,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #fede  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #a1          
#bjbc,mrs4 ,mill]-,meeks 7= h]self1 ,mr4
 ,buc%on1 ,ms4 ,s*ri]1 ,ms4 ,kelly (    
,ill9ois1 ,mr4 ,burgess1 ,mr4 ,murphy1  
,mr4 ,w5/rup1 ,mr4 ,b]a1 ,mr4 ,crd5as1 &
 ,mr4 ,ruiz7 introduc$ ! foll[+ bill2   
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce1 & 9 addition to ! ,committee 
on ,ways & ,means1 = 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 am5d title      
,,xviii ( ! ,social ,security ,act to   
make improvem5ts to ! physician fee     
s*$ule "u ! ,m$ic>e program4  #a4 ,%ort 
title ,?is ,act may be ref]r$ to z !    
,physician ,fee ,s*$ule ,update &       
,improvem5ts ,act4  #b4 ,ext5d+ floor = 
"w geographic index ,section            
#ahdh7;e77#a77;,e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciew-#d7;e77#a77;,e77 is am5d$ by     

/rik+ ,janu>y #bj1 #bjbd & ins]t+       
,janu>y #a1 #bjbe4  #c4 ,increas+       
support = physicians & o!r practition]s 
9 adju/+ to ,m$ic>e paym5t *anges       
,section #ahdh7t77#a77;,d7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7t77#a77;,d77 is am5d$ by /rik+
 #a4be p]c5t & ins]t+ #c p]c5t4  #d4    
,ext5d+ inc5tive paym5ts = p>ticipation 
9 eligible alt]native paym5t models  7a7
 ,9 g5]al ,section #ahcc7z7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #aciel7z77
 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 
9 subp>agraph 7,a7-- 7i7 by /rik+ ,9 !  
case & ins]t+ ,subject to subp>agraph   
7,e71 9 ! case2  7ii7 by /rik+ end+ )   
#bjbe & ins]t+ end+ ) #bjbf2 &  7iii7 by
 ins]t+ & #bjbf aft] ) respect to #bjbe2
 &  7,b7 by add+ at ! end ! foll[+ new  
subp>agraph3  7,e7 ,special paym5t rule 
= #bjbf  7i7 ,9 g5]al ,subject to clause
 7ii71 ) respect to an am\nt payable "u 
subp>agraph 7,a7 = #bjbf to an eligible 
pr(essional :o is a qualify+ ,,apm      
p>ticipant = su* ye>1 su* am\nt %all be 

r$uc$1 9 ! case su* p>ticipant has      
receiv$ paym5t "u su* subp>agraph-- 7,i7
 = at lea/ #d ye>s b few] ?an #g ye>s1  
by #cd p]c5t2 or  7,,ii7 = #g ye>s1 by  
#fg p]c5t4  7ii7 ,exception ,if an      
eligible pr(essional describ$ 9 clause  
7i7 increas$ su* pr(essional's f9ancial 
risk 7z specifi$ by ! ,secret>y7 )      
respect to ! furni%+ ( items & s]vices  
dur+ ! mo/ rec5t p]iod = :i* data are   
available 7:i* may be less ?an a ye>7 = 
#bjbf z comp>$ to su* pr(essional's     
f9ancial risk ) respect to ! furni%+ (  
su* items & s]vices dur+ ! mo/ rec5t    
p]iod = :i* data 7 available 7:i* may be
 less ?an a ye>7 = #bjbe1 ! ,secret>y   
may r$uce ! am\nt payable "u subp>agraph
 7,a7 = #bjbf to su* pr(essional by a   
p]c5tage t is less ?an ! p]c5tage       
o!rwise applicable to su* am\nt "u      
clause 7i7 7& :i* may include #j p]c5t74
  2  7#b7 9 p>agraph 7#b7-- 7,a7 9      
subp>agraph 7,b7-- 7i7 9 ! subp>agraph  
head+1 by /rik+ #bjbe & ins]t+ #bjbf2 & 
7ii7 9 ! matt] prec$+ clause 7i71 by    

