,,ii #aai? ,,congress #b;d ,session ,s4 #ebfi ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,augu/ #e1 #bjbf,mr4 ,:iteh\se 7= himself & ,mr4 ,cassidy7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to provide = ! e/abli%m5t ( hybrid prim>y c>e paym5ts "u ! ,m$ic>e program1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,pay ,p,c,ps ,act ( #bjbf4 #b4 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,trans=mation ( prim>y c>e practices s]ves z an ess5tial f\ndation = improv+ heal? & life outcomes = ,m$ic>e b5efici>ies1 p>ticul>ly = ^? ) multiple *ronic conditions & complex ne$s1 m5tal heal? *all5ges1 or liv+ 9 rural & o!r socioeconomically *all5g$ communities4 7#b7 ,rese>* has %[n t #be p]c5t or m ( prim>y c>e activities are n recogniz$ = paym5t "u mo/ fee s*$ules1 includ+ ! ,m$ic>e physician fee s*$ule1 l>gely because ^! activities reflect a wide range ( high frequ5cy1 brief activities t _c effici5tly be paid fee-=-s]vice & because ! bill+ co/s = submitt+ claims = su* s]vices w\ld usually exce$ ! value ( paym5t4 7#c7 ,fee-=-s]vice is ill-suit$ to support _m elem5ts ( practice trans=mation to produce effective prim>y c>e1 su* z develop+ & ma9ta9+ multi-discipl9>y team-bas$ c>e /rategies t lev]age cl9icians su* z nurse practition]s1 physician assi/ants1 nutritioni/s1 & ph>maci/s1 & coord9at+ c>e ) o!r cl9icians & social s]vice provid]s4 7#d7 ,rese>* has %[n t prim>y c>e repres5ts a mu* small] p]c5tage ( total heal? c>e sp5d+ by pay]s1 reg>dless ( type ( insurance cov]age1 9 ! ,unit$ ,/ates ?an 9 o!r weal?y nations1 & t high] p]c5tage ( total sp5d+ t is devot$ to prim>y c>e s]vices is associat$ ) l[] ov]all heal? c>e sp5d+1 & 9 ! ,m$ic>e ,%>$ ,sav+s ,program1 ) high] sav+s p]=mance by acc\ntable c>e organizations l$ by physician gr\ps4 7#e7 ,a composite1 prospective paym5t w\ld provide prim>y c>e practices ) m pr$ictable & flexible rev5ues to support su* elem5ts ( effective prim>y c>e & help appropriately value s]vices & activities p]=m$ by prim>y c>e provid]s & critical s]vices n curr5tly paid =4 7#f7 ,paym5ts = "s physician s]vices "u ! ,m$ic>e program1 includ+ _m t produce sub/antial sp5d+ "u ! ,m$ic>e program1 h major di/ortions4 7#g7 ,det]m9ation ( paym5ts = physician s]vices "u ! ,m$ic>e program curr5tly beg9s ) subjective survey-bas$ e/imates ( cl9ician "t & ef=t p] discrete s]vice4 ,?is approa* to valu+ physician s]vices is inconsi/5t ) ! compreh5sive & cont9u\s nature ( prim>y c>e4 7#h7 ,/udies h f\nd t paym5t levels 9 ! ,m$ic>e physician fee s*$ule reflect e/imates ( cl9ician "t p] s]vice = a v>iety ( s]vices t are p>ticul>ly inaccurate4 7#i7 ,! extreme complexity ( hav+ m ?an #h1jjj bill+ codes 9 ! ,m$ic>e physician fee s*$ule risks inaccuracy 9 e/imations ( relative values = closely relat$ proc$ures & obscures di/ortions 9 pric+ t gr[ ov] "t = specific s]vices4 #c4 ,e/abli%+ hybrid prim>y c>e paym5t 9 m$ic>e 7a7 ,e/abli%m5t ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 may e/abli% )9 ! ,m$ic>e physician fee s*$ule e/abli%$ "u section #ahdh7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;b771 hybrid paym5ts only to be available to prim>y c>e provid]s 7z def9$ 9 subsection 7g774 7b7 ,hybrid paym5ts 7#a7 ,9 g5]al ,su* hybrid paym5ts may be compris$ ( ! sum (-- 7,a7 prospective1 p]-memb]-p]-mon? paym5ts2 & 7,b7 fee-=-s]vice paym5ts4 7#b7 ,det]m9ation ( am\nt ( prospective1 