,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #eaaj  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #ae1 #bjad ,mr4 
,wald5 7= himself1 ,mr4 ,price (        
,georgia1 ,mrs4 ,ellm]s1 ,mr4           
,mc,kinley1 ,mr4 ,la?am1 ,mr4 ,duffy1   
,mrs4 ,mc,morris ,rodg]s1 ,mr4 ,graves (
 ,miss\ri1 ,mr4 ,b\/any1 ,mr4 ,pauls51  
,mr4 ,?ompson ( ,p5nsylvania1 ,mr4 ,"y (
 ,alaska1 & ,mr4 ,g>dn]7 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 repeal rebas+ 
( paym5ts = home heal? s]vices1 z       
requir$ "u ! ,pati5t ,protection &      
,af=dable ,c>e ,act1 & to replace su*   
rebas+ ) a ,m$ic>e home heal? value-bas$
 pur*as+ program1 & = o!r purposes4  #a4
 ,%ort title ,?is ,act may be cit$ z !  

,secur+ ,access ,via ,excell5ce =       
,m$ic>e ,home ,heal? ,act ( #bjad or !  
,,save ,m$ic>e ,home ,heal? ,act (      
#bjad4  #b4 ,repeal ( ,m$ic>e home heal?
 rebas+ r$uction provid$ "u ,,ppaca &   
detail$ analysis ( su* r$uction  7a7    
,repeal ( rebas+ r$uction & codification
 ( ,,cy #bjad paym5t adju/m5t  7#a7     
,repeal ,section #ahie7;b77#c77;,a7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acie;fff7b77#c77;,a77 is am5d$ by /rik+
 clause 7iii74  7#b7 ,codification ,su* 
section1 z am5d$ by p>agraph 7#a71 is   
fur!r am5d$ by add+ at ! end ! foll[+   
new clause3  7iii7 ,codification ( ,,cy 
#bjad paym5t adju/m5t ,! am\nt 7or      
am\nts7 t w\ld o!rwise be applicable "u 
clause 7i77,,iii7 = #bjae & subsequ5t   
ye>s %all be det]m9$ tak+ into acc\nt ! 
#c4e p]c5tage po9t r$uction effective = 
#bjad pursuant to ! rule = home heal?   
prospective paym5t sy/em rate update =  
cal5d> ye> #bjad 7promulgat$ on ,decemb]
 #b1 #bjac1 #gh ,f$]al ,regi/] #gbbef74 
4  7b7 ,detail$ analysis ( rebas+       

r$uction  7#a7 ,9 g5]al ,! ,secret>y (  
,heal? & ,human ,s]vices %all conduct a 
detail$ analysis ( ! rebas+ r$uction 9  
,m$ic>e paym5ts = home heal? s]vices    
promulgat$ "u ! rule = home heal?       
prospective paym5t sy/em rate update =  
cal5d> ye> #bjad 7promulgat$ on ,decemb]
 #b1 #bjac1 #gh ,f$]al ,regi/] #gbbef71 
pursuant to ! ,regulatory ,flexibility  
,act1 ,executive ,ord] #acefc1 section  
#caca7;a7 ( ! ,pati5t ,protection &     
,af=dable ,c>e ,act1 & o!r specifi$     
factors4 ,su* analysis %all include an  
assessm5t ( at lea/ ! foll[+ factors3   
7,a7 ,! age1 pov]ty level1 g5d]1 rural  
resid5ce1 e?nic or racial m9ority1 &    
infirmity ( ,m$ic>e b5efici>ies receiv+ 
home heal? s]vices 9 comp>ison to o!r   
,m$ic>e b5efici>ies4  7,b7 ,! numb]1    
g5d]1 & geographic di/ribution (        
pr(essional ,m$ic>e home heal? c>egiv]s4
  7,c7 ,! numb] & location ( home heal? 
ag5cies t h clos$1 consolidat$1 or be5  
acquir$ s9ce ! rebas+ r$uction 0        
implem5t$4  7,d7 ,! numb] & location (  

