	Introduction

The 21 st Century Cures Act ( P.L. The Increasing Choice, Access, and Quality in Health Care for Americans Act (Division C of P.L. Division C comprises Title XV through Title XVIII. The first three titles in Division C include provisions primarily relating to Medicare. Title XVII focuses on provisions relating to other aspects of Medicare, such as Medicare Part C (Medicare Advantage, or MA, the private plan option for beneficiaries that covers all Parts A and B services, except hospice); Medicare Part D (Prescription Drug Plan, or PDP, which covers outpatient prescription drug benefits); MA quality ratings; enrollment data; the Welcome to Medicare package; the Medicare Shared Savings Program (MSSP); and payments to Medicare, Medicaid, or Children's Health Insurance Program (CHIP) providers and suppliers. The fourth title in Division C includes a single provision relating to the small-group health insurance market. Title XV—Provisions Relating to Medicare Part A

			Section 15001. Provisions

Sections 15009 and 15010 create or reinstate two sets of temporary clinical criteria for an LTCH to receive payment under the LTCH PPS rather than the site neutral payment. Provision

Section 16001 makes modifications for certain new PBD HOPDs to be paid under the OPPS in 2017 and beyond. Beginning in 2015, physicians who do not successfully demonstrate meaningful use are subject to a penalty in the form of a payment adjustment that reduces their Part B reimbursement for covered services. Provision

Section 16004 extends the moratorium on enforcement of the requirement of direct supervision of outpatient therapeutic services furnished in CAHs and small rural hospitals through the end of CY2016. Provision

Section 16005 delays the date when the HHS Secretary can begin using information from competitive bidding to adjust the fee schedule rates for accessories used with Group 3 complex rehabilitative power wheelchairs by six months (to July 1, 2017). Provision

Section 16007 requires the HHS Secretary to extend the transition to the adjusted fee schedule amounts by six months so that (1) for items and services furnished January 1, 2016, through December 31, 2016, 50% of the payment is based on the new adjusted fee schedule methodology and 50% is based on the unadjusted fee schedule amount and (2) for items and services furnished starting January 1, 2017, the Medicare payment is based entirely on the adjusted fee schedule amount. Provision

Section 16008 requires the HHS Secretary to solicit and take into account stakeholder input when adjusting fee schedule rates outside of competitive bidding areas for items and services furnished on or after January 1, 2019. Title XVII—Other Medicare Provisions

			Section 17001. Provision

Section 17001 expresses the intent of Congress, consistent with the IMPACT Act, to continue to study and request input on the effects of socioeconomic status and dual-eligible populations on the MA five-star rating system before reforming the system with the input of stakeholders. 114-255 until the end of plan year 2018, the HHS Secretary may not terminate an MA organization's contract solely because the MA plan has failed to achieve a minimum quality rating under the five-star rating system. States that determine a temporary moratorium on new provider enrollment would reduce beneficiaries' access to care are required to notify the HHS Secretary in writing. Provision

Under Section 17004, beginning October 1, 2017, the HHS Secretary is authorized to prohibit payment for services or items furnished by Medicare, Medicaid, or CHIP providers and suppliers who are subject to temporary new provider or supplier enrollment moratoria. Starting in 2019, this provision creates a continuous open enrollment and disenrollment period during the first three months of each year, during which an MA enrollee may switch to a different MA plan or disenroll from MA to return to Parts A and B (with or without a PDP). Exception from Group Health Plan Requirements for Qualified Small Employer Health Reimbursement Arrangements