p]-memb]-p]-mon? paym5t 7,a7 ,9 g5]al ,subject to ! prec$+ provisions ( ?is subsection1 ! total prospective1 p]-memb]-p]-mon? paym5t-- 7i7 may repres5t betwe5 #dj & #gj p]c5t ( expect$ annual total all[$ *>ges d]iv$ f ! ,m$ic>e physician fee s*$ule = prim>y c>e provid]s ( s]vices & suppli]s2 7ii7 %\ld exce$ ! hi/oric actu>ially equival5t to ! applicable physician fee s*$ule am\nts = ! s]vices includ$ )9 ! total prospective1 p]-memb]-p]-mon? paym5t2 7iii7 %\ld be calculat$ bas$ on hi/oric ,m$ic>e paym5ts = ^? s]vices :i* w\ld be includ$ z "p ( ! prospective1 p]-memb]-p]-mon? paym5t2 & 7iv7 %\ld support practice trans=mation1 exp&$ c>e coord9ation capacity1 multidiscipl9>y team-bas$ c>e1 & s]vices & activities n hi/orically recogniz$ = sep>ate paym5t "u ! physician fee s*$ule1 su* z communications ) pati5ts & _! c>egiv]s includ+ emails1 phone calls1 & communications ?r\gh pati5t portals4 7,b7 ,application ( c]ta9 factors ,! ,secret>y may consid] apply+ p]c5tages diff]5t f ^? specifi$ 9 subp>agraph 7,a7 = diff]5t types ( prim>y c>e provid]s bas$ on factors su* z hi/orical fee-=-s]vice rev5ue patt]ns or quality p]=mance ( ! provid]4 7,c7 ,risk adju/m5t ,! ,secret>y may assess ! ne$ to risk adju/ ! prospective1 p]-memb]-p]-mon? paym5t & develop appropriate risk adju/m5t me?odologies1 tak+ into consid]ation factors t pr$ict levels ( prim>y c>e s]vice utilization4 ,risk adju/m5t me?odologies may incorporate cl9ical diagnoses1 demographic factors1 & o!r relevant in=mation su* z social det]m9ants ( heal?4 7c7 ,categorization ( s]vices 7#a7 ,9 g5]al ,= su* hybrid paym5ts1 ! ,secret>y may create categories ( diff]5t s]vices t are :olly reimburs$ "u ! ,m$ic>e physician fee s*$ule1 b may n include s]vices = :i* reimbursem5t occurs p>tly ?r\gh o!r paym5t s*$ules "u ! ,m$ic>e program4 7#b7 ,s]vices includ$ 9 prospective1 p]-memb]-p]-mon? paym5t ,! ,secret>y may include ! foll[+ types ( s]vices 9 ! prospective1 p]-memb]-p]-mon? paym5t "u ?is section3 7,a7 ,c>e managem5t s]vices4 7,b7 ,communications ) pati5ts & _! c>egiv]s1 su* z emails1 phone calls1 & communications ?r\gh pati5t portals4 7,c7 ,behavioral heal? integration s]vices4 7,d7 ,(fice-bas$ evaluation & managem5t visits1 reg>dless ( modality1 = new & e/abli%$ pati5ts4 7#c7 ,cl>ification reg>d+ fee-=-s]vice paym5t = o!r s]vices ,= su* hybrid paym5ts1 ! ,secret>y may cont9ue to pay ?r\gh fee-=-s]vice paym5ts = all o!r s]vices n specifi$ 9 p>agraph 7#b7 "u ! ,m$ic>e physician fee s*$ule1 includ+ scre5+s1 additional prev5tive s]vices 7z def9$ 9 section #ahfa7;ddd77#a771 annual wellness visits 7z def9$ 9 section #ahfa7;hhh7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7hhh7771 vacc9ations1 & initial prev5tive physical exam9ations 7z def9$ 9 section #ahfa7ww7 ( su* ,act 7#db ,u4,s4,c4 #aciex7ww7774 ,! ,secret>y %all ensure t ! s]vices describ$ 9 ! prec$+ s5t5ce rema9 sep>ately payable "u ! ,m$ic>e physician fee s*$ule & ! proportion ( ! paym5ts repres5t$ by ^! s]vices w be n less ?an ! ,m$ic>e paym5ts = ^! s]vices4 7d7 ,id5tification ( quality measures ,! ,secret>y may id5tify quality measures ) respect to prim>y c>e provid]s t receive hybrid paym5t "u ?is section to safegu>d heal? outcomes = ,m$ic>e b5efici>ies1 & rew>d high quality p]=mance ?r\gh me*anisms su* z annual bonus paym5ts4 ,quality measures may be id5tifi$ us+ exi/+ me*anisms su* z ^? approv$ = use 9 ! ,acc\ntable ,c>e ,organization_/,pati5t-,c5t]$ ,m$ical ,home_/,prim>y ,c>e ,core ,set agre$ to by memb]s ( ! ,core ,quality ,measure ,collaborative4 ,measurem5t may address areas su* z-- 7#a7 pati5t exp]i5ce2 7#b7 cl9ical quality measures2 7#c7 s]vice utilization1 includ+ measures ( rates ( em]g5cy dep>tm5t visits & hospitalizations2 & 7#d7 effici5cy 9 ref]rals1 :i* may include measures ( ! compreh5siv5ess ( s]vices t ! prim>y c>e provid] furni%es4 7e7 ,attribution ,! ,secret>y %all e/abli% proc$ures "u :i* a b5efici>y is attribut$ to a prim>y c>e provid] us+ hi/orical claims data & ! b5efici>y affirms t ! provid] is _! prim>y c>e provid]4 7f7 ,exclusion f ,,mips ,section #ahdh7q77#a77;,c77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77#a77;,c77ii77 is am5d$-- 7#a7 9 subclause 7,,ii71 by /rik+ or at ! end2 7#b7 9 subclause 7,,iii71 by /rik+ ! p]iod at ! end & ins]t+ 2 or2 & 7#c7 by add+ at ! end ! foll[+ new subclause3 7,,iv7 is a prim>y c>e provid] t receives hybrid paym5ts pursuant to section #c ( ! ,pay ,p,c,ps ,act ( #bjbf4 4 7g7 ,prim>y c>e provid] def9$ ,9 ?is section1 ! t]m prim>y c>e provid] means a practition] 7z def9$ 9 section #ahdb7;b77#ah77;,c77 ( su* ,act 7#db ,u4,s4,c4 #acieu7b77#ah77;,c77 or a physician 7z def9$ 9 section #ahfa7r77 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7r77 :o furni%es prim>y c>e s]vices 7z def9$ 9 section #ahdb7;i77#d77 ( su* ,act 7#db ,u4,s4,c4 #acieu7i77#d774 7h7 ,appropriation 7#a7 ,9 g5]al ,9 addition to o!r am\nts made available1 = purposes ( mak+ hybrid paym5ts "u ?is section1 !re is appropriat$ to ! ,secret>y1 out ( any moneys 9 ! ,treasury n o!rwise appropriat$1 #aj1jjj1jjj1jjj = fiscal ye>s #bjbg ?r\gh #bjca4 7#b7 ,budget neutrality waiv] ,! am\nts made available "u p>agraph 7#a7 %all n be tak5 into acc\nt 9 apply+ section #ahdh7;c77#b77;,b77ii77,,ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,b77ii77,,ii774 7i7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ to require a prim>y c>e provid] to receive hybrid paym5ts e/abli%$ "u ?is section4 #d4 ,r$uc+ b5efici>y co/ %>+ = prim>y c>e s]vices 7a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 ! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 may r$uce by #ej p]c5t any b5efici>y co/ %>+ o!rwise applicable "u "p ,b ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;j et seq47 = prim>y c>e s]vices t are reimburs$ ?r\gh ! hybrid paym5ts e/abli%$ "u section #c1 provid$ t ! b5efici>y designates a prim>y c>e provid] z _! usual s\rce ( c>e & in=ms ! ,secret>y ( :o t provid] is pursuant to ! proc$ures e/abli%$ "u section #c7;e74 7b7 ,report to ,congress ,n lat] ?an #ahj days aft] ! date on :i* subsection 7a7 is fir/ implem5t$1 & annually !reaft]1 ! ,secret>y %all submit to ,congress a report on ! implem5tation ( su* subsection1 includ+ an analysis (-- 7#a7 :e!r ! r$uction ( b5efici>y co/-%>+ "u su* subsection has impact$ b5efici>y utilization ( prim>y c>e s]vices t may be reimburs$ ?r\gh ! newly e/abli%$ p]-memb]-p]-mon? paym5t2 & 7#b7 :e!r ! ,secret>y has obs]v$ any in/ances ( fraud or abuse associat$ ) ! r$uction ( su* co/-%>+1 & :e!r ! ,secret>y has tak5 /eps to m9imize any su* fraud or abuse4 #e4 ,e/abli%+ a new te*nical advisory committee on relative value updates & revisions ,section #ahdh7;c77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,p7 ,e/abli%m5t ( te*nical advisory committee on relative