Summary:
(This measure has not been amended since it was introduced. The summary has been expanded because action occurred on the measure.)

SGR Repeal and Medicare Beneficiary Access Act of 2013 - Title I: Medicare Payment for Physicians' Services - (Sec. 101) Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) end and remove sustainable growth rate (SGR) methodology from the determination of annual conversion factors in the formula for payment for physicians' services; (2) freeze the update to the single conversion factor at 0.00% for 2014 through 2023, and (3) establish an update of 2% for health professionals participating in alternative payment models (APMs) and an update of 1% for all other health professionals after 2023.

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 rate 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 (Supplementary Medical Insurance), and D (Voluntary Prescription Drug Benefit Program).

Revises and consolidates components of the three specified existing performance incentive programs into a value-based performance (VBP) incentive program the Secretary of Health and Human Services (HHS) is directed to establish, under which VBP eligible professionals (excluding most APM participants) receive annual payment increases or decreases based on their performance. Applies such VBP program only to payments for items and services furnished on or after January 1, 2017.

Limits VBP eligible professionals to physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and, for the third and succeeding years of the VBP program, other eligible professionals as specified by the Secretary.

Excludes from the ranks of VBP eligible professionals any eligible professional who: (1) is a qualifying APM participant; (2) is a partial qualifying APM participant for the most recent period for which data are available and who, for the performance period with respect to such year, does not report on certain measures and activities required to be reported by a professional under the VBP program; or (3) does not exceed, for the performance period concerned, the low-volume threshold measurement selected by the Secretary.

Requires the Secretary to select as a low-volume threshold measurement either: (1) the minimum number of individuals enrolled under Medicare part B who are treated by the VBP eligible professional for the performance period involved, (2) the minimum number of items and services furnished to such individuals by that professional for the performance period, or (3) the minimum amount of allowed part B charges billed by the professional for the performance period.

Requires the Secretary also to establish and apply a process for assessing the performance of VBP eligible professionals in a group practice (including a voluntary virtual group).

Prescribes measures and activities for each performance category of: (1) quality, (2) resource use, (3) clinical practice improvement activities, and (4) meaningful use of electronic health record (EHR) technology.

Requires the Secretary to establish: (1) performance standards for such measures and activities as well as a performance period (or periods) for each year, and (2) a process under which a VBP eligible professional may seek an informal review of the calculation of his or her VBP program incentive payment adjustment factor.

Prescribes requirements for: (1) funding VBP program incentive payments by reducing the otherwise applicable fee schedule for items and services in order to create a performance funding pool, and (2) devising a VBP program incentive payment adjustment factor for each VBP eligible professional for a year to determine VBP program incentive payment amounts.

Directs the Secretary to enter into contracts or agreements to provide technical assistance to VBP eligible professionals in small practices, practices in health professional shortage areas, medically underserved areas, or practices with low VBP eligible professional composite scores, including technical assistance on how to transition to the implementation of and participation in an APM.

Requires specified incentive payments to be made to eligible APM participants.

Requires the Comptroller General (GAO) to: (1) evaluate the VBP program; (2) compare the similarities and differences in the use of quality measures under the original Medicare fee-for-service programs, the MedicareAdvantage (MA) program under Medicare part C (Medicare+Choice Program), selected state Medicaid programs, and private payer arrangements; and (3) make recommendations on how to reduce the administrative burden involved in applying such quality measures.

Directs GAO also to examine the transition to an APM of professionals in rural areas, health professional shortage areas, or medically underserved areas.

Prescribes requirements for incentive payments for participation in eligible APMs.

Requires the Secretary to study: (1) the application of federal fraud prevention laws to Medicare items and services paid for under APMs; (2) the effect of individuals' socioeconomic status on Medicare quality and resource use outcome measures; and (3) the impact of risk factors, race, health literacy, limited English proficiency (LEP), and patient activation on such quality and resource use outcome measures.

(Sec. 102) Directs the Secretary to develop, and post on the Internet website of the Centers for Medicare & Medicaid Services (CMS), a draft plan for the development of quality measures to assess professionals.

Directs the Secretary to enter into contracts or other arrangements with entities to develop, improve, update, or expand quality measures.

(Sec. 103) Directs the Secretary, in developing physicians' fee schedules, to: (1) establish one or more Health Common Procedures Coding System (HCPCS) codes for chronic care management services for individuals with chronic care needs, (2) make payment for chronic care management 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 part B enrollees of the benefits of such services and encourage individuals with chronic care needs to receive them.

(Sec. 104) Authorizes the Secretary to: (1) collect and use information on the resources directly or indirectly related to physicians' services in the determination of relative values under the fee schedule; and (2) establish or adjust practice expense relative values using cost, charge, or other data from suppliers or service providers.

Revises and expands factors for identification of potentially misvalued codes. Sets an annual target for relative value adjustments for misvalued services. Phases-in significant relative value unit (RVU) reductions.

Directs the Comptroller General to study the processes used by the Relative Value Scale Update Committee (RUC) in order to make recommendations to the Secretary on relative values for specific services under the Medicare physician fee schedule

(Sec. 105) Directs the Secretary to establish a program to promote the use of appropriate use criteria for: (1) applicable imaging services furnished in a hospital outpatient department (including an emergency department), an ambulatory surgical center, and any other appropriate provider-led outpatient setting by ordering professionals and furnishing professionals; and (2) other part B services.

(Sec. 106) Directs the Secretary to make certain services and charge information about eligible professionals available to the public on Physician Compare.

(Sec. 107) Authorizes qualified entities to use certain available data to develop and participate in quality and patient care improvement activities.

Directs the Secretary to provide Medicare data to qualified clinical data registries to support quality improvement or patient safety.

Title II: Extensions and Other Provisions - Subtitle A: Medicare Extensions - (Sec. 201) Makes permanent the 1.0 floor on the work geographic index.

(Sec. 202) Terminates the cap on the payment for therapy services.

Extends for one year through December 31, 2014, the threshold for manual medical review of any request for an exception to ordinary payment requirements with respect to expenses that would be incurred for outpatient therapy services.

Directs the Secretary to: (1) implement a new process for the medical review for outpatient therapy services furnished on or after January 1, 2015; and (2) use prior authorization medical review for outpatient therapy services furnished to an individual above one or more HHS-established thresholds, such as a dollar threshold or a threshold based on such factors as the type of outpatient therapy service or setting.

Directs GAO to study the effectiveness of the medical review of outpatient therapy services.

Requires the Secretary to: (1) post on the CMS Internet website a draft list and then an operational list of standardized data elements for individuals receiving outpatient therapy services, (2) develop and implement an electronic system for therapy providers to report such standardised data elements, and (3) report to Congress on the design of a new payment system for outpatient therapy services.

(Sec. 203) Extends add-on payments for ground ambulance and super rural ambulance services an additional five years for services furnished before January 1, 2019.

Requires the Secretary to: (1) develop a data collection system for providers and suppliers of ambulance services, and (2) specify the data collection methodology and dentify the providers and suppliers required to submit such data.

Reduces by 5% the ambulance payments for one year for identified providers and suppliers who fail to submit such data.

Authorizes the Secretary to revise the data collection system.

(Sec. 204) Revises requirements for the Medicare-dependent hospital (MDH) program.

(A Medicare-dependent hospital [MDH] is specifically a subsection [d] hospital which is a Medicare-dependent, small rural hospital. Generally, a subsection [d] hospital is an acute care hospital, particularly one that receives payments under Medicare's inpatient prospective payment system [IPPS] when providing covered inpatient services to eligible beneficiaries.)

Makes permanent the MDH program and the low-volume hospital payment adjustment.

Directs GAO to study: (1) the payor mix of MDHs, how that mix will trend in future years, and whether or not certain requirements should be revised; and (2) the characteristics of such hospitals that meet certain requirements.

