,,ii  #aai? ,,congress  #a/ ,session    
,s4 #abfd  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,april #b1 #bjbe,mr4   
,b5net introduc$ ! foll[+ bill2 :i* 0   
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
e/abli% a demon/ration program to       
promote collaborative treatm5t ( m5tal &
 physical heal? comorbidities "u !      
,m$ic>e program4  #a4 ,%ort title ,?is  
,act may be cit$ z ! ,m5tal & ,physical 
,heal? ,c>e ,comorbidities ,act ( #bjbe4
  #b4 ,e/abli%+ a demon/ration program  
to promote collaborative treatm5t (     
m5tal & physical heal? comorbidities "u 
! ,m$ic>e program ,title ,,xviii ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 is am5d$ by ins]t+ aft]  
section #ahff;,g ! foll[+ new section3  
#ahff;,h4 ,m5tal & physical heal?       
comorbidities collaborative demon/ration
 program  7a7 ,9 g5]al ,consi/5t ) !    
model describ$ 9 section                
#aaae;,a7b77#b77;,b77xv7 7relat+ to     

promot+ improv$ quality & r$uc$ co/ by  
develop+ a collaborative ( high-quality1
 l[-co/ heal? c>e in/itutions71 !       
,secret>y %all conduct a demon/ration   
program 79 ?is section ref]r$ to z !    
#8program'7 to te/ & evaluate           
innovations implem5t$ by eligible       
hospitals 7z def9$ 9 subsection 7f77 9 !
 furni%+ ( items & s]vices to applicable
 individuals 7z def9$ 9 subsection 7f77 
) m5tal & physical heal? comorbidities  
7& ^? at risk ( develop+ su*            
comorbidities71 includ+ by address+ !   
adv]se social det]m9ants ( heal? t su*  
individuals (t5 exp]i5ce4  7b7          
,activities "u program ,"u ! program1 ! 
,secret>y %all1 9 coord9ation ) eligible
 hospitals p>ticipat+ 9 ! program-- 7#a7
 id5tify1 validate1 & dissem9ate        
innovative1 effective evid5ce-bas$ be/  
practices & models t improve c>e &      
outcomes = applicable individuals )     
m5tal & physical heal? comorbidities    
locat$ 9 vuln]able communities1 includ+ 
by address+ ! social det]m9ants ( heal? 

t adv]sely impact su* individuals2 &    
7#b7 assi/ 9 ! id5tification ( pot5tial 
paym5t re=ms "u ?is title & title ,,xix 
t c\ld m broadly effectuate su*         
improvem5ts4  7c7 ,duration & scope ,!  
program conduct$ "u ?is section %all    
op]ate dur+ ! p]iod beg9n+ on ,octob]   
#a1 #bjbe1 & end+ no lat] ?an ,septemb] 
#cj1 #bjcj4  7d7 ,program elem5ts  7#a7 
,9 g5]al ,an eligible hospital elect+ to
 p>ticipate 9 ! program %all ent] into  
an agreem5t ) ! ,secret>y = purposes (  
c>ry+ out ! activities describ$ 9       
subsection 7b74 ,su* an agreem5t %all   
include ! plan describ$ 9 p>agraph 7#b71
 along ) an annualiz$ paym5t arrangem5t 
z describ$ 9 p>agraph 7#c7 to support   
implem5tation ( su* plan4 ,su* agreem5t 
%all include a requirem5t = ! hospital  
to-- 7,a7 engage 9 ! le>n+ collaborative
 e/abli%$ "u subsection 7e72  7,b7      
c]tify t all propos$ innovations "u su* 
plan w supplem5t & n supplant exi/+     
activities1 :e!r by augm5t+ exi/+       
activities or initiat+ new activities2 &

