,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #dehj  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #f1 #bjag,mr4
 ,wel* 7= himself & ,mrs4 ,black7       
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 ( #bjag4  #b4    
,m$ic>e ,,aco program improvem5ts  7a7  
,improv+ outcomes ?r\gh great] b5efici>y
 engagem5t  7#a7 ,9 g5]al ,section #ahii
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;jjj7 is am5d$ 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>y1 ! ,secret>y %all p]mit an    
,,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 inc5tives to 
enc\rage pati5t engagem5t & p>ticipation
 9 _! own wellness4  ,! co/ ( !         
inc5tives "u ?is p>agraph %all be borne 
by ! ,,aco & %all n affect ! paym5ts to 
! ,,aco "u subsection 7d74  7#b7 ,fo/]+ 
/rong] pati5t-provid] ties  7,a7        
,p]mitt+ prospective assignm5t (        
b5efici>ies ,9 c>ry+ out subsection 7c7 
) respect to any agreem5t ) an ,,aco "u 
?is section1 ! ,,aco may elect "u any   
su* agreem5t prospective assignm5t (    
,m$ic>e fee-=-s]vice b5efici>ies be=e ! 
beg9n+ ( a ye> to ! ,,aco & a prim>y c>e
 ,,aco pr(essional4  7,b7 ,inclusion (  

aco in=mation 9 welcome to m$ic>e visit 
& annual wellness visits ,! ,secret>y   
may enc\rage a prim>y c>e ,,aco         
pr(essional to include1 z "p ( ! initial
 prev5tive physical exam9ation "u       
section #ahfa7ww77#a7 or p]sonaliz$     
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 ,mov+ f volume to value ,subject to
 p>agraph 7#d7-- 7,a7 ,regulatory relief
 = mov+ to two-sid$ risk ,9 ! case ( an 
,,aco t has elect$ a two-sid$ risk model
 7z provid$ = "u regulations71 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  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 ,,aco1 !         
,secret>y %all grant a waiv]1 & ! ,,aco 
may elect1 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 pay+ = 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 n m exp5sive ?an ! furni%+ ( 
a home heal? visit4  7,c7 ,mov+ up risk 
track annually ,ea* ye> ( an agreem5t   
p]iod1 ! ,secret>y %all p]mit an ,,aco  
to make an election to assume great]    
risk4  7#d7 ,discretion>y revocation ,! 
,secret>y may revoke1 at ! ,secret>y's  
discretion1 a waiv] grant$ "u p>agraph  
7#c74  7#e7 ,provisions = %>+ ( int]nal 
co/ sav+s  7,a7 ,9 g5]al ,subject to !  
succe$+ provisions ( ?is p>agraph1 !    
,secret>y %all p]mit an ,,aco to        
di/ribute int]nal co/ sav+s among ,,aco 
p>ticipants pursuant to an int]nal co/  
sav+s %>+ arrangem5t if ! arrangem5t    
meets ! requirem5ts ( subp>agraph 7,b7 &
 ! ,,aco meets ! report+ requirem5ts (  
subp>agraph 7,c7 ) respect to su*       
arrangem5t4  7,b7 ,requirem5ts relat+ to
 design ( arrangem5t ,! requirem5ts (   
?is subp>agraph = an int]nal co/ sav+s  
%>+ arrangem5t ( an ,,aco are z foll[s3 
7i7 ,no r$uction 9 m$ically necess>y c>e
 ,,aco p>ticipants may n r$uce or limit 
m$ically necess>y items & s]vices       

furni%$ to ,m$ic>e fee-=-s]vice         
b5efici>ies4  7ii7 ,volunt>y            
p>ticipation ,p>ticipation by provid]s (
 s]vices & suppli]s 9 ! arrangem5t is   
volunt>y4  7iii7 ,transp>5cy ,!         
arrangem5t is transp>5t & subject to    
audit by ! ,secret>y4  7iv7 ,quality (  
c>e ,,aco p>ticipants p>ticipat+ 9 !    
arrangem5t meet quality p]=mance /&>ds  
e/abli%$ by ! ,secret>y "u subsection   
7b77#c74  7v7 ,paym5t me?odology        
,di/ributions ( int]nal co/ sav+s "u !  
arrangem5t is n bas$ on ! volume or     
value ( ref]rals or bus9ess o!rwise     
g5]at$4  7,c7 ,report+ requirem5ts ,!   
requirem5ts ( ?is subp>agraph = an      
arrangem5t ( an ,,aco is t ! ,,aco      
provides ! foll[+ in=mation to !        
,secret>y = purposes ( evaluat+ !       
arrangem5t3  7i7 ,me?odology ,!         
me?odology = di/ributions ( int]nal co/ 
sav+s "u ! arrangem5t among all ,,aco   
p>ticipants1 includ+ ! frequ5cy ( & !   
crit]ia = su* di/ributions4  7ii7 ,c>e  
r$esign ,a detail$ explanation ( h[ !   

arrangem5t w a*ieve improv$ quality &   
pati5t exp]i5ce1 z well z ! anticipat$  
co/ sav+s4  7iii7 ,eligibility to       
p>ticipate 9 arrangem5t ,! crit]ia =    
p>ticipation by ,,aco p>ticipants1      
p>ticul>ly pr(essionals1 9 ! arrangem5t4
  7iv7 ,di/ribution plan ,a compreh5sive
 plan = di/ributions ( int]nal co/ sav+s
 "u ! arrangem5t4  7,d7 ,waiv]s ,!      
,secret>y %all waive su* provisions (   
?is title & title ,,xi z may be necess>y
 to c>ry out ?is p>agraph4  7,e7        
,def9itions ,9 ?is p>agraph3 7i7        
,int]nal co/ sav+s %>+ arrangem5t ,! t]m
 int]nal co/ sav+s %>+ arrangem5t means 
an arrangem5t among ,,aco p>ticipants ( 
an ,,aco = ! di/ributions ( int]nal co/ 
sav+s to su* ,,aco p>ticipants1 includ+ 
to ,,aco pr(essionals1 solely f ga9s or 
sav+s t are a direct result (           
collaborative ef=ts among ,,aco         
p>ticipants ( an ,,aco to improve !     
quality & effici5cy ( c>e furni%$ to    
,m$ic>e fee-=-s]vice b5efici>ies1 b does
 n include %>$ sav+s "u subsection      

