---
kind: "section"
citation: "42 U.S.C. § 1395lll"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1395lll"
heading: "Standardized post-acute care (PAC) assessment data for quality, payment, and discharge planning"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1395lll"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XVIII — Health Insurance for Aged and Disabled"
  - "Part E — Miscellaneous Provisions"
---

# §1395lll. Standardized post-acute care (PAC) assessment data for quality, payment, and discharge planning

- (a) **Requirement for standardized assessment data—**
  - (1) **In general—** The [Secretary](/usc/42/1301.md?p=a-6) shall—
    - (A) require under the applicable reporting provisions post-acute care providers (as defined in [paragraph (2)(A)](#a-2-A)) to report—
      - (i) standardized patient assessment data in accordance with [subsection (b)](#b);
      - (ii) data on quality measures under [subsection (c)(1)](#c-1); and
      - (iii) data on resource use and other measures under [subsection (d)(1)](#d-1);
    - (B) require data described in [subparagraph (A)](#a-1-A) to be standardized and interoperable so as to allow for the exchange of such data among such post-acute care providers and other providers and the use by such providers of such data that has been so exchanged, [including](/usc/42/1301.md?p=b) by using common [standards](/usc/42/1320d.md?p=7) and definitions, in order to provide access to longitudinal information for such providers to facilitate coordinated care and improved Medicare beneficiary outcomes; and
    - (C) in accordance with subsections [(b)(1)](#b-1) and [(c)(2)](#c-2), modify PAC assessment instruments (as defined in [paragraph (2)(B)](#a-2-B)) applicable to post-acute care providers to—
      - (i) provide for the submission of standardized patient assessment data under this subchapter with respect to such providers; and
      - (ii) enable comparison of such assessment data across all such providers to whom such data are applicable.
  - (2) **Definitions—** For purposes of this section:
    - (A) **Post-acute care (PAC) provider—** The terms “post-acute care provider” and “PAC provider” mean—
      - (i) a [home health agency](/usc/42/1395x.md?p=o);
      - (ii) a [skilled nursing facility](/usc/42/1395x.md?p=j);
      - (iii) an inpatient [rehabilitation facility](/usc/42/300s–3.md?p=5); and
      - (iv) a [long-term care hospital](/usc/42/1395x.md?p=ccc) (other than a [hospital](/usc/42/1395x.md?p=e) classified under [section 1395ww(d)(1)(B)(vi) of this title](/usc/42/1395ww.md?p=d-1-B-vi)).
    - (B) **PAC assessment instrument—** The term “PAC assessment instrument” means—
      - (i) in the case of [home health agencies](/usc/42/1395x.md?p=o), the instrument used for purposes of reporting and assessment with respect to the Outcome and Assessment Information Set (OASIS), as described in sections 484.55 and 484.250 of title 42, the Code of Federal Regulations, or any successor regulation, or any other instrument used with respect to [home health agencies](/usc/42/1395x.md?p=o) for such purposes;
      - (ii) in the case of [skilled nursing facilities](/usc/42/1395x.md?p=j), the resident’s assessment under [section 1395i–3(b)(3) of this title](/usc/42/1395i–3.md?p=b-3);
      - (iii) in the case of inpatient [rehabilitation facilities](/usc/42/300s–3.md?p=5), any Medicare beneficiary assessment instrument established by the [Secretary](/usc/42/1301.md?p=a-6) for purposes of [section 1395ww(j) of this title](/usc/42/1395ww.md?p=j); and
      - (iv) in the case of [long-term care hospitals](/usc/42/1395x.md?p=ccc), the Medicare beneficiary assessment instrument used with respect to such [hospitals](/usc/42/1395x.md?p=e) for the collection of data elements necessary to calculate quality measures as described in the August 18, 2011, Federal Register (76 Fed. Reg. 51754–51755), [including](/usc/42/1301.md?p=b) for purposes of [section 1395ww(m)(5)(C) of this title](/usc/42/1395ww.md?p=m-5-C), or any other instrument used with respect to such [hospitals](/usc/42/1395x.md?p=e) for assessment purposes.
    - (C) **Applicable reporting provision—** The term “applicable reporting provision” means—
      - (i) for [home health agencies](/usc/42/1395x.md?p=o), [section 1395fff(b)(3)(B)(v) of this title](/usc/42/1395fff.md?p=b-3-B-v);
      - (ii) for [skilled nursing facilities](/usc/42/1395x.md?p=j), [section 1395yy(e)(6) of this title](/usc/42/1395yy.md?p=e-6);
      - (iii) for inpatient [rehabilitation facilities](/usc/42/300s–3.md?p=5), [section 1395ww(j)(7) of this title](/usc/42/1395ww.md?p=j-7); and
      - (iv) for [long-term care hospitals](/usc/42/1395x.md?p=ccc), [section 1395ww(m)(5) of this title](/usc/42/1395ww.md?p=m-5).
    - (D) **PAC payment system—** The term “PAC payment system” means—
