,i  #aae? ,,congress  #b;d ,session  ,h4
 ,r4 #gabb  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,novemb] #ac1         
#bjah,mr4 ,pauls5 introduc$ ! foll[+    
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce1 & 9 addition to !    
,committee on ,ways & ,means1 = 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 ,,iii ( ! ,public ,heal? ,s]vice  
,act & titles ,,xi & ,,xviii ( ! ,social
 ,security ,act to accel]ate ! adoption 
( value-bas$ paym5t & deliv]y           
arrangem5ts among heal? c>e /akehold]s  
int5d$ to coord9ate c>e1 improve pati5t 
outcomes1 %>e acc\ntability1 or l[]     
co/s1 & = o!r purposes4  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,%>$         
,acc\ntability = ,improv$ ,pati5t       
,outcomes ,act ( #bjah4  #b4 ,value-bas$
 arrangem5ts ,subp>t ,i ( "p ,s ( title 
,,iii ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #bhj;j et seq47 is am5d$ 

by add+ at ! end ! foll[+ new section3  
#cii,,ll4 ,educational campaigns to     
enc\rage value-bas$ heal? c>e deliv]y & 
quality improvem5t  7a7 ,9 g5]al ,beg9n+
 n lat] ?an ,janu>y #a1 #bjai1 !        
,secret>y %all conduct annual education 
campaigns t>get$ to heal? c>e provid]s &
 pay]s to enc\rage ! developm5t (       
value-bas$ arrangem5ts 7z def9$ 9       
section #aabh;,b7b77#e77;,b7 ( ! ,social
 ,security ,act7 t are design$ to meet  
"o or m ( ! foll[+ goals3 7#a7          
,promotion ( acc\ntability ) respect to 
quality1 co/1 coord9ation1 & ov]all c>e 
( pati5t populations1 includ+ pati5t    
populations t receive s]vices :i* are   
reimburs$ by v>i\s heal? c>e pay]s4     
7#b7 ,improvem5t ( managem5t &          
coord9ation ( c>e = pati5ts ?r\gh su*   
arrangem5ts approv$ by ! p>ties to !    
arrangem5t4  7#c7 ,enc\ragem5t (        
inve/m5t 9 heal? c>e infra/ructure &    
r$esign$ c>e processes = high-quality & 
effici5t s]vice deliv]y = pati5ts1      
includ+ individuals entitl$ to b5efits  

"u "p ,a ( title ,,xviii ( ! ,social    
,security ,act or enroll$ "u "p ,b ( su*
 title1 su* z appropriate r$uction (    
co/s or gr[? 9 exp5ditures = items &    
s]vices provid$ to pati5ts1 consi/5t )  
quality ( c>e1 physician m$ical judgm5t1
 & pati5t fre$om ( *oice4  7b7          
,au?orization ( appropriations ,!re are 
au?oriz$ to be appropriat$ to c>ry out  
?is section su* sums z may be necess>y =
 ea* ( fiscal ye>s #bjai ?r\gh #bjbc4  4
  #c4 ,antikickback exception =         
value-bas$ arrangem5ts  7a7 ,9 g5]al    
,section #aabh;,b7b7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acbj;a-#g;b7b77 is am5d$ by add+ at !  
end ! foll[+ new p>agraph3  7#e7  7,a7  
,p>agraphs 7#a7 & 7#b7 %all n apply to  
any remun]ation ex*ang$ "u a value-bas$ 
arrangem5t 7z def9$ 9 subp>agraph 7,b77 
directly or indirectly betwe51 among1 or
 on behalf ( "o or m p>ties paid "u su* 
arrangem5t4  7,b7 ,= purposes ( ?is     
p>agraph1 ! t]m value-bas$ arrangem5t   
means an arrangem5t t meets ! foll[+    

crit]ia3  7i7 ,! arrangem5t is set out 9
 writ+ 9 advance ( ! execution ( !      
arrangem5t & specifies ! heal? c>e items
 & s]vices cov]$ by ! arrangem5t4  7ii7 
,! arrangem5t is reasonably relat$ to "o
 or m ( ! goals describ$ 9 section      
#cii,,ll7a7 ( ! ,public ,heal? ,s]vice  
,act4  7iii7 ,! arrangem5t-- 7,i7 is a  
value-bas$ risk-%>+ transaction 7z def9$
 9 subp>agraph 7,c772  7,,ii7 provides =
 paym5t = items & s]vices furni%$ "u !  
arrangem5t betwe51 among1 or on behalf (
 "o or m p>ties p>ticipat+ 9 a          
value-bas$ risk-%>+ network arrangem5t  
7z def9$ 9 subp>agraph 7,c772 or        
7,,iii7 is ano!r arrangem5t det]m9$     
appropriate by ! ,secret>y4  7,c7 ,9 ?is
 p>agraph3 7i7 ,! t]m f9ancial risk     
means upside or d[nside risk su* t ea*  
p>ty is eligible or liable = paym5t     
?r\gh a specifi$ me?odology t may       
include %>$ sav+s1 )holds1 or bonuses4  
7ii7 ,! t]m value-bas$ risk-%>+ network 
arrangem5t means an arrangem5t "u :i* an
 entity is e/abli%$ betwe5 or organiz$ &

