P.L. 112–240, Approved January 2, 2013 (126Stat. 2313)

SEC. 603. 

(d)  Implementation.—Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the provisions of, and the amendments [to SSAct §1833] made by this section by program instruction or otherwise.

SEC. 601. MEDICARE PHYSICIAN PAYMENT UPDATE

(b) Advancement of Clinical Data Registries To Improve the Quality of Health Care.—

(2) GAO study and report on incorporatiing registry data into the medicare program in order to improve quality and efficiency.—

(A)  Study.—The Comptroller General of the United States shall conduct a study on the potential of clinical data registries to improve the quality and efficiency of care in the Medicare program, including through payment system incentives. Such study shall include an analysis of the role of health information technology in facilitating clinical data registries and the use of data from such registries among private health insurers as well as other entities the Comptroller General determines appropriate.

(B)  Report.—Not later than November 15, 2013, the Comptroller General of the United States shall submit to Congress a report on the study conducted under subparagraph (A), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.

SEC. 604. AMBULANCE ADD-ON PAYMENTS.

(d)  Studies of ambulance costs.—

(1)  In general.—The Secretary of Health and Health and Human Services (in this subsection referred to as the “Secretary”) shall conduct a study of each of the following:

(A)  A study that analyzes data on existing cost reports for ambulance services furnished by hospitals and critical access hospitals, including variation by characteristics of such providers of services.

(B)  A study of the feasibility of obtaining cost data on a periodic basis from all ambulance providers of services and suppliers for potential use in examining the appropriateness of the Medicare add-on payments for ground ambulance services furnished under the fee schedule under section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) and in preparing for future reform of such payment system.

(2)  Components of one of the studies.—In conducting the study under paragraph (1)(B), the Secretary shall—

(A)  consult with industry on the design of such cost collection efforts;

(B)  explore use of cost surveys and cost reports to collect appropriate cost data and the periodicity of such cost data collection;

(C)  examine the feasibility of development of a standard cost reporting tool for providers of services and suppliers of ground ambulance services; and

(D)  examine the ability to furnish such cost data by various types of ambulance providers of services and suppliers, especially by rural and super-rural providers of services and suppliers.

(3) Reports.—

(A)  Existing cost reports.—Not later than October 1, 2013, the Secretary shall submit a report to Congress on the study conducted under paragraph (1)(A), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.

(B)  Obtaining cost data.—Not later than July 1, 2014, the Secretary shall submit a report to Congress on the study conducted under paragraph (1)(B), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.

SEC. 609. PERFORMANCE IMPROVEMENT.

(b) Providing Data for Performance Improvement in a Timely Manner.—

(1)  In general.—The Secretary of Health and Human Services (in this subsection referred to as the “Secretary”) shall develop a strategy to provide data for performance improvement in a timely manner to applicable providers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), including with respect to the provision of the following:

(A)  Utilization data, including such data for items and services under parts A, B, and D of the Medicare program. (B) Feedback on quality data submitted by the applicable provider under the Medicare program.

(B)  Feedback on quality data submitted by the applicable provider under the Medicare program.

(2)  Considerations.—In developing the strategy under paragraph (1), the Secretary shall consider—

(A)  the type of applicable provider receiving the data;

(B)  the frequency of providing the data so that it can be the most relevant in improving provider performance;

(C)  risk adjustment methods;

(D)  presentation of the data in a meaningful manner and easily understandable format;

(E)  with respect to utilization data, the provision of data that the Secretary determines would be useful to improve the performance of the type of applicable provider involved; and

(F)  administrative costs involved with providing data.

(3)  Submission and availability of initial strategy.—Not later than 1 year after the date of the enactment of this Act, the Secretary shall—

(A)  submit to the relevant committees of Congress the strategy described in paragraph (1); and (B) post such strategy on the website of the Centers for Medicare & Medicaid Services.

(B)  post such strategy on the website of the Centers for Medicare & Medicaid Services.

(4) Strategy update.—

(A)  Feedback from stakeholders.—The Secretary shall seek feedback from stakeholders on the initial strategy submitted under paragraph (3).

(B)  Strategy update.—The Secretary shall—

(i)  update the strategy described in paragraph (1) based on the feedback submitted under subparagraph (A); and (ii) not later than 18 months after the date of the enactment of this Act—

(ii)  not later than 18 months after the date of the enactment of this Act—

(I)  submit such updated strategy to the relevant committees of Congress; and (II) post such updated strategy on the website of the Centers for Medicare & Medicaid Services.

