H.R.2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013113th Congress (2013-2014)
Summary: H.R.2810 — 113th Congress (2013-2014)
Reported to House amended, Part I (11/12/2013)
Medicare Patient Access and Quality Improvement Act of 2013 - (Sec. 2) Amends title XVIII (Medicare) part B (Supplementary Medical Insurance) of the Social Security Act (SSA) to: (1) repeal sustainable growth rate (SGR) methodology from the determination of annual conversion factors in the formula for payment for physicians' services; and (2) prescribe an update to the single conversion factor for 2014 through 2018, as well as 2019 all subsequent years, of 0.5%.
Phases in a Quality Update Incentive Program (QUIP) under which the 0.5% update to physicians' payment rates, beginning in 2019, shall be adjusted by an applicable quality adjustment for a physician's performance under QUIP.
Requires the quality reporting system to cover clinical practice improvement activities that relevant eligible professional organizations and other relevant stakeholders identify as improving clinical practice or care delivery and the Secretary determines are likely to result in improved outcomes.
Prescribes requirements for establishment of core measure sets as well as quality measures for them.
Directs the Secretary of Health and Human Services (HHS) to identify and publish a list of peer cohorts, including for multispecialty groups, by which eligible professionals shall self-identify with respect to a performance period and for whom a final core measure set shall be assessed to determine the applicable quality adjustment.
Directs the Secretary to establish an eligible professional QUIP meeting specified criteria, including one or more methods to assess an eligible professional's performance with respect to quality measures and clinical practice improvement activities.
Directs the Secretary to establish a process for the testing and implementing of cost-effective and high-quality Alternative Payment Models.
(Sec. 3) Allows qualified entities to use Medicare claims data they receive, and information derived from a specified performance evaluation of service providers and suppliers, for additional analyses they may provide or sell to such providers and suppliers.
Requires the Secretary to provide such data to qualified entities to facilitate development of new models of care.
(Sec. 4) Requires the Secretary to develop one or more Healthcare Common Procedure Coding System codes for complex chronic care management services for patients with complex chronic care needs. Requires participating physicians to: (1) be certified as a medical home or have an equivalent certification, or (2) be recognized as a patient-centered specialty practice.
(Sec. 5) Directs the Administrator of the Centers for Medicare & Medicaid Services (CMS) to request eligible professional organizations and other relevant stakeholders to submit recommendations for defining non-acute related episodes of care.
Directs the CMS Administrator to solicit from eligible professional organizations recommendations for payment bundles for chronic conditions and expensive, high volumes services.
Directs the Secretary to: (1) implement a system for physicians to report periodically data on the accuracy of relative values, such as data relating to service volume and time; and (2) establish a mechanism for physicians to participate as a reporting group under the system.
Requires the Secretary, with respect to 2016, 2017, and 2018 fee schedules, to: (1) identify misvalued services for which adjustments to the relative values would result in a net reduction in expenditures under the fee schedule for the year of at most 1% of the projected amount of expenditures; and (2) make such adjustments for each year so as to result in such a net reduction.
Declares that the development, recognition, or implementation of any guideline or other standard under any federal health care provision shall not be construed to establish the standard of care or duty of care owed by a health care provider to a patient in any medical malpractice or medical product liability action or claim.