,i  #aae? ,,congress  #b;d ,session  ,h4
 ,r4 #fejb  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #be1 #bjah,mr4  
,smi? ( ,nebraska 7= himself1 ,mrs4     
,black1 ,mr4 ,cr[ley1 ,mr4 ,griffi?1 &  
,mr4 ,b5 ,ray ,lujn ( ,new ,mexico7     
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 e/abli% a     
program to all[ qualifi$ gr\p practices 
to furni% c]ta9 items & s]vices at      
qualifi$ skill$ nurs+ facilities to     
individuals entitl$ to b5efits "u "p ,a 
& enroll$ "u "p ,b ( ! ,m$ic>e program  
to r$uce unnecess>y hospitalizations1 & 
= o!r purposes4  #a4 ,%ort title ,?is   
,act may be cit$ z ! ,r$uc+ ,unnecess>y 
,s5ior ,hospitalizations ,act ( #bjah or
 ! ,,ru% ,act ( #bjah4  #b4 ,,snf-bas$  

provision ( prev5tive acute c>e &       
hospitalization r$uction program ,title 
,,xviii ( ! ,social ,security ,act is   
am5d$ by add+ at ! end ! foll[+ new     
section3  #ahii;,c4 ,,snf-bas$ provision
 ( prev5tive acute c>e & hospitalization
 r$uction program  7a7 ,e/abli%m5t ,!re 
is e/abli%$ a program to be kn[n z !    
,,snf-bas$ ,provision ( ,prev5tive      
,acute ,c>e & ,hospitalization ,r$uction
 ,program 79 ?is section ref]r$ to z !  
,program71 to be adm9i/]$ by !          
,secret>y1 = purposes ( r$uc+ unnecess>y
 hospitalizations & em]g5cy dep>tm5t    
visits by all[+ qualifi$ gr\p practices 
7z def9$ 9 section #ahgg7;h77#d77 on or 
aft] ,janu>y #a1 #bjai1 to furni% items 
& s]vices id5tifi$ "u subsection 7b77#c7
 to individuals entitl$ to b5efits "u "p
 ,a & enroll$ "u "p ,b resid+ 9 qualifi$
 skill$ nurs+ facilities4  7b7 ,op]ation
 ( ,program ,"u ! ,program1 ! ,secret>y 
%all provide = ! foll[+3 7#a7           
,c]tification ( skill$ nurs+ facilities 
z qualifi$ skill$ nurs+ facilities "u   

subsection 7c77#a74  7#b7 ,c]tification 
( gr\p practices z qualifi$ gr\p        
practices "u subsection 7c77#b74  7#c7  
,id5tification ( m9imum requir$         
nonsurgical items & s]vices furni%$ at a
 hospital em]g5cy dep>tm5t t may be     
safely furni%$ by a qualifi$ gr\p       
practice at a qualifi$ skill$ nurs+     
facility "u ! ,program & t su* qualifi$ 
gr\p practice %all (f] to furni% "u !   
,program4  7#d7 ,annual id5tification ( 
additional items & s]vices furni%$ at a 
hospital em]g5cy dep>tm5t t may be      
safely furni%$ by a qualifi$ gr\p       
practice at a qualifi$ skill$ nurs+     
facility "u ! ,program dur+ a ye> & t   
su* qualifi$ gr\p practice may (f] to   
furni% "u ! ,program dur+ su* ye>4  7#e7
 ,e/abli%m5t ( qualifications =         
nonphysician employees ( su* qualifi$   
gr\p practices :o may furni% su* items &
 s]vices at a qualifi$ skill$ nurs+     
facility4 ,su* qualifications %all      
include ! requirem5t t su* an employee--
  7,a7 be c]tifi$ 9 advanc$ c>diovascul>