(II)  post such updated strategy on the website of the Centers for Medicare & Medicaid Services.

(5) GAO study and report on private sector information sharing activities.—

(A)  Study.—The Comptroller General of the United States (in this paragraph referred to as the ‘‘Comptroller General’’) shall conduct a study on information sharing activities. Such study shall include an analysis of—

(i)  how private sector entities share timely data with hospitals, physicians, and other providers and what lessons can be learned from those activities; (ii) how the Medicare program currently shares data with providers, including what data is provided and to which providers, and what divisions within the Centers for Medicare & Medicaid Services oversee those efforts;

(ii)  how the Medicare program currently shares data with providers, including what data is provided and to which providers, and what divisions within the Centers for Medicare & Medicaid Services oversee those efforts;

(iii)  what, if any, differences there are between the private sector and the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) in terms of sharing data; and

(iv)  what, if any, barriers there are for the Centers for Medicare & Medicaid Services to sharing timely data with applicable providers and recommendations to eliminate or reduce such barriers.

(B)  Report.—Not later than 8 months after the date of the enactment of this Act, the Comptroller General shall submit to the relevant committees of Congress a report containing the results of the study conducted under subparagraph (A), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.

(6)  Definitions.—In this subsection—

(A)  Applicable provider.—The term “applicable provider” means the following:

(i)  A critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act (42 U.S.C. 1395xx(mm)(1))).

(ii)  (ii) A hospital (as defined in section 1861(e) of such Act (42 U.S.C. 1395x(e))).

(iii)  (iii) A physician (as defined in section 1861(r) of such Act (42 U.S.C. 1395x(r))).

(iv)  Any other provider the Secretary determines should receive the information described in subsection (a).

(B)  Performance improvement.—The term “performance improvement” means improvements in quality, reducing per capita costs, and other criteria the Secretary determines appropriate.

SEC. 631. IPPS DOCUMENTATION AND CODING ADJUSTMENT FOR IMPLEMENTATION OF MS-DRGS.

(a) Rule of Construction and Clarification.—

(1)  Rule of Construction.—Nothing in the amendments made by subsection (b) shall be construed as changing the existing authority under section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) to make prospective documentation and coding adjustments to the standardized amounts under such section 1886(d) to correct for changes in the coding or classification of discharges that do not reflect real changes in case mix.

(2)  Clarification.—Effective on the date of the enactment of this section, except as provided in section 7(b)(1)(B)(ii) of the TMA, Abstinence Education, and QI Programs Extension Act of 2007, as added by subsection (b)(2)(A)(ii)(IV) of this section, the Secretary of Health and Human Services shall not have authority to fully recoup past overpayments related to documentation and coding changes from fiscal years 2008 and 2009.

SEC. 632. REVISIONS TO THE MEDICARE ESRD BUNDLED PAYMENT SYSTEM TO REFLECT FINDINGS IN THE GAO REPORT.

(b) [42 U.S.C. 1395rr note] Two-year Delay of Implementation of Oral-Only ESRD-Related Drugs in the ESRD Prospective Payment System; Monitoring.—

(1) [42 U.S.C. 1395rr note]  Delay.—The Secretary of Health and Human Services may not implement the policy under section 413.174(f)(6) of title 42, Code of Federal Regulations (relating to oral-only ESRD-related drugs in the ESRD prospective payment system), prior to January 1, 2016.

(2)  Monitoring.—With respect to the implementation of oral-only ESRD-related drugs in the ESRD prospective payment system under subsection (b)(14) of section 1881 of the Social Security Act (42 U.S.C. 1395rr(b)(14)), the Secretary of Health and Human Services shall monitor the bone and mineral metabolism of individuals with end stage renal disease.

(c) [42 U.S.C. 1395rr note]  Analysis of Case Mix Payment Adjustments.—By not later than January 1, 2016, the Secretary of Health and Human Services shall—

(1)  conduct an analysis of the case mix payment adjustments being used under section 1881(b)(14)(D)(i) of the Social Security Act (42 U.S.C. 1395rr(b)(14)(D)(i)); and

(2)  make appropriate revisions to such case mix payment adjustments.