      - (i) with respect to a [home health agency](/usc/42/1395x.md?p=o), the prospective payment system under [section 1395fff of this title](/usc/42/1395fff.md);
      - (ii) with respect to a [skilled nursing facility](/usc/42/1395x.md?p=j), the prospective payment system under [section 1395yy(e) of this title](/usc/42/1395yy.md?p=e);
      - (iii) with respect to an inpatient [rehabilitation facility](/usc/42/300s–3.md?p=5), the prospective payment system under [section 1395ww(j) of this title](/usc/42/1395ww.md?p=j); and
      - (iv) with respect to a [long-term care hospital](/usc/42/1395x.md?p=ccc), the prospective payment system under [section 1395ww(m) of this title](/usc/42/1395ww.md?p=m).
    - (E) **Specified application date—** The term “specified application date” means the following:
      - (i) **Quality measures—** In the case of quality measures under [subsection (c)(1)](#c-1)—
        - (I) with respect to the domain described in [subsection (c)(1)(A)](#c-1-A) (relating to functional status, cognitive function, and changes in function and cognitive function)—
          - (aa) for PAC providers described in clauses [(ii)](#a-2-A-ii) and [(iii)](#a-2-A-iii) of paragraph (2)(A), October 1, 2016;
          - (bb) for PAC providers described in clause (iv) of such paragraph, October 1, 2018; and
          - (cc) for PAC providers described in [clause (i)](#a-2-E-i) of such paragraph, January 1, 2019;
        - (II) with respect to the domain described in [subsection (c)(1)(B)](#c-1-B) (relating to skin integrity and changes in skin integrity)—
          - (aa) for PAC providers described in clauses [(ii)](#a-2-A-ii), [(iii)](#a-2-A-iii), and [(iv)](#a-2-A-iv) of paragraph (2)(A), October 1, 2016; and
          - (bb) for PAC providers described in [clause (i)](#a-2-E-i) of such paragraph, January 1, 2017;
        - (III) with respect to the domain described in [subsection (c)(1)(C)](#c-1-C) (relating to medication reconciliation)—
          - (aa) for PAC providers described in [clause (i)](#a-2-E-i) of such paragraph, January 1, 2017; and
          - (bb) for PAC providers described in clauses [(ii)](#a-2-E-ii), (iii), and (iv) of such paragraph, October 1, 2018;
        - (IV) with respect to the domain described in [subsection (c)(1)(D)](#c-1-D) (relating to incidence of major falls)—
          - (aa) for PAC providers described in clauses [(ii)](#a-2-A-ii), [(iii)](#a-2-A-iii), and [(iv)](#a-2-A-iv) of paragraph (2)(A), October 1, 2016; and
          - (bb) for PAC providers described in [clause (i)](#a-2-E-i) of such paragraph, January 1, 2019; and
        - (V) with respect to the domain described in [subsection (c)(1)(E)](#c-1-E) (relating to accurately communicating the existence of and providing for the transfer of [health information](/usc/42/1320d.md?p=4) and care preferences)—
          - (aa) for PAC providers described in clauses [(ii)](#a-2-A-ii), [(iii)](#a-2-A-iii), and [(iv)](#a-2-A-iv) of paragraph (2)(A), October 1, 2018; and
          - (bb) for PAC providers described in [clause (i)](#a-2-E-i) of such paragraph, January 1, 2019.
      - (ii) **Resource use and other measures—** In the case of resource use and other measures under [subsection (d)(1)](#d-1)—
        - (I) for PAC providers described in clauses [(ii)](#a-2-A-ii), [(iii)](#a-2-A-iii), and [(iv)](#a-2-A-iv) of paragraph (2)(A), October 1, 2016; and
        - (II) for PAC providers described in [clause (i)](#a-2-E-i) of such paragraph, January 1, 2017.
    - (F) **Medicare beneficiary—** The term “Medicare beneficiary” means an individual entitled to benefits under part A or, as appropriate, enrolled for benefits under part B.
- (b) **Standardized patient assessment data—**
  - (1) **Requirement for reporting assessment data—**
    - (A) **In general—** Beginning not later than October 1, 2018, for PAC providers described in clauses [(ii)](#a-2-A-ii), [(iii)](#a-2-A-iii), and [(iv)](#a-2-A-iv) of subsection (a)(2)(A) and January 1, 2019, for PAC providers described in [clause (i)](#a-2-A-i) of such subsection, the [Secretary](/usc/42/1301.md?p=a-6) shall require PAC providers to submit to the [Secretary](/usc/42/1301.md?p=a-6), under the applicable reporting provisions and through the use of PAC assessment instruments, the standardized patient assessment data described in [subparagraph (B)](#b-1-B). The [Secretary](/usc/42/1301.md?p=a-6) shall require such data be submitted with respect to admission and discharge of an individual (and may be submitted more frequently as the [Secretary](/usc/42/1301.md?p=a-6) deems appropriate).
    - (B) **Standardized patient assessment data described—** For purposes of [subparagraph (A)](#b-1-A), the standardized patient assessment data described in this subparagraph is data required for at least the quality measures described in [subsection (c)(1)](#c-1) and that is with respect to the following categories:
