,,ii  #aah? ,,congress  #a/ ,session    
,s4 #cejc  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #ac1 #bjbc,mr4
 ,:iteh\se 7= himself1 ,mr4 ,b>rasso1   
,mr4 ,wel*1 ,mr4 ,tillis1 ,mr4 ,cassidy1
 ,mr4 ,?une1 & ,mrs4 ,blackburn7        
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,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;jjj77 "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$ic>e  ,m$icaid ,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$-- 7#a7 9 
p>agraph 7#a77;,a7-- 7,a7 by /rik+ )    
#bjbe & ins]t+ ) #bjbg2 &  7,b7 by      
ins]t+ 1 or1 ) respect to #bjbf & #bjbg1
 ! scal$ p]c5tage am\nt 7z def9$ 9      

p>agraph 7#b77;,c77vi77 aft] #c4e p]c5t2
  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  
clauses3  7iv7 ,applicable p]c5t def9$  
,= purposes ( clauses 7i7 & 7ii71       
subject to clause 7v71 ! t]m applicable 
p]c5t means-- 7,i7 = ea* ( #bjbf &      
#bjbg1 #ej p]c5t2 &  7,,ii7 = #bjbh &   
ea* 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$+ ye>4  
7v7 ,alt]native applicable p]c5t        
,not)/&+ any o!r provision ( law1 !     
,secret>y may def9e ! applicable p]c5t =
 purposes ( clause 7i7 or 7ii7 ( ?is    
subp>agraph or a giv5 alt]native paym5t 
model 7or = purposes ( p>tial qualify+  
,,apm p>ticipants "u section            
#ahdh7q77#a77;,c77iii77,,iii77 to mean a
 p]c5tage am\nt t is l[] ?an ! am\nt 7or
 range7 o!rwise specifi$ 9 clause 7iv7  
7or1 z applicable1 "u section           
#ahdh7q77#a77;,c77iii77,,iii771 if !    
,secret>y det]m9es !re is good cause to 
support su* alt]native applicable p]c5t1
 includ+ :]e ! design ( an alt]native   
paym5t model 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 clause 7iv7 

7or1 z applicable1 "u section           
#ahdh7q77#a77;,c77iii77,,iii77 = !      
applicable ye>4  7vi7 ,scal$ p]c5tage   
am\nt ,= purposes ( p>agraphs 7#a77;,a7 
& 7#d77;,b73 7,i7 ,9 g5]al ,! t]m scal$ 
p]c5tage am\nt means a progressively    
scal$ p]c5tage am\nt designat$ by !     
,secret>y4 ,subject to subclause 7,,ii71
 ! ,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  7,,ii7 ,maximum am\nt  7aa7 
,9 g5]al ,! maximum scal$ p]c5tage am\nt
 %all be #e p]c5t &1 subject to item    
7bb71 su* maximum am\nt %all apply to an
 eligible pr(essional ) respect to a ye>
 if ! eligible pr(essional meets or     
exce$s ! ?re%old "u clause 7i7 or 7ii7 )
 respect to su* ye> 7det]m9$ bas$ on    
application ( ! applicable p]c5t1 z     
def9$ "u clause 7iv774  7bb7            
,cl>ification ,9 no case may an eligible
 pr(essional :o meets or exce$s !       

?re%old "u clause 7i7 or 7ii7 ) respect 
to a ye> ?r\gh application ( an         
alt]native applicable p]c5t "u clause   
7v7 t is less ?an ! applicable p]c5t 7z 
def9$ "u clause 7iv77 be eligible = !   
maximum scal$ p]c5tage am\nt "u ?is     
clause4  2 &  7#c7 9 p>agraph 7#d77;,b71
 by ins]t+ 1 or1 ) respect to #bjbf &   
ea* subsequ5t ye>1 ! scal$ p]c5tage     
am\nt 7z def9$ 9 p>agraph 7#b77;,c77vi77
 aft] #c4e p]c5t4  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$-- 7#a7 9 item 7aa71 by /rik+ #ej  
p]c5t 0 in/ead a ref]5ce to #dj p]c5t & 
ins]t+ ! applicable p]c5t 7 in/ead a    
ref]5ce to ! p]c5t t is #aj p]c5tage    
po9ts less ?an ! applicable p]c5t2 &    
7#b7 9 item 7bb7-- 7,a7 by /rik+ #ge    
p]c5t & ins]t+ ! applicable p]c5t2 &    
7,b7 by /rik+ #ej p]c5t & ins]t+ ! p]c5t
 t is #aj p]c5tage po9ts less ?an !     
applicable p]c5t4  #d ,/udy on          
alt]native paym5t models & ,m$ic>e      
,advantage ,n lat] ?an #ah mon?s aft] ! 

date ( enactm5t ( ?is ,act1 !           
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all conduct a /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 ,advantage       
organizations 7z def9$ 9 section        
#ahei7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#bh7;a77#a7774 ,!
 objective ( su* /udy & report %all be  
to bett] und]/& ! effect ( diff]5t      
policies "u ! ,m$ic>e program "u title  
,,xviii ( ! ,social ,security ,act 7#db 
,u4,s4,c4 #acie et seq47 ) respect to   
su* models & organizations on diff]5t   
types ( b5efici>ies & p>ticipat+        
provid]s1 includ+ specialty1 safety net1
 small practice1 & rural provid]s1 ) !  
goal ( id5tify+ areas to enhance        
alignm5t betwe5 su* policies & b5*m>ks1 
includ+ ?r\gh me*anisms t c\ld          

facilitate great] alignm5t 9 su*        
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$ic>e      
,advantage organizations "u ! ,m$ic>e   
program4