pr(essional home heal? c>egiv] jobs t h 
be5 lo/ s9ce ! rebas+ r$uction 0        
implem5t$4  7#b7 ,report ,n lat] ?an    
,febru>y #a1 #bjae1 ! ,secret>y %all    
submit to ,congress a report t conta9s  
f9d+s reg>d+ ! analysis conduct$ "u     
p>agraph 7#a71 includ+ ! ,secret>y's    
assessm5t ( ! factors specifi$ 9 su*    
p>agraph4  #c4 ,e/abli%m5t ( home heal? 
value-bas$ pur*as+ 7,,vbp7 program  7a7 
,readmission measures ,section #ahie ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;fff7 is am5d$ by add+ at ! end !  
foll[+ new subsection3  7f7             
,po/-,hospital home heal? s]vices       
readmission measure  7#a7 ,readmission  
measure ,n lat] ?an ,janu>y #a1 #bjaf1 !
 ,secret>y %all specify a home heal?    
all-cause all-condition hospital        
unplann$ readmission measure 7or any    
successor to su* a measure7 =           
readmissions 7= any cause7 to a hospital
 = an individual :o is entitl$ to       
b5efits "u "p ,a 7or enroll$ "u "p ,b7 &
 :o is receiv+ po/-hospital home heal?  

s]vices4  7#b7 ,res\rce use measure ,n  
lat] ?an ,janu>y #a1 #bjag1 ! ,secret>y 
%all specify a measure t is ! measure   
specifi$ "u p>agraph 7#a71 risk-adju/$ =
 pot5tially prev5table readmissions to a
 hospital = an individual describ$ 9 su*
 p>agraph4  7#c7 ,developm5t ,! measures
 specifi$ "u p>agraphs 7#a7 & 7#b7 %all 
be develop$ ?r\gh a =mal process t is   
bas$ on input f a gr\p ( multiple       
/akehold]s consi/+ ( at lea/ s5ior      
advocates1 ,m$ic>e b5efici>ies1         
c>egiv]s1 & home heal? physicians1      
nurses1 !rapi/s1 & op]ators ( home heal?
 ag5cies4  7#d7 ,qu>t]ly fe$back reports
 to home heal? ag5cies ,beg9n+ ,janu>y  
#a1 #bjag1 & e qu>t] !reaft]1 !         
,secret>y %all provide confid5tial      
fe$back to home heal? ag5cies on _!     
p]=mance ) respect to su* measures4     
7#e7 ,public report+ on p]=mance  7,a7  
,9 g5]al ,subject to subp>agraphs 7,b7 &
 7,c71 ! ,secret>y %all e/abli%         
proc$ures = mak+ public on ! ,m$ic>e    
,home ,heal? ,comp>e website 7or        

successor to su* website7 ! p]=mance (  
home heal? ag5cies ) respect to a       
measure specifi$ "u p>agraph 7#a7 & a   
measure specifi$ "u p>agraph 7#b74  7,b7
 ,opportunity to review ,! proc$ures "u 
subp>agraph 7,a7 %all ensure t a home   
heal? ag5cy has ! opportunity to review 
& submit corrections to ! in=mation t is
 to be made public ) respect to su*     
ag5cy be=e su* in=mation is made public4
  7,c7 ,tim+ ,su* proc$ures %all provide
 t ! in=mation describ$ 9 subp>agraph   
7,a7 is fir/ made publicly available    
beg9n+ no lat] ?an ,janu>y #a1 #bjah4  4
  7b7 ,value-,bas$ pur*as+ program =    
home heal? ag5cies ,section #ahie ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acie;fff71 z am5d$ by subsection 7a71  
is fur!r am5d$ by add+ at ! end ! foll[+
 new subsection3  7g7 ,application (    
value-,bas$ pur*as+ program  7#a7       
,e/abli%m5t  7,a7 ,9 g5]al ,subject to !
 succe$+ provisions ( ?is subsection1 ! 
,secret>y %all e/abli% a home heal?     
ag5cy value-bas$ pur*as+ program 79 ?is 

