Summary: Veterans Telemedicine Act of 2011 - Directs the Secretary of Veterans Affairs to carry out a program of: (1) teleconsultation for the provision of remote mental health and traumatic brain injury assessments in facilities of the Department of Veterans Affairs (VA) that are not otherwise able to provide such assessments without contracting with third party providers or reimbursing providers through a fee basis system, and (2) teleretinal imaging in each Veterans Integrated Services Network (VISN). Requires the Secretary to modify the Veterans Equitable Resource Allocation (VERA) system to provide incentives for such programs, telemedicine, and telehealth coordination services. Defines: (1) "teleconsultation" as the use of telecommunications by a health care specialist to assist another health care provider in rendering a diagnosis or treatment; (2) "teleretinal imaging" as the use by a health care specialist of telecommunications, digital retinal imaging, and remote image interpretation to provide eye care; and (3) "telehealth" as the use of telecommunications to collect patient data remotely and send data to a monitoring station for interpretation. Directs the Secretary to require each VA facility involved in training medical residents to work with each university concerned to develop an elective rotation in telemedicine for such residents.

veterans telemedicine act directs secretary veterans_affairs carry program teleconsultation provision remote mental health traumatic brain injury assessments facilities department_of_veterans_affairs able provide assessments contracting party providers reimbursing providers fee basis system imaging veterans_integrated_services_network visn requires secretary modify vera system provide incentives programs telemedicine telehealth coordination services defines teleconsultation use telecommunications health care specialist assist health care provider rendering diagnosis treatment imaging use health care specialist telecommunications digital imaging remote image interpretation provide eye care telehealth use telecommunications collect patient data remotely send data monitoring station interpretation directs secretary require facility involved training medical residents work university concerned develop elective rotation telemedicine residents


Summary: Chiropractic Care Available to All Veterans Act of 2011 - Amends the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001 to require a program under which the Secretary of Veterans Affairs provides chiropractic care and services to veterans through Department of Veterans Affairs (VA) medical centers and clinics to be carried out at: (1) no fewer than 75 medical centers by December 31, 2012; and (2) all medical centers by December 31, 2014. Includes chiropractic examinations and services within required VA medical, rehabilitative, and preventive health care services.

chiropractic_care_available veterans act amends department_of_veterans_affairs require program secretary veterans_affairs provides chiropractic care services veterans department_of_veterans_affairs medical centers clinics carried fewer medical centers december medical centers december includes chiropractic examinations services required medical rehabilitative preventive health care services


Summary: Hereditary Hemorrhagic Telangiectasia Diagnosis and Treatment Act of 2011 - Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS) to establish and implement a hereditary hemorrhagic telangiectasia (HHT, a vascular genetic bleeding disorder that causes abnormalities of the blood vessels) initiative to assist in coordinating activities to improve early detection, screening, and treatment of people who suffer from HHT, focusing on advancing research on the causes, diagnosis, and treatment of HHT and increasing physician and public awareness of HHT. Directs the Secretary to establish the HHT Coordinating Committee to develop and coordinate implementation of a plan to advance research and understanding of HHT, including by: (1) conducting or supporting research across relevant National Institutes of Health (NIH) institutes, and (2) conducting evaluations and making recommendations regarding the prioritization and award of NIH research grants relating to HHT. Requires the Director of the Centers for Disease Control and Prevention (CDC) to carry out activities with respect to HHT, including conducting population screening and establishing an HHT resource center to provide comprehensive education on, and disseminate information about, HHT to health professionals, patients, industry, and the public. Sets forth requirements for HHT population screening, including requiring the Director of CDC to designate and provide funding for HHT Treatment Centers of Excellence. Requires the Administrator of the Centers for Medicare & Medicaid Services (CMS) to award grants for: (1) an analysis of the Medicare Provider Analysis and Review (MEDPAR) file to develop preliminary estimates on the totals costs to Medicare for items, services, and treatments for HHT; and (2) recommendations regarding an enhanced data collection protocol to permit a more precise determination of such costs.

diagnosis treatment act amends public_health_service_act require secretary health_and_human_services hhs establish implement vascular genetic disorder causes abnormalities blood vessels initiative assist coordinating activities improve early detection screening treatment people suffer focusing advancing research causes diagnosis treatment increasing physician public awareness directs secretary establish develop coordinate implementation plan advance research understanding including conducting supporting research relevant national_institutes_of_health nih institutes conducting evaluations making recommendations prioritization award nih research grants relating requires director centers_for_disease_control_and_prevention cdc carry activities respect including conducting population screening establishing resource center provide comprehensive education disseminate information health professionals patients industry public sets forth requirements population screening including requiring director cdc designate provide funding requires administrator centers cms award grants analysis medicare provider analysis review file develop preliminary estimates totals costs medicare items services treatments recommendations enhanced data collection protocol permit precise determination costs


Summary: Breast Cancer Patient Equity Act - Amends title XVIII (Medicare) of the Social Security Act to extend coverage to custom fabricated breast prostheses after a mastectomy.

breast cancer patient equity act amends title xviii medicare social security act extend coverage custom fabricated breast prostheses mastectomy


Summary: Equity and Access for Podiatric Physicians Under Medicaid Act - Amends title XIX (Medicaid) of the Social Security Act to include podiatrists as physicians in order to cover their services under the Medicaid program.

equity access podiatric physicians title xix medicaid social security act include podiatrists physicians order cover services medicaid program


Summary: Physician Pathology Services Continuity Act of 2012 - Amends title XVIII (Medicare) of the Social Security Act to require the Secretary of Health and Human Services (HHS), with regard to a laboratory-furnished technical component of certain physician pathology services, to treat such component as a service for which payment shall be made to the laboratory, and not as an inpatient hospital or hospital outpatient service for which payment is made to the hospital.

physician_pathology_services continuity act amends title xviii medicare social security act require secretary health_and_human_services hhs regard laboratory furnished technical component certain physician pathology services treat component service payment shall laboratory inpatient hospital hospital outpatient service payment hospital


Summary: Senior Medicare Fairness Act - Amends title XVIII (Medicare) of the Social Security Act for plan year 2013 and subsequent plan years with respect to payments to Medicare + Choice organizations for original fee-for-service benefits under a specialized Medicare Advantage plan for special needs individuals that: (1) offers integrated Medicare and Medicaid services under contract with the state agency under title XIX (Medicaid) of the Social Security Act; and (2) is offered by a Medicare Advantage organization that as of January 1, 2010, had a contract with such state Medicaid agency that participated in the "Demonstrations Serving Those Dually-Eligible for Medicare and Medicaid." Directs the Secretary of Health and Human Services (HHS) to apply the frailty adjustment under payment rules for programs of all-inclusive care for the elderly (PACE) rather than those which would otherwise apply for plan enrollees.

senior medicare fairness act amends title xviii medicare social security act plan year subsequent plan years respect payments organizations original fee service benefits specialized medicare_advantage plan special needs individuals offers integrated medicare medicaid services contract state agency title xix medicaid social security act offered medicare_advantage organization january contract state medicaid agency participated medicare medicaid directs secretary health_and_human_services hhs apply adjustment payment rules programs inclusive care elderly pace apply plan enrollees


Summary: Access to Independent Health Insurance Advisors Act of 2012 - Amends the Public Health Service Act to exclude remuneration paid for licensed independent insurance producers from administrative cost calculations for purposes of calculating the medical-loss ratio of a health insurance plan. Defines "independent insurance producer" to mean an insurance agent or broker, insurance consultant, benefit specialist, limited insurance representative, and any other person required to be licensed under the laws of the particular state to sell, solicit, negotiate, service, effect, procure, renew, or bind policies of insurance coverage or offer advice, counsel, opinions, or services related to insurance.

amends public_health_service_act exclude remuneration paid licensed independent insurance producers administrative cost calculations purposes calculating medical loss ratio health insurance plan defines independent insurance producer mean insurance agent broker insurance consultant benefit specialist limited insurance representative person required licensed laws particular state sell solicit negotiate service effect procure renew bind policies insurance coverage offer advice counsel opinions services related insurance


