Summary
Requires CMS to implement quality reporting programs for these providers by FY14, subjecting non-compliant providers to up to a 2% reduction in payments.
Implementation Status
CMS is in the process of implementing these programs. See the LTCH Quality Reporting website, the IRF Quality Reporting website and the Hospice Quality Reporting website for more information.
2013
On January 31, 2013, CMS posted a revision of a currently approved information collection request pertaining to the LTCH Continuity Assessment Record and Evaluation (CARE) Data Set as called for under the new ACA quality reporting program for LTCHs. Comments were due on or about March 31.
On April 26, 2013, CMS issued a proposed rule updating FY 2014 Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCHs). Both the Medicare Inpatient Prospective Payment System (IPPS) and LTCH proposals, following CMS’ consideration of public comments and upon finalization, take effect October 1, 2013. Under the proposed rules, CMS estimates that gross hospital payments will be $27 million higher in FY14 than they were in FY15 (which reflects the ACA Medicare DSH cuts, which are expected to result in a -0.9% cut to hospital payments). Gross LTCH payments under the proposed rule will increase by 1.1% or $62 million, with the proposed implementation of the 25% Rule costing the sector $190 million. CMS fact sheets on the rule are available here and here. Comments on the proposal are due by June 25, 2013.
On May 2, CMS released its FY 2014 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) proposed rule. Among other things, CMS proposes revisions to the FY 2014 market basket (MB) update, as well as revises the list of diagnosis codes that are used to determine presumptive compliance under the “60% rule,” in addition to delineating changes to the quality measures and reporting requirements under the IRF quality reporting program (QRP). Comments are due July 1.
On June 7, CMS published in the Federal Register a proposed new information collection in which it intends to implement a Hospice Experience of Care Survey pursuant to the broader requirements set forth under the National Quality Strategy and related to this section.
In August, 2013, CMS announced through an Open Door Forum (ODF) and other provider communication means that it sought input from IRF and LTCH providers (by a date not specified) on the new respective LTCH and IRF Quality Reporting Programs (QRPs). In a related event, CMS recently released a MLN Matters provider education article (MM8241) titled, “Implementation of the Hospice Quality Reporting Required by the Affordable Care Act Section 3004.”
On July 31, 2013, CMS issued its FY 2014 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) final rule under which payments are projected to increase by 2.3% in FY14 , or by $170 million relative to FY13 figures. The final rule includes a discussion of the ACA-mandated productivity adjustment at section 3401; hospice wage index improvements delineated at section 3137; and the IRF Quality Reporting Program (QRP) at section 3004.
On August 2, CMS issued its FY 2014 Medicare Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS final rule under which gross hospital payments will be $1.2 billion higher in FY 2014 than they were in FY 2013 – much higher than the $27 million increase initially proposed. The final rule addresses a number of IPPS and LTCH payment and quality-related provisions authorized or amended by the ACA.
In early September 2013, as a follow-up to previous solicitations towards this end impacting IRF and LTCH providers, CMS announced through an ODF and other provider communication channels that it sought feedback from providers relative to the implementation of the Hospice Quality Reporting Program (HQRP) established pursuant to this section.
On Nov. 14, 2013, CMS held an IRF Special ODF “to make IRF providers aware of recent program updates and new measures that have been added to the IRF Quality Reporting Program” pursuant to this section of the law. Details here. A similar ODF was held for LTCHs on Nov. 21; details here.
2014
On March 10, 2014, CMS issued two new information collections pertaining to the upcoming evaluation of ACA-mandated quality reporting programs (QRPs) for IRFs and hospice providers. Comments are due April 9, 2014.
On April 8, CMS issued a notice announcing a new system of records regarding the Hospice Item Set (HIS) System to support data collections effort under the ACA-mandated Hospice Quality Reporting Program (HQRP).
On May 1, CMS issued a proposed rule updating FY 2015 Medicare payment policies and rates for inpatient stays at general acute care and LTCHs. Under the proposed rule, hospitals that participate in the Hospital Inpatient Quality Reporting (IQR) Program and are ‘meaningful users’ of EHRs would receive a 1.3% payment update. However, the 1.3% rate increase, when coupled with the payment policy reductions – including those under the Hospital Readmissions Reduction Program, the Hospital Acquired Condition (HAC) Reduction Program, Medicare DSH changes as well as “the expiration of certain statutory provisions that provided special temporary increases in payments to hospitals and other proposed changes” – would ultimately decrease IPPS operating payments by approximately 0.8% or $241 million over FY 2015 payment levels. Also of note, gross LTCH payments under the proposed rule would increase by 0.8% or $44 million over FY 2014 payments, with a delay (pursuant to the statutory mandate) in the full application of the 25% Rule patient threshold, among other key LTCH policy changes denoted further below. Comments are due by June 30, 2014. CMS fact sheets are available here and here. A CMS press release is available here.