subsection ref]r$ to z ! ,,hha ,,vbp    
,program7 "u :i* value-bas$ inc5tive    
paym5ts are made 9 a ye> to home heal?  
ag5cies4  7,b7 ,program to beg9 9 #bjai 
,! ,,hha ,,vbp ,program %all apply to   
paym5ts = episodes ( home heal? s]vices 
beg9n+ on or aft] ,janu>y #a1 #bjai4    
7#b7 ,application ( measures --  7,a7 ,9
 g5]al ,subject to subp>agraph 7,b71 !  
,secret>y %all apply ! measure specifi$ 
"u subsection 7f77#b7 = purposes ( !    
,,hha ,,vbp ,program4  7,b7 ,replacem5t 
,if ! ,secret>y det]m9es t ! application
 ( su* measure is n practicable & %\ld  
be delay$ & ! ,secret>y notifies !      
,committee on ,f9ance ( ! ,s5ate & !    
,committees on ,ways & ,means & ,en]gy &
 ,comm]ce ( ! ,h\se ( ,repres5tatives ( 
! reasons = su* delay 9 advance (       
implem5t+ su* delay1 ! ,secret>y may    
delay ! application ( su* measure = a   
p]iod ( up to #a ye>4 ,= ! p]iod ( any  
su* delay1 ! measure specifi$ "u        
subsection 7f77#a7 %all apply = purposes
 ( ! ,,hha ,,vbp ,program in/ead ( !    

measure specifi$ "u subsection 7f77#b74 
7#c7 ,p]=mance /&>ds  7,a7 ,e/abli%m5t  
,! ,secret>y %all e/abli% p]=mance /&>ds
 ) respect to ! measure appli$ "u       
p>agraph 7#b7 = a p]=mance p]iod = a    
ye>4  7,b7 ,high] ( a*ievem5t &         
improvem5t ,! p]=mance /&>ds e/abli%$ "u
 subp>agraph 7,a7 %all include levels ( 
a*ievem5t & improvem5t4 ,9 calculat+ !  
,,hha p]=mance score "u p>agraph 7#d71 !
 ,secret>y %all use ! high] ( ei!r      
improvem5t or a*ievem5t4  7,c7 ,tim+ ,! 
,secret>y %all e/abli% & ann\nce !      
p]=mance /&>ds e/abli%$ "u subp>agraph  
7,a7 n lat] ?an #fj days be=e ! beg9n+ (
 ! p]=mance p]iod = ! ye> involv$4  7#d7
 ,,hha p]=mance score  7,a7 ,9 g5]al ,! 
,secret>y %all develop by regulation a  
me?odology = assess+ ! total p]=mance ( 
ea* home heal? ag5cy bas$ on p]=mance   
/&>ds e/abli%$ "u p>agraph 7#c7 )       
respect to ! measure appli$ "u p>agraph 
7#b74 ,us+ su* me?odology1 ! ,secret>y  
%all provide = an assessm5t 79 ?is      
subsection ref]r$ to z ! ,,hha p]=mance 

score7 = ea* home heal? ag5cy = ea* su* 
p]=mance p]iod4  7,b7 ,rank+ ( hha      
p]=mance scores ,! ,secret>y %all1 = !  
p]=mance p]iod = ea* ye>1 rank ! ,,hha  
p]=mance scores det]m9$ "u subp>agraph  
7,a7 f l[ to high4  7#e7 ,budget neutral
 )hold+ ,! ,secret>y %all )hold f !     
paym5t rates made = ea* ye> 7dur+ !     
p]iod beg9n+ ) #bjai & end+ ) #bjbd7 =  
home heal? s]vices "u ?is section su*   
)hold+ p]c5tage z is necess>y s t !     
enactm5t ( ! ,secur+ ,access ,via       
,excell5ce = ,m$ic>e ,home ,heal? ,act (
 #bjad is e/imat$ n to result 9 any net 
*ange 9 paym5ts made = su* s]vices "u   
?is title4  7#f7 ,value-bas$ inc5tive   
paym5t p]c5tage ,! ,secret>y %all       
provide = a di/ribution ( a portion ( ! 
am\nts )held "u p>agraph 7#e7 = p]=mance
 paym5ts to home heal? ag5cies 9 a mann]
 s z to ensure t--  7,a7 ! di/ribution  
7express$ z a p]c5tage ( su* )held      
am\nts7 is bas$ on ea* ag5cy's ,,hha    
p]=mance rank+ "u p>agraph 7#d77;,b7 = !
 p]=mance p]iod = ! ye> involv$2  7,b7 !