Summary: Excellence in Mental Health Act - Amends the Public Health Service Act (PHSA) to set forth criteria for the certification of federally-qualified community behavioral health centers. Amends title XIX (Medicaid) of the Social Security Act to make such centers eligible for payments for services under Medicaid. Authorizes the Secretary of Health and Human Services (HHS) to award matching grants to states or Indian tribes to expend funds for the construction or modernization of facilities used to provide mental health and substance abuse services to individuals. Amends the Public Health Service Act to expand the 340B drug discount program (a program limiting the cost of covered outpatient drugs to certain federal grantees) to allow participation by entities providing community mental health services or providing treatment services for substance abuse.

excellence mental health act amends public_health_service_act phsa set forth criteria certification federally qualified community behavioral health centers amends title xix medicaid social security act centers eligible payments services medicaid authorizes secretary health_and_human_services hhs award matching grants states indian tribes expend funds construction modernization facilities provide mental health substance abuse services individuals amends public_health_service_act expand 340b drug discount program program limiting cost covered outpatient drugs certain federal grantees allow participation entities providing community mental health services providing treatment services substance abuse


Summary: Chiropractors Equity Act - Amends title XVIII (Medicare) of the Social Security Act to allow chiropractors to provide items and services through private contracts.

chiropractors equity act amends title xviii medicare social security act allow chiropractors provide items services private contracts


Summary: Access to Physicians in Medicare Act of 2012 - Amends title XVIII (Medicare) of the Social Security Act with respect to payment for physicians' services to require that, in lieu of the update to the single conversion factor that would otherwise apply for 2013 and thereafter, the update to the single conversion factor for each such year be the lesser of: (1) the annual percentage increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers for the year; and (2) 3.0%. (Thus repeals the Medicare sustainable growth rate formula.) Repeals as of its date of enactment any provision of the Patient Protection and Affordable Care Act (PPACA), or any amendment made by it, that amends or authorizes a program or activity with respect to the Medicaid program under SSA title XIX or the Children's Health Insurance Program (CHIP) under SSA title XXI, except for certain program integrity and transparency requirements. Repeals PPACA title I, relating to health care access and coverage, and restores or revives the provisions of law amended or repealed by title I as if title I had not been enacted. Repeals provisions of the Health Care and Education Reconciliation Act of 2010 related to: (1) amendments to the Internal Revenue Code regarding health care coverage, including establishment in the Department of Health and Human Services (HHS) of a Health Insurance Reform Implementation Fund; and (2) Medicaid. Requires the use of any reduced federal expenditures resulting from this Act to reduce the federal deficit.

access physicians medicare_act amends title xviii medicare social security act respect payment physicians services require lieu update single conversion factor apply update single conversion factor year lesser annual percentage increase consumer price index year repeals medicare sustainable growth rate formula repeals date enactment provision patient_protection affordable care act ppaca amendment amends authorizes program activity respect medicaid program ssa title xix ssa title xxi certain program integrity transparency requirements repeals ppaca title relating health care access coverage restores revives provisions law amended repealed title title enacted repeals provisions health_care_and_education reconciliation act related amendments internal revenue code health care coverage including establishment department_of_health_and_human_services hhs medicaid requires use reduced federal expenditures resulting act reduce federal deficit


Summary: Recruiting Individuals to Drive Our Elders Act of 2012 or RIDE Act of 2012 - Directs the Secretary of Health and Human Services (HHS) to publish an interim final rule to revise certain Medicaid transportation regulations to allow a state plan under title XIX (Medicaid) of the Social Security Act to provide, at state option, reimbursement for costs attributable to providing no-load volunteer travel services to Medicaid-eligible individuals who require transportation to receive non-emergency medical treatment.

recruiting individuals drive elders act ride act directs secretary health_and_human_services hhs publish interim final rule revise certain medicaid transportation regulations allow state plan title xix medicaid social security act provide state option reimbursement costs attributable providing load volunteer travel services medicaid eligible individuals require transportation receive non emergency medical treatment


Summary:
Medicare Physician Payment Innovation Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to revise requirements for payments for physician's services to eliminate the sustainable growth rate system from the formula for determination of the fee schedules for such services.

Sets at 0.0 the 2014 update to the single conversion factor in such formula.

Establishes updates for separate primary care and other service categories beginning January 1, 2015, as well as separate conversion factors and separate updates through 2018 for each service category.

Directs the Secretary, through the Center for Medicare and Medicaid Innovation, to: (1) expand testing of each innovative payment and service delivery model in at least three geographic regions; and (2) include analysis of average implementation costs, per physician, in evaluations of models in phase 1 testing.

Specifies as such a model, subject to testing, payment for outpatient therapy services and speech language pathology services on the basis of a treatment session, an episode of care, or other bundled payment methodology as a model to be tested during phase 1 testing.

Directs the Comptroller General to study the evaluations of each model tested.

Directs the Secretary to release to the public a comprehensive list of such health care delivery models identified as likely to: (1) reduce spending without reducing quality of care, or (2) improve the quality of patient care without increasing spending.

Requires the Secretary to inform physicians, nurse practitioners, group practices, and institutions employing Medicare part B (Supplementary Medical Insurance) providers on how best to transition to alternative health care delivery and payment models aimed at improving the coordination, quality, and efficiency of health care.

Freezes the physician fee schedule for 2019 by requiring 0.0 updates to the relevant conversion factors.

Directs the Secretary to: (1) contract and agree with regional extension centers to provide guidance and assistance on how physicians may transition to implementation of alternative health care delivery models identified as represernting best practices; and (2) make certain funding available to the Office of the National Coordinator for Health Care Technology to award grants and incentive payments under a competitive process to regional extension centers and other qualified entities for such activities.

Requires the Office to: (1) establish a process for the competitive selection of regional extension centers (and other qualified entities) in the third quarter of 2015, and (2) authorize the initial distribution of funds to such centers and entities.

Prescribes updates to conversion factors for 2020-2023, but freezes them again beginning in 2024.

Requires the Secretary to consider certain factors in determining the growth rates to be recognized beginning with 2020 for alternative payment and delivery models.

Directs the Secretary to report to Congress on the impact on spending and on access to services under Medicare resulting from changes to the Medicare delivery and payments systems, including those made by this Act.

amends title xviii medicare social security act ssa revise requirements payments physician services eliminate sustainable growth rate system formula determination fee schedules services sets update single conversion factor formula establishes updates separate primary care service categories beginning january separate conversion factors separate updates service category directs secretary center medicare medicaid_innovation expand testing innovative payment service delivery model geographic regions include analysis average implementation costs physician evaluations models phase testing specifies model subject testing payment outpatient therapy services speech language pathology services basis treatment session episode care bundled payment methodology model tested phase testing directs comptroller general study evaluations model tested directs secretary release public comprehensive list health care delivery models identified likely reduce spending reducing quality care improve quality patient care increasing spending requires secretary inform physicians nurse practitioners group practices institutions employing medicare supplementary_medical_insurance providers best transition alternative health care delivery payment models aimed improving coordination quality efficiency health care freezes physician fee schedule requiring updates relevant conversion factors directs secretary contract agree regional extension centers provide guidance assistance physicians transition implementation alternative health care delivery models identified best practices certain funding available award grants incentive payments competitive process regional extension centers qualified entities activities requires office establish process competitive selection regional extension centers qualified entities quarter authorize initial distribution funds centers entities prescribes updates conversion factors freezes beginning requires secretary consider certain factors determining growth rates recognized beginning alternative payment delivery models directs secretary report congress impact spending access services medicare resulting changes medicare delivery payments systems including act


Summary: Medical Practice Freedom Act of 2013 - Prohibits the Secretary of Health and Human Services (HHS) or any state from requiring any health care provider to participate in any health plan as a condition of the provider's licensure in any state.

medical practice freedom act prohibits secretary health_and_human_services hhs state requiring health care provider participate health plan condition provider licensure state


Summary: Health Information Technology Reform Act - Amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to exclude pathologists from Medicare and Medicaid incentive payments and, in particular, penalties relating to the meaningful use of electronic health records.

titles xviii medicare xix medicaid social security act exclude pathologists medicare medicaid incentive payments particular penalties relating meaningful use electronic health records