(d)  Updated GAO Report.—Not later than December 31, 2015, the Comptroller General of the United States shall submit to Congress a report that updates the report submitted to Congress under section 10336 of the Patient Protection and Affordable Care Act (Public Law 111–148; 124 Stat. 974). The updated report shall include an analysis of how the Secretary of Health and Human Services has addressed points raised in the report submitted under such section 10336 with respect to the Secretary’s preparations to implement payment for oral-only ESRD-related drugs in the bundled prospective payment system under section 1881(b)(14) of the Social Security Act (42 U.S.C. 1395rr(b)(14)).

SEC. 643.  COMMISSION ON LONG-TERM CARE.

(a)  Establishment.—There is established a commission to be known as the Commission on Long-Term Care (referred to in this section as the “Commission”).

(b) Duties.—

(1)  In general.—The Commission shall develop a plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports for individuals in need of such services and supports, including elderly individuals, individuals with substantial cognitive or functional limitations, other individuals who require assistance to perform activities of daily living, and individuals desiring to plan for future long-term care needs.

(2)  Existing health care programs.—For purposes of developing the plan described in paragraph (1), the Commission shall provide recommendations for—

(A)  addressing the interaction of a long-term services and support system with existing programs for long-term services and supports, including the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) and the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), and private long-term care insurance(C) issues related to workers who provide long-term services and supports, including—

(B)  improvements to such health care programs that are necessary for ensuring the availability of long-term services and supports; and

(C)  issues related to workers who provide long-term services and supports, including—

(i)  whether the number of such workers is adequate to provide long-term services and supports to individuals with long-term care needs; (ii) workforce development necessary to deliver high-quality services to such individuals; (iii) development of entities that have the capacity to serve as employers and fiscal agents for workers who provide long-term services and supports in the homes of such individuals; and (iv) addressing gaps in Federal and State infrastructure that prevent delivery of high-quality long term services and supports to such individuals.

(ii)  workforce development necessary to deliver high-quality services to such individuals;

(iii)  development of entities that have the capacity to serve as employers and fiscal agents for workers who provide long-term services and supports in the homes of such individuals; and

(iv)  addressing gaps in Federal and State infrastructure that prevent delivery of high-quality long term services and supports to such individuals.

(3)  Additional considerations.—For purposes of developing the plan described in paragraph (1), the Commission shall take into account projeAdditiocted demographic changes and trends in the population of the United States, as well as the potential for development of new technologies, delivery systems, or other mechanisms to improve the availability and quality of long-term services and supports.

(4)  Consultation.—For purposes of developing the plan described in paragraph (1), the Commission shall consult with the Medicare Payment Advisory Commission, the Medicaid and CHIP Payment and Access Commission, the National Council on Disability, and relevant consumer groups.

(c) Membership.—

(1)  In general.—The Commission shall be composed of 15 members, to be appointed not later than 30 days after the date of enactment of this Act, as follows:

(A)  The President of the United States shall appoint 3 members.

(B)  The majority leader of the Senate shall appoint 3 members.

(C)  The minority leader of the Senate shall appoint 3 members.

(D)  The Speaker of the House of Representatives shall appoint 3 members.

(E)  The minority leader of the House of Representatives shall appoint 3 members.

(2)  Representation.—The membership of the Commission shall include individuals who—

(A)  represent the interests of—

(i)  consumers of long-term services and supports and related insurance products, as well as their representatives; (ii) older adults; (iii) individuals with cognitive or functional limitations; (iv) family caregivers for individuals described in clause (i), (ii), or (iii); (v) the health care workforce who directly provide long-term services and supports; (vi) private long-term care insurance providers; (vii) employers; (viii) State insurance departments; and (ix) State Medicaid agencies;

(ii)  older adults;

(iii)  individuals with cognitive or functional limitations;

(iv)  family caregivers for individuals described in clause (i), (ii), or (iii);

(v)  the health care workforce who directly provide long-term services and supports;

(vi)  private long-term care insurance providers;

(vii)  employers; (viii) State insurance departments; and (ix) State Medicaid agencies;

(viii)  State insurance departments; and (ix) State Medicaid agencies;

(ix)  State Medicaid agencies;

(B)  have demonstrated experience in dealing with issues related to long-term services and supports, health care policy, and public and private insurance; and

(C)  represent the health care interests and needs of a variety of geographic areas and demographic groups

(3)  Chairman and vice-chairman.—The Commission shall elect a chairman and vice chairman from among its members.

(4)  Vacancies.—Any vacancy in the membership of the Commission shall be filled in the manner in which the original appointment was made and shall not affect the power of the remaining members to execute the duties of the Commission.