 life support by a nationally recogniz$ 
specialty bo>d ( c]tification or        
equival5t c]tification bo>d2 &  7,b7 h  
at lea/ "o ye> ( cl9ical exp]i5ce       
furni%+ m$ical c>e-- 7i7 9 a hospital   
em]g5cy dep>tm5t sett+2 or  7ii7 z an   
employee ( a provid] or suppli] (       
ambulance s]vices4  7#f7 ,paym5t "u ?is 
title = items & s]vices id5tifi$ "u     
p>agraph 7#c7 or 7#d7 furni%$ by su*    
qualifi$ gr\p practices at su* a        
facility 9 am\nts det]m9$ "u subsection 
7d74  7c7 ,c]tifications  7#a7 ,qualifi$
 skill$ nurs+ facilities ,= purposes (  
?is section1 ! ,secret>y %all c]tify a  
skill$ nurs+ facility z a qualifi$      
skill$ nurs+ facility if ! facility     
submits an application 9 a "t & mann]   
specifi$ by ! ,secret>y & meets ! foll[+
 requirem5ts3  7,a7 ,! facility has     
on-site diagno/ic equipm5t necess>y = a 
qualifi$ gr\p practice to furni% on-site
 items & s]vices "u ! ,program & real-"t
 audio & visual capabilities4  7,b7 ,!  
facility ensures t resid5ts ( su*       

facility1 ^u ent]+ su* facility1 are    
all[$ to specify 9 an advanc$ c>e       
directive :e!r ! resid5t wi%es to       
receive items & s]vices furni%$ at !    
facility "u ! ,program 9 a case :]e     
communication ) ! resid5t is n possible4
  7,c7 ,! facility ensures t individuals
 to be furni%$ su* items & s]vices "u ! 
,program at su* facility h !            
opportunity1 at _! reque/1 to in/ead be 
transport$ to a hospital em]g5cy        
dep>tm5t4  7#b7 ,qualifi$ gr\p practices
 ,= purposes ( ?is section1 ! ,secret>y 
%all c]tify a gr\p practice z a qualifi$
 gr\p practice = a p]iod ( #c ye>s if ! 
gr\p practice submits an application 9 a
 "t & mann] specifi$ by ! ,secret>y &   
meets ! foll[+ requirem5ts3  7,a7 ,!    
gr\p practice (f]s to furni% all m9imum 
requir$ items & s]vices id5tifi$ "u     
subsection 7b77#c7 "u ! ,program4  7,b7 
,! gr\p practice submits a notification 
to ! ,secret>y annually specify+ :i* 7if
 any7 additional items & s]vices        
id5tifi$ "u subsection 7b77#d7 = a ye> !

 gr\p practice w (f] to furni% = su* ye>
 "u ! ,program4  7,c7 ,! gr\p practice  
ensures t only individuals :o meet !    
qualifications e/abli%$ "u subsection   
7b77#d7 or a physician :o is "p ( su*   
gr\p practice may furni% su* m9imum     
requir$ items & s]vices & su* additional
 items & s]vices4  7,d7 ,! gr\p practice
 ensures t at lea/ #a su* individual or 
su* physician is pres5t at all times at 
ea* qualifi$ skill$ nurs+ facility :]e !
 gr\p practice may furni% su* m9imum    
requir$ items & s]vices & su* additional
 items & s]vices4  7,e7 ,! gr\p practice
 ensures t1 9 ! case :]e su* m9imum     
requir$ items & s]vices or su*          
additional items & s]vices are furni%$  
by su* an individual1 su* individual    
furni%es su* m9imum requir$ items &     
s]vices or additional items & s]vices "u
 ! sup]vision1 ei!r 9-p]son or ?r\gh !  
use ( teleheal? 7n includ+ /ore-&-=w>d  
te*nologies71 (--  7i7 a physician--    
7,i7 :o is bo>d c]tifi$ or bo>d eligible
 9 em]g5cy m$ic9e1 family m$ic9e1 or    