Summary: Disabled Veterans Red Tape Reduction Act - Amends the Veterans Benefits Act of 2003 to extend through 2018 Department of Veterans Affairs (VA) authority for the performance of medical disability evaluations by contract physicians.

disabled veterans red tape reduction act amends veterans benefits act extend authority performance medical disability evaluations contract physicians


Summary: Health IT Modernization for Underserved Communities Act of 2013 - Amends title XIX (Medicaid) of the Social Security Act to extend to physician assistants eligibility for Medicaid electronic health record incentive payments, regardless of whether or not such physician assistants practice at a rural health center that is led by a physician assistant or in a federally qualified health center.

amends title xix medicaid social security act extend physician assistants eligibility medicaid electronic health record incentive payments regardless physician assistants practice rural health center led physician assistant federally qualified health center


Summary: Enhanced Access to Medicaid Services Act of 2013 - Amends title XIX (Medicaid) of the Social Security Act to apply the Medicaid primary care payment rate in 2013 and 2014 to additional physicians with a primary specialty designation of neurology, psychiatry, or obstetrics and gynecology.

enhanced access medicaid services act amends title xix medicaid social security act apply medicaid primary care payment rate additional physicians primary specialty designation psychiatry obstetrics gynecology


Summary: Medicaid Accountability and Care Act of 2013 - Amends title XIX (Medicaid) of the Social Security Act (SSA) to revise payments to states under the Medicaid program, including granting an option to receive Medicare payments for full-benefit dual eligible individuals (who are eligible for Medicare benefits under SSA title XVIII as well as Medicaid).

care act amends title xix medicaid social security act ssa revise payments states medicaid program including granting option receive medicare payments benefit dual eligible individuals eligible medicare benefits ssa title xviii medicaid


Summary: Expediting Veteran's Benefits Act - Amends the Veterans Benefits Act of 2003 to extend through 2016 Department of Veterans Affairs (VA) authority for the performance of medical disability evaluations by contract physicians.

expediting veteran benefits act amends veterans benefits act extend department_of_veterans_affairs authority performance medical disability evaluations contract physicians


Summary:
Diagnostic Innovation Testing and Knowledge Advancement Act of 2013 - Sets forth additional factors for the Secretary of Health and Human Services (HHS) to consider in determining the payment amount for new clinical diagnostic laboratory tests under gapfilling procedures which are used when no comparable existing test is available.

Directs the Secretary to convene an independent advisory panel to inform and make recommendations to the Secretary regarding any new test.

Requires the Secretary to justify publicly the basis and rate determination for any payments made under the clinical laboratory fee schedule for new clinical diagnostic laboratory tests, including a detailed summary of information received regarding the additional factors considered. Requires the Secretary then, after publishing such justification, to provide for a reasonable period of reconsideration to: (1) receive any appeal of the payment determination, and (2) evaluate any additional information received regarding the justification and the factors considered.

Requires the Secretary, following the period of reconsideration, to make a final payment basis and payment rate determination, providing a justification for it with an explanation of what additional information was evaluated during reconsideration and how it was taken into account. Directs the Secretary to: (1) establish a process for application for the assignment of a temporary national HCPCS (Healthcare Common Procedure Coding System) code to uniquely identify a diagnostic test until a permanent national HCPCS code is available for assignment to that test, (2) analyze the process used for the gapfilling procedures used in determining payment amounts for new clinical diagnostic laboratory tests, and (3) implement improvements in the process after public notice and opportunity for comment.

Applies this Act to payment basis and payment rate determinations made on or after January 1, 2013.

diagnostic innovation testing knowledge advancement act sets forth additional factors secretary health_and_human_services hhs consider determining payment new clinical diagnostic laboratory tests procedures comparable existing test available directs secretary convene independent advisory panel inform recommendations secretary new test requires secretary justify publicly basis rate determination payments clinical laboratory fee schedule new clinical diagnostic laboratory tests including detailed summary information received additional factors considered requires secretary publishing justification provide reasonable period reconsideration receive appeal payment determination evaluate additional information received justification factors considered requires secretary following period reconsideration final payment basis payment rate determination providing justification explanation additional information evaluated reconsideration taken account directs secretary establish process application assignment temporary national hcpcs healthcare common procedure coding system code uniquely identify diagnostic test permanent national hcpcs code available assignment test analyze process procedures determining payment amounts new clinical diagnostic laboratory tests implement improvements process public notice opportunity comment applies act payment basis payment rate determinations january


Summary: Accuracy in Medicare Physician Payment Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to establish and appoint an expert outside advisory panel for purposes of providing oversight to the processes relating to valuation of physicians' services.

accuracy medicare physician payment act amends title xviii medicare social security act direct secretary health_and_human_services hhs establish appoint expert outside advisory panel purposes providing oversight processes relating valuation physicians services


Summary:
SGR Repeal and Medicare Beneficiary Access Act of 2013 - (Sec. 2) Amends part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act (SSA) to: (1) end with 2013 the current formula for an update to the single conversion factor in the formula for payment for physicians' services, (2) end and remove sustainable growth rate (SGR) methodology from the determination of such annual conversion factors, (3) prescribe an update to the single conversion factor for 2014-2016 of 0.5%, (4) freeze the update to the single conversion factor at 0.00% for 2017-2023, and (5) establish for 2024 and subsequent years an update of 2% for health professionals participating in alternative payment models (APMs) and an update of 1% for all other health professionals.

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 rates of increase) on items and services for which Medicare payment is made, and (2) total utilization and expenditures (and the rate of increase of such utilization and expenditures) under Medicare parts A (Hospital Insurance), B, and D (Voluntary Prescription Drug Benefit Program).

Directs the Secretary of Health and Human Services (HHS) to establish a value-based performance (VBP) incentive program by consolidating (with certain revisions) the existing: (1) electronic health record (EHR) meaningful use incentive program, (2) quality reporting program, and (3) value-based payment program.

Requires VBP-eligible professionals (excluding most APM participants) to receive annual payment increases or decreases based on their performance.

Defines VBP-eligible professional as: (1) a physician, a physician assistant, nurse practitioner, clinical nurse specialist, and a certified registered nurse anesthetist during the VBP program's first two years, and (2) also other eligible professionals specified by the Secretary for succeeding years.

 Excludes from treatment as a VBP eligible professional any eligible professional who is: (1) a qualifying APM participant; (2) a partial qualifying APM participant for the most recent period for which data are available and who, for the performance period with respect to that year, does not report on applicable measures and activities a VBP professional is required to report; or (3) does not exceed, for that performance period, a specified low-volume threshold measurement.

Qualifies for VBP incentive payments a partial qualifying APM participant who reports on applicable measures and activities a VBP professional is required to report. Prescribes requirements for: (1) application of the VBP program to group practices; and (2) measures and activities under the performance categories of quality, resource use, clinical practice improvement, and meaningful use of EHR technology. Requires the Secretary to: (1) establish performance standards for the VBP program, taking into account historical performance standards, improvement rates, and the opportunity for continued improvement; and (2) develop a methodology for assessing the total performance of each VBP eligible professional according to such standards with respect to applicable measures and activities for each performance category, leading to a composite performance score for each professional for each performance period. Prescribes requirements for creation of a performance funding pool from which all VBP program incentives payments shall be made. Makes such a funding pool consist of the total amount of specified gradual reductions to the otherwise applicable physician fee schedule for the years 2017-2021 and following years. Prescribes a formula for the calculation of VBP program incentive payments, beginning with 2017, subject to criteria for budget neutrality as well as a process for informal review of the calculation of an individual professional's VBP program incentive payment adjustment factor for a year. Directs the Secretary to enter into contracts or agreements with appropriate entities (such as quality improvement organizations, regional extension centers, or regional health collaboratives) to offer guidance and assistance about performance categories or transition to an APM to MIPS-eligible professionals in practices of 15 or fewer professionals (with priority given to such practices located in rural areas, health professional shortage areas, medically underserved areas, and practices with low composite performance scores). Requires the Secretary to make available to each VBP eligible professional timely (such as quarterly) confidential feedback and other information to improve performance. Requires the Comptroller General (GAO) to: (1) evaluate the VBP program; and (2) report on the similarities and differences in the use of quality measures under the original Medicare fee-for-service program, the Medicare Advantage program under Medicare part C, and private payer arrangements, and make recommendations on how to reduce the administrative burden involved in applying such quality measures. Prescribes incentive payments for participation in eligible APMs between 2017 and 2022, consisting of an additional 5% of the current-year payment amount for the covered professional services for the preceding year.