(Sec. 205) Revises requirements for the Medicare inpatient hospital payment adjustment for low-volume hospitals.

(Sec. 206) Revises requirements for specialized MA plans for special needs individuals (SNPs).

Authorizes a specialized MA SNP to restrict the enrollment of individuals under the plan permanently to those who are within one or more classes of special needs individuals.

Applies this restriction to: (1) dual SNPs only through December 31, 2021, and (2) disabling chronic condition SNPs only through December 31, 2018.

Directs the Secretary, acting through the Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office [MMCO]), to serve as a dedicated point of contact for states to address misalignments that arise with the integration of specialized MA SNPs.

Requires the MMCO to establish: (1) a uniform process for disseminating to state Medicaid agencies (under SSA title XIX [Medicaid]) dual SNP information affecting contracts between them and specialized MA SNPs, and (2) basic resources for states interested in exploring specialized MA SNPs as a platform for integration.

Directs the Secretary to establish procedures unifying the appeals procedures for items and services provided by specialized MA SNPs. Requires the contract of a specialized MA SNP with a state Medicaid agency to require the use of such unified appeals procedures.

Requires a specialized MA dual SNP to integrate all benefits under Medicare and Medicaid and meet the requirements of a fully integrated plan. Specifies administrative penalties for failing to do so.

Sets forth requirements pertaining to care management for severe or disabling chronic conditions.

Directs GAO to study how the Secretary could change the MA quality measurement system to allow an accurate comparison of the quality of care provided by specialized MA SNPs, both for individual plans and such plans overall, compared to the quality of care delivered by the original Medicare fee-for-service program and other MA plans across similar populations.

Requires the Secretary to increase the emphasis on a SNP's improvement or decline in performance when determining its star (quality) ratings.

(Sec. 207) Allows extension or renewal for one last year of any reasonable cost reimbursement contract offered by a health maintenance organization or a competitive medical plan (eligible organization) that may no longer be extended or renewed for specified reasons.Prohibits the organization from enrolling any new enrollees under the contract during that last year.

Requires an eligible organization, before the beginning of a last reasonable cost reimbursement contract year, to notify the Secretary as to whether or not it will apply to have the contract converted over and offered as an MA plan for the following year. Applies to any such contract: (1) deemed enrollment in the MA plan (unless he or she opts out) of an enrollee under the reasonable cost reimbursement contract, and (2) a certain new special rule for quality increases.

(Sec. 208) Directs the Secretary to identify and contract with a private nonprofit entity meeting certain requirements to perform specified duties regarding input on the selections of quality measures.

Revises the duties of the consensus-based entities contracted to perform similar duties with respect to performance measurement. Reduces the term of such a contract from 4 to 3 years. Requires the entity to facilitate increased coordination and alignment between the public and private sector with respect to quality and efficiency measures.

Modifies the duties of the Secretary regarding the use of quality and efficiency measures and their endorsement, including funds transfers for FY2014-FY2017.

(Sec. 209) Amends the Medicare Improvements for Patients and Providers Act of 2008 to extend permanently the funding for low-income outreach and assistance activities.

Subtitle B: Medicaid and Other Extensions - (Sec. 211) Amends SSA title XIX to extend the Qualifying Individual (QI) program through December 31, 2018.

Removes the limitation on the number of beneficiaries who may receive QI assistance due to the capped allocation that states have been required to use in determining which eligible beneficiaries would receive assistance. Repeals such capped allocation as well as other eligibility requirements.

Sets the federal medical assistance percentage (FMAP) for the QI program at 100%.

(Sec. 212) Extends the transitional medical assistance (TMA) program through December 31, 2018.

Permits states that expand adult coverage and provide 12-month continuous eligibility under Medicaid and SSA title XXI (Children's Health Insurance) (CHIP) to opt-out of TMA.

Grants states the option to extend 12-month continuous eligibility to certain adult Medicaid enrollees.

(Sec. 213) Extends state authority to opt for "Express Lane" child Medicaid eligibility determinations until September 30, 2015.

(Sec. 214) Amends SSA title XI to modify the funding for adult quality measure development to require the Secretary to spend at least $15 million of the $60 million appropriated on pediatric quality measure development instead.

Eliminates the limitation (currently to the amount of grants for children's health care services) on the aggregate amount the Secretary must award for grants and contracts for the development, testing, and validation of emerging and innovative evidence-based adult quality measures.

(Sec. 215) Amends the Public Health Service Act (PHSA) to extend funding through FY2019 for: (1) the special diabetes programs for Type I diabetes, and (2) the special diabetes programs for Indians.

Subtitle C: Human Services Extensions - (Sec. 221) Extends the authorization and funding for the Abstinence Education grant program through FY2019.

(Sec. 222) Extends the authorization and funding for the Personal Responsibility Education program (PREP) through FY2019.

Expands PREP's target population to include youth at risk of becoming victims of sex trafficking or victims of a severe form of trafficking in persons.

(Sec. 223) Appropriates $6 million for each of FY2014-FY2018 for the family-to-family health information centers program.

Repeals the program's restriction to the 50 states and the District of Columbia (thus making the territories eligible for it).

(Sec. 224) Makes appropriations for the health workforce demonstration project for low-income individuals under SSA title XX (Block Grants to States for Social Services) for FY2013-FY2016.

Subtitle D: Program Integrity - (Sec. 231) Amends SSA title XVIII (Medicare) to require each Medicare administrative contractor, in order to reduce improper Medicare payments, to establish and have in place an improper payment outreach and education program, of which error rate reduction training is one of the program activities.

Requires the Secretary to provide each Medicare administrative contractor with a complete list of improper payments identified by recovery audit contractors (RACs). Requires the Secretary's annual report to Congress to contain information resulting from appeals of RAC audits.

Requires a RAC demonstration project.

(Sec. 232) Revises requirements for a Medicaid Fraud Control Unit to include a statewide program to investigate and prosecute (or refer for prosecution) complaints of abuse or neglect of: (1) individuals in connection with any aspect of benefits or services provided and the activities of assistance providers in a home- or community-based setting paid for under the state Medicaid plan (or a waiver), and (2) patients residing in board and care facilities.

(Sec. 233) Revises the authority of the HHS Inspector General to receive and retain reimbursement for the costs of conducting fraud and abuse investigations and audits and for monitoring compliance plans. Authorizes the HHS Inspector General to receive and retain 3% of all amounts collected pursuant to civil debt collection actions related to false claims or frauds involving the Medicare or Medicaid program. Requires funds received by the Inspector General to be deposited to the credit of any appropriation available for oversight and enforcement activities.

(Sec. 234) Amends SSA title XVIII part D (Voluntary Prescription Drug Benefit Program) to direct the Secretary, for 2015 and each subsequent plan year, to prohibit prescription drug plan (PDP) sponsors from paying claims for prescription drugs that do not include a valid prescriber National Provider Identifier (NPI).

Requires annual reports to Congress on RACs for 2015 and each subsequent year to describe: (1) the types and financial costs to Medicare of improper payment vulnerabilities identified by RACs, and (2) how the Secretary is addressing such vulnerabilities. Requires such reports also to assess the effectiveness of changes made to payment policies and procedures under Medicare in order to adddress the vulnerabilities identified.

Allows the Secretary to use Medicaid Integrity Program (MIP) funding for equipment, travel, benefits, training and salaries. Allows MIP funding to be used to employ whatever number of staff the Secretary determines necessary to carry out program integrity (PI) initiatives.

Requires the CMS Administrator to have access to the information in the National Directory of New Hires (NDNH) to determine the eligibility of an applicant for, or enrollee in, Medicare or an applicable state health subsidy program.

