,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #egda  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,febru>y #c1 #bjbj,ms4
 ,sewell ( ,alabama 7= h]self1 ,mr4     
,smi? ( ,nebraska1 ,mr4 ,crd5as1 ,mr4   
,%imkus1 ,mr4 ,w5/rup1 & ,mr4 ,s*rad]7  
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committees on ,ways &    
,means1 & ,rules1 = 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 ,,xi 
( ! ,social ,security ,act to cl>ify    
p>amet]s = model te/+ & add             
acc\ntability to model expansion "u !   
,c5t] = ,m$ic>e & ,m$icaid ,innovation1 
& = o!r purposes4  #a4 ,%ort title ,?is 
,act may be cit$ z ! ,/r5g!n+           
,innovation 9 ,m$ic>e & ,m$icaid ,act4  
#b4 ,def9+ ,,cmi model te/+ p>amet]s    
7a7 ,scope & duration ( models ,section 
#aaae;,a7a7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acae;a7a77 is am5d$ by  

add+ at ! end ! foll[+ new p>agraph3    
7#f7 ,scope & duration ( models te/$    
,beg9n+ on or aft] ! date ( ! enactm5t (
 ! ,/r5g!n+ ,innovation 9 ,m$ic>e &     
,m$icaid ,act1 = purposes ( te/+ new    
paym5t & s]vice deliv]y models or exp&+ 
paym5t & s]vice deliv] models "u ?is    
section1 ! ,secret>y %all limit te/+ ( a
 model--  7,a7 to a p]iod n to exce$ #e 
ye>s2 &  7,b7 no m applicable           
individuals ?an necess>y to obta9 a     
/ati/ically valid sample4  4  7b7 ,model
 requirem5t waiv]s = h>d%ip ,section    
#aaae;,a7a7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acae;a7a771 z am5d$ by  
subsection 7a71 is fur!r am5d$ by add+  
at ! end ! foll[+ new p>agraph3  7#g7   
,h>d%ip waiv]s ,n lat] ?an #fj days aft]
 ! date ( ! enactm5t ( ! ,/r5g!n+       
,innovation 9 ,m$ic>e & ,m$icaid ,act1 !
 ,secret>y %all develop & implem5t a    
plan to all[ provid]s ( s]vices &       
suppli]s to reque/ a waiv] f any        
requirem5t ( a model if ! ,secret>y     
det]m9es t su* requirem5t w\ld result 9 

undue economic h>d%ip to su* provid] or 
suppli] or loss ( access to su* provid] 
or suppli] = vuln]able populations4  4  
7c7 ,monitor+ impact ,section           
#aaae;,a7a7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acae;a7a771 z am5d$ by  
subsections 7a7 & 7b71 is fur!r am5d$ by
 add+ at ! end ! foll[+ new p>agraph3   
7#h7 ,monitor+ impact ,n lat] ?an #fj   
days aft] ! date ( ! enactm5t ( !       
,/r5g!n+ ,innovation 9 ,m$ic>e &        
,m$icaid ,act1 ! ,secret>y %all develop 
& implem5t a plan to--  7,a7 monitor    
cont9u\sly & on a real-"t basis ! effect
 ( a model "u subsection 7b7 on         
applicable individuals1 & mitigate any  
adv]se impact1 su* z inappropriate      
r$uctions 9 c>e or r$uc$ access to c>e2 
7,b7 assess & track ! impact ( deliv]y &
 paym5t models on heal? disp>ities1 us+ 
exi/+ measures su* z ! ,national        
,quality ,=um ,heal?c>e ,disp>ities &   
,cultural ,compet5cy ,measure2 &  7,c7  
mitigate any adv]se impact t ! ,secret>y
 det]m9es c\ld affect b5efici>y heal?4  

4  #c4 ,implem5tation ( te/+ & expansion
 ( models ) ,congressional inaction     
,section #aaae;,a7d7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acae;a7d77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraph3  7#d7              
,implem5tation ( te/+ & expansion (     
models ) ,congressional inaction  7,a7  
,! ,secret>y %all transmit a proposal = 
! te/+1 expansion1 or modification ( a  
model "u subsection 7b7 or 7c71 includ+ 
a propos$ effective date & a summ>y ( ! 
det]m9ations & c]tification made "u     
p>agraphs 7#a7 ?r\gh 7#c7 ( subsection  
7c71 if applicable1 to ! ,committee on  
,ways & ,means & ! ,committee on ,en]gy 
& ,comm]ce ( ! ,h\se ( ,repres5tatives &
 to ! ,committee on ,f9ance & !         
,committee on ,heal?1 ,education1       
,labor1 & ,p5sions ( ! ,s5ate4  7,b7 ,! 
te/+1 expansion1 or modification ( model
 propos$ 9 a report submitt$ "u         
subp>agraph 7,a7 %all be c>ri$ out by ! 
,secret>y if ! ,congress does n1 )9 #de 
days ( receiv+ a report transmitt$ f !  

