,,ii  #aai? ,,congress  #b;d ,session   
,s4 #ebfg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,augu/ #e1 #bjbf,mr4   
,banks 7= himself1 ,mr4 ,padilla1 & ,mr4
 ,m>%all7 introduc$ ! foll[+ bill2 :i* 0
 read twice & ref]r$ to ! ,committee on 
,f9ance  ,a ,,bill  ,to am5d title ,,xi 
( ! ,social ,security ,act to require ! 
,c5t] = ,m$ic>e & ,m$icaid ,innovation  
to te/ a model to r$uce *ronic diseases 
by us+ ,acc\ntable ,produce is ,m$ic9e4 
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,acc\ntable ,produce is ,m$ic9e ,act (
 #bjbf4  #b4 ,s5se ( ,congress ,x is !  
s5se ( ,congress t-- 7#a7 diet-relat$   
*ronic diseases are a lead+ driv] (     
heal? c>e co/s 9 ! ,unit$ ,/ates2  7#b7 
evid5ce-bas$ food-is-m$ic9e int]v5tions1
 includ+ m$ically tailor$ meals1        
m$ically tailor$ groc]ies1 produce      
prescriptions1 & nutrition c\nsel+1 h ! 
pot5tial to improve heal? outcomes &    
r$uce heal? c>e exp5ditures2  7#c7 !    
,c5t] = ,m$ic>e & ,m$icaid ,innovation  
%\ld1 to ! ext5t practicable1           

incorporate su* int]v5tions1 z          
appropriate1 into models te/$ "u section
 #aaae;,a ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acae;a72 &  7#d7        
incorporat+ food-is-m$ic9e int]v5tions  
into ! ,c5t] = ,m$ic>e & ,m$icaid       
,innovation models may improve quality (
 c>e1 r$uce co/s1 & support ! prev5tion 
& managem5t ( *ronic disease4  #c4      
,requir+ ! ,c5t] = ,m$ic>e & ,m$icaid   
,innovation to te/ a model to improve   
outcomes = pati5ts ) *ronic diseases by 
us+ acc\ntable produce is m$ic9e        
,section #aaae;,a ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acae;a7 is am5d$-- 
7#a7 9 subsection 7b77#b77;,a71 9 ! ?ird
 s5t5ce1 by ins]t+ 1 &1 beg9n+ n lat]   
?an ! date t is #ahj days aft] !        
enactm5t ( ! ,acc\ntable ,produce is    
,m$ic9e ,act ( #bjbf1 %all include !    
,acc\ntable ,produce is ,m$ic9e ,bundl$ 
,paym5t ,model describ$ 9 subsection 7h7
 be=e ! p]iod at ! end2 &  7#b7 by add+ 
at ! end ! foll[+ new subsection3  7h7  
,acc\ntable ,produce is ,m$ic9e ,bundl$ 

,paym5t ,model  7#a7 ,9 g5]al ,=        
purposes ( subsection 7b77#b77;,a71 !   
,acc\ntable ,produce is ,m$ic9e ,bundl$ 
,paym5t ,model 79 ?is subsection1 ref]r$
 to z ! model7 describ$ 9 ?is subsection
 is a model "u :i* a bundl$ paym5t is   
made "u title ,,xviii1 title ,,xix1 or  
title ,,xxi1 z appropriate1 = select$   
programs to furni% ,acc\ntable ,produce 
is ,m$ic9e s]vices to eligible          
individuals4  7#b7 ,selection ( programs
 to p>ticipate  7,a7 ,select$ programs  
,! ,secret>y %all select to p>ticipate 9
 ! model at lea/ #e eligible programs1  
ea* to p>ticipate = a p]iod ( n less ?an
 #b ye>s1 t ! ,secret>y det]m9es h !    
capacity to satisfy ! requirem5ts       
describ$ 9 p>agraph 7#c74 ,9 ?is        
subsection1 ea* su* eligible program s  
select$ %all be ref]r$ to z a select$   
program4  7,b7 ,priority ,9 select+     
eligible programs "u subp>agraph 7,a71 !
 ,secret>y %all give priority to any su*
 program t furni%es 7includ+ ?r\gh an   
arrangem5t ) a provid] ( s]vices or     

