,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #ejac  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #bg1 #bjbc,mr4  
,la,hood 7= himself1 ,ms4 ,del,bene1    
,mr4 ,w5/rup1 ,ms4 ,s*ri]1 ,mr4 ,buc%on1
 & ,mr4 ,blum5au]7 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 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 ( #bjbc4  #b4 ,enc\rag+       
p>ticipation 9 ! m$ic>e %>$ sav+s       
program  7a7 ,remov+ b>ri]s to %>$ sav+s
 program p>ticipation ,prior to ! beg9n+
 ( ! fir/ p]=mance ye> 7z def9$ 9       

section #dbe4bj ( title #db1 ,code (    
,f$]al ,regulations 7or a successor     
regulation77 t beg9s at lea/ #ij days   
aft] ! date ( enactm5t ( ?is ,act1 !    
,secret>y ( ,heal? & ,human ,s]vices    
%all revise "p #dbe ( title #db1 ,code (
 ,f$]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 #bjbd1      
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  
7b7 ,f9ancial me?odology enhancem5ts ,to
 promote success ( %>$ sav+s program    
,prior to ! beg9n+ ( ! fir/ p]=mance ye>
 7z def9$ = purposes ( subsection 7a77 t
 beg9s at lea/ #ij days aft] ! date (   
enactm5t ( ?is ,act1 ! ,secret>y %all-- 
7#a7 ensure t any me?odology us$ to     
e/abli%1 adju/1 or update b5*m>k        
exp5ditures be develop$ & implem5t$ 9 a 
cle> & transp>5t mann]1 includ+ by mak+ 
publicly available suffici5t in=mation &
 data to all[ int]e/$ memb]s ( ! public 
to replicate ! me?odology us$ by !      
,secret>y & to evaluate ! accuracy ( !  
,secret>y's b5*m>k exp5diture           

calculations2  7#b7 implem5t a process t
 all[s ,a,c,os to appeal ! accuracy (   
b5*m>k exp5ditures 9 a he>+ be=e an     
adm9i/rative law judge1 & ensure t any  
su* appeal be he>d )9 a #ij-;day p]iod  
beg9n+ on ! date a reque/ = he>+ is     
fil$2 &  7#c7 require t any regional    
contributions or exp5ditures 7bel[ !    
national level7 us$ directly or         
indirectly to e/abli%1 update1 or adju/ 
b5*m>k exp5ditures be calculat$ 9 a     
mann] t excludes ! exp5diture impact (  
,a,c,os 9 ! applicable region1 includ+  
any regional exp5ditures associat$ )    
,m$ic>e fee-=-s]vice b5efici>ies assign$
 to su* ,a,c,os4  7c7 ,%>$ sav+s option 
,prior to ! beg9n+ ( ! fir/ p]=mance ye>
 7z def9$ = purposes ( subsection 7a77 t
 beg9s aft] ! date ( ! enactm5t ( ?is   
,act1 & not)/&+ any o!r provision ( law1
 ! ,secret>y ( ,heal? & ,human ,s]vices 
%all e/abli% a volunt>y full-risk option
 "u ! ,m$ic>e ,%>$ ,sav+s ,program 7z   
describ$ 9 section #ahii ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acie;jjj7

