[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 966 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                 S. 966

   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 SENATE OF THE UNITED STATES

                             April 1, 2019

Mr. Portman (for himself and Mr. Bennet) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 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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