,i #aac? ,,congress #b;d ,session ,h4 ,r4 #dfgc ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,may #ai1 #bjad ,mr4 ,mc,kinley 7= himself & ,mr4 ,price ( ,georgia7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,ways & ,means1 & 9 addition to ! ,committee on ,en]gy & ,comm]ce1 = 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 title ,,xviii ( ! ,social ,security ,act to provide bundl$ paym5ts = po/-acute c>e s]vices "u p>ts ,a & ,b ( ,m$ic>e1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,bundl+ & ,coord9at+ ,po/-,acute ,c>e ,act ( #bjad & z ! ,,bacpac ,act ( #bjad4 #b4 ,purposes ,! purposes ( ?is ,act are to-- 7#a7 fo/] ! deliv]y ( high-quality po/-acute c>e s]vices 9 ! mo/ co/-effective mann] possible2 7#b7 pres]ve ! ability ( pati5ts1 ) ! guidance ( _! physicians1 to select _! pref]r$ provid]s ( po/-acute c>e s]vices2 7#c7 promote competition among po/-acute c>e provid]s on ! basis ( quality1 co/1 acc\ntability1 & cu/om] s]vice2 7#d7 a*ieve long-t]m su/a9ability by ensur+ op]ational /ability ?r\gh regional bread? & ! engagem5t ( exp]i5c$ c>e ,,pac coord9ators2 7#e7 advance innovation 9 fields includ+ teleheal?1 c>e coord9ation1 m$ication managem5t1 & hospitalization avoidance2 & 7#f7 provide = ! f9ancial security ( ! ,m$ic>e program by a*iev+ sub/antial program sav+s ?r\gh maximiz$ effici5cies1 co/ avoidance1 & outcomes improvem5t4 #c4 ,provid+ bundl$ paym5ts = po/-acute c>e s]vices "u p>ts ,a & ,b ( ,m$ic>e ,title ,,xviii ( ! ,social ,security ,act is am5d$ by ins]t+ aft] section #ahff;,e 7#db ,u4,s4,c4 #acie;cc-#e7 ! foll[+ new section3 #ahff;,f4 ,provid+ bundl$ paym5ts = po/-acute c>e s]vices 7a7 ,9 g5]al ,= a ,,pac bundle ) respect to qualify+ dis*>ges occurr+ on or aft] ,janu>y #a1 #bjaf1 in/ead ( ! paym5t o!rwise provid$ "u p>ts ,a & ,b1 !re %all be paid a s+le paym5t am\nt 7det]m9$ "u subsection 7d7 & z limit$ "u p>agraph 7#d7 ( su* subsection7 to be paid to a ,,pac coord9ator 7z describ$ 9 subsection 7c77 select$ by an individual "u su* subsection4 7b7 ,,pac-,relat$ def9itions ,9 ?is section3 7#a7 ,,pac bundle ,! t]m ,,pac bundle means ,,pac s]vices furni%$ to an individual dur+ a ,,pac p]iod 9 a ,,pac area4 7#b7 ,,pac s]vices 7,a7 ,9 g5]al ,! t]m ,,pac s]vices includes-- 7i7 po/-hospital ext5d$ c>e s]vices1 subject to subp>agraph 7,c77i72 7ii7 home heal? s]vices1 subject to subp>agraph 7,c77ii72 7iii7 inpati5t s]vices provid$ 9 a rehabilitation facility1 subject to subp>agraph 7,c77iii72 7iv7 inpati5t hospital s]vices provid$ by a long-t]m c>e hospital1 subject to subp>agraph 7,c77iv72 7v7 durable m$ical equipm5t2 7vi7 outpati5t prescription drugs & biologicals2 & 7vii7 skill$ nurs+ facility s]vices4 7,b7 ,exceptions ,su* t]m does n include-- 7i7 physicians' s]vices2 7ii7 hospice c>e2 7iii7 outpati5t hospital s]vices2 7iv7 ambulance s]vices2 7v7 outpati5t physical !rapy s]vices2 7vi7 outpati5t occupational !rapy s]vices2 7vii7 outpati5t spee*-language pa?ology s]vices2 & 7viii7 ! items & s]vices describ$ 9 section #ahfa7s77#i74 7,c7 ,nonapplication ( c]ta9 cov]age limitations 7i7 ,waiv] ( skill$ nurs+ facility ?ree-day /ay requirem5t ,9 apply+ subp>agraph 7,a77i71 ! #c-;day /ay requirem5t describ$ 9 section #ahfa7;i7 7requir+ t an individual's inpati5t /ay 9 a dis*>g+ hospital be = a duration ( n less ?an #c consecutive days7 %all n apply4 7ii7 ,waiv] ( homeb\nd requirem5t = home heal? s]vices ,9 apply+ subp>agraph 7,a77ii71 ! requirem5ts cit$ 9 sections #ahad7;a77#b77;,c7 & #ahce7;a77#b77;,a7 t home heal? s]vices are or 7 requir$ because ! individual is or 0 conf9$ to ! home ( ! individual %all n apply4 7iii7 ,nonapplication ( rehabilitation facility p]c5tage requirem5t ,9 apply+ subp>agraph 7,a77iii71 any requirem5t t a specifi$ p]c5tage ( ! inpati5t population s]v$ by ! facility require int5sive rehabilitation s]vices = treatm5t ( "o or m ( ! conditions specifi$ 9 section #dab4bi7;b77#b7 ( title #db1 ,code ( ,f$]al ,regulations1 z ( ,decemb] #ai1 #bjac1 %all n apply4 7iv7 ,nonapplication ( long-t]m c>e hospital p]c5tage requirem5t ,9 apply+ subp>agraph 7,a77iv71 any requirem5t t a specifi$ p]c5tage ( ! dis*>g$ ,m$ic>e inpati5t population ( ! long-t]m c>e hospital or its satellite facility be admitt$ to ! hospital or its satellite facility f its co-locat$ hospital %all n apply4 7#c7 ,,pac p]iod ,! t]m ,,pac p]iod means ! p]iod beg9n+ on ! date ( a qualify+ dis*>ge 7z def9$ 9 p>agraph 7#aj77 & end+ on ! date t is ! e>li] ( ! foll[+3 7,a7 ,! date t is #ij days aft] ! date ( su* dis*>ge4 7,b7 ,! date on :i* ! individual is admitt$ to a hospital = purposes ( receiv+ s]vices = a condition t is n relat$ to ! condition = :i* ! individual receiv$ ! acute c>e inpati5t hospital s]vices describ$ 9 p>agraph 7#aj77;,a74 7#d7 ,,pac area ,! t]m ,,pac area means an area ) respect to :i* a ,,pac coord9ator has a ,,pac agreem5t 9 effect "u subsection 7c77#a77;,b74 7#e7 ,,pac physician ,! t]m ,,pac physician means1 ) respect to an individual receiv+ a ,,pac bundle1 ! physician :o has prim>y responsibility ) respect to sup]vis+ ! deliv]y ( s]vices dur+ ! c\rse ( a ,,pac p]iod4 7#f7 ,,pac provid] ,! t]m ,,pac provid] means1 ) respect to ,,pac s]vices1 ! provid] ( s]vices or suppli] furni%+ su* s]vices4 7#g7 ,,pac network agreem5t ,! t]m ,,pac network agreem5t means1 9 ! case t an individual has select$ a ,,pac coord9ator "u subsection 7c77#d77;,a7 = ! furni%+ ( ,,pac s]vices1 an agreem5t ( a ,,pac coord9ator ) "o or m ,,pac provid]s to provide su* s]vices to su* individual4 7#h7 ,,pac readmission ,! t]m ,,pac readmission means1 ) respect to an individual receiv+ a ,,pac bundle1 ! individual's admission to a hospital )9 #ij days ( ! date ( ! qualify+ dis*>ge ( ! individual1 = purposes ( receiv+ s]vices = a condition t is relat$ to ! condition = :i* ! individual receiv$ ! acute c>e inpati5t hospital s]vices describ$ 9 p>agraph 7#aj77;,a74 7#i7 ,,pac assessm5t tool ,! t]m ,,pac assessm5t tool means ! ,cont9uity ,assessm5t ,record & ,evaluation 7,,c>e7 tool 7or su* equival5t assessm5t tool z ! ,secret>y may specify74 7#aj7 ,qualify+ dis*>ge ,subject to subsection 7e71 ! t]m qualify+ dis*>ge means a dis*>ge aft] receiv+ acute c>e inpati5t hospital s]vices 7z def9$ by ! ,secret>y7 9 a subsection 7d7 hospital 7z def9$ 9 section #ahhf7;d77#a77;,b77 = :i* ! dis*>ge plan includes ! furni%+ ( ,,pac s]vices4 7#aa7 ,,crg ,! t]m ,,crg means a condition-relat$ gr\p e/abli%$ "u subsection 7d77#a74 7c7 ,,pac coord9ators 7#a7 ,9 g5]al ,9 ?is section1 ! t]m ,,pac coord9ator means an entity 7su* z a hospital1 heal? insurance issu]1 ?ird-p>ty b5efit manag]1 or ,,pac provid]7 t-- 7,a7 is c]tifi$1 "u a process e/abli%$ by ! ,secret>y1 z meet+ appropriate requirem5ts specifi$ by ! ,secret>y1 includ+ ! requirem5ts specifi$ 9 p>agraph 7#b72 & 7,b7 has ent]$ into & has 9 effect a ,,pac agreem5t ) ! ,secret>y describ$ 9 p>agraph 7#c74 7#b7 ,requirem5ts ,! requirem5ts specifi$ 9 ?is p>agraph1 ) respect to an entity s]v+ a ,,pac area1 are ! foll[+3 7,a7 ,f9ancial solv5cy ,! entity has ! capacity1 & provides suffici5t assurances ( solv5cy1 to be> f9ancial risk z a ,,pac coord9ator "u ?is section4 7,b7 ,capacity to manage c>e & fund+ ,! entity has ! capability to manage ! c>e & fund+ = ,,pac s]vices 9 su* area4 7,c7 ,,pac network agreem5ts 7i7 ,network capacity to s]ve ,,pac area ,! entity has ent]$ into ,,pac network agreem5ts ) "o or m ,,pac provid]s 9 a ,,pac area 9 a mann] suffici5t to ensure ! availability ( ,,pac s]vices = individuals resid+ 9 ! area :o select ! entity = ! furni%+ ( ,,pac s]vices4 7ii7 ,limitation on balance bill+ ,su* a ,,pac network agreem5t %all provide t ! ,,pac provid] %all accept z paym5t 9 full = ,,pac s]vices furni%$ by su* ,,pac provid] ! applicable am\nt describ$ 9 p>agraph 7#c77;,c74 7iii7 ,quality assurance ,su* a ,,pac network agreem5t %all provide t ! ,,pac provid] %all h 9 effect a writt5 plan ( quality assurance & improvem5t1 & proc$ures implem5t+ su* plan1 t meet su* quality /&>ds z ! ,secret>y may specify4 7,d7 ,cr$it-wor?9ess ,! entity has demon/rat$ cr$it-wor?9ess4 7,e7 ,m$ical director ,! entity employs or contracts ) a m$ical director :o has an appropriate m$ical backgr\nd4 7#c7 ,t]ms ( ,,pac agreem5t ,! ,,pac agreem5t describ$ 9 ?is p>agraph betwe5 an entity & ! ,secret>y %all1 ) respect to ! ,,pac area specifi$ "u subp>agraph 7,b71 h su* t]ms & conditions z are specifi$ by ! ,secret>y consi/5t ) ?is section & %all include ! foll[+3 7,a7 ,c>e coord9ation ,) respect to an individual :o selects ! entity "u p>agraph 7#d77;,a7-- 7i7 ! entity %all select "o or m ,,pac provid]s 9 su* area to furni%1 directly or indirectly1 cl9ically appropriate ,,pac s]vices 7z det]m9$ ?r\gh ! use ( ! ,,pac assessm5t tool7 to ! individual2 & 7ii7 ! entity %all coord9ate ! furni%+ ( all su* s]vices = ! individual4 7,b7 ,,pac area cov]$ ,! ,,pac agreem5t %all specify ! ,,pac area "u ! ,,pac agreem5t4 7,c7 ,paym5t am\nt = ,,pac s]vices ,= ,,pac s]vices furni%$ by a ,,pac provid] & furni%$ ) respect to a qualify+ dis*>ge t occurs-- 7i7 be=e ,janu>y #a1 #bjai1 ! entity %all pay ! ,,pac provid] "u ! ,,pac network