  7,c7 remit paym5ts made "u su*        
arrangem5t to ! ,secret>y if ! ,secret>y
 det]m9es t su* hospital has n compli$ )
 ! t]ms ( su* agreem5t4  7#b7 ,program  
elem5ts ,an eligible hospital elect+ to 
p>ticipate 9 ! program %all submit a    
propos$ plan & associat$ quality metrics
 = review & approval by ! ,secret>y4    
,su* plan & metrics %all1 at a m9imum1  
address-- 7,a7 ! specific innovations   
address+ m5tal & physical heal?         
comorbidities 7z def9$ 9 subsection 7f77
 & innovations address+ social          
det]m9ants ( heal? 7z def9$ 9 su*       
subsection7 t w be employ$ & ! evid5ce  
base support+ ! propos$ approa*2  7,b7 !
 propos$ t>get population ( applicable  
individuals ) respect to :i* su*        
innovations w be employ$1 includ+ a     
description ( ! ext5t to :i* su*        
population consi/s ( applicable         
individuals describ$ 9 subp>agraph 7,a71
 7,b71 or 7,c7 ( subsection 7f77#a72    
7,c7 ! evid5ce-bas$ data support+ a     
community's /atus z a vuln]able         

community ?r\gh s\rces1 su* z ,bureau ( 
! ,c5sus data & measures su* z !        
,neighborhood ,deprivation ,index or !  
,*ild ,opportunity ,index2  7,d7        
community p>tn]s1 su* z nonpr(it        
organizations1 f$]ally qualifi$ heal?   
c5t]s1 rural heal? cl9ics1 & units (    
local gov]nm5t 7includ+ law en=cem5t &  
judicial entities7 t w p>ticipate 9 !   
implem5tation ( su* innovations2  7,e7  
h[ su* innovations w address m5tal &    
physical heal? comorbidities & social   
det]m9ants ( heal? = ! t>get population2
  7,f7 h[ su* innovations may in=m      
*anges 9 paym5t & o!r policies "u ?is   
title & title ,,xix 7su* z c>e          
coord9ation reimbursem5t1 m5tal heal?   
homes1 improvem5ts to home &            
community-bas$ s]vice portfolios1 &     
cov]age ( supportive s]vices72  7,g7 h[ 
su* innovations might contribute to a   
r$uction 9 ov]all heal? c>e co/s1       
includ+ "u ?is title & title ,,xix & =  
un9sur$ p]sons1 ?r\gh improvem5ts 9     
population heal?1 r$uctions 9 heal? c>e 

utilization 7su* z inpati5t admissions1 
utilization ( em]g5cy dep>tm5ts1 & bo>d+
 ( pati5ts71 & o!rwise2  7,h7 h[ su*    
innovations c be expect$ to improve !   
m5tal & physical heal? /atus ( m9ority  
populations2  7,i7 h[ su* innovations c 
be expect$ to r$uce o!r non-m$ical      
public exp5ditures2  7,j7 metrics to    
track c>e quality1 improvem5t 9         
outcomes1 & ! impact ( su* innovations  
on heal? c>e & o!r public exp5ditures2  
7,k7 h[ program outcomes w be assess$ & 
evaluat$2 &  7,l7 h[ ! hospital w       
collect & organize data & fully         
p>ticipate 9 ! le>n+ collaborative      
e/abli%$ "u subsection 7e74  7#c7       
,p>ticipation2 paym5ts ,! ,secret>y %all
 negotiate an annualiz$ paym5t          
arrangem5t ) ea* eligible hospital      
p>ticipat+ 9 ! program4 ,su* arrangem5t 
may include an annual lump sum am\nt1   
capitat$ paym5t am\nt1 or su* o!r       
arrangem5t z det]m9$ appropriate by !   
,secret>y1 & :i* may include an         
arrangem5t t includes f9ancial risk = ! 