      - (i) Functional status, such as mobility and self care at admission to a PAC provider and before discharge from a PAC provider.
      - (ii) Cognitive function, such as ability to express ideas and to understand, and mental status, such as depression and dementia.
      - (iii) Special services, [treatments](/usc/42/11851.md?p=11), and [interventions](/usc/42/1397n–12.md?p=2), such as need for ventilator use, dialysis, chemotherapy, central line placement, and total parenteral nutrition.
      - (iv) Medical conditions and co-morbidities, such as diabetes, congestive heart failure, and pressure ulcers.
      - (v) Impairments, such as incontinence and an impaired ability to hear, see, or swallow.
      - (vi) Other categories deemed necessary and appropriate by the [Secretary](/usc/42/1301.md?p=a-6).
  - (2) **Alignment of claims data with standardized patient assessment data—** To the extent practicable, not later than October 1, 2018, for PAC providers described in clauses [(ii)](#a-2-A-ii), [(iii)](#a-2-A-iii), and [(iv)](#a-2-A-iv) of subsection (a)(2)(A), and January 1, 2019, for PAC providers described in [clause (i)](#a-2-A-i) of such subsection, the [Secretary](/usc/42/1301.md?p=a-6) shall match claims data with assessment data pursuant to this section for purposes of assessing prior service use and concurrent service use, such as antecedent [hospital](/usc/42/1395x.md?p=e) or PAC provider use, and may use such matched data for such other uses as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate.
  - (3) **Replacement of certain existing data—** In the case of patient assessment data being used with respect to a PAC assessment instrument that duplicates or overlaps with standardized patient assessment data within a category described in [paragraph (1)](#b-1), the [Secretary](/usc/42/1301.md?p=a-6) shall, as soon as practicable, revise or replace such existing data with the standardized data.
  - (4) **Clarification—** Standardized patient assessment data submitted pursuant to this subsection shall not be used to require individuals to be provided post-acute care by a specific type of PAC provider in order for such care to be eligible for payment under this subchapter.
- (c) **Quality measures—**
  - (1) **Requirement for reporting quality measures—** Not later than the specified application date, as applicable to measures and PAC providers, the [Secretary](/usc/42/1301.md?p=a-6) shall specify quality measures on which PAC providers are required under the applicable reporting provisions to submit standardized patient assessment data described in [subsection (b)(1)](#b-1) and other necessary data specified by the [Secretary](/usc/42/1301.md?p=a-6). Such measures shall be with respect to at least the following domains:
    - (A) Functional status, cognitive function, and changes in function and cognitive function.
    - (B) Skin integrity and changes in skin integrity.
    - (C) Medication reconciliation.
    - (D) Incidence of major falls.
    - (E) Accurately communicating the existence of and providing for the transfer of [health information](/usc/42/1320d.md?p=4) and care preferences of an individual to the individual, family [caregiver](/usc/42/1397j.md?p=3) of the individual, and providers of services furnishing items and services to the individual, when the individual transitions—
      - (i) from a [hospital](/usc/42/1395x.md?p=e) or [critical access hospital](/usc/42/1395x.md?p=mm-1) to another applicable setting, [including](/usc/42/1301.md?p=b) a PAC provider or the [home](/usc/42/1395x.md?p=iii-3-B) of the individual; or
      - (ii) from a PAC provider to another applicable setting, [including](/usc/42/1301.md?p=b) a different PAC provider, a [hospital](/usc/42/1395x.md?p=e), a [critical access hospital](/usc/42/1395x.md?p=mm-1), or the [home](/usc/42/1395x.md?p=iii-3-B) of the individual.
  - (2) **Reporting through PAC assessment instruments—**
    - (A) **In general—** To the extent possible, the [Secretary](/usc/42/1301.md?p=a-6) shall require such reporting by a PAC provider of quality measures under [paragraph (1)](#c-1) through the use of a PAC assessment instrument and shall modify such PAC assessment instrument as necessary to enable the use of such instrument with respect to such quality measures.
    - (B) **Limitation—** The [Secretary](/usc/42/1301.md?p=a-6) may not make significant modifications to a PAC assessment instrument more than once per calendar year or [fiscal year](/usc/42/619.md?p=3), as applicable, unless the [Secretary](/usc/42/1301.md?p=a-6) publishes in the Federal Register a justification for such significant modification.
  - (3) **Adjustments—**
    - (A) **In general—** The [Secretary](/usc/42/1301.md?p=a-6) shall consider applying adjustments to the quality measures under this subsection taking into consideration the studies under section 2(d) of the IMPACT Act of 2014.