Directs the Secretary to study: (1) the applicability of federal fraud prevention laws to items and services furnished under Medicare for which payment is made under an APM, (2) aspects of such APMs that are vulnerable to fraudulent activity, and (3) the implication of waivers to such laws granted in support of such APMs.

Directs the Secretary to study: (1) the effect of individuals' socioeconomic status on quality and resource use outcome measures for individuals under the Medicare program, and (2) the impact of certain risk factors on such quality and resource use outcome measures.

Directs the Secretary, taking account of such studies, to: (1) estimate how an individual's health status and other risk factors affect quality and resource use outcome measures and, as feasible, to incorporate information from quality and resource use outcome measurement into the eligible professional VBP incentive program; and (2) account for other identified factors with an effect on quality and resource use outcome measures when determining payment adjustments under the VBP incentive program.

Directs the Secretary to develop and report to Congress on a strategic plan for collecting or otherwise assessing data on race and ethnicity for purposes of carrying out the eligible professional VBP incentive program.

Directs the Secretary to take certain steps, including development of care episode and patient condition groups as well as proposed classification codes, in order to involve the physician, practitioner, and other stakeholder communities in enhancing the infrastructure for resource use measurement for VBP, APM, and other purposes.

(Sec. 3) Directs the Secretary to develop and post on the Internet website of the Centers for Medicare and Medicaid Services (CMS) a draft plan as well as an operational plan, taking stakeholder comments on the draft plan into account, for the development of quality measures.

Directs the Secretary to enter into contracts or other arrangements with entities, which may include physician specialty societies and other practitioner organizations, for the purpose of developing, improving, updating, or expanding such quality measures.

Requires the Secretary to transfer $15 million from the Federal Supplemental Medical Insurance Trust Fund to the CMS Program Management Account for each of FY2014-2018.

 (Sec. 4) Requires the Secretary to: (1) establish one or more Healthcare Common Procedure Coding System (HCPCS) codes for chronic care management services for patients with chronic care needs, and (2) make payments for any such services furnished by an applicable provider.

(Sec. 5) Authorizes the Secretary to: (1) collect or obtain information from any eligible professional or any other source on the resources directly or indirectly related to furnishing services paid for under the Medicare fee schedule, and (2) use such information to determine relative values for those services.

Authorizes the Secretary to establish or adjust practice expense relative values using cost, charge, or other data from suppliers or service providers, including any such collected or obtained information.

Expands the list of codes the Secretary must examine to identify services that may be misvalued, including codes: (1) that account for the majority of spending under the physician fee schedule, (2) that have experienced a substantial change in the hospital length of stay or procedure time, (3) for which there is a significant difference in payment for the same service between different sites of service, (4) with high intra-service work per unit of time, (5) with high practice expense relative value units (RVUs), and (6) with high cost supplies.

Sets at 0.5% of the estimated amount of fee schedule expenditures in 2015-2018 the annual target (estimated net reduction in expenditures under the fee schedule) with respect to relative value adjustments for misvalued services.

Declares that, for fee schedules beginning with 2015, if the RVUs for a service for a year would otherwise be decreased by an estimated 20% or more as compared to the total RVUs for the previous year, the applicable adjustments in work, practice expense, and malpractice RVUs must be phased-in over a two-year period.

Directs GAO to study the processes used by the Relative Value Scale Update Committee (RUC) (of the American Medical Association) to make recommendations to the Secretary regarding relative values for specific services.

Requires the use on or after January 1, 2017, of metropolitan statistical areas (MSAs) as fee schedule areas in California, with all areas not included in an MSA to be treated as a single rest-of-state fee schedule area.

Prescribes a formula for the geographic index values applied to the physicians fee schedule for MSAs previously in the rest-of-payment locality or in locality 3.

(Sec. 6) Directs the Secretary to: (1) establish a program to promote the use of appropriate use criteria for certain advanced diagnostic imaging services furnished by ordering and furnishing professionals, and (2) specify applicable appropriate use criteria for imaging services from among appropriate use criteria developed or endorsed by national professional medical specialty societies or other entities.

Directs the Secretary to: (1) determine, on a periodic basis, outlier ordering professionals; (2) apply prior authorization for applicable imaging services ordered by an outlier ordering professional; (3) establish an appropriate use program for other Medicare part B services; and (4) make publicly available on the Physician Compare website specified information with respect to an eligible professional.

(Sec. 8) Expands the kinds (including standardized extracts) and uses of claims data available to qualified entities for quality improvement activities, including analysis of data for non-public uses as well as their provision or sale (subject to certain conditions) to physicians, other professionals, providers, medical societies, and hospital associations and certain other entities.

Directs the Secretary to provide Medicare claims data to requesting qualified clinical data registries to link it with clinical data and perform analyses and research to support quality improvement or patient safety.

Restricts access to claims data through a qualified data enclave only (a web-based portal or comparable mechanism) from which data cannot be extracted. Requires any data or analyses to have no individually identifiable data about a particular patient, with specified exceptions.

Requires any fees charged for making standardized extracts of claims data available to qualified entities to be deposited into the CMS Program Management Account (currently, into the Federal Supplementary Medical Insurance Trust Fund).

(Sec. 9) Permits continuing automatic extensions of a Medicare physician and practitioner election to opt-out of the Medicare physician payment system into private contracts.

Directs the Secretary to: (1) make publicly available through an appropriate publicly accessible website information on the number and characteristics of opt-out physicians and practitioners, and (2) establish a demonstration project to make sure that Medicare payments for services furnished by non-participating physicians to individuals entitled to benefits under part A or enrolled under part B are paid directly to such physicians.

Directs the Secretary to make recommendations to Congress to amend existing fraud and abuse law to permit gainsharing or similar arrangements between physicians and hospitals that improve care while reducing waste and increasing efficiency.

Declares it a national objective to achieve widespread and nationwide exchange of health information through interoperable certified EHR technology by December 31, 2019, as a consequence of a significant federal investment in the implementation of health information technology through the Medicare EHR incentive programs.

Directs the Secretary to study the feasibility of establishing a website to compare certified EHR technology products.

Requires a GAO study on the use of telehealth under federal programs.

