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Title II — Rural and Quality Improvements

H.R. 3417 · 116th Congress · Jun 21, 2019 · Lineage

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 trains residents and has not entered into a GME affiliation agreement (as defined by the Secretary for purposes of paragraph (4)(H)(ii)), on or after the date of the enactment of this clause, 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 or programs 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,

“(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 residents in an approved medical residency training program or programs 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 training residents in a new approved medical residency training program or programs (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 or programs 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 begins training at least 1.0 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.

“(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 entity—

“(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

“(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.”

(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.