Index for HR3962: Affordable Health Care for America Act
DIVISION B — MEDICARE AND MEDICAID IMPROVEMENTS.
TITLE III — PROMOTING PRIMARY CARE, MENTAL HEALTH SERVICES, AND COORDINATED CARE.
SEC 1301. — ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM.
Table Of Contents of the INDEX
Capitation model: partial
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (2) (A)
Automated Concept:
Automated Concept:
CAPITATION model described in paragraph being model in which qualifying ACO at financial risk ; Partial
Index of Sec 1301. ... (B) NO ADDITIONAL PROGRAM EXPENDITURES.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (2) (B)
Automated Concept:
Automated Concept:
CAPITATION model to be established in manner not resulting in spending more for ACO for beneficiaries ; Payments to qualifying ACO for items and services under title for applicable beneficiaries for year under partial
Index of Sec 1301. ...Clinical care
Sec 1301. -- Accountable Care Organization Pilot Program.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (d) (1) (A)
Automated Concept:
Automated Concept:
CLINICAL care, care coordination and patient experience of care ; Requiring reporting of starter set of measures focused on
Index of Sec 1301. ...Expenditure
Expenditures
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (A)
Automated Concept:
Automated Concept:
EXPENDITURES for items and services covered under parts A and B ; Resulting from normal variation in
Index of Sec 1301. ... (iii) ADJUSTMENT FACTOR.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (B) (iii)
Automated Concept:
Automated Concept:
EXPENDITURES from period of base amount to current year representing appropriate performance target for applicable beneficiaries ; Adjustment factor in clause equalling annual per capita amount reflecting changes in
Index of Sec 1301. ... (1) TESTING AND REFINEMENT OF PAYMENT INCENTIVE MODELS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (h) (1)
Automated Concept:
Automated Concept:
EXPENDITURES, access and quality under title ; Report addressing impact of use of models on
Index of Sec 1301. ...Expenditure: aggregate
Sec 1301. -- Accountable Care Organization Pilot Program.
(ii) LIMITATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (C) (ii)
Automated Concept:
Automated Concept:
EXPENDITURES with respect to applicable beneficiaries for ACOS under title not exceeding amount ; Secretary limiting incentive payments to qualifying ACO under paragraph as necessary to ensure that aggregate
Index of Sec 1301. ...Expenditure: annual attributable
Sec 1301. -- Accountable Care Organization Pilot Program.
(1) AUTHORITY FOR SEPARATE INCENTIVE ARRANGEMENTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (k) (1)
Automated Concept:
Automated Concept:
EXPENDITURES and other mattering Secretary deeming appropriate ; Secretary creating separate incentive arrangements for different categories of qualifying ACOS to reflect variation in average annual attributable
Index of Sec 1301. ...Expenditure: growth of
Sec 1301. -- Accountable Care Organization Pilot Program.
(a) ESTABLISHMENT. - paragraph (1)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (a) (1)
Automated Concept:
Automated Concept:
EXPENDITURES and improving health outcomes in provision of items and services under title to applicable beneficiaries by qualifying accountable care organizations in order ; Designing to reduce growth of
Index of Sec 1301. ...Expenditure amount: base
Sec 1301. -- Accountable Care Organization Pilot Program.
(iv) REBASING.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (B) (iv)
Automated Concept:
Automated Concept:
EXPENDITURE amount described in clause ; Model Secretary periodically rebasing base
Index of Sec 1301. ...Expenditures and quality of services
Sec 1301. -- Accountable Care Organization Pilot Program.
(2) WAIVER.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (e) (2)
Automated Concept:
Automated Concept:
EXPENDITURES and quality of services under title after applicable beneficiary discontinuing receiving services under title through qualifying ACO ; Secretary monitoring data on
Index of Sec 1301. ...Financial risk
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (2) (A)
Automated Concept:
Automated Concept:
FINANCIAL risk ; Partial capitation model described in paragraph being model in which qualifying ACO at
Index of Sec 1301. ... (1) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (d) (1)
Automated Concept:
Automated Concept:
FINANCIAL risk or otherwise participating in alternative financing models under section ; Operating at
Index of Sec 1301. ...Financing models: alternative
Sec 1301. -- Accountable Care Organization Pilot Program.
