,,ii  #aad? ,,congress  #a/ ,session    
,s4 #aihi  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,augu/ #e1 #bjae ,mr4  
,cassidy introduc$ ! foll[+ bill2 :i* 0 
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to improve access  
to prim>y c>e s]vices4  #a4 ,%ort title 
,?is ,act may be cit$ z ! ,prim>y ,c>e  
,enhancem5t ,act ( #bjae4  #b4 ,treatm5t
 ( direct prim>y c>e s]vice arrangem5ts 
7a7 ,9 g5]al ,section #bbc7;c7 ( !      
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 
7#f7 ,treatm5t ( direct prim>y c>e      
s]vice arrangem5ts ,an arrangem5t "u :i*
 an individual is provid$ ongo+ prim>y  
c>e s]vices 9 ex*ange = a fix$ p]iodic  
fee :i* is n bill$ to any ?ird p>ty on a
 fee = s]vice basis--  7,a7 %all n be   
treat$ z a heal? plan = purposes (      
p>agraph 7#a77;,a77ii71 &  7,b7 %all n  
be treat$ z insurance = purposes (      
subsection 7d77#b77;,b74  4  7b7        
,effective date ,! am5dm5t made by ?is  
section %all apply to taxable ye>s      

beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act4  #c4 ,c]ta9 provid] fees to be    
treat$ z m$ical c>e  7a7 ,9 g5]al       
,subsection 7d7 ( section #bac ( !      
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 
7#ab7 ,p]iodic provid] fees ,! t]m      
m$ical c>e %all include p]iodic fees    
paid to a prim>y c>e physician = a def9$
 set ( m$ical s]vices on an z-ne$$      
basis4  4  7b7 ,effective date ,!       
am5dm5t made by ?is section %all apply  
to taxable ye>s beg9n+ aft] ! date ( !  
enactm5t ( ?is ,act4  #d4 ,m$ic>e prim>y
 c>e m$ical home demon/ration program   
,section #aaae;,a ( title ,,xi ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acae;a7 is am5d$--  7#a7 9 subsection  
7b77#b77;,a71 9 ! la/ s5t5ce1 by ins]t+ 
1 & %all include ! model describ$ 9     
subsection 7h7 be=e ! p]iod at ! end2 & 
7#b7 by add+ at ! end ! foll[+ new      
subsection3  7h7 ,prim>y c>e m$ical home
 model  7#a7 ,model  7,a7 ,9 g5]al ,!   
model describ$ 9 ?is subsection is a    

model "u :i* qualifi$ direct prim>y c>e 
m$ical home practices are reimburs$ a   
p]iodic fee = furni%+ s]vices to an     
individual enroll$ "u "p ,b ( title     
,,xviii4  7,b7 ,qualifi$ direct prim>y  
c>e m$ical home practice ,9 ?is         
subsection1 ! t]m qualifi$ direct prim>y
 c>e m$ical home practice means a       
qualifi$ direct prim>y c>e m$ical home  
practice describ$ 9 section             
#acja7;a77#c7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7z am5d$ by section 
#ajajd7;a7 ( su* ,act74  7#b7 ,p]iodic  
fee  7,a7 ,9 g5]al ,subject to ! succe$+
 provisions ( ?is p>agraph1 ! ,secret>y 
%all e/abli% ! p]iodic fee to be paid to
 qualifi$ direct prim>y c>e m$ical home 
practices p>ticipat+ 9 ! model "u ?is   
subsection = ea* individual enroll$ 9 ! 
practice4  7,b7 ,af=dable prim>y c>e ,9 
no case may a mon?ly equival5t ( !      
p]iodic fee e/abli%$ by ! ,secret>y "u  
subp>agraph 7,a7 exce$ an am\nt equal to
 tw5ty p]c5t ( ! av]age p] capita mon?ly
 am\nt t ! ,secret>y e/imates w be      

