,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ajeba  ,,9 ,,! ,,h\se ,,(         
,,repres5tatives  ,septemb] #ba1        
#bjbf,mr4 ,kelly ( ,p5nsylvania         
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 !          
regulations implem5t+ ! #e-/> rat+ sy/em
 "u ,m$ic>e ,advantage4  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,m$ic>e      
,advantage ,/r5g!n+ ,transp>5cy &       
,acc\ntability 9 ,rat+ ,sy/ems ,act or !
 ,,ma ,,/>s ,act4  #b4 ,revis+          
regulations implem5t+ ,m$ic>e ,advantage
 #e-/> rat+ sy/em  7a7 ,9 g5]al ,!      
,secret>y ( ,heal? & ,human ,s]vices    
%all1 ?r\gh notice & comm5t rulemak+1   
revise sections #dbb4afj ?r\gh #dbb4aff 
( title #db1 ,code ( ,f$]al             

,regulations1 to provide t1 9 implem5t+ 
! ,/> ,rat+s program ) respect to an    
,,ma-only contract or an ,,ma-,,pd      
contract1 = ! #bjca contract ye> & ea*  
subsequ5t contract ye>1 ! calculation ( 
,/> ,rat+s = su* ye> %all--  7#a7       
exclude any measure t-- 7,a7 ! ,secret>y
 det]m9es is n relat$ to cl9ical        
quality1 pati5t outcomes1 or pati5t     
exp]i5ce = individuals enroll$ "u !     
contract2  7,b7 ! ,secret>y det]m9es is 
n reasonably attributable to actions ( !
 issu] & its delegat$ entities1 consi/5t
 ) program guidance2  7,c7 is bas$ on   
data f a survey di/ribut$ to individuals
 enroll$ "u ! contract if su* survey--  
7i7 includes m ?an #aj que/ions2  7ii7  
does n yield responses f a              
geographically1 demographically1 &      
socioeconomically div]se set (          
individuals2 or  7iii7 fails to meet su*
 m9imum response1 sampl+1 or            
repres5tativ5ess crit]ia z ! ,secret>y  
det]m9es necess>y to implem5t clause    
7ii72 or  7,d7 ! ,secret>y det]m9es is  

no long] competitive z a metric = !     
majority ( ,,ma-only contracts &        
,,ma-,,pd contracts1 & ! cont9u$        
inclusion ( :i* w\ld n diff]5tiate      
p]=mance among su* contracts2  7#b7 only
 include measures newly add$ to ! ,/>   
,rat+s program = su* ye> t ! ,secret>y  
det]m9es are relat$ to cl9ical quality1 
pati5t outcomes1 or pati5t exp]i5ce2 &  
7#c7 ) respect to any measure exclud$ "u
 p>agraph 7#a77;,d71 include su* measure
 9 ! ,/> ,rat+s program z a display-only
 measure1 includ+ by publicly report+   
p]=mance on su* measure 9 a =m & mann]  
det]m9$ appropriate by ! ,secret>y4  7b7
 ,b5efici>y survey te*nical exp]t panel 
,! ,secret>y %all e/abli% a te*nical    
exp]t panel1 consi/5t ) subsection 7e71 
to evaluate & recomm5d ! use (          
/ati/ically s\nd b5efici>y survey       
in/rum5ts z data s\rces = measures 9 !  
,/> ,rat+s program4 ,su* panel %all--   
7#a7 id5tify survey in/rum5ts t--  7,a7 
are develop$1 endors$1 & ma9ta9$ by a   
?ird-p>ty quality measure organization  

or ,f$]al ag5cy1 su* z ! ,national      
,committee = ,quality ,assurance or !   
,ag5cy = ,heal?c>e ,rese>* & ,quality2  
7,b7 h relevance to cl9ical quality1    
pati5t outcomes1 or pati5t exp]i5ce2    
7,c7 yield responses f a geographically1
 demographically1 & socioeconomically   
div]se set ( individuals2 &  7,d7 are   
design$ to meet su* m9imum response1    
sampl+1 or repres5tativ5ess crit]ia z   
necess>y to implem5t subp>agraph 7,c71 )
 consid]ation = ! numb] & complexity (  
que/ions1 av]age "t to completion1      
modality & tim+ ( survey deliv]y1 & o!r 
factors t maximize survey response      
rates2  7#b7 solicit relevant /akehold] 
fe$back on ! f9d+s ( its evaluation &   
recomm5dations1 & provide opportunities 
= public comm5t2 &  7#c7 n lat] ?an #b  
ye>s aft] ! date ( enactm5t ( ?is       
section1 submit to ! ,secret>y a report 
summ>iz+ ! f9d+s ( ! evaluation &       
recomm5dations = /ati/ically s\nd       
b5efici>y survey in/rum5ts to use z data
 s\rces = measures 9 ! ,/> ,rat+s       

