,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #cbih  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #bi1 #bjae ,mr4 
,brady ( ,texas 7= himself & ,mr4 ,k9d7 
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 =     
value-bas$ pur*as+ ( po/-acute c>e      
s]vices "u ! ,m$ic>e program1 & = o!r   
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,m$ic>e ,po/-,acute ,c>e   
,value-,bas$ ,pur*as+ ,act ( #bjae4  #b4
 ,repeal ( m>ket basket cuts = po/-acute
 provid]s  7a7 ,s,n,fs ,section         
#ahhh7;e7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acieyy7e771 z am5d$ by  
section #daa7;a7 ( ! ,m$ic>e ,access &  
,,*ip ,reau?orization ,act ( #bjae1 is  
am5d$--  7#a7 9 p>agraph 7#e77;,b7--    

7,a7 9 clause 7i71 by /rik+ clauses 7ii7
 & 7iii7 & ins]t+ clause 7ii72  7,b7 9  
clause 7ii71 by /rik+ subject to clause 
7iii712 &  7,c7 by /rik+ clause 7iii72 &
  7#b7 9 p>agraph 7#f77;,a77i71 by /rik+
 clauses 7ii7 & 7iii7 ( p>agraph        
7#e77;,b7 & ins]t+ p>agraph             
7#e77;,b77ii74  7b7 ,i,r,fs ,section    
#ahhf7;j7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acieww7j771 z am5d$ by  
section #daa7;b7 ( ! ,m$ic>e ,access &  
,,*ip ,reau?orization ,act ( #bjae1 is  
am5d$--  7#a7 9 p>agraph 7#c77;,c7--    
7,a7 9 clause 7i71 by /rik+ clauses 7ii7
 & 7iii7 & ins]t+ clause 7ii72  7,b7 9  
clause 7ii71 by /rik+ ,subject to clause
 7iii71 aft] & ins]t+ ,aft] 2 &  7,c7 by
 /rik+ clause 7iii72 &  7#b7 9 p>agraph 
7#g77;,a77i71 by /rik+ subp>agraphs     
7,c77iii7 & 7,d7 ( p>agraph 7#c7 &      
ins]t+ p>agraph 7#c77;,d74  7c7 ,h,h,as 
,section #ahie7;b77#c77;,b7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acie;fff7b77#c77;,b771 z am5d$ by      
section #daa7;c7 ( ! ,m$ic>e ,access &  

,,*ip ,reau?orization ,act ( #bjae1 is  
am5d$--  7#a7 9 clause 7iii71 by /rik+ !
 la/ s5t5ce2 &  7#b7 9 clause 7vi77,i71 
by /rik+ 7except #bjah74  7d7 ,l,t,c,hs 
,section #ahhf7m77#c7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7m77#c771 z am5d$ by section     
#daa7;e7 ( ! ,m$ic>e ,access & ,,*ip    
,reau?orization ,act ( #bjae1 is am5d$--
 7#a7 9 subp>agraph 7,a71 by /rik+      
,subject to subp>agraph 7,c71 9         
implem5t+ & ins]t+ ,9 implem5t+2 &  7#b7
 by /rik+ subp>agraph 7,c74  7e7        
,effective date ,! am5dm5ts made by ?is 
section %all be effective z if includ$ 9
 ! enactm5t ( ! ,m$ic>e ,access & ,,*ip 
,reau?orization ,act ( #bjae4  #c4      
,po/-acute c>e value-bas$ pur*as+       
program  7a7 ,9 g5]al ,section #ahii;,b 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acielll7 is am5d$-- 7#a7 9 ! 
head+1 by ins]t+ 2 po/-acute c>e        
value-bas$ pur*as+ program be=e ! p]iod 
at ! end2 &  7#b7 by add+ at ! end !    
foll[+ new subsection3  7n7 ,po/-,acute 