In early May, CMS announced the availability of recorded HIS technical training modules for the Hospice QRP (see the training announcement). On 7, CMS convened a conference call to discuss provider training under the LTCH QRP (see here). Also, on May 12, CMS hosted training on the IRF QRP (details here).
On May 1, CMS issued its FY 2015 IRF PPS proposed rule under which the agency proposes a net increase of 2.2%, or roughly $160 million, in Medicare payments to IRFs in FY 2015 over the FY 2014 payment update. CMS indicates that the net update reflects a 2.1% increase (2.7% MB update less the 0.4% statutory productivity adjustment, further reduced by the 0.2% reduction called for by the ACA). However, “[a]n additional 0.1% increase to aggregate payments due to updating the outlier threshold results in an overall update of 2.2%…” A CMS fact sheet is available here. Comments are due June 30, 2014.
On May 2, CMS released the proposed FY 2015 hospice wage index and payment rate update (available here; fact sheet), in which the agency estimates that FY15 hospice payments would increase by an estimated $230 million, 1.3% net, reflecting the following factors: (1) 2.0% proposed payment update to the hospice per diem rates (a “hospital market basket” increase of 2.7 percent minus 0.7 percentage point for statutory reductions); and -0.7% in hospice payments, stemming from “updated wage data and the sixth year of CMS’s seven-year phase-out of its wage index budget neutrality adjustment factor (BNAF),” the agency explains. The regulation addresses these ACA provisions. Comments are due by July 1.
On July 2, CMS issued various announcements soliciting input from IRFs, LTCHs, and hospices on the agency’s ongoing implementation of the respective QRPs. Specifically, CMS indicated that, under partnership with Health Care Innovation Services (HCIS), the agency intends to conduct voluntary provider interviews this month and next (August) to “to assist CMS in better understanding the strengths, weaknesses, priorities and burdens associated with the [respective] QRP[s].” CMS also seeks to ascertain “the means by which [the above-referenced PAC] providers ensure the accuracy of submitted data; to understand the impact the [respective] QRP has or has had on [specific PAC] patient services and outcomes; and to understand how CMS might improve the program and associated processes in the future.” CMS asks that any interested providers contact HCIS at help@hcareis.com to express their willingness to participate in this voluntary interview process. Details available here (IRFs); here (hospices); and here (LTCHs).
On August 4, CMS issued a final rule updating FY 2015 Medicare payment policies and rates for inpatient stays at general acute care and LTCHs. The final rule also codifies “two interim final rules with comment period relating to criteria for disproportionate share hospital [DSH] uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.”
Under the final rule, hospitals that participate in the Hospital Inpatient Quality Reporting Program and are ‘meaningful users’ of EHRs would receive a 1.4% payment update – up slightly from the agency’s 1.3% proposed increased. However, the 1.4% rate increase, when coupled with payment policy reductions enumerated further below – including reductions under the Hospital Readmissions Reduction Program, changes to Medicare DSH payments, and so forth – are projected to decrease IPPS operating payments by approximately 0.6%” (compared to the net decrease of 0.8% under the proposed rule) – or by roughly $756 million in FY 2015.
CMS also finalized its proposal to continue its slow phase-in of the ATRA’s coding intensity adjustment, leaving ~$8 billion to be recouped in FYs ‘15 and ‘16.
Gross LTCH payments under the final rule would increase by 1.1% – up from the 0.8% CMS put forward in its proposed rule, with a delay (pursuant to the statutory mandate) in the full application of the 25% Rule patient threshold, among other key LTCH policy changes denoted further below.
CMS fact sheets are available here and here. An agency press release is available here.
On August 11, CMS issued a MLN Matters article addressing hospice market basket revisions and quality reporting program provisions pursuant to the ACA.
In late October, CMS announced the addition of quality measures (for which data collection and submission began on Oct. 1, 2014) to FY 2016 payment determinations for the IRF and LTCH Quality Reporting Programs, the details of which are available here and here, respectively. CMS also posted here a 3rd quarter Q&A document on the Hospice Item Set (HIS).
