,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #ciib  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,octob] #f1 #bjag,mrs4
 ,noem 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   
delay application (1 transition to1 &   
limit sav+s = ! home heal? gr\p+s model 
"u ! ,m$ic>e home heal? prospective     
paym5t sy/em1 & = o!r purposes4  #a4    
,%ort title ,?is ,act may be cit$ z !   
,rural ,home ,heal? ,ext5sion &         
,regulatory ,relief ,act4  #b4 ,delay+  
application (1 transition+ to1 & limit+ 
sav+s = home heal? gr\p+s model "u      
,m$ic>e home heal? prospective paym5t   
sy/em2 home heal? rural add-on  7a7     
,delay$ implem5tation ( home heal?      
gr\p+s model ) limit on sav+s & )       

transition  7#a7 ,9 g5]al ,section      
#ahie7;b7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;fff7b77 is am5d$ by
 ins]t+ at ! end ! foll[+ new p>agraph3 
7#g7 ,implem5tation ( home heal? gr\p+s 
model  7,a7 ,use ( home heal? gr\p+s    
model ) delay$ implem5tation ,= purposes
 ( calculat+ /&>d prospective paym5t    
am\nts "u ! prospective paym5t sy/em "u 
?is subsection ) respect to home heal?  
units ( s]vice furni%$ on or aft]       
,janu>y #a1 #bjbj1 & subject to !       
succe$+ subp>agraphs ( ?is p>agraph1 !  
,secret>y %all apply ! home heal? gr\p+s
 model includ+ use ( a #cj-;day unit (  
paym5t1 z describ$ 9 ! propos$ rule     
entitl$ ,m$ic>e & ,m$icaid ,programs2   
,,cy #bjah ,home ,heal? ,prospective    
,paym5t ,sy/em ,rate ,update & ,propos$ 
,,cy #bjai ,case-,mix ,adju/m5t         
,me?odology ,ref9em5ts2 ,home ,heal?    
,value-,bas$ ,pur*as+ ,model2 & ,home   
,heal? ,quality ,report+ ,requirem5ts   
7#hb ,f$4 ,reg4 #cebid ?r\gh #ceccb     
7,july #bh1 #bjag7 7h]e9 ref]r$ to z !  

#bjah ,home ,heal? ,propos$ ,rule77 & z 
su* model may subsequ5tly be revis$     
?r\gh notice & comm5t rulemak+4  7,b7   
,calculation ( budget neutral paym5t    
am\nts  7i7 ,9 g5]al ,! ,secret>y %all1 
subject to subp>agraph 7,f71 calculate  
paym5t am\nts "u ?is subsection )       
respect to home heal? #cj-;day p]iods ( 
c>e furni%$ 9 #bjbj 9 a mann] su* t !   
e/imat$ aggregate am\nt ( exp5ditures "u
 ! prospective paym5t sy/em "u ?is      
subsection ) application ( ?is p>agraph 
is equal to ! e/imat$ aggregate am\nt ( 
exp5ditures "u ?is subsection )\t       
application ( ?is p>agraph4  7ii7       
,exclusion ( adju/m5ts f calculation    
,adju/m5ts "u p>agraph 7#c7 7includ+    
adju/m5ts = case mix *anges "u clause   
7iv7 ( su* p>agraph7 & p>agraph 7#e7 &  
subp>agraphs 7,e7 & 7,f7 %all n be      
includ$ 9 ! calculation "u clause 7i74  
7,c7 ,limit+ sav+s comp>$ to ! #bjah    
home heal? propos$ rule ,9 ord] to r$uce
 ! aggregate am\nt ( sav+s "u ! home    
heal? gr\p+s model comp>$ to ! e/imat$  

impacts 9 ! #bjah ,home ,heal? ,propos$ 
,rule1 aft] calculat+ am\nts 9          
subp>agraph 7,b71 ! ,secret>y %all r$uce
 su* #bjbj am\nts by #c4g p]c5t4  7,d7  
,/&>d prospective paym5t am\nts = #bjbj 
& subsequ5t ye>s  7i7 ,/&>d prospective 
paym5t am\nts ,! /&>d prospective paym5t
 am\nts = home heal? #cj-;day p]iods (  
c>e beg9n+ ) #bjbj %all be ! am\nts     
r$uc$ 9 subp>agraph 7,c7 subject to     
clauses 7iv7 & 7v7 ( subp>agraph 7,f74  
7ii7 ,application ( adju/m5ts ,adju/m5ts
 describ$ 9 subp>agraph 7,b77ii7 7o!r   
?an ! adju/m5t describ$ 9 subp>agraph   
7,e77 %all be appli$ to su* /&>d        
prospective paym5t am\nts4  7,e7        
,transitional adju/m5ts to home heal?   
gr\p+s model ,9 ord] to provide = a     
transition to ! home heal? gr\p+s model1
 ! ,secret>y %all1 aft] application (   
adju/m5ts describ$ 9 subp>agraph        
7,d77ii71 increase paym5t am\nts "u     
clause 7iii7 z foll[s3  7i7 ,= #bjbj1 ! 
increase %all be #a4e p]c5t4  7ii7 ,=   
#bjba1 ! increase %all be #a4j p]c5t4   