    - (B) **Risk adjustment—** Such quality measures shall be risk adjusted, as determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6).
- (d) **Resource use and other measures—**
  - (1) **Requirement for resource use and other measures—** Not later than the specified application date, as applicable to measures and PAC providers, the [Secretary](/usc/42/1301.md?p=a-6) shall specify resource use and other measures on which PAC providers are required under the applicable reporting provisions to submit any necessary data specified by the [Secretary](/usc/42/1301.md?p=a-6), which may include standardized assessment data in addition to claims data. Such measures shall be with respect to at least the following domains:
    - (A) Resource use measures, [including](/usc/42/1301.md?p=b) total estimated Medicare spending per beneficiary.
    - (B) Discharge to community.
    - (C) Measures to reflect all-condition risk-adjusted potentially preventable [hospital](/usc/42/1395x.md?p=e) readmission rates.
  - (2) **Aligning methodology adjustments for resource use measures—**
    - (A) **Period of time—** With respect to the period of time used for calculating measures under [paragraph (1)(A)](#d-1-A), the [Secretary](/usc/42/1301.md?p=a-6) shall, to the extent the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate, align resource use with the methodology used for purposes of [section 1395ww(o)(2)(B)(ii)](/usc/42/1395ww.md?p=o-2-B-ii) of this title.
    - (B) **Geographic and other adjustments—** The [Secretary](/usc/42/1301.md?p=a-6) shall standardize measures with respect to the domain described in [paragraph (1)(A)](#d-1-A) for geographic payment rate differences and payment differentials (and other adjustments, as applicable) consistent with the methodology published in the Federal Register on August 18, 2011 (76 Fed. Reg. 51624 through 51626), or any subsequent modifications made to the methodology.
    - (C) **Medicare spending per beneficiary—** The [Secretary](/usc/42/1301.md?p=a-6) shall adjust, as appropriate, measures with respect to the domain described in [paragraph (1)(A)](#d-1-A) for the factors applied under [section 1395ww(o)(2)(B)(ii)](/usc/42/1395ww.md?p=o-2-B-ii) of this title.
  - (3) **Adjustments—**
    - (A) **In general—** The [Secretary](/usc/42/1301.md?p=a-6) shall consider applying adjustments to the resource use and other measures specified under this subsection with respect to the domain described in [paragraph (1)(A)](#d-1-A), taking into consideration the studies under section 2(d) of the IMPACT Act of 2014.
    - (B) **Risk adjustment—** Such resource use and other measures shall be risk adjusted, as determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6).
- (e) **Measurement implementation phases; selection of quality measures and resource use and other measures—**
  - (1) **Measurement implementation phases—** In the case of quality measures specified under [subsection (c)(1)](#c-1) and resource use and other measures specified under [subsection (d)(1)](#d-1), the provisions of this section shall be implemented in accordance with the following phases:
    - (A) **Initial implementation phase—** The initial implementation phase, with respect to such a measure, shall, in accordance with subsections [(c)](#c) and [(d)](#d), as applicable, consist of—
      - (i) measure specification, [including](/usc/42/1301.md?p=b) informing the public of the measure’s numerator, denominator, exclusions, and any other aspects the [Secretary](/usc/42/1301.md?p=a-6) determines necessary;
      - (ii) data collection, [including](/usc/42/1301.md?p=b), in the case of quality measures, requiring PAC providers to report data elements needed to calculate such a measure; and
      - (iii) data analysis, [including](/usc/42/1301.md?p=b), in the case of resource use and other measures, the use of claims data to calculate such a measure.
    - (B) **Second implementation phase—** The second implementation phase, with respect to such a measure, shall consist of the provision of feedback reports to PAC providers, in accordance with [subsection (f)](#f).
    - (C) **Third implementation phase—** The third implementation phase, with respect to such a measure, shall consist of public reporting of PAC providers’ performance on such measure in accordance with [subsection (g)](#g).
  - (2) **Consensus-based entity—**
    - (A) **In general—** Subject to [subparagraph (B)](#e-2-B), each measure specified by the [Secretary](/usc/42/1301.md?p=a-6) under this section shall be endorsed by the entity with a contract under [section 1395aaa(a) of this title](/usc/42/1395aaa.md?p=a).