sgr_repeal medicare beneficiary access act sec amends supplementary_medical_insurance title xviii medicare social security act ssa end current formula update single conversion factor formula payment physicians services end remove sustainable growth rate sgr methodology determination annual conversion factors prescribe update single conversion factor freeze update single conversion factor establish subsequent years update health professionals participating alternative payment models apms update health professionals directs medicare_payment_advisory_commission medpac report congress relationship physician health professional utilization expenditures rates increase items services medicare payment total utilization expenditures rate increase utilization expenditures medicare parts voluntary prescription drug benefit program directs secretary health_and_human_services hhs establish value based performance incentive program consolidating certain revisions existing electronic health record ehr meaningful use incentive program quality reporting program value based payment program requires eligible professionals excluding apm participants receive annual payment increases decreases based performance defines eligible professional physician physician assistant nurse practitioner clinical nurse specialist certified registered nurse anesthetist program years eligible professionals specified secretary succeeding years excludes treatment eligible professional eligible professional qualifying apm participant partial qualifying apm participant recent period data available performance period respect year report applicable measures activities professional required report exceed performance period specified low volume threshold measurement qualifies incentive payments partial qualifying apm participant reports applicable measures activities professional required report prescribes requirements application program group practices measures activities performance categories quality resource use clinical practice improvement meaningful use ehr technology requires secretary establish performance standards program taking account historical performance standards improvement rates opportunity continued improvement develop methodology assessing total performance eligible professional according standards respect applicable measures activities performance category leading composite performance score professional performance period prescribes requirements creation performance funding pool program incentives payments shall makes funding pool consist total specified gradual reductions applicable physician fee schedule years following years prescribes formula calculation program incentive payments beginning subject criteria budget neutrality process informal review calculation individual professional program incentive payment adjustment factor year directs secretary enter contracts agreements appropriate entities quality improvement organizations regional extension centers regional health collaboratives offer guidance assistance performance categories transition apm eligible professionals practices fewer professionals priority given practices located rural areas health professional shortage areas medically underserved areas practices low composite performance scores requires secretary available eligible professional timely quarterly confidential feedback information improve performance requires comptroller general gao evaluate program report similarities differences use quality measures original medicare fee service program medicare_advantage program medicare private payer arrangements recommendations reduce administrative burden involved applying quality measures prescribes incentive payments participation eligible apms consisting additional current year payment covered professional services preceding year directs secretary study applicability federal fraud prevention laws items services furnished medicare payment apm aspects apms vulnerable fraudulent activity waivers laws granted support apms directs secretary study effect individuals socioeconomic status quality resource use outcome measures individuals medicare program impact certain risk factors quality resource use outcome measures directs secretary taking account studies estimate individual health status risk factors affect quality resource use outcome measures feasible incorporate information quality resource use outcome measurement eligible professional incentive program account identified factors effect quality resource use outcome measures determining payment adjustments incentive program directs secretary develop report congress strategic plan collecting assessing data race ethnicity purposes carrying eligible professional incentive program directs secretary certain steps including development care episode patient condition groups proposed classification codes order involve physician practitioner stakeholder communities enhancing infrastructure resource use measurement apm purposes sec directs secretary develop post internet website centers medicare medicaid_services cms draft plan operational plan taking stakeholder comments draft plan account development quality measures directs secretary enter contracts arrangements entities include physician specialty societies practitioner organizations purpose developing improving updating expanding quality measures requires secretary transfer million fy2014 sec requires secretary establish healthcare common procedure coding system hcpcs codes chronic care management services patients chronic care needs payments services furnished applicable provider sec authorizes secretary collect obtain information eligible professional source resources directly indirectly related furnishing services paid medicare fee schedule use information determine relative values services authorizes secretary establish adjust practice expense relative values cost charge data suppliers service providers including collected obtained information expands list codes secretary examine identify services misvalued including codes account majority spending physician fee schedule experienced substantial change hospital length stay procedure time significant difference payment service different sites service high intra service work unit time high practice expense relative value units high cost supplies sets estimated fee schedule expenditures annual target estimated net reduction expenditures fee schedule respect relative value adjustments misvalued services declares fee schedules beginning service year decreased estimated compared total previous year applicable adjustments work practice expense malpractice phased year period directs gao study processes ruc recommendations secretary relative values specific services requires use january metropolitan statistical areas msas fee schedule areas california areas included msa treated single rest state fee schedule area prescribes formula geographic index values applied physicians fee schedule msas previously rest payment locality locality sec directs secretary establish program promote use appropriate use criteria certain advanced diagnostic imaging services furnished ordering furnishing professionals specify applicable appropriate use criteria imaging services appropriate use criteria developed endorsed national professional medical specialty societies entities directs secretary determine periodic basis outlier ordering professionals apply prior authorization applicable imaging services ordered outlier ordering professional establish appropriate use program medicare services publicly available website specified information respect eligible professional sec expands kinds including standardized uses claims data available qualified entities quality improvement activities including analysis data non public uses provision sale subject certain conditions physicians professionals providers medical societies hospital associations certain entities directs secretary provide medicare claims data requesting qualified clinical data registries link clinical data perform analyses research support quality improvement patient safety restricts access claims data qualified data web based portal comparable mechanism data extracted requires data analyses individually identifiable data particular patient specified exceptions requires fees charged making standardized claims data available qualified entities deposited currently federal_supplementary_medical_insurance_trust_fund sec permits continuing automatic extensions medicare physician practitioner election opt medicare physician payment system private contracts directs secretary publicly available appropriate publicly accessible website information number characteristics opt physicians practitioners establish demonstration project sure medicare payments services furnished non participating physicians individuals entitled benefits enrolled paid directly physicians directs secretary recommendations congress amend existing fraud abuse law permit gainsharing similar arrangements physicians hospitals improve care reducing waste increasing efficiency declares national objective achieve widespread nationwide exchange health information interoperable certified ehr technology december consequence significant federal investment implementation health information technology medicare ehr incentive programs directs secretary study feasibility establishing website compare certified ehr technology products requires gao study use telehealth federal programs


Summary:
Medicare Patient Access to Cancer Treatment Act of 2013 - Expresses the sense of Congress that, to ensure the future of community cancer care, Medicare reimbursement should be equal for the same service provided to a cancer patient regardless of whether the service is delivered in the hospital outpatient department (OPD) or physician's office.

Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to the prospective payment system (PPS) for OPD services to require that the payment amount under PPS and physician fee schedules for covered OPD cancer services be a budget neutral combination of the amount otherwise payable under the PPS and the amount otherwise payable under the physician fee schedule for such services.

medicare_patient_access cancer treatment act expresses sense congress ensure future community cancer care medicare reimbursement equal service provided cancer patient regardless service delivered hospital outpatient department opd physician office amends title xviii medicare social security act ssa respect prospective payment system pps opd services require payment pps physician fee schedules covered opd cancer services budget neutral combination payable pps payable physician fee schedule services


Summary: Protecting Access to Primary Care Act - Amends title XIX (Medicaid) of the Social Security Act to extend to nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse midwives payment for primary care services furnished in 2013 and 2014 at a rate not less than 100% of the Medicare payment rate applicable to physician for such services.

title xix medicaid social security act extend nurse practitioners physician assistants clinical nurse specialists certified nurse midwives payment primary care services furnished rate medicare payment rate applicable physician services


Summary:
Prevent Interruptions in Physical Therapy Act of 2013 - Amends part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to require physical therapists furnishing outpatient physical therapy services to use specified locum tenens arrangements for payment purposes in the same manner as such arrangements are used to apply to physicians furnishing substitute physicians services for other physicians.

(Locum tenens [place holder], or substitute, physicians usually assume professional practices in the absence of a regular physician for reasons such as illness, pregnancy, vacation, or continuing medical education.)

prevent interruptions physical therapy act amends supplementary_medical_insurance title xviii medicare social security act require physical therapists furnishing outpatient physical therapy services use specified locum tenens arrangements payment purposes manner arrangements apply physicians furnishing substitute physicians services physicians locum tenens place holder substitute physicians usually assume professional practices absence regular physician reasons illness pregnancy vacation continuing medical education


Summary:
Amends title XIX (Medicaid) of the Social Security Act (SSA) to repeal the requirement that state plans for medical assistance pay for covered prenatal or preventive pediatric care services, or other covered services provided to an individual on whose behalf a state agency is enforcing child support, without regard to a third party's liability for payment for such services, and then seek reimbursement from the third party.

Requires a state plan to require any contract with a managed care entity to specify whether the state is: (1) delegating to the entity all or some of its right of recovery for payment of an item or service, and (2) transferring to the entity all or some of the assignment to the state of any right of an individual or other entity to payment from a health insurer for an item or service.

Requires any state that makes such a delegation or transfer to have in effect laws requiring such health insurers, as a condition of doing business, to: (1) provide the managed care entity certain information upon request; (2) accept the delegated right of recovery and the transferred assignment of rights; and (3) agree not to deny a claim submitted by a managed care entity, for which the state has delegated or transferred rights, in the same manner that the insurer may not deny a claim submitted by a state.

 Requires the state plan of any state that contracts with a health insurer to require that any contract of the health insurer with a pharmacy benefit manager to manage benefits under the insurer's health plan shall require that the pharmacy benefit manager regularly report to the state any relevant data it obtains to assist the state in determining whether the insurer is legally responsible for paying a claim for a health care item or service available under the plan.

Requires such a contract also to require the insurer to cooperate with the state Medicaid plan for the proper coordination of benefits offered in order to effectuate the principle of the Medicaid program's being the payer of last resort.

Directs the Secretary of Health and Human Services (HHS) to develop and make available to the states a model uniform reporting field that states may use for reporting to the Secretary within CME Form 64 (or any successor form) information identifying third-party health insurers and other relevant information for ascertaining the legal responsibility of such third parties to pay for care and services under Medicaid.

Requires the Secretary to apply the federal medical assistance percentage (FMAP) for the state in determining the amount, if any, of any overpayment with respect to Medicaid services for newly eligible individuals.