Requires the Secretary, if the HHS Inspector General (IG) transmits the names and Social Security numbers of individuals, to disclose to the IG any information about them and their employers maintained in the NDNH. Allows the IG to use this information only to determine the eligibility of an applicant for, or enrollee in, Medicare or a state subsidy program or to evaluate program integrity.

Applies the same NDNH information disclosure requirement to the Secretary if a state health subsidy program transmits names, dates of birth, and Social Security numbers of individuals for program eligibility purposes.

Requires the Secretary to: (1) establish a plan to encourage and facilitate the participation of states in the Medicare-Medicaid Match (Medi-Medi) Program, and (2) develop and implement a plan that allows each state agency responsible for administering a state Medicaid program access to relevant data on improper or fraudulent payments made under Medicare for health care items provided to dual eligible individuals.

 Subtitle E: Other Provisions - (Sec. 241) Amends SSA title XI (General Provisions) to direct the Secretary to establish the Commission on Improving Patient Directed Health Care to: (1) hold hearings and report to the public on improving patient self-determination in health care decision-making, and (2) report to the public on patient-directed health care.

Requires the President to report to Congress for action after receiving the final Commission recommendations.

Authorizes appropriations for FY2014-FY2015.

(Sec. 242) Permits cancer hospitals located in the same building or on the same campus as another hospital as of the enactment of this Act to obtain routine inpatient hospital items and services furnished after enactment by the hospital or by others under arrangements with the hospital.

(Sec. 243) Directs the Secretary to provide for the development of one or more Medicare quality measures to communicate accurately the existence and provide for the transfer of patient health information and patient care preferences when an individual transitions from a hospital to return home or move to other post-acute care settings.

(Sec. 244) Directs the Secretary to determine the appropriate criteria for Medicare payment for certain medically necessary inpatient hospital admissions for less than two midnights.

(Sec. 245) Requires the Secretary, in the final rule updating any list of surgical procedures appropriately performed on an inpatient basis in a hospital but which also can be performed safely on an ambulatory basis in an ambulatory surgical center (ASC), to describe the specific safety criteria for not including on that list a surgical procedure requested during the public comment period but which the Secretary does not propose to include in that rule.

(Sec. 246) Declares that the level of supervision for Medicare payment with respect to therapeutic outpatient critical access hospital (CAH) services shall be general supervision.

Includes supervision by nurse practitioners, clinical nurse specialists, or physician assistants as appropriate supervision for cardiac and pulmonary rehabilitation programs at CAHs.

(Sec. 247) Requires state licensure of bidding entities under the competitive acquisition program for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

(Sec. 248) Recognizes attending physician assistants as attending physicians to serve hospice patients under Medicare.

(Sec. 249) Directs the Secretary to: (1) conduct remote patient monitoring pilot projects; and (2) establish a performance target, using one of specified methodologies, for each participating home health agency.

(Sec. 250) Requires the Secretary to establish a Community-Based Institutional Special Needs Plan demonstration project to prevent and delay institutionalization under Medicaid among targeted low-income Medicare beneficiaries.

(Sec. 251) Authorizes the Secretary to waive applicable general and Medicaid requirements of the Program of All-Inclusive Care for Elderly (PACE) in order to conduct demonstration projects through the Center for Medicare and Medicaid Innovations (CMMI) that involve PACE. Prohibits the Secretary, however, as part of a CMMI demonstration, from waiving: (1) the requirement to offer items and services under Medicare without limitations, and (2) certain requirements regarding enrollment in and disenrollment from PACE programs.

Expresses the sense of the Senate that the Secretary should use waiver authority to provide, in a budget neutral manner, PACE programs with increased operational flexibility to support their ability to improve and innovate and to reduce technical and administrative barriers that have hindered enrollment in them.

(Sec. 252) Directs the Secretary to implement a strategic plan to increase the usefulness of data about state Medicaid programs reported by the states to CMS. Requires the strategic plan to address redundancies and gaps in Medicaid data systems and reporting through improvements to, and modernization of, computer and data systems.

(Sec. 253) Allows an individual under age 65 with a disability, who otherwise qualifies for a Medicaid supplemental needs trust ([d][4][A] trust), to create a (d)(4)(A) trust on his or her own.

(Sec. 254) Includes podiatrists as physicians under Medicaid.

Modifies requirements for diabetic shoes to be included under medical and other health services under Medicare.

(Sec. 255) Directs the Secretary to award planning grants to enable up to 10 states to carry out five-year demonstration programs to improve the provision of behavioral health services by certified behavioral health clinics in the state.

Authorizes appropriations for FY2016.

(Sec. 256) Requires the Secretary to report annually to Congress on the program for making Medicaid payment adjustments to disproportionate share hospitals (DSHs) to provide Congress with information relevant to determining an appropriate level of overall funding payments for such adjustments during and after the period in which aggregate reductions in the DSH allotments to states are required.

(Sec. 257) Specifies deadlines for successive stages in the issuance of implementing regulations under this Act.

