H.R. 4994, IMPACT Act of 2014

H.R. 4994

IMPACT Act of 2014

Rep. Dave Camp

Ways and Means

September 16, 2014 (113th Congress, 2nd Session)

Staff Contact

Floor Situation

On Tuesday, September 16, 2014, the House will consider H.R. 4994, the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, under a suspension of the rules.  H.R. 4994 was introduced on June 26, 2014 by Rep. Dave Camp (R-MI) and referred to the Committees on Ways and Means and Energy and Commerce.

Bill Summary

H.R. 4994 amends Title XVIII of the Social Security Act to require that post-acute care (PAC) standardized assessment data be reported for quality, payment, and discharge planning, and requires the Secretary to modify PAC assessment instruments to allow for the submission of standardized patient assessment data (and to allow for comparison of such data).  The bill also requires the data to be interoperable to allow for the exchange of such data among PAC providers to give them access to the information necessary to facilitate coordinated care and improve Medicare beneficiary outcomes.  H.R. 4994 also requires the modification of PAC assessment instruments for the submission of standardized patient assessment data.  In addition, it directs the Secretary to: 1) provide confidential feedback reports to PAC providers on their performance with respect to all quality measures and resource use measures under the applicable reporting provisions; and 2) arrange for public reporting of PAC provider performance on quality, resource use, and other measures.

H.R. 4994 requires the Medicare Payment Advisory Commission (MedPAC) to submit a report to Congress that evaluates and recommends features of a PAC payment system that would establish payment rates according to individual characteristics instead of the “setting” in which patients are treated.  The report is due before July 1, 2016.  Furthermore, it requires MedPAC to recommend a technical prototype for a PAC prospective payment system.  The bill will also skilled nursing facilities in the requirement that any post acute provider that does not report assessment and quality data have their market basket update reduced by two percentage points.  Finally, this legislation directs the Secretary to study: 1) the effect of individuals’ socioeconomic status, race, health literacy, limited English proficiency, and patient activation on quality and resource use; 2) the impact on such measures of specified risk factors.  Finally, this legislation recalculates the hospice cap index using a slower growth rate.


MedPAC first raised the need for a common PAC assessment tool in 2005.  As a result, CMS was directed to test the concept of a common standardized assessment tool in the form of the PAC reform demonstration.[1]  In 2013, Ways and Means Committee leaders invited stakeholders to submit ideas on how to strengthen post-acute care (PAC), which support a patient’s continued recovery from a serious illness.[2]  This legislation is the result of the input of more than 70 stakeholders, and is intended to lay the groundwork for the modernization of PAC services.[3]  The IMPACT Act moves forward on the long-standing goal of collecting standardized data to inform future payment reforms.

[1] http://waysandmeans.house.gov/news/documentsingle.aspx?DocumentID=373213
[2] See Id.
[3] See Id.


CBO estimates that enacting H.R. 4994 would not add to the deficit for the 2014-2024 period.[4]

[4] http://www.cbo.gov/sites/default/files/cbofiles/attachments/hr4994.pdf

Additional Information

For questions or further information contact the GOP Conference at 5-5107.