Bill > HR2

Introduced Session

Medicare Access and CHIP Reauthorization Act of 2015 TITLE I--SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION (Sec. 101) Amends title XVIII (Medicare) of the Social Security Act (SSAct) to: (1) remove sustainable growth rate (SGR) methodology from the determination of annual conversion factors in the formula for payment for physicians' services, and (2) revise the update in rates for 2015 and subsequent years. Requires two separate conversion factors for each year beginning with 2026, one for items and services furnished by a qualifying alternative payment model (APM) participant (qualifying APM conversion factor), and the other for other items and services (nonqualifying APM conversion factor). Freezes the update to the single conversion factor at 0.0% for January through June 2015. Sets the same update at 0.5% for July1 through December 31, 2015, as well as for 2016 through 2019, then reduces it to 0.00% for 2020 through 2025. Sets the update to the qualifying APM conversion factor at 0.75%, and the update to the nonqualifying APM conversion factor at .0.25%, for 2026 and each subsequent year. Directs the Medicare Payment Advisory Commission (MEDPAC) to report to Congress on the relationship between: (1) physician and other health professional utilization and expenditures (and their rate of increase) of items and services for which Medicare payment is made; and (2) total utilization and expenditures (and their rate of increase) under Medicare parts A (Hospital Insurance), B (Supplementary Medical Insurance), and D (Voluntary Prescription Drug Benefit Program). Requires a separate report on the 2015-2019 update to physicians' services under Medicare. Directs the Secretary of Health and Human Services to consolidate components of the three specified existing performance incentive programs into a new Merit-based Incentive Payment (MIP) system under which eligible professionals (including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists, but excluding most APM participants) shall receive annual payment increases or decreases based on their performance as measured by standards the Secretary shall establish according to specified criteria. Requires the Government Accountability Office (GAO) to: (1) evaluate the MIP System; (2) examine the similarities and differences in the use of quality measures under the original Medicare fee-for-service program under SSAct title XVIII parts A (Hospital Insurance) and B (Supplementary Medical Insurance), the Medicare Advantage program under SSAct title XVIII part C (Medicare+Choice), selected state medical assistance programs under SSA title XIX (Medicaid), and private payer arrangements; and (3) make recommendations on how to reduce the administrative burden in applying such measures. Directs GAO also to: (1) examine whether entities that pool financial risk for physician practices, such as independent risk managers, can play a role in supporting such practices, particularly small physician practices, in assuming financial risk for the treatment of patients; (2) report on the transition of professionals in rural areas, health professional shortage areas, or medically underserved areas to an APM; and (3) make recommendations for removing administrative barriers to such arrangements, on the one hand, and practices, including small practices, in such areas to participate in APM models. Establishes an ad hoc Physician-Focused Payment Technical Advisory Committee to make comments and recommendations to the Secretary on physician-focused payment models.. Prescribes requirements for incentive payments to eligible APM participants. Directs the Secretary to study: (1) the feasibility of integrating APMs into the Medicare Advantage payment system; and (2) the applicability of federal fraud prevention laws to items and services paid for under an APM. (Sec. 102) Directs the Secretary to draft a plan for development of quality measures to assess professionals, including non-patient-facing professionals. (Sec. 103) Directs the Secretary to make payments for chronic care management services furnished by a physician, physician assistant or nurse practitioner, clinical nurse specialist, or certified nurse midwife. Directs the Secretary to conduct an education and outreach campaign to inform relevant professionals and Medicare part B enrollees of the benefits of chronic care management services. (Sec. 104) Directs the Secretary to make publicly available, on an annual basis, information with respect to physicians and other eligible professionals on items and services furnished to Medicare beneficiaries. (Sec. 105) Expands the kinds of uses of Medicare data available to qualified entities for quality improvement activities. Directs the Secretary to provide Medicare data to qualified clinical data registries to facilitate quality improvement or patient safety. (Sec. 106) Allows continuing renewals of any two-year period for which a physician or practitioner opts out of the Medicare claims process under a private contract. Directs the Secretary to make publicly available through an appropriate HHS website information on the number and characteristics of opt-out physicians and practitioners. Declares it a national objective to achieve widespread exchange of health information through interoperable certified electronic health records (EHR) technology nationwide by December 31, 2018. Directs the Secretary to establish related metrics. Requires the Secretary to examine the feasibility of establishing one or more mechanisms to assist providers in comparing and selecting certified EHR technology products Directs GAO to study specified telehealth and remote patient monitoring services. TITLE II--MEDICARE AND OTHER HEALTH EXTENDERS Subtitle A--Medicare Extenders (Sec. 201) Amends SSAct title XVIII to extend through calendar year 2017 the current 1.0 floor for the work geographic practice cost index for adjusting the Medicare fee schedule for physician services. (Sec. 202) Extends through calendar year 2017 the process under which an individual may, upon request, obtain an exception from the uniform dollar limitation for physical therapy services, speech-language pathology services, and occupational therapy services. Directs the Secretary, in place of the manual medical review process, to implement a targeted medical review process to identify and conduct medical reviews for outpatient therapy services furnished by a service provider or supplier. (Sec. 203) Extends through calendar year 2017 the temporary increase in payment for ground ambulance services, including urban, rural, and super rural ground ambulance services. (Sec. 204) Extends through FY2017 the increased inpatient hospital payment adjustment for certain low-volume (subsection [d]) hospitals. (Generally, a subsection [d] hospital is an acute care hospital, particularly one that receives payments under Medicare's inpatient prospective payment system when providing covered inpatient services to eligible beneficiaries.) (Sec. 205) Extends through FY2016 the Medicare-dependent hospital program for certain small rural subsection (d) hospitals. (Sec. 206) Extends through calendar year 2018 the authority of specialized MA plans for special needs individuals to restrict enrollment to individuals within one or more classes of special needs individuals.

Committee Categories

Michael Burgess (R)*,  Charles Boustany (R),  Kevin Brady (R),  Joe Courtney (D),  Gene Green (D),  Joseph Heck (R),  Sander Levin (D),  Jim McDermott (D),  Frank Pallone (D),  Ed Perlmutter (D),  Joseph Pitts (R),  Paul Ryan (R),  Pete Sessions (R),  Fred Upton (R), 

Became Public Law No: 114-10. (TXT | PDF) (on 04/16/2015)

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