,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #adhg  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,april #aa1 #bjac ,mr4
 ,mc,dermott introduc$ ! foll[+ bill2   
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce1 & 9 addition to ! ,committee 
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d titles     
,,xviii & ,,xi ( ! ,social ,security    
,act to e/abli% an exception f !        
physician self-ref]ral prohibition & a  
safe h>bor f ,f$]al antikickback & o!r  
sanctions = inc5tive paym5ts made by    
hospitals to physicians "u c]ta9        
inc5tive paym5t programs4  #a4 ,%ort    
title ,?is ,act may be cit$ z ! ,improv$
 ,heal? ,c>e at ,l[] ,co/ ,act ( #bjac4 
#b4 ,exception & safe h>bor f ,f$]al    
sanctions = inc5tive paym5ts f hospitals
 to physicians "u c]ta9 inc5tive paym5t 
programs  7a7 ,f9d+s ,congress f9ds !   
foll[+3  7#a7 ,! ,dep>tm5t ( ,heal? &   

,human ,s]vices has be5 engag$ 9        
approv+1 on a project-by-project basis1 
ga9-%>+ arrangem5ts "u demon/ration     
au?ority = ne>ly a decade4 ,bas$ on ! k 
ga9$ f su* demon/ration projects1 !     
,dep>tm5t is capable ( develop+ & apply+
 /&>ds = p]mitt+ su* arrangem5ts m      
g5]ally )\t ! use ( su* au?ority4  7#b7 
,! ,inspector ,g5]al ( ! ,dep>tm5t (    
,heal? & ,human ,s]vices has issu$ a    
special advisory bullet9 9 ,july #aiii t
 indicates t !re is no g5]al au?ority = 
waiv+ sanctions = any ga9-%>+           
arrangem5ts betwe5 physicians &         
hospitals4  7#c7 ,due to lack (         
capitalization1 size limitations1 risk  
*>act]i/ics1 & o!r factors1 _m hospitals
 & physicians h be5 unable or unwill+ to
 ent] into ga9-%>+ types ( arrangem5ts t
 meet ! requirem5ts ( ! %>$ sav+s       
program4  7b7 ,purpose ,! purpose ( ?is 
section is to e/abli% g5]al /atutory    
au?ority )9 ! ,dep>tm5t ( ,heal? &      
,human ,s]vices to recognize ga9-%>+ &  
o!r inc5tive paym5t programs1 o!r ?an ! 

%>$ sav+s program1 t align inc5tives    
among hospitals & physicians to improve 
effici5cy & decrease co/s :ile ma9ta9+  
or improv+ quality c>e4  7c7 ,exception 
f physician self-,ref]ral prohibition   
,section #ahgg7;e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acienn7e77 is     
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#i7 ,paym5ts "u c]ta9       
inc5tive paym5t programs betwe5         
hospitals & physicians  7,a7 ,9 g5]al ,9
 ! case ( a monet>y inc5tive paym5t :i* 
is made by a hospital to a physician "u 
an inc5tive paym5t program 7z def9$ 9   
subp>agraph 7,b77 t meets requirem5ts   
e/abli%$ by ! ,secret>y 9 consultation )
 ! ,attorney ,g5]al & ! ,inspector      
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices = purposes ( ?is p>agraph4     
7,b7 ,inc5tive paym5t program def9$ ,9  
?is p>agraph1 ! t]m inc5tive paym5t     
program means a program t is design$ to 
align inc5tives among hospitals &       
physicians 7?r\gh te*niques su* z       
product /&>dization1 ! sub/itution ( l[]

 co/ products1 & c>e coord9ation        
initiatives t enc\rage m$ically         
appropriate decreases 9 l5g? ( /ay7 to  
improve effici5cy & decrease co/s :ile  
ma9ta9+ or improv+ quality4  4  7d7     
,safe h>bor f antikickback & o!r ,f$]al 
sanctions  7#a7 ,section #aabh;,b7b77#c7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acbj;a-#g;b7b77#c77 is       
am5d$--  7,a7 by /rik+ & at ! end (     
subp>agraph 7,i72  7,b7 9 subp>agraph   
7,j71 by mov+ ! ind5tation #b ems to !  
left & by /rik+ ! p]iod at ! end &      
ins]t+ 2 &2 &  7,c7 by add+ at ! end !  
foll[+ new subp>agraph3  7,k7 any       
monet>y inc5tive paym5t :i* is made by a
 hospital to a physician "u an inc5tive 
paym5t program 7z def9$ 9 subp>agraph   
7,b7 ( section #ahgg7;e77#i77 t meets   
requirem5ts e/abli%$ by ! ,inspector    
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices 9 consultation ) ! ,attorney   
,g5]al = purposes ( apply+ ?is          
subp>agraph 7:i* requirem5ts ne$s n be !
 same z ^? e/abli%$ "u subp>agraph 7,a7 

( su* section74  4  7#b7 ,section       
#aabh;,a7b77#a7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acbj;a-#g;a7b77#a77
 is am5d$ by ins]t+ 7o!r ?an a monet>y  
inc5tive paym5t describ$ 9 section      
#aabh;,b7b77#c77,k77 aft] makes a       
paym5t4  7e7 ,publication ( guidance ,! 
,secret>y ( ,heal? & ,human ,s]vices & !
 ,inspector ,g5]al ( ! ,dep>tm5t (      
,heal? & ,human ,s]vices--  7#a7 n lat] 
?an #f mon?s aft] ! date ( ! enactm5t ( 
?is ,act1 %all jo9tly publi% a          
solicitation ( comm5ts to c>ry out !    
am5dm5ts made by ?is section2 &  7#b7 n 
lat] ?an #ab mon?s aft] su* date (      
enactm5t1 %all publi%1 jo9tly or        
sep>ately1 su* guidance or rules1 :i*   
may be effective on an int]im1 f9al     
basis1 z may be necess>y to c>ry out su*
 am5dm5ts 9 a timely mann]4  7f7        
,con/ruction ,no?+ 9 ?is section 7or !  
am5dm5ts made by ?is section7 %all be   
con/ru$ z affect+ ! op]ation ( ! %>$    
sav+s program4  7g7 ,%>$ sav+s program  
def9$ ,9 ?is section1 ! t]m %>$ sav+s   

program means su* program "u section    
#ahii ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acie;jjj74