On Oct. 29, CMS announced the addition of quality measures to the FY 16 payment determinations to the respective IRF and LTCH Quality Reporting Programs. For more information, see here and here. Regarding the latter, a Nov. 5 CMS LTCH Quality Training call was held; details here.
2015
On Mar. 6, CMS released Transmittal 39 on “Payments to Hospice Agencies That Do Not Submit Required Quality Data,” which applies a 2% reduction in hospice payment for agencies that do not submit required data.
On Apr. 17, as part of a proposed rule updating FY 2016 Medicare payment policies and rates for inpatient stays at general acute care and LTCHs, CMS proposed to retain 12 previously adopted quality measures, and adopted 3 new cross-setting measures to satisfy requirements of the IMPACT Act
On Apr. 23, CMS proposed to increase Medicare payments to inpatient rehabilitation facilities (IRFs) by a net 1.7%, or roughly $130 million in FY 2016, which addressed these provisions in the law
On May 5, CMS released a transmittal titled “Payments to Inpatient Rehabilitation Facilities That Do Not Submit Required Quality Data.”
On May 5, CMS released a transmittal, “Payments to Long Term Care Hospitals that Do Not Submit Required Quality Data.”
On May 7, CMS released the Physician Quality Reporting Programs Strategic Vision which describes a “long-term vision for CMS quality measurement for physicians, professionals, and public reporting programs, and how they can be optimized and aligned to support better decision-making from doctors, consumers, and every part of the healthcare system.”
On May 21, CMS posted a video presentation providing an overview of the Physician Quality Reporting System (PQRS) and how a provider’s participation in 2015 will determine how the Value-Based Payment Modifier will be applied to their reimbursement in 2017.
On July 31 CMS released the FY 16 inpatient prospective payment system (IPPS) and long-term care hospital PPS final rule affecting discharges beginning on Oct. 1, 2015. The rule also includes an embedded interim final rule with comment period effectuating the statutory extension of the Medicare-dependent, small rural hospital Program and changes to the low-volume payment adjustment.
On July 31, CMS released its final FY 16 hospice wage index and payment rate update (available here; fact sheet), estimating that net Medicare payments to hospices will increase by $160 million, or 1.1%.
On July 31, CMS released an Inpatient Rehabilitation Facility (IRF) final rule in which it estimated that FY 16 payments will increase by 1.8% or $135 million across all IRFs compared with FY 2015.
On July 31, CMS finalized its proposal (fact sheet here) to update rates and certain policies related to the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) for FY 16. The final rule reflects a 1.5% increase in CMS’ estimated payments to IPFs relative to its FY 15 estimate.
On Sep. 21, CMS posted an errata document for V2.00.0 of the LTCH CARE Data Submission Specifications.
On Dec. 10, CMS released the FY 2016 results of the Hospital-Acquired Conditions (HAC) Reduction program. CMS reported that, in FY 2016, 758 out of 3,308 hospitals subject to the HAC RP are in the lowest performing quartile and will have a 1% reduction applied to all Medicare discharges in FY 2016 ($364 million in total savings). Publicly-available information for each eligible hospital includes: the Patient Safety Index-90 (PSI-90) Composite scores; Central Line-Associated Blood Stream Infection (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), and Surgical Site Infection (SSI) measures; Domain Scores; and total HAC scores.
2016
On Feb. 25, 2016, CMS released a new FAQ, providing guidance on the Physician PQRS and providing answers to some frequently asked questions raised by staff at Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs) who submit claims to Medicare Administrative Contractors (MACs) for services furnished to Medicare beneficiaries.
On Apr. 19, CMS released the FY 2017 inpatient prospective payment system (IPPS) and long-term care hospital PPS and policy proposed rule that, once, finalized, will apply to discharges beginning on or after Oct. 1, 2016. Under the rule, CMS estimates a net average payment increase of 0.7% (a roughly $539 million increase in spending, including capital) in FY 2017 for the IPPS. For LTCH’s, and stemming largely from the application of statutory site-neutrality provisions in the Pathway for SGR Reform Act, CMS estimates that FY 2017 payments will decrease by an estimated $355 million or -6.9% in FY 2017.
On Apr. 21, CMS released a proposal updating Medicare payment regulations for hospices. Under the proposed rule, net Medicare payments to hospices will increase by $330 million or 2.0 percent. The update is based on a market basket of 2.8 percent less a 0.5 percent productivity adjustment and a 0.3 percentage point adjustment set by the ACA.
