,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #abjb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,april #aa1 #bjai,mr4  
,m>key 7= himself & ,mr4 ,portman7      
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide = a p]man5t ,indep5d5ce at ,home
 m$ical practice program "u ! ,m$ic>e   
program4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,indep5d5ce at ,home ,act ( 
#bjai4  #b4 ,indep5d5ce at home m$ical  
practice program  7a7 ,program ,title   
,,xviii ( ! ,social ,security ,act is   
am5d$ by ins]t+ aft] section #ahff;,f ! 
foll[+ new section3  #ahff;,g4          
,indep5d5ce at home m$ical practice     
program  7a7 ,e/abli%m5t  7#a7 ,9 g5]al 
,n lat] ?an ,janu>y #a1 #bjba1 !        
,secret>y %all e/abli% & implem5t a     
national indep5d5ce at home m$ical      
practice program 79 ?is section ref]r$  
to z ! ,program7 t utilizes prim>y c>e  
teams t--  7,a7 are direct$ by          

physicians1 nurse practition]s1 or      
physician assi/ants2 &  7,b7 emphasize  
home-bas$ c>e t is design$ to r$uce     
exp5ditures & improve heal? outcomes 9 !
 provision ( items & s]vices "u ?is     
title to applicable b5efici>ies4  7#b7  
,goals ,"u ! ,program1 an indep5d5ce at 
home m$ical practice %all be acc\ntable 
= provid+ compreh5sive1 coord9at$1      
cont9u\s1 & accessible c>e to applicable
 b5efici>ies at home & coord9at+ heal?  
c>e across all treatm5t sett+s1 result+ 
9--  7,a7 r$uc+ prev5table              
hospitalizations2  7,b7 prev5t+ hospital
 readmissions2  7,c7 r$uc+ em]g5cy room 
visits2  7,d7 improv+ heal? outcomes    
comm5surate ) ea* applicable b5efici>y's
 /age ( *ronic illness2  7,e7 improv+ ! 
effici5cy ( c>e1 su* z by r$uc+         
duplicative diagno/ic & laboratory te/s2
  7,f7 r$uc+ ! co/ ( items & s]vices    
cov]$ "u ?is title2 &  7,g7 a*iev+      
applicable b5efici>y & family c>egiv]   
satisfaction4  7b7 ,indep5d5ce at home  
m$ical practice  7#a7 ,indep5d5ce at    

home m$ical practice def9$ ,9 ?is       
section3  7,a7 ,9 g5]al ,! t]m          
indep5d5ce at home m$ical practice means
 a legal entity t meets ea* ( ! foll[+  
requirem5ts3 7i7 ,! entity is compris$ (
 an individual physician1 nurse         
practition]1 or physician assi/ant or   
gr\p ( su* practition]s t furni%es c>e z
 "p ( a team t may include physicians1  
nurse practition]s1 nurses1 physician   
assi/ants1 ph>maci/s1 lic5s$ m5tal heal?
 practition]s1 social work]s1 & o!r     
heal? & social s]vices /aff1 z          
appropriate4  7ii7 ,! entity is         
organiz$1 at lea/ 9 "p1 = ! purpose (   
furni%+ physicians' s]vices4  7iii7 ,!  
entity--  7,i7 has exp]i5ce 9 furni%+   
home-bas$ prim>y c>e s]vices to         
applicable b5efici>ies1 z det]m9$       
appropriate by ! ,secret>y2  7,,ii7     
makes 9-home visits2 &  7,,iii7 is      
available #bd h\rs p] day1 sev5 days p] 
week1 to c>ry out plans ( c>e t are     
tailor$ to an applicable b5efici>y's    
*ronic conditions & design$ to a*ieve ! 

