3.0.0 5841 2023-01-11T13:33:21Z 2023-01-11T13:33:21Z House HR 2016-07-14 114 [Congressional Record Volume 162, Number 114 (Thursday, July 14, 2016)]From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]By Mr. KELLY of Pennsylvania:H.R. 5841.Congress has the power to enact this legislation pursuantto the following:The Congress enacts this bill pursuant to Article I Section8 of the United States Constitution.[Page H5013]]]> hswm00 Ways and Means Committee House Standing hswm02 Health Subcommittee Referred to 2016-08-02T14:00:08Z Referred to 2016-07-14T13:10:30Z hsif00 Energy and Commerce Committee House Standing Referred to 2016-07-14T13:10:35Z 2016-08-02 hswm02 Health Subcommittee 1 House committee actions Referred to the Subcommittee on Health. Committee 2016-07-14 Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. IntroReferral H11100 2 House floor actions hsif00 Energy and Commerce Committee 2016-07-14 Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. IntroReferral H11100-A 9 Library of Congress 2016-07-14 Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. IntroReferral H11100 2 House floor actions hswm00 Ways and Means Committee 2016-07-14 Introduced in House IntroReferral Intro-H 9 Library of Congress 2016-07-14 Introduced in House IntroReferral 1000 9 Library of Congress K000376 Rep. Kelly, Mike [R-PA-3] Mike Kelly R PA 3 N N000015 Rep. Neal, Richard E. [D-MA-1] RICHARD NEAL D MA E. 1 2016-07-14 True Health Health care costs and insurance Health care coverage and access Health care quality Health facilities and institutions Health personnel Medicare Performance measurement Prescription drugs Health 00 2016-07-14 Introduced in House 2017-04-12T20:52:06Z This bill amends title XVIII (Medicare) of the Social Security Act to establish a five-year, population-based payment demonstration project through which provider networks are prospectively paid monthly capitated payments for coordinated care furnished to Medicare beneficiaries.

To be eligible to participate in the project, a provider network must:

  • be an integrated care system that provides Medicare services directly;
  • include physicians in group practice arrangements, a federally qualified health center, and at least one hospital;
  • enter into, and be responsible for making payments to providers under, appropriate contractual arrangements;
  • be accountable for the quality, cost, and overall care of the network's participating beneficiaries;
  • enter into a participation agreement with the Centers for Medicare & Medicaid Services (CMS); and
  • meet other specified requirements.

CMS shall establish a process for prospectively assigning Medicare fee-for-service beneficiaries to a participating provider network. This process must allow beneficiaries to opt out of such assignment.

The bill limits Medicare payment for out-of-network services furnished to a participating beneficiary.

To calculate payments to participating networks, CMS shall: (1) determine a base annual prospective population health budget, (2) adjust such budget to account for the number and characteristics of participating beneficiaries with respect to each network, and (3) annually update the budget to account for population changes and Medicare program growth.

The bill establishes certain limits on total program expenditures for the program's initial three years.

CMS may expand the project's duration and scope under specified circumstances.

]]> To amend title XVIII of the Social Security Act to establish a population based payment demonstration project under which Patient Care Networks are paid prospective monthly capitated payments for coordinated care furnished to Medicare beneficiaries. Display Title To amend title XVIII of the Social Security Act to establish a population based payment demonstration project under which Patient Care Networks are paid prospective monthly capitated payments for coordinated care furnished to Medicare beneficiaries. Official Title as Introduced To amend title XVIII of the Social Security Act to establish a population based payment demonstration project under which Patient Care Networks are paid prospective monthly capitated payments for coordinated care furnished to Medicare beneficiaries. Introduced in House 2016-07-14T04:00:00Z https://www.govinfo.gov/content/pkg/BILLS-114hr5841ih/xml/BILLS-114hr5841ih.xml 2016-08-02 Referred to the Subcommittee on Health. text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. Congressional Research Service, Library of Congress This file contains bill summaries and statuses for federal legislation. A bill summary describes the most significant provisions of a piece of legislation and details the effects the legislative text may have on current law and federal programs. Bill summaries are authored by the Congressional Research Service (CRS) of the Library of Congress. As stated in Public Law 91-510 (2 USC 166 (d)(6)), one of the duties of CRS is "to prepare summaries and digests of bills and resolutions of a public general nature introduced in the Senate or House of Representatives". For more information, refer to the User Guide that accompanies this file.