int]nal m$ic9e2 or  7,,ii7 :o has be5   
c]tifi$ by a nationally recogniz$       
specialty bo>d ( c]tification or        
equival5t c]tification bo>d 9 advanc$   
c>diac life support & advanc$ trauma    
life support2  7ii7 a nurse practition] 
:o has be5 c]tifi$ by a nationally      
recogniz$ specialty bo>d ( c]tification 
or equival5t c]tification bo>d 9 advanc$
 c>diac life support & advanc$ trauma   
life support2 or  7iii7 a physician     
assi/ant :o has be5 c]tifi$ by a        
nationally recogniz$ specialty bo>d (   
c]tification or equival5t c]tification  
bo>d 9 advanc$ c>diac life support &    
advanc$ trauma life support4  7,f7 ,)   
respect to any ye> 9 :i* ! qualifi$ gr\p
 practice w\ld p>ticipate 9 ! ,program1 
! ,*ief ,actu>y = ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices det]m9es t su*        
p>ticipation dur+ su* ye> w n result 9  
total e/imat$ exp5ditures "u ?is title =
 su* ye> be+ great] ?an total e/imat$   
exp5ditures "u su* title = su* ye> )\t  
su* p>ticipation4  7d7 ,paym5ts  7#a7 ,9

 g5]al ,= #bjai & ea* subsequ5t ye>1 !  
,secret>y %all develop a s*$ule (       
paym5ts to apply = items & s]vices      
id5tifi$ "u p>agraph 7#c7 or p>agraph   
7#d7 ( subsection 7b7 furni%$ dur+ su*  
ye> by a qualifi$ gr\p practice "u !    
,program4 ,su* paym5ts %all be 9 lieu ( 
any o!r paym5ts t may be made "u ?is    
title = su* items & s]vices furni%$ "u !
 ,program4  7#b7 ,%>$ sav+s ,9 ! case ( 
a ye> = :i* ! ,secret>y det]m9es t a    
qualifi$ gr\p practice's p>ticipation 9 
! ,program result$ 9 a r$uction 9       
exp5ditures "u ?is title comp>$ to :at  
su* exp5ditures w\ld h be5 )\t su*      
p>ticipation1 ! ,secret>y %all--  7,a7  
pay to su* qualifi$ gr\p practice an    
am\nt equal to #cg4e p]c5t ( ! e/imat$  
am\nt ( su* r$uction2 &  7,b7 pay to ea*
 qualifi$ skill$ nurs+ facility :]e su* 
qualifi$ gr\p practice furni%$ items &  
s]vices "u ! ,program dur+ su* ye> an   
am\nt t be>s ! same ratio to #ab4e p]c5t
 ( ! e/imat$ am\nt ( su* r$uction z !   
am\nt ( exp5ditures "u ! ,program = su* 

items & s]vices furni%$ ) respect to    
individuals at su* facility by su*      
qualifi$ gr\p practice dur+ su* ye> be>s
 to ! total am\nt ( exp5ditures "u !    
,program = su* items & s]vices furni%$ )
 respect to all individuals by su*      
qualifi$ gr\p practice dur+ su* ye>4    
7e7 ,evaluation  7#a7 ,9 g5]al ,)       
respect to a qualifi$ gr\p practice & a 
qualifi$ skill$ nurs+ facility1 n lat]  
?an #f mon?s aft] su* gr\p practice     
beg9s furni%+ items & s]vices "u !      
,program 7or1 9 ! case ( a qualifi$     
skill$ nurs+ facility1 n less ?an #f    
mon?s aft] a qualifi$ gr\p practice fir/
 furni%es su* items & s]vices at su*    
facility71 & n less ?an once e #b ye>s  
!reaft]1 ! ,secret>y %all evaluate su*  
qualifi$ gr\p practice & su* qualifi$   
facility us+ in=mation receiv$ "u       
p>agraph 7#b7 on su* crit]ia z det]m9$  
appropriate by ! ,secret>y4  7#b7       
,report+ ( in=mation ,9 a "t & mann]    
specifi$ by ! ,secret>y1 a qualifi$ gr\p
 practice & a qualifi$ skill$ nurs+     