(1) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (d) (1)
Automated Concept:
Automated Concept:
FINANCING models under section ; Operating at financial risk or otherwise participating in alternative
Index of Sec 1301. ...Fiscal year
Sec 1301. -- Accountable Care Organization Pilot Program.
(5) FUNDING.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (k) (5)
Automated Concept:
Automated Concept:
FISCAL year to be available until expended ; Amounts appropriated under paragraph for
Index of Sec 1301. ...Health care items or services
Sec 1301. -- Accountable Care Organization Pilot Program.
(4) ANTIDISCRIMINATION LIMITATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (k) (4)
Automated Concept:
Automated Concept:
HEALTH care items or services under pilot program or entity to administer program unless entity guarantees not denying, limiting or conditioning coverage or provision of benefits under program based on health status-related factor described in section 2702(a)(1) of Public Health Service Act ; Secretary not entering into agreement with entity to provide
Index of Sec 1301. ...Health care services and share: efficient
Sec 1301. -- Accountable Care Organization Pilot Program.
(D) OTHER PHYSICIAN ORGANIZATIONAL MODEL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (b) (1) (D)
Automated Concept:
Automated Concept:
HEALTH care services and share in incentive payments under program ; Model of organization under which physicians entering into agreements with other providers of services for purposes of participation in pilot program in order to provide high quality and efficient
Index of Sec 1301. ...Health outcomes
Sec 1301. -- Accountable Care Organization Pilot Program.
(a) ESTABLISHMENT. - paragraph (1)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (a) (1)
Automated Concept:
Automated Concept:
HEALTH outcomes in provision of items and services under title to applicable beneficiaries by qualifying accountable care organizations in order ; Designing to reduce growth of expenditures and improving
Index of Sec 1301. ...Health records: electronic
Sec 1301. -- Accountable Care Organization Pilot Program.
(D) REPORTING AND OTHER REQUIREMENTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (D)
Automated Concept:
Automated Concept:
HEALTH records and other similar initiatives under section 1848 and using alternative criteria ; Electronic
Index of Sec 1301. ...Health status
Sec 1301. -- Accountable Care Organization Pilot Program.
(4) ANTIDISCRIMINATION LIMITATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (k) (4)
Automated Concept:
Automated Concept:
HEALTH status-related factor described in section 2702(a)(1) of Public Health Service Act ; Secretary not entering into agreement with entity to provide health care items or services under pilot program or entity to administer program unless entity guarantees not denying, limiting or conditioning coverage or provision of benefits under program based on
Index of Sec 1301. ...Hospital
Sec 1301. -- Accountable Care Organization Pilot Program.
(B) INCLUSION OF OTHER PROVIDERS OF SERVICES AND SUPPLIERS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (b) (1) (B)
Automated Concept:
Automated Concept:
HOSPITAL or other provider of services or supplier furnishing items or services For which payment to be made under title affiliated with ACO under arrangement structured so that provider or supplier participating in pilot program and shares in incentive payments under pilot program ; Nothing in subsection to be construed as preventing qualifying ACO from including
Index of Sec 1301. ...Incentive arrangements: separate
Sec 1301. -- Accountable Care Organization Pilot Program.
(1) AUTHORITY FOR SEPARATE INCENTIVE ARRANGEMENTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (k) (1)
Automated Concept:
Automated Concept:
EXPENDITURES and other mattering Secretary deeming appropriate ; Secretary creating separate incentive arrangements for different categories of qualifying ACOS to reflect variation in average annual attributable
Index of Sec 1301. ...Incentive payment
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (A)
Automated Concept:
Automated Concept:
EXPENDITURES for items and services covered under parts A and B ; Resulting from normal variation in
Index of Sec 1301. ... (i) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (C) (i)
Automated Concept:
Automated Concept:
INCENTIVE payment for year equal to portion of amount by which payments under title for year estimated below performance target for year as determined by Secretary ; Qualifying ACO meeting or exceeding annual quality and performance targets for year receiving
Index of Sec 1301. ... (2) ENCOURAGEMENT OF PARTICIPATION OF SMALLER ORGANIZATIONS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (j) (2)
Automated Concept:
Automated Concept:
INCENTIVE payment being made under subsection ; Secretary treating receipt of incentive payment for year by organization under physician group practice demonstration pursuant to section 1866a as year For which
Index of Sec 1301. ...Incentive payment: receipt of
Sec 1301. -- Accountable Care Organization Pilot Program.