    - (B) **Exception—** In the case of a specified area or medical topic determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6) for which a feasible and practical measure has not been endorsed by the entity with a contract under [section 1395aaa(a) of this title](/usc/42/1395aaa.md?p=a), the [Secretary](/usc/42/1301.md?p=a-6) may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the [Secretary](/usc/42/1301.md?p=a-6).
  - (3) **Treatment of application of pre-rulemaking process (measure applications partnership process)—**
    - (A) **In general—** Subject to [subparagraph (B)](#e-3-B), the provisions of [section 1395aaa–1 of this title](/usc/42/1395aaa–1.md) shall apply in the case of a quality measure specified under [subsection (c)](#c) or a resource use or other measure specified under [subsection (d)](#d).
    - (B) **Exceptions—**
      - (i) **Expedited procedures—** For purposes of satisfying [subparagraph (A)](#e-3-A), the [Secretary](/usc/42/1301.md?p=a-6) may use expedited procedures, such as ad-hoc reviews, as necessary, in the case of a quality measure specified under [subsection (c)](#c) or a resource use or other measure specified in [subsection (d)](#d) required with respect to data submissions under the applicable reporting provisions during the 1-year period before the specified application date applicable to such a measure and provider involved.
      - (ii) **Option to waive provisions—** The [Secretary](/usc/42/1301.md?p=a-6) may waive the application of the provisions of [section 1395aaa–1 of this title](/usc/42/1395aaa–1.md) in the case of a quality measure or resource use or other measure described in [clause (i)](#e-3-B-i), if the application of such provisions ([including](/usc/42/1301.md?p=b) through the use of an expedited procedure described in such clause) would result in the inability of the [Secretary](/usc/42/1301.md?p=a-6) to satisfy any deadline specified in this section with respect to such measure.
- (f) **Feedback reports to PAC providers—**
  - (1) **In general—** Beginning one year after the specified application date, as applicable to PAC providers and quality measures and resource use and other measures under this section, the [Secretary](/usc/42/1301.md?p=a-6) shall provide confidential feedback reports to such PAC providers on the performance of such providers with respect to such measures required under the applicable provisions.
  - (2) **Frequency—** To the extent feasible, the [Secretary](/usc/42/1301.md?p=a-6) shall provide feedback reports described in [paragraph (1)](#f-1) not less frequently than on a quarterly basis. Notwithstanding the previous sentence, with respect to measures described in such paragraph that are reported on an annual basis, the [Secretary](/usc/42/1301.md?p=a-6) may provide such feedback reports on an annual basis.
- (g) **Public reporting of PAC provider performance—**
  - (1) **In general—** Subject to the succeeding paragraphs of this subsection, the [Secretary](/usc/42/1301.md?p=a-6) shall provide for public reporting of PAC provider performance on quality measures under [subsection (c)(1)](#c-1) and the resource use and other measures under [subsection (d)(1)](#d-1), [including](/usc/42/1301.md?p=b) by establishing procedures for making available to the public information regarding the performance of individual PAC providers with respect to such measures.
  - (2) **Opportunity to review—** The procedures under [paragraph (1)](#g-1) shall ensure, [including](/usc/42/1301.md?p=b) through a process consistent with the process applied under [section 1395ww(b)(3)(B)(viii)(VII) of this title](/usc/42/1395ww.md?p=b-3-B-viii-VII) for similar purposes, that a PAC provider has the opportunity to review and submit corrections to the data and information that is to be made public with respect to the provider prior to such data being made public.
  - (3) **Timing—** Such procedures shall provide that the data and information described in [paragraph (1)](#g-1), with respect to a measure and PAC provider, is made publicly available beginning not later than two years after the specified application date applicable to such a measure and provider.
  - (4) **Coordination with existing programs—** Such procedures shall provide that data and information described in [paragraph (1)](#g-1) with respect to quality measures and resource use and other measures under subsections [(c)(1)](#c-1) and [(d)(1)](#d-1) shall be made publicly available consistent with the following provisions:
    - (A) In the case of [home health agencies](/usc/42/1395x.md?p=o), [section 1395fff(b)(3)(B)(v)(III) of this title](/usc/42/1395fff.md?p=b-3-B-v-III).
    - (B) In the case of [skilled nursing facilities](/usc/42/1395x.md?p=j), sections [1395i–3(i)](/usc/42/1395i–3.md?p=i) and [1396r(i)](/usc/42/1396r.md?p=i) of this title.
    - (C) In the case of inpatient [rehabilitation facilities](/usc/42/300s–3.md?p=5), [section 1395ww(j)(7)(E) of this title](/usc/42/1395ww.md?p=j-7-E).