,secret>y detail+ ! propos$ te/+ or     
expansion includ+ ! propos$ effective   
date = su* te/+ or expansion & a summ>y 
( ! det]m9ations & c]tification made "u 
p>agraphs 7#a7 ?r\gh 7#c71 pass a jo9t  
resolution disapprov+ ( ! propos$ te/+  
or expansion 9 accordance ) ! foll[+    
proc$ure3  7i7 ,! succe$+ subp>agraphs (
 ?is p>agraph are enact$ by ,congress z 
an ex]cise ( ! rulemak+ p[] ( ! ,s5ate &
 ! ,h\se ( ,repres5tatives1             
respectively1 & z su* !y %all be deem$ a
 "p ( ! rules ( ea* ,h\se1 respectively1
 b applicable only ) ! respect to !     
proc$ure to be foll[$ 9 t ,h\se 9 ! case
 ( resolutions describ$ 9 subp>agraph   
7,b74 ,!y %all sup]s$e o!r rules only to
 ! ext5t t !y are inconsi/5t !re)4 ,!y  
are enact$ ) full recognition ( !       
con/itutional "r ( ei!r ,h\se to *ange !
 rules 7s f> z relat+ to ! proc$ure ( t 
,h\se7 at any "t1 9 ! same mann] & to ! 
same ext5t z 9 ! case ( any ruse ( t    
,h\se4  7ii7 ,= ! purpose ( ! succe$+   
provisions ( ?is subp>agraph1           

8resolution0 means only a jo9t          
resolution1 ! matt] aft] ! resolv+      
clause ( :i* is z foll[s3 #8,t ,congress
 disapproves ! model expansion reque/$  
pursuant to section #aaae;,a7c7 ( !     
,social ,security ,act transmitt$ by !  
,secret>y on 1 & su* an expansion %all n
 proce$4'1 ! blank space !re9 be+ fill$ 
) ! date on :i* ! ,secret>y's message   
propos+ su* expansion 0 deliv]$4  7iii7 
,^u receipt ( a report submitt$ to      
,congress "u subp>agraph 7c77#d71 ea*   
,h\se %all provide copies ( ! report to 
! *airman & rank+ memb] ( ! ,committee  
on ,ways & ,means & ! ,committee on     
,en]gy & ,comm]ce ( ! ,h\se (           
,repres5tatives & to ! ,committee on    
,f9ance & ! ,committee on ,heal?1       
,education1 ,labor1 & ,p5sions ( !      
,s5ate4  7iv7 ,a resolution %all be     
ref]r$ to ! ,committee on ,ways & ,means
 & ! ,committee on ,en]gy & ,comm]ce ( !
 ,h\se ( ,repres5tatives & to !         
,committee on ,f9ance & ! ,committee on 
,heal?1 ,education1 ,labor1 & ,p5sions (

 ! ,s5ate4  7v7 ,if a committee to :i*  
has be5 ref]r$ a resolution has n       
report$ x be=e ! expiration ( #aj       
legislative days aft] its introduction1 
x %all !n 7b n be=e7 be 9 ord] to move  
to dis*>ge ! committee f fur!r          
consid]ation ( t resolution1 or to      
dis*>ge ! committee f fur!r consid]ation
 ( any o!r resolution ) respect to !    
propos$ expansion :i* has be5 ref]r$ to 
! committee4 ,! motion to dis*>ge may be
 made only by a p]son favor+ !          
resolution1 %all be highly privileg$    
7except t x may n be made aft] !        
committee has report$ a resolution )    
respect to ! same propos$ expansion71 & 
debate !reon %all be limit$ to n m ?an  
#a h\r1 to be divid$ equally betwe5 ^?  
favor+ & ^? oppos+ ! resolution4 ,an    
am5dm5t to ! motion is n 9 ord]1 & x is 
n 9 ord] to move to reconsid] ! vote by 
:i* ! motion is agre$ to or disagre$ to4
 ,if ! motion to dis*>ge is agre$ to or 
disagre$ to1 ! motion may n be r5ew$1   
nor may ano!r motion to dis*>ge !       

