,i #aac? ,,congress #b;d ,session ,h4 ,r4 #eeeh ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,septemb] #ah1 #bjad ,mrs4 ,black 7= h]self & ,mr4 ,wel*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 improve ! ,m$ic>e acc\ntable c>e organization 7,,aco7 program1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,,aco ,improvem5t ,act ( #bjad4 #b4 ,m$ic>e ,,aco program improvem5ts 7a7 ,9 g5]al ,section #ahii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7l7 ,improv+ outcomes ?r\gh great] b5efici>y engagem5t 7#a7 ,use ( b5efici>y inc5tives ,subject to approval ( ! ,secret>y & 9 ! case ( an ,,aco t has elect$ a two-sid$ risk model 7z provid$ = "u regulations71 ! ,secret>y %all p]mit ! ,,aco-- 7,a7 to r$uce or elim9ate co/-%>+ o!rwise applicable "u "p ,b = "s or all prim>y c>e s]vices 7z id5tifi$ by ! ,,aco7 furni%$ by heal? c>e pr(essionals 7includ+1 z applicable1 pr(essionals furni%+ s]vices ?r\gh a rural heal? cl9ic or ,f$]ally qualifi$ heal? c5t]7 )9 ! network ( ! ,,aco2 & 7,b7 to develop additional inc5tive programs to enc\rage pati5t engagem5t & p>ticipation 9 _! own wellness4 ,! co/ ( ! su* inc5tives %all be borne by ! ,,aco & %all n affect ! paym5ts "u subsection 7d74 7#b7 ,fo/]+ /rong] pati5t-provid] ties 7,a7 ,provid+ prospective assignm5t ( b5efici>ies 7i7 ,9 g5]al ,9 c>ry+ out subsection 7c71 ! ,secret>y %all provide = a prospective assignm5t ( ,m$ic>e fee-=-s]vice b5efici>ies be=e ! beg9n+ ( a ye> to an ,,aco & prim>y c>e ,,aco pr(essional 9 accordance ) ! practice "u ?is section = ,pione] ,a,c,os1 subject to clause 7ii74 7ii7 ,*ang+ prim>y c>e ,,aco pr(essionals ,an ,,aco %all p]mit a b5efici>y to select ! prim>y c>e ,,aco pr(essional )9 ! ,,aco to :i* ! b5efici>y is assign$4 7,b7 ,inclusion ( ,,aco in=mation 9 welcome to m$ic>e visit & annual wellness visits ,! ,secret>y %all require a prim>y c>e ,,aco pr(essional to include1 z "p ( ! initial prev5tive physical exam9ation "u section #ahfa7ww77#a7 or p]sonaliz$ prev5tion plan s]vices "u section #ahfa7;hhh77#a7 = a ,m$ic>e fee-=-s]vice b5efici>y assign$ to t pr(essional "u ?is section1 to provide ! b5efici>y ) in=mation conc]n+ ! ,,aco program "u ?is section1 includ+ in=mation on any co/-%>+ r$uctions all[$ "u ?is section4 7,c7 ,/akehold] advisory gr\p ,! ,secret>y %all =m a /akehold] gr\p1 includ+ repres5tatives ( ,a,c,os1 heal? c>e provid]s 7includ+ ,,aco pr(essionals71 ,m$ic>e b5efici>ies1 & ,,aco exp]ts1 to advise ! ,secret>y ) recomm5dations to improve ! process ( ,,aco-to-b5efici>y communication4 7#c7 ,mov+ f volume to value 7,a7 ,regulatory relief = mov+ to two-sid$ risk ,9 ! case ( an ,,aco t has elect$ a two-sid$ risk model 7z describ$ 9 p>agraph 7#a771 9 addition to ! au?ority provid$ "u p>agraph 7#a71 ! ,secret>y %all provide ! foll[+ regulatory relief3 7i7 #c-;day prior hospitalization waiv] = ,,snf s]vices ,waiv] ( ! #c-;day prior hospitalization requirem5t = cov]age ( skill$ nurs+ facility s]vices4 7ii7 ,homeb\nd requirem5t waiv] = home heal? s]vices ,waiv] ( ! homeb\nd requirem5t = cov]age ( home heal? s]vices4 7iii7 ,,rac hospital audit relief ,relief f reviews ( s*$ul$ admissions by recov]y audit contractors = individuals attribut$ to an ,,aco :5 admitt$ on ord]s ( a physician p>ticipat+ 9 ! ,,aco4 7,b7 ,improv+ c>e coord9ation ?r\gh access to teleheal? 