/rik+ #bjbe & ins]t+ #bjbf2  7,b7 9     
subp>agraph 7,c7-- 7i7 9 ! subp>agraph  
head+1 by /rik+ #bjbf & ins]t+ #bjbg2 & 
7ii7 9 ! matt] prec$+ clause 7i71 by    
/rik+ #bjbf & ins]t+ #bjbg2 &  7,c7 9   
subp>agraph 7,d71 by /rik+ #bjbd1 &     
#bjbe & ins]t+ #bjbd1 #bjbe1 & #bjbf2 & 
7#c7 9 p>agraph 7#d77;,b71 by /rik+     
#bjbe & ins]t+ #bjbe & #bjbf4  7b7      
,con=m+ am5dm5ts ,section               
#ahdh7q77#a77;,c77iii7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7q77#a77;,c77iii7 is am5d$--   
7#a7 9 subclause 7,,ii71 by /rik+ #bjbe 
& ins]t+ #bjbf2 &  7#b7 9 subclause     
7,,iii71 by /rik+ #bjbf & ins]t+ #bjbg4 
#e4 ,updat+ ! budget neutrality ?re%old 
,section #ahdh7;c77#b77;,b77ii77,,ii7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciew-#d7;c77#b77;,b77ii77,,ii77 is    
am5d$-- 7#a7 by /rik+ ,subject to &     
ins]t+ ! foll[+3  7aa7 ,9 g5]al ,subject
 to  2  7#b7 9 item 7aa71 z ins]t$ by   
subp>agraph 7,a71 by /rik+ #bj1jjj1jjj &
 ins]t+ ! am\nt specifi$ 9 item 7bb7 =  

su* ye>2 &  7#c7 by add+ at ! end !     
foll[+ new items3  7bb7 ,am\nt specifi$ 
,= purposes ( item 7aa71 subject to item
 7cc71 ! am\nt specifi$ 9 ?is item is-- 
7,,aa7 = ye>s be=e #bjbe1 #bj1jjj1jjj2  
7,,bb7 = #bjbe1 #ec1jjj1jjj2 & 7,,cc7 = 
#bjbf & ea* subsequ5t ye>1 ! am\nt      
specifi$ 9 ?is item = ! prec$+ ye>4     
7cc7 ,index+ limitation on annual       
adju/m5ts ,= #bjcj & e subsequ5t fif?   
ye>1 ! ,secret>y %all increase ! am\nt  
specifi$ 9 item 7bb7 = su* ye> by !     
cumulative increase 9 ! ,,mei 7z def9$ 9
 section #ahdb7;i77#c77 applicable to   
physicians' s]vices ov] ! #e-ye> p]iod  
end+ on ! la/ day ( ! prec$+ ye>4  4    
#f4 ,timely updates to direct co/s us$  
to calculate practice exp5se ,r,v,us    
,section #ahdh7;c77#b77;,b7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7;c77#b77;,b77 is am5d$ by add+
 at ! end ! foll[+ new clause3  7vii7   
,timely updates to direct co/s us$ to   
calculate practice exp5se relative value
 units  7,i7 ,simultane\s updates to    

direct co/ inputs at lea/ once e #e ye>s
 ,! ,secret>y %all1 n less (t5 ?an e #e 
ye>s1 update ! prices & rates1 z        
applicable1 = ea* ( ! direct co/s inputs
 describ$ 9 subclause 7,,ii7 us$ 9 !    
me?odology = calculat+ ! practice exp5se
 relative value units "u ?is subsection 
= physicians' s]vices4 ,updates made    
pursuant to ! previ\s s5t5ce %all be    
made 9 ! same ye> = all direct co/      
inputs describ$ 9 su* subclause4  7,,ii7
 ,direct co/s input categories describ$ 
,= purposes ( ?is clause1 ! direct co/s 
inputs describ$ 9 ?is subclause are     
cl9ical /aff wage rates1 prices ( m$ical
 supplies1 & prices ( equipm5t4  7,,iii7
 ,consultation ,9 mak+ ! updates "u ?is 
clause1 ! ,secret>y %all consult )      
relevant /akehold]s1 includ+ physician  
specialty societies4  4