Prescribes an administrative penalty for non-compliance with the additional Medicaid requirements imposed by this Act.

amends title xix medicaid social security act ssa repeal requirement state plans medical assistance pay covered prenatal preventive pediatric care services covered services provided individual behalf state agency enforcing child support regard party liability payment services seek reimbursement party requires state plan require contract managed care entity specify state delegating entity right recovery payment item service transferring entity assignment state right individual entity payment health insurer item service requires state makes delegation transfer effect laws requiring health insurers condition business provide managed care entity certain information request accept delegated right recovery transferred assignment rights agree deny claim submitted managed care entity state delegated transferred rights manner insurer deny claim submitted state requires state plan state contracts health insurer require contract health insurer pharmacy benefit manager manage benefits insurer health plan shall require pharmacy benefit manager regularly report state relevant data obtains assist state determining insurer legally responsible paying claim health care item service available plan requires contract require insurer cooperate state medicaid plan proper coordination benefits offered order effectuate principle medicaid program payer resort directs secretary health_and_human_services hhs develop available states model uniform reporting field states use reporting secretary successor form information identifying party health insurers relevant information legal responsibility parties pay care services medicaid requires secretary apply federal medical assistance percentage fmap state determining overpayment respect medicaid services newly eligible individuals prescribes administrative penalty non compliance additional medicaid requirements imposed act


Summary: Amends the Patient Protection and Affordable Care Act to direct the Secretary of Health and Human Services (HHS) to prohibit any funds under a grant to a state for establishing an American Health Benefit Exchange from being used for a bonus or pay increase for a chief executive officer, chief information officer, chief operating officer, or similar executive with respect to the operation of such an Exchange on or after October 1, 2013.

amends patient_protection affordable care act direct secretary health_and_human_services hhs prohibit funds grant state establishing american_health_benefit_exchange bonus pay increase chief executive officer chief information officer chief operating officer similar executive respect operation exchange october


Summary: Federal Acupuncture Coverage Act of 2013 - Amends part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act and federal civil service law relating to the Federal Employees Health Benefits Program to cover qualified acupuncturist services.

federal acupuncture coverage act amends supplementary_medical_insurance title xviii medicare social security act federal civil service law relating federal_employees_health_benefits_program cover qualified acupuncturist services


Summary: Critical Access Hospital Relief Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act to repeal the 96-hour physician certification requirement for inpatient critical access hospital services under which a physician must certify that a patient may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital.

critical access hospital relief act amends title xviii medicare social security act repeal hour physician certification requirement inpatient critical access hospital services physician certify patient reasonably expected discharged transferred hospital hours admission critical access hospital


Summary:
SGR Repeal and Medicare Provider Payment Modernization Act of 2014 - (Sec. 2) Amends part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act (SSA) to: (1) end with 2013 the current formula for an update to the single conversion factor in the formula for payment for physicians' services, (2) end and remove sustainable growth rate (SGR) methodology from the determination of such annual conversion factors, (3) prescribe an update to the single conversion factor for 2014-2018 of 0.5%, (4) freeze the update to the single conversion factor at 0.00% for 2019-2023, and (5) establish for 2024 and subsequent years an update of 1% for health professionals participating in alternative payment models (APMs) and an update of 0.5% for all other health professionals.

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 rates 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, and D (Voluntary Prescription Drug Benefit Program).

Directs MEDPAC to report to Congress on: (1) the payment update for professional services applied for 2014-2018; (2) the effect of that update on the efficiency, economy, and quality of care; (3) the update's effect on ensuring a sufficient number of providers to maintain access to care by Medicare beneficiaries; and (4) recommendations for any future payment updates to ensure adequate access to care is maintained for such beneficiaries.

Directs the Secretary of Health and Human Services (HHS) to establish a merit-based incentive payment system (MIPS) by consolidating (with certain revisions) the existing: (1) electronic health record (EHR) meaningful use incentive program, (2) quality reporting program, and (3) value-based payment program.

 Applies the MIPS program to payments for items and services furnished on or after January 1, 2018.

Requires MIPS-eligible professionals (excluding most APM participants) to receive annual payment increases or decreases based on their performance.

Defines MIPS-eligible professional as: (1) a physician, a physician assistant, nurse practitioner, clinical nurse specialist, and a certified registered nurse anesthetist during the MIPS program's first two years, and (2) also other eligible professionals specified by the Secretary for succeeding years.

 Excludes from treatment as a MIPS eligible professional any eligible professional who is: (1) a qualifying APM participant; (2) a partial qualifying APM participant for the most recent period for which data are available and who, for the performance period with respect to that year, does not report on applicable measures and activities a MIPS professional is required to report; or (3) does not exceed, for that performance period, a specified low-volume threshold measurement.

Qualifies for MIPS incentive payments a partial qualifying APM participant who reports on applicable measures and activities a MIPS professional is required to report.

Prescribes requirements for: (1) application of the MIPS program to group practices; and (2) measures and activities under the performance categories of quality, resource use, clinical practice improvement, and meaningful use of EHR technology.

Requires the Secretary, on an ongoing basis, to: (1) estimate how an individual's health status and other risk factors affect quality and resource use outcome measures; (2) incorporate information from quality and resource use outcome measurements (including care episode and patient condition groups) into the MIPS; and (3) account for identified factors with an effect on those measures when determining payment adjustments, composite performance scores, scores for performance categories, or scores for measures or activities under the MIPS. Requires the Secretary to: (1) establish performance standards for the MIPS program, taking into account historical performance standards, improvement rates, and the opportunity for continued improvement; and (2) develop a methodology for assessing the total performance of each MIPS eligible professional according to such standards with respect to applicable measures and activities for each performance category, leading to a composite performance score for each professional for each performance period.

Directs the Secretary to specify a MIPS adjustment factor for each MIPS eligible professional for a year according to a formula taking into account composite performance scores above or below a performance threshold, including those at or above an additional performance threshold (for exceptional performance).

Makes appropriations for 2018-2023 from the Federal Supplementary Medical Insurance Trust Fund for MIPS payments resulting from additional MIPS adjustment factors.

Prescribes a formula for the calculation of MIPS program incentive payments, beginning with 2018, subject to criteria for budget neutrality as well as a process for review of the calculation of an individual professional's MIPS program incentive payment adjustment factor for a year.

Directs the Secretary to make available on the Physician Compare website of the Centers for Medicare & Medicaid Services (CMS) certain information, including information regarding the performance of MIPS-eligible professionals.

Directs the Secretary to enter into contracts or agreements with appropriate entities (such as quality improvement organizations, regional extension centers, or regional health collaboratives) to offer guidance and assistance about performance categories or transition to an APM to MIPS-eligible professionals in practices of 15 or fewer professionals (with priority given to practices located in rural areas, health professional shortage areas, medically underserved areas, and practices with low composite performance scores).

Requires the Secretary to make available to each MIPS eligible professional timely (such as quarterly) confidential feedback and other information to improve performance.

Requires the Comptroller General (GAO) to: (1) evaluate the MIPS program; and (2) report on the similarities and differences in the use of quality measures under the original Medicare fee-for-service program, the Medicare Advantage program under Medicare part C (Medicare+Choice), selected state medical assistance programs under SSA title XIX (Medicaid), and private payer arrangements, and make recommendations on how to reduce the administrative burden involved in applying such quality measures.

Directs GAO to examine: (1) whether entities that pool financial risk for physician services (such as independent risk managers) can play a role in supporting physician practices in assuming financial risk for treatment of patients; and (2) the transition to an APM of professionals in rural areas, health professional shortage areas, or medically underserved areas.

Establishes the Payment Model Technical Advisory Committee to make recommendations to the Secretary on physician-focused payment models.

Prescribes incentive payments for participation in eligible APMs between 2018 and 2023, consisting of an additional 5% of the current-year payment amount for the covered professional services for the preceding year.

Prohibits any construction of this Act to preclude an APM or a qualifying APM participant from furnishing a telehealth service for which Medicare payment is not made.

Directs the Secretary to study: (1) the feasibility of integrating APMs in the Medicare Advantage payment system, (2) the applicability of federal fraud prevention laws to items and services furnished under Medicare for which payment is made under an APM, (2) aspects of such APMs that are vulnerable to fraudulent activity, and (3) the implication of waivers to such laws granted in support of such APMs.