c>e value-,bas$ pur*as+ program 7,,pac  
,,vbp program7  7#a7 ,e/abli%m5t  7,a7  
,9 g5]al ,subject to ! succe$+          
provisions ( ?is subsection1 ! ,secret>y
 %all e/abli% a po/-acute c>e value-bas$
 pur*as+ program 79 ?is subsection      
ref]r$ to z ! ,,pac ,,vbp ,program7 "u  
:i* value-bas$ inc5tive paym5ts are made
 9 a paym5t ye> to ,,pac provid]s4  7,b7
 ,program implem5tation ,! ,,pac ,,vbp  
,program %all apply to paym5ts = s]vices
 furni%$ 9 paym5t ye>s beg9n+ on or aft]
 ,octob] #a1 #bjai4  7,c7 ,treatm5t (   
new ,,pac provid]s ,9 ! case ( a ,,pac  
provid] t fir/ beg9s p>ticipation 9 !   
program "u ?is title dur+ ! p]=mance    
p]iod = a paym5t ye> 7& _h n previ\sly  
submitt$ claims "u ?is title z su* a    
provid] "u a diff]5t bill+ numb] or tax 
id5tifi]71 su* provid] %all n be treat$ 
"u ?is subsection z a ,,pac provid]     
until ! subsequ5t paym5t ye> & p]=mance 
p]iod = su* subsequ5t paym5t ye>4  7,d7 
,paym5t ye> def9$ ,9 ?is subsection1 !  
t]m paym5t ye> means-- 7i7 = ,,pac      

provid]s describ$ 9 clause 7i7 (        
subsection 7a77#b77;,a7 7relat+ to home 
heal? ag5cies71 a cal5d> ye>2 &  7ii7 = 
all o!r ,,pac provid]s1 a fiscal ye>4   
7,e7 ,type ( provid] def9$ ,9 ?is       
subsection1 ! t]m provid] type means1 ) 
respect to ,,pac provid]s1 ea* ( ! types
 ( ,,pac provid]s describ$ 9 a clause 9 
subsection 7a77#b77;,a74  7#b7          
,application ( measure  7,a7 ,9 g5]al   
,"u ! ,,pac ,,vbp ,program1 ! ,secret>y 
%all apply ! res\rce use measure        
specifi$ "u subsection 7d77#a77;,a7 =   
purposes ( ! ,,pac ,,vbp ,program4  7,b7
 ,application on provid] & area basis   
,su* measure %all be appli$ sep>ately-- 
7i7 = ea* ,,pac provid]2 &  7ii7 = all  
,,pac provid]s1 reg>dless ( type1 9 ea* 
hospital s]vice area or comp>able area  
7z det]m9$ by ! ,secret>y7 9 :i* an     
individual receives a s]vice f any ,,pac
 provid] involv$ "u ?is title 9 su*     
area4  7#c7 ,p]=mance /&>ds  7,a7       
,e/abli%m5t ,! ,secret>y %all e/abli%   
p]=mance /&>ds consi/5t ) ?is p>agraph )

 respect to ! measure appli$ "u p>agraph
 7#b7 = a p]=mance p]iod = a paym5t 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+ !  
p]=mance score ( a ,,pac provid]        
7includ+ an area7 "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 #ij days be=e ! beg9n+ (
 ! p]=mance p]iod = ! paym5t ye>        
involv$4  7#d7 ,,pac p]=mance scores    
7,a7 ,9 g5]al ,! ,secret>y %all develop 
a me?odology = assess+ ! total p]=mance 
( ea* ,,pac provid]1 & ( ea* hospital   
s]vice area or comp>able area 7z det]m9$
 by ! ,secret>y1 bas$ on p]=mance /&>ds 
e/abli%$ "u p>agraph 7#c7 ) respect to !
 measure appli$ "u p>agraph 7#b7 = a    
p]=mance p]iod = a paym5t ye>4  7,b7    
,computation ( individual1 area1 &      
composite p]=mance scores ,us+ su*      

