To amend title XVIII of the Social Security Act to improve measurements under the skilled nursing facility value-based purchasing program under the Medicare program, and for other purposes.

I 116TH CONGRESS 1ST SESSION H. R. 3406 To amend title XVIII of the Social Security Act to improve measurements under the skilled nursing facility value-based purchasing program under the Medicare program, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JUNE 21, 2019 Mr. NEAL (for himself and Mr. BRADY) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provi- sions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to improve measurements under the skilled nursing facility value- based purchasing program under the Medicare program, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 23:21 Jun 26, 2019 Jkt 034408 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3406.IH H3406 pbinns on DSK79D2C42PROD with BILLS 2 •HR 3406 IH SECTION 1. IMPROVING MEASUREMENTS UNDER THE 1 SKILLED NURSING FACILITY VALUE-BASED 2 PURCHASING PROGRAM UNDER THE MEDI- 3 CARE PROGRAM. 4 (a) IN GENERAL.—Section 1888(h) of the Social Se- 5 curity Act (42 U.S.C. 1395yy(h)) is amended— 6 (1) in paragraph (1), by adding at the end the 7 following new subparagraph: 8 ‘‘(C) EXCLUSIONS.—With respect to pay- 9 ments for services furnished on or after October 10 1, 2021, this subsection shall not apply to a fa- 11 cility for which there are not a minimum num- 12 ber (as determined by the Secretary) of— 13 ‘‘(i) cases for the measures that apply 14 to the facility for the performance period 15 for the applicable fiscal year; or 16 ‘‘(ii) measures that apply to the facil- 17 ity for the performance period for the ap- 18 plicable fiscal year.’’; 19 (2) in paragraph (2)(A)— 20 (A) by striking ‘‘The Secretary shall 21 apply’’ and inserting ‘‘The Secretary— 22 ‘‘(i) shall apply’’; 23 (B) by striking the period at the end and 24 inserting ‘‘; and’’; and 25 (C) by adding at the end the following: 26 VerDate Sep 11 2014 23:21 Jun 26, 2019 Jkt 034408 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3406.IH H3406 pbinns on DSK79D2C42PROD with BILLS 3 •HR 3406 IH ‘‘(ii) may, with respect to payments 1 for services furnished on or after October 2 1, 2022, apply additional measures deter- 3 mined appropriate by the Secretary, which 4 may include measures of functional status, 5 patient safety, care coordination, or patient 6 experience. 7 Subject to the succeeding sentence, in the case 8 that the Secretary applies additional measures 9 under clause (ii), the Secretary shall consider 10 and apply, as appropriate, quality measures 11 specified under section 1899B(c)(1). In no case 12 may the Secretary apply more than 10 meas- 13 ures under this subparagraph.’’; 14 (3) in subparagraph (A) of each of paragraphs 15 (3) and (4), by striking ‘‘measure’’ and inserting 16 ‘‘measures’’; and 17 (4) by adding at the end the following new 18 paragraph: 19 ‘‘(12) VALIDATION.— 20 ‘‘(A) IN GENERAL.—The Secretary shall 21 apply to the measures applied under this sub- 22 section and the data submitted under sub- 23 section (e)(6) a process to validate such meas- 24 ures and data, as appropriate, which may be 25 VerDate Sep 11 2014 23:21 Jun 26, 2019 Jkt 034408 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3406.IH H3406 pbinns on DSK79D2C42PROD with BILLS 4 •HR 3406 IH similar to the process specified in section 1 1886(b)(3)(B)(viii)(XI) for validating inpatient 2 hospital measures. 3 ‘‘(B) FUNDING.—For purposes of carrying 4 out this paragraph, the Secretary shall provide 5 for the transfer, from the Federal Hospital In- 6 surance Trust Fund established under section 7 1817, of $5,000,000 to the Centers for Medi- 8 care & Medicaid Services Program Management 9 Account for each of fiscal years 2022 through 10 2024.’’. 11 (b) REPORT BY MEDPAC.—Not later than March 12 15, 2021, the Medicare Payment Advisory Commission 13 shall submit to Congress a report on establishing a proto- 14 type value-based payment program under a unified pro- 15 spective payment system for post-acute care services under 16 the Medicare program under title XVIII of the Social Se- 17 curity Act (42 U.S.C. 1395 et seq.). Such report— 18 (1) shall— 19 (A) consider design elements such as— 20 (i) measures that are important to the 21 Medicare program and to beneficiaries 22 under such program; 23 (ii) methodologies for scoring provider 24 performance and effects on payment; and 25 VerDate Sep 11 2014 23:21 Jun 26, 2019 Jkt 034408 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3406.IH H3406 pbinns on DSK79D2C42PROD with BILLS 5 •HR 3406 IH (iii) other elements determined appro- 1 priate by the Commission; and 2 (B) analyze the effects of implementing 3 such prototype program; and 4 (2) may— 5 (A) discuss the possible effects, with re- 6 spect to the Medicare program, on program 7 spending, post-acute care providers, patient out- 8 comes, and other effects determined appropriate 9 by the Commission; and 10 (B) include recommendations with respect 11 to such prototype program, as determined ap- 12 propriate by the Commission, to Congress and 13 the Secretary of Health and Human Services. 14 Æ VerDate Sep 11 2014 23:21 Jun 26, 2019 Jkt 034408 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H3406.IH H3406 pbinns on DSK79D2C42PROD with BILLS