measure amended introduced summary expanded action occurred measure sgr_repeal medicare beneficiary access act title medicare payment physicians services sec amends title xviii medicare social_security_act ssa end remove sustainable growth rate sgr methodology determination annual conversion factors formula payment physicians services freeze update single conversion factor establish 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 rate increase items services medicare payment total utilization expenditures rate increase medicare parts hospital insurance supplementary_medical_insurance voluntary prescription drug benefit program revises consolidates components specified existing performance incentive programs value based performance incentive program secretary health_and_human_services hhs directed establish eligible professionals excluding apm participants receive annual payment increases decreases based performance applies program payments items services furnished january limits eligible professionals physicians physician assistants nurse practitioners clinical nurse specialists certified registered nurse anesthetists succeeding years program eligible professionals specified secretary excludes ranks eligible professionals eligible professional qualifying apm participant partial qualifying apm participant recent period data available performance period respect year report certain measures activities required reported professional program exceed performance period concerned low volume threshold measurement selected secretary requires secretary select low volume threshold measurement minimum number individuals enrolled medicare treated eligible professional performance period involved minimum number items services furnished individuals professional performance period minimum allowed charges billed professional performance period requires secretary establish apply process assessing performance eligible professionals group practice including voluntary virtual group prescribes measures activities performance category quality resource use clinical practice improvement activities meaningful use electronic health record ehr technology requires secretary establish performance standards measures activities performance period periods year process eligible professional seek informal review calculation program incentive payment adjustment factor prescribes requirements funding program incentive payments reducing applicable fee schedule items services order create performance funding pool devising program incentive payment adjustment factor eligible professional year determine program incentive payment amounts directs secretary enter contracts agreements provide technical assistance eligible professionals small practices practices health professional shortage areas medically underserved areas practices low eligible professional composite scores including technical assistance transition implementation participation apm requires specified incentive payments eligible apm participants requires comptroller_general gao evaluate program compare similarities differences use quality measures original medicare fee service programs medicareadvantage program medicare program selected state medicaid programs private payer arrangements recommendations reduce administrative burden involved applying quality measures directs gao examine transition apm professionals rural areas health professional shortage areas medically underserved areas prescribes requirements incentive payments participation eligible apms requires secretary study application federal fraud prevention laws medicare items services paid apms effect individuals socioeconomic status medicare quality resource use outcome measures impact risk factors race health literacy limited english proficiency lep patient activation quality resource use outcome measures sec directs secretary develop post internet website centers medicare medicaid_services cms draft plan development quality measures assess professionals directs secretary enter contracts arrangements entities develop improve update expand quality measures sec directs secretary developing physicians fee schedules establish health common procedures coding system hcpcs codes chronic care management services individuals chronic care needs payment chronic care management services furnished applicable provider conduct education outreach campaign inform professionals furnish items services medicare enrollees benefits services encourage individuals chronic care needs receive sec authorizes secretary collect use information resources directly indirectly related physicians services determination relative values fee schedule establish adjust practice expense relative values cost charge data suppliers service providers revises expands factors identification potentially misvalued codes sets annual target relative value adjustments misvalued services phases significant relative value unit reductions directs comptroller_general study processes relative value scale update committee ruc order recommendations secretary relative values specific services medicare physician fee schedule sec directs secretary establish program promote use appropriate use criteria applicable imaging services furnished hospital outpatient department including emergency department ambulatory surgical center appropriate provider led outpatient setting ordering professionals furnishing professionals services sec directs secretary certain services charge information eligible professionals available public physician compare sec authorizes qualified entities use certain available data develop participate quality patient care improvement activities directs secretary provide medicare data qualified clinical data registries support quality improvement patient safety title extensions provisions subtitle medicare extensions sec makes permanent floor work geographic index sec terminates cap payment therapy services extends year december threshold manual medical review request exception ordinary payment requirements respect expenses incurred outpatient therapy services directs secretary implement new process medical review outpatient therapy services furnished january use prior authorization medical review outpatient therapy services furnished individual hhs established thresholds dollar threshold threshold based factors type outpatient therapy service setting directs gao study effectiveness medical review outpatient therapy services requires secretary post cms internet website draft list operational list standardized data elements individuals receiving outpatient therapy services develop implement electronic system therapy providers report data elements report congress design new payment system outpatient therapy services sec extends add payments ground ambulance super rural ambulance services additional years services furnished january requires secretary develop data collection system providers suppliers ambulance services specify data collection methodology providers suppliers required submit data reduces ambulance payments year identified providers suppliers fail submit data authorizes secretary revise data collection system sec revises requirements medicare dependent hospital program medicare dependent hospital specifically subsection hospital medicare dependent small rural hospital generally subsection hospital acute care hospital particularly receives payments medicare inpatient prospective payment system ipps providing covered inpatient services eligible beneficiaries makes permanent program low volume hospital payment adjustment directs gao study payor mix mix trend future years certain requirements revised characteristics hospitals meet certain requirements sec revises requirements medicare inpatient hospital payment adjustment low volume hospitals sec revises requirements specialized plans special needs individuals authorizes specialized restrict enrollment individuals plan permanently classes special needs individuals applies restriction dual december disabling chronic condition december directs secretary acting federal coordinated health_care office medicare-medicaid coordination office serve dedicated point contact states address arise integration specialized requires establish uniform process disseminating state medicaid agencies ssa title xix medicaid dual information affecting contracts specialized basic resources states interested exploring specialized platform integration directs secretary establish procedures appeals procedures items services provided specialized requires contract specialized state medicaid agency require use unified appeals procedures requires specialized dual integrate benefits medicare medicaid meet requirements fully integrated plan specifies administrative penalties failing sets forth requirements pertaining care management severe disabling chronic conditions directs gao study secretary change quality measurement system allow accurate comparison quality care provided specialized individual plans plans overall compared quality care delivered original medicare fee service program plans similar populations requires secretary increase emphasis improvement decline performance determining star quality ratings sec allows extension renewal year reasonable cost reimbursement contract offered health maintenance organization competitive medical plan eligible organization longer extended renewed specified reasons prohibits organization enrolling new enrollees contract year requires eligible organization beginning reasonable cost reimbursement contract year notify secretary apply contract converted offered plan following year applies contract deemed enrollment plan enrollee reasonable cost reimbursement contract certain new special rule quality increases sec directs secretary identify contract private nonprofit entity meeting certain requirements perform specified duties input selections quality measures revises duties consensus based entities contracted perform similar duties respect performance measurement reduces term contract years requires entity facilitate increased coordination alignment public private sector respect quality efficiency measures modifies duties secretary use quality efficiency measures endorsement including funds transfers fy2014 fy2017 sec amends medicare_improvements_for_patients_and_providers_act extend permanently funding low income outreach assistance activities subtitle medicaid extensions sec amends ssa title xix extend qualifying individual program december removes limitation number beneficiaries receive assistance capped allocation states required use determining eligible beneficiaries receive assistance repeals capped allocation eligibility requirements sets federal medical assistance percentage fmap program sec extends transitional medical assistance tma program december permits states expand adult coverage provide month continuous eligibility medicaid ssa title xxi children health insurance chip opt tma grants states option extend month continuous eligibility certain adult medicaid enrollees sec extends state authority opt express lane child medicaid eligibility determinations september sec amends ssa title modify funding adult quality measure development require secretary spend million million appropriated pediatric quality measure development instead eliminates limitation currently grants children health_care services aggregate secretary award grants contracts development testing validation emerging innovative evidence based adult quality measures sec amends public_health_service_act phsa extend funding fy2019 special diabetes programs type diabetes special diabetes programs indians subtitle human services extensions sec extends authorization funding abstinence education grant program fy2019 sec extends authorization funding personal responsibility education program prep fy2019 expands prep target population include youth risk victims sex trafficking victims severe form trafficking persons sec appropriates million fy2014-fy2018 family family health information centers program repeals program restriction states district_of_columbia making territories eligible sec makes appropriations health workforce demonstration project low income individuals ssa title block grants states social_services fy2013 fy2016 subtitle program integrity sec amends ssa title xviii medicare require medicare administrative contractor order reduce improper medicare payments establish place improper payment outreach education program error rate reduction training program activities requires secretary provide medicare administrative contractor complete list improper payments identified recovery audit contractors requires secretary annual report congress contain information resulting appeals audits requires demonstration project sec revises requirements medicaid fraud control unit include statewide program investigate prosecute refer prosecution complaints abuse neglect individuals connection aspect benefits services provided activities assistance providers home- community based setting paid state medicaid plan waiver patients residing board care facilities sec revises authority hhs_inspector general receive retain reimbursement costs conducting fraud abuse investigations audits monitoring compliance plans authorizes hhs_inspector general receive retain amounts collected pursuant civil debt collection actions related false claims involving medicare medicaid program requires funds received inspector_general deposited credit appropriation available oversight enforcement activities sec amends ssa title xviii voluntary prescription drug benefit program direct secretary subsequent plan year prohibit prescription drug plan pdp sponsors paying claims prescription drugs include valid prescriber national provider identifier requires annual reports congress subsequent year describe types financial costs medicare improper payment vulnerabilities identified secretary addressing vulnerabilities requires reports assess effectiveness changes payment policies procedures medicare order vulnerabilities identified allows secretary use medicaid_integrity_program mip funding equipment travel benefits training salaries allows mip funding employ number staff secretary determines necessary carry program integrity initiatives requires cms administrator access information national_directory_of_new_hires determine eligibility applicant enrollee medicare applicable state health subsidy program requires secretary hhs_inspector general transmits names social_security numbers individuals disclose information employers maintained allows use information determine eligibility applicant enrollee medicare state subsidy program evaluate program integrity applies information disclosure requirement secretary state health subsidy program transmits names dates birth social_security numbers individuals program eligibility purposes requires secretary establish plan encourage facilitate participation states medicare-medicaid match program develop implement plan allows state agency responsible administering state medicaid program access relevant data improper fraudulent payments medicare health_care items provided dual eligible individuals subtitle provisions sec amends ssa title general_provisions direct secretary establish commission improving patient directed health_care hold hearings report public improving patient self determination health_care decision making report public patient directed health_care requires president report congress action receiving final commission recommendations authorizes appropriations fy2014 fy2015 sec permits cancer hospitals located building campus hospital enactment act obtain routine inpatient hospital items services furnished enactment hospital arrangements hospital sec directs secretary provide development medicare quality measures communicate accurately existence provide transfer patient health information patient care preferences individual transitions hospital return home post acute care settings sec directs secretary determine appropriate criteria medicare payment certain medically necessary inpatient hospital admissions sec requires secretary final rule updating list surgical procedures appropriately performed inpatient basis hospital performed safely ambulatory basis ambulatory surgical center describe specific safety criteria including list surgical procedure requested public comment period secretary propose include rule sec declares level supervision medicare payment respect therapeutic outpatient critical access hospital services shall general supervision includes supervision nurse practitioners clinical nurse specialists physician assistants appropriate supervision cardiac pulmonary rehabilitation programs sec requires state licensure bidding entities competitive acquisition program certain durable medical equipment prosthetics orthotics supplies dmepos sec recognizes attending physician assistants attending physicians serve hospice patients medicare sec directs secretary conduct remote patient monitoring pilot projects establish performance target specified methodologies participating home health agency sec requires secretary establish community based institutional special needs plan demonstration project prevent delay institutionalization medicaid targeted low income medicare beneficiaries sec authorizes secretary waive applicable general medicaid requirements program inclusive care elderly pace order conduct demonstration projects center medicare medicaid innovations involve pace prohibits secretary demonstration waiving requirement offer items services medicare limitations certain requirements enrollment disenrollment pace programs expresses sense senate secretary use waiver authority provide budget neutral manner pace programs increased operational flexibility support ability improve innovate reduce technical administrative barriers enrollment sec directs secretary implement strategic plan increase usefulness data state medicaid programs reported states cms requires strategic plan address gaps medicaid data systems reporting improvements modernization computer data systems sec allows individual age disability qualifies medicaid supplemental needs trust trust create trust sec includes podiatrists physicians medicaid modifies requirements diabetic shoes included medical health services medicare sec directs secretary award planning grants enable states carry year demonstration programs improve provision behavioral health services certified behavioral health clinics state authorizes appropriations fy2016 sec requires secretary report annually congress program making medicaid payment adjustments disproportionate share hospitals provide congress information relevant determining appropriate level overall funding payments adjustments period aggregate reductions dsh allotments states required sec specifies deadlines successive stages issuance implementing regulations act