suppli] or o!r entity7 fre%1 froz51 or  
m9imally process$ fruits & vegetables   
)\t add$ sug>s1 sodium1 or saturat$ fats
 7except ^? occurr+ naturally71 & o!r   
plant-bas$1 nutri5t-d5se foods1 includ+ 
nuts1 se$s1 intact :ole gra9s1 beans1 & 
l5tils4  7#c7 ,m9imum program           
requirem5ts ,"u ! model1 a select$      
program %all comply ) ea* ( ! foll[+    
requirem5ts3 7,a7 ,scre5+ ,! select$    
program %all scre5 individuals :o are   
ref]r$ to ! program by a physician1     
hospital1 or o!r heal? c>e provid]1 to  
det]m9e :e!r su* individuals are        
eligible individuals4  7,b7 ,acc\ntable 
,produce is ,m$ic9e s]vices ,9 ! case ( 
an individual :o is det]m9$ by ! select$
 program "u subp>agraph 7,a7 to be an   
eligible individual1 ! select$ program  
%all1 = ! #a-ye> p]iod foll[+ su*       
det]m9ation 7subject to subp>agraph     
7,d771 make available 7includ+ ?r\gh an 
arrangem5t ) a provid] ( s]vices or     
suppli] or o!r entity7 to su* individual
 ! foll[+ s]vices 79 ?is subsection     

ref]r$ to z ,acc\ntable ,produce is     
,m$ic9e s]vices or ,,apim s]vices73 7i7 
,a p]sonaliz$ heal? risk assessm5t &    
p]sonaliz$ prev5tion plan4  7ii7 ,c>e   
coord9ation s]vices4  7iii7 ,teleheal?  
s]vices relat$ to *ronic disease        
monitor+1 education1 & foll[-up4  7iv7  
,remote pati5t monitor+ items & s]vices 
t are cl9ically appropriate = monitor+  
*ronic disease & facilitat+ a timely    
response f a provid] 9 ! case t !       
select$ program detects significant     
*anges 9 ! data be+ monitor$4  7v7      
,life/yle modification programs1 includ+
 nutrition c\nsel+ provid$ by a regi/]$ 
dietician or o!r qualifi$ provid]1      
ex]cise programs1 & smok+ cessation     
c\nsel+4  7vi7 ,heal?y1 nutri5t-d5se    
foods meet+ su* /&>ds z ! ,secret>y %all
 det]m9e1 ) pref]5ce giv5 to produce    
gr[n )9 #bej miles ( ! select$ program  
or ?r\gh ! use ( reg5]ative agriculture4
  7,c7 ,collection ( heal? data2        
re5rollm5t assessm5t ,9 ! case ( an     
individual :o is det]m9$ by ! select$   

program "u subp>agraph 7,a7 to be an    
eligible individual1 ! select$ program  
%all-- 7i7 track ! ,,apim s]vices t !   
individual has receiv$ f ! program "u ! 
model2  7ii7 regul>ly evaluate !        
individual's engagem5t ) ! program &    
adh]5ce to program requirem5ts2  7iii7  
on a qu>t]ly basis collect f su*        
individual updat$ weight1 blood         
pressure1 & blood glucose measurem5ts1 &
 any o!r measurem5ts det]m9$ appropriate
 by ! ,secret>y2 &  7iv7 at ! end ( !   
#a-ye> p]iod describ$ 9 subp>agraph     
7,b7-- 7,i7 evaluate ! measurem5ts      
collect$ "u clause 7iii72  7,,ii7 submit
 to ! ,secret>y su* data z ! ,secret>y  
det]m9es necess>y = purposes ( evaluat+ 
! heal? c>e co/ sav+s a*iev$ = su*      
individual dur+ su* p]iod2 &  7,,iii7   
provide = an additional det]m9ation "u  
subp>agraph 7,a7 z to :e!r su*          
individual rema9s an eligible           
individual4  7,d7 ,dis5rollm5t ,9 ! case
 ( an individual :o is det]m9$ by !     
select$ program "u subp>agraph 7,a7 to  

