,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #cddg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,m>* #aa1 #bjbj,mr4    
,?une 7= himself & ,mr4 ,c>d97 introduc$
 ! foll[+ bill2 :i* 0 read twice &      
ref]r$ to ! ,committee on ,f9ance  ,a   
,,bill  ,to am5d title ,,xviii ( !      
,social ,security ,act to e/abli% a     
program to all[ qualifi$ gr\p practices 
to furni% c]ta9 items & s]vices at      
qualifi$ skill$ nurs+ facilities to     
individuals entitl$ to b5efits "u "p ,a 
& enroll$ "u "p ,b ( ! ,m$ic>e program  
to r$uce unnecess>y hospitalizations1 & 
= o!r purposes4  #a4 ,%ort title ,?is   
,act may be cit$ z ! ,r$uc+ ,unnecess>y 
,s5ior ,hospitalizations ,act ( #bjbj or
 ! ,,ru% ,act ( #bjbj4  #b4 ,,snf-bas$  
provision ( prev5tive acute c>e &       
hospitalization r$uction program ,title 
,,xviii ( ! ,social ,security ,act is   
am5d$ by add+ at ! end ! foll[+ new     
section3  #ahii;,c4 ,,snf-bas$ provision
 ( prev5tive acute c>e & hospitalization
 r$uction program  7a7 ,e/abli%m5t ,!re 

is e/abli%$ a program to be kn[n z !    
,,snf-bas$ ,provision ( ,prev5tive      
,acute ,c>e & ,hospitalization ,r$uction
 ,program 79 ?is section ref]r$ to z !  
,program71 to be adm9i/]$ by !          
,secret>y1 = purposes ( r$uc+ unnecess>y
 hospitalizations & em]g5cy dep>tm5t    
visits by all[+ qualifi$ gr\p practices 
7z def9$ 9 section #ahgg7;h77#d77 on or 
aft] ,janu>y #a1 #bjba1 to furni% items 
& s]vices id5tifi$ "u subsection 7b77#c7
 to individuals entitl$ to b5efits "u "p
 ,a & enroll$ "u "p ,b resid+ 9 qualifi$
 skill$ nurs+ facilities4  7b7 ,op]ation
 ( ,program ,"u ! ,program1 ! ,secret>y 
%all provide = ! foll[+3 7#a7           
,c]tification ( skill$ nurs+ facilities 
z qualifi$ skill$ nurs+ facilities "u   
subsection 7c77#a74  7#b7 ,c]tification 
( gr\p practices z qualifi$ gr\p        
practices "u subsection 7c77#b74  7#c7  
,id5tification ( m9imum requir$         
nonsurgical items & s]vices furni%$ at a
 hospital em]g5cy dep>tm5t t may be     
safely furni%$ by a qualifi$ gr\p       

practice at a qualifi$ skill$ nurs+     
facility "u ! ,program & t su* qualifi$ 
gr\p practice %all (f] to furni% "u !   
,program4  7#d7 ,annual id5tification ( 
additional items & s]vices furni%$ at a 
hospital em]g5cy dep>tm5t t may be      
safely furni%$ by a qualifi$ gr\p       
practice at a qualifi$ skill$ nurs+     
facility "u ! ,program dur+ a ye> & t   
su* qualifi$ gr\p practice may (f] to   
furni% "u ! ,program dur+ su* ye>4  7#e7
 ,e/abli%m5t ( qualifications =         
nonphysician employees :o may furni% su*
 items & s]vices at a qualifi$ skill$   
nurs+ facility4 ,su* qualifications %all
 include ! requirem5t t su* an          
employee-- 7,a7 be c]tifi$ 9 basic life 
support by a nationally recogniz$       
specialty bo>d ( c]tification or        
equival5t c]tification bo>d2 &  7,b7 h--
 7i7 cl9ical exp]i5ce furni%+ m$ical    
c>e-- 7,i7 9 a skill$ nurs+ facility2   
7,,ii7 9 a hospital em]g5cy dep>tm5t    
sett+2 or  7,,iii7 z an employee ( a    
provid] or suppli] ( ambulance s]vices2 