hospital1 to support implem5tation ( !  
innovations specifi$ 9 ! plan describ$ 9
 p>agraph 7#b74  7e7 ,le>n+             
collaborative  7#a7 ,9 g5]al ,!         
,secret>y %all e/abli% a le>n+          
collaborative t %all conv5e eligible    
hospitals p>ticipat+ 9 ! program & o!r  
int]e/$ p>ties on a regul> basis to     
report on & %>e in=mation reg>d+        
evid5ce-bas$ innovations address+ m5tal 
& physical heal? comorbidities1         
innovations address+ social det]m9ants (
 heal?1 & associat$ metrics & outcomes4 
7#b7 ,focus$ =ums ,! ,secret>y may      
e/abli% diff]5t focus$ =ums )9 !        
collaborative1 su* z ones t specifically
 address diff]5t geographic regions 7su*
 z urban & rural71 c]ta9 types (        
comorbidities1 or z ! ,secret>y o!rwise 
det]m9es appropriate bas$ on ! types (  
agreem5ts ent]$ into "u subsection 7d74 
7#c7 ,dissem9ation ( in=mation ,!       
,secret>y %all provide = ! dissem9ation 
to o!r heal? c>e provid]s & int]e/$     
p>ties ( in=mation on promis+ &         

effective activities4  7f7 ,def9itions  
,= purposes ( ?is section3 7#a7         
,applicable individual ,! t]m applicable
 individual means an individual ) m5tal 
& physical heal? comorbidities :o is--  
7,a7 a subsidy eligible individual 7z   
def9$ 9 section                         
#ahfj;,d-#ad7;a77#c77;,a77 )\t reg>d to 
clause 7i7 ( su* section2  7,b7 enroll$ 
"u a ,/ate plan 7or waiv] ( su* plan7 "u
 title ,,xix2 or  7,c7 un9sur$4  7#b7   
,eligible hospital ,! t]m eligible      
hospital means a hospital t is-- 7,a7 a 
rural hospital ) a disproportionate     
pati5t p]c5tage ( at lea/ #ce p]c5t 7z  
det]m9$ by ! ,secret>y "u section       
#ahhf7;d77#e77;,f77vi77 or w\ld h a     
disproportionate pati5t p]c5tage ( at   
lea/ #ce p]c5t 7z s det]m9$7 if !       
hospital 7 a subsection 7d7 hospital    
7or1 a p]c5tage ( inpati5t days consi/+ 
( items & s]vices furni%$ to individuals
 entitl$ to b5efits "u "p ,a t exce$s   
#he p]c5t ( all su* days7 t is ei!r a   
critical access hospital1 a sole        

community hospital 7z def9$ 9 section   
#ahhf7;d77#e77;,d77iii771 or a          
m$ic>e-dep5d5t1 small rural hospital 7z 
def9$ 9 section #ahhf7;d77#e77;,g77iv772
  7,b7 a l>ge subsection 7d7 tea*+ &    
t]ti>y hospital ) m ?an #bjj b$s t z (1 
or subsequ5t to ,july #a1 #bjbj1 has an 
av]age ,m$ic>e case mix index ( at lea/ 
#a4e1 an int]n & resid5t-to-b$ ratio (  
at lea/ #j4be p]c5t 7or at lea/ #aej    
full-"t equival5t int]ns1 resid5ts1 &   
fell[s71 & is ei!r a public hospital ) a
 disproportionate pati5t p]c5tage ( at  
lea/ #ce p]c5t 7z det]m9$ by ! ,secret>y
 "u section #ahhf7;d77#e77;,f77vi77 or a
 nonpr(it hospital ) a disproportionate 
pati5t p]c5tage ( at lea/ #de p]c5t2 or 
7,c7 a small subsection 7d7 urban safety
 net hospital 7z det]m9$ by ! ,secret>y7
 ) less ?an #bjj b$s t is deem$ to be a 
disproportionate %>e hospital "u section
 #aibc7;b74  7#c7 ,innovations address+ 
m5tal & physical heal? comorbidities ,! 
t]m innovations address+ m5tal &        
physical heal? comorbidities means      