agreem5t betwe5 ! entity & ! ,,pac provid]-- 7,i7 ) respect to su* ,,pac s]vices t are s]vices = :i* ! ,,pac provid] w\ld receive paym5t "u ?is title )\t reg>d to ?is section1 an am\nt t is n less ?an ! am\nt t w\ld o!rwise be paid to su* ,,pac provid] "u ?is title = su* s]vices2 & 7,,ii7 ) respect to su* ,,pac s]vices t are s]vices = :i* ! ,,pac provid] w\ld n receive paym5t "u ?is title )\t reg>d to ?is section1 an am\nt specifi$ "u su* ,,pac network agreem5t2 & 7ii7 on or aft] ,janu>y #a1 #bjai1 ! entity %all pay ! ,,pac provid] "u su* ,,pac network agreem5t an am\nt specifi$ "u su* agreem5t4 7,d7 ,di/ribution ( sav+s ,ins(> z ! paym5t am\nt to a ,,pac coord9ator "u subsection 7d77#c7 = a ,,pac bundle furni%$ to an individual is great] ?an ! aggregate am\nts paid to ,,pac provid]s "u subp>agraph 7,c7 = su* bundle = su* individual1 ! entity %all n reta9 an am\nt great] ?an #gj p]c5t ( su* sav+s & %all pay an am\nt equival5t to-- 7i7 n less ?an #aj p]c5t ( su* sav+s to su* ,,pac provid]s2 7ii7 n less ?an #aj p]c5t ( su* sav+s to ! ,,pac physician ( ! individual2 & 7iii7 9 ! case t !re is no ,,pac readmission ( ! individual1 n less ?an #aj p]c5t ( su* sav+s to ! hospital dis*>g+ ! individual imm$iately prior to ! furni%+ ( su* s]vices4 ,paym5ts %all be made "u ea* ( clauses 7i71 7ii71 & 7iii7 to individuals & entities indep5d5t ( :e!r paym5t may be made to su* an individual or entity "u ano!r su* clause4 7,e7 ,ma9t5ance ( advisory committee ,! entity %all ma9ta9 an advisory committee ( ,,pac provid]s & ( pati5t /akehold]s to advise ! entity reg>d+ its activities "u ?is section4 7#d7 ,selection & *ange ( selection ( ,,pac coord9ators by individual 7,a7 ,9 g5]al ,! ,secret>y %all e/abli% a process = ! selection & *ange ( selection ( a ,,pac coord9ator by an individual :o is receiv+ inpati5t hospital s]vices & ^: dis*>ge has be5 or is likely to be classifi$ z a qualify+ dis*>ge4 7,b7 ,limitation on selection due to network adequacy ,! process e/abli%$ "u subp>agraph 7,a7 may n all[ an individual to select 7or to *ange a selection to7 a ,,pac coord9ator 9 a ,,pac area unless ! ,,pac coord9ator has ent]$ into ,,pac network agreem5ts ) su* ,,pac provid]s 9 su* ,,pac area su* t ! ,,pac coord9ator has a suffici5t numb] & range ( heal? c>e pr(essionals & provid]s will+ to provide s]vices "u ! t]ms ( ! ,,pac agreem5t4 7#e7 ,con/ruction relat+ to ,,pac coord9ators (f]+ non-,,pac s]vices ,no?+ 9 ?is section %all be con/ru$ z prohibit+ ,,pac provid]s f (f]+1 ei!r directly or indirectly1 s]vices t contribute to pati5t c>e1 safety1 & readmission avoidance 7su* z m$ication managem5t1 teleheal? te*nologies1 home environm5t s]vices1 & transportation s]vices7 t are n ,,pac s]vices4 7#f7 ,con/ruction reg>d+ flexibility 9 ! deliv]y ( ,,pac s]vices ,no?