or  7ii7 a c]tification 9 p>am$ic9e4    
7#f7 ,paym5t "u ?is title = items &     
s]vices id5tifi$ "u p>agraph 7#c7 or    
7#d7 furni%$ by su* qualifi$ gr\p       
practices at su* a facility 9 am\nts    
det]m9$ "u subsection 7d74  7c7         
,c]tifications  7#a7 ,qualifi$ skill$   
nurs+ facilities ,= purposes ( ?is      
section1 ! ,secret>y %all c]tify a      
skill$ nurs+ facility z a qualifi$      
skill$ nurs+ facility if ! facility     
submits an application 9 a "t & mann]   
specifi$ by ! ,secret>y & meets ! foll[+
 requirem5ts3 7,a7 ,! facility has      
on-site diagno/ic equipm5t necess>y = a 
qualifi$ gr\p practice to furni% items &
 s]vices "u ! ,program & real-"t audio &
 visual capabilities4  7,b7 ,! facility 
has at lea/ "o individual :o meets !    
qualifications describ$ 9 p>agraph 7#e7 
or a physician pres5t #bd h\rs a day &  
#g days a week to "w ) ! qualifi$ gr\p  
practice4 ,su* individual may be a memb]
 ( ! /aff ( ! qualifi$ skill$ nurs+     
facility or ( ! qualifi$ gr\p practice4 

7,c7 ,! facility ensures t resid5ts (   
su* facility1 ^u ent]+ su* facility1 are
 all[$ to specify 9 an advanc$ c>e      
directive :e!r ! resid5t wi%es to       
receive items & s]vices furni%$ at !    
facility "u ! ,program 9 a case :]e     
communication ) ! resid5t is n possible4
  7,d7 ,! facility ensures t individuals
 to be furni%$ su* items & s]vices "u ! 
,program at su* facility h !            
opportunity1 at _! reque/1 to in/ead be 
transport$ to a hospital em]g5cy        
dep>tm5t4  7,e7 ,! facility is n "p ( ! 
,special ,focus ,facility program ( !   
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices     
7al?\gh ! facility may1 at ! discretion 
( ! ,secret>y1 be a c&idate = selection 
"u su* program74  ,no?+ 9 ?is p>agraph  
%all affect ! requirem5ts "u section    
#ahai7;b77#d74  7#b7 ,qualifi$ gr\p     
practices ,= purposes ( ?is section1 !  
,secret>y %all c]tify a gr\p practice z 
a qualifi$ gr\p practice = a p]iod ( #c 
ye>s if ! gr\p practice submits an      
application 9 a "t & mann] specifi$ by !

 ,secret>y & meets ! foll[+ requirem5ts3
 7,a7 ,! gr\p practice (f]s to furni%   
all m9imum requir$ items & s]vices      
id5tifi$ "u subsection 7b77#c7 "u !     
,program4  7,b7 ,! gr\p practice submits
 a notification to ! ,secret>y annually 
specify+ :i* 7if any7 additional items &
 s]vices id5tifi$ "u subsection 7b77#d7 
= a ye> ! gr\p practice w (f] to furni% 
= su* ye> "u ! ,program4  7,c7 ,! gr\p  
practice ensures t only individuals :o  
meet ! qualifications e/abli%$ "u       
subsection 7b77#e7 or a physician :o is 
"p ( su* gr\p practice may furni% su*   
m9imum requir$ items & s]vices & su*    
additional items & s]vices4  7,d7 ,!    
gr\p practice ensures t1 9 ! case :]e   
su* m9imum requir$ items & s]vices or   
su* additional items & s]vices are      
furni%$ by su* an individual1 su*       
individual furni%es su* m9imum requir$  
items & s]vices or additional items &   
s]vices "u ! sup]vision1 ei!r 9-p]son or
 ?r\gh ! use ( teleheal? 7n includ+     
/ore-&-=w>d te*nologies71 (-- 7i7 a     

physician-- 7,i7 :o is bo>d c]tifi$ or  
bo>d eligible 9 em]g5cy m$ic9e1 family  
m$ic9e1 g]iatrics1 or int]nal m$ic9e2 or
  7,,ii7 :o has be5 c]tifi$ by a        
nationally recogniz$ specialty bo>d (   
c]tification or equival5t c]tification  
bo>d 9 basic life support2  7ii7 a nurse
 practition] :o has be5 c]tifi$ by a    
nationally recogniz$ specialty bo>d (   
c]tification or equival5t c]tification  
bo>d 9 basic life support2 or  7iii7 a  
physician assi/ant :o has be5 c]tifi$ by
 a nationally recogniz$ specialty bo>d (
 c]tification or equival5t c]tification 
bo>d 9 basic life support4  7,e7 ,)     
respect to any ye> 9 :i* ! qualifi$ gr\p
 practice w\ld p>ticipate 9 ! ,program1 
! ,*ief ,actu>y = ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices det]m9es t su*        
p>ticipation dur+ su* ye> w n result 9  
total e/imat$ exp5ditures "u ?is title =
 su* ye> be+ great] ?an total e/imat$   
exp5ditures "u su* title = su* ye> )\t  
su* p>ticipation4  7d7 ,paym5ts  7#a7 ,9
 g5]al ,= #bjba & ea* subsequ5t ye>1 !  