innovations implem5t$ by an eligible    
hospital t seek to promote holi/ic c>e &
 treatm5t ( an applicable individual's  
co-occurr+ m5tal & physical heal?       
comorbidities1 support e>ly detection ( 
su* comorbidities1 or prev5t _! onset1  
includ+ ! foll[+3 7,a7 ,implem5tation ( 
int]discipl9>y integrative coord9at$ c>e
 team models1 includ+ ^? t utilize m5tal
 heal? em]g5cy dep>tm5t 9-rea* /aff 7&  
o!r em]g5cy-dep>tm5t int]v5tions71 c>e  
coord9ation /aff & social s]vices       
support1 & cl9ic-bas$ s]vices4  7,b7    
,integration ( m5tal heal? s]vices into 
m$ical homes1 coord9at$ c>e             
organizations1 acc\ntable c>e entities1 
& 9-home s]vices4  7,c7 ,incorporation (
 m5tal heal? & social risk scre5+ into  
m$ical scre5+1 p>ticul>ly 9 *ild &      
adolesc5t populations4  7,d7 ,prev5t+   
adv]se impacts on m5tal heal? result+ f 
physical heal? treatm5ts or m$ications1 
or on physical heal? result+ f m5tal    
heal? treatm5ts or m$ications1 ?r\gh    
cross discipl9>y provid] education1     

quality metrics1 & o!r me*anisms4  7,e7 
,improvem5ts 9 electronic heal? records 
& o!r te*nology plat=ms or networks to  
capture1 track1 & monitor m5tal &       
physical heal? treatm5ts & m$ications   
provid$ across c>e sett+s & o!rwise     
facilitate c>e coord9ation4  7,f7       
,pilot+ ( reimbursem5t modifications t  
utilize site-neutral paym5ts & t address
 conflicts & dis9c5tives relat$ to      
*ronic c>e managem5t & behavioral heal? 
managem5t & diff]5tial treatm5t (       
inpati5t & outpati5t sett+s4  7,g7      
,mitigat+ ! incid5ce ( admission &      
readmission into psy*iatric inpati5t    
sett+s ( *ronically ill eld]ly pati5ts  
?r\gh me?ods su* z active inpati5t      
managem5t1 v>iations 9 initial l5g? (   
/ay1 enhanc$ dis*>ge plann+1 &          
psy*osocial int]v5tions4  7,h7 ,deliv]+ 
heal? behavior assessm5ts & int]v5tions 
to improve physical heal? outcomes =    
pati5ts & aid 9 ! managem5t ( *ronic    
heal? conditions4  7,i7 ,9 coord9ation )
 law en=cem5t ag5cies & judicial        

entities1 int]v5tions t>get$ at provid+ 
m5tal & physical heal? s]vices 7includ+1
 z appropriate1 sub/ance use disord]    
s]vices7 to individuals convict$ (      
crim9al (f5ses = purposes ( mitigat+    
recidivism4  7#d7 ,innovations address+ 
social det]m9ants ( heal? ,! t]m        
innovations address+ social det]m9ants (
 heal? means innovations implem5t$ by an
 eligible hospital t seek to address    
social det]m9ants ( heal? t negatively  
impact ! heal? outcomes ( applicable    
individuals1 includ+ ! foll[+3 7,a7     
,improvem5ts 9 electronic heal? records 
to bett] integrate m5tal heal?1 m$ical  
c>e1 & social c>e 7su* z scre5+ = social
 factors1 facilitat$ or clos$ loop      
ref]ral1 risk /ratification1 & %>$      
records ) community-bas$ organizations74
  7,b7 ,p]sonnel-support$ wrap ar\nd    
s]vices = at-risk individuals ) m5tal & 
physical heal? comorbidities 7su* z     
nutrition & diet c\nsel+1 social s]vices
 ref]ral1 respiratory !rapy1            
m$ical-legal assi/ance1 f9ancial        