committee be made ) respect to any o!r  
resolution ) respect to ! same propos$  
expansion4  7vi7 ,:5 ! committee has    
report$1 or has be5 dis*>g$ f fur!r     
consid]ation ( a resolution1 x is at any
 "t !reaft] 9 ord] 7ev5 ?\gh a previ\s  
motion to ! same effect has be5 disagre$
 to7 to move to proce$ to ! consid]ation
 ( ! resolution4 ,! motion is highly    
privileg$ & is n debatable4 ,an am5dm5t 
to ! motion is n 9 ord]1 & x is n 9 ord]
 to move to reconsid] ! vote by :i* !   
motion is agre$ to or disagre$ to4      
,debate on ! resolution %all be limit$  
to n m ?an #b h\rs1 :i* %all be divid$  
equally betwe5 ^? favor+ & ^? oppos+ !  
resolution4 ,a motion fur!r to limit    
debate is n debatable4 ,an am5dm5t to1  
or motion to recommit1 ! resolution is n
 9 ord]1 & x is n 9 ord] to move to     
reconsid] ! vote by :i* ! resolution is 
agre$ to or disagre$ to4  7vii7 ,motions
 to po/pone1 made ) respect to ! dis*>ge
 f committee1 or ! consid]ation (1 a    
resolution & motions to proce$ to !     

consid]ation ( o!r bus9ess %all be      
decid$ )\t debate4 ,appeals f ! decision
 ( ! ,*air relat+ to ! application ( !  
rules ( ! ,s5ate or ! ,h\se (           
,repres5tatives1 z ! case may be1 to !  
proc$ure relat+ to a resolution %all be 
decid$ )\t debate4  7viii7 ,coord9ation 
) action by o!r ,h\se ,if1 be=e !       
passage by "o ,h\se ( a jo9t resolution 
( t ,h\se1 t ,h\se receives f ! o!r     
,h\se a jo9t resolution1 !n ! foll[+    
proc$ures %all apply3  7,i7 ,! jo9t     
resolution ( ! o!r ,h\se %all n be      
ref]r$ to a committee4  7,,ii7 ,)       
respect to a jo9t resolution ( ! ,h\se  
receiv+ ! resolution1 ! proc$ure 9 t    
,h\se %all be ! same z if no jo9t       
resolution _h be5 receiv$ f ! o!r ,h\se1
 ! vote on passage %all be on ! jo9t    
resolution ( ! o!r ,h\se4  7ix7 ,if "o  
,h\se fails to introduce or consid] a   
jo9t resolution "u ?is section1 ! jo9t  
resolution ( ! o!r ,h\se %all be entitl$
 to exp$it$ floor proc$ures "u ?is      
section4  7x7 ,if1 foll[+ passage ( !   

jo9t resolution 9 ! ,s5ate1 ! ,s5ate !n 
receives ! companion measure f ! ,h\se (
 ,repres5tatives1 ! companion measure   
%all n be debatable4  7xi7 ,if ,congress
 passes a jo9t resolution1 ! p]iod      
beg9n+ on ! date ! ,presid5t is pres5t$ 
) ! jo9t resolution & end+ on ! date !  
,presid5t takes action ) respect to !   
jo9t resolution %all be disreg>d$ 9     
comput+ ! #de-;cal5d> day p]iod describ$
 9 subp>agraph 7c77#d74  7xii7 ,if !    
,presid5t vetoes ! jo9t resolution--    
7,i7 ! p]iod beg9n+ on ! date !         
,presid5t vetoes ! jo9t resolution &    
end+ on ! date ! ,congress receives !   
veto message ) respect to ! jo9t        
resolution %all be disreg>d$ 9 comput+ !
 #de-;cal5d> day p]iod describ$ 9       
subp>agraph 7c77#d71 &  7,,ii7 debate on
 a veto message 9 ! ,s5ate "u ?is       
section %all be #a h\r equally divid$   
betwe5 ! majority & m9ority lead]s or _!
 designees4  4  #d4 ,public input &     
consultation ,section #aaae;,a7d7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   

