and participation in, services described in subsection (a)(2)(D) to individuals eligible for medical assistance under the State Medicaid program;
(iii)
will improve availability of, access to, and participation in assisted outpatient mental health treatment in the State; or
(iv)
demonstrate the potential to expand available mental health services in a demonstration area and increase the quality of such services without increasing net Federal spending.
(5)
Payment for medical assistance for mental health services provided by certified community behavioral health clinics—
(A)
In general— The Secretary shall pay a State participating in a demonstration program under this subsection the Federal matching percentage specified in subparagraph (B) for amounts expended by the State to provide medical assistance for mental health services described in the demonstration program application in accordance with paragraph (2)(B)(iv) that are provided by certified community behavioral health clinics to individuals who are enrolled in the State Medicaid program. Payments to States made under this paragraph shall be considered to have been under, and are subject to the requirements of, section 1903 of the Social Security Act (42 U.S.C. 1396b).
(B)
Federal matching percentage— The Federal matching percentage specified in this subparagraph is with respect to medical assistance described in subparagraph (A) that is furnished—
(i)
to a newly eligible individual described in paragraph (2) of section 1905(y) of the Social Security Act (42 U.S.C. 1396d(y)), the matching rate applicable under paragraph (1) of that section; and
(ii)
to an individual who is not a newly eligible individual (as so described) but who is eligible for medical assistance under the State Medicaid program, the enhanced FMAP applicable to the State.
(C)
Limitations—
(i)
In general— Payments shall be made under this paragraph to a State only for mental health services—
(I)
that are described in the demonstration program application in accordance with paragraph (2)(B)(iv);
(II)
for which payment is available under the State Medicaid program; and
(III)
that are provided to an individual who is eligible for medical assistance under the State Medicaid program.
(ii)
Prohibited payments— No payment shall be made under this paragraph—
(I)
for inpatient care, residential treatment, room and board expenses, or any other non-ambulatory services, as determined by the Secretary; or
(II)
with respect to payments made to satellite facilities of certified community behavioral health clinics if such facilities are established after the date of enactment of this Act.
(6)
Waiver of statewideness requirement— The Secretary shall waive section 1902(a)(1) of the Social Security Act (42 U.S.C. 1396a(a)(1)) (relating to statewideness) as may be necessary to conduct demonstration programs in accordance with the requirements of this subsection.
(7)
Annual reports—
(A)
In general— Not later than 1 year after the date on which the first State is selected for a demonstration program under this subsection, and annually thereafter, the Secretary shall submit to Congress an annual report on the use of funds provided under all demonstration programs conducted under this subsection. Each such report shall include—
(i)
an assessment of access to community-based mental health services under the Medicaid program in the area or areas of a State targeted by a demonstration program compared to other areas of the State;
(ii)
an assessment of the quality and scope of services provided by certified community behavioral health clinics compared to community-based mental health services provided in States not participating in a demonstration program under this subsection and in areas of a demonstration State that are not participating in the demonstration program; and
(iii)
an assessment of the impact of the demonstration programs on the Federal and State costs of a full range of mental health services (including inpatient, emergency and ambulatory services).
(B)
Recommendations— Not later than December 31, 2021, the Secretary shall submit to Congress recommendations concerning whether the demonstration programs under this section should be continued, expanded, modified, or terminated.
(e)
Definitions— In this section:
(1)
Federally-qualified health center services; Federally-qualified health center; rural health clinic services; rural health clinic— The terms Federally-qualified health center services, Federally-qualified health center, rural health clinic services, and rural health clinic have the meanings given those terms in section 1905(l) of the Social Security Act (42 U.S.C. 1396d(l)).
(2)
Enhanced FMAP— The term enhanced FMAP has the meaning given that term in section 2105(b) of the Social Security Act (42 U.S.C. 1397dd(b) but without regard to the second and third sentences of that section.
(3)
Secretary— The term Secretary means the Secretary of Health and Human Services.
(4)
State— The term State has the meaning given such term for purposes of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
(f)
Funding—
(1)
In general— Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary—
(A)
for purposes of carrying out subsections (a), (b), and (d)(7), $2,000,000 for fiscal year 2014; and
(B)
for purposes of awarding planning grants under subsection (c), $25,000,000 for fiscal year 2016.
(2)
Availability— Funds appropriated under paragraph (1) shall remain available until expended.