me?odology1 ! ,secret>y %all provide =--
 7i7 an assessm5t1 bas$ on ! measure    
appli$ "u p>agraph 7#b77;,b77i71 = ea*  
individual ,,pac provid] = ea* p]=mance 
p]iod2  7ii7 an assessm5t1 bas$ on !    
measure appli$ "u p>agraph              
7#b77;,b77ii71 = all ,,pac provid]s 9   
ea* area describ$ 9 su* p>agraph = ea*  
p]=mance p]iod2 &  7iii7 a composite    
assessm5t 79 ?is subsection ref]r$ to z 
! ,,pac composite p]=mance score7 = ea* 
,,pac provid] = ea* p]=mance p]iod equal
 to ! sum (--  7,i7 #ee p]c5t ( !       
p]=mance score "u clause 7i7 = ! p]iod =
 t ,,pac provid]2 &  7,,ii7 #de p]c5t ( 
! p]=mance score "u clause 7ii7 = !     
p]iod = all ,,pac provid]s locat$ 9 !   
area 9 :i* ! ,,pac provid] is locat$4   
7,c7 ,rank+ ( ,,pac p]=mance scores ,!  
,secret>y %all1 = ! p]=mance p]iod = ea*
 paym5t ye> = ea* type ( ,,pac provid]1 
rank ! ,,pac composite p]=mance scores  
det]m9$ "u subp>agraph 7,b77iii7 f l[ to
 high4  7#e7 ,calculation ( value-bas$  
inc5tive paym5ts  7,a7 ,9 g5]al ,)      

respect to a ,,pac provid]1 bas$ on !   
rank+ "u p>agraph 7#d77;,c7 = a p]=mance
 p]iod = a paym5t ye>1 ! ,secret>y %all 
increase ! paym5t basis specifi$ 9      
subp>agraph 7,b7 o!rwise applicable to  
su* provid] = s]vices furni%$ by su*    
provid] dur+ su* paym5t ye> by !        
value-bas$ inc5tive paym5t p]c5tage     
specifi$ "u subp>agraph 7,c7 = ! provid]
 & paym5t ye>4  7,b7 ,paym5t basis ,!   
paym5t basis specifi$ 9 ?is subp>agraph 
= a type ( provid] is z foll[s1 z appli$
 aft] ! application ( p>agraph 7#f73 7i7
 ,skill$ nurs+ facilities ,= skill$     
nurs+ facilities1 ! adju/$ ,f$]al p]    
diem rate "u section #ahhh7;e77#d77;,b74
  7ii7 ,inpati5t rehabilitation         
facilities ,= inpati5t rehabilitation   
facilities1 ! prospective p] unit paym5t
 rate "u section #ahhf7;j77#c74  7iii7  
,long-t]m c>e hospitals ,= long-t]m c>e 
hospitals1 ! /&>d ,f$]al rate "u section
 #ahhf7m71 or1 if applicable1 !         
applicable site neutral paym5t rate "u  
p>agraph 7#f7 ( su* section4  7iv7 ,home

 heal? ag5cies ,= home heal? ag5cies1 ! 
/&>d prospective paym5t am\nt 7or       
am\nts7 "u section #ahie7;b77#c74  7,c7 
,value-bas$ inc5tive paym5t p]c5tage ,! 
,secret>y %all specify a value-bas$     
inc5tive paym5t p]c5tage = ea* ,,pac    
provid] = a paym5t ye>1 :i* may include 
a z]o p]c5tage b n a p]c5tage bel[ z]o4 
,9 specify+ ! value-bas$ inc5tive paym5t
 p]c5tage = ea* ,,pac provid] = a paym5t
 ye> "u ?is subp>agraph1 ! ,secret>y    
%all ensure t--  7i7 su* p]c5tage is    
bas$ on ! rank+ ( ,,pac composite       
p]=mance score ( ! provid] "u p>agraph  
7#d7 = ! p]=mance p]iod = ! paym5t ye>2 
7ii7 ! application ( all su* p]c5tages =
 a type ( ,,pac provid] = a paym5t ye>  
results 9 an appropriate di/ribution (  
value-bas$ inc5tive increases "u        
subp>agraph 7,a7 su* t--  7,i7 ,,pac    
provid]s ) ! highe/ rank+s "u p>agraph  
7#d77;,c7 receive ! highe/ value-bas$   
inc5tive paym5t p]c5tages "u ?is        
subp>agraph2 &  7,,ii7 ,,pac provid]s ) 
! l[e/ rank+s "u su* p>agraph receive ! 