payable f ! ,f$]al ,hospital ,insurance 
,tru/ ,fund "u section #ahag & f !      
,f$]al ,supplem5t>y ,m$ical ,insurance  
,tru/ ,fund = s]vices & relat$          
adm9i/rative co/s = an individual "u    
p>ts ,a & ,b ( title ,,xviii4  7,c7     
,adju/m5t to p]iodic fee  7i7 ,p]=mance 
b5*m>k ,! ,secret>y %all e/abli% a      
p]=mance b5*m>k = a ye> us+ ! ,,aco     
quality measures 9 ! ,m$ic>e %>$ sav+s  
program "u section #ahii4  7ii7         
,adju/m5t ,beg9n+ ) ! second ye> ! model
 "u ?is subsection is conduct$1 9 ! case
 ( a qualifi$ direct prim>y c>e m$ical  
home practice p>ticipat+ 9 ! model "u   
?is subsection--  7,i7 t meets or exce$s
 ! p]=mance b5*m>k = ! ye> "u clause    
7i71 ! p]iodic fee paid to ! practice = 
ea* individual enroll$ 9 ! practice %all
 be increas$ by #e p]c5t2 &  7,,ii7 t   
does n meet ! p]=mance b5*m>k = ! ye> "u
 clause 7i71 ! p]iodic fee paid to !    
practice = ea* individual enroll$ 9 !   
practice %all be r$uc$ by #e p]c5t4     
7#c7 ,t]m9ation if p]=mance b5*m>k n net

 = #b consecutive ye>s ,! ,secret>y %all
 t]m9ate ! p>ticipation ( a qualifi$    
direct prim>y c>e m$ical home practice 9
 ! model "u ?is subsection if ! practice
 w\ld o!rwise be subject to ! adju/m5t  
"u p>agraph 7#b77;,c77ii77,,ii7 = #b    
consecutive ye>s4  7#d7 ,scope ( s]vices
 ,ea* qualifi$ direct prim>y c>e m$ical 
home practice %all employ ! foll[+      
activities & functions associat$ )      
direct prim>y c>e m$ical homes3  7,a7   
,prev5tive c>e4  7,b7 ,wellness c\nsel+4
  7,c7 ,prim>y c>e4  7,d7 ,coord9ation (
 prim>y c>e ) specialty & hospital c>e4 
7,e7 ,availability ( ongo+ c>e          
appo9tm5ts #g days p] week4  7,f7       
,secure e-mail & telephone consultation4
  7,g7 ,availability ( telephone access 
= ongo+ c>e consultation on a           
#g-;day-p]-week1 #bd-;h\r-p]-day basis4 
7,h7 ,use ( a prim>y c>e provid] panel  
size t promotes ! ability ( p>ticipat+  
provid]s to appropriately provide !     
scope ( s]vices describ$ 9 ?is p>agraph4
  7#e7 ,priority  7,a7 ,9 g5]al ,9      

select+ qualifi$ direct prim>y c>e      
m$ical home practices to p>ticipate "u  
?is subsection1 ! ,secret>y %all provide
 priority to practices t seek to enroll 
individuals :o are dual eligible        
individuals4  7,b7 ,dual eligible       
individual ,9 subp>agraph 7,a71 ! t]m   
dual eligible individual means an       
individual :o is-- 7i7 enroll$ "u "p ,b 
( title ,,xviii2 &  7ii7 describ$ 9     
subp>agraph 7,a77ii7 ( section          
#aice7;c77#f7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifu-#e7;c77#f771 tak+
 into acc\nt ! application ( subp>agraph
 7,b7 ( su* section4  7#f7 ,n insurance 
,c>e provid$ 9 a qualifi$ direct prim>y 
c>e m$ical home practice p>ticipat+ 9 ! 
model "u ?is subsection %all n be       
consid]$ an insurance product & %all n  
be subject to regulation z an insurance 
product or heal? ma9t5ance organization 
by ,/ate insurance commission]s4  7#g7  
,report+ to ,secret>y ,a qualifi$ direct
 prim>y c>e m$ical home practice        
p>ticipat+ 9 ! model "u ?is subsection  