#acae;a7d771 z am5d$ by section #c1 is  
fur!r am5d$ by add+ at ! end ( ! foll[+ 
new p>agraphs3  7#f7 ,public input ,!   
,secret>y %all use a process involv+    
advance public notice & an opportunity =
 /akehold] input & public comm5ts to    
ensure transp>5cy & acc\ntability reg>d+
 ! e/abli%m5t1 te/+1 implem5tation1     
evaluation1 & expansion ( a model "u    
subsections 7b7 & 7c7 ( section         
#aaae;,a4 ,su* public notice %all       
describe & def9e ! /&>ds1 crit]ia1 &    
processes t ! ,secret>y w use = select+ 
& evaluat+--  7,a7 dur+ initial /ages ( 
model developm5t2  7,b7 prior to te/+ "u
 section 7b77#a72  7,c7 prior to        
modification ( non-contractual models "u
 section 7b77#c77;,b72 &  7,d7 foll[+   
evaluation ( a model "u section 7b77#d7 
& prior to rulemak+ "u section 7c74     
,su* notice %all expla9 ! basis = !     
,secret>y's det]m9ation t ! conditions  
set =? 9 subsection 7c7 h be5 met4      
,additionally1 ! notice %all expla9 !   
basis = selection & ! /&>ds e/abli%$ by 

! ,secret>y "u ! regulations issu$ "u   
p>agraph 7#a71 & any additional factors 
t w be us$ to te/ ! model's impact on   
quality ( c>e1 pati5t-c5t]$ness1 &      
innovation4 ,! notice %all provide a    
m9imum #de-;day p]iod = public comm5t4  
,! ,secret>y %all take /akehold] comm5ts
 into consid]ation :5 det]m9+ :e!r or h[
 to ref9e ! model or :e!r to proce$ )   
te/+ "u subsection 7b77#a74  7#g7       
,consultation ,9 c>ry+ out ! duties "u  
?is section1 ! ,,cmi %all consult       
repres5tatives ( relevant ,f$]al        
ag5cies1 & cl9ical & analytical exp]ts )
 exp]tise 9 m$ic9e & heal? c>e          
managem5t1 specifically su* exp]ts )    
exp]tise 9--  7,a7 ! heal? c>e ne$s (   
m9ority1 rural1 & und]s]v$ populations2 
&  7,b7 ! f9ancial ne$s ( safety net1   
community bas$1 rural1 & critical access
 provid]s1 includ+ f$]ally qualifi$     
heal? c5t]s4  ,! ,,cmi %all use op5 door
 =ums or o!r me*anisms to seek ext]nal  
fe$back f int]e/$ p>ties & incorporate t
 fe$back into ! developm5t ( models4  4 

#e4 ,ree/abli%+ judicial review ,section
 #aaae;,a7d77#b7 ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #acae;a7d77#b77 is  
am5d$-- 7#a7 9 ! matt] prec$+           
subp>agraph 7,a71 by ins]t+ aft] or     
o!rwise ! foll[+3 7except z may be      
necess>y to en=ce requirem5ts ( ?is     
section or o!r laws or con/itutional    
provisions int5d$ to protect b5efici>ies
 ( affect$ programs72  7#b7 by /rik+    
subp>agraph 7,c72  7#c7 9 subp>agraph   
7,d71 by add+ at ! end 2 &2  7#d7 by    
r$esignat+ subp>agraph 7,d7 z           
subp>agraph 7,c72  7#e7 9 subp>agraph   
7,e71 at ! end1 by /rik+ 2 & & ins]t+ a 
p]iod2  7#f7 by r$esignat+ subp>agraph  
7,e7 z subp>agraph 7,d72 &  7#g7 by     
/rik+ subp>agraph 7,f74  #f4 ,revision (
 report+ requirem5t ,section #aaae;,a7g7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acae;a7g77 is am5d$-- 7#a7 by
 /rik+ & n less ?an once e o!r ye>      
!reaft] & ins]t+ &1 = ye>s be=e #bjbj1 n
 less ?an once bi5nially 7&1 = ye>s     
beg9n+ ) #bjbj1 n less ?an annually7    

!reaft]2 &  7#b7 by add+ at ! end !     
foll[+ new s5t5ce3 ,) respect to #bjbj &
 ea* subsequ5t ye>1 ! ,secret>y %all    
submit ea* su* report by n lat] ?an     
,decemb] #ae ( su* ye>44  #g4 ,address+ 
ov]lap 9 value bas$ c>e programs  7a7 ,9
 g5]al  7#a7 ,,cmi ,section             
#aaae;,a7a77#e7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acae;a7a77#e77 is  
am5d$ by add+ at ! end ! foll[+ new     
s5t5ce3 ,9 e/abli%+ su* limits1 !       
,secret>y %all take into acc\nt paym5t &
 s]vice deliv]y models 9 progress 9 su* 
geographic areas44  7#b7 ,repeal (      
,m$ic>e duplication prohibition ,section
 #ahii7;b77#d7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acie;jjj7b77 is    
am5d$ by /rik+ subp>agraph 7,a74  7b7   
,report ,n lat] ?an #fj days aft] ! date
 ( ! enactm5t ( ?is ,act1 ! ,secret>y ( 
,heal? & ,human ,s]vices %all conduct an
 assessm5t & submit to ,congress a      
report on alt]native paym5t model ov]lap
 "u ! ,m$ic>e program "u title ,,xviii (
 ! ,social ,security ,act4 ,su* report  