 "u :i* ! p]c5t ( %>$ sav+s paid to an  
,,aco "u section #ahii7;d77#b7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acie;jjj7d77#b77 %all be set at #ajj   
p]c5t1 ) ! ,,aco be>+ comm5surate risk (
 any %>$ losses4  7d7 ,report ,n lat]   
?an #ij days aft] ! date ( enactm5t (   
?is ,act1 ! ,adm9i/rator ( ! ,c5t]s =   
,m$ic>e  ,m$ica ,s]vices %all submit to 
! appropriate committees ( ,congress a  
report on me*anisms t ! ag5cy c take to 
avoid p5aliz+ ,a,c,os = a*iev+ co/ sav+s
 & acc\nt = regional v>iations 9 sp5d+ 9
 a mann] t prev5ts arbitr>y ,m$ic>e ,%>$
 ,sav+s ,program outcomes = ,a,c,os4    
,su* report %all include specific       
actions t ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices c take to develop & implem5t   
effective b5*m>ks & gu>drails = any     
*anges made to ! ag5cy's b5*m>k+        
policies4  #c4 ,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+ #bjbe &    
ins]t+ #bjbg & by add+ aft] #e p]c5t    
7or1 ) respect to #bjbe1 #c4e p]c5t &   
be=e ! close p>5!sis or1 ) respect to   
#bjbf & any subsequ5t ye>1 ! scal$      
p]c5tage am\nt2  7#b7 9 p>agraph        
7#b77;,c7-- 7,a7 9 clause 7i71 by /rik+ 
#ge p]c5t& ins]t+ ! applicable p]c5t 7z 
def9$ 9 clause 7iv77 = su* ye>2  7,b7 9 
clause 7ii77,i7-- 7i7 9 ! matt] prec$+  
item 7aa71 by /rik+ #ge p]c5t & ins]t+ !
 applicable p]c5t 7z def9$ 9 clause     
7iv77 = su* ye>2 &  7ii7 9 item 7bb7--  
7,i7 by /rik+ & o!r ?an paym5ts made "u 
title ,,xix & ins]t+ o!r ?an paym5ts    
made "u title ,,xix2 &  7,,ii7 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 &  7,c7 by add+ at ! end !
 foll[+ new clause3  7iv7 ,applicable   
p]c5t def9$ ,= purposes ( clauses 7i7 & 

7ii71 ! t]m applicable p]c5t means--    
7,i7 = #bjbf ?r\gh #bjbg1 #ej p]c5t2 &  
7,,ii7 = #bjbh & any subsequ5t ye>1 a   
p]c5t specifi$ by ! ,secret>y1 b 9 no   
case less ?an ! p]c5t specifi$ "u ?is   
clause = ! prec$+ ye> or m ?an ! less] (
 #ge p]c5t or #e p]c5tage po9ts high]   
?an ! p]c5t specifi$ "u ?is clause = !  
prec$+ ye>4  7v7 ,alt]native applicable 
p]c5t ,not)/&+ any o!r provision ( law1 
! ,secret>y may def9e ! applicable p]c5t
 = purposes ( a giv5 alt]native paym5t  
model 7or = purposes ( p>tial qualify+  
,,apm p>ticipants "u section            
#ahdh7q77#a77;,c77iii77,,iii77 to mean a
 p]c5tage am\nt t is l[] ?an ! am\nt 7or
 range7 o!rwise specifi$ 9 su* prec$+   
clause 7or1 z applicable1 "u section    
#ahdh7q77#a77;,c77iii77,,iii771 if !re  
is good cause to support su* alt]native 
applicable p]c5t1 includ+ :]e an        
alt]native paym5t model's design w>rants
 use ( su* alt]native applicable p]c5t4 
,9 no case %all ! ,secret>y designate an
 alt]native applicable p]c5t t exce$s ! 

maximum applicable p]c5t specifi$ 9 !   
prec$+ clause 7or1 z applicable1 "u     
section #ahdh7q77#a77;,c77iii77,,iii77 =
 ! applicable ye>2 &  7vi7 ,scal$       
p]c5tage am\nt ,= purposes ( ?is        
subsection 7includ+ p>agraph 7#a771 !   
t]m scal$ p]c5tage am\nt means a        
progressively scal$ p]c5tage am\nt      
designat$ by ! ,secret>y4 ,! ,secret>y  
%all det]m9e an appropriate progressive 
p]c5tage scale = diff]5t categories (   
eligible pr(essionals bas$ on           
programmatic int]e/s 9 effici5cy1       
equity1 & alignm5t ( appropriate        
inc5tives4 ,! maximum scal$ p]c5tage    
am\nt %all be #e p]c5t1 & su* maximum   
am\nt %all apply to an eligible         
pr(essional t meets or exce$s !         
applicable p]c5t 7z def9$ 9 p>agraph    
7#b77;,c77iv774 ,9 no case may an       
eligible pr(essional bel[ ! applicable  
p]c5t qualify = ! maximum scal$ p]c5tage
 am\nt  2 &  7#c7 9 p>agraph 7#d77;,b71 
by add+ aft] #e p]c5t 7or1 ) respect to 
#bjbe1 #c4e p]c5t & be=e ! close p>5!sis

