[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4206 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 4206

   To amend title XVIII of the Social Security Act to modernize the 
 physician self-referral prohibitions to promote care coordination in 
 the merit-based incentive payment system and to facilitate physician 
practice participation in alternative payment models under the Medicare 
                    program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            November 1, 2017

    Mr. Bucshon (for himself, Mr. Ruiz, Mr. Marchant, and Mr. Kind) 
 introduced the following bill; which was referred to the Committee on 
   Energy and Commerce, and in addition to the Committee on Ways and 
 Means, 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

_______________________________________________________________________

                                 A BILL


 
   To amend title XVIII of the Social Security Act to modernize the 
 physician self-referral prohibitions to promote care coordination in 
 the merit-based incentive payment system and to facilitate physician 
practice participation in alternative payment models under the Medicare 
                    program, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Care Coordination 
Improvement Act of 2017''.

SEC. 2. MODERNIZATION OF LIMITATIONS ON PHYSICIAN SELF-REFERRAL.

    (a) Waivers To Promote Care Coordination by Facilitating 
Participation in Alternative Payment Models.--
            (1) In general.--Section 1833 of the Social Security Act 
        (42 U.S.C. 1395l) is amended--
                    (A) in subsection (z), as added by section 
                101(e)(2) of the Medicare Access and CHIP 
                Reauthorization Act of 2015 (Public Law 114-10), by 
                adding at the end the following new paragraph:
            ``(5) Waiver authority.--
                    ``(A) In general.--The provisions of subsection (f) 
                of section 1899 shall apply with respect to covered APM 
                entities to the same extent and in the same manner as 
                such provisions apply with respect to accountable care 
                organizations under such section.
                    ``(B) Covered apm entities.--For purposes of 
                subparagraph (A), the term `covered APM entity' means, 
                subject to subparagraph (C), each of the following:
                            ``(i) An eligible alternative payment 
                        entity as defined in paragraph (3)(D).
                            ``(ii) An entity participating in an 
                        alternative payment model as defined in 
                        paragraph (3)(C), including such participation 
                        that qualifies as a clinical practice 
                        improvement activity under section 
                        1848(q)(2)(B)(iii)(VI).
                            ``(iii) An entity participating in a 
                        physician-focused payment model for which 
                        comments and recommendations have, under 
                        subparagraph (C) of section 1868(c)(2), been 
                        submitted indicating that such model meets the 
                        criteria described in subparagraph (A) of such 
                        section.
                            ``(iv) An entity participating in any other 
                        model that the Secretary determines is a 
                        covered APM for purposes of subparagraph (A), 
                        including such a determination made pursuant to 
                        physicians submitting a proposal to the 
                        Secretary for an alternative payment model.
                            ``(v) An entity engaging in activities that 
                        the Secretary has determined constitute 
                        significant progress toward establishing a 
                        model referred to in any of clauses (i) through 
                        (iv).
                    ``(C) Certain requirements.--A model referred to in 
                any of clauses (i) through (iv) of subparagraph (B) may 
                not be considered a covered APM entity for purposes of 
                subparagraph (A) unless the model meets the 
                requirements described in section 1877(b)(6)(B).''; and
                    (B) by redesignating subsection (z), as added by 
                section 514(a) of the Medicare Access and CHIP 
                Reauthorization Act of 2015 (Public Law 114-10), as 
                subsection (aa).
            (2) Conforming amendment.--Section 514(c)(1) of the 
        Medicare Access and CHIP Reauthorization Act of 2015 (Public 
        Law 114-10) is amended by striking ``subsection (z)'' and 
        inserting ``subsection (aa)''.
    (b) Expansion of Administrative Authority To Provide Exceptions to 
Physician Ownership and Compensation Arrangement Prohibitions To 
Promote Care Coordination.--
            (1) Promoting care coordination.--Section 1877(b)(4) of the 
        Social Security Act (U.S.C. 1395nn(b)(4)) is amended by 
        striking ``risk of program or patient abuse'' and inserting the 
        following: ``significant risk of program or patient abuse, 
        including those that would promote care coordination, quality 
        improvement, or resource conservation by physician practices 
        under part B''.
            (2) Care coordination in mips and participation in apms.--
        Section 1877(a) of the Social Security Act (U.S.C. 1395nn(a)) 
        is amended by adding at the end the following new paragraph:
            ``(3) Limitation.--The Secretary may not impose 
        requirements under this section that could adversely affect--
                    ``(A) physician care coordination in the merit-
                based incentive payment system under section 1848(q); 
                or
                    ``(B) physician participation in an alternative 
                payment model under 1833(z).''.
    (c) Exception Facilitating the Development and Operation of 
Alternative Payment Models.--Section 1877(b) of the Social Security Act 
(42 U.S.C. 1395nn(b)) is amended by adding at the end the following new 
paragraph:
            ``(6) Development and operation of alternative payment 
        models.--
                    ``(A) In general.--In the case of services 
                furnished pursuant to an arrangement that meets the 
                requirements described in subparagraph (B) entered into 
                for the purpose of developing or operating an 
                alternative payment model, including--
                            ``(i) advanced alternative payment models 
                        described in section 1833(z) (including 
                        physician-focused payment models referred to in 
                        section 1868(c));
                            ``(ii) MIPS APMs (as defined by the 
                        Secretary); and
                            ``(iii) any other alternative payment model 
                        that the Secretary may, by regulation, specify.
                    ``(B) Requirements.--The requirements described in 
                this subparagraph with respect to an arrangement 
                relating to an alternative payment model are as 
                follows:
                            ``(i) The arrangement is in writing, 
                        identifies the services, items, or actions 
                        subject to the arrangement and is signed by the 
                        parties to the arrangement.
                            ``(ii) Items and services furnished subject 
                        to the arrangement are furnished at fair market 
                        value. In this clause, the term `fair market 
                        value' has the meaning given such term in 
                        subsection (h)(3), except that the Secretary 
                        may not take into account the volume or value 
                        of referrals in determining such value for 
                        purposes of this clause.
                            ``(iii) The arrangement includes a 
                        description of the alternative payment model.
                            ``(iv) Under the arrangement written 
                        reports are submitted to the Secretary on a 
                        semi-annual basis on the progress achieved in 
                        the development and operation of the 
                        alternative payment model
                            ``(v) The arrangement meets such other 
                        requirements as the Secretary may impose by 
                        regulation as needed to protect against a 
                        significant risk of program patient abuse''.
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