%all submit to ! ,secret>y an annual    
report on--  7,a7 ! progress1 (         
individuals enroll$ 9 ! practice ) "o or
 m *ronic conditions1 on ! foll[+3  7i7 
,em]g5cy room visits4  7ii7             
,hospitalizations4  7iii7 ,surg]ies     
7includ+ type ( surg]y74  7iv7          
,speciali/ visits4  7v7 ,use ( advanc$  
radiology 7o!r ?an mammograms & ,,dexa  
scans72 &  7,b7 su* o!r areas det]m9$   
appropriate by ! ,secret>y4  7#h7       
,provision ( data to practices ,!       
,secret>y %all provide qualifi$ direct  
prim>y c>e m$ical home practices        
p>ticipat+ 9 ! model "u ?is subsection )
 all necess>y & relevant pati5t data1   
includ+ any prior claims data1 ne$$ =   
cl9ical purposes & = ! purpose ( provid+
 an evaluation ( su* ! model "u ?is     
subsection4  7#i7 ,provid]s curr5tly    
opt$ out ( ,m$ic>e ,not)/&+ section     
#ahjb7;b71 a physician or practition] :o
 has curr5tly opt$ out ( ! ,m$ic>e      
program "u su* section may p>ticipate 9 
a qualifi$ direct prim>y c>e m$ical home

 practice p>ticipat+ 9 ! model "u ?is   
subsection & paym5t may be made "u ?is  
title ) respect to items & s]vices      
furni%$ by su* physician or practition] 
"u su* model to ,m$ic>e b5efici>ies )   
:om ! physician or practition] has 9    
effect a private contract "u su*        
section4  7#aj7 ,fraud ,a physician or  
practition] :o has be5 exclud$ f        
p>ticipation 9 a ,f$]al heal? c>e       
program 7z def9$ 9 section #aabh;,c7f77 
%all n be p]mitt$ to p>ticipate 9 a     
qualifi$ direct prim>y c>e m$ical home  
practice "u ! model "u ?is subsection4  
7#aa7 ,duration ,subject to subsection  
7b77#c71 ! ,secret>y %all conduct !     
model "u ?is subsection = a p]iod ( n   
less ?an #c ye>s4  7#ab7 ,expansion     
,not)/&+ subsection 7c71 if ! ,secret>y 
det]m9es1 aft] ! ?ird ye> t ! model "u  
?is subsection is conduct$1 t--  7,a7 a 
qualifi$ direct prim>y c>e m$ical home  
practice p>ticipat+ 9 ! model "u ?is    
subsection meets ! requirem5ts "u       
p>agraphs 7#a71 7#b71 & 7#c7 ( su*      

subsection1 su* practice %all cont9ue   
p]man5tly z long z x cont9ues to meet   
su* requirem5ts & ! o!r requirem5ts (   
?is subsection2 &  7,b7 a majority (    
qualifi$ direct prim>y c>e m$ical home  
practice p>ticipat+ 9 ! model "u ?is    
subsection meet ! requirem5ts "u        
p>agraphs 7#a71 7#b71 & 7#c7 ( su*      
subsection1 ! ,secret>y %all exp& !     
model on a nationwide basis4  4  #e4    
,use ( direct prim>y c>e m$ical homes "u
 ! ,m$ic>e ,advantage program  7a7 ,9   
g5]al ,no?+ 9 title ,,xviii ( ! ,social 
,security ,act or any o!r provision (   
law %all be con/ru$ to prohibit a       
,m$ic>e ,advantage organization (f]+ a  
,m$ic>e ,advantage plan "u "p ,c ( su*  
title f--  7#a7 contract+ ) a qualifi$  
direct prim>y c>e m$ical home practice  
to (f] prim>y c>e s]vices "u su* plan2  
or  7#b7 includ+ 9 su* contract         
provisions = %>$ sav+s agre$ ^u betwe5 !
 ,m$ic>e ,advantage organization & ! !  
qualifi$ direct prim>y c>e m$ical home  
practice4  7b7 ,qualifi$ direct prim>y  

c>e m$ical home practice ,9 ?is section1
 ! t]m qualifi$ direct prim>y c>e m$ical
 home practice means a qualifi$ direct  
prim>y c>e m$ical home practice describ$
 9 section #acja7;a77#c7 ( ! ,pati5t    
,protection & ,af=dable ,c>e ,act 7z    
am5d$ by section #ajajd7;a7 ( su* ,act74