Summary:
Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014 - Amends federal veterans provisions to revise or add provisions concerning medical services and other benefits provided to veterans and/or their dependents through the Department of Veterans Affairs (VA) relating to the following areas:

 survivor and dependent matters, including benefits for children of certain veterans born with spina bifida; education matters, including the approval of courses for purposes of the All-Volunteer Force and the Post-9/11 Educational Assistance programs; the expansion and extension of certain health care benefits, including immunizations, chiropractic care, treatment for traumatic brain injury, and wellness promotion; health care administration, including extension of the Department of Veterans Affairs Health Professional Scholarship Program; complementary and alternative medicine; mental health care, including an education program and peer support program for family members and caregivers of veterans with mental health disorders; dental care eligibility and expansion, including a program of education to promote dental health in veterans; health care related to sexual trauma, including appropriate counseling and treatment and a screening mechanism to detect incidents of domestic abuse; reproductive treatment and services, including fertility counseling as well as adoption assistance for severely wounded veterans; major medical facility leases; veterans' employment training and related services; veterans' employment, including within the federal government and as first responders; career transition services; employment and reemployment rights of members of the Armed Forces after active duty service; small business matters, including contracting and subcontracting participation goals with federal departments and agencies; administrative matters, including regional support centers for Veterans Integrated Service Networks; the revision of claims based on military sexual trauma as well as claims for dependency and indemnity compensation; jurisdictional matters, including with respect to the Board of Veterans' Appeals and the Court of Appeals for Veterans Claims; and outreach and miscellaneous matters, including repeal of the provision of the Bipartisan Budget Act of 2013 that reduces the cost-of-living adjustment to the retirement pay of members of the Armed Forces under age 62.

comprehensive veterans health benefits military retirement pay restoration act amends federal veterans provisions revise add provisions concerning medical services benefits provided veterans dependents department_of_veterans_affairs relating following areas survivor dependent matters including benefits children certain veterans born spina bifida education matters including approval courses purposes volunteer force educational assistance programs expansion extension certain health_care benefits including immunizations chiropractic care treatment traumatic brain injury wellness promotion health_care administration including extension department_of_veterans_affairs health professional scholarship program complementary alternative medicine mental health_care including education program peer support program family members caregivers veterans mental health disorders dental care eligibility expansion including program education promote dental health veterans health_care related sexual trauma including appropriate counseling treatment screening mechanism detect incidents domestic abuse reproductive treatment services including fertility counseling adoption assistance severely wounded veterans major medical facility leases veterans employment training related services veterans employment including federal_government responders career transition services employment reemployment rights members armed_forces active duty service small business matters including contracting subcontracting participation goals federal departments agencies administrative matters including regional support centers veterans_integrated_service_networks revision claims based military sexual trauma claims dependency indemnity compensation jurisdictional matters including respect board veterans appeals court_of_appeals veterans claims outreach miscellaneous matters including repeal provision bipartisan_budget_act reduces cost living adjustment retirement pay members armed_forces age


Summary:
Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014 - Amends federal veterans provisions to revise or add provisions concerning medical services and other benefits provided to veterans and/or their dependents through the Department of Veterans Affairs (VA) relating to the following areas:

 survivor and dependent matters, including benefits for children of certain veterans born with spina bifida; education matters, including the approval of courses for purposes of the All-Volunteer Force and the Post-9/11 Educational Assistance programs; the expansion and extension of certain health care benefits, including immunizations, chiropractic care, treatment for traumatic brain injury, and wellness promotion; health care administration, including extension of the Department of Veterans Affairs Health Professional Scholarship Program, and complementary and alternative medicine; mental health care, including an education program and peer support program for family members and caregivers of veterans with mental health disorders; dental care eligibility and expansion, including a program of education to promote dental health in veterans; health care related to sexual trauma, including appropriate counseling and treatment and a screening mechanism to detect incidents of domestic abuse; reproductive treatment and services, including fertility counseling as well as adoption assistance for severely wounded veterans; major medical facility leases; veterans' employment training and related services; veterans' employment, including within the federal government and as first responders; career transition services; employment and reemployment rights of members of the Armed Forces after active duty service; small business matters, including contracting and subcontracting participation goals with federal departments and agencies; administrative matters, including regional support centers for Veterans Integrated Service Networks; the revision of claims based on military sexual trauma as well as claims for dependency and indemnity compensation; jurisdictional matters, including with respect to the Board of Veterans' Appeals and the Court of Appeals for Veterans Claims; the revision of certain rights under the Servicemembers Civil Relief Act, including protections with respect to the expiration of professional licenses, a prohibition on the denial of credit or the termination of residential leases due to military service, and the temporary protection of surviving spouses under mortgage foreclosures; and outreach and miscellaneous matters, including: (1) repeal of the provision of the Bipartisan Budget Act of 2013 that reduces the cost-of-living adjustment to the retirement pay of members of the Armed Forces under age 62, and (2) the accounting for discretionary accounts designated for overseas contingency operations/global war on terrorism.

comprehensive veterans health benefits military retirement pay restoration act amends federal veterans provisions revise add provisions concerning medical services benefits provided veterans dependents department_of_veterans_affairs relating following areas survivor dependent matters including benefits children certain veterans born spina bifida education matters including approval courses purposes volunteer force educational assistance programs expansion extension certain health_care benefits including immunizations chiropractic care treatment traumatic brain injury wellness promotion health_care administration including extension department_of_veterans_affairs health professional scholarship program complementary alternative medicine mental health_care including education program peer support program family members caregivers veterans mental health disorders dental care eligibility expansion including program education promote dental health veterans health_care related sexual trauma including appropriate counseling treatment screening mechanism detect incidents domestic abuse reproductive treatment services including fertility counseling adoption assistance severely wounded veterans major medical facility leases veterans employment training related services veterans employment including federal_government responders career transition services employment reemployment rights members armed_forces active duty service small business matters including contracting subcontracting participation goals federal departments agencies administrative matters including regional support centers veterans_integrated_service_networks revision claims based military sexual trauma claims dependency indemnity compensation jurisdictional matters including respect board veterans appeals court_of_appeals veterans claims revision certain rights servicemembers_civil_relief_act including protections respect expiration professional licenses prohibition denial credit termination residential leases military service temporary protection surviving spouses mortgage foreclosures outreach miscellaneous matters including repeal provision bipartisan_budget_act reduces cost living adjustment retirement pay members armed_forces age accounting discretionary accounts designated overseas contingency operations global war terrorism


Summary:
Four Rationers Repeal Act of 2014 - Repeals sections of the Patient Protection and Affordable Care (PPACA) (and restores provisions of law amended by such sections) related to the establishment of an Independent Payment Advisory Board to develop and submit detailed proposals to reduce the per capita rate of growth in Medicare spending to the President for Congress to consider.