On Apr. 21, CMS released a proposal updating payment regulations for Inpatient Rehabilitation Facilities (IRFs). Under the proposed rule, FY 2017 Medicare payments will increase by $125 million or 1.6 percent across all IRFs compared with FY 2016. This stems from an estimated 1.45 percent increase factor (an IRF-specific market basket estimate of 2.7 percent, minus a 0.5 percent multi-factor productivity adjustment and 0.75 percentage point statutory reduction) plus 0.2 percent for outlier threshold result updates. Table 21 on p. 158 of the public inspection copy provides fuller detail on the estimated payment impacts across facilities (by region, ownership status, etc.)
On May 16, CMS extended an information collection on the Long Term Care Hospital (LCTH) Continuity Assessment Record and Evaluation (CARE) Data Set.
On July 20, CMS said it has provided notifications to facilities that were determined to be out of compliance with Inpatient Rehabilitation Facility (IRF) and Long-Term Care Hospital (LTCH) Quality Reporting Programs (QRP). Non-compliance notifications were placed into facilities CASPER folders in QIES on July 20, 2016. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than Aug. 19, 2016.
On July 27, CMS announced that they updated the star ratings on their Hospital Compare website to include an Overall Hospital Quality Star Rating. The Overall Star Rating, CMS says, is a unified rating of one to five stars, drawing from 64 existing quality measures already reported on the site.
On July 28, 2016, CMS issued a notice updating fiscal year (FY) 2017 Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS). CMS estimates IPF payments to increase by 2.2 percent or $100 million in FY 2017.
On July 29 CMS released a final rule estimating that net Medicare payments to hospices will increase by $350 million or 2.1 percent. The update is based on a market basket (MB) of 2.7 percent less a 0.3 percent productivity adjustment and a 0.3 percentage point adjustment set by the ACA. The final rule reflects a $20 million increase over proposed levels.
On July 29, CMS announced Inpatient Rehabilitation Facility (IRF) rates in its annual payment rule. Under the rule, FY 2017 Medicare payments will increase by $145 million or 1.9 percent across all IRFs compared with FY 2016. This stems from an estimated 1.65 percent increase factor (an IRF-specific market basket estimate of 2.7 percent, minus a 0.3 percent multi-factor productivity adjustment and 0.75 percentage point statutory reduction) plus 0.3 percent for outlier threshold result updates. The final rule reflects a $20 million increase over proposed levels.
On Aug. 2, CMS released the FY 2017 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) PPS and policy final rule. The final rule governs FY 2017 payments to approximately 3,330 acute care hospitals and 430 LTCHs through the IPPS and LTCH PPS, respectively, and effectuates key policy changes. Under the rule, net payments to inpatient hospitals will increase by 0.95 percent on average compared with FY 2016. For the IPPS, the rule finalizes the 1.5 percent documentation and coding recoupment cut, as proposed, and delays the proposed incorporation of S-10 data into uncompensated care calculations. LTCH PPS payments will decrease by 7.1 percent under the LTCH PPS amid the ongoing implementation of site neutrality and will increase by 0.7 percent for cases qualifying for the higher standard rate. The aforementioned provisions are addressed in this regulation.
On Sept. 2, CMS announced that the IRF and LTCH Quality Reporting Program (QRP) Provider Preview Reports would be made available until September 30, 2016. During that period, providers could review their performance data on each quality measure prior to public display on the IRF Compare or LTCH Compare websites.
On Oct. 25, CMS announced the upcoming submission deadline for IRF and LTCH Quality Reporting Program (QRP) second quarter (April-June) Calendar Year (CY) 2016 data – due 15.
2016
On Dec. 14, 2016, CMS announced the launch of new Comparewebsites for Inpatient Rehabilitation Facilities (IRFs) and Long-Term Care Hospitals (LTCHs), as well as updates and redesigns to existing CMS Compare websites for hospitals, hospices and physicians.
2017
On Jan. 24, 2017, CMS announced that it sought individuals to join two newly-installed Technical Expert Panels (TEPs) tasked with developing and maintaining quality measures for the Inpatient Rehabilitation Facility (IRF) and Long-Term Care Hospital (LTCH) Quality Reporting Programs (QRPs).
On Feb. 21, CMS posted Quick Reference Guides for the Home Health Quality Reporting Program (QRP) (here); Hospice QRP (Hospice-QRP-Quick-Reference-Guide-February-2017); Inpatient Rehabilitation Facilities (IRF) QRP (here); and Long-Term Care Hospital (LTCH) QRP (here).
