Sec. 4. Medicare indirect medical education performance adjustment
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Section 1886 of the Social Security Act (42 U.S.C. 1395ww) is amended— in subsection (d)(5)(B), in the matter preceding clause (i), by inserting subject to subsection
(t)and before except as follows ; and by adding at the end the following new subsection: Subject to the succeeding provisions of this subsection, the Secretary shall establish and implement procedures under which the amount of payments that a hospital (as defined in paragraph (11)) would otherwise receive for indirect medical education costs under subsection (d)(5)(B) for discharges occurring during a fiscal year is adjusted based on the reporting of measures and the performance of the hospital on measures of population health priorities specified by the Secretary. The adjustments shall apply to payments for discharges occurring— with respect to the adjustments for reporting under paragraph (8)(A), during fiscal year 2018; and with respect to the adjustments for performance under paragraph (8)(B), on or after October 1, 2018. The measures of population health priorities specified by the Secretary under this subsection shall include measures relating to— the extent of training provided in— shortage specialties; a variety of settings and systems; the coordination of patient care across settings; interprofessional and multidisciplinary care teams; methods for identifying system errors and implementing system solutions; and the use of health information technology; and the number of graduates practicing in shortage specialties 5 years after graduation, including in shortage specialties in health professional shortage areas. The measures of patient care specified by the Secretary under this subsection— shall— be measures that have been adopted or endorsed by an accrediting organization (such as the Accreditation Council for Graduate Medical Education or American Osteopathic Association); and be measures that the Secretary identifies as having used a consensus-based process for developing such measures; and may include measures that have been submitted by teaching hospitals and medical schools (allopathic and osteopathic). Not later than July 1, 2015, the Secretary shall publish in the Federal Register a proposed initial set of measures for use under this subsection. The Secretary shall provide for a period of public comment on such measures. Not later than January 1, 2016, the Secretary shall publish in the Federal Register the set of initial measures to be specified by the Secretary for use under this subsection. The Secretary may, through notice and comment rulemaking, periodically update the measures specified under this subsection pursuant to the requirements under subparagraph (A). The Secretary shall establish performance standards with respect to measures specified by the Secretary under this subsection for a performance period for a fiscal year (as established under paragraph (6)). The Secretary shall establish the performance period for a fiscal year. Such performance period shall begin and end prior to the beginning of such fiscal year. The procedures established and implemented under paragraph
(1)shall include a process under which hospitals shall submit data on the measures specified by the Secretary under this subsection to the Secretary in a form and manner, and at a time, specified by the Secretary for purposes of this subsection. For fiscal year 2018, in the case of a hospital that does not submit, to the Secretary in accordance with this subsection, data required to be submitted under paragraph
(7)for a period (determined appropriate by the Secretary) for such fiscal year, the total amount that the hospital would otherwise receive under subsection (d)(5)(B) for discharges in such fiscal year shall be reduced by 1 percent. Subject to clause (ii), based on the performance of each hospital with respect to compliance with the measures for a performance period for a fiscal year (beginning with fiscal year 2019), the Secretary shall determine the amount of any adjustment under this subparagraph to payments to the hospital under subsection (d)(5)(B) for discharges in such fiscal year. Such adjustment may not exceed an amount equal to 2 percent of the total amount that the hospital would otherwise receive under such subsection for discharges in such fiscal year. In making adjustments under this subparagraph, the Secretary shall ensure that the total amount of payments made to all hospitals under subsection (d)(5)(B) for discharges in a fiscal year is equal to the total amount of payments that would have been made to such hospitals under such subsection for discharges in such fiscal year if this subsection had not been enacted. Any adjustment under subparagraph
(A)or
(B)of paragraph
(8)shall apply only with respect to the fiscal year involved, and the Secretary shall not take into account any such adjustment in making payments to a hospital under this section in a subsequent fiscal year. Not later than January 1, 2018, and every five years thereafter, the Secretary shall submit to Congress a report on the implementation of this subsection, including— the measure development procedures, including any barriers to measure development; the compliance with reporting on the performance measures, including any barriers to such compliance; and recommendations to address any barriers described in subparagraph
(A)or (B). In this subsection: The term hospital means a hospital that receives payments under subsection (d)(5)(B). The term shortage specialty means the following specialties and subspecialties: Family medicine. Geriatric medicine. General internal medicine. General surgery. High priority pediatric subspecialties. Psychiatry. Other specialties and subspecialties determined appropriate by the Secretary. .
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Sec. 4
Medicare indirect medical education performance adjustment
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