(5)  Quorum.—A quorum shall consist of 8 members of the Commission, except that 4 members may conduct a hearing under subsection (e)(1).

(6)  Meetings.—The Commission shall meet at the call of its chairman or a majority of its members.

(7) Compensation and reimbursement of expenses.—

(A)  In general.—To enable the Commission to exercise its powers, functions, and duties, there are authorized to be disbursed by the Senate the actual and necessary expenses of the Commission approved by the chairman and vice chairman, subject to subparagraph (B) and the rules and regulations of the Senate.

(B)  Members.—Members of the Commission are not entitled to receive compensation for service on the Commission. Members may be reimbursed for travel, subsistence, and other necessary expenses incurred in carrying out the duties of the Commission.

(d) Staff and Ethical Standards.—

(1)  Staff.—The chairman and vice chairman of the Commission may jointly appoint and fix the compensation of staff as they deem necessary, within the guidelines for employees of the Senate and following all applicable rules and employment requirements of the Senate.

(2)  Ethical standards.—Members of the Commission who serve in the House of Representatives shall be governed by the ethics rules and requirements of the House. Members of the Senate who serve on the Commission and staff of the Commission shall comply with the ethics rules of the Senate.

(e)  Powers.—

(1)  Hearings and other activities.—For the purpose of carrying out its duties, the Commission may hold such hearings and undertake such other activities as the Commission determines to be necessary to carry out its duties..

(2)  Studies by general accounting office.—Upon the request of the Commission, the Comptroller General of the United States shall conduct such studies or investigations as the Commission determines to be necessary to carry out its duties.

(3)  Cost estimates by congressional budget office.—Upon the request of the Commission, the Director of the Congressional Budget Office shall provide to the Commission such cost estimates as the Commission determines to be necessary to carry out its duties.

(4)  Detail of federal employees.—Upon the request of the Commission, the head of any Federal agency is authorized to detail, without reimbursement, any of the personnel of such agency to the Commission to assist the Commission in carrying out its duties. Any such detail shall not interrupt or otherwise affect the civil service status or privileges of the Federal employee.

(5)  Technical assistance.—Upon the request of the Commission, the head of a Federal agency shall provide such technical assistance to the Commission as the Commission determines to be necessary to carry out its duties..

(6)  Use of mails.—The Commission may use the United States mails in the same manner and under the same conditions as Federal agencies.

(7)  Obtaining information.—The Commission may secure directly from any Federal agency information necessary to enable it to carry out its duties, if the information may be disclosed under section 552 of title 5, United States Code. Upon request of the Chairman of the Commission, the head of such agency shall furnish such information to the Commission.

(8)  Administrative support services.—Upon the request of the Commission, the Administrator of General Services shall provide to the Commission on a reimbursable basis such administrative support services as the Commission may request.

(f) Commission Consideration.—

(1) Approval of report and legislative language.—

(A)  In general.—Not later than 6 months after appointment of the members of the Commission (as described in subsection (c)(1)), the Commission shall vote on a comprehensive and detailed report based on the longterm care plan described in subsection (b)(1) that contains any recommendations or proposals for legislative or administrative action as the Commission deems appropriate, including proposed legislative language to carry out the recommendations or proposals (referred to in this section as the “Commission bill”).

(B)  Approval by majority of members.—The Commission bill shall require the approval of a majority of the members of the Commission.

(2) Transmission of commission bill.—

(A)  In general.—If the Commission bill is approved by the Commission pursuant to paragraph (1), then not later than 10 days after such approval, the Commission shall submit the Commission bill to the President, the Vice President, the Speaker of the House of Representatives, and the majority and minority Leaders of each House on Congress.

(B)  Commission bill to be made public.—Upon the approval or disapproval of the Commission bill pursuant to paragraph (1), the Commission shall promptly make such proposal, and a record of the vote, available to the public.

(g)  Termination.—The Commission shall terminate 30 days after the vote described in subsection (f)(1).

(h)  Consideration of Commission Recommendations.—If approved by the majority required by subsection (f)(1), the Commission bill that has been submitted pursuant to subsection (f)(2)(A) shall be introduced in the Senate (by request) on the next day on which the Senate is in session by the majority leader of the Senate or by a Member of the Senate designated by the majority leader of the Senate and shall be introduced in the House of Representatives (by request) on the next legislative day by the majority leader of the House or by a member of the House designated by the majority leader of the House.