On March 10, due to an error in calculations, CMS encouragedhospice providers to rerun Hospice-Level Quality Measure Reports and Hospice Patient Stay-Level Quality Measure Reports with implementation dates between Dec. 18 2016 and Feb. 26, 2017.
On April 27, CMS released its hospice proposed rule updating the hospice wage index, payment rates, and cap amount for FY 2018. This provision of the ACA is addressed in the rule.
On April 27, CMS released proposed rule that would update the FY 2018 prospective payment rates for IRFs. This provision of the ACA is addressed in the rule.
2017
On Aug. 1, CMS finalized rulemaking that would update the prospective payment rates for skilled nursing facilities (SNFs) for FY 2018. This provision of the ACA is addressed in the rule.
On Aug. 1, CMS released final rulemaking that to update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for FY 2018. This provision of the ACA is addressed in the rule.
Statutory Text
SEC. 3004. QUALITY REPORTING FOR LONG-TERM CARE HOSPITALS, INPATIENT REHABILITATION HOSPITALS, AND HOSPICE PROGRAMS. (a) LONG-TERM CARE HOSPITALS.—Section 1886(m) of the Social Security Act (42 U.S.C. 1395ww(m)), as amended by section 3401(c), is amended by adding at the end the following new paragraph: ‘‘(5) QUALITY REPORTING.— ‘‘(A) REDUCTION IN UPDATE FOR FAILURE TO REPORT.— ‘‘(i) IN GENERAL.—Under the system described in paragraph (1), for rate year 2014 and each subsequent rate year, in the case of a long-term care hospital that does not submit data to the Secretary in accordance with subparagraph (C) with respect to such a rate year, any annual update to a standard Federal rate for discharges for the hospital during the rate year, and after application of paragraph (3), shall be reduced by 2 percentage points. ‘‘(ii) SPECIAL RULE.—The application of this subparagraph may result in such annual update being less than 0.0 for a rate year, and may result in payment rates under the system described in paragraph (1) for a rate year being less than such payment rates for the preceding rate year. ‘‘(B) NONCUMULATIVE APPLICATION.—Any reduction under subparagraph (A) shall apply only with respect to the rate year involved and the Secretary shall not take into account such reduction in computing the payment amount under the system described in paragraph (1) for a subsequent rate year. ‘‘(C) SUBMISSION OF QUALITY DATA.—For rate year 2014 and each subsequent rate year, each long-term care hospital shall submit to the Secretary data on quality measures specified under subparagraph (D). Such data shall be submitted in a form and manner, and at a time, specified by the Secretary for purposes of this subparagraph. ‘‘(D) QUALITY MEASURES.— ‘‘(i) IN GENERAL.—Subject to clause (ii), any measure specified by the Secretary under this subparagraph must have been endorsed by the entity with a contract under section 1890(a). ‘‘(ii) EXCEPTION.—In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary. ‘‘(iii) TIME FRAME.—Not later than October 1, 2012, the Secretary shall publish the measures selected under this subparagraph that will be applicable with respect to rate year 2014. ‘‘(E) PUBLIC AVAILABILITY OF DATA SUBMITTED.—The Secretary shall establish procedures for making data submitted under subparagraph (C) available to the public. Such procedures shall ensure that a long-term care hospital has the opportunity to review the data that is to be made public with respect to the hospital prior to such data being made public. The Secretary shall report quality measures that relate to services furnished in inpatient settings in long-term care hospitals on the Internet website of the Centers for Medicare & Medicaid Services.’’. (b) INPATIENT REHABILITATION HOSPITALS.—Section 1886(j) of the Social Security Act (42 U.S.C. 1395ww(j)) is amended— (1) by redesignating paragraph (7) as paragraph (8); and (2) by inserting after paragraph (6) the following new paragraph: ‘‘(7) QUALITY REPORTING.— ‘‘(A) REDUCTION IN UPDATE FOR FAILURE TO REPORT.— ‘‘(i) IN GENERAL.—For purposes of fiscal year 2014 and each subsequent fiscal year, in the case of a rehabilitation facility that does not submit data to the Secretary in accordance with subparagraph (C) with respect to such a fiscal year, after determining the increase factor described in paragraph (3)(C), and after application of paragraph (3)(D), the Secretary shall reduce such increase factor for payments for discharges occurring during such fiscal year by 2 percentage points. ‘‘(ii) SPECIAL RULE.