    - (D) In the case of [long-term care hospitals](/usc/42/1395x.md?p=ccc), [section 1395ww(m)(5)(E) of this title](/usc/42/1395ww.md?p=m-5-E).
- (h) **Removing, suspending, or adding measures—**
  - (1) **In general—** The [Secretary](/usc/42/1301.md?p=a-6) may remove, suspend, or add a quality measure or resource use or other measure described in subsection [(c)(1)](#c-1) or [(d)(1)](#d-1), so long as, subject to [paragraph (2)](#h-2), the [Secretary](/usc/42/1301.md?p=a-6) publishes in the Federal Register (with a notice and comment period) a justification for such removal, suspension, or addition.
  - (2) **Exception—** In the case of such a quality measure or resource use or other measure for which there is a reason to believe that the continued collection of such measure raises potential safety concerns or would cause other unintended consequences, the [Secretary](/usc/42/1301.md?p=a-6) may promptly suspend or remove such measure and satisfy [paragraph (1)](#h-1) by publishing in the Federal Register a justification for such suspension or removal in the next rulemaking cycle following such suspension or removal.
- (i) **Use of standardized assessment data, quality measures, and resource use and other measures to inform discharge planning and incorporate patient preference—**
  - (1) **In general—** Not later than January 1, 2016, and periodically thereafter (but not less frequently than once every 5 years), the [Secretary](/usc/42/1301.md?p=a-6) shall promulgate regulations to modify conditions of participation and subsequent interpretive guidance applicable to PAC providers, [hospitals](/usc/42/1395x.md?p=e), and [critical access hospitals](/usc/42/1395x.md?p=mm-1). Such regulations and interpretive guidance shall require such providers to take into account quality, resource use, and other measures under the applicable reporting provisions (which, as available, shall include measures specified under subsections [(c)](#c) and [(d)](#d), and other relevant measures) in the discharge planning process. Specifically, such regulations and interpretive guidance shall address the settings to which a patient may be discharged in order to assist [subsection (d)](#d) [hospitals](/usc/42/1395x.md?p=e), [critical access hospitals](/usc/42/1395x.md?p=mm-1), [hospitals](/usc/42/1395x.md?p=e) described in [section 1395ww(d)(1)(B)(v) of this title](/usc/42/1395ww.md?p=d-1-B-v), PAC providers, patients, and families of such patients with discharge planning from inpatient settings, [including](/usc/42/1301.md?p=b) such [hospitals](/usc/42/1395x.md?p=e), and from PAC provider settings. In addition, such regulations and interpretive guidance shall include procedures to address—
    - (A) [treatment](/usc/42/11851.md?p=11) preferences of patients; and
    - (B) goals of care of patients.
  - (2) **Discharge planning—** All requirements applied pursuant to [paragraph (1)](#i-1) shall be used to help inform and mandate the discharge planning process.
  - (3) **Clarification—** Such regulations shall not require an individual to be provided post-acute care by a specific type of PAC provider in order for such care to be eligible for payment under this subchapter.
- (j) **Stakeholder input—** Before the initial rulemaking process to implement this section, the [Secretary](/usc/42/1301.md?p=a-6) shall allow for stakeholder input, such as through town halls, open door forums, and mail-box submissions.
- (k) **Funding—** For purposes of carrying out this section, the [Secretary](/usc/42/1301.md?p=a-6) shall provide for the transfer to the Centers for Medicare & Medicaid Services Program Management Account, from the Federal [Hospital](/usc/42/1395x.md?p=e) Insurance Trust Fund under [section 1395i of this title](/usc/42/1395i.md) and the Federal Supplementary Medical Insurance Trust Fund under [section 1395t of this title](/usc/42/1395t.md), in such proportion as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate, of $130,000,000. Fifty percent of such amount shall be available on October 6, 2014, and fifty percent of such amount shall be equally proportioned for each of [fiscal years](/usc/42/619.md?p=3) 2015 through 2019. Such sums shall remain available until expended.
- (l) **Limitation—** There shall be no administrative or judicial review under sections [1395ff](/usc/42/1395ff.md) and [1395oo](/usc/42/1395oo.md) of this title or otherwise of the specification of standardized patient assessment data required, the determination of measures, and the systems to report such standardized data under this section.
- (m) **Non-application of Paperwork Reduction Act—** [Chapter 35](/usc/44/chch35.md) of title 44 (commonly referred to as the “Paperwork Reduction Act of 1995”) shall not apply to this section and the sections referenced in [subsection (a)(2)(B)](#a-2-B) that require modification in order to achieve the standardization of patient assessment data.