program4  7c7 ,di/ribution ( ,/> ,rat+s 
te*nical exp]t panel ,! ,secret>y %all  
e/abli% a te*nical exp]t panel1 consi/5t
 ) subsection 7e71 to evaluate !        
me?odology = calculat+ measure-level cut
 po9ts & assign+ ov]all ,/> ,rat+s4 ,su*
 panel %all-- 7#a7 solicit relevant     
/akehold] fe$back on ! f9d+s ( its      
evaluation & recomm5dations1 includ+    
opportunities = public comm5t2 &  7#b7 n
 lat] ?an #b ye>s aft] ! date ( enactm5t
 ( ?is section1 submit to ! ,secret>y a 
report on recomm5dations to re=m su*    
me?odology 9 a mann] t rew>ds p]=mance &
 promotes competition4  7d7 ,annual     
public report ,= ! #bjca contract ye> & 
ea* subsequ5t contract ye>1 n lat] ?an a
 date det]m9$ appropriate by ! ,secret>y
 prior to ! beg9n+ ( su* contract ye>1 !
 ,secret>y %all make publicly available 
a report describ+ ! di/ribution ( ov]all
 ,/> ,rat+s & ! me?odology us$ to       
e/abli% cut po9ts & assign su* rat+s =  
su* contract ye>4 ,su* report %all also 
include--  7#a7 a li/ ( measures exclud$

 f ! calculation ( ,/> ,rat+s = su*     
contract ye>2 &  7#b7 = ea* su* exclud$ 
measure1 ! basis = exclusion1 includ+ ! 
applicable provision "u subsection      
7a77#a71 & a brief description ( !      
,secret>y's rationale = su* exclusion1  
includ+ any data or analysis reli$ ^u1 z
 det]m9$ appropriate by ! ,secret>y4    
7e7 ,te*nical exp]t panel composition ,9
 e/abli%+ any te*nical exp]t panel "u   
subsection 7b7 or 7c71 ! ,secret>y %all 
ensure a balanc$ repres5tation (        
relevant /akehold]s & exp]ts1 includ+1 z
 appropriate1 b5efici>ies1 c>egiv]s1    
cl9icians1 provid] organizations1       
facility repres5tatives1 measure        
develop]s1 heal? insurance provid]s1    
rese>*]s1 gov]nm5t ag5cies1 quality     
measurem5t exp]ts1 survey me?odology    
exp]ts & ,m$ic>e ,advantage             
organizations ( diff]5t sizes1 own]%ip  
/ructures1 geographic s]vice areas1 &   
deliv]y models4 ,su* repres5tation %all 
include consid]ation ( nonpr(it & o!r   
mission-driv5 organizations1            

organizations ) provid]-align$ c>e      
deliv]y arrangem5ts1 & organizations )  
local & regional m>ket exp]i5ce4  7f7   
,def9itions ,9 ?is section3  7#a7       
,,ma-only contract2 ,,ma-,,pd contract2 
,/> ,rat+ ,! t]ms ,,ma-only contract1   
,,ma-,,pd contract & ,/> ,rat+ h !      
mean+s giv5 ea* su* t]m 9 ! regulations 
"u subp>t ,d ( "p #dbb ( title #db1     
,code ( ,f$]al ,regulations4  7#b7      
,delegat$ entity ,! t]m delegat$ entity 
means any provid]1 provid] organization1
 subcontractor1 or o!r entity to :i* an 
issu] delegates functions relat$ to     
b5efits adm9i/ration1 utilization       
managem5t1 quality improvem5t1 or       
enrollee s]vices4  7#c7 ,newly add$ ,!  
t]m newly add$1 ) respect to a measure1 
means a measure fir/ includ$ 9 ! ,/>    
,rat+s program = ! applicable contract  
ye> & does n include a measure cont9u$ f
 a prior ye>1 unless ! ,secret>y        
designates su* measure z newly add$ due 
to a mat]ial *ange 9 specifications4    
7#d7 ,relevant /akehold]s ,! t]m        

relevant /akehold]s means individuals & 
entities ) exp]tise or direct exp]i5ce  
relat$ to ! ,/> ,rat+s program1 includ+ 
pati5ts1 c>egiv]s1 cl9icians1 provid]   
organizations1 facility repres5tatives1 
measure develop]s1 includ+ ?ird-p>ty    
quality measure organizations & ,f$]al  
ag5cies1 heal? insurance provid]s1      
,m$ic>e ,advantage organizations (      
diff]5t sizes1 own]%ip /ructures1       
geographic s]vice areas & deliv]y       
models1 includ+ nonpr(it & o!r          
mission-driv5 organizations1            
organizations ) provid]-align$ c>e      
deliv]y arrangem5ts1 & organizations )  
local & regional m>ket exp]i5ce1 quality
 measurem5t exp]ts1 survey me?odology   
exp]ts1 rese>*]s1 gov]nm5t ag5cies1 &   
individuals ) exp]tise 9 rural & urban  
heal? c>e deliv]y4  7#e7 ,secret>y ,!   
t]m ,secret>y means ! ,secret>y ( ,heal?
 & ,human ,s]vices4  7#f7 ,/> ,rat+s    
program ,! t]m ,/> ,rat+s program means 
! #e-/> rat+ sy/em "u section           
#ahec7o77#d7 ( ! ,social ,security ,act 

7#db ,u4,s4,c4 #aciew-#bc7o77#d774