[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2282 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 2282
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
April 10, 2019
Mr. Ruiz (for himself, Mr. Bucshon, Mr. Kind, and Mr. Marchant)
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 2019''.
SEC. 2. MODERNIZATION OF LIMITATIONS ON PHYSICIAN SELF-REFERRAL.
(a) Facilitation of 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 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.--
``(i) In general.--For purposes of
subparagraph (A), the term `covered APM entity'
means, subject to clause (ii) of this
subparagraph and 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 entity for
purposes of subparagraph (A), including
such a determination made pursuant to
one or more physicians submitting a
proposal to the Secretary for an
alternative payment model.
``(ii) Inclusion of certain entities.--Such
term may include an entity engaging in
activities that the Secretary has determined
constitute significant progress toward
establishing a model referred to in any of
subclauses (I) through (IV). Any waiver under
this paragraph with respect to an entity
described in the preceding sentence may only be
approved for three years.
``(C) Certain requirements.--A model referred to in
any of subclauses (I) through (IV) of subparagraph
(B)(i) 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) 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 items and
services furnished pursuant to an arrangement that
meets the requirements described in subparagraph (B)
entered into for the purpose of developing or operating
a covered APM entity (as defined in section
1833(z)(5)(B)), including--
``(i) an advanced alternative payment model
described in section 1833(z) (including a
physician-focused payment model referred to in
section 1868(c));
``(ii) a MIPS APM (as defined by the
Secretary); and
``(iii) any other alternative payment model
that the Secretary may, by regulation, specify.
``(B) Requirements.--
``(i) In general.--Subject to clause (ii),
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) The arrangement includes a
description of the alternative payment
model.
``(III) 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.
``(IV) The arrangement meets such
other requirements as the Secretary may
impose by regulation as needed to
protect against a significant risk of
program or patient abuse.
``(ii) Clarification.--The Secretary shall
not prohibit or restrict an arrangement from
meeting the requirements described in this
subparagraph on the basis that the arrangement
takes into account the volume or value of
referrals if such arrangement otherwise meets
the requirements described in clause (i).''.
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