,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #iff  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,april #a1 #bjai,mr4   
,portman 7= himself & ,mr4 ,b5net7      
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
mod]nize ! physician self-ref]ral       
prohibitions to promote c>e coord9ation 
9 ! m]it-bas$ inc5tive paym5t sy/em & to
 facilitate physician practice          
p>ticipation 9 alt]native paym5t models 
"u ! ,m$ic>e program1 & = o!r purposes4 
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,m$ic>e ,c>e ,coord9ation ,improvem5t 
,act ( #bjai4  #b4 ,mod]nization (      
limitations on physician self-ref]ral   
7a7 ,facilitation ( p>ticipation 9      
alt]native paym5t models  7#a7 ,9 g5]al 
,section #ahcc ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciel7 is am5d$--  
7,a7 9 subsection 7z71 z add$ by section
 #aja7;e77#b7 ( ! ,m$ic>e ,access &     
,,*ip ,reau?orization ,act ( #bjae      

7,public ,law #aad-aj71 by add+ at ! end
 ! foll[+ p>agraph3  7#e7 ,waiv]        
au?ority  7,a7 ,9 g5]al ,! provisions ( 
subsection 7f7 ( section #ahii %all     
apply ) respect to cov]$ ,,apm entities 
to ! same ext5t & 9 ! same mann] z su*  
provisions apply ) respect to acc\ntable
 c>e organizations "u su* section4  7,b7
 ,cov]$ ,,apm entities  7i7 ,9 g5]al ,= 
purposes ( subp>agraph 7,a71 ! t]m cov]$
 ,,apm entity means1 subject to clause  
7ii7 ( ?is subp>agraph & subp>agraph    
7,c71 ea* ( ! foll[+3 7,i7 ,an eligible 
alt]native paym5t entity z def9$ 9      
p>agraph 7#c77;,d74  7,,ii7 ,an entity  
p>ticipat+ 9 an alt]native paym5t model 
z def9$ 9 p>agraph 7#c77;,c71 includ+   
su* p>ticipation t qualifies z a cl9ical
 practice improvem5t activity "u section
 #ahdh7q77#b77;,b77iii77,,vi74  7,,iii7 
,an entity p>ticipat+ 9 a               
physician-focus$ paym5t model = :i*     
comm5ts & recomm5dations h1 "u          
subp>agraph 7,c7 ( section              
#ahfh7;c77#b71 be5 submitt$ indicat+ t  

su* model meets ! crit]ia describ$ 9    
subp>agraph 7,a7 ( su* section4  7,,iv7 
,an entity p>ticipat+ 9 any o!r model t 
! ,secret>y det]m9es is a cov]$ ,,apm   
entity = purposes ( subp>agraph 7,a71   
includ+ su* a det]m9ation made pursuant 
to "o or m physicians submitt+ a        
proposal to ! ,secret>y = an alt]native 
paym5t model4  7ii7 ,inclusion ( c]ta9  
entities ,su* t]m may include an entity 
engag+ 9 activities t ! ,secret>y has   
det]m9$ con/itute significant progress  
t[>d e/abli%+ a model ref]r$ to 9 any ( 
subclauses 7,i7 ?r\gh 7,,iv74 ,any waiv]
 "u ?is p>agraph ) respect to an entity 
describ$ 9 ! prec$+ s5t5ce may only be  
approv$ = ?ree ye>s4  7,c7 ,c]ta9       
requirem5ts ,a model ref]r$ to 9 any (  
subclauses 7,i7 ?r\gh 7,,iv7 (          
subp>agraph 7,b77i7 may n be consid]$ a 
cov]$ ,,apm entity = purposes (         
subp>agraph 7,a7 unless ! model meets ! 
requirem5ts describ$ 9 section          
#ahgg7;b77#f77;,b74  2 &  7,b7 by       
r$esignat+ subsection 7z71 z add$ by    

section #ead7;a7 ( ! ,m$ic>e ,access &  
,,*ip ,reau?orization ,act ( #bjae      
7,public ,law #aad-aj71 z subsection    
7aa74  7#b7 ,con=m+ am5dm5t ,section    
#ead7;c77#a7 ( ! ,m$ic>e ,access & ,,*ip
 ,reau?orization ,act ( #bjae 7,public  
,law #aad-aj7 is am5d$ by /rik+         
subsection 7z7 & ins]t+ subsection 7aa74
  7b7 ,exception facilitat+ ! developm5t
 & op]ation ( alt]native paym5t models  
,section #ahgg7;b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acienn7b77 is     
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#f7 ,developm5t & op]ation (
 alt]native paym5t models  7,a7 ,9 g5]al
 ,9 ! case ( items & s]vices furni%$    
pursuant to an arrangem5t t meets !     
requirem5ts describ$ 9 subp>agraph 7,b7 
ent]$ into = ! purpose ( develop+ or    
op]at+ a cov]$ ,,apm entity 7z def9$ 9  
section #ahcc7z77#e77;,b771 includ+--   
7i7 an advanc$ alt]native paym5t model  
describ$ 9 section #ahcc7z7 7includ+ a  
physician-focus$ paym5t model ref]r$ to 
9 section #ahfh7;c772  7ii7 a ,,mips    

,,apm 7z def9$ by ! ,secret>y72 &  7iii7
 any o!r alt]native paym5t model t !    
,secret>y may1 by regulation1 specify4  
7,b7 ,requirem5ts  7i7 ,9 g5]al ,subject
 to clause 7ii71 ! requirem5ts describ$ 
9 ?is subp>agraph ) respect to an       
arrangem5t relat+ to an alt]native      
paym5t model are z foll[s3  7,i7 ,!     
arrangem5t is 9 writ+1 id5tifies !      
s]vices1 items1 or actions subject to ! 
arrangem5t & is sign$ by ! p>ties to !  
arrangem5t4  7,,ii7 ,! arrangem5t       
includes a description ( ! alt]native   
paym5t model4  7,,iii7 ,"u ! arrangem5t 
writt5 reports are submitt$ to !        
,secret>y on a semi-annual basis on !   
progress a*iev$ 9 ! developm5t &        
op]ation ( ! alt]native paym5t model4   
7,,iv7 ,! arrangem5t meets su* o!r      
requirem5ts z ! ,secret>y may impose by 
regulation z ne$$ to protect aga9/ a    
significant risk ( program or pati5t    
abuse4  7ii7 ,cl>ification ,! ,secret>y 
%all n prohibit or re/rict an arrangem5t
 f meet+ ! requirem5ts describ$ 9 ?is   

subp>agraph on ! basis t ! arrangem5t   
takes into acc\nt ! volume or value (   
ref]rals if su* arrangem5t o!rwise meets
 ! requirem5ts describ$ 9 clause 7i74  4