—The application of this subparagraph may result in the increase factor described in paragraph (3)(C) being less than 0.0 for a fiscal year, and may result in payment rates under this subsection for a fiscal year being less than such payment rates for the preceding fiscal year. ‘‘(B) NONCUMULATIVE APPLICATION.—Any reduction under subparagraph (A) shall apply only with respect to the fiscal year involved and the Secretary shall not take into account such reduction in computing the payment amount under this subsection for a subsequent fiscal year. ‘‘(C) SUBMISSION OF QUALITY DATA.—For fiscal year 2014 and each subsequent rate year, each rehabilitation facility shall submit to the Secretary data on quality measures specified under subparagraph (D). Such data shall be submitted in a form and manner, and at a time, specified by the Secretary for purposes of this subparagraph. ‘‘(D) QUALITY MEASURES.— ‘‘(i) IN GENERAL.—Subject to clause (ii), any measure specified by the Secretary under this subparagraph must have been endorsed by the entity with a contract under section 1890(a). ‘‘(ii) EXCEPTION.—In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary. ‘‘(iii) TIME FRAME.—Not later than October 1, 2012, the Secretary shall publish the measures selected under this subparagraph that will be applicable with respect to fiscal year 2014. ‘‘(E) PUBLIC AVAILABILITY OF DATA SUBMITTED.—The Secretary shall establish procedures for making data submitted under subparagraph (C) available to the public. Such procedures shall ensure that a rehabilitation facility has the opportunity to review the data that is to be made public with respect to the facility prior to such data being made public. The Secretary shall report quality measures that relate to services furnished in inpatient settings in rehabilitation facilities on the Internet website of the Centers for Medicare & Medicaid Services.’’. (c) HOSPICE PROGRAMS.—Section 1814(i) of the Social Security Act (42 U.S.C. 1395f(i)) is amended— (1) by redesignating paragraph (5) as paragraph (6); and (2) by inserting after paragraph (4) the following new paragraph: ‘‘(5) QUALITY REPORTING.— ‘‘(A) REDUCTION IN UPDATE FOR FAILURE TO REPORT.— ‘‘(i) IN GENERAL.—For purposes of fiscal year 2014 and each subsequent fiscal year, in the case of a hospice program that does not submit data to the Secretary in accordance with subparagraph (C) with respect to such a fiscal year, after determining the market basket percentage increase under paragraph (1)(C)(ii)(VII) or paragraph (1)(C)(iii), as applicable, and after application of paragraph (1)(C)(iv), with respect to the fiscal year, the Secretary shall reduce such market basket percentage increase by 2 percentage points. ‘‘(ii) SPECIAL RULE.—The application of this subparagraph may result in the market basket percentage increase under paragraph (1)(C)(ii)(VII) or paragraph (1)(C)(iii), as applicable, being less than 0.0 for a fiscal year, and may result in payment rates under this subsection for a fiscal year being less than such payment rates for the preceding fiscal year. ‘‘(B) NONCUMULATIVE APPLICATION.—Any reduction under subparagraph (A) shall apply only with respect to the fiscal year involved and the Secretary shall not take into account such reduction in computing the payment amount under this subsection for a subsequent fiscal year. ‘‘(C) SUBMISSION OF QUALITY DATA.—For fiscal year 2014 and each subsequent fiscal year, each hospice program shall submit to the Secretary data on quality measures specified under subparagraph (D). Such data shall be submitted in a form and manner, and at a time, specified by the Secretary for purposes of this subparagraph. ‘‘(D) QUALITY MEASURES.— ‘‘(i) IN GENERAL.—Subject to clause (ii), any measure specified by the Secretary under this subparagraph must have been endorsed by the entity with a contract under section 1890(a). ‘‘(ii) EXCEPTION.—In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary. ‘‘(iii) TIME FRAME.—Not later than October 1, 2012, the Secretary shall publish the measures selected under this subparagraph that will be applicable with respect to fiscal year 2014. ‘‘(E) PUBLIC AVAILABILITY OF DATA SUBMITTED.—The Secretary shall establish procedures for making data submitted under subparagraph (C) available to the public. Such procedures shall ensure that a hospice program has the opportunity to review the data that is to be made public with respect to the hospice program prior to such data being made public. The Secretary shall report quality measures that relate to hospice care provided by hospice programs on the Internet website of the Centers for Medicare & Medicaid Services.’’.