%all include a description ( &          
recomm5dations relat+ to--  7#a7 any    
issues reg>d+ ! exi/5ce ( multiple      
alt]native paym5t model p>ticipation    
opportunities = heal? c>e provid]s2 &   
7#b7 ob/acles creat$ by compet+         
inc5tives ) respect to alt]native paym5t
 models4  #h4 ,,gao report ,n lat] ?an  
#ab mon?s aft] ! date ( enactm5t ( ?is  
,act1 ! ,comptroll] ,g5]al ( ! ,unit$   
,/ates %all submit to ,congress a report
 on ! ef=ts ( ! ,c5t] = ,m$ic>e &       
,m$icaid ,innovation to attract1 reta91 
& develop em]g+ exp]ts1 includ+         
"u-repres5t$ individuals 9 m$ic9e1 su* z
 wom51 racial & e?nic m9orities1 & o!r  
gr\ps4 ,su* report %all include an      
analysis ( ! impact ( ! exi/+ au?ority  
provid$ to ! ,c5t] = ,m$ic>e & ,m$icaid 
,innovation to address work=ce %ortages 
& gaps 9 priority areas4  #i4 ,models   
specifically to improve quality ( c>e   
7a7 ,cl>ification ( model eligibility   
,section #aaae;,a ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acae;a7 is am5d$-- 

7#a7 9 subsection 7a77#a7--  7,a7 by    
/rik+ :ile pres]v+ or enhanc+ ! quality 
( c>e & ins]t+ or to enhance quality (  
c>e2 &  7,b7 by /rik+ also be=e improve2
 &  7#b7 9 subsection 7b77#b77;,a7 by   
ins]t+ aft] ! second s5t5ce ! foll[+ new
 s5t5ce3 ,! ,secret>y may also focus on 
models solely aim$ at practices to      
significantly improve ! c>e & heal?     
outcomes ( individuals receiv+ b5efits  
"u ! applicable title 9 anticipation t  
quality ( c>e b5efits & pot5tial direct 
or indirect sav+s w accrue to ! ,m$ic>e 
or ,m$icaid program44  7b7 ,additional  
opportunity ,section                    
#aaae;,a7b77#b77;,b7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acae;a7b77#b77;,b77 is am5d$ by add+ at
 ! end ! foll[+ new clause3  7xxviii7   
,implem5t+ newly recogniz$ &            
evid5ce-bas$1 pr(essionally support$ c>e
 deliv]y practices & bundles to improve 
! effici5t & effective deliv]y (        
hospital-bas$ c>e & lead to enhanc$     
pati5t outcomes1 r$uctions 9            

readmissions1 or avoidance ( co/ly      
m$ical errors or complications4  4  7c7 
,inclusion ( indirect sav+s ,section    
#aaae;,a7b77#c77;,a7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acae;a7b77#c77;,a77 is am5d$ by ins]t+ 
at ! end or t sav+s _c be made          
indirectly ov] "t :5 te/+ quality ( c>e 
deliv]y models44  7d7 ,evaluat+ quality 
( c>e ,section #aaae;,a7b77#d7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acae;a7b77#d77 is am5d$-- 7#a7 9       
subp>agraph 7,a71 by am5d+ clause 7i7 to
 read z foll[s3  7i7 ! quality ( c>e    
furni%$ "u ! model1 includ+ ! measurem5t
 ( pati5t-level outcomes1               
pati5t-c5t]$ness1 & any un9t5d$         
consequ5ces1 su* z access to s]vices1   
us+ crit]ia det]m9$ appropriate by !    
,secret>y = ea* model2 &  2 &  7#b7 9   
subp>agraph 7,c71 by /rik+ & be=e       
pati5t-c5t]$ c>e & ins]t+ 1 are         
appropriate to issues ( quality outcomes
 relat$ to ! m$ical conditions "u /udy1 
& are4  #aj4 ,effective date ,except z  

o!rwise provid$ 9 ! previ\s sections (  
?is ,act 7or ! am5dm5ts made by su*     
sections71 su* am5dm5ts %all apply )    
respect to ! te/+1 expansion1 or        
modification ( models on or aft] ,janu>y
 #a1 #bjbj4