7i7 ,flexibility 9 furni%+ teleheal? s]vices ,9 apply+ section #ahcd7m7 9 ! case ( an ,,aco t has elect$ a two-sid$ risk model 7z describ$ 9 p>agraph 7#a771 ! ,,aco may elect to h ! limitations on orig9at+ site 7"u p>agraph 7#d77;,c7 ( su* section7 & on ! use ( /ore-&-=w>d te*nologies 7"u p>agraph 7#a7 ( su* section7 n apply4 ,! previ\s s5t5ce %all n be con/ru$ z affect+ ! au?ority ( ! ,secret>y "u subsection 7f7 to waive o!r provisions ( su* section4 7ii7 ,provision ( remote monitor+ 9 connection ) home heal? s]vices ,no?+ 9 ?is section %all be con/ru$ z prev5t+ an ,,aco f includ+ paym5ts = remote pati5t monitor+ & home-bas$ video conf]5c+ s]vices 9 connection ) ! provision ( home heal? s]vices 7"u conditions = :i* paym5t = su* s]vices w\ld n be made "u section #ahie = su* s]vices7 9 a mann] t is f9ancially equival5t to ! furni%+ ( a home heal? visit4 7#d7 ,e/abli%+ great] c]ta9ty = ,a,c,os 7,a7 ,b5*m>ks & paym5ts ,! ,secret>y %all conduct a demon/ration project to te/ ! use ( paym5t b5*m>ks t take into acc\nt geographic area diff]5ces1 su* z diff]5ces 9 sp5d+ tr5ds )9 & across regions1 & v>iations 9 deliv]y & utilization bas$ on ! socioeconomic /atus ( b5efici>ies s]v$4 7,b7 ,advance notification ( ,a,c,os ( b5*m>ks & pa/ p]=mance ,! ,secret>y %all in=m ,a,c,os1 9 advance ( ea* p]=mance p]iod1 ( ! quality b5*m>ks applicable to ! ,,aco & p]iod & ( ! pa/ p]=mance 7if any7 ( ! ,,aco "u ?is section4 7,c7 ,/udy & report on feasibility on provid+ electronic access to ,m$ic>e claims data ,! ,secret>y %all conduct a /udy reg>d+ ! feasibility ( e/abli%+ a sy/em ( electronic access ( provid]s ( s]vices & suppli]s to 9-process & complete pati5t claims data4 ,su* sy/em may be a modification ( an exi/+ data base1 su* z ! ,virtual ,rese>* ,data ,c5t]4 ,! /udy %all take into acc\nt ! measures ne$$ to ensure ! security & privacy ( b5efici>y & provid] in=mation4 ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report on su* /udy4 ,! ,secret>y %all include 9 su* report su* recomm5dations z ! ,secret>y deems appropriate4 4 7b7 ,requir+ te/+ ( global capitation paym5t model ,section #ahii7;i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7i77 is am5d$-- 7#a7 9 ! head+1 by /rik+ ,option to use o!r paym5t models & ins]t+ ,alt]native paym5t models2 7#b7 9 p>agraph 7#a71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 except t ! ,secret>y %all1 beg9n+ no lat] ?an ,janu>y #a1 #bjaf1 e/abli% "o or m demon/ration programs to te/ ! paym5t model describ$ 9 p>agraph 7#c77;,a72 & 7#c7 9 p>agraph 7#c77;,a71 by /rik+ is any paym5t model & ins]t+ ! foll[+3 7i7 a global capitation model 9 :i* an ,,aco is at f9ancial risk = all items & s]vices cov]$ "u p>ts ,a & ,b2 & 7ii7 any o!r paym5t model t ! ,secret>y det]m9es w improve ! quality & effici5cy ( items & s]vices furni%$ "u ?is title4 4 7c7 ,assignm5t tak+ into acc\nt s]vices ( non-,physician practition]s ,section #ahii7;c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7c77 is am5d$ by ins]t+ 7or1 9 ! case ( an ,,aco t is locat$ 9 a rural or m$ically und]s]v$ area or t is affiliat$ ) a ,f$]ally qualifi$ heal? c5t] or rural heal? cl9ic1 an ,,aco pr(essional describ$ 9 subsection 7h77#a77;,b77 aft] subsection 7h77#a77;,a74 7d7 ,creat+ inc5tives = ,,aco developm5t ,! ,secret>y ( ,heal? & ,human ,s]vices %all develop a me*anism to make p]man5t ^? ,,aco-relat$ pilot programs1 includ+ ! ,advance ,paym5t ,,aco ,model1 t h be5 successful4 ,! ,secret>y %all submit to ,congress a report on ! /udy & %all include 9 ! report su* recomm5dations1 includ+ su* *anges 9 legislation1 z ! ,secret>y deems appropriate4 7e7 ,effective date ,! am5dm5ts made by subsection 7a7 %all apply to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjaf4