US Codex
Pub. L.
Notes

Title IV — Offsets

114th Congress · Approved Apr 16, 2015 · 129 Stat. 87

TITLE IV Offsets

Subtitle A Medicare Beneficiary Reforms

SEC. 401. Limitation on Certain Medigap Policies for Newly Eligible Medicare Beneficiaries.

Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is amended by adding at the end the following new subsection:

“(z) Limitation on Certain Medigap Policies for Newly Eligible Medicare Beneficiaries.—

“(1) In general.—Notwithstanding any other provision of this section, on or after January 1, 2020, a medicare supplemental policy that provides coverage of the part B deductible, including any such policy (or rider to such a policy) issued under a waiver granted under subsection (p)(6), may not be sold or issued to a newly eligible Medicare beneficiary.

“(2) Newly eligible medicare beneficiary defined.—In this subsection, the term ‘newly eligible Medicare beneficiary’ means an individual who is neither of the following:

“(A) An individual who has attained age 65 before January 1, 2020.

“(B) An individual who was entitled to benefits under part A pursuant to section 226(b) or 226A, or deemed to be eligible for benefits under section 226(a), before January 1, 2020.

“(3) Treatment of waivered states.—In the case of a State described in subsection (p)(6), nothing in this section shall be construed as preventing the State from modifying its alternative simplification program under such subsection so as to eliminate the coverage of the part B deductible for any medical supplemental policy sold or issued under such program to a newly eligible Medicare beneficiary on or after January 1, 2020.

“(4) Treatment of references to certain policies.—In the case of a newly eligible Medicare beneficiary, except as the Secretary may otherwise provide, any reference in this section to a medicare supplemental policy which has a benefit package classified as ‘C’ or ‘F’ shall be deemed, as of January 1, 2020, to be a reference to a medicare supplemental policy which has a benefit package classified as ‘D’ or ‘G’, respectively.

“(5) Enforcement.—The penalties described in clause (ii) of subsection (d)(3)(A) shall apply with respect to a violation of paragraph (1) in the same manner as it applies to a violation of clause (i) of such subsection.”

SEC. 402. Income-Related Premium Adjustment for Parts B and D.

(a)
In General.— Section 1839(i)(3)(C)(i) of the Social Security Act (42 U.S.C. 1395r(i)(3)(C)(i)) is amended—
(1)
by inserting after “ In general.—” the following:

“(I) Subject to paragraphs (5) and (6), for years before 2018:”

; and

(2)
by adding at the end the following:

“(II) Subject to paragraph (5), for years beginning with 2018:
“If the modified adjusted gross income is: The applicable percentage is:
More than $85,000 but not more than $107,000 35 percent
More than $107,000 but not more than $133,500 50 percent
More than $133,500 but not more than $160,000 65 percent
More than $160,000 80 percent.”.
(b)
Conforming Amendments.— Section 1839(i) of the Social Security Act (42 U.S.C. 1395r(i)) is amended—
(1)
in paragraph (2)(A), by inserting “ (or, beginning with 2018, $85,000)” after “ $80,000”;
(2)
in paragraph (3)(A)(i), by inserting “ applicable” before “ table”;
(3)
in paragraph (5)(A)—
(A)
in the matter before clause (i), by inserting “ (other than 2018 and 2019)” after “ 2007”; and
(B)
in clause (ii), by inserting “ (or, in the case of a calendar year beginning with 2020, August 2018)” after “ August 2006”; and
(4)
in paragraph (6), in the matter before subparagraph (A), by striking “ 2019” and inserting “ 2017”.

Subtitle B Other Offsets

SEC. 411. Medicare Payment Updates for Post-Acute Providers.

(a)
SNFs.— Section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e))—
(1)
in paragraph (5)(B)—
(A)
in clause (i), by striking “ clause (ii)” and inserting “ clauses (ii) and (iii)”;
(B)
in clause (ii), by inserting “ subject to clause (iii),” after “ each subsequent fiscal year,”; and
(C)
by adding at the end the following new clause:

“(iii) Special rule for fiscal year 2018.—For fiscal year 2018 (or other similar annual period specified in clause (i)), the skilled nursing facility market basket percentage, after application of clause (ii), is equal to 1 percent.”

; and

(2)
in paragraph (6)(A), by striking “ paragraph (5)(B)(ii)” and inserting “ clauses (ii) and (iii) of paragraph (5)(B)” each place it appears.
(b)
IRFs.— Section 1886(j) of the Social Security Act (42 U.S.C. 1395ww(j)) is amended—
(1)
in paragraph (3)(C)—
(A)
in clause (i), by striking “ clause (ii)” and inserting “ clauses (ii) and (iii)”;
(B)
in clause (ii), by striking “ After” and inserting “ Subject to clause (iii), after”; and
(C)
by adding at the end the following new clause:

“(iii) Special rule for fiscal year 2018.—The increase factor to be applied under this subparagraph for fiscal year 2018, after the application of clause (ii), shall be 1 percent.”