Amends title XI of the Social Security Act to repeal provisions establishing the Center for Medicare and Medicaid Innovation.

Amends the Public Health Service Act, with respect to coverage of preventive health services by a group health plan or health insurance issuer, to repeal provisions that prohibit cost sharing requirements for evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. (Such ratings are based upon determinations of net benefit by the Task Force.)

Repeals PPACA requirements that: (1) the Director of the Agency for Healthcare Research and Quality convene an independent Preventive Services Task Force, and (2) the Director of the Centers for Disease Control and Prevention (CDC) convene an independent Community Preventive Services Task Force. Restores provisions of law amended by such provisions.

Prohibits the Secretary of Health and Human Services (HHS) from using data obtained from comparative effectiveness research, including any conducted or supported using funds appropriated under the American Recovery and Reinvestment Act of 2009 (ARRA) or authorized or appropriated under the Patient Protection and Affordable Care Act, to deny or delay coverage of an item or service under a federal health care program. Requires the Secretary to ensure that comparative effectiveness research conducted or supported by the federal government accounts for factors contributing to differences in the treatment response and preferences of patients, including patient-reported outcomes, genomics and personalized medicine, the unique needs of health disparity populations, and indirect patient benefits.

repeal act repeals sections patient_protection affordable care ppaca restores provisions law amended sections related establishment independent_payment_advisory_board develop submit detailed proposals reduce capita rate growth medicare spending president congress consider amends title social_security_act repeal provisions establishing center medicare medicaid_innovation amends public_health_service_act respect coverage preventive health services group health plan health insurance issuer repeal provisions prohibit cost sharing requirements evidence based items services effect rating current recommendations united_states_preventive_services_task_force ratings based determinations net benefit task_force repeals ppaca requirements director agency healthcare_research_and_quality convene independent preventive services task_force director centers_for_disease_control_and_prevention cdc convene independent community preventive services task_force restores provisions law amended provisions prohibits secretary health_and_human_services hhs data obtained comparative effectiveness research including conducted supported funds appropriated american_recovery_and_reinvestment_act arra authorized appropriated patient_protection affordable care act deny delay coverage item service federal health_care program requires secretary ensure comparative effectiveness research conducted supported federal_government accounts factors contributing differences treatment response preferences patients including patient reported outcomes personalized medicine unique needs health disparity populations indirect patient benefits


Summary: Freeing Americans from Inequitable Requirements Act of 2014 or the FAIR Act of 2014 - Amends the Internal Revenue Code, with respect to the individual mandate to purchase health care coverage, to delay such requirement from taking effect until the Secretary of the Treasury submits to Congress a certification that the employer mandate to provide health care coverage for employees is being applied and administered without any administratively created exceptions.

americans requirements act fair act amends_the_internal_revenue_code respect individual mandate purchase health_care coverage delay requirement taking effect secretary treasury submits congress certification employer mandate provide health_care coverage employees applied administered administratively created exceptions


Summary: Treating Families Fairly Act - Amend the Internal Revenue Code to provide that an employee who has minimum essential health care coverage under an eligible employer-sponsored plan as the spouse or child of another employee of such employer shall not be counted as a full-time employee of an applicable large employer for purposes of determining whether such employer is subject to the mandate to provide its employees with minimum coverage.

treating families fairly act amend internal_revenue_code provide employee minimum essential health_care coverage eligible employer sponsored plan spouse child employee employer shall counted time employee applicable large employer purposes determining employer subject mandate provide employees minimum coverage


Summary: Small Business Stability Act - Amends the Internal Revenue Code to modify the definition of "applicable large employer," for purposes of the mandate under the Patient Protection and Affordable Care Act to provide employees with minimum essential health care coverage, to mean an employer who employed an average of at least 100 (currently, 50) full-time employees during the preceding calendar year.

small business stability act amends_the_internal_revenue_code modify definition applicable large employer purposes mandate patient_protection affordable care act provide employees minimum essential health_care coverage mean employer employed average currently time employees preceding calendar year


Summary: Hire More Heroes Act of 2014 - Amends the Internal Revenue Code to permit an employer, for purposes of determining whether such employer is an applicable large employer and thus required to provide health care coverage to its employees under the Patient Protection and Affordable Care Act, to exclude employees who have coverage under a health care program administered by the Department of Defense (DOD), including TRICARE, or the Department of Veterans Affairs (VA).

hire heroes act amends_the_internal_revenue_code permit employer purposes determining employer applicable large employer required provide health_care coverage employees patient_protection affordable care act exclude employees coverage health_care program administered department_of_defense dod including tricare department_of_veterans_affairs


Summary: Small Business Fairness in Health Care Act - Amends the Internal Revenue Code, as amended by the Patient Protection and Affordable Care Act (PPACA), to: (1) exempt a small business concern, as defined by the Small Business Act, from the PPACA employer mandate to provide employees with minimum essential health care coverage; and (2) redefine "full-time employee," for purposes of such mandate, as an employee who is employed on average at least 40 (currently, 30) hours a week.

small business fairness health_care act amends_the_internal_revenue_code amended patient_protection affordable care act ppaca exempt small business concern defined small_business_act ppaca employer mandate provide employees minimum essential health_care coverage redefine time employee purposes mandate employee employed average currently hours week


Summary: Medicare Choices Empowerment and Protection Act - Amends part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to: (1) establish an Advance Directive Certification Program to encourage eligible beneficiaries to adopt and maintain certified advance directives to guide the delivery of health care to them, and (2) make a one-time payment (of $50 for using a manual process, of $75 for using on-line processes only) to each eligible beneficiary that adopts a certified advance directive and registers it with the Program.

medicare choices empowerment protection act_-_amends supplementary_medical_insurance title xviii medicare social_security_act direct secretary health_and_human_services hhs establish advance directive certification program encourage eligible beneficiaries adopt maintain certified advance directives guide delivery health_care time payment manual process line processes eligible beneficiary adopts certified advance directive registers program


Summary:
State Exchange Accountability Act - Amends the Patient Protection and Affordable Care Act to require a state to reimburse the federal government for the amount of establishment or early innovator grants the state received to operate a health care exchange if it operated an exchange in 2014 but subsequently elected to provide for enrollment in qualified health plans solely through the federal health care exchange.

Requires that: (1) reimbursement be made in full within 10 years of such election, pursuant to an agreement with the Department of Health and Human Services (HHS); and (2) in case of failure to enter such an agreement, the Secretary of HHS shall reduce the state's Medicaid funding for 10 fiscal years in an aggregate amount equal to the reimbursement amount.

state exchange accountability act_-_amends patient_protection affordable care act require state reimburse federal_government establishment early innovator grants state received operate health_care exchange operated exchange subsequently elected provide enrollment qualified health plans solely federal health_care exchange requires reimbursement years election pursuant agreement department_of_health_and_human_services hhs case failure enter agreement secretary hhs shall reduce state medicaid funding fiscal years aggregate equal reimbursement


Summary:
Certify It Act of 2014 - Directs the Comptroller General (GAO) to study the impact of the Patient Protection and Affordable Care Act (PPACA) on small businesses and the Office of the Actuary, Centers for Medicare & Medicaid Services, to study the Act's impact on small group health insurance costs.