goals describ$ 9 subp>agraphs 7,a7 ?r\gh
 7,g7 ( subsection 7a77#b74  7iv7 ,!    
entity ent]s into an agreem5t ) !       
,secret>y4  7v7 ,! entity furni%es      
s]vices to at lea/ #bjj applicable      
b5efici>ies dur+ ea* ye> cov]$ "u !     
agreem5t unless ! ,secret>y det]m9es t a
 l[] m9imum numb] ( applicable          
b5efici>ies is necess>y = ! goals ( !   
,program to be a*iev$4  7vi7 ,! entity  
uses c]tifi$ electronic heal? record    
te*nology & may use remote monitor+1    
mobile diagno/ic te*nology1 teleheal?1 &
 o!r communications-bas$ te*nology      
s]vices1 z det]m9$ appropriate by !     
,secret>y4  7vii7 ,! entity meets su*   
o!r crit]ia z ! ,secret>y det]m9es to be
 appropriate to p>ticipate 9 ! ,program4
  7,b7 ,physician ,! t]m physician means
 a physician describ$ 9 section         
#ahfa7r77#a7 :o has ! m$ical tra9+ or   
exp]i5ce to fulfill ! physician's role  
describ$ 9 subp>agraph 7,a77i74  7#b7   
,inclusion ( affiliat$ provid]s &       
practition]s ,no?+ 9 ?is subsection %all

 prev5t an indep5d5ce at home m$ical    
practice f includ+ provid]s ( s]vices1  
practition]s describ$ 9 section         
#ahdb7;b77#ah77;,c71 or o!r             
practition]s1 includ+ ph>maci/s1 9 an   
arrangem5t ) ! practice to %>e 9 any    
sav+s "u ! ,program4  7c7 ,quality      
measures & p]=mance /&>ds  7#a7 ,quality
 measures  7,a7 ,9 g5]al ,! ,secret>y   
%all solicit /akehold] input &1 tak+    
into consid]ation su* input1 det]m9e    
appropriate quality measures to assess !
 quality ( c>e furni%$ by indep5d5ce at 
home m$ical practices4 ,to ! ext5t      
possible1 su* measures %all include     
outcome measures & exp]i5ce ( c>e       
measures4  7,b7 ,report+ requirem5ts ,"u
 ! ,program1 an indep5d5ce at home      
m$ical practice %all submit data 9 a =m 
& mann] & at a frequ5cy specifi$ by !   
,secret>y4  7#b7 ,quality p]=mance /&>ds
 ,! ,secret>y %all e/abli% quality      
p]=mance /&>ds t indep5d5ce at home     
m$ical practices mu/ meet 9 ord] to be  
eligible to receive inc5tive paym5ts "u 

subsection 7d77#b74  7#c7 ,data ,%>+ ,n 
less frequ5tly ?an on a qu>t]ly basis1 !
 ,secret>y %all provide indep5d5ce at   
home m$ical practices ) regul>          
practice-level fe$back reports on co/ & 
utilization data 9 a cle> & actionable  
mann]4 ,^! reports %all include1 to !   
ext5t practicable1 in=mation on         
fee-=-s]vice co/ & utilization1 z well z
 b5efici>y-level li/s ( em]g5cy dep>tm5t
 visits1 hospitalizations1 hi]>*ical    
condition category risk scores1 quality 
p]=mance data1 claims l9e fe$1 & o!r    
high-co/ s]vices us$ 9 ! previ\s qu>t]1 
toge!r ) o!r data t may be useful =     
practices1 z det]m9$ by ! ,secret>y4    
7d7 ,inc5tive paym5t me?odology  7#a7   
,e/abli%m5t ( t>get sp5d+ level ,!      
,secret>y %all e/abli% an e/imat$ annual
 sp5d+ t>get bas$ on ! am\nt ! ,secret>y
 e/imates w\ld h be5 sp5t 9 ! abs5ce ( !
 ,program1 = items & s]vices cov]$ "u   
p>ts ,a & ,b furni%$ to applicable      
b5efici>ies or comp>able b5efici>ies1 z 
det]m9$ by ! ,secret>y1 = ea* indep5d5ce