l[e/ value-bas$ inc5tive paym5t         
p]c5tages "u ?is subp>agraph2 &  7iii7 !
 total am\nt ( value-bas$ inc5tive      
increases "u ?is p>agraph = all ,,pac   
provid]s = ea* type ( provid] 9 su*     
paym5t ye> %all be at lea/ #ej p]c5t1 b 
n great] ?an #gj p]c5t1 ( ! total am\nt 
( ! r$uctions to paym5ts = ,,pac        
provid]s ( su* type = su* paym5t ye> "u 
p>agraph 7#f71 z e/imat$ by ! ,secret>y4
  7#f7 ,fund+ = value-bas$ inc5tive     
paym5ts  7,a7 ,9 g5]al ,! ,secret>y %all
 r$uce ! paym5t basis 7z def9$ 9        
p>agraph 7#e77;,b771 n tak+ into acc\nt 
any increase "u p>agraph 7#e71 = ea*    
type ( ,,pac provid] = ea* paym5t ye>   
beg9n+--  7i7 dur+ fiscal ye> #bjbj by  
#c p]c5t2  7ii7 dur+ fiscal ye> #bjba by
 #d p]c5t2  7iii7 dur+ fiscal ye> #bjbb 
by #e p]c5t2  7iv7 dur+ fiscal ye> #bjbc
 by #f p]c5t2  7v7 dur+ fiscal ye> #bjbd
 by #g p]c5t2 &  7vi7 dur+ or aft]      
fiscal ye> #bjbe by #h p]c5t4  7,b7     
,implem5tation ,! ,secret>y %all make   
su* r$uctions = all ,,pac provid]s 9 !  

paym5t ye> involv$1 reg>dless ( :e!r or 
n ! ,,pac provid] has be5 det]m9$ by !  
,secret>y to h e>n$ a value-bas$        
inc5tive paym5t increase "u p>agraph    
7#e7 = su* paym5t ye>4  7#g7 ,ann\ncem5t
 ( net result ( adju/m5ts ,"u ! ,,pac   
,,vbp ,program1 ! ,secret>y %all1 n lat]
 ?an #ij days prior to ! paym5t ye>     
involv$1 in=m ea* ,,pac provid] ( !     
adju/m5ts to paym5ts to ! ,,pac provid] 
= s]vices furni%$ by su* provid] dur+ ! 
paym5t ye> "u p>agraphs 7#e7 & 7#f74    
7#h7 ,no effect 9 subsequ5t fiscal ye>s 
,! value-bas$ inc5tive paym5t increase  
"u p>agraph 7#e7 & ! paym5t r$uction "u 
p>agraph 7#f7 %all ea* apply only )     
respect to ! paym5t ye> involv$1 & !    
,secret>y %all n take into acc\nt su*   
value-bas$ inc5tive paym5t increase or  
paym5t r$uction 9 mak+ paym5ts to a     
,,pac provid] "u ?is title 9 a subsequ5t
 paym5t ye>4  7#i7 ,public report+  7,a7
 ,,pac specific in=mation ,! ,secret>y  
%all make available to ! public1 by po/+
 on ! relevant ,comp>e ,m$ic>e website  