c\nsel+1 consum] education1 ph>macy     
education1 a/hma education1 & ref]ral to
 food res\rces su* z ref]ral to ! ,,snap
 program1 ! ,,wic program1 a food bank1 
case managem5t assi/ance1 employm5t or  
education support1 intimate p>tn]       
viol5ce1 & behavioral heal? support74   
7,c7 ,home & community-bas$ s]vices t   
provide collaborative c>e to address    
m5tal & physical heal? comorbidities    
?r\gh heal? behavior s]vices1 nutrition 
support1 m$ication managem5t1           
transitional c>e1 teleheal?1 mobile     
integrat$ heal? c>e1 p>am$ic-bas$ home  
visitation1 or utilization ( community  
heal? work]s4  7,d7 ,hospital-bas$      
int]v5tions 7su* z same day prim>y c>e  
s]vices1 skill$ nurs+ int]v5tions1      
sub/ance use disord] & behavioral heal? 
treatm5t coord9ation ( c>e1             
collaborative c>e models1 dis*>ge plann+
 & m$ication reconciliation1 long-t]m   
c>e managem5t1 & po/-traumatic injury   
managem5t74  7#e7 ,individual ) m5tal & 
physical heal? comorbidities ,! t]m     

individual ) m5tal & physical heal?     
comorbidities means an individual :o is 
*all5g$ by s]i\s m5tal illness or s]i\s 
emotional di/urbance z well z #a or m ( 
! foll[+ conditions or *>act]i/ics3 7,a7
 ,has or is at risk = "o or m *ronic    
conditions 7z def9$ by ! ,secret>y74    
7,b7 ,high-risk pregnancy4  7,c7 ,hi/ory
 ( high utilization ( acute c>e s]vices4
  7,d7 ,frail eld]ly 7def9$ by          
impairm5ts 9 activities ( daily liv+74  
7,e7 ,disability1 includ+ traumatic bra9
 injury4  7,f7 ,critical illness or     
injury requir+ long-t]m recov]y4  7#f7  
,vuln]able community ,! t]m vuln]able   
community means a geographic area s]v$  
by an eligible hospital *>act]iz$ by a  
population t has a /ati/ically          
significant numb] ( individuals ) m5tal 
& physical heal? comorbidities1         
indicators ( poor population heal?      
/atus1 l[-income /atus1 or /atus z a    
,,usda-recogniz$ food des]t4  7g7       
,evaluation & report ,n lat] ?an #a ye> 
aft] ! date ( completion ( ! program "u 

?is section1 ! ,secret>y %all submit to 
,congress a report conta9+ an evaluation
 ( ! activities support$ by ! program4  
,su* report %all include ! foll[+3 7#a7 
,a description ( ea* su* activity1      
includ+-- 7,a7 ! t>get population ( su* 
activity2  7,b7 h[ su* activity address$
 ! adv]se social det]m9ants ( heal? 9   
su* population2 &  7,c7 ! role (        
community-bas$ organizations & o!r      
community p>tn]s 7su* z nonpr(its &     
units ( local gov]nm5t7 9 su* activity4 
7#b7 ,evid5ce %[+ :e!r & h[ ea* su*     
activity advanc$ any ( ! foll[+         
objectives3 7,a7 ,improv$ access to c>e4
  7,b7 ,improv$ quality ( c>e4  7,c7    
,improv$ heal? outcomes4  7,d7          
,amelioration ( disp>ities 9 c>e4  7,e7 
,improv$ c>e coord9ation4  7,f7         
,r$uction 9 heal? c>e co/s 7includ+ su* 
r$uctions "u ?is title & title ,,xix &  
su* r$uctions occurr+ = un9sur$         
individuals74  7,g7 ,r$uction 9 heal?   
c>e utilization 7includ+ ) respect to   
inpati5t admissions1 utilization (      

em]g5cy dep>tm5ts1 & room & bo>d provid$
 to individuals74  7,h7 ,r$uction 9     
non-m$ical public exp5ditures4  7,i7    
,*anges 9 pati5t & provid] satisfaction 
) c>e deliv]y4  7,j7 ,r$uctions 9       
involvem5t ) ! ju/ice sy/em1 includ+    
r$uctions 9 recidivism4  7#c7 ,a        
description ( ! metrics us$ to track !  
implem5tation & results ( ea* su*       
activity4  7#d7 ,recomm5dations = any   
legislation or adm9i/rative action !    
,secret>y det]m9es appropriate4  7h7    
,fund+ ,any funds appropriat$ "u section
 #aaae;,a7f7 %all be available to !     
,secret>y )\t fur!r appropriation = !   
purposes ( c>ry+ out ?is section4  4