 at home m$ical practice "u ?is section4
 ,su* sp5d+ t>gets %all be det]m9$ on a 
p] capita basis4 ,su* sp5d+ t>gets %all 
include a risk corridor t takes into    
acc\nt normal v>iation 9 exp5ditures =  
items & s]vices cov]$ "u p>ts ,a & ,b   
furni%$ to su* b5efici>ies ) ! size ( ! 
corridor be+ relat$ to ! numb] (        
applicable b5efici>ies furni%$ s]vices  
by ea* indep5d5ce at home m$ical        
practice4 ,! sp5d+ t>gets may also be   
adju/$ = applicable b5efici>y risk      
*>act]i/ics1 factors relevant to        
*>act]ize r&om v>iation among practices1
 & o!r factors z ! ,secret>y det]m9es   
appropriate4  7#b7 ,inc5tive paym5ts    
,subject to meet+ ! quality p]=mance    
/&>ds "u subsection 7c77#b71 an         
indep5d5ce at home m$ical practice is   
eligible to receive an inc5tive paym5t  
"u ! ,program if actual exp5ditures = a 
ye> = ! applicable b5efici>ies :o are   
attribut$ to ! practice are less ?an !  
e/imat$ sp5d+ t>get e/abli%$ "u p>agraph
 7#a7 = su* ye>4 ,an inc5tive paym5t =  

su* ye> %all be equal to a portion 7z   
det]m9$ by ! ,secret>y b 9 no case      
great] ?an #hj p]c5t7 ( ! am\nt by :i*  
actual exp5ditures 7includ+ inc5tive    
paym5ts "u ?is p>agraph7 = applicable   
b5efici>ies "u p>ts ,a & ,b = su* ye>   
are e/imat$ to be less ?an #e p]c5t less
 ?an ! e/imat$ sp5d+ t>get = su* ye>1 z 
det]m9$ "u p>agraph 7#a74  7e7          
,applicable b5efici>y  7#a7 ,9 g5]al ,9 
?is section1 ! t]m applicable b5efici>y1
 ) respect to an indep5d5ce at home     
m$ical practice1 is an individual :o is 
attribut$ to su* practice z a           
newly-assign$ b5efici>y or a            
cont9u\sly-assign$ b5efici>y 7z su* t]ms
 are def9$ 9 p>agraphs 7#b7 & 7#c71     
respectively74  7#b7 ,newly-assign$     
b5efici>y def9$ ,= purposes ( p>agraph  
7#a71 ! t]m newly-assign$ b5efici>y     
means an individual :om ! indep5d5ce at 
home m$ical practice has det]m9$-- 7,a7 
is entitl$ to b5efits "u "p ,a & enroll$
 = b5efits "u "p ,b2  7,b7 is n-- 7i7   
enroll$ 9 a ,m$ic>e ,advantage plan "u  

"p ,c or a ,,pace program "u section    
#ahid2  7ii7 attribut$ "u-- 7,i7 ano!r  
%>$ sav+s program1 "u ?is title1 su* z  
"u section #ahii2 or  7,,ii7 a model    
te/$ or exp&$ "u section #aaae;,a t     
involves %>$ sav+s "u ?is title1 or any 
o!r demon/ration t involves su* %>$     
sav+s2 or  7iii7 det]m9$ to h end /age  
r5al disease z provid$ 9 section #bbf;,a
 or receiv+ dialysis at home2  7,c7 has 
two or m *ronic illnesses1 z det]m9$ by 
! ,secret>y1 su* z conge/ive he>t       
failure1 diabetes1 *ronic ob/ructive    
pulmon>y disease1 is*emic he>t disease1 
/roke1 ,alzheim]'s ,disease &           
neurodeg5]ative diseases1 o!r dem5tias  
designat$ by ! ,secret>y1 & o!r diseases
 & conditions :i* result 9 high co/s "u 
?is title2  7,d7 subject to p>agraph    
7#d71 dur+ ! #ab-mon? p]iod imm$iately  
prec$+ ! individual's attribution to an 
indep5d5ce at home m$ical practice--    
7i7 _h a nonelective hospital admission2
 &  7ii7 receiv$--  7,i7 skill$ nurs+   
c>e or rehabilitation s]vices 9 a skill$