7or a successor website7 9 an easily    
und]/&able =mat1 in=mation reg>d+ !     
p]=mance ( individual ,,pac provid]s "u 
! ,,pac ,,vbp ,program1 ) respect to a  
paym5t ye>1 includ+--  7i7 ! ,,pac      
composite p]=mance score ( ! ,,pac      
provid] = su* paym5t ye>2 &  7ii7 !     
rank+ ( ! ,,pac provid] "u p>agraph     
7#d77;,c7 = ! p]=mance p]iod = su*      
paym5t ye>4  7,b7 ,aggregate in=mation  
,! ,secret>y %all p]iodically po/ on !  
relevant websites ref]r$ to 9           
subp>agraph 7,a7 aggregate in=mation on 
! ,,pac ,,vbp ,program = ! types (      
provid]s1 includ+-- 7i7 ! range ( ,,pac 
composite p]=mance scores "u p>agraph   
7#d77;,b72 &  7ii7 ! numb] ( ,,pac      
provid]s ( ea* type receiv+ value-bas$  
inc5tive paym5t increases "u p>agraph   
7#e7 & ! range & total am\nt ( su*      
value-bas$ inc5tive paym5t increases4   
7#aj7 ,limitation on review ,!re %all be
 no adm9i/rative or judicial review "u  
section #ahfi1 section #ahgh1 or o!rwise
 ( ! foll[+3  7,a7 ,! e/abli%m5t ( !    

p]=mance /&>ds "u p>agraph 7#c7 & !     
p]=mance p]iod4  7,b7 ,! me?odology     
develop$ "u p>agraph 7#d7 t is us$ to   
calculate ,,pac composite p]=mance      
scores & ! calculation ( su* scores4    
7,c7 ,! rank+ det]m9ations "u p>agraph  
7#d77;,c74  7,d7 ,! me?odology us$ to   
det]m9e ! value-bas$ inc5tive paym5t    
p]c5tages "u p>agraph 7#e74  7,e7 ,!    
det]m9ation ( ! am\nt ( fund+ available 
= su* value-bas$ inc5tive paym5ts "u    
p>agraph 7#e77;,c77iii74  4  7b7 ,con=m+
 am5dm5ts  7#a7 ,,snf paym5t ,section   
#ahhh7;e77#d7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acieyy7e77#d77 is am5d$
 by add+ at ! end ! foll[+ new          
subp>agraph3  7,i7 ,value-bas$ pur*as+  
adju/m5t ,! adju/$ ,f$]al p] diem rate  
"u subp>agraph 7,b7 is subject to       
adju/m5t "u p>agraphs 7#e7 & 7#f7 (     
section #ahii;,b7n74  4  7#b7 ,inpati5t 
rehabilitation facilities ,section      
#ahhf7;j77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acieww7j77#c77 is am5d$
 by add+ at ! end ! foll[+ new          

subp>agraph3  7,d7 ,value-bas$ pur*as+  
adju/m5t ,! prospective p] unit paym5t  
rate "u ?is p>agraph is subject to      
adju/m5t "u p>agraphs 7#e7 & 7#f7 (     
section #ahii;,b7n74  4  7#c7 ,long-t]m 
c>e hospitals ,section #ahhf7m7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7m77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraph3  7#g7 ,value-bas$  
pur*as+ adju/m5t ,! /&>d ,f$]al rate "u 
?is subsection1 or1 if applicable1 !    
applicable site neutral paym5t rate "u  
p>agraph 7#f71 is subject to adju/m5t "u
 p>agraphs 7#e7 & 7#f7 ( section        
#ahii;,b7n74  4  7#d7 ,home heal?       
ag5cies ,section #ahie7;b77#c7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acie;fff7b77#c77 is am5d$ by add+ at ! 
end ! foll[+ new subp>agraph3  7,d7     
,value-bas$ pur*as+ adju/m5t ,! /&>d    
prospective paym5t am\nt 7or am\nts7 "u 
?is p>agraph is subject to adju/m5t "u  
p>agraphs 7#e7 & 7#f7 ( section         
#ahii;,b7n74  4  #d4 ,sunsett+ ( skill$ 
nurs+ facility value-bas$ pur*as+ 7,,snf

 ,,vbp7 program ,section                
#ahhh7;h77#a77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acieyy7h77#a77;,b77 is am5d$--  7#a7 9 
! head+1 by ins]t+ & to end 9 fiscal ye>
 #bjbe aft] fiscal ye> #bjai2 &  7#b7 by
 ins]t+ & be=e ,octob] #a1 #bjbe aft]   
#bjah4