Sec. 5. Miscellaneous
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The Administrator of the Centers for Medicare & Medicaid Services shall request eligible professional organizations (as defined in section 1848(k)(3) of the Social Security Act (42 U.S.C. 1395w–4(k)(3))) and other relevant stakeholders to submit recommendations for defining non-acute related episodes of care for purposes of applying such definition under subsections
(k)and
(q)of section 1848 of the Social Security Act ( 42 U.S.C. 1395w–4 ) and section 1848A of such Act, as added by subsections
(b)and
(c)of section 2. The Administrator of the Centers for Medicare & Medicaid Services shall solicit from eligible professional organizations (as defined in section 1848(k)(3) of the Social Security Act ( 42 U.S.C. 1395w–4(k)(3) )) recommendations for payment bundles for chronic conditions and expensive, high-volume services for which payment is made under title XVIII of such Act. Not later than 24 months after the date of the enactment of this Act, the Administrator shall submit to Congress a report proposals for such payment bundles. Not later than January 15, 2016, and annually thereafter, the Secretary of Health and Human Services shall submit to Congress and post on the public Internet website of the Centers for Medicare & Medicaid Services a biannual progress report— on the implementation of paragraph
(9)of section 1848(k) of the Social Security Act ( 42 U.S.C. 1395w–4(k) ), as added by section 2(b)(2), and the quality update incentive program under subsection
(q)of section 1848 of the Social Security Act ( 42 U.S.C. 1395w–4 ), as added by section 2(b)(3); that includes an evaluation of such paragraph and such quality update incentive program and recommendations with respect to such program and appropriate update mechanisms; and on the actions taken to promote and fulfill the identification of eligible APMs under section 1848A of the Social Security Act, as added by section 2(c), for application under such section 1848A. The Comptroller General of the United States shall submit to Congress a report analyzing the extent to which the system under section 1848(k)(9) of the Social Security Act ( 42 U.S.C. 1395w–4(k)(9) ) and such quality update incentive program under section 1848(q) of the Social Security Act, as added by section 2(b), as of such date, is successfully satisfying performance objectives, including with respect to— the process for developing and selecting measures and activities under subsection (k)(9) of section 1848 of such Act (42 U.S.C. 1395w–4); the process for assessing performance against such measures and activities under subsection
(q)of such section; and the adequacy of the measures and activities so selected. The Comptroller General of the United States shall evaluate the initial phase of the quality update incentive program under subsection
(q)of section 1848 of the Social Security Act (42 U.S.C. 1395w–4) and shall submit to Congress, not later than 2019, a report with recommendations for improving such quality update incentive program. In the course of its March Report to Congress on Medicare payment policy, MedPAC shall analyze the initial phase of such quality update incentive program and make recommendations, as appropriate, for improving such quality update incentive program. Not later than June 15, 2016, the Medicare Payment Advisory Commission shall submit to Congress a report that analyzes multiple options for alternative payment models in lieu of section 1848 of the Social Security Act ( 42 U.S.C. 1395w–4 ). In analyzing such models, the Medicare Payment Advisory Commission shall examine at least the following models: Accountable care organization payment models. Primary care medical home payment models. Bundled or episodic payments for certain conditions and services. Gainsharing arrangements Such report shall include information on how each recommended new payment model will achieve maximum flexibility to reward high-quality, efficient care. Beginning in 2015, the Chief Actuary of the Centers for Medicare & Medicaid Services shall track expenditure growth and beneficiary access to physicians’ services under section 1848 of the Social Security Act ( 42 U.S.C. 1395w–4 ) and shall post on the public Internet website of the Centers for Medicare & Medicaid Services annual reports on such topics. Section 1848(c) of the Social Security Act (42 U.S.C. 1395w–4(c)) is amended by adding at the end the following new paragraph: The Secretary shall implement a system for the periodic reporting by physicians of data on the accuracy of relative values under this subsection, such as data relating to service volume and time. Such data shall be submitted in a form and manner specified by the Secretary and shall, as appropriate, incorporate data from existing sources of data, patient scheduling systems, cost accounting