,i  #aacth ,,congress  #b;d ,session    
,h4 ,r4 #eeeh  ,,in ,,the ,,house ,,of  
,,representatives  ,september #ah1 #bjad
 ,mrs4 ,black 7for herself and ,mr4     
,welch7 introduced the following bill2  
which was referred to the ,committee on 
,ways and ,means1 and in addition to the
 ,committee on ,energy and ,commerce1   
for a period to be subsequently         
determined by the ,speaker1 in each case
 for consideration of such provisions as
 fall within the jurisdiction of the    
committee concerned  ,a ,,bill  ,to     
amend title ,,xviii of the ,social      
,security ,act to improve the ,medicare 
accountable care organization 7,,aco7   
program1 and for other purposes4  #a4   
,short title ,this ,act may be cited as 
the ,,aco ,improvement ,act of #bjad4   
#b4 ,medicare ,,aco program improvements
  7a7 ,in general ,section #ahii of the 
,social ,security ,act 7#db ,u4,s4,c4   
#acie;jjj7 is amended by adding at the  
end the following new subsection3  7l7  
,improving outcomes through greater     

beneficiary engagement  7#a7 ,use of    
beneficiary incentives ,subject to      
approval of the ,secretary and in the   
case of an ,,aco that has elected a     
two-sided risk model 7as provided for   
under regulations71 the ,secretary shall
 permit the ,,aco--  7,a7 to reduce or  
eliminate cost-sharing otherwise        
applicable under part ,b for some or all
 primary care services 7as identified by
 the ,,aco7 furnished by health care    
professionals 7including1 as applicable1
 professionals furnishing services      
through a rural health clinic or        
,federally qualified health center7     
within the network of the ,,aco2 and    
7,b7 to develop additional incentive    
programs to encourage patient engagement
 and participation in their own         
wellness4  ,the cost of the such        
incentives shall be borne by the ,,aco  
and shall not affect the payments under 
subsection 7d74  7#b7 ,fostering        
stronger patient-provider ties  7,a7    
,providing prospective assignment of    

beneficiaries  7i7 ,in general ,in      
carrying out subsection 7c71 the        
,secretary shall provide for a          
prospective assignment of ,medicare     
fee-for-service beneficiaries before the
 beginning of a year to an ,,aco and    
primary care ,,aco professional in      
accordance with the practice under this 
section for ,pioneer ,a,c,os1 subject to
 clause 7ii74  7ii7 ,changing primary   
care ,,aco professionals ,an ,,aco shall
 permit a beneficiary to select the     
primary care ,,aco professional within  
the ,,aco to which the beneficiary is   
assigned4  7,b7 ,inclusion of ,,aco     
information in welcome to medicare visit
 and annual wellness visits ,the        
,secretary shall require a primary care 
,,aco professional to include1 as part  
of the initial preventive physical      
examination under section #ahfa7ww77#a7 
or personalized prevention plan services
 under section #ahfa7;hhh77#a7 for a    
,medicare fee-for-service beneficiary   
assigned to that professional under this

 section1 to provide the beneficiary    
with information concerning the ,,aco   
program under this section1 including   
information on any cost-sharing         
reductions allowed under this section4  
7,c7 ,stakeholder advisory group ,the   
,secretary shall form a stakeholder     
group1 including representatives of     
,a,c,os1 health care providers          
7including ,,aco professionals71        
,medicare beneficiaries1 and ,,aco      
experts1 to advise the ,secretary with  
recommendations to improve the process  
of ,,aco-to-beneficiary communication4  
7#c7 ,moving from volume to value  7,a7 
,regulatory relief for moving to        
two-sided risk ,in the case of an ,,aco 
that has elected a two-sided risk model 
7as described in paragraph 7#a771 in    
addition to the authority provided under
 paragraph 7#a71 the ,secretary shall   
provide the following regulatory relief3
  7i7 #c-;day prior hospitalization     
waiver for ,,snf services ,waiver of the
 #c-;day prior hospitalization          

