,i #aafth ,,congress #ast ,session ,h4 ,r4 #bbhb ,,in ,,the ,,house ,,of ,,representatives ,april #aj1 #bjai,mr4 ,ruiz 7for himself1 ,mr4 ,bucshon1 ,mr4 ,kind1 and ,mr4 ,marchant7 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 #bjai4 #b4 ,modernization of limitations on physician self-referral 7a7 ,facilitation of 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 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 7i7 ,in general ,for purposes of subparagraph 7,a71 the term covered ,,apm entity means1 subject to clause 7ii7 of this subparagraph and subparagraph 7,c71 each of the following3 7,i7 ,an eligible alternative payment entity as defined in paragraph 7#c77;,d74 7,,ii7 ,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 7,,iii7 ,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 7,,iv7 ,an entity participating in any other model that the ,secretary determines is a covered ,,apm entity for purposes of subparagraph 7,a71 including such a determination made pursuant to one or more physicians submitting a proposal to the ,secretary for an alternative payment model4 7ii7 ,inclusion of certain entities ,such term may include an entity engaging in activities that the ,secretary has determined constitute significant progress toward establishing a model referred to in any of subclauses 7,i7 through 7,,iv74 ,any waiver under this paragraph with respect to an entity described in the preceding sentence may only be approved for three years4 7,c7 ,certain requirements ,a model referred to in any of subclauses 7,i7 through 7,,iv7 of subparagraph 7,b77i7 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 ,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 items and services furnished pursuant to an arrangement that meets the requirements described in subparagraph 7,b7 entered into for the purpose of developing or operating a covered ,,apm entity 7as defined in section #ahcc7z77#e77;,b771 including-- 7i7 an advanced alternative payment model described in section #ahcc7z7 7including a physician-focused payment model referred to in section #ahfh7;c772 7ii7 a ,,mips ,,apm 7as defined by the ,secretary72 and 7iii7 any other alternative payment model that the ,secretary may1 by regulation1 specify4 7,b7 ,requirements 7i7 ,in general ,subject to clause 7ii71 the requirements described in this subparagraph with respect to an arrangement relating to an alternative payment model are as follows3 7,i7 ,the arrangement is in writing1 identifies the services1 items1 or actions subject to the arrangement and is signed by the parties to the arrangement4 7,,ii7 ,the arrangement includes a description of the alternative payment model4 7,,iii7 ,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 model4 7,,iv7 ,the arrangement meets such other requirements as the ,secretary may impose by regulation as needed to protect against a significant risk of program or patient abuse4 7ii7 ,clarification ,the ,secretary shall not prohibit or restrict an arrangement from meeting the requirements described in this subparagraph on the basis that the arrangement takes into account the volume or value of referrals if such arrangement otherwise meets the requirements described in clause 7i74 4