Requires the Secretary to study: (1) the effect of individuals' socioeconomic status on quality and resource use outcome measures for individuals under Medicare; and (2) the impact of certain risk factors, race, health literacy, limited English proficiency (LEP), and patient activation on quality and resource use outcome measures under Medicare.

Directs the Secretary, taking account of such studies, to: (1) estimate how an individual's health status and other risk factors affect quality and resource use outcome measures and, as feasible, to incorporate information from quality and resource use outcome measurement into the eligible professional MIPS incentive program; and (2) account for other identified factors with an effect on quality and resource use outcome measures when determining payment adjustments under the MIPS incentive program.

Directs the Secretary to develop and report to Congress on a strategic plan for collecting or otherwise assessing data on race and ethnicity for purposes of carrying out the eligible professional MIPS incentive program.

Directs the Secretary to take certain steps, including development of care episode and patient condition groups as well as proposed classification codes, in order to involve the physician, practitioner, and other stakeholder communities in enhancing the infrastructure for resource use measurement for MIPS, APM, and other purposes.

 Prohibits the Secretary from contracting with an entity, or an entity from subcontracting with another entity, if either the contracting or the subcontracting entity currently makes recommendations to the Secretary on relative values for physicians' services under the fee schedule. (Sec. 3) Directs the Secretary to develop and post on the Internet website of the Centers for Medicare and Medicaid Services (CMS) a draft plan as well as an operational plan, taking stakeholder comments on the draft plan into account, for the development of quality measures to assess professionals.

Directs the Secretary to enter into contracts or other arrangements with entities, including those organizations with quality measure development expertise, for the purpose of developing, improving, updating, or expanding such quality measures.

Requires the Secretary to transfer $15 million from the Federal Supplemental Medical Insurance Trust Fund to the CMS Program Management Account for each of FY2014-2018.

(Sec. 4) Requires the Secretary to: (1) establish one or more Healthcare Common Procedure Coding System (HCPCS) codes for chronic care management services for patients with chronic care needs, (2) make payments for any such services furnished by an applicable provider, and (3) conduct an education and outreach campaign to inform professionals who furnish items and services under Medicare part B and Medicare part B enrollees of the benefits of chronic care management services.

(Sec. 5) Authorizes the Secretary to: (1) collect or obtain information from any eligible professional or any other source on the resources directly or indirectly related to furnishing services paid for under the Medicare fee schedule, and (2) use such information to determine relative values for those services.

Authorizes the Secretary to establish or adjust practice expense relative values using cost, charge, or other data from suppliers or service providers, including any such collected or obtained information.

Expands the list of codes the Secretary must examine to identify services that may be misvalued, including codes: (1) that account for the majority of spending under the physician fee schedule, (2) that have experienced a substantial change in the hospital length of stay or procedure time, (3) for which there is a significant difference in payment for the same service between different sites of service, (4) with high intra-service work per unit of time, (5) with high practice expense relative value units (RVUs), and (6) with high cost supplies.

Sets at 0.5% of the estimated amount of fee schedule expenditures in 2015-2018 the annual target (estimated net reduction in expenditures under the fee schedule) with respect to relative value adjustments for misvalued services.

Declares that, for fee schedules beginning with 2015, if the RVUs for a service for a year would otherwise be decreased by an estimated 20% or more as compared to the total RVUs for the previous year, the applicable adjustments in work, practice expense, and malpractice RVUs must be phased-in over a two-year period.

Directs GAO to study the processes used by the Relative Value Scale Update Committee (RUC) (of the American Medical Association) to make recommendations to the Secretary regarding relative values for specific services.

Requires the use on or after January 1, 2017, of metropolitan statistical areas (MSAs) as fee schedule areas in California, with all areas not included in an MSA to be treated as a single rest-of-state fee schedule area.

Prescribes a formula for the geographic index values applied to the physicians fee schedule for MSAs previously in the rest-of-payment locality or in locality 3.

 Directs the Secretary to make publicly available the information used to establish the multiple procedure payment reduction policy to the professional component of imaging services in a specified final rule under the physicians fee schedule.

(Sec. 6) Directs the Secretary to: (1) establish a program to promote the use of appropriate use criteria for certain advanced diagnostic imaging services furnished by ordering and furnishing professionals, and (2) specify applicable appropriate use criteria for imaging services from among appropriate use criteria developed or endorsed by national professional medical specialty societies or other entities.

Directs the Secretary to: (1) determine, on a periodic basis, outlier ordering professionals; and (2) apply prior authorization for applicable imaging services ordered by an outlier ordering professional.

Prohibits the construction of these requirements as authorizing the Secretary to develop or initiate the development of clinical practice guidelines or appropriate use criteria.

(Sec. 7) Requires the Secretary to make publicly available on the CMS Physician Compare website specified information with respect to eligible professionals.

(Sec. 8) Allows a qualified entity, beginning July 1, 2015, to use Medicare claims data combined with data from sources other than claims data, as well as information derived from a specified performance evaluation of service providers and suppliers, to: (1) conduct additional appropriate non-public analyses; and (2) provide or sell them (subject to certain conditions) to physicians, other professionals, providers, medical societies, and hospital associations and certain other entities for non-public use. Prohibits any use of an analysis or data for marketing purposes.

Expands the kinds (including standardized extracts) and uses of claims data available to qualified entities for quality improvement activities.

Limits the provision or sale of such analyses to: (1) an employer solely for the purposes of providing health insurance to its employees and retirees, and (2) a health insurance issuer only if the issuer is providing the qualified entity offering the analyses with Medicare claims data combined with data from sources other than claims data.

Requires a qualified entity and an authorized user that is a service provider, supplier, or medical society or hospital association to enter into an agreement regarding the use of any data that the qualified entity is providing to or selling the user, including privacy and data security requirements and any prohibitions on using such data to link to other individually identifiable sources of information. Requires the Secretary to: (1) impose a specified administrative assessment for any breach of such an agreement by a qualified entity, and (2) deposit assessment amounts into the Federal Supplementary Medical Insurance Trust Fund. Prohibits authorized users from redisclosing (except for performance improvement and care coordination activities) or making public any analysis, data, or analysis using data they have obtained or bought. Requires any fees charged for making standardized extracts of claims data available to qualified entities to be deposited into the CMS Program Management Account (currently, into the Federal Supplementary Medical Insurance Trust Fund). Directs the Secretary to provide Medicare claims data, and if appropriate also data under Medicaid and SSA title XXI (Children's Health Insurance Program) (CHIP), to requesting qualified clinical data registries in order to link such data with clinical outcomes data and perform risk-adjusted, scientifically valid analyses and research to support quality improvement or patient safety. Limits fees charged for such data to the cost of providing it, and requires their deposit into the CMS Program Management Account.

Requires any fees charged for making standardized extracts of claims data available to qualified entities to be deposited into the CMS Program Management Account (currently, into the Federal Supplementary Medical Insurance Trust Fund).

(Sec. 9) Permits continuing automatic extensions of a Medicare physician and practitioner election to opt-out of the Medicare physician payment system into private contracts.

Directs the Secretary to make publicly available through an appropriate publicly accessible website information on the number and characteristics of opt-out physicians and practitioners.

Directs the Secretary to make recommendations to Congress to amend existing fraud and abuse law to permit gainsharing or similar arrangements between physicians and hospitals that improve care while reducing waste and increasing efficiency.

Declares it a national objective to achieve widespread and nationwide exchange of health information through interoperable certified EHR technology by December 31, 2017, as a consequence of a significant federal investment in the implementation of health information technology through the Medicare and Medicaid EHR incentive programs.

Directs the Secretary to study the feasibility of establishing mechanisms to compare certified EHR technology products.

