,i #aaeth ,,congress #ast ,session ,h4 ,r4 #dbjf ,,in ,,the ,,house ,,of ,,representatives ,november #a1 #bjag,mr4 ,bucshon 7for himself1 ,mr4 ,ruiz1 ,mr4 ,marchant1 and ,mr4 ,kind7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 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 modernize the physician self-referral prohibitions to promote care coordination in the merit-based incentive payment system and to facilitate physician practice participation in alternative payment models under the ,medicare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medicare ,care ,coordination ,improvement ,act of #bjag4 #b4 ,modernization of limitations on physician self-referral 7a7 ,waivers ,to promote care coordination by facilitating participation in alternative payment models 7#a7 ,in general ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is amended-- 7,a7 in subsection 7z71 as added by section #aja7;e77#b7 of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae 7,public ,law #aad-aj71 by adding at the end the following new paragraph3 7#e7 ,waiver authority 7,a7 ,in general ,the provisions of subsection 7f7 of section #ahii shall apply with respect to covered ,,apm entities to the same extent and in the same manner as such provisions apply with respect to accountable care organizations under such section4 7,b7 ,covered ,,apm entities ,for purposes of subparagraph 7,a71 the term covered ,,apm entity means1 subject to subparagraph 7,c71 each of the following3 7i7 ,an eligible alternative payment entity as defined in paragraph 7#c77;,d74 7ii7 ,an entity participating in an alternative payment model as defined in paragraph 7#c77;,c71 including such participation that qualifies as a clinical practice improvement activity under section #ahdh7q77#b77;,b77iii77,,vi74 7iii7 ,an entity participating in a physician-focused payment model for which comments and recommendations have1 under subparagraph 7,c7 of section #ahfh7;c77#b71 been submitted indicating that such model meets the criteria described in subparagraph 7,a7 of such section4 7iv7 ,an entity participating in any other model that the ,secretary determines is a covered ,,apm for purposes of subparagraph 7,a71 including such a determination made pursuant to physicians submitting a proposal to the ,secretary for an alternative payment model4 7v7 ,an entity engaging in activities that the ,secretary has determined constitute significant progress toward establishing a model referred to in any of clauses 7i7 through 7iv74 7,c7 ,certain requirements ,a model referred to in any of clauses 7i7 through 7iv7 of subparagraph 7,b7 may not be considered a covered ,,apm entity for purposes of subparagraph 7,a7 unless the model meets the requirements described in section #ahgg7;b77#f77;,b74 2 and 7,b7 by redesignating subsection 7z71 as added by section #ead7;a7 of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae 7,public ,law #aad-aj71 as subsection 7aa74 7#b7 ,conforming amendment ,section #ead7;c77#a7 of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae 7,public ,law #aad-aj7 is amended by striking subsection 7z7 and inserting subsection 7aa74 7b7 ,expansion of administrative authority ,to provide exceptions to physician ownership and compensation arrangement prohibitions ,to promote care coordination 7#a7 ,promoting care coordination ,section #ahgg7;b77#d7 of the ,social ,security ,act 7,u4,s4,c4 #acienn7b77#d77 is amended by striking risk of program or patient abuse and inserting the following3 significant risk of program or patient abuse1 including those that would promote care coordination1 quality improvement1 or resource conservation by physician practices under part ,b4 7#b7 ,care coordination in mips and participation in apms ,section #ahgg7;a7 of the ,social ,security ,act 7,u4,s4,c4 #acienn7a77 is amended by adding at the end the following new paragraph3 7#c7 ,limitation ,the ,secretary may not impose requirements under this section that could adversely affect-- 7,a7 physician care coordination in the merit-based incentive payment system under section #ahdh7q72 or 7,b7 physician participation in an alternative payment model under #ahcc7z74 4 7c7 ,exception facilitating the development and operation of alternative payment models ,section #ahgg7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acienn7b77 is amended by adding at the end the following new paragraph3 7#f7 ,development and operation of alternative payment models 7,a7 ,in general ,in the case of services furnished pursuant to an arrangement that meets the requirements described in subparagraph 7,b7 entered into for the purpose of developing or operating an alternative payment model1 including-- 7i7 advanced alternative payment models described in section #ahcc7z7 7including physician-focused payment models referred to in section #ahfh7;c772 7ii7 ,,mips ,a,p,ms 7as defined by the ,secretary72 and 7iii7 any other alternative payment model that the ,secretary may1 by regulation1 specify4 7,b7 ,requirements ,the requirements described in this subparagraph with respect to an arrangement relating to an alternative payment model are as follows3 7i7 ,the arrangement is in writing1 identifies the services1 items1 or actions subject to the arrangement and is signed by the parties to the arrangement4 7ii7 ,items and services furnished subject to the arrangement are furnished at fair market value4 ,in this clause1 the term fair market value has the meaning given such term in subsection 7h77#c71 except that the ,secretary may not take into account the volume or value of referrals in determining such value for purposes of this clause4 7iii7 ,the arrangement includes a description of the alternative payment model4 7iv7 ,under the arrangement written reports are submitted to the ,secretary on a semi-annual basis on the progress achieved in the development and operation of the alternative payment model 7v7 ,the arrangement meets such other requirements as the ,secretary may impose by regulation as needed to protect against a significant risk of program patient abuse 4