+ 9 ?is section %all be con/ru$ to prev5t a ,,pac network agreem5t f p]mitt+ a ,,pac provid] to subcontract = ! furni%+ ( ,,pac s]vices t ! ,,pac provid] is o!rwise obligat$ to provide "u ! agreem5t s long z ! subcontractor meets ! same t]ms & conditions 9 furni%+ su* s]vices z w\ld apply if ! ,,pac provid] 7 to provide su* s]vices4 7d7 ,paym5t am\nts 7#a7 ,classification ( conditions by ,c,r,gs2 me?odology = classification ,! ,secret>y %all e/abli% a classification ( ! conditions ( individuals receiv+ a ,,pac bundle by ,,crg & a me?odology = classify+ specific ,,pac bundles )9 ^! gr\ps4 ,! me?odology %all1 to ! ext5t feasible1 classify su* bundles ?r\gh ! use ( ! ,,pac assessm5t tool4 7#b7 ,computation ( base rate 7,a7 ,9 g5]al ,! ,secret>y %all compute an av]age paym5t rate = ,,pac bundles classifi$ 9 ea* ,,crg & furni%$ dur+ a ,,pac p]iod end+ 9 ! base ye> select$ "u subp>agraph 7,b74 7,b7 ,base ye> selection ,! ,secret>y %all select z a base ye> ! mo/ rec5t ye> end+ be=e ! date ( ! enactm5t ( ?is section = :i* data are available to c>ry out ?is section4 7,c7 ,budget-neutral computation ,! av]age paym5t rate = a ,,pac bundle classifi$ 9 a ,,crg %all be comput$ 9 a mann] s t1 if x _h be5 appli$ 9 ! base ye>1 ! aggregate paym5ts = ,,pac bundles classifi$ 9 su* ,,crg & furni%$ dur+ a ,,pac p]iod end+ 9 su* ye> w\ld be equival5t to ! aggregate paym5ts "u ?is title = su* bundles4 7#c7 ,calculation ( paym5t am\nt bas$ on base rate ,subject to ! succe$+ provisions ( ?is subsection1 ! am\nt ( ! s+le paym5t describ$ 9 ?is p>agraph1 ) respect to a ,,pac bundle classifi$ )9 a ,,crg & furni%$ to an individual dur+ a ,,pac p]iod end+-- 7,a7 9 #bjaf1 is ! base av]age paym5t rate = su* bundle comput$ "u p>agraph 7#b71 increas$ by su* p]c5tage z ! ,secret>y e/imates is ! av]age rate ( increase 9 paym5ts "u ?is title = su* bundle betwe5 ! base ye> & #bjaf2 & 7,b7 9 a subsequ5t ye>1 is ! am\nt ( ! s+le paym5t = su* bundle comput$ "u ?is p>agraph = ! previ\s ye>1 increas$ by a p]c5tage specifi$ by ! ,secret>y consi/5t ) p>agraph 7#d74 7#d7 ,calculation ( annual p]c5tage increase ,9 calculat+ ! p]c5tage increases appli$ "u p>agraph 7#c77;,b71 ! ,secret>y %all ensure t total exp5ditures = all ,,pac bundles provid$ 9 accordance ) ?is section d n exce$ #if p]c5t ( ! applicable basel9e ov] ! #h-;fiscal-ye> p]iod beg9n+ ) fiscal ye> #bjaf4 7#e7 ,adju/m5t = readmissions dur+ ,,pac p]iod ,! am\nt paid to a ,,pac coord9ator "u ?is subsection = a ,,pac bundle 9 a ,,pac p]iod t includes a ,,pac readmission %all be r$uc$ by an am\nt equal to ! aggregate am\nt ( paym5ts made = su* ,,pac readmission ( su* individual4 7#f7 ,adju/m5t = geographic & risk factors ,! ,secret>y %all adju/ ! am\nt ( paym5t describ$ 9 p>agraph 7#c7 ) respect to s]vices furni%$ to an individual 9 a ,,pac area 9 a budget-neutral mann] = a ye>-- 7,a7 by an appropriate factor t reflects v>iations 9 co/s = ! furni%+ ( ,,pac bundles among diff]5t geographic areas2 7,b7 by an appropriate factor t acc\nts = v>iations 9 co/s = ! furni%+ ( su* ,,pac s]vices to ! individual bas$ ^u ! heal? /atus ( ! individual2 & 7,c7 by an am\nt t acc\nts = hi/orical local 7hospital ref]ral clu/]7 pric+4 7#g7 ,adju/m5t 9 case ( *ange ( selection by individual ,9 ! case ( a *ange ( selection ( ,,pac coord9ator by ! individual "u subsection 7c77#d7 dur+ a ,,pac p]iod1 ! ,secret>y %all adju/ ! am\nt ( paym5t describ$ 9 p>agraph 7#c7 9 ord] to provide appropriate p>tial paym5ts to be paid to ! ,,pac coord9ator select$ initially by ! individual & to ! ,,pac coord9ator select$ "u ! *ange ( selection by ! individual4 ,! me?od ( calculat+ ! respective am\nts ( su* appropriate p>tial paym5ts %all be bas$ on ! me?od us$ = ! ,home ,heal? ,p>tial ,episode ,paym5t adju/m5t4 7#h7 ,use ( ,,pac assessm5t tool = purposes ( adju/m5t = risk factors ,9 det]m9+ an appropriate factor "u p>agraph 7#f77;,b7 ) respect to an individual1 ! ,secret>y %all take into acc\nt an assessm5t ( ! individual conduct$ us+ ! ,,pac assessm5t tool4 7e7 ,phase-,9 7#a7 ,det]m9ation ( ,,pac exp5ditures by ,,crg ,bas$ on ! mo/ rec5t data available1 ! ,secret>y %all det]m9e ! aggregate am\nt ( exp5ditures "u ?is title = ,,pac s]vices furni%$ dur+ ! ,,pac p]iod = ea* ,,crg 7z def9$ 9 p>agraph 7b77#aa774 7#b7 ,rank+ ( ,c,r,gs by volume ( exp5diture ,! ,secret>y %all rank ! ,c,r,gs 9 ord] bas$ on ! aggregate am\nt ( exp5ditures = ,,pac s]vices describ$ 9 clause 7i7 = ea* ,,crg4 7#c7 ,gr\p+ ( ,c,r,gs ,! ,secret>y %all gr\p ,c,r,gs into f\r gr\ps z foll[s3 7,a7 ,fir/ gr\p ,! fir/ gr\p consi/s ( ! ,c,r,gs t h ! highe/ rank "u clause 7ii7 & t collectively acc\nt = #be p]c5t ( ! aggregate am\nt ( exp5ditures = ,,pac s]vices describ$ 9 clause 7i74 7,b7 ,second gr\p ,! second gr\p consi/s ( ! ,c,r,gs t h ! next highe/ rank "u clause 7ii7 aft] ! fir/ gr\p 9 subclause 7,i7 & t collectively acc\nt = #be p]c5t ( ! aggregate am\nt ( exp5ditures = ,,pac s]vices describ$ 9 clause 7i74 7,c7 ,?ird gr\p ,! ?ird gr\p consi/s ( ! ,c,r,gs t h ! next highe/ rank "u clause 7ii7 aft] ! second gr\p 9 subclause 7,,ii7 & t collectively acc\nt = #be p]c5t ( ! aggregate am\nt ( exp5ditures = ,,pac s]vices describ$ 9 clause 7i74 7,d7 ,f\r? gr\p ,! f\r? gr\p consi/s ( ! ,c,r,gs t are n includ$ 9 ! fir/1 second1 or ?ird gr\p "u ?is clause4 7#d7 ,phase-9 by ,,crg gr\p+ ,9 apply+ ?is section = dis*>ges 9-- 7,a7 #bjaf1 only dis*>ges t are classifi$ )9 ! fir/ gr\p "u subclause 7,i7 ( clause 7iii7 %all be includ$2 7,b7 #bjag1 only dis*>ges t are classifi$ )9 ! fir/ or second gr\p "u subclause 7,i7 or 7,,ii7 ( clause 7iii7 %all be includ$2 7,c7 #bjah1 only dis*>ges t are classifi$ )9 ! fir/1 second1 or ?ird gr\p "u subclause 7,i71 7,,ii71 or 7,,iii7 ( clause 7iii7 %all be includ$2 & 7,d7 #bjai & subsequ5t ye>s1 dis*>ges t are classifi$ )9 any gr\p ( ,c,r,gs %all be includ$4 4 #d4 ,transitional c>e managem5t paym5ts = physicians ,= purposes ( enc\rag+ transitional c>e managem5t by ,,pac physicians 7z def9$ 9 section #ahff;,f7b77#e7 ( ! ,social ,security ,act71 9 c>ry+ out section #ahdh7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;e771 ! ,secret>y ( ,heal? & ,human ,s]vices %all e/abli% a new ,transitional ,c>e ,managem5t 7,,tcm7 code to pay = c>e managem5t by su* a ,,pac physician or revise & exp& ! use ( exi/+ ,,tcm codes #iidie & #iidid4