 application ( all su* p]c5tages 9 su*  
ye> results 9 an appropriate di/ribution
 ( value-bas$ inc5tive paym5ts "u ?is   
subsection su* t--  7i7 home heal?      
ag5cies ) ! highe/ rank+s "u p>agraph   
7#d77;,b7 receive ! highe/ value-bas$   
inc5tive paym5t am\nts "u ?is           
subsection2  7ii7 home heal? ag5cies ) !
 l[e/ rank+s "u p>agraph 7#d77;,b7      
receive ! l[e/ value-bas$ inc5tive      
paym5t am\nts "u ?is subsection2 &      
7iii7 9 ! case ( home heal? ag5cies 9 ! 
l[e/ #dj p]c5t ( ! rank+ "u p>agraph    
7#d77;,b71 ! paym5t rate "u ?is         
subsection = s]vices furni%$ by su*     
facility dur+ su* ye> %all be less ?an !
 paym5t rate = su* s]vices = su* ye> t  
w\ld o!rwise apply )\t application ( ?is
 subsection2 &  7,c7 ! total am\nt (    
value-bas$ inc5tive paym5ts "u ?is      
subsection = all home heal? ag5cies 9   
su* ye> %all be great] ?an or equal to  
#ej p]c5t1 b n great] ?an #gj p]c5t1 ( !
 total am\nt ( ! paym5ts )held = su* ye>
 "u p>agraph 7#e71 z e/imat$ by !       

,secret>y4  7#g7 ,ann\ncem5t ( result ( 
adju/m5ts ,"u ! ,,hha ,,vbp program1 !  
,secret>y %all1 n lat] ?an #fj days be=e
 a ye> involv$1 in=m ea* home heal?     
ag5cy ( ! adju/m5ts to paym5ts to !     
ag5cy = s]vices furni%$ by ! ag5cy dur+ 
! ye> "u ?is subsection4  7#h7 ,no      
effect 9 subsequ5t ye> ,! value-bas$    
paym5t adju/m5ts "u ?is subsection %all 
only apply ) respect to ! ye> involv$1 &
 ! ,secret>y %all n take into acc\nt su*
 adju/m5t 9 mak+ paym5ts to a home heal?
 ag5cy "u ?is section 9 a subsequ5t ye>4
  7#i7 ,fund+ = program managem5t ,!    
,secret>y %all provide = ! "o-"t transf]
 f ! ,f$]al ,supplem5t>y ,m$ical        
,insurance ,tru/ ,fund e/abli%$ "u      
section #ahda to ! ,c5t]s = ,m$ic>e     
,m$icaid ,s]vices ,program ,managem5t   
,acc\nt (--  7,a7 #b1jjj1jjj = purposes 
( subsection 7f72 &  7,b7 #aj1jjj1jjj = 
purposes ( implem5t+ ?is subsection4    
,su* funds %all rema9 available until   
exp5d$4  4  7c7 ,med,p,a,c ,/udy ,n lat]
 ?an ,june #cj1 #bjba1 ! ,m$ic>e ,paym5t

 ,advisory ,commission %all submit to   
,congress a report t reviews ! progress 
( ! home heal? value-bas$ pur*as+       
program e/abli%$ "u section #ahie7;g7 ( 
! ,social ,security ,act1 z add$ by     
subsection 7b71 & makes recomm5dations1 
z appropriate1 on any improvem5ts t %\ld
 be made to su* program4 ,= purposes ( !
 previ\s s5t5ce1 ! ,m$ic>e ,paym5t      
,advisory ,commission %all consid] any  
un9t5d$ consequ5ces ) respect to su*    
home heal? ag5cy value-bas$ pur*as+     
program & any pot5tial adju/m5ts to !   
readmission measure specifi$ "u section 
#ahie7;f7 ( su* ,act1 z add$ by         
subsection 7a71 = purposes ( det]m9+ !  
effect ( ! socio-economic /atus ( a     
b5efici>y "u ! ,m$ic>e program "u title 
,,xviii ( ! ,social ,security ,act on ! 
p]=mance score ( a home heal? ag5cy     
provid$ "u section #ahie7;g77#d7 ( su*  
,act1 z add$ by subsection 7b74