,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #ggia  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #bd1 #bjbj,mr4  
,wel* 7= himself1 ,ms4 ,del,bene1 & ,mr4
 ,la,hood7 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 direct !        
,secret>y ( ,heal? & ,human ,s]vices to 
revise c]ta9 regulations 9 relation to !
 ,m$ic>e %>$ sav+s program & o!r advanc$
 alt]native paym5t arrangem5ts to       
enc\rage p>ticipation 9 su* program1 & =
 o!r purposes4  #a4 ,%ort title ,?is    
,act may be cit$ z ! ,value 9 ,heal?    
,c>e ,act ( #bjbj4  #b4 ,enc\rag+       
p>ticipation 9 ! ,m$ic>e %>$ sav+s      
program  7a7 ,increas+ %>$ sav+s rates =
 c]ta9 acc\ntable c>e organizations     
,prior to ! beg9n+ ( ! fir/ p]=mance ye>
 7z def9$ 9 section #dbe4bj ( title #db1

 ,code ( ,f$]al ,regulations 7or a      
successor regulation77 t beg9s aft] !   
date ( ! enactm5t ( ?is ,act1 !         
,secret>y ( ,heal? & ,human ,s]vices    
%all revise section #dbe4fje7;d77#a7 (  
title #db1 ,code ( ,f$]al ,regulations  
7or a successor regulation71 to provide 
t ! %>$ sav+s rate = an acc\ntable c>e  
organization p>ticipat+ 9-- 7#a7 ,level 
,a 7z describ$ 9 p>agraph 7i77,a7 ( su* 
section7 or ,level ,b 7z describ$ 9     
p>agraph 7ii77,a7 ( su* section7 ( !    
,,basic track %all be at lea/ #ej p]c5t 
( all ! sav+s "u ! updat$ b5*m>k 7z s   
describ$71 z det]m9$ on ! basis ( su*   
organization's quality p]=mance2  7#b7  
,level ,c 7z describ$ 9 p>agraph        
7iii77,a7 ( su* section7 or ,level ,d 7z
 describ$ 9 p>agraph 7iv77,a7 ( su*     
section7 ( ! ,,basic track %all be at   
lea/ #ee p]c5t ( all ! sav+s "u ! updat$
 b5*m>k 7z s describ$71 z det]m9$ on !  
basis ( su* organization's quality      
p]=mance2 or  7#c7 ,level ,e 7z describ$
 9 p>agraph 7v77,a7 ( su* section7 %all 

be at lea/ #fj p]c5t ( all ! sav+s "u ! 
updat$ b5*m>k 7z s describ$71 z det]m9$ 
on ! basis ( su* organization's quality 
p]=mance4  7b7 ,modify+ risk adju/m5t   
me?odology ,prior to ! beg9n+ ( ! fir/  
p]=mance ye> 7z def9$ = purposes (      
subsection 7a77 t beg9s aft] ! date ( ! 
enactm5t ( ?is ,act1 ! ,secret>y (      
,heal? & ,human ,s]vices %all revise--  
7#a7 section #dbe4fje7;a77#a77;i7 (     
title #db1 ,code ( ,f$]al ,regulations1 
or a successor regulation1 to provide t 
positive adju/m5ts1 if applicable1 9    
prospective ,,hcc risk scores 7z appli$ 
= purposes ( su* section7 are subject to
 a cap ( no less ?an #e p]c5t1 & any    
negative adju/m5ts1 if applicable1 9    
prospective ,,hcc risk scores 7z appli$ 
= purposes ( su* section7 %all be betwe5
 #j & negative #e p]c5t2  7#b7 section  
#dbe4faj7;a77#b77;i7 ( title #db1 ,code 
( ,f$]al ,regulations1 or a successor   
regulation1 to provide t positive       
adju/m5ts1 if applicable1 9 prospective 
,,hcc risk scores 7z appli$ = purposes (