 op]at$ by two or m p>ties 7:i* may     
include provid]s1 suppli]s1             
corporations1 or individuals7-- 7,i7 to 
accept capitation paym5ts ) respect to  
c]ta9 items & s]vices furni%$ to an     
individual2  7,,ii7 to accept z paym5t =
 su* items & s]vices a pr$et]m9$        
p]c5tage ( ! value-bas$ risk-%>+        
network's rev5ue "u ! arrangem5t2 or    
7,,iii7 to provide f9ancial inc5tives to
 p>ties to ! arrangem5t = purposes (    
a*iev+ "o or m ( ! goals describ$ 9     
section #cii,,ll7a7 ( ! ,public ,heal?  
,s]vice ,act ?r\gh ! use (--  7aa7      
arrangem5ts "u :i* su* p>ties agree to a
 )hold ( a significant am\nt ( !        
comp5sation due !m1 to be us$ to cov]   
losses ( ! arrangem5t1 to cov] losses ( 
o!r p>ties )9 ! arrangem5t1 to be       
return$ to all p>ties to ! arrangem5t if
 su* p>ties meet _! utilization         
managem5t or co/-conta9m5t goals = a    
specifi$ "t p]iod1 or to be di/ribut$   
among all p>ties if ! arrangem5t meets  
its utilization managem5t or            

co/-conta9m5t goals = a specifi$ "t     
p]iod2  7bb7 arrangem5ts :]e su* p>ties 
agree to pree/abli%$ co/ or utilization 
t>gets & to subsequ5t significant       
f9ancial rew>ds or p5alties 7:i* may    
include a r$uction 9 paym5ts to d[n/ream
 provid]s or suppli]s 9 ! network7 bas$ 
on ! p]=mance ( all su* p>ties ) respect
 to su* t>gets2 or  7cc7 o!r me*anisms t
 demon/rate significant %>$ f9ancial    
risk 7z def9$ 9 clause 7i77 or          
significantly assi/ su* p>ties 9 meet+  
risk-%>+ t>gets1 includ+ %>$-sav+s      
paym5ts1 )holds1 or bonuses4            
,remun]ation to p>ties :o p>ticipate 9 a
 value-bas$ risk-%>+ network arrangem5t 
may be 9-k9d or monet>y paym5ts1 :i* may
 b are n requir$ to place ! p>ties to   
su* arrangem5t at f9ancial risk 7z def9$
 9 clause 7i774  7iii7 ,! t]m value-bas$
 risk-%>+ transaction means a paym5t    
made "u an arrangem5t "u :i* ea* p>ty   
agrees--  7,i7 to contribute to !       
a*ievem5t ( preid5tifi$ cl9ical or      
economic t>get metrics t are            

specifically tailor$ to improve pati5t  
outcomes or r$uce ! co/s ( heal? c>e    
deliv]y )\t negatively affect+ pati5t   
outcomes2  7,,ii7 to implem5t processes 
or proc$ures t o!rwise optimize !       
deliv]y1 effici5cy1 or quality (        
pati5t-c5t]$ c>e2 &  7,,iii7 to         
pr$et]m9e ! allocation ( f9ancial risk  
7z def9$ 9 clause 7i77 assum$ by ea*    
p>ty bas$ on ! p>ticipant's relative    
contribution to ! a*ievem5t ( t>get$    
outcomes4  4  7b7 ,effective date ,!    
am5dm5t made by ?is section %all apply  
to arrangem5ts ent]$ into on or aft] !  
date ( enactm5t ( ?is ,act4  #d4 ,/>k   
law exception = value-bas$ arrangem5ts  
7a7 ,section #ahgg7;e7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acienn7e77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraphs3  7#i7 ,value-bas$ 
arrangem5ts ,remun]ation to a physician 
7or an imm$iate family memb] ( su*      
physician7 paid "u a value-bas$         
arrangem5t 7z def9$ 9 section           
#aabh;,b7b77#e77;,b774  4  7b7          

,effective date ,! am5dm5t made by ?is  
section %all apply ) respect to         
arrangem5ts ent]$ into on or aft] ! date
 ( enactm5t ( ?is ,act4