be an eligible individual1 if ! select$ 
program det]m9es 79 accordance ) /&>ds  
e/abli%$ by ! ,secret>y7 be=e ! end ( ! 
#a-ye> p]iod describ$ 9 subp>agraph 7,b7
 t su* individual is n adequately engag+
 ) ! program or is n adh]+ to program   
requirem5ts1 ! select$ program %all     
t]m9ate ! individual's p>ticipation 9 ! 
program & may n furni% any additional   
,,apim s]vices to su* individual "u !   
model4  7#d7 ,paym5t  7,a7 ,9 g5]al ,!  
,secret>y %all det]m9e ! =m1 mann]1 &   
am\nt ( bundl$ paym5t to be provid$ to  
select$ programs "u ! model &1 beg9n+ 9 
! ?ird ye> 9 :i* su* model is c>ri$ out1
 may require t select$ programs assume  
f9ancial risk = p]=mance "u ! model4    
7,b7 ,co/ %>+ ,,apim s]vices furni%$ by 
a select$ program to an eligible        
individual %all be provid$ )\t          
application ( d$uctibles1 copaym5ts1    
co9surance1 or o!r co/-%>+ "u !         
applicable title4  7#e7 ,duration ,!    
model %all be c>ri$ out = a p]iod ( n   
less ?an #e ye>s4  7#f7 ,def9itions ,9  

?is subsection3 7,a7 ,eligible          
individual ,! t]m eligible individual   
means an individual-- 7i7 :o is-- 7,i7  
entitl$ to b5efits "u "p ,a ( title     
,,xviii or enroll$ = b5efits "u "p ,b ( 
su* title2  7,,ii7 enroll$ "u a ,/ate   
plan 7or waiv] ( su* plan7 "u title     
,,xix2 or  7,,iii7 enroll$ "u a ,/ate   
*ild heal? plan 7or waiv] ( su* plan7 "u
 title ,,xxi2  7ii7 :o resides 9 a      
m$ically und]s]v$ area 7z designat$     
pursuant to section #ccj7;b77#c77;,a7 ( 
! ,public ,heal? ,s]vice ,act71 a rural 
area 7z def9$ 9 section                 
#ahhf7;d77#b77;,d771 a heal? pr(essional
 %ortage area describ$ 9 section        
#ccb7;a77#a77;,a7 ( ! ,public ,heal?    
,s]vice ,act1 or ano!r area det]m9$     
appropriate by ! ,secret>y2  7iii7 :o   
has diabetes1 obesity1 c>diovascul>     
disease1 hyp]t5sion1 malnutrition1 or   
any o!r disease or *ronic condition t ! 
,secret>y det]m9es appropriate2  7iv7 9 
! cl9ical judgm5t ( a physician or o!r  
heal? c>e pr(essional1 :o w\ld b5efit f 

p>ticipation 9 ! model2  7v7 :o !       
eligible program det]m9es to be prep>$  
to p>ticipate 9 ! model2 &  7vi7 :o is n
 already receiv+ items or s]vices t !   
,secret>y det]m9es are sub/antially     
simil> 7& duplicative 9 purpose &       
cl9ical function7 to ! ,,apim s]vices   
describ$ 9 clause 7v7 ( p>agraph        
7#c77;,b74  7,b7 ,eligible program ,!   
t]m eligible program means a provid] (  
s]vices 7z def9$ 9 section #ahfa7u77 or 
suppli] enroll$ 9 ! program "u title    
,,xviii1 title ,,xix1 or title ,,xxi4   
7,c7 ,reg5]ative agriculture ,! t]m     
reg5]ative agriculture means a          
cons]vation managem5t approa* t         
emphasizes natural res\rces ?r\gh       
improv$ soil heal?1 wat] managem5t1 &   
natural vitality4  7,d7 ,suppli] ,! t]m 
suppli] means a physician or o!r        
practition]1 a facility1 or o!r entity t
 furni%es s]vices "u title ,,xviii1     
title ,,xix1 or title ,,xxi4  4