,i  #aafth ,,congress  #b;d ,session    
,h4 ,r4 #hhcd  ,,in ,,the ,,house ,,of  
,,representatives  ,december #b1        
#bjbj,mrs4 ,dingell 7for herself1 ,ms4  
,stevens1 ,mr4 ,blumenauer1 and ,mr4    
,thompson of ,california7 introduced the
 following bill2 which was referred to  
the ,committee on ,ways and ,means1 and 
in addition to the ,committee on ,energy
 and ,commerce1 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 extend and
 improve the ,independence at ,home     
,medical ,practice ,demonstration       
,program under the ,medicare program4   
#a4 ,short title ,this ,act may be cited
 as the ,independence at ,home          
,demonstration ,improvement ,act of     
#bjbj4  #b4 ,extending and improving the
 ,independence at ,home ,medical        
,practice ,demonstration ,program under 

the ,medicare program ,section #ahff;,e 
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acie;cc-#e7 is amended-- 7#a7
 in subsection 7e7-- 7,a7 in paragraph  
7#a71 by striking #g and inserting #aj2 
7,b7 in paragraph 7#b7-- 7i7 in the     
header1 by striking ,no physician and   
inserting ,physician2 and  7ii7 by      
adding at the end the following new     
sentence3 ,nothing in the previous      
sentence shall be construed to prohibit 
an independence at home medical practice
 from participating in any model or     
demonstration with a shared savings     
component under this title 7other than  
the program under section #ahii7 or     
under section #aaae;,a if such          
participation is determined appropriate 
by the ,secretary42 and  7,c7 in        
paragraph 7#d7-- 7i7 by redesignating   
subparagraphs 7,a7 through 7,c7 as      
clauses 7i7 through 7iii71 respectively1
 and adjusting the margins accordingly2 
7ii7 in clause 7i71 as so redesignated1 
by inserting are before located2  7iii7 

in clause 7iii71 as so redesignated1 by 
striking the period at the end and      
inserting 2 and2  7iv7 in the matter    
preceding clause 7i71 as so             
redesignated1 by striking to practices  
that are-- and inserting the following3 
to-- 7,a7 practices that--  2 and  7v7  
by adding at the end the following new  
subparagraph3  7,b7 practices with the  
same tax identification number as an    
independence at home medical practice   
approved under this paragraph as of the 
date of the enactment of this           
subparagraph4  2 and  7,d7 in paragraph 
7#e7-- 7i7 in the first sentence1 by    
inserting in #bjai after #ae1jjj2  7ii7 
by inserting ,for each subsequent year1 
the beneficiary limitation in effect    
under this paragraph for the previous   
year 7including1 if applicable1 any     
increase made under this sentence7 shall
 be increased by #e1jjj if the          
,secretary determines that operation of 
the program under this section for such 
previous year resulted in aggregate     

savings under this title for such year  
compared to expenditures under this     
title for such year had such program not
 been in effect4 after the first        
sentence2  7iii7 by striking the        
increase from #aj1jjj to #ae1jjj in the 
preceding sentence and inserting an     
increase2  7iv7 by inserting or the     
amendment made by section #b7a77;,d77ii7
 of the ,independence at ,home          
,demonstration ,improvement ,act of     
#bjbj after ,social ,services ,act2  7v7
 by striking and seventh and inserting  
through tenth2 and  7vi7 by inserting 1 
as applicable after such program2  7#b7 
in subsection 7g7-- 7,a7 by striking    
,the ,secretary shall and inserting the 
following3  7#b7 ,final report ,the     
,secretary shall  2 and  7,b7 by        
inserting before paragraph 7#b71 as     
designated by subparagraph 7,a71 the    
following new paragraph3  7#a7 ,annual  
reports ,the ,secretary shall conduct an
 independent evaluation of the          
demonstration program and submit to     

,congress an annual report at the close 
of each performance year 7beginning with
 performance year #bjba71 including a   
specification of any improvements made  
to the program for such year4 ,such     
report shall include an analysis such   
improvements' impact on coordination of 
care1 expenditures under this title1    
applicable beneficiary access to        
services1 and the quality of health care
 services provided to applicable        
beneficiaries4  2  7#c7 in subsection   
7h71 by striking each of fiscal years   
#bjaj through #bjae and inserting fiscal
 year #bjba2 and  7#d7 by adding at the 
end the following new subsection3  7j7  
,authority ,to implement improvements to
 program ,the ,secretary may make such  
improvements to the demonstration       
program not inconsistent with the       
preceding provisions of this section as 
the ,secretary determines appropriate   
for purposes of-- 7#a7 improving        
coordination of care2  7#b7 lowering    
expenditures2  7#c7 increasing access to

 items and services under the program2  
or  7#d7 improving the quality of items 
and services furnished under the        
program4  4