,i #aai? ,,congress #b;d ,session ,h4 ,r4 #hfbb ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,april #cj1 #bjbf,mrs4 ,mill]-,meeks 7= h]self & ,mr4 ,conaway7 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 trans=m ! ,m]it-bas$ ,inc5tive ,paym5t ,sy/em into ! ,data-driv5 ,p]=mance ,paym5t ,sy/em "u ! ,m$ic>e physician fee s*$ule1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e ,physician ,data-driv5 ,p]=mance ,paym5t ,sy/em ,act ( #bjbf4 #b4 ,trans=m+ ! ,m]it-bas$ ,inc5tive ,paym5t ,sy/em into ! ,data-driv5 ,p]=mance ,paym5t ,sy/em 7a7 ,implem5tation ( ! ,data-driv5 ,p]=mance ,paym5t ,sy/em 7#a7 ,9 g5]al ,effective ,janu>y #a1 #bjbg1 !re is e/abli%$ ! ,data-driv5 ,p]=mance ,paym5t ,sy/em1 :i* %all consi/ ( ! paym5t sy/em "u section #ahdh7q7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q771 includ+ z am5d$ by ?is section4 7#b7 ,ref]5ces ,subject to p>agraph 7#c71 any ref]5ce to ! paym5t sy/em "u section #ahdh7q7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q771 includ+ ! t]ms ,m]it-bas$ ,inc5tive ,paym5t ,sy/em & ,,mips1 %all be deem$ a ref]5ce to ! ,data-driv5 ,p]=mance ,paym5t ,sy/em & ,,dpps1 respectively4 7#c7 ,transition ,9 ord] to provide = an ord]ly transition & avoid provid] confusion1 ! ,secret>y ( ,heal? & ,human ,s]vices %all provide = an appropriate transition 9 ! use ( ! t]ms ,m]it-bas$ ,inc5tive ,paym5t ,sy/em 7& ,,mips7 & ,data-driv5 ,p]=mance ,paym5t ,sy/em 7& ,,dpps7 9 ref]5ce to ! paym5t sy/em "u section #ahdh7q7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q774 ,be=e ! completion ( su* transition1 any ref]5ce to ! ,data-driv5 ,p]=mance ,paym5t ,sy/em 7or ,,dpps7 %all be deem$ to include a ref]5ce to ! ,m]it-bas$ ,inc5tive ,paym5t ,sy/em4 7b7 ,re=m+ application ( adju/m5t factors 7#a7 ,9 g5]al ,section #ahdh7q77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77#f77 is am5d$-- 7,a7 9 subp>agraph 7,a7-- 7i7 by ins]t+ = ye>s be=e #bjbh1 aft] ,tak+ into acc\nt p>agraph 7#a77;,g712 7ii7 9 clause 7ii7-- 7,i7 9 subclause 7,i71 by /rik+ clause 7iii7 & ins]t+ subclause 7,,iii72 7,,ii7 9 subclause 7,,ii71 by /rik+ clause 7iv7 & ins]t+ subclause 7,,iv72 & 7,,iii7 by r$esignat+ subclauses 7,i7 & 7,,ii7 z items 7aa7 & 7bb71 respectively1 & adju/+ ! m>g9s accord+ly2 7iii7 9 clause 7iii71 by /rik+ clause 7ii77,i7 & ins]t+ subclause 7,,ii77aa72 7iv7 9 clause 7iv7-- 7,i7 by /rik+ subclause 7,,ii7 & ins]t+ item 7bb72 7,,ii7 by /rik+ clause 7ii77,,ii7 & ins]t+ subclause 7,,ii77bb72 & 7,,iii7 by r$esignat+ subclauses 7,i7 & 7,,ii7 z items 7aa7 & 7bb71 respectively1 & adju/+ ! m>g9s accord+ly2 7v7 by r$esignat+ clauses 7i7 ?r\gh 7iv7 z subclauses 7,i7 ?r\gh 7,,iv7 & adju/+ ! m>g9s accord+ly2 7vi7 by /rik+ ,tak+ into acc\nt & ins]t+ ! foll[+3 