; and

(2)
in paragraph (7)(A)(i), by striking “ paragraph (3)(D)” and inserting “ subparagraphs (C)(iii) and (D) of paragraph (3)”.
(c)
HHAs.— Section 1895(b)(3)(B) of the Social Security Act (42 U.S.C. 1395fff(b)(3)(B)) is amended—
(1)
in clause (iii), by adding at the end the following: “ Notwithstanding the previous sentence, the home health market basket percentage increase for 2018 shall be 1 percent.”; and
(2)
in clause (vi)(I), by inserting “ (except 2018)” after “ each subsequent year”.
(d)
Hospice.— Section 1814(i) of the Social Security Act (42 U.S.C. 1395f(i)) is amended—
(1)
in paragraph (1)(C)—
(A)
in clause (ii)(VII), by striking “ clause (iv),,” and inserting “ clauses (iv) and (vi),”;
(B)
in clause (iii), by striking “ clause (iv),” and inserting “ clauses (iv) and (vi),”;
(C)
in clause (iv), by striking “ After determining” and inserting “ Subject to clause (vi), after determining”; and
(D)
by adding at the end the following new clause:

“(vi) For fiscal year 2018, the market basket percentage increase under clause (ii)(VII) or (iii), as applicable, after application of clause (iv), shall be 1 percent.”

; and

(2)
in paragraph (5)(A)(i), by striking “ paragraph (1)(C)(iv)” and inserting “ clauses (iv) and (vi) of paragraph (1)(C)”.
(e)
LTCHs.— Section 1886(m)(3) of the Social Security Act (42 U.S.C. 1395ww(m)(3)) is amended—
(1)
in subparagraph (A), in the matter preceding clause (i), by striking “ In implementing” and inserting “ Subject to subparagraph (C), in implementing”; and
(2)
by adding at the end the following new subparagraph:

“(C) Additional special rule.—For fiscal year 2018, the annual update under subparagraph (A) for the fiscal year, after application of clauses (i) and (ii) of subparagraph (A), shall be 1 percent.”

SEC. 412. Delay of Reduction to Medicaid Dsh Allotments.

Section 1923(f) of the Social Security Act (42 U.S.C. 1396r–4(f)) is amended—
(1)
in paragraph (7)(A)—
(A)
in clause (i), by striking “ 2017 through 2024” and inserting “ 2018 through 2025”;
(B)
by striking clause (ii) and inserting the following new clause:

“(ii) Aggregate reductions.—The aggregate reductions in DSH allotments for all States under clause (i)(I) shall be equal to—

“(I) $2,000,000,000 for fiscal year 2018;

“(II) $3,000,000,000 for fiscal year 2019;

“(III) $4,000,000,000 for fiscal year 2020;

“(IV) $5,000,000,000 for fiscal year 2021;

“(V) $6,000,000,000 for fiscal year 2022;

“(VI) $7,000,000,000 for fiscal year 2023;

“(VII) $8,000,000,000 for fiscal year 2024; and

“(VIII) $8,000,000,000 for fiscal year 2025.”

; and

(C)
by adding at the end the following new clause:

“(v) Distribution of aggregate reductions.—The Secretary shall distribute the aggregate reductions under clause (ii) among States in accordance with subparagraph (B).”

; and

(2)
in paragraph (8), by striking “ 2024” and inserting “ 2025”.

SEC. 413. Levy on Delinquent Providers.

(a)
In General.— Paragraph (3) of section 6331(h) of the Internal Revenue Code of 1986 is amended by striking “ 30 percent” and inserting “ 100 percent”.
(b)
Effective Date.— The amendment made by this section shall apply to payments made after 180 days after the date of the enactment of this Act.

SEC. 414. Adjustments to Inpatient Hospital Payment Rates.

Section 7(b) of the TMA, Abstinence Education, and QI Programs Extension Act of 2007 (Public Law 110–90), as amended by section 631(b) of the American Taxpayer Relief Act of 2012 (Public Law 112–240), is amended—
(1)
in paragraph (1)—
(A)
in the matter preceding subparagraph (A), by striking “ , 2009, or 2010” and inserting “ or 2009”; and
(B)
in subparagraph (B)—
(i)
in clause (i), by striking “ and” at the end;
(ii)
in clause (ii), by striking the period at the end and inserting “ ; and”; and
(iii)
by adding at the end the following new clause:

“(iii) make an additional adjustment to the standardized amounts under such section 1886(d) of an increase of 0.5 percentage points for discharges occurring during each of fiscal years 2018 through 2023 and not make the adjustment (estimated to be an increase of 3.2 percent) that would otherwise apply for discharges occurring during fiscal year 2018 by reason of the completion of the adjustments required under clause (ii).”

(2)
in paragraph (3)—
(A)
by striking “ shall be construed” and all that follows through “ providing authority” and inserting “ shall be construed as providing authority”; and
(B)
by inserting “ and each succeeding fiscal year through fiscal year 2023” after “ 2017”;
(3)
by redesignating paragraphs (3) and (4) as paragraphs (4) and (5), respectively; and
(4)
by inserting after paragraph (2) the following new paragraph:

“(3) Prohibition.—The Secretary shall not make an additional prospective adjustment (estimated to be a decrease of 0.55 percent) to the standardized amounts under such section 1886(d) to offset the amount of the increase in aggregate payments related to documentation and coding changes for discharges occurring during fiscal year 2010.”