,secret>y %all develop a s*$ule (       
paym5ts to apply = items & s]vices      
id5tifi$ "u p>agraph 7#c7 or p>agraph   
7#d7 ( subsection 7b7 furni%$ dur+ su*  
ye> "u ! ,program4 ,su* paym5ts %all be 
9 lieu ( any o!r paym5ts t may be made  
"u ?is title = su* items & s]vices4     
7#b7 ,%>$ sav+s ,9 ! case ( a ye> = :i* 
! ,secret>y det]m9es t p>ticipation 9 ! 
,program result$ 9 a r$uction 9         
exp5ditures "u ?is title comp>$ to :at  
su* exp5ditures w\ld h be5 )\t su*      
p>ticipation1 ! ,secret>y %all-- 7,a7   
pay to su* qualifi$ gr\p practice an    
am\nt equal to #cg4e p]c5t ( ! e/imat$  
am\nt ( su* r$uction2 &  7,b7 9 ! case (
 ea* qualifi$ skill$ nurs+ facility :]e 
su* qualifi$ gr\p practice furni%$ items
 & s]vices "u ! ,program dur+ su* ye>-- 
7i7 if ! qualifi$ skill$ nurs+ facility 
has at lea/ a ?ree-/> rat+ "u ! ,five   
,/> ,quality ,rat+ ,sy/em 7or a         
successor sy/em71 pay to ! facility an  
am\nt t be>s ! same ratio to #ab4e p]c5t
 ( ! e/imat$ am\nt ( su* r$uction z !   

am\nt ( exp5ditures "u ! ,program = su* 
items & s]vices furni%$ ) respect to    
individuals at su* facility by su*      
qualifi$ gr\p practice dur+ su* ye> be>s
 to ! total am\nt ( exp5ditures "u !    
,program = su* items & s]vices furni%$ )
 respect to all individuals by su*      
qualifi$ gr\p practice dur+ su* ye>2 &  
7ii7 9 ! case ( a qualifi$ skill$ nurs+ 
facility t is n describ$ 9 clause 7i71  
reta9 9 ! ,f$]al ,hospital ,insurance   
,tru/ ,fund "u section #ahag ! am\nt t !
 facility w\ld h be5 paid pursuant to   
clause 7i7 if ! facility 7 describ$ 9   
su* clause until su* "t z ! facility has
 at lea/ a ?ree-/> rat+ "u ! ,five ,/>  
,quality ,rat+ ,sy/em 7or a successor   
sy/em71 at :i* po9t ! ,secret>y %all pay
 su* am\nt to ! facility4  7#c7 ,advanc$
 alt]native paym5t models ,p>agraph 7#b7
 %all n apply to items & s]vices furni%$
 to an individual entitl$ to b5efits "u 
"p ,a & enroll$ "u ,"p ,b = :om %>$     
sav+s w\ld o!rwise be attribut$ ?r\gh an
 advanc$ alt]native paym5t model z      

au?oriz$ "u section #aaae;,a or section 
#ahii4  7e7 ,evaluation  7#a7 ,9 g5]al  
,) respect to a qualifi$ gr\p practice &
 a qualifi$ skill$ nurs+ facility1 n    
lat] ?an #f mon?s aft] su* gr\p practice
 beg9s furni%+ items & s]vices "u !     
,program 7or1 9 ! case ( a qualifi$     
skill$ nurs+ facility1 n less ?an #f    
mon?s aft] a qualifi$ gr\p practice fir/
 furni%es su* items & s]vices at su*    
facility71 & n less ?an once e #b ye>s  
!reaft]1 ! ,secret>y %all evaluate su*  
qualifi$ gr\p practice & su* qualifi$   
facility us+ in=mation receiv$ "u       
p>agraph 7#b7 on su* crit]ia z det]m9$  
appropriate by ! ,secret>y4  7#b7       
,report+ ( in=mation ,9 a "t & mann]    
specifi$ by ! ,secret>y1 a qualifi$ gr\p
 practice & a qualifi$ skill$ nurs+     
facility %all submit to ! ,secret>y a   
report conta9+ ! foll[+ in=mation )     
respect to items & s]vices furni%$ "u ! 
,program dur+ a report+ p]iod 7z        
specifi$ by ! ,secret>y73 7,a7 ,! numb] 
( individuals ) respect to :om su* gr\p 