(Sec. 10) Amends the Internal Revenue Code to delay until January 1, 2019, implementation of the penalty for failure to comply with the individual health insurance mandate under the Patient Protection and Affordable Care Act to maintain minimum essential health care coverage.

sgr_repeal medicare provider payment modernization act sec amends supplementary_medical_insurance title xviii medicare social security act ssa end current formula update single conversion factor formula payment physicians services end remove sustainable growth rate sgr methodology determination annual conversion factors prescribe update single conversion factor freeze update single conversion factor establish subsequent years update health professionals participating alternative payment models apms update health professionals directs medicare_payment_advisory_commission medpac report congress relationship physician health professional utilization expenditures rates increase items services medicare payment total utilization expenditures rate increase medicare parts voluntary prescription drug benefit program directs medpac report congress payment update professional services applied effect update efficiency economy quality care update effect ensuring sufficient number providers maintain access care medicare beneficiaries recommendations future payment updates ensure adequate access care maintained beneficiaries directs secretary health_and_human_services hhs establish merit based incentive payment system consolidating certain revisions existing electronic health record ehr meaningful use incentive program quality reporting program value based payment program applies program payments items services furnished january requires eligible professionals excluding apm participants receive annual payment increases decreases based performance defines eligible professional physician physician assistant nurse practitioner clinical nurse specialist certified registered nurse anesthetist program years eligible professionals specified secretary succeeding years excludes treatment eligible professional eligible professional qualifying apm participant partial qualifying apm participant recent period data available performance period respect year report applicable measures activities professional required report exceed performance period specified low volume threshold measurement qualifies incentive payments partial qualifying apm participant reports applicable measures activities professional required report prescribes requirements application program group practices measures activities performance categories quality resource use clinical practice improvement meaningful use ehr technology requires secretary ongoing basis estimate individual health status risk factors affect quality resource use outcome measures incorporate information quality resource use outcome measurements including care episode patient condition groups account identified factors effect measures determining payment adjustments composite performance scores scores performance categories scores measures activities requires secretary establish performance standards program taking account historical performance standards improvement rates opportunity continued improvement develop methodology assessing total performance eligible professional according standards respect applicable measures activities performance category leading composite performance score professional performance period directs secretary specify adjustment factor eligible professional year according formula taking account composite performance scores performance threshold including additional performance threshold exceptional performance makes appropriations federal_supplementary_medical_insurance_trust_fund payments resulting additional adjustment factors prescribes formula calculation program incentive payments beginning subject criteria budget neutrality process review calculation individual professional program incentive payment adjustment factor year directs secretary available website centers cms certain information including information performance eligible professionals directs secretary enter contracts agreements appropriate entities quality improvement organizations regional extension centers regional health collaboratives offer guidance assistance performance categories transition apm eligible professionals practices fewer professionals priority given practices located rural areas health professional shortage areas medically underserved areas practices low composite performance scores requires secretary available eligible professional timely quarterly confidential feedback information improve performance requires comptroller general gao evaluate program report similarities differences use quality measures original medicare fee service program medicare_advantage program medicare selected state medical assistance programs ssa title xix medicaid private payer arrangements recommendations reduce administrative burden involved applying quality measures directs gao examine entities pool financial risk physician services independent risk managers play role supporting physician practices assuming financial risk treatment patients transition apm professionals rural areas health professional shortage areas medically underserved areas establishes recommendations secretary physician focused payment models prescribes incentive payments participation eligible apms consisting additional current year payment covered professional services preceding year prohibits construction act preclude apm qualifying apm participant furnishing telehealth service medicare payment directs secretary study feasibility integrating apms medicare advantage payment system applicability federal fraud prevention laws items services furnished medicare payment apm aspects apms vulnerable fraudulent activity waivers laws granted support apms requires secretary study effect individuals socioeconomic status quality resource use outcome measures individuals medicare impact certain risk factors race health literacy limited english proficiency lep patient activation quality resource use outcome measures medicare directs secretary taking account studies estimate individual health status risk factors affect quality resource use outcome measures feasible incorporate information quality resource use outcome measurement eligible professional incentive program account identified factors effect quality resource use outcome measures determining payment adjustments incentive program directs secretary develop report congress strategic plan collecting assessing data race ethnicity purposes carrying eligible professional incentive program directs secretary certain steps including development care episode patient condition groups proposed classification codes order involve physician practitioner stakeholder communities enhancing infrastructure resource use measurement apm purposes prohibits secretary contracting entity entity subcontracting entity contracting subcontracting entity currently makes recommendations secretary relative values physicians services fee schedule sec directs secretary develop post internet website centers medicare medicaid_services cms draft plan operational plan taking stakeholder comments draft plan account development quality measures assess professionals directs secretary enter contracts arrangements entities including organizations quality measure development expertise purpose developing improving updating expanding quality measures requires secretary transfer million fy2014 sec requires secretary establish healthcare common procedure coding system hcpcs codes chronic care management services patients chronic care needs payments services furnished applicable provider conduct education outreach campaign inform professionals furnish items services medicare medicare enrollees benefits chronic care management services sec authorizes secretary collect obtain information eligible professional source resources directly indirectly related furnishing services paid medicare fee schedule use information determine relative values services authorizes secretary establish adjust practice expense relative values cost charge data suppliers service providers including collected obtained information expands list codes secretary examine identify services misvalued including codes account majority spending physician fee schedule experienced substantial change hospital length stay procedure time significant difference payment service different sites service high intra service work unit time high practice expense relative value units high cost supplies sets estimated fee schedule expenditures annual target estimated net reduction expenditures fee schedule respect relative value adjustments misvalued services declares fee schedules beginning service year decreased estimated compared total previous year applicable adjustments work practice expense malpractice phased year period directs gao study processes ruc recommendations secretary relative values specific services requires use january metropolitan statistical areas msas fee schedule areas california areas included msa treated single rest state fee schedule area prescribes formula geographic index values applied physicians fee schedule msas previously rest payment locality locality directs secretary publicly available information establish multiple procedure payment reduction policy professional component imaging services specified final rule physicians fee schedule sec directs secretary establish program promote use appropriate use criteria certain advanced diagnostic imaging services furnished ordering furnishing professionals specify applicable appropriate use criteria imaging services appropriate use criteria developed endorsed national professional medical specialty societies entities directs secretary determine periodic basis outlier ordering professionals apply prior authorization applicable imaging services ordered outlier ordering professional prohibits construction requirements authorizing secretary develop initiate development clinical practice guidelines appropriate use criteria sec requires secretary publicly available website specified information respect eligible professionals sec allows qualified entity beginning july use medicare claims data combined data sources claims data information derived specified performance evaluation service providers suppliers conduct additional appropriate non public analyses provide sell subject certain conditions physicians professionals providers medical societies hospital associations certain entities non public use prohibits use analysis data marketing purposes expands kinds including standardized uses claims data available qualified entities quality improvement activities limits provision sale analyses employer solely purposes providing health insurance employees retirees health insurance issuer issuer providing qualified entity offering analyses medicare claims data combined data sources claims data requires qualified entity authorized user service provider supplier medical society hospital association enter agreement use data qualified entity providing selling user including privacy data security requirements prohibitions data link individually identifiable sources information requires secretary impose specified administrative assessment breach agreement qualified entity deposit assessment amounts federal_supplementary_medical_insurance_trust_fund prohibits authorized users performance improvement care coordination activities making public analysis data analysis data obtained requires fees charged making standardized claims data available qualified entities deposited currently federal_supplementary_medical_insurance_trust_fund directs secretary provide medicare claims data appropriate data medicaid ssa title chip requesting qualified clinical data registries order link data clinical outcomes data perform risk adjusted scientifically valid analyses research support quality improvement patient safety limits fees charged data cost providing requires deposit requires fees charged making standardized claims data available qualified entities deposited currently federal_supplementary_medical_insurance_trust_fund sec permits continuing automatic extensions medicare physician practitioner election opt medicare physician payment system private contracts directs secretary publicly available appropriate publicly accessible website information number characteristics opt physicians practitioners directs secretary recommendations congress amend existing fraud abuse law permit gainsharing similar arrangements physicians hospitals improve care reducing waste increasing efficiency declares national objective achieve widespread nationwide exchange health information interoperable certified ehr technology december consequence significant federal investment implementation health information technology medicare medicaid ehr incentive programs directs secretary study feasibility establishing mechanisms compare certified ehr technology products sec amends internal revenue code delay january implementation penalty failure comply individual health insurance mandate patient_protection affordable care act maintain minimum essential health care coverage