Payment reform

(a) In general Section 1848(q) of the Social Security Act (42 U.S.C. 1395w–4(q)) is amended— (1) in paragraph (1)(D)(i)(II), by striking (iv) and inserting (v); (2) in paragraph (2)— (A) in subparagraph (A)— (i) in clause (iii), by striking Clinical practice and inserting For performance periods beginning before January 1, 2032, clinical practice; (ii) in clause (iv), by striking Meaningful use and inserting For performance periods before January 1, 2032, meaningful use; and (iii) by adding at the end the following new clause: (v) For performance periods beginning on or after January 1, 2032, care efficiency.; (B) in subparagraph (B)— (i) in clause (ii)— (I) by striking subparagraph (A)(ii), the measurement and inserting the following: subparagraph (A)(ii)— (I) for performance periods beginning before January 1, 2032, the measurement; and (II) by striking the period at the end and inserting the following:; and (II) for performance periods beginning on or after January 1, 2032, the measurement described in subclause (I) and any resource use measures included in the final measures list published under subparagraph (D)(i) for such period.; and (ii) by inserting after clause (iv) the following new clause: (v) Care efficiency For the performance category described in subparagraph (A)(v), care efficiency measures (such as measures relating to reductions in avoidable hospitalizations, reductions in medication burden (when clinically appropriate), reductions in complications from chronic diseases, and referral patterns to the lowest-cost clinically appropriate settings) included in the final measures list published under subparagraph (D)(i) for such period.; (C) in subparagraph (D)— (i) in the header, by striking quality; (ii) in clause (i)— (I) in the matter preceding subclause (I), by inserting (or, with respect to performance periods beginning on or after January 1, 2032, an annual final list of quality measures, resource use measures (if determined appropriate by the Secretary), and care efficiency measures) after quality measures; and (II) in subclause (II)— (aa) in item (aa), by striking quality measures and inserting measures; (bb) in item (bb), by inserting (or, with respect to a final list for a performance period beginning on or after January 1, 2032, new quality measures, resource use measures, or care efficiency measures) after quality measures; and (cc) in item (cc), by striking quality measures and inserting measures; (iii) in clause (ii)— (I) in the header, by striking quality; and (II) in subclause (I)— (aa) by inserting (or, with respect to such an annual list for a performance period beginning on or after January 1, 2032, quality measures, resource use measures, and care efficiency measures) after submit quality measures; and (bb) by striking quality measures published and inserting measures published; (iv) in clause (iii)— (I) in the matter preceding subclause (I), by striking quality; (II) in subclause (I), by striking and at the end; (III) in subclause (II)— (aa) by striking ensure that and inserting with respect to such an annual final list for a performance period beginning before January 1, 2032, ensure that; and (bb) by striking the period at the end and inserting; and; and (IV) by adding at the end the following new subclause: (III) with respect to such an annual final list for a performance period beginning on or after January 1, 2032, provide that— (aa) no quality measure applicable to a medical specialty is included on such list if— (AA) the task force established under subparagraph (E) has issued recommendations on quality measures for use under this subsection with respect to such specialty; and (BB) the quality measure does not have in effect such a recommendation; and (bb) no resource use measure or care efficiency measure is included on such list unless such measure has in effect a recommendation from such task force.; (v) in clause (v), in the matter preceding subclause (I), by inserting for a performance period beginning before January 1, 2032, after published under clause (i); (vi) in clause (vi), by striking under clauses (i), (iv), and (v) and inserting under this subparagraph; and (vii) in clause (vii)(II), by striking shall be and inserting subject to clause (iii)(III)(aa), shall be; (3) in paragraph (5)— (A) in subparagraph (B)— (i) in clause (ii)— (I) in subclause (I)— (aa) by striking encourage and inserting with respect to a performance period beginning before January 1, 2032, encourage; and (bb) by striking and at the end; (II) in subclause (II), by striking the period and inserting; and; and (III) by adding at the end the following new subclause: (III) with respect to a performance period beginning on or after January 1, 2032, with respect to a year, provide that in the case of a MIPS eligible professional who fails to report on an applicable quality measure through the use of certified EHR technology or clinical data registries, the professional shall be treated as achieving the lowest potential score applicable to such measure.; and (ii) by adding at the end the following new clause: (iii) Incentive to report on certain measures (I) In general With respect to performance periods for years beginning on or after January 1, 2027, in the case a MIPS eligible professional elects to report on a measure for such period that, with respect to such professional and such period, is a new measure described in subclause (II), a substantively changed measure described in subclause (III), or a measure described in paragraph (2)(B)(i) for which the Secretary is unable to establish a benchmark, such professional shall be treated as achieving the highest possible score with respect to such measure. (II) New measures For purposes of subclause (I), a new measure described in this subclause, with respect to a MIPS eligible professional and performance period for a year, is a measure applicable to such professional with respect to the performance category described in paragraph (2)(A)(i) that is included in the final list of quality measures published under paragraph (2)(D)(i) (or the list of quality measures described in paragraph (2)(D)(vi) used by qualified clinical data registries under subsection (m)(3)(E)) for such year but was not included in such final list under paragraph (2)(D)(i) (or list under paragraph (2)(D)(vi)) for any of the previous 3 years. (III) Substantively changed measure For purposes of subclause (I), a substantively changed measure described in this subclause, with respect to a MIPS eligible professional and performance period for a year, is a measure applicable to such professional with respect to the performance category described in paragraph (2)(A)(i) that is included in the final list of quality measures published under paragraph (2)(D)(i) (or the list of quality measures described in paragraph (2)(D)(vi) used by qualified clinical data registries under subsection (m)(3)(E)) for such year and each of the previous three years but that underwent a substantive change (as defined by the Secretary) during any of such previous three years.; and (B) in subparagraph (E)— (i) in clause (i)— (I) in subclause (I)(aa), by inserting (or, with respect to 2032 and subsequent years, 65 percent) after thirty percent; (II) in subclause (II)(aa), by inserting (or, with respect to 2032 and subsequent years, 20 percent) after thirty percent; (III) in subclause (III), by inserting (or, with respect to 2032 and subsequent years, 0 percent) after fifteen percent; (IV) in subclause (IV), by inserting (or, with respect to 2032 and subsequent years, 0 percent) after twenty-five percent; and (V) by adding at the end the following new subclause: (V) Care efficiency With respect to 2032 and subsequent years, 15 percent of such score shall be based on performance with respect to the category described in clause (v) of paragraph (2)(A).; and (ii) in clause (ii), by inserting (before 2032) after In any year; (4) in paragraph (11)(A)(i), by striking clauses (i) through (iv) of; and (5) in paragraph (12)(A)(i)(II), by striking and (iv) and inserting through (v). (b) Improvements to resource use performance category Section 1848(r) of the Social Security Act (42 U.S.C. 1395w–4(r)) is amended— (1) in paragraph (2)(H), by adding at the end the following new sentence: In making such revisions for 2027 and subsequent years, the Secretary shall revise care episode groups and patient condition groups without regard to any target described in subparagraph (D)(i)(I).; and (2) in paragraph (5)(C)(i)— (A) by inserting, for years before 2027, after shall; and (B) by inserting and shall, for 2027 and subsequent years, use such care episode codes and patient condition codes before the period.