 nurs+ facility paid "u section         
#ahhh7;e72  7,,ii7 rehabilitation       
s]vices 9 an inpati5t rehabilitation    
facility2 or  7,,iii7 "p-"t or          
int]mitt5t nurs+ c>e 7z describ$ 9      
section #ahfa7m77#a77 ?r\gh a home heal?
 ag5cy or physical or occupational !rapy
 or spee*-language pa?ology s]vices 7z  
describ$ 9 section #ahfa7m77#b77 ?r\gh a
 home heal? ag5cy2  7,e7 has n be5      
assign$ to an indep5d5ce at home m$ical 
practice 9 a previ\s p>ticipation ye>   
dur+ an agreem5t p]iod2 &  7,f7 meets   
su* o!r crit]ia z ! ,secret>y det]m9es  
appropriate4  7#c7 ,cont9u\sly-assign$  
b5efici>y def9$ ,= purposes ( p>agraph  
7#a71 ! t]m cont9u\sly-assign$ b5efici>y
 means an individual :om ! indep5d5ce at
 home m$ical practice has det]m9$--     
7,a7 meets ! crit]ia describ$ 9         
subp>agraphs 7,a7 ?r\gh 7,c7 &          
subp>agraph 7,f7 ( p>agraph 7#b72 &     
7,b7 has two or m functional dep5d5cies 
requir+ ! assi/ance ( ano!r p]son 7su* z
 ba?+1 dress+1 toilet+1 walk+1 or fe$+74

  7#d7 ,waiv] ( c]ta9 requirem5ts :5    
b5efici>y *anges plans ,! requirem5ts "u
 p>agraph 7#b77;,d7 %all n apply :5 an  
individual is attribut$ to an indep5d5ce
 at home m$ical practice "u ?is section 
subsequ5t to ! fir/ "t an individual is 
attribut$ to su* a practice "u ?is      
section4  7#e7 ,pati5t election to      
p>ticipate ,! ,secret>y %all adopt an   
appropriate me?od to det]m9e t          
applicable b5efici>ies h agre$ to enroll
 9 an indep5d5ce at home m$ical         
practice4 ,enrollm5t 9 an indep5d5ce at 
home m$ical practice %all be volunt>y4  
7#f7 ,b5efici>y access to s]vices ,no?+ 
9 ?is section %all be con/ru$ z-- 7,a7  
enc\rag+ physicians1 nurse practition]s1
 physician assi/ants1 or o!r team memb]s
 to limit applicable b5efici>y access to
 s]vices cov]$ "u ?is title2 or  7,b7   
requir+ applicable b5efici>ies to       
rel9qui% access to any b5efit "u ?is    
title z a condition ( receiv+ s]vices f 
an indep5d5ce at home m$ical practice4  
7f7 ,agreem5ts  7#a7 ,9 g5]al ,subject  