7d77#b74  7ii7 ,di/ribution ( int]nal   
co/ sav+s ,! t]m di/ribution ( int]nal  
co/ sav+s means a paym5t ( a p]c5tage ( 
! ga9s or sav+s f an int]nal co/ sav+s  
%>+ arrangem5t to ,,aco p>ticipants4    
7iii7 ,,aco p>ticipants ,! t]m ,,aco    
p>ticipants means provid]s ( s]vices &  
suppli]s p>ticipat+ 9 an ,,aco :o       
volunt>ily p>ticipate 9 an int]nal co/  
sav+s %>+ arrangem5t "u ?is p>agraph4  4
  7#b7 ,effective date ,! am5dm5t made  
by p>agraph 7#a7 %all apply z if includ$
 9 ! enactm5t ( section #cjbb ( ,public 
,law #aaa-adh4  7#c7 ,con=m+ am5dm5t    
,effective z if includ$ 9 ! enactm5t (  
section #cjba ( ,public ,law #aaa-adh1 !
 provisions ( section #ahii7l77#e7 ( !  
,social ,security ,act 7relat+ to       
au?ority = di/ributions ( int]nal co/   
sav+s "u int]nal co/ sav+s %>+          
arrangem5ts71 z add$ by p>agraph 7#a71  
%all apply to p>ticipants 9 acc\ntable  
c>e organization paym5t & s]vice deliv]y
 models 7& o!r appropriate models7 te/$ 
pursuant to section #aaae;,a ( ! ,social

 ,security ,act 7#db ,u4,s4,c4 #acae;a74
  7b7 ,/udy & report on feasibility on  
provid+ electronic access to ,m$ic>e    
claims data  7#a7 ,/udy ,! ,secret>y (  
,heal? & ,human ,s]vices %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/+        
database1 su* z ! ,virtual ,rese>* ,data
 ,c5t]4 ,! /udy %all take into acc\nt ! 
measures ne$$ to ensure ! security &    
privacy ( b5efici>y & provid] in=mation4
  7#b7 ,report ,n lat] ?an six mon?s    
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  7c7   
,p]mitt+ de m9imis v>iation f m9imum    
enrollm5t requirem5t ,section           
#ahii7;b77#b77;,d7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acie;jjj7b77#b77;,d77 is am5d$ by      

ins]t+ be=e ! p]iod at ! end ! foll[+3 1
 except t ! ,secret>y may p]mit an ,,aco
 ) few] ?an #e1jjj p>ticipants by a de  
m9imis numb] 7n to exce$ #ajj7 to be    
eligible to cont9ue to p>ticipate 9     
cases :]e su* few] numb] does n         
negatively impact ! ,,aco's p>ticipation
 9 ! program & ! ,,aco meets o!r        
conditions to be s eligible4  7d7       
,paym5ts = %>$ sav+s ,section           
#ahii7;d77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;jjj7d77#b77 is    
am5d$ by add+ at ! end ! foll[+3 ,= ye>s
 beg9n+ on or aft] ,janu>y #a1 #bjah1 ! 
,secret>y may use a slid+ scale to      
increase by up to #aj p]c5tage po9ts !  
appropriate p]c5t o!rwise appli$ "u ?is 
p>agraph = an ,,aco t a*ieves ! m$ian ( 
quality p]=mance /&>ds1 or a*ieves      
quality improvem5t scores above su*     
m$ian1 e/abli%$ "u subsection 7b77#c74  
,! ,secret>y %all n decrease su*        
appropriate p]c5t o!rwise appli$ to an  
,,aco because ( ! application ( an      
increase "u ! previ\s s5t5ce = ano!r    

,,aco44  7e7 ,demon/ration = all[+ gr[? 
( ,,hcc scores ,section                 
#ahii7;d77#a77;,b77ii7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;jjj7d77#a77;,b77ii77 is am5d$ by  
add+ at ! end ! foll[+3 ,9 c>ry+ out ?is
 subsection1 ! ,secret>y %all e/abli% a 
#c-ye> demon/ration project t develops &
 applies a me?odology1 simil> to !      
,m$ic>e ,advantage normalization factor 
appli$ "u section #ahec7;a77#c71 t all[s
 gr[? ( ,,hcc scores = ^? :o are        
cont9u\sly enroll$ ) an ,,aco4 ,!       
,secret>y %all submit to ,congress a    
report on ! results ( su* demon/ration  
project44  7f7 ,creat+ inc5tives = ,,aco
 developm5t ,! ,secret>y ( ,heal? &     
,human ,s]vices may develop a me*anism  
to make p]man5t ^? ,,aco-relat$ pilot   
programs1 includ+ ! ,advance ,paym5t    
,,aco ,model1 t ! ,secret>y det]m9es h  
be5 successful4 ,! ,secret>y %all submit
 to ,congress a report on ! me*anism &  
%all include 9 ! report su*             
recomm5dations1 includ+ su* *anges 9    

legislation1 z ! ,secret>y det]m9es     
appropriate4