7i7 ,adju/m5t factors = ye>s be=e #bjbh ,tak+ into acc\nt 2 & 7vii7 by add+ at ! end ! foll[+ new clause3 7ii7 ,adju/m5t factors = #bjbh & subsequ5t ye>s ,= #bjbh & ea* subsequ5t ye>1 ! ,,dpps adju/m5t factor specifi$ "u ?is subp>agraph = a ,,dpps eligible pr(essional = su* ye> %all be equal to-- 7,i7 subject to subp>agraph 7,f77v71 9 ! case ( a ,,dpps eligible pr(essional ) a composite p]=mance score = su* ye> above ! p]=mance ?re%old e/abli%$ "u subp>agraph 7,d7 = su* ye>1 #a4be2 7,,ii7 9 ! case ( a ,,dpps eligible pr(essional ) a composite p]=mance score = su* ye> equal to su* p]=mance ?re%old1 #a2 7,,iii7 9 ! case ( a ,,dpps eligible pr(essional n describ$ 9 subclause 7,,iv7 ) a composite p]=mance score = su* ye> bel[ su* p]=mance ?re%old1 #j4ge2 & 7,,iv7 9 ! case ( a ,,dpps eligible pr(essional :o is treat$ "u p>agraph 7#e77;,b77i7 z a*iev+ ! l[e/ pot5tial score applicable to ea* applicable measure or activity t is requir$ to be report$ by ! pr(essional = su* ye>1 #j4e4 2 7,b7 9 subp>agraph 7,b77iv71 by /rik+ & subsequ5t ye>s & ins]t+ & ea* subsequ5t ye> ?r\gh #bjbg2 7,c7 9 subp>agraph 7,d77i71 by /rik+ t are positive1 negative1 & z]o2 & 7,d7 9 subp>agraph 7,e7-- 7i7 by ins]t+ & end+ ) #bjbg aft] beg9n+ ) #bjai2 7ii7 9 clause 7ii7-- 7,i7 by /rik+ subp>agraph 7,a7 & ins]t+ subp>agraph 7,a77i72 & 7,,ii7 by r$esignat+ subclauses 7,i7 & 7,,ii7 z items 7aa7 & 7bb71 respectively2 7iii7 by r$esignat+ clauses 7i7 & 7ii7 z subclauses 7,i7 & 7,,ii71 respectively2 7iv7 by /rik+ ,9 ! case ( & ins]t+ ! foll[+3 7i7 ,application ( adju/m5t factors = ye>s be=e #bjbh ,9 ! case ( 2 & 7v7 by add+ at ! end ! foll[+ new clause3 7ii7 ,application ( adju/m5t factors = #bjbh & subsequ5t ye>s 7,i7 ,9 g5]al ,9 ! case ( cov]$ pr(essional s]vices 7z def9$ 9 subsection 7k77#c77;,a77 furni%$ by a ,,dpps eligible pr(essional dur+ a ye> 7beg9n+ ) #bjbh71 subject to subclauses 7,,ii7 & 7,,iii71 = purposes ( det]m9+ ! am\nt paid "u ?is "p ) respect to su* cov]$ pr(essional s]vices & ,,dpps eligible pr(essional = su* ye>1 ! update to ! nonqualify+ ,,apm conv]sion factor e/abli%$ "u subsection 7d7 applicable to su* s]vices & su* pr(essional = su* ye> %all be multipli$ by ! adju/m5t factor specifi$ "u subp>agraph 7,a77ii7 ) respect to su* pr(essional & su* ye>4 7,,ii7 ,nonapplication to c]ta9 updates ,subclause 7,i7 %all n apply ) respect to cov]$ pr(essional s]vices furni%$ dur+ a ye> 9 ! case t ! update to ! conv]sion factor describ$ 9 su* subclause = su* ye> is less ?an #j p]c5t4 7,,iii7 ,nonapplication ( c]ta9 adju/m5t factors = lack ( timely fe$back reports 7aa7 ,9 g5]al ,subclause 7,i7 %all n apply ) respect to cov]$ pr(essional s]vices furni%$ by a ,,dpps eligible pr(essional dur+ a ye> if ! ,,dpps