to p>agraph 7#b71 an agreem5t ) an      
indep5d5ce at home m$ical practice "u ! 
,program %all be = a p]iod det]m9$      
appropriate by ! ,secret>y b 9 no case  
less ?an #c ye>s4  7#b7 ,r5ewals        
,subject to subsection 7j71 ! ,secret>y 
may r5ew an agreem5t ) an indep5d5ce at 
home m$ical practice "u ! ,program4  7g7
 ,p]mitt+ practices ,to furni%          
supplem5tal b5efits at own exp5se ,"u ! 
,program1 indep5d5ce at home m$ical     
practices may furni% applicable         
b5efici>ies ) items & s]vices = :i*     
paym5t is n made "u p>ts ,a & ,b1 z     
det]m9$ by ! ,secret>y4 ,no paym5t = su*
 items & s]vices %all be made "u ?is    
title4  7h7 ,waiv] au?ority  7#a7 ,9    
g5]al ,subject to p>agraph 7#b71 !      
,secret>y may waive su* provisions ( ?is
 title & title ,,xi z ! ,secret>y       
det]m9es necess>y 9 ord] to implem5t !  
,program4  7#b7 ,limitation ,! ,secret>y
 may only waive ! collection (          
co9surance t is payable by individuals  
"u section #ahcc7;a77#a7 if ! ,*ief     

,actu>y ( ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices c]tifies t su* a waiv] w\ld    
r$uce 7or w\ld n result 9 any increase  
97 net program sp5d+ "u ?is title4  7i7 
,adm9i/ration ,*apt] #ce ( title #dd1   
,unit$ ,/ates ,code1 %all n apply to ?is
 section4  7j7 ,t]m9ation & re-,entry   
7#a7 ,m&atory t]m9ation ,! ,secret>y    
%all t]m9ate an agreem5t ) an indep5d5ce
 at home m$ical practice if--  7,a7 !   
,secret>y det]m9es t ! practice did n   
a*ieve sav+s = ! ?ird ( #c consecutive  
ye>s "u ! ,program2 or  7,b7 su*        
practice fails to meet at lea/ a m9imum 
numb] ( quality p]=mance /&>ds e/abli%$ 
"u subsection 7c77#b7 dur+ any ye> ( !  
agreem5t p]iod4  7#b7 ,p]missive        
t]m9ation ,! ,secret>y may t]m9ate an   
agreem5t ) an indep5d5ce at home m$ical 
practice = su* o!r reasons det]m9$      
appropriate by ! ,secret>y4  7#c7       
,re-entry ,9 ! case :]e an indep5d5ce at
 home m$ical practice volunt>ily elects 
to exit ! ,program dur+ ! demon/ration  
phase "u section #ahff;,e or !          

transition "u subsection 7k77#a71 !     
,secret>y may re-ent] into an agreem5t )
 su* practice "u ?is section if !       
,secret>y det]m9es t ! practice w\ld h  
o!rwise met ! requirem5ts to rema9 9 !  
,program "u ?is section4  7k7 ,practice 
transitions  7#a7 ,practice mak+        
transition f demon/ration ,! ,secret>y  
%all provide = an appropriate transition
 f ! demon/ration program "u section    
#ahff;,e to ! ,program "u ?is section4  
,su* transition %all include a process t
 ensures t indep5d5ce at home m$ical    
practices & applicable b5efici>ies      
p>ticipat+ 9 su* demon/ration are       
automatically includ$ 9 ! ,program "u   
?is section at ! "t ( ! implem5tation ( 
! ,program4  7#b7 ,practices ,newly     
,enroll+ 9 ! ,program ,! ,secret>y %all 
also provide = ! p>ticipation ( new     
m$ical practices 9 ! ,program "u ?is    
section1 def9$ z practices t h n        
p>ticipat$ 9 ! demon/ration program "u  
section #ahff;,e previ\sly1 z well z    
practices ) previ\s exp]i5ce p>ticipat+ 