facility %all submit to ! ,secret>y a   
report conta9+ ! foll[+ in=mation )     
respect to items & s]vices furni%$ "u ! 
,program dur+ a report+ p]iod 7z        
specifi$ by ! ,secret>y73  7,a7 ,! numb]
 ( individuals ) respect to :om su* gr\p
 practice furni%$ su* items & s]vices 9 
su* p]iod 7or1 9 ! case ( a qualifi$    
skill$ nurs+ facility1 ! numb] (        
individuals ) respect to :om su* a gr\p 
practice furni%$ su* items & s]vices at 
su* facility 9 su* p]iod74  7,b7 ,!     
numb] ( su* individuals :o 7 admitt$ to 
a hospital or treat$ 9 ! em]g5cy        
dep>tm5t ( a hospital )9 #bd h\rs ( be+ 
furni%$ su* items & s]vices4  7,c7 ,o!r 
in=mation det]m9$ appropriate by !      
,secret>y4  7#c7 ,loss ( qualifi$       
c]tification  7,a7 ,9 g5]al ,n lat] ?an 
#c mon?s aft] a det]m9ation describ$ 9  
?is s5t5ce is made1 ! ,secret>y may     
revoke ! c]tification ( a qualifi$      
skill$ nurs+ facility or a qualifi$ gr\p
 practice made "u subsection 7c7 if--   
7i7 ! ,*ief ,actu>y ( ! ,c5t]s = ,m$ic>e

  ,m$icaid ,s]vices det]m9es t su*      
skill$ nurs+ facility's or su* gr\p     
practice's p>ticipation 9 ! ,program    
dur+ a ye> result$ 9 total exp5ditures  
"u ?is title = su* p]iod be+ great] ?an 
total exp5ditures "u su* title w\ld h   
be5 dur+ su* p]iod )\t su* p>ticipation2
 or  7ii7 ! ,secret>y det]m9es t su*    
skill$ nurs+ facility or su* gr\p       
practice has fail$ to comply ) a        
requirem5t specifi$ 9 p>agraph 7#a7 or  
7#b7 ( subsection 7c71 z applicable4    
7,b7 ,exclusion f c]tification = #c-ye> 
p]iod ,9 ! case t ! ,secret>y revokes ! 
c]tification ( a qualifi$ skill$ nurs+  
facility or a qualifi$ gr\p practice "u 
subp>agraph 7,a71 su* skill$ nurs+      
facility or su* gr\p practice %all be   
ineligible = c]tification z a qualifi$  
skill$ nurs+ facility or a qualifi$ gr\p
 practice 7z applicable7 "u subsection  
7c7 = a p]iod ( #c ye>s beg9n+ on ! date
 ( su* revocation4  7f7 ,det]m9ation (  
budget neutrality2 t]m9ation ( program  
7#a7 ,det]m9ation ,n lat] ?an ,july #a1 

#bjbd1 ! ,*ief ,actu>y ( ! ,c5t]s =     
,m$ic>e  ,m$icaid ,s]vices %all det]m9e 
:e!r ! ,program has result$ 9 an        
increase 9 total exp5ditures "u ?is     
title ) respect to ! p]iod beg9n+ on    
,janu>y #a1 #bjai1 & end+ on ,decemb]   
#ca1 #bjbc1 comp>$ to :at su*           
exp5ditures w\ld h be5 dur+ su* p]iod _h
 ! ,program n be5 9 op]ation4  7#b7     
,t]m9ation ,if ! ,*ief ,actu>y makes a  
det]m9ation "u p>agraph 7#a7 t !        
,program has result$ 9 an increase 9    
total exp5ditures "u ?is title1 !       
,secret>y %all t]m9ate ! ,program z (   
,janu>y #a ( ! fir/ ye> beg9n+ aft] su* 
det]m9ation4  4