requirement for coverage of skilled     
nursing facility services4  7ii7        
,homebound requirement waiver for home  
health services ,waiver of the homebound
 requirement for coverage of home health
 services4  7iii7 ,,rac hospital audit  
relief ,relief from reviews of scheduled
 admissions by recovery audit           
contractors for individuals attributed  
to an ,,aco when admitted on orders of a
 physician participating in the ,,aco4  
7,b7 ,improving care coordination       
through access to telehealth  7i7       
,flexibility in furnishing telehealth   
services ,in applying section #ahcd7m7  
in the case of an ,,aco that has elected
 a two-sided risk model 7as described in
 paragraph 7#a771 the ,,aco may elect to
 have the limitations on originating    
site 7under paragraph 7#d77;,c7 of such 
section7 and on the use of              
store-and-forward technologies 7under   
paragraph 7#a7 of such section7 not     
apply4 ,the previous sentence shall not 
be construed as affecting the authority 

of the ,secretary under subsection 7f7  
to waive other provisions of such       
section4  7ii7 ,provision of remote     
monitoring in connection with home      
health services ,nothing in this section
 shall be construed as preventing an    
,,aco from including payments for remote
 patient monitoring and home-based video
 conferencing services in connection    
with the provision of home health       
services 7under conditions for which    
payment for such services would not be  
made under section #ahie for such       
services7 in a manner that is           
financially equivalent to the furnishing
 of a home health visit4  7#d7          
,establishing greater certainty for     
,a,c,os  7,a7 ,benchmarks and payments  
,the ,secretary shall conduct a         
demonstration project to test the use of
 payment benchmarks that take into      
account geographic area differences1    
such as differences in spending trends  
within and across regions1 and          
variations in delivery and utilization  

based on the socioeconomic status of    
beneficiaries served4  7,b7 ,advance    
notification of ,a,c,os of benchmarks   
and past performance ,the ,secretary    
shall inform ,a,c,os1 in advance of each
 performance period1 of the quality     
benchmarks applicable to the ,,aco and  
period and of the past performance 7if  
any7 of the ,,aco under this section4   
7,c7 ,study and report on feasibility on
 providing electronic access to         
,medicare claims data ,the ,secretary   
shall conduct a study regarding the     
feasibility of establishing a system of 
electronic access of providers of       
services and suppliers to in-process and
 complete patient claims data4 ,such    
system may be a modification of an      
existing data base1 such as the ,virtual
 ,research ,data ,center4 ,the study    
shall take into account the measures    
needed to ensure the security and       
privacy of beneficiary and provider     
information4 ,not later than one year   
after the date of the enactment of this 

,act1 the ,secretary shall submit to    
,congress a report on such study4 ,the  
,secretary shall include in such report 
such recommendations as the ,secretary  
deems appropriate4  4  7b7 ,requiring   
testing of global capitation payment    
model ,section #ahii7;i7 of the ,social 
,security ,act 7#db ,u4,s4,c4           
#acie;jjj7i77 is amended--  7#a7 in the 
heading1 by striking ,option to use     
other payment models and inserting      
,alternative payment models2  7#b7 in   
paragraph 7#a71 by inserting before the 
period at the end the following3 except 
that the ,secretary shall1 beginning no 
later than ,january #a1 #bjaf1 establish
 one or more demonstration programs to  
test the payment model described in     
paragraph 7#c77;,a72 and  7#c7 in       
paragraph 7#c77;,a71 by striking is any 
payment model and inserting the         
following3  7i7 a global capitation     
model in which an ,,aco is at financial 
risk for all items and services covered 
under parts ,a and ,b2 and  7ii7 any    

other payment model that the ,secretary 
determines will improve the quality and 
efficiency of items and services        
furnished under this title4  4  7c7     
,assignment taking into account services
 of non-,physician practitioners        
,section #ahii7;c7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acie;jjj7c77 is amended by inserting   
7or1 in the case of an ,,aco that is    
located in a rural or medically         
underserved area or that is affiliated  
with a ,federally qualified health      
center or rural health clinic1 an ,,aco 
professional described in subsection    
7h77#a77;,b77 after subsection          
7h77#a77;,a74  7d7 ,creating incentives 
for ,,aco development ,the ,secretary of
 ,health and ,human ,services shall     
develop a mechanism to make permanent   
those ,,aco-related pilot programs1     
including the ,advance ,payment ,,aco   
,model1 that have been successful4 ,the 
,secretary shall submit to ,congress a  
report on the study and shall include in

 the report such recommendations1       
including such changes in legislation1  
as the ,secretary deems appropriate4    
7e7 ,effective date ,the amendments made
 by subsection 7a7 shall apply to plan  
years beginning on or after ,january #a1
 #bjaf4