## Source credit

(Aug. 14, 1935, ch. 531, title XVIII, § 1899B, as added Pub. L. 113–185, § 2(a), Oct. 6, 2014, 128 Stat. 1952; amended Pub. L. 114–255, div. C, title XV, § 15008(d)(1), Dec. 13, 2016, 130 Stat. 1321.)

## Notes

### Editorial Notes

### References in Text

Section 2(d) of the IMPACT Act of 2014, referred to in subsecs. (c)(3)(A) and (d)(3)(A), is section 2(d) of Pub. L. 113–185, which is set out as a note under this section.

### Amendments

2016—Subsec. (a)(2)(A)(iv). Pub. L. 114–255 substituted “1395ww(d)(1)(B)(vi)” for “1395ww(d)(1)(B)(iv)(II)”.

### Statutory Notes and Related Subsidiaries

### Permitting Occupational Therapists To Conduct the Initial Assessment Visit and Complete the Comprehensive Assessment With Respect to Certain Rehabilitation Services for Home Health Agencies Under the Medicare Program

Pub. L. 116–260, div. CC, title I, § 115, Dec. 27, 2020, 134 Stat. 2948, provided that: “Not later than January 1, 2022, the Secretary of Health and Human Services shall revise subsections (a)(2) and (b)(3) of section 484.55 of title 42, Code of Federal Regulations, or a successor regulation, to permit an occupational therapist to conduct the initial assessment visit and to complete the comprehensive assessment (as such terms are described in such subsections, respectively) for home health services for an individual under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) if the home health plan of care for such individual— does not initially include skilled nursing care; includes occupational therapy; and includes physical therapy or speech language pathology.”