 su* section7 are subject to a cap ( no 
less ?an #e p]c5t1 & any negative       
adju/m5ts1 if applicable1 9 prospective 
,,hcc risk scores 7z appli$ = purposes (
 su* section7 %all be betwe5 #j &       
negative #e p]c5t2 &  7#c7 section      
#dbe4fji7;c77#c77;i77,a7 ( title #db1   
,code ( ,f$]al ,regulations1 or a       
successor regulation1 to provide t ! cap
 describ$ 9 su* section ref]5ces no less
 ?an #e p]c5t1 & any negative adju/m5ts1
 if applicable1 9 prospective ,,hcc risk
 scores 7z appli$ = purposes ( su*      
section7 %all be betwe5 #j & negative #e
 p]c5t4  7c7 ,remov+ b>ri]s to %>$ sav+s
 program p>ticipation ,prior to ! beg9n+
 ( ! fir/ p]=mance ye> 7z def9$ =       
purposes ( subsection 7a77 t beg9s aft] 
! date ( ! enactm5t ( ?is ,act1 !       
,secret>y ( ,heal? & ,human ,s]vices    
%all revise "p #dbe ( title #db1 ,code (
 ,f$]al ,regulations1 or any successor  
regulation1 to-- 7#a7 elim9ate any      
di/9ction 9 requirem5ts 9 su* "p betwe5 
a l[ rev5ue ,,aco & a high rev5ue ,,aco 

7z su* t]ms are def9$ 9 section #dbe4bj 
( title #db1 ,code ( ,f$]al             
,regulations1 or a successor regulation7
 &1 ) respect to su* a l[ rev5ue ,,aco  
or high rev5ue ,,aco & except z o!rwise 
modifi$ 9 ?is ,act1 apply ! requirem5ts 
( su* "p z su* requirem5ts appli$ to l[ 
rev5ue ,a,c,os on ,july #a1 #bjai1      
except t ! ,secret>y ( ,heal? & ,human  
,s]vices may1 if ! ,secret>y det]m9es   
appropriate1 apply less /r+5t           
requirem5ts ?an ^? requirem5ts t appli$ 
to l[ rev5ue ,a,c,os z ( su* date2 &    
7#b7 remove any provision requir+ an    
acc\ntable c>e organization to assume   
responsibility = repaym5t ( any %>$     
losses or p>ticipate 9 a two-sid$ risk  
model be=e ! organization has p>ticipat$
 = at lea/ #c ye>s 9 any program subject
 to ! provisions ( "p #dbe ( title #db1 
,code ( ,f$]al ,regulations1 or any     
successor regulation1 provid$ t su* an  
organization %all be all[$ to elect to  
p>ticipate 9 su* two-sid$ risk models or
 models requir+ repaym5t ( su* losses4  

7d7 ,ensur+ fair & accurate b5*m>ks     
,prior to ! beg9n+ ( ! fir/ p]=mance ye>
 7z def9$ = purposes ( subsection 7a77 t
 beg9s aft] ! date ( ! enactm5t ( ?is   
,act1 ! ,secret>y ( ,heal? & ,human     
,s]vices %all revise "p #dbe ( title    
#db1 ,code ( ,f$]al ,regulations1 to    
remove ,m$ic>e b5efici>ies :o are       
assign$ to an acc\ntable c>e            
organization f ! me?odology = calculat+ 
! regional exp5ditures us$ to e/abli%1  
adju/1 & update ! b5*m>k exp5ditures =  
,,aco p]=mance p]iods beg9n+ on or aft] 
,july #a1 #bjai4  #c4 ,provid+          
educational & te*nical support = !      
,m$ic>e %>$ sav+s program ,section #ahii
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;jjj7 is am5d$ by add+ at
 ! end ! foll[+ new subsection3  7n7    
,educational & te*nical support  7#a7 ,9
 g5]al ,! ,secret>y %all e/abli% a      
program to assi/ eligible ,a,c,os 9     
meet+ />t-up & ongo+ op]ational co/s    
associat$ ) e/abli%+ & p>ticipat+ 9 !   
%>$ sav+s program e/abli%$ "u subsection

 7a74 ,! ,secret>y %all e/abli% ?r\gh   
notice-&-comm5t rulemak+ ! requirem5ts =
 p>ticipation & use ( funds 9 ! program 
e/abli%$ 9 ! prec$+ s5t5ce4  7#b7       
,r$uction 9 %>$ sav+s paym5ts ,!        
,secret>y %all r$uce any %>$ sav+s      
paym5t ow$ to an ,,aco "u subsection 7d7
 9 an am\nt equal to any funds provid$  
to su* ,,aco "u ! program e/abli%$ "u   
p>agraph 7#a74  4  #d4 ,advanc$ paym5t  
model inc5tive1 p>ticipation1 & ?re%old 
modifications  7a7 ,9 g5]al ,section    
#ahcc7z7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciel7z77 is am5d$-- 7#a7 9 
p>agraph 7#a77;,a71 by /rik+ #bjbd &    
ins]t+ #bjcj2 &  7#b7 9 p>agraph 7#b7-- 
7,a7 9 subp>agraph 7,b7-- 7i7 by /rik+ !
 head] & ins]t+ #bjba & subsequ5t ye>s2 
7ii7 9 ! matt] prec$+ clause 7i71 by    
/rik+ #bjba & #bjbb & ins]t+ #bjba or a 
subsequ5t ye>2  7iii7 9 clause 7i71 by  
/rik+ #ej p]c5t & ! applicable p]c5t 7z 
def9$ 9 clause 7iv77 = su* ye>2  7iv7 9 
clause 7ii77,i7-- 7,i7 9 ! matt] prec$+ 
item 7aa71 by /rik+ #ej p]c5t & ins]t+ !

 applicable p]c5t 7z def9$ 9 clause     
7iv77 = su* ye>2 &  7,,ii7 9 item 7bb7--
 7aa7 by /rik+ & o!r ?an paym5ts made "u
 title ,,xix & ins]t+ o!r ?an paym5ts   
made "u title ,,xix2 &  7bb7 by /rik+   
,/ate program "u t title71 & ins]t+     
,/ate program "u t title1 & o!r ?an     
paym5ts made by pay]s 9 :i* no paym5t or
 program meet+ ! requirem5ts describ$ 9 
clause 7iii77,,ii7 is available f ! pay]
 = p>ticipation by ! eligible           
pr(essional72 &  7v7 by add+ at ! end ! 
foll[+ new clause3  7iv7 ,applicable    
p]c5t def9$ ,= purposes ( clauses 7i7 & 
7ii71 ! t]m applicable p]c5t means--    
7,i7 = #bjba1 #ej p]c5t2 &  7,,ii7 = a  
subsequ5t ye>1 a p]c5t specifi$ by !    
,secret>y1 b 9 no case less ?an ! p]c5t 
specifi$ "u ?is clause = ! prec$+ ye> or
 m ?an #e p]c5tage po9ts high] ?an !    
p]c5t specifi$ "u ?is clause = su*      
prec$+ ye>4  2  7,b7 by /rik+           
subp>agraph 7,c72 &  7,c7 by r$esignat+ 
subp>agraph 7,d7 z subp>agraph 7,c74    
7b7 ,p>tial qualify+ ,,apm p>ticipant   

modifications ,section                  
#ahdh7q77#a77;,c77iii7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7q77#a77;,c77iii77 is am5d$--  
7#a7 9 subclause 7,i71 by add+ & at !   
end2  7#b7 9 subclause 7,,ii7-- 7,a7 9 !
 matt] prec$+ item 7aa71 by /rik+ #bjbb 
& ins]t+ subsequ5t ye>s2  7,b7 9 item   
7aa71 by /rik+ #ej p]c5t 0 in/ead a     
ref]5ce to #dj p]c5t & ins]t+ !         
applicable p]c5t 7 in/ead a ref]5ce to  
#aj p]c5tage po9ts less ?an ! applicable
 p]c5t2 &  7,c7 9 item 7bb7-- 7i7 by    
/rik+ #ej p]c5t & ins]t+ ! applicable   
p]c5t2 &  7ii7 by /rik+ #dj p]c5t &     
ins]t+ #aj p]c5tage po9ts less ?an !    
applicable p]c5t2 &  7#c7 by /rik+      
subclause 7,,iii74  7c7 ,effective date 
,! am5dm5ts made by ?is section %all    
apply ) respect to ye>s beg9n+ on or    
aft] ,janu>y #a1 #bjba4  #e4 ,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$ic>e duplication prohibition ,section
 #ahii7;b7 ( ! ,social ,security ,act   
7#db ,u4,s4,c4 #acie;jjj7b77 is am5d$ by
 /rik+ p>agraph 7#d74  7b7 ,report ,n   
lat] ?an #a ye> 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 9 !  
,m$ic>e program4 ,su* report %all       
include a description ( & recomm5dations
 relat+ to-- 7#a7 any issues reg>d+ !   
exi/5ce ( multiple alt]native paym5t    
model p>ticipation opportunities = heal?
 c>e provid]s2 &  7#b7 ob/acles creat$  
by compet+ inc5tives ) respect to       
alt]native paym5t models4