systems, and other similar systems. Not later than January 1, 2015, the Secretary shall establish a mechanism for physicians to participate under the reporting system under this paragraph, all of whom shall collectively be referred to under this paragraph as the reporting group . The reporting group shall include physicians across settings that collectively represent a range of specialties and practitioner types, furnish a range of physicians’ services, and serve a range of patient populations. Under the system under this paragraph, the Secretary may provide for such payments under this part to physicians included in the reporting group as the Secretary determines appropriate to compensate such physicians for reporting data under the system. Such payments shall be provided in such form and manner as specified by the Secretary. In carrying out this subparagraph, reporting by such a physician under this paragraph shall not be treated as the furnishing of physicians’ services for purposes of applying this section. To carry out this paragraph (other than with respect to payments made under subparagraph (C)), in addition to funds otherwise appropriated, the Secretary shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund under section 1841 of $1,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for each fiscal year beginning with fiscal year 2014. Amounts transferred under this subparagraph for a fiscal year shall be available until expended. . Section 1848(c)(2) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)) is amended by adding at the end the following new subparagraph: With respect to fee schedules established for 2016, 2017, and 2018, the Secretary shall— identify, based on the data reported under paragraph
(8)and other relevant data, misvalued services for which adjustments to the relative values established under this paragraph would result in a net reduction in expenditures under the fee schedule under this section, with respect to such year, of not more than 1 percent of the projected amount of expenditures under such fee schedule for such year; and make such adjustments for each such year so as to result in such a net reduction for such year. . Section 1848(c)(2)(B)(v) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2)(B)(v) ) is amended by adding at the end the following new subclause: Reduced expenditures attributable to subparagraph (M). . The development, recognition, or implementation of any guideline or other standard under any Federal health care provision shall not be construed to establish the standard of care or duty of care owed by a health care provider to a patient in any medical malpractice or medical product liability action or claim. For purposes of this subsection: The term Federal health care provision means any provision of the Patient Protection and Affordable Care Act ( Public Law 111–148 ), title I and subtitle B of title III of the Health Care and Education Reconciliation Act of 2010 ( Public Law 111–152 ), and titles XVIII and XIX of the Social Security Act. The term health care provider means any individual or entity— licensed, registered, or certified under Federal or State laws or regulations to provide health care services; or required to be so licensed, registered, or certified but that is exempted by other statute or regulation. The term medical malpractice or medical liability action or claim means a medical malpractice action or claim (as defined in section 431(7) of the Health Care Quality Improvement Act of 1986 ( 42 U.S.C. 11151(7) )) and includes a liability action or claim relating to a health care provider’s prescription or provision of a drug, device, or biological product (as such terms are defined in section 201 of the Federal Food, Drug, and Cosmetic Act or section 351 of the Public Health Service Act). The term State includes the District of Columbia, Puerto Rico, and any other commonwealth, possession, or territory of the United States. No provision of the Patient Protection and Affordable Care Act ( Public Law 111–148 ), title I or subtitle B of title III of the Health Care and Education Reconciliation Act of 2010 ( Public Law 111–152 ), or title XVIII or XIX of the Social Security Act shall be construed to preempt any State or common law governing medical professional or medical product liability actions or claims.
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U.S. Code
9 references not yet in our index
- 42 USC 1395w–4(k)(3)
- 42 USC 1395w–4
- 42 USC 1395w–4(k)
- 42 USC 1395w–4(k)(9)
- 42 USC 1395w–4(c)
- 42 USC 1395w–4(c)(2)
- 42 USC 1395w–4(c)(2)(B)(v)
- Pub. L. 111-148
- Pub. L. 111-152
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cites case law
Sec. 5
Miscellaneous
Cite42 USC 1395w–4(k)(3)
Cite42 USC 1395w–4
Cite42 USC 1395w–4(k)
Cite42 USC 1395w–4(k)(9)
Cite42 USC 1395w–4(c)
Cites 10 · showing 6Cited by 0 across 0 sources