eligible pr(essional does n receive timely fe$back 9 accordance ) item 7bb7 ) respect to ea* qu>t] ( ! p]=mance p]iod = su* ye> & w\ld1 )\t application ( ?is item1 o!rwise be subject to ! ,,dpps adju/m5t factor describ$ 9 subp>agraph 7,a77ii77,,iii7 = su* ye>4 7bb7 ,timely fe$back describ$ ,= purposes ( item 7aa71 a ,,dpps eligible pr(essional receives timely fe$back 9 accordance ) ?is item ) respect to a qu>t] ( a p]=mance p]iod if1 n lat] ?an ! date t is #fj days aft] ! la/ day ( su* qu>t]1 su* pr(essional receives ! confid5tial fe$back requir$ "u p>agraph 7#ab7 on ! p]=mance ( su* pr(essional dur+ su* qu>t] ) respect to adm9i/rative claims-bas$ measures includ$ 9 ! p]=mance categories describ$ 9 subp>agraph 7,a77i77,,ii7 ( su* p>agraph1 includ+-- 7,,aa7 a description ( ! pati5ts & episodes attribut$ ) respect to su* measures = purposes ( assess+ ! p]=mance ( su* pr(essional dur+ su* qu>t]2 7,,bb7 an id5tification ( ! items & s]vices furni%$ by su* pr(essional or ano!r individual t w contribute to ! assessm5t ( ! p]=mance ( su* pr(essional dur+ su* qu>t] ) respect to su* measures2 & 7,,cc7 an id5tification ( :e!r ea* item or s]vice id5tifi$ "u subitem 7,,bb7 = ! qu>t] 0 furni%$ by su* pr(essional or ano!r individual 7&1 9 ! case t ! p]=mance ( su* pr(essional = su* qu>t] ) respect to su* measures is assess$ bas$ on p>ticipation 9 a gr\p practice or o!r gr\p1 :e!r ea* su* item or s]vice 0 furni%$ by su* pr(essional1 ano!r individual 9 su* gr\p1 or ano!r individual outside ( su* gr\p74 7,,iv7 ,hold h>mless ,9 comput+ ! am\nt ( any co9surance "u section #ahcc7;a77#a7 & ! exp5ses incurr$ = apply+ ! d$uctible "u section #ahcc7;b7 ) respect to cov]$ pr(essional s]vices furni%$ by a ,,dpps eligible pr(essional = a ye>1 su* co9surance & incurr$ exp5ses %all be comput$ z if ! update to ! conv]sion factor applicable to su* s]vices & pr(essional = su* ye> 7 n subject to ! adju/m5t factor "u subclause 7,i74 4 7#b7 ,con=m+ am5dm5t ,section #ahdh7;d77#bj7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;d77#bj77 is am5d$ by ins]t+ 1 subject to subsection 7q77#f77;,e77ii71 be=e ! update to ! nonqualify+ ,,apm conv]sion factor4 7c7 ,re=m+ p]=mance ?re%olds ,section #ahdh7q77#f77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77#f77;,d77 is am5d$-- 7#a7 9 clause 7i71 by /rik+ clauses 7iii7 & 7iv7 & ins]t+ clauses 7iii7 ?r\gh 7vi72 & 7#b7 by add+ at ! end ! foll[+ new clauses3 7v7 ,tempor>y ext5sion ( special rules 7,i7 ,9 g5]al ,) respect to ea* ( #bjbh ?r\gh #bjcc 7or su* lat] ye> z det]m9$ by ! ,secret>y pursuant to subclause 7,,ii771 ! ,secret>y %all e/abli% a p]=mance ?re%old = purposes ( det]m9+ ,,dpps adju/m5t factors "u subp>agraph 7,a7 = su* ye> 9 accordance ) ! requirem5ts