### Improving Payment Accuracy Under the PAC Payment Systems and Other Medicare Payment Systems

Pub. L. 113–185, § 2(d), Oct. 6, 2014, 128 Stat. 1966, provided that:Studies and reports of effect of certain information on quality and resource use.—Study using existing medicare data.— Study.—The Secretary of Health and Human Services (in this subsection referred to as the ‘Secretary’) shall conduct a study that examines the effect of individuals’ socioeconomic status on quality measures and resource use and other measures for individuals under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) (such as to recognize that less healthy individuals may require more intensive interventions). The study shall use information collected on such individuals in carrying out such program, such as urban and rural location, eligibility for Medicaid under title XIX of such Act (42 U.S.C. 1396 et seq.) (recognizing and accounting for varying Medicaid eligibility across States), and eligibility for benefits under the supplemental security income (SSI) program. The Secretary shall carry out this paragraph acting through the Assistant Secretary for Planning and Evaluation. Report.—Not later than 2 years after the date of the enactment of this Act [Oct. 6, 2014], the Secretary shall submit to Congress a report on the study conducted under clause (i).Study using other data.— Study.—The Secretary shall conduct a study that examines the impact of risk factors, such as those described in section 1848(p)(3) of the Social Security Act (42 U.S.C. 1395w–4(p)(3)), race, health literacy, limited English proficiency (LEP), and Medicare beneficiary activation, on quality measures and resource use and other measures under the Medicare program (such as to recognize that less healthy individuals may require more intensive interventions). In conducting such study the Secretary may use existing Federal data and collect such additional data as may be necessary to complete the study. Report.—Not later than 5 years after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under clause (i). Examination of data in conducting studies.—In conducting the studies under subparagraphs (A) and (B), the Secretary shall examine what non-Medicare data sets, such as data from the American Community Survey (ACS), can be useful in conducting the types of studies under such paragraphs and how such data sets that are identified as useful can be coordinated with Medicare administrative data in order to improve the overall data set available to do such studies and for the administration of the Medicare program. Recommendations to account for information in payment adjustment mechanisms.—If the studies conducted under subparagraphs (A) and (B) find a relationship between the factors examined in the studies and quality measures and resource use and other measures, then the Secretary shall also provide recommendations for how the Centers for Medicare & Medicaid Services should— obtain access to the necessary data (if such data is not already being collected) on such factors, including recommendations on how to address barriers to the Centers in accessing such data; and account for such factors— in quality measures, resource use measures, and other measures under title XVIII of the Social Security Act (including such measures specified under subsections (c) and (d) of section 1899B of such Act [42 U.S.C. 1395lll], as added by subsection (a)); and in determining payment adjustments based on such measures in other applicable provisions of such title. Funding.—There are hereby appropriated to the Secretary from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t) (in proportions determined appropriate by the Secretary) to carry out this paragraph $6,000,000, to remain available until expended.CMS activities.— In general.—Taking into account the relevant studies conducted and recommendations made in reports under paragraph (1) and, as appropriate, other information, including information collected before completion of such studies and recommendations, the Secretary, on an ongoing basis, shall, as the Secretary determines appropriate and based on an individual’s health status and other factors— assess appropriate adjustments to quality measures, resource use measures, and other measures under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) (including measures specified in subsections (c) and (d) of section 1899B of such Act, as added by subsection (a)); and assess and implement appropriate adjustments to payments under such title based on measures described in clause (i). Accessing data.—The Secretary shall collect or otherwise obtain access to the data necessary to carry out this paragraph through existing and new data sources. Periodic analyses.—The Secretary shall carry out periodic analyses, at least every 3 years, based on the factors referred to in subparagraph (A) so as to monitor changes in possible relationships. Funding.—There are hereby appropriated to the Secretary from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t) (in proportions determined appropriate by the Secretary) to carry out this paragraph $10,000,000, to remain available until expended. Strategic plan for accessing race and ethnicity data.—Not later than 18 months after the date of the enactment of this Act [Oct. 6, 2014], the Secretary shall develop and report to Congress on a strategic plan for collecting or otherwise accessing data on race and ethnicity for purposes of specifying quality measures and resource use and other measures under subsections (c) and (d) of section 1899B of the Social Security Act, as added by subsection (a), and, as the Secretary determines appropriate, other similar provisions of, including payment adjustments under, title XVIII of such Act (42 U.S.C. 1395 et seq.).”