Declares that, if GAO or the Office of the Actuary reports to Congress that PPACA has caused either net employment loss amongst small businesses or small group health insurance costs to rise, certain PPACA assessments that may be imposed on employers for failing to offer their full-time employees (and their dependents) the opportunity to enroll in minimum essential coverage shall not apply for a specified one-year period.

Declares further that, if GAO or the Office fails to submit such a report in accordance with specified timelines, such assessments shall not apply during the following calendar year.

certify act directs comptroller_general gao study impact patient_protection affordable care act ppaca small businesses office actuary centers medicare medicaid_services study act impact small group health insurance costs declares gao office actuary reports congress ppaca caused net employment loss small businesses small group health insurance costs rise certain ppaca assessments imposed employers failing offer time employees dependents opportunity enroll minimum essential coverage shall apply specified year period declares gao office fails submit report accordance specified timelines assessments shall apply following calendar year


Summary:
Restoring Veterans Trust Act of 2014 - Revises veterans' benefit programs to address:

 veterans' access to medical care, including through measures that address the Department of Veterans Affairs' (VA's) scheduling and performance management systems, VA health facility staffing shortages, and veterans' access to covered care at non-VA facilities; the expansion and extension of certain health care benefits, including caregiver support services, immunizations, chiropractic care, and treatment for traumatic brain injury; health care administration, including by extending the Department of Veterans Affairs Health Professional Scholarship Program; complementary and alternative medicine; mental health care; dental care eligibility and expansion, including by requiring the creation of a program of education to promote veterans' dental health; health care related to sexual trauma, including by requiring the provision of counseling and treatment to members of the Armed Forces and the development of a screening mechanism to detect incidents of domestic abuse; reproductive treatment and services, including by requiring the provision of fertility counseling and adoption assistance to severely wounded veterans; major medical facility leases; survivor and dependent matters, including the provision of benefits to the children of certain veterans who are born with spina bifida; education matters, including the approval of courses for purposes of the All-Volunteer Force and the Post-9/11 Educational Assistance programs; the extension of the Secretary of Veterans Affairs' authority to provide the same rehabilitation and vocational benefits to members of the Armed Forces with severe injuries or illnesses as are provided to veterans; veterans' employment, including employment within the federal government; sanctions for federal contractors who repeatedly violate the employment and reemployment rights of members of the Armed Forces; small business matters, including contracting and subcontracting participation goals with federal departments and agencies; administrative matters, including by requiring the Secretary to establish regional support centers for Veterans Integrated Service Networks; the processing of disability claims, including those based on military sexual trauma, as well as claims for pensions and dependency and indemnity compensation; the manner in which hearings before the Board of Veterans' Appeals are to be conducted; certain rights under the Servicemembers Civil Relief Act, including protections regarding the expiration of professional licenses, the denial of credit or the termination of residential leases due to military service, and mortgage foreclosures against surviving spouses; and outreach and miscellaneous matters, including the repeal of a provision of the Bipartisan Budget Act of 2013 that reduces the cost-of-living adjustment to the retirement pay of members of the Armed Forces who are under age 62.

restoring veterans trust act revises veterans benefit programs address veterans access medical care including measures address department_of_veterans_affairs scheduling performance management systems health facility staffing shortages veterans access covered care non-va facilities expansion extension certain health_care benefits including caregiver support services immunizations chiropractic care treatment traumatic brain injury health_care administration including extending department_of_veterans_affairs health professional scholarship program complementary alternative medicine mental health_care dental care eligibility expansion including requiring creation program education promote veterans dental health health_care related sexual trauma including requiring provision counseling treatment members armed_forces development screening mechanism detect incidents domestic abuse reproductive treatment services including requiring provision fertility counseling adoption assistance severely wounded veterans major medical facility leases survivor dependent matters including provision benefits children certain veterans born spina bifida education matters including approval courses purposes volunteer force educational assistance programs extension secretary veterans_affairs authority provide rehabilitation vocational benefits members armed_forces severe injuries illnesses provided veterans veterans employment including employment federal_government sanctions federal contractors repeatedly violate employment reemployment rights members armed_forces small business matters including contracting subcontracting participation goals federal departments agencies administrative matters including requiring secretary establish regional support centers veterans_integrated_service_networks processing disability claims including based military sexual trauma claims pensions dependency indemnity compensation manner hearings board veterans appeals conducted certain rights servicemembers_civil_relief_act including protections expiration professional licenses denial credit termination residential leases military service mortgage foreclosures surviving spouses outreach miscellaneous matters including repeal provision bipartisan_budget_act reduces cost living adjustment retirement pay members armed_forces age


Summary:
Veterans Choice Act of 2014 - Requires hospital care and medical services to be furnished to veterans through contracts with Medicare providers if the veterans: (1) have been unable to schedule an appointment at a Department of Veterans Affairs (VA) medical facility within the Veterans Health Administration's (VHA's) wait-time goals for hospital care or medical services, and (2) opt for care or services from such providers.

Directs the VA Secretary to provide veterans with information about the availability of care and services from Medicare providers when they: (1) enroll in the VA patient enrollment system, and (2) attempt to schedule an appointment for VA hospital care or medical services but are unable to do so within VHA's wait-time goals.

Terminates this Act's requirement that the Secretary furnish care and services through contracts with Medicare providers two years after the Secretary publishes interim final regulations implementing the program.

Expresses the sense of Congress that the Secretary must comply with the prompt payment rule or any similar regulation or ruling in paying for health care under contracts with non-VA providers.

Requires the Secretary to ensure that scheduling and wait-time metrics or goals are not used as factors in determining the performance of: (1) directors, associate directors, assistant directors, deputy directors, chiefs of staff, and clinical leads of VA medical centers; and (2) directors, assistant directors, and quality management officers of the Veterans Integrated Service Networks (VISNs).

Directs the Secretary to modify the performance plans of the directors of VA medical centers and VISNs to ensure that such plans are based on the quality of care received by veterans at the health care facilities under their jurisdiction.

Requires the Secretary to publish: (1) within 90 days after this Act's enactment, VA's wait-time goals for the scheduling of a veterans' appointment for health care; and (2) within one year after this Act's enactment, the current wait times for an appointment for primary care and specialty care at each VA medical center.

Directs the Secretary to develop, update, and make publicly available a comprehensive database containing all applicable patient safety, quality of care, and outcome measures for VA health care that are tracked by the Secretary.

Requires the Secretary to enter into an agreement with the Secretary of Health and Human Services (HHS) to provide the HHS Secretary with the information needed to make VA medical center patient quality and outcome information publicly available through HHS's Hospital Compare website.

Requires: (1) the VA website to include a link to the VA's health care providers database that provides veterans with the location of each VA physician's residency training, and (2) each veteran who is to undergo a surgical procedure by or through the VA to be provided information on the credentials of the surgeon who is to perform the procedure.

Directs the Comptroller General (GAO) to submit an assessment to Congress of: (1) the manner in which contractors under the VA's Patient-Centered Community Care initiative oversee the credentials of physicians within their networks, and (2) VA's oversight of the contracts under the Patient-Centered Community Care initiative.

Requires the annual budget that the President submits to Congress to include specified information regarding: (1) the cost of providing, and the number of veterans receiving, medical care through contracts with Medicare providers; and (2) the number of VA employees on paid administrative leave during the preceding fiscal year.

Directs the Secretary to establish policies penalizing VA employees who knowingly submit, or knowingly require another VA employee to submit, to another VA employee false data concerning health care wait times or quality measures.