Health reimbursement arrangements (HRAs) are employer-established arrangements that pay or reimburse employees for substantiated medical care expenses up to a maximum dollar amount. 114-113 )
CAH: Critical Access Hospital
CBO: Congressional Budget Office
CEHRT: Certified Electronic Health Records Technology
CHIP: Children's Health Insurance Program
CMS: Centers for Medicare & Medicaid Services
DRG: Diagnosis Related Group
DME: Durable Medical Equipment
DMEPOS: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
EHR : Electronic Health Record
ERISA: Employee Retirement Income Security Act
ESRD: End-Stage Renal Disease
FFS: Fee-For-Service
FY: Fiscal Year
HCPCS: Healthcare Common Procedure Code System
HHS: Department of Health and Human Services
HI: Hospital Insurance
HITECH: Health Information Technology for Economic and Clinical Health Act
HOPD: Hospital Outpatient Department
HRA: Health Reimbursement Arrangement
HRRP: Hospital Readmission Reduction Program
ICD: International Classification of Diseases
IMPACT: Improving Medicare Post-Acute Care Transformation Act of 2014 ( P.L.
This report summarizes the Increasing Choice, Access, and Quality in Health Care for Americans Act, enacted December 13, 2016, as Division C of the 21st Century Cures Act (P.L. 114-255). Division C comprises Title XV through Title XVII, which include provisions primarily relating to Medicare and Title XVIII, which includes a provision relating to the small-group health insurance market.
Title XV Medicare Part A provisions:
extend the Rural Community Hospital demonstration five years; require the Secretary of the Department of Health and Human Services (HHS) to account for socioeconomic factors in administering the Hospital Readmission Reduction Program; reduce a specific inpatient hospital payment update for FY2018; require the HHS Secretary to create a crosswalk between codes used for reimbursing procedures performed in inpatient and outpatient settings; and make adjustments to long-term care hospital (LTCH) reimbursement including creating or reinstating temporary clinical criteria for payment under the LTCH prospective payment system (PPS) rather than site neutral payment; modifying the average length of stay formula that determines whether a hospital qualifies as an LTCH; reinstating an exemption from a temporary moratorium on additional LTCH beds; delaying implementation of a rule that lowers reimbursement for certain LTCHs that rely disproportionately on referrals from a single acute-care hospital; and creating a new, non-LTCH hospital category in statute for a specific type of long-stay hospital.
Title XVI Medicare Part B provisions:
make modifications for PPS-exempt cancer hospital and certain new provider-based hospital outpatient departments to be paid under the outpatient PPS; exclude certain ambulatory surgical center-based eligible professionals from the electronic health records meaningful use payment adjustment; allow physical therapists who furnish outpatient physical therapy in certain areas to use locum tenens arrangements for payment purposes; extend the delay in enforcement of direct physician supervision requirements for outpatient therapeutic services in critical access hospitals and small rural hospitals; and make changes to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) payment including delaying when competitive bidding information can be used to adjust fee schedule rates for Group 3 complex rehabilitative power wheelchairs accessories; extending the transition to the adjusted fee schedule for DMEPOS; and requiring the HHS Secretary to consider stakeholder input when adjusting fee schedule rates outside of competitive bidding areas.
Title XVII's other Medicare provisions:
express Congress's intent to continue to study the effects of socioeconomic status and dual-eligible populations on the Medicare Advantage (MA) five-star rating system before reforming the system with stakeholder input; instruct that the HHS Secretary may not terminate MA or Prescription Drug Plan (PDP) contracts solely because of failure to achieve a minimum quality rating; create a three-month period at the beginning of the year during which an MA enrollee may switch to a different MA plan or return to Medicare Parts A and B (with or without a PDP); allow beneficiaries with end-stage renal disease (ESRD) to enroll in MA beginning January 1, 2021; modify the requirements for assigning beneficiaries to Medicare Shared Savings Program (MSSP) accountable care organizations; require the HHS Secretary to submit Medicare enrollment data to Congress annually; require the HHS Secretary to update the new beneficiary Welcome to Medicare package; and authorize the HHS Secretary to prohibit payment for services or items furnished by Medicare, Medicaid, or State Children's Health Insurance Program providers and suppliers who are subject to temporary new provider or supplier enrollment moratoria.
Title XVIII:
creates qualified small employer health reimbursement arrangements, which are arrangements offered by eligible employers that pay or reimburse employees for substantiated medical expenses. Under certain conditions, employers may make contributions up to a specified limit and employees do not owe income tax on the payments and reimbursements.