 or1 ) respect to #bjbf & any subsequ5t 
ye>1 ! scal$ p]c5tage am\nt4  7b7       
,te*nical assi/ance ,! ,secret>y (      
,heal? & ,human ,s]vices %all provide   
education & te*nical assi/ance to       
,a,c,os & o!r types ( provid]s 7z def9$ 
"u section #dad4acje ( title #db1 ,code 
( ,f$]al ,regulations 7or a successor   
regulation77 t ! ,secret>y det]m9es to  
t>get or o!rwise op]ate 9 rural or      
m$ically und]s]v$ areas or to involve   
mat]ial p>ticipation by small practice  
or safety net gr\ps ( provid]s ( s]vices
 & suppli]s4 ,su* education & te*nical  
assi/ance may include infra/ructure     
support or access to data analytics to  
support ,,aco implem5tation 9 su* rural 
or m$ically und]s]v$ areas or to b5efit 
small practice or safety net gr\ps (    
provid]s ( s]vices & suppli]s1 or o!r   
gr\ps ( provid]s ( s]vices & suppli]s   
deem$ to require additional support1 su*
 z provid]s ( s]vices or suppli]s t are 
new to ,a,p,ms1 includ+ speciali/s4  7c7
 ,p>tial qualify+ ,,apm p>ticipant      

modification ,section                   
#ahdh7q77#a77;,c77iii77,,iii7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#d7q77#a77;,c77iii77,,iii77 is   
am5d$-- 7#a7 9 item 7aa71 by /rik+ #ej  
p]c5t 0 in/ead a ref]5ce to #dj p]c5t & 
ins]t+ ! applicable p]c5t 7 in/ead a    
ref]5ce to #aj p]c5tage po9ts less ?an !
 applicable p]c5t2 &  7#b7 9 item 7bb7--
 7,a7 by /rik+ #ge p]c5t & ins]t+ !     
applicable p]c5t2 &  7,b7 by /rik+ #ej  
p]c5t & ins]t+ #aj p]c5tage po9ts less  
?an ! applicable p]c5t4  #d ,/udy on    
alt]native paym5t models & m$ic>e*oice  
,n lat] ?an #ah mon?s aft] ! date (     
enactm5t ( ?is ,act1 ! ,comptroll]      
,g5]al ( ! ,gov]nm5t ,acc\ntability     
,(fice %all /udy & submit to !          
appropriate committees ( ,congress a    
report evaluat+ ! b5efits &             
flexibilities provid$ to support        
alt]native paym5t models 7z def9$ "u    
section #dad4acje ( title #db1 ,code (  
,f$]al ,regulations 7or a successor     
regulation77 & ,m$ic>e,*oice            

,organizations 7z def9$ 9 section       
#ahei7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#bh7;a77#a774 ,! 
objective ( su* report %all be to bett] 
und]/& ! effect ( ^! programs' diff]5t  
policies on diff]5t types ( p>ticipat+  
pati5ts & provid]s1 includ+ specialty1  
safety net1 small practice1 & rural     
provid]s1 ) ! goal ( id5tify+ areas to  
enhance alignm5t betwe5 su* programs'   
policies & b5*m>ks includ+ ?r\gh        
me*anisms t c\ld facilitate great]      
alignm5t 9 policies & b5*m>ks & to      
enc\rage ! adoption ( value-bas$        
arrangem5ts across pay]s or t c\ld      
o!rwise increase p>ity 9 ! flexibilities
 available to alt]native paym5t models &
 ,m$ic>e,*oice ,organizations4