Sec. 416 Annual Medicaid DSH report

Section 1923 of the Social Security Act (42 U.S.C. 1396r–4) is amended by adding at the end the following:

“(k) Annual report to Congress

“(1) In general—Beginning January 1, 2015, and annually thereafter, the Secretary shall submit a report to Congress on the program established under this section for making payment adjustments to disproportionate share hospitals for the purpose of providing Congress with information relevant to determining an appropriate level of overall funding for such payment adjustments during and after the period in which aggregate reductions in the DSH allotments to States are required under paragraphs (7) and (8) of subsection (f).

“(2) Required report information—Except as otherwise provided, each report submitted under this subsection shall include the following:

“(A) Information and data relating to changes in the number of uninsured individuals for the most recent year for which such data are available as compared to 2013 and as compared to the Congressional Budget Office estimates of uninsured individuals made at the time of the enactment of the Patient Protection and Affordable Care Act (Public Law 111–148) and the Health Care and Education Reconciliation Act of 2010 (Public Law 111–152).

“(B) Information and data relating to the extent to which hospitals continue to incur uncompensated care costs from providing unreimbursed or under-reimbursed services to individuals who either are eligible for medical assistance under the State plan under this title or under a waiver of such plan or who have no health insurance (or other source of third party coverage) for such services.

“(C) Information and data relating to the extent to which hospitals continue to provide charity care and unreimbursed or under-reimbursed services, or otherwise incur bad debt, under the program established under this title, the State Children's Health Insurance Program established under title XXI, and State or local indigent care programs, as reported on cost reports submitted under title XVIII or such other data as the Secretary determines appropriate.

“(D) In the first report submitted under this section, a methodology for estimating the amount of unpaid patient deductibles, copayments and coinsurance incurred by hospitals for patients enrolled in qualified health plans through an American Health Benefits Exchange, using existing data and minimizing the administrative burden on hospitals to the extent possible, and in subsequent reports, data regarding such uncompensated care costs collected pursuant to such methodology.

“(E) For each State, information and data relating to the difference between the DSH allotment for the State for the fiscal year that began on October 1 of the year preceding the year in which the report is submitted and the aggregate amount of uncompensated care costs for all disproportionate share hospitals in the State.

“(F) Information and data relating to the extent to which there are certain vital hospital systems that are disproportionately experiencing high levels of uncompensated care and that have multiple other missions, such as a commitment to graduate medical education, the provision of tertiary and trauma care services, providing public health and essential community services, and providing comprehensive, coordinated care.

“(G) Such other information and data relevant to the determination of the level of funding for, and amount of, State DSH allotments as the Secretary determines appropriate

“(3) Authorization of appropriations—There is authorized to be appropriated to the Secretary for the period of fiscal years 2015 through 2019, such sums as may be necessary to carry out this subsection.”

Sec. 417 Implementation

To the extent the Secretary of Health and Human Services issues a regulation to carry out the provisions of this Act, the Secretary shall, unless otherwise specified in this Act—
(1)
issue a notice of proposed rulemaking that includes the proposed regulation;
(2)
provide a period of not less than 60 calendar days for comments on the proposed regulation;
(3)
not more than 24 months following the date of publication of the proposed rule, publish the final regulation or take alternative action (such as withdrawing the rule or proposing a revised rule with a new comment period) on the proposed regulation; and
(4)
not less than 30 days before the effective date of the final regulation, publish the final regulation or take alternative action (such as withdrawing the rule or proposing a revised rule with a new comment period) on the proposed regulation.