Congressional Research Service

Increasing Choice, Access, and Quality in Health Care for Americans ACT Congressional Research Service

This report summarizes the Increasing Choice, Access, and Quality in Health Care for Americans Act, enacted December 13, 2016, as Division C of the 21st Century Cures Act (P. L. 114-255). Division C comprises Title XV through Title XVII, which include provisions primarily relating to Medicare and Title XVIII, which includes a provision relating to the small-group health insurance market. Title XV Medicare Part A provisions: extend the Rural Community Hospital demonstration five years; require the Secretary of the Department of Health and Human Services (HHS) to account for socioeconomic factors in administering the Hospital Readmission Reduction Program; reduce a specific inpatient hospital payment update for FY2018; require the HHS Secretary to create a crosswalk between codes used for reimbursing procedures performed in inpatient and outpatient settings; and make adjustments to long-term care hospital (LTCH) reimbursement including creating or reinstating temporary clinical criteria for payment under the LTCH prospective payment system (PPS) rather than site neutral payment; modifying the average length of stay formula that determines whether a hospital qualifies as an LTCH; reinstating an exemption from a temporary moratorium on additional LTCH beds; delaying implementation of a rule that lowers reimbursement for certain LTCHs that rely disproportionately on referrals from a single acute-care hospital; and creating a new, non-LTCH hospital category in statute for a specific type of long-stay hospital. Title XVI Medicare Part B provisions: make modifications for PPS-exempt cancer hospital and certain new provider-based hospital outpatient departments to be paid under the outpatient PPS; exclude certain ambulatory surgical center-based eligible professionals from the electronic health records meaningful use payment adjustment; allow physical therapists who furnish outpatient physical therapy in certain areas to use locum tenens arrangements for payment purposes; extend the delay in enforcement of direct physician supervision requirements for outpatient therapeutic services in critical access hospitals and small rural hospitals; and make changes to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) payment including delaying when competitive bidding information can be used to adjust fee schedule rates for Group 3 complex rehabilitative power wheelchairs accessories;. Title XVII's other Medicare provisions: express Congress's intent to continue to study the effects of socioeconomic status and dual-eligible populations on the Medicare Advantage (MA) five-star rating system before reforming the system with stakeholder input; instruct that the HHS Secretary may not terminate MA or Prescription Drug Plan (PDP) contracts solely because of failure to achieve a minimum quality rating; create a three-month period at the beginning of the year during which an MA enrollee may switch to a different MA plan or return to Medicare Parts A and B (with or without a PDP); allow beneficiaries with end-stage renal disease (ESRD) to enroll in MA beginning January 1, 2021; modify the requirements for assigning beneficiaries to Medicare Shared Savings Program (MSSP) accountable care organizations; require the HHS Secretary to update the new beneficiary Welcome to Medicare package; and authorize the HHS Secretary to prohibit payment for services or items furnished by Medicare, Medicaid, or State Children's Health Insurance Program providers and suppliers who are subject to temporary new provider or supplier enrollment moratoria. Title XVIII: creates qualified small employer health reimbursement arrangements, which are arrangements offered by eligible employers that pay or reimburse employees for substantiated medical expenses. Under certain conditions, employers may make contributions up to a specified limit and employees do not owe income tax on the payments and reimbursements.