,,ii  #aae? ,,congress  #b;d ,session   
,s4 #cede  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,octob] #c 7legislative
 day1 ,septemb] #bh71 #bjah ,ms4 ,coll9s
 7= h]self1 ,ms4 ,/ab5[1 & ,mr4 ,nelson7
 introduc$ ! foll[+ bill2 :i* 0 read    
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
improve home heal? paym5t re=ms "u !    
,m$ic>e program4  #a4 ,%ort title  ,?is 
,act may be cit$ z ! ,home ,heal?       
,paym5t ,innovation ,act ( #bjah4  #b4  
,improvem5ts to ,m$ic>e innovations &   
manag$ c>e relat$ to home heal? s]vices 
7a7 ,exp&$ waiv]s 9 %>$ sav+s programs  
,section #ahii7;f7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #cie;jjj7f771 is   
am5d$ by add+ at ! end ! foll[+3 ,beg9n+
 n lat] ?an ,janu>y #a1 #bjbj1 !        
,secret>y %all include a waiv] ( !      
conf9$ to 8 home requirem5t "u sections 
#ahad7;a77#b77;,c7 & #ahce7;a77#b77;,a7 
9 "o or m programs "u ?is section44  7b7
 ,flexibility 9 ,m$ic>e advantage plans 

,section #aheb ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acieww-#b7 is am5d$
 by add+ at ! end ! foll[+3  7n7        
,flexibility if provid+ home heal?      
s]vices ,not)/&+ any o!r provision (    
law1 any ,,ma organization %all be      
p]mitt$ to waive ! conf9$ to 8 home     
requirem5t 9 ! home heal? s]vices b5efit
 :5 ! organization det]m9es x is 9 ! be/
 int]e/ ( ! enrollee4  4  #c4           
,improvem5ts to home heal? paym5t re=ms 
"u ,m$ic>e  7a7 ,application ( budget   
neutrality ,section #ahie7;b77#c7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acie;fff7b77#c771 z am5d$ by section   
#eajja7;a77#b7 ( ! ,bip>tisan ,budget   
,act ( #bjah 7,public ,law #aae-abc71 is
 am5d$--  7#a7 9 subp>agraph 7,a77iv71 9
 ! f\r? s5t5ce-- 7,a7 by /rik+ %all make
 & ins]t+ %all n make2 &  7,b7 by /rik+ 
& %all provide a description & all t    
foll[s ?r\gh ! p]iod & ins]t+ a p]iod2 &
  7#b7 9 subp>agraph 7,d7--  7,a7 9 !   
subp>agraph head+1 by /rik+ assumptions 
& ins]t+ obs]v$ evid5ce2  7,b7 9 clause 

7i7--  7i7 by /rik+ diff]5ces betwe5    
assum$ & all t foll[s ?r\gh & actual2   
7ii7 by ins]t+ attributable to !        
implem5tation ( p>agraphs 7#b77;,b7 &   
7#d77;,b7 aft] behavior *anges2 &  7iii7
 by add+ at ! end ! foll[+3 ,! ,secret>y
 %all publi% ! det]m9ation "u ?is clause
 ) respect to an applicable ye>1 includ+
 a description ( ! obs]v$ evid5ce us$ to
 make su* det]m9ation1 9 ! notice &     
comm5t rulemak+ to update ! prospective 
paym5t sy/em "u ?is subsection = su*    
ye>4 ,= purposes ( ! prec$+ s5t5ce1 !   
t]m obs]v$ evid5ce means /ati/ically    
valid data f ! mo/ rec5t co/ report &   
claims reg>d+ *anges 9 ! nature ( home  
heal? ag5cy pati5ts1 patt]ns ( c>e1     
s]vice co/s1 & claims cod+ aft] ,janu>y 
#a1 #bjbj1 reflect+ behavioral *anges   
relat+ to implem5tation ( ! provisions (
 & am5dm5ts made by section #eajja ( !  
,bip>tisan ,budget ,act ( #bjah 7,public
 ,law #aae-abc742  7,c7 9 clause 7ii71  
by ins]t+ attributable to !             
implem5tation ( p>agraphs 7#b77;,b7 &   

7#d77;,b7 aft] exp5ditures2 &  7,d7 9   
clause 7iii7--  7i7 by add+ attributable
 to ! implem5tation ( p>agraphs         
7#b77;,b7 & 7#d77;,b7 aft] exp5ditures2 
&  7ii7 by add+ at ! end ! foll[+3 ,if  
su* a tempor>y increase or decrease does
 n exce$ #b4jj p]c5t 9 any giv5 ye>1 !  
,secret>y %all apply ! entire increase  
or decrease 9 ! next cal5d> ye> paym5t  
update2 h[ev]1 if su* a tempor>y        
increase or decrease exce$s #b4jj1 to   
provide = m9imal disruption to pati5ts &
 provid]s1 ! ,secret>y %all phase 9 !   
tempor>y increase or decrease 9 equal   
am\nts n to exce$ #b4jj p]c5t 9 any giv5
 ye> ?r\gh ! respective cal5d> ye>      
paym5t updates44  7b7 ,effective date ,!
 am5dm5ts made by ?is section %all take 
effect z if includ$ 9 ! enactm5t ( su*  
section #eajja7;a77#b74