value updates & revisions 7i7 ,9 g5]al ,! ,secret>y %all e/abli% a te*nical advisory committee 79 ?is section ref]r$ to z ! committee7 )9 ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices to provide ! ,secret>y ) te*nical input reg>d+ ! accurate det]m9ation ( relative value units "u ?is p>agraph4 7ii7 ,memb]%ip 7,i7 ,9 g5]al ,! committee %all be compos$ ( #ac memb]s appo9t$ by ! ,secret>y f among individuals-- 7aa7 reflect+ div]se exp]i5ces 9 provid] paym5t1 includ+ provid]s bill+ ! ,m$ic>e program "u ?is title1 provid]s provid+ c>e "u ! laws adm9i/]$ by ! ,secret>y ( ,vet]ans ,affairs or ! ,secret>y ( ,def5se1 & prim>y c>e provid]s 7z def9$ 9 subclause 7,,iii772 & 7bb7 ) te*nical exp]tise 9 ,m$ic>e paym5t policies4 7,,ii7 ,*air #a ( ! memb]s appo9t$ "u subclause 7,i7 %all be a repres5tative ( p]sonnel ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 & t memb] %all s]ve z *air ( ! committee4 7,,iii7 ,prim>y c>e provid] ,= purposes ( ?is clause1 ! t]m prim>y c>e provid] means a practition] 7z def9$ 9 section #ahdb7;b77#ah77;,c77 or a physician 7z def9$ 9 section #ahfa7r77 :o furni%es prim>y c>e s]vices 7z def9$ 9 section #ahdb7;i77#d774 7iii7 ,/aff ,! committee %all be /aff$ by p]sonnel ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7iv7 ,duties ,! committee %all advise ! ,secret>y on an ongo+ basis reg>d+ ! det]m9ation ( relative value units "u ! physician fee s*$ule ?r\gh duties su* z ! foll[+3 7,i7 ,design+ new valuation me?odologies ! ,secret>y may use to det]m9e ! "t & res\rces use by heal? pr(essionals associat$ ) furni%+ s]vices or o!r new approa*es to det]m9+ relative res\rces = ea* ,,hcpcs code4 ,! committee may prioritize furni%$ s]vices t are mo/ common or repres5t ! s]vices ) ! highe/ all[$ *>ges4 7,,ii7 ,advis+ on rese>* & developm5t relevant to ! det]m9ation ( relative value units = individual ,,hcpcs codes4 7,,iii7 ,provid+ recomm5dations ) respect to *anges 9 valuations ( curr5t ,,hcpcs codes bas$ ^u any newly develop$ valuation me?odologies4 7,,iv7 ,evaluat+ :e!r exi/+ ,,hcpcs codes )9 ! same family ( s]vices %\ld be collaps$ to result 9 few] paym5t codes4 7,v7 ,id5tify+ opportunities = bundl+ or unbundl+ s]vices = paym5t purposes4 7,,vi7 ,assess+ ! op]ational burd5 ( new approa*es on physicians & o!r suppli]s & b5efici>ies :ile also consid]+ ! vuln]abilities ( new approa*es on ov]t fraud & abuse4 7,,vii7 ,assess+ ! impacts ( ^! new approa*es & pot5tial adoption on b5efici>y access1 f9ancial liabilities1 quality ( c>e1 & heal? disp>ities4 7v7 ,fund+ 7,i7 ,implem5tation ,! ,secret>y may provide = ! transf]1 f ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda1 su* am\nts z are necess>y to c>ry out ?is subsection 7o!r ?an rese>* & developm5t "u clause 7iv77,,ii77 7n to exce$ #e1jjj1jjj7 = ea* ( fiscal ye>s #bjbg ?r\gh #bjca4 ,any am\nts transf]r$ "u ! prec$+ s5t5ce = a fiscal ye> %all rema9 available until exp5d$4 7,,ii7 ,rese>* & developm5t ,! ,secret>y may provide = ! transf]1 f ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda1 su* am\nts z are necess>y to c>ry out rese>* & developm5t "u clause 7iv77,,ii7 7n to exce$ #aj1jjj1jjj7 = ea* ( fiscal ye>s #bjbg ?r\gh #bjca4 ,any am\nts transf]r$ "u ! prec$+ s5t5ce = a fiscal ye> %all rema9 available until exp5d$4 7vi7 ,duration ,! committee %all t]m9ate n lat] ?an ! expiration ( ! #e-ye> p]iod beg9n+ on ! date ( its e/abli%m5t4 4