9 su* demon/ration program b :o may n be
 p>ticipat+ at ! "t ( ! implem5tation ( 
! ,program "u ?is section4  7#c7        
,special rule = individuals p>ticipat+ 9
 simil> programs ,9 ! case ( an         
individual :o has regul>ly receiv$      
home-bas$ prim>y c>e s]vices1 z det]m9$ 
by ! ,secret>y1 dur+ ! #ab-mon? p]iod   
imm$iately prec$+ ! individual's        
attribution to an indep5d5ce at home    
m$ical practice = ! fir/ "t1 ! ,secret>y
 may1 z det]m9$ appropriate1 apply      
clause 7i7 ( subsection 7e77#b77;,d7    
7relat+ to a prior nonelective hospital 
admission7 by increas+ ! #ab-mon? p]iod 
describ$ 9 su* subsection z x relates to
 su* clause to a p]iod ( up to #bd      
mon?s4  7l7 ,limitation on review ,!re  
%all be no adm9i/rative or judicial     
review "u section #ahfi1 section #ahgh1 
or o!rwise (--  7#a7 ! attribution (    
applicable b5efici>ies to an indep5d5ce 
at home m$ical practice2  7#b7 !        
det]m9ation ( ! e/imat$ annual sp5d+    
t>get = an indep5d5ce at home m$ical    

practice "u subsection 7d77#a72  7#c7 ! 
assessm5t ( ! quality ( c>e furni%$ by  
an indep5d5ce at home m$ical practice & 
! e/abli%m5t ( quality p]=mance /&>ds "u
 subsection 7c72  7#d7 ! det]m9ation (  
:e!r an indep5d5ce at home m$ical       
practice is eligible = inc5tive paym5ts 
"u subsection 7d77#b71 & ! am\nt ( su*  
inc5tive paym5ts2 &  7#e7 ! t]m9ation ( 
an indep5d5ce at home m$ical practice "u
 subsection 7j74  4  7b7 ,,gao /udy &   
report  7#a7 ,/udy ,! ,comptroll] ,g5]al
 ( ! ,unit$ ,/ates %all conduct a /udy  
on ! indep5d5ce at home m$ical practice 
program "u section #ahff;,g ( ! ,social 
,security ,act1 z add$ by subsection    
7a74 ,su* /udy %all include an analysis 
(--  7,a7 :e!r indep5d5ce at home m$ical
 practices are meet+ ! requirem5ts "u   
su* program2  7,b7 :e!r su* program is  
r$uc+ exp5ditures "u ?is title2  7,c7 ! 
c>e t b5efici>ies are receiv+ "u su*    
program2 &  7,d7 o!r areas det]m9$      
appropriate by ! ,comptroll] ,g5]al4    
7#b7 ,report ,n lat] ?an #e ye>s aft] ! 

date ( ! implem5tation ( su* indep5d5ce 
at home m$ical practice program1 !      
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ,congress a report on !  
/udy conduct$ "u p>agraph 7#a71 toge!r )
 su* recomm5dations z ! ,comptroll]     
,g5]al det]m9es to be appropriate4  7c7 
,revisions to exi/+ demon/ration program
  7#a7 ,ext5sion ?r\gh ! implem5tation (
 ! new program ,section #ahff;,e7e77#a7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie;cc-#e7;e77#a77 is am5d$ 
by ins]t+ plus ! p]iod beg9n+ at ! end (
 su* #g-ye> p]iod & end+ on ! date ( !  
implem5tation ( ! ,program "u section   
#ahff;,g aft] #g-ye> p]iod4  7#b7       
,p]mitt+ exi/+ practices to see m       
b5efici>ies ,section #ahff;,e7e77#e7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;cc-#e7;e77#a77 is am5d$-- 7,a7 9 !
 second s5t5ce1 by ins]t+ ! foll[+ be=e 
! p]iod3 plus = ! p]iod beg9n+ at ! end 
( su* sev5? ye> & end+ on ! date ( !    
implem5tation ( ! ,program "u section   
#ahff;,g2 &  7,b7 by add+ at ! end !    

foll[+ new s5t5ce3 ,beg9n+ on ! date ( !
 enactm5t ( ?is s5t5ce1 ! limitation on 
! numb] ( b5efici>ies t may p>ticipate 9
 ! demon/ration program pursuant to !   
fir/ s5t5ce %all n apply ) respect to   
indep5d5ce at home m$ical practices     
p>ticipat+ 9 ! demon/ration program z ( 
su* date ( enactm5t44