practice furni%$ su* items & s]vices 9  
su* p]iod 7or1 9 ! case ( a qualifi$    
skill$ nurs+ facility1 ! numb] (        
individuals ) respect to :om su* a gr\p 
practice furni%$ su* items & s]vices at 
su* facility 9 su* p]iod74  7,b7 ,!     
numb] ( su* individuals :o 7 admitt$ to 
a hospital or treat$ 9 ! em]g5cy        
dep>tm5t ( a hospital )9 #bd h\rs ( be+ 
furni%$ su* items & s]vices4  7,c7 ,o!r 
in=mation det]m9$ appropriate by !      
,secret>y4  7#c7 ,loss ( qualifi$       
c]tification  7,a7 ,9 g5]al ,n lat] ?an 
#c mon?s aft] a det]m9ation describ$ 9  
?is s5t5ce is made1 ! ,secret>y may     
revoke ! c]tification ( a qualifi$      
skill$ nurs+ facility or a qualifi$ gr\p
 practice made "u subsection 7c7 if--   
7i7 ! ,*ief ,actu>y ( ! ,c5t]s = ,m$ic>e
  ,m$icaid ,s]vices det]m9es t !        
p>ticipation ( su* skill$ nurs+ facility
 or su* gr\p practice 9 ! ,program dur+ 
a ye> result$ 9 total exp5ditures "u ?is
 title = su* p]iod be+ great] ?an total 
exp5ditures "u su* title w\ld h be5 dur+

 su* p]iod )\t su* p>ticipation2 or     
7ii7 a facility is select$ = ! ,special 
,focus ,facility program or1 if !       
facility is a c&idate = ! ,special      
,focus ,facility program1 ! ,secret>y   
det]m9es t ! p>ticipation ( su* facility
 9 ! ,program %\ld be t]m9at$4  7,b7    
,exclusion f c]tification  7i7 ,9 g5]al 
,9 ! case t ! ,secret>y revokes !       
c]tification ( a qualifi$ skill$ nurs+  
facility or a qualifi$ gr\p practice "u 
subp>agraph 7,a71 su* skill$ nurs+      
facility or su* gr\p practice %all be   
ineligible = c]tification z a qualifi$  
skill$ nurs+ facility or a qualifi$ gr\p
 practice 7z applicable7 "u subsection  
7c7 = ! applicable p]iod 7z def9$ "u    
clause 7ii774  7ii7 ,applicable p]iod   
def9$ ,9 ?is subp>agraph1 ! t]m         
applicable p]iod means-- 7,i7 if !      
revocation ( a facility or gr\p practice
 "u subp>agraph 7,a7 is due to !        
application ( clause 7i7 ( su*          
subp>agraph1 a #a-ye> p]iod beg9n+ on ! 
date ( su* revocation2 &  7,,ii7 9 !    

revocation ( a facility "u subp>agraph  
7,a7 is due to ! application ( clause   
7ii7 ( su* subp>agraph1 ! p]iod beg9n+  
on ! date ( su* revocation & end+ on !  
date on :i* ! facility graduates f !    
,special ,focus ,facility program 7or1 9
 ! case ( a facility t is a c&idate =   
su* program1 ! date on :i* ! facility is
 no long] su* a c&idate1 z det]m9$ by ! 
,secret>y74  7f7 ,det]m9ation ( budget  
neutrality2 t]m9ation ( program  7#a7   
,det]m9ation ,n lat] ?an ,july #a1      
#bjbf1 ! ,*ief ,actu>y ( ! ,c5t]s =     
,m$ic>e  ,m$icaid ,s]vices %all det]m9e 
:e!r ! ,program has result$ 9 an        
increase 9 total exp5ditures "u ?is     
title ) respect to ! p]iod beg9n+ on    
,janu>y #a1 #bjba1 & end+ on ,decemb]   
#ca1 #bjbe1 comp>$ to :at su*           
exp5ditures w\ld h be5 dur+ su* p]iod _h
 ! ,program n be5 9 op]ation4  7#b7     
,t]m9ation ,if ! ,*ief ,actu>y makes a  
det]m9ation "u p>agraph 7#a7 t !        
,program has result$ 9 an increase 9    
total exp5ditures "u ?is title1 !       

,secret>y %all t]m9ate ! ,program z (   
,janu>y #a ( ! fir/ ye> beg9n+ aft] su* 
det]m9ation4  4