7iii7 ,= #bjbb1 ! increase %all be #j4e 
p]c5t4  7,f7 ,provid] behavior          
assumptions & reconciliation  7i7       
,assumptions ,9 calculat+ am\nts "u     
subp>agraph 7,b77i71 ! ,secret>y %all   
make assumptions ab\t provid] behavioral
 *ange t c\ld occur z a result (        
implem5tation ( ! home heal? gr\p+s     
model su* z = *anges 9 ! numb] ( s]vice 
units & *anges 9 diagnosis codes bill$4 
7ii7 ,description ( assumptions ,!      
,secret>y %all provide a description ( !
 assumptions made "u clause 7i7 9 !     
notice & comm5t rulemak+ us$ to implem5t
 ?is p>agraph4  7iii7 ,reconciliation ,n
 lat] ?an #bjbe1 & 9 subsequ5t ye>s z   
appropriate1 ! ,secret>y %all det]m9e ! 
impact ( diff]5ces betwe5 actual &      
assum$ behavior on e/imat$ aggregate    
exp5ditures "u ?is subsection4  7iv7    
,p]man5t adju/m5ts ,! ,secret>y %all1 at
 a "t & 9 a mann] det]m9$ appropriate1  
provide = "o or m p]man5t increases or  
decreases to ! /&>d prospective paym5t  
am\nts = applicable ye>s1 on a          

prospective basis1 to acc\nt = !        
det]m9ation "u clause 7iii74  7v7       
,tempor>y adju/m5ts = retrospective     
behavior ,! ,secret>y %all1 at a "t & 9 
a mann] det]m9$ appropriate1 provide =  
"o or m tempor>y increases or decreases 
to ! /&>d prospective paym5t am\nts =   
applicable ye>s1 on a prospective basis1
 to acc\nt = ! det]m9ation "u clause    
7iii7 ) respect to ye>s be=e ! adju/m5t 
9 clause 7iv74  7vi7 ,o!r behavior ,!   
,secret>y %all1 at a "t & 9 a mann]     
det]m9$ appropriate1 apply p]man5t &    
tempor>y adju/m5ts to adju/ = increases 
9 e/imat$ aggregate exp5ditures z a     
result ( behavior responses n describ$ 9
 clause 7ii74  7,g7 ,cont9u$ application
 ( provisions ,except z describ$ 9 ?is  
p>agraph1 ! provisions ( ?is section    
%all cont9ue to apply4  4  7#b7 ,con=m+ 
am5dm5t ,p>agraph 7#b7 ( section        
#ahie7;b7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;fff7b77#b77 is     
am5d$ by /rik+ ,9 & ins]t+ ,subject to  
p>agraph 7#g77;,a71 94  7b7 ,ext5sion ( 

home heal? rural add-,on ,section #dba (
 ! ,m$ic>e ,prescription ,drug1         
,improvem5t1 & ,mod]nization ,act (     
#bjjc 7,public ,law #ajh-agc2 #aag ,/at4
 #bbhc71 z am5d$ by section #ebja7;b7 ( 
! ,deficit ,r$uction ,act ( #bjje       
7,public ,law #aji-aga2 #abj ,/at4 #df71
 section #caca7;c7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act       
7,public ,law #aaa-adh2 #abd ,/at4      
#dbh71 & section #baj ( ! ,m$ic>e       
,access & ,,*ip ,reau?orization ,act (  
#bjae 7,public ,law #aad-aj2 #abi ,/at4 
#hg71 is am5d$ by /rik+ ,janu>y #a1     
#bjah ea* place x appe>s & ins]t+       
,janu>y #a1 #bjbc4  7c7 ,reports  7#a7  
,int]im report ,n lat] ?an ,m>* #ae1    
#bjbb1 ! ,m$ic>e ,paym5t ,advisory      
,commission %all submit to ,congress an 
int]im report on ! modifications made by
 section #ahie7;b77#g7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;fff7b77#g771 z add$ by subsection 
7a71 & any un9t5d$ consequ5ces includ+--
  7,a7 behavioral *anges t may occur due

 to l[] reimbursem5t = ,m$ication       
,managem5t1 ,tra9+ & ,assessm5t2  7,b7  
behavioral *anges t may occur due to    
high] reimbursem5t foll[+               
hospitalizations2  7,c7 use (           
/ati/ically d]iv$1 v]sus actual1 paym5t 
weights2  7,d7 que/ionable enc\nt]s2    
7,e7 use ( bo? prim>y & second>y        
diagnosis codes = episode assignm5t2 &  
7,f7 r$uc+ reimbursem5t ( behavioral    
heal? episodes1 comp>$ to ! ,home ,heal?
 ,res\rce ,gr\p model4  7#b7 ,f9al      
report ,n lat] ?an ,m>* #ae1 #bjbf1     
,med,p,a,c1 ! ,m$ic>e ,paym5t ,advisory 
,commission %all submit to ,congress a  
f9al report on su* modifications & any  
su* consequ5ces4