describ$ 9 clause 7iii71 except t su* p]=mance ?re%old may n be great] ?an #ge po9ts4 7,,ii7 ,flexibility to ext5d special rule ,9 ! case t extraord9>y circum/ances1 includ+ a natural disa/]1 a public heal? em]g5cy1 or cyb]security incid5t1 affect report+1 data collection1 or ! assessm5t ( p]=mance "u ?is subsection = #bjcd1 ! ,secret>y may ext5d ! application ( subclause 7,i7 until ! fir/ ye> = :i* su* extraord9>y circum/ances d n affect report+1 data collection1 or assessm5t ( p]=mance "u ?is subsection 7z det]m9$ by ! ,secret>y74 7,,iii7 ,optional transition p]iod ,) respect to ! ye> imm$iately foll[+ ! la/ ye> ) respect to :i* subclause 7,i7 applies 7aft] application ( subclause 7,,ii71 if applicable71 ! ,secret>y may1 pursuant to notice & comm5t rulemak+1 e/abli% a p]=mance ?re%old = purposes ( det]m9+ ,,dpps adju/m5t factors "u subp>agraph 7,a7 = su* ye> & su* subsequ5t consecutive ye>s z specifi$ by ! ,secret>y 9 a mann] t provides = a gradual & increm5tal transition f ! p]=mance ?re%old e/abli%$ "u subclause 7,i7 to ! p]=mance ?re%old e/abli%$ "u clause 7vi74 7vi7 ,replacem5t p]=mance ?re%old 7,i7 ,9 g5]al ,) respect to ! ye> imm$iately foll[+ ! la/ ye> ) respect to :i* clause 7v7 applies & ea* subsequ5t ye>1 ! p]=mance ?re%old e/abli%$ "u ?is subp>agraph = purposes ( det]m9+ ,,dpps adju/m5t factors "u subp>agraph 7,a7 %all be comput$ 9 accordance ) ! replacem5t p]=mance ?re%old me?odology e/abli%$ by ! ,secret>y "u 9 subclause 7,,ii74 7,,ii7 ,replacem5t p]=mance ?re%old me?odology ,= purposes ( subclause 7,i71 ! ,secret>y %all1 pursuant to notice & comm5t rulemak+ & bas$ on ! recomm5dations submitt$ "u subclause 7,,iii71 e/abli% a me?odology 7ref]r$ to 9 ?is clause z ! replacem5t p]=mance ?re%old me?odology7 to be us$ in/ead ( ! mean or m$ian describ$ 9 clause 7i7 = comput+ ! p]=mance ?re%old appli$ "u ?is subp>agraph4 7,,iii7 ,recomm5dations = replacem5t p]=mance ?re%old me?odology ,n lat] ?an ,decemb] #ca1 #bjbi1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all1 9 accordance ) subclause 7,,iv71 submit to ,congress & ! ,secret>y a report includ+ detail$ recomm5dations on a me?odology to be us$ in/ead ( ! mean or m$ian describ$ 9 clause 7i7 = comput+ ! p]=mance ?re%old describ$ 9 subclause 7,i7 & t is bas$ on data t are accurate & reliable4 7,,iv7 ,recomm5dation requirem5ts ,9 mak+ ! recomm5dations requir$ "u subclause 7,,iii71 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all-- 7aa7 seek to prev5t un9t5d$ consequ5ces t may result f weigh+ quality & co/ p]=mance categories2 7bb7 consid] ! impact ( su* recomm5dations on diff]5t types ( ,,dpps eligible pr(essionals1 includ+ su* pr(essionals 9 a small gr\p practice & su* pr(essionals t s]ve rural or und]s]v$ communities2 & 7cc7 consult ) /akehold]s1 includ+ organizations repres5t+ physicians4 4 7d7 ,ma9ta9+ budget neutrality ,section #ahdh7q77#f77;,f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77#f77;,f77 is am5d$-- 7#a7 9 clause 7i7-- 7,a7 9 ! clause head+1 by ins]t+ = ye>s be=e #bjbh aft] factor2 & 7,b7 9 subclause 7,i7-- 7i7 by /rik+ ,) respect & ins]t+ ,= ye>s be=e #bjbh1 ) respect2 & 7ii7 by /rik+ subp>agraph 7,a77ii77,i7 & ins]t+ subp>agraph 7,a77i77,,ii77aa72 7#b7 9 clause 7ii7-- 7,a7 9 ! clause head+1 by ins]t+ = ye>s be=e #bjbh aft] requirem5t2 & 7,b7 9 subclause 7,i71 by /rik+ ,subject to & ins]t+ ,= ye>s be=e #bjbh1 subject to2 7#c7 9 clause 7iii7-- 7,a7 9 subclause 7,i71 by ins]t+ be=e #bjbh be=e t are bel[2 & 7,b7 9 subclause 7,,ii71 by ins]t+ be=e #bjbh aft] ) respect to a ye>2 & 7#d7 by add+ at ! end ! foll[+ new clause3 7v7 ,budget neutrality = #bjbh & subsequ5t ye>s ,= #bjbh & ea* subsequ5t ye>1 ! ,secret>y %all decrease ,,dpps adju/m5t factors "u subp>agraph 7,a77ii77,i7 = ,,dpps eligible pr(essionals ^: composite p]=mance score = su* ye> is above ! p]=mance ?re%old e/abli%$ "u subp>agraph 7,d7 = su* ye> 9 ord] to ensure t ! e/imat$ increase 9 ! aggregate all[$ *>ges result+ f ! application ( su* adju/m5t factors 7aft] application ( ?is clause7 to su* pr(essionals = su* ye> is n m ?an ! e/imat$ decrease 9 su* *>ges result+ f ! application = su* ye> ( ,,dpps adju/m5t factors "u subclauses 7,,iii7 & 7,,iv7 ( subp>agraph 7,a77ii7 to ,,dpps eligible pr(essionals ^: composite p]=mance score = su* ye> is bel[ su* p]=mance ?re%old4 4 7e7 ,inve/+ 9 "u-res\rc$ practices to assi/ 9 value-bas$ c>e & quality improvem5t ,section #ahdh7q77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77#f77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,g7 ,inve/+ 9 "u-res\rc$ practices to assi/ 9 value-bas$ c>e & quality improvem5t 7i7 ,9 g5]al ,9 ! case ( a ,,dpps eligible pr(essional :o furni%es cov]$ pr(essional s]vices dur+ a ye> t is a ,,dpps sav+s ye> 7z def9$ 9 clause 7v77 & = :i* ! pr(essional meets ! crit]ia specifi$ 9 clause 7ii71 9 addition to ! am\nt ( paym5t t w\ld o!rwise be made = su* s]vices "u ?is "p = su* ye>1 !re also %all be paid to su* pr(essional1 f ! am\nt specifi$ 9 clause 7iv77,i7 = su* ,,dpps sav+s ye>1 a lump-sum inc5tive paym5t 79 su* am\nt z specifi$ by ! ,secret>y7 :i* %all be us$ by su* pr(essional to improve c>e managem5t1 address heal?