Authorizes the Secretary to: (1) remove any individual from the VA's Senior Executive Service if the Secretary determines that the individual's performance warrants such removal, and (2) remove such individual from the civil service or appoint the individual to a General Schedule position at any grade the Secretary determines to be appropriate. Requires such removals to be performed in the same manner as removals of professional staff of Members of Congress.

veterans choice act requires hospital care medical services furnished veterans contracts medicare providers veterans unable schedule appointment department_of_veterans_affairs medical facility veterans_health_administration vha wait time goals hospital care medical services opt care services providers directs secretary provide veterans information availability care services medicare providers enroll patient enrollment system attempt schedule appointment hospital care medical services unable vha wait time goals terminates act requirement secretary furnish care services contracts medicare providers years secretary publishes interim final regulations implementing program expresses sense congress secretary comply prompt payment rule similar regulation ruling paying health_care contracts non-va providers requires secretary ensure scheduling wait time metrics goals factors determining performance directors associate directors assistant directors deputy directors chiefs staff clinical leads medical centers directors assistant directors quality management officers veterans_integrated_service_networks visns directs secretary modify performance plans directors medical centers visns ensure plans based quality care received veterans health_care facilities jurisdiction requires secretary publish days act enactment wait time goals scheduling veterans appointment health_care year act enactment current wait times appointment primary care specialty care medical center directs secretary develop update publicly available comprehensive database containing applicable patient safety quality care outcome measures health_care tracked secretary requires secretary enter agreement secretary health_and_human_services hhs provide hhs secretary information needed medical center patient quality outcome information publicly available hhs hospital compare website requires website include link health_care providers database provides veterans location physician residency training veteran undergo surgical procedure provided information credentials surgeon perform procedure directs comptroller_general gao submit assessment congress manner contractors patient centered community care initiative oversee credentials physicians networks oversight contracts patient centered community care initiative requires annual budget president submits congress include specified information cost providing number veterans receiving medical care contracts medicare providers number employees paid administrative leave preceding fiscal year directs secretary establish policies penalizing employees knowingly submit knowingly require employee submit employee false data concerning health_care wait times quality measures authorizes secretary remove individual senior_executive_service secretary determines individual performance warrants removal remove individual civil service appoint individual general_schedule position grade secretary determines appropriate requires removals performed manner removals professional staff members congress


Summary: Truth in Obamacare Accounting Act - Requires the Congressional Budget Office (CBO) to provide regular estimates of the net effect that enactment and implementation of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 had on direct spending, revenue, and the deficit. Requires CBO to include the estimates in each annual and revised report on the budget and economic outlook prepared pursuant to the Congressional Budget Act of 1974.

truth obamacare accounting act_-_requires congressional_budget_office cbo provide regular estimates net effect enactment implementation patient_protection affordable care act health_care_and_education reconciliation act direct spending revenue deficit requires cbo include estimates annual revised report budget economic outlook prepared pursuant congressional_budget_act


Summary: Safeguarding Classrooms Hurt by ObamaCare's Obligatory Levies - Amends the Internal Revenue Code to exclude any elementary or secondary school, state or local educational agency, and institution of higher education from the definition of "applicable large employer" for purposes of the employer mandate to provide health care coverage for employees.

safeguarding classrooms obamacare levies amends_the_internal_revenue_code exclude elementary secondary school state local educational agency institution higher education definition applicable large employer purposes employer mandate provide health_care coverage employees


Summary:
Telehealth Enhancement Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS), in order to provide a positive incentive for certain hospitals to lower their excess readmission ratios for inpatient services, to make an additional payment to a hospital in such proportion that provides for a sharing of the savings from better-than-expected performance between the hospital and the Medicare program.

Authorizes the Secretary, in the case of a state that has amended its Medicaid plan to provide coordinated care through a health home for individuals with chronic conditions, to contract with the state medical assistance agency to serve eligible individuals with chronic conditions who select a designated provider, a team of health care professionals operating with such a provider, or a health team as the individual's health home.

Authorizes the Secretary to contract with a national or multi-state regional center of excellence with a network of affiliated local providers to provide through one or more medical homes for targeted, accessible, continuous, and coordinated care to individuals under Medicare and Medicaid with a long-term illness or medical condition that requires regular medical treatment, advising, and monitoring.

Authorizes an Accountable Care Organization (ACO) to include coverage of telehealth and remote patient monitoring services as supplemental health care benefits to the same extent as a Medicare Advantage plan is permitted to provide such coverage of such services as supplemental health care.

Recognizes telehealth services and remote patient monitoring in the national pilot program on payment bundling.

Includes among originating sites (at which an eligible telehealth individual is located at the time a service is furnished via a telecommunications system), but without receiving payment of a facility fee, any critical access hospitals, sole community hospitals, home telehealth sites, as well as specified others.

Amends SSA title XIX (Medicaid) to give states the option to provide coordinated care for enrollees with high-risk pregnancies and births.

Amends the Communications Act of 1934 to specify additional health care providers to which universal telecommunications service support must be provided.

Requires Federal Communications Commission (FCC) rules for enhancing health care provider access to advanced telecommunications and information services to disregard provider location.

telehealth enhancement_act amends title xviii medicare social_security_act ssa direct secretary health_and_human_services hhs order provide positive incentive certain hospitals lower excess ratios inpatient services additional payment hospital proportion provides sharing savings better expected performance hospital medicare program authorizes secretary case state amended medicaid plan provide coordinated care health home individuals chronic conditions contract state medical assistance agency serve eligible individuals chronic conditions select designated provider team health_care professionals operating provider health team individual health home authorizes secretary contract national multi state regional center_of_excellence network affiliated local providers provide medical homes targeted accessible continuous coordinated care individuals medicare medicaid long term illness medical condition requires regular medical treatment advising monitoring authorizes accountable care organization aco include coverage telehealth remote patient monitoring services supplemental health_care benefits extent medicare_advantage plan permitted provide coverage services supplemental health_care recognizes telehealth services remote patient monitoring national pilot program payment bundling includes originating sites eligible telehealth individual located time service furnished telecommunications system receiving payment facility fee critical access hospitals sole community hospitals home telehealth sites specified amends ssa title xix medicaid states option provide coordinated care enrollees high risk pregnancies amends communications act specify additional health_care providers universal telecommunications service support provided requires federal_communications_commission fcc rules enhancing health_care provider access advanced telecommunications information services disregard provider location


Summary:
Amends the Patient Protection and Affordable Care Act to establish the Marketplace Health Insurance Corporation, with a Chief Executive Officer (CEO) and Board of Directors, to oversee health care exchanges and health insurance.

Directs the President, with the consent of the Senate, to appoint as CEO an individual with a background in health care issues and private-sector management experience.

Requires the Board of Directors to advise the CEO on issues including: (1) the functionality of healthcare.gov, (2) the selection of federal exchange health plans, (3) ensuring the accuracy of premium subsidies, and (4) the transition from a state exchange to the federal exchange.

Requires the Board of Directors to establish a technical advisory committee to assist the Board of Directors and CEO in carrying out their duties.

amends patient_protection affordable care act establish marketplace health insurance corporation chief executive officer ceo board_of_directors oversee health_care exchanges health insurance directs president consent senate appoint ceo individual background health_care issues private sector management experience requires board_of_directors advise ceo issues including functionality selection federal exchange health plans ensuring accuracy premium subsidies transition state exchange federal exchange requires board_of_directors establish technical advisory_committee assist board_of_directors ceo carrying duties


Summary: Medical Expense Deduction Act - Amends the Internal Revenue Code to reduce from 10% to 7.5% of adjusted gross income the threshold after which medical expenses are fully deductible.

medical expense deduction act amends_the_internal_revenue_code reduce adjusted gross income threshold medical expenses fully deductible