-relat$ social ne$s1 implem5t & fur!r ! use ( c]tifi$ ,,ehr te*nology 7z def9$ 9 subsection 7o77#d771 improve p]=mance ) respect to ! p]=mance categories describ$ 9 p>agraph 7#b77;,a71 or implem5t & p>ticipate 9 value-bas$ c>e models4 7ii7 ,crit]ia 7,i7 ,atte/ation ,a ,,dpps eligible pr(essional meets ! crit]ia specifi$ 9 ?is clause = a ye> if1 ) respect to su* ye> & pr(essional1 data 0 submitt$ "u ?is subsection &1 = purposes ( ?is subp>agraph1 x is demon/rat$ ?r\gh an atte/ation t ! pr(essional is 9 a small practice describ$ 9 subclause 7,,ii74 7,,ii7 ,small practices ,subject to clause 7iii71 a small practice describ$ 9 ?is subclause is a practice ( #ae or few] pr(essionals4 7iii7 ,secret>ial au?ority to give priority to c]ta9 small practices ,! ,secret>y may1 ) respect to a ,,dpps sav+s ye> & bas$ on ! am\nt specifi$ 9 clause 7iv77,i7 ) respect to su* ye>1 = purposes ( ?is subp>agraph give priority to ,,dpps eligible pr(essionals 9 c]ta9 small practices by apply+ clause 7ii77,,ii7 = su* ye> z if in/ead ( describ+ a practice ( #ae or few] pr(essionals1 su* clause describ$ any "o or m ( ! foll[+3 7,i7 ,a practice ( #ae or few] pr(essionals locat$ 9 a rural area4 7,,ii7 ,a practice ( #ae or few] pr(essionals locat$ 9 a heal? pr(essional %ortage area 7z designat$ "u 9 section #ccb7;a77#a77;,a7 ( su* ,act74 7,,iii7 ,a practice ( #ae or few] pr(essionals locat$ 9 a m$ically und]s]v$ area4 7,,iv7 ,a practice ( #ae or few] pr(essionals ) a l[ composite score4 7iv7 ,fund+ = inc5tive paym5ts 7,i7 ,am\nt available ,! am\nt specifi$ 9 ?is subclause1 ) respect to a ,,dpps sav+s ye>1 is ! am\nt by :i* ! am\nt describ$ 9 subclause 7,,ii7 = su* ye> exce$s ! am\nt describ$ 9 subclause 7,,iii7 = su* ye>4 7,,ii7 ,aggregate decrease ,! am\nt describ$ 9 ?is subclause is ! e/imat$ decrease 9 ! aggregate all[$ *>ges result+ f ! application ( ,,dpps adju/m5t factors "u subclauses 7,,iii7 & 7,,iv7 ( subp>agraph 7,a77ii7 to ,,dpps eligible pr(essionals ^: composite p]=mance score = a ye> is bel[ ! p]=mance ?re%old "u subp>agraph 7,d7 = su* ye>4 7,,iii7 ,aggregate increase ,! am\nt describ$ 9 ?is subclause is ! e/imat$ increase 9 ! aggregate all[$ *>ges result+ f ! application ( ,,dpps adju/m5t factors "u subp>agraph 7,a77ii77,i7 7aft] application ( subp>agraph 7,f77v77 to ,,dpps eligible pr(essionals ^: composite p]=mance score = a ye> is above ! p]=mance ?re%old "u subp>agraph 7,d7 = su* ye>4 7,,iv7 ,fund+ limitation ,9 no case may ! am\nts us$ to c>ry out ?is subp>agraph ) respect to a ye> exce$ ! am\nt specifi$ = su* ye> "u subclause 7,i74 7v7 ,,dpps sav+s ye> ,= purposes ( ?is subp>agraph1 ! t]m ,,dpps sav+s ye> means a ye> 7beg9n+ ) #bjbh7 = :i* ! am\nt describ$ 9 clause 7iv77,,ii7 exce$s ! am\nt describ$ 9 clause 7iv77,,iii74 7vi7 ,coord9ation ) o!r inc5tive paym5ts ,! am\nt ( any additional paym5t "u ?is subp>agraph & any o!r provision "u ?is section or section #ahcc1 includ+ section #ahcc7m7 %all be det]m9$ )\t reg>d to any additional paym5t "u su* o!r provision & ?is subp>agraph1 respectively4 4