(2) ENCOURAGEMENT OF PARTICIPATION OF SMALLER ORGANIZATIONS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (j) (2)
Automated Concept:
Automated Concept:
INCENTIVE payment being made under subsection ; Secretary treating receipt of incentive payment for year by organization under physician group practice demonstration pursuant to section 1866a as year For which
Index of Sec 1301. ...Incentive payments
Sec 1301. -- Accountable Care Organization Pilot Program.
(B) INCLUSION OF OTHER PROVIDERS OF SERVICES AND SUPPLIERS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (b) (1) (B)
Automated Concept:
Automated Concept:
INCENTIVE payments under pilot program ; Nothing in subsection to be construed as preventing qualifying ACO from including hospital or other provider of services or supplier furnishing items or services For which payment to be made under title affiliated with ACO under arrangement structured so that provider or supplier participating in pilot program and shares in
Index of Sec 1301. ... (D) OTHER PHYSICIAN ORGANIZATIONAL MODEL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (b) (1) (D)
Automated Concept:
Automated Concept:
INCENTIVE payments under program ; Model of organization under which physicians entering into agreements with other providers of services for purposes of participation in pilot program in order to provide high quality and efficient health care services and share in
Index of Sec 1301. ... (2) QUALIFYING CRITERIA. - paragraph (A)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (b) (2) (A)
Automated Concept:
Automated Concept:
INCENTIVE payments under section ; Group having legal structure allowing group to receive and distribute
Index of Sec 1301. ... (ii) LIMITATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (C) (ii)
Automated Concept:
Automated Concept:
EXPENDITURES with respect to applicable beneficiaries for ACOS under title not exceeding amount ; Secretary limiting incentive payments to qualifying ACO under paragraph as necessary to ensure that aggregate
Index of Sec 1301. ... (D) REPORTING AND OTHER REQUIREMENTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (D)
Automated Concept:
Automated Concept:
INCENTIVE payments described in subparagraph not to be included in limit described in subparagraph or performance target model described in paragraph ;
Index of Sec 1301. ... (1) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (d) (1)
Automated Concept:
Automated Concept:
INCENTIVE payments ; Secretary establishing annual quality targets qualifying ACOS meeting to receive
Index of Sec 1301. ... (A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (h) (2) (A)
Automated Concept:
Automated Concept:
INCENTIVE payments with respect to first 4 years of pilot agreement and consistently meeting quality standards ; ACO receiving
Index of Sec 1301. ... (3) TERMINATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (h) (3)
Automated Concept:
Automated Concept:
INCENTIVE payments or consistently failed to meet quality standards in first 3 years under program ; Secretary terminating agreement with qualifying ACO under pilot program if ACO not receiving
Index of Sec 1301. ...Incentive payments and penalties
Sec 1301. -- Accountable Care Organization Pilot Program.
(D) REPORTING AND OTHER REQUIREMENTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (D)
Automated Concept:
Automated Concept:
INCENTIVE payments and penalties related to physician quality reporting initiative ; Secretary incorporating reporting requirements,
Index of Sec 1301. ...Payment
Sec 1301. -- Accountable Care Organization Pilot Program.
(B) INCLUSION OF OTHER PROVIDERS OF SERVICES AND SUPPLIERS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (b) (1) (B)
Automated Concept:
Automated Concept:
INCENTIVE payments under pilot program ; Nothing in subsection to be construed as preventing qualifying ACO from including hospital or other provider of services or supplier furnishing items or services For which payment to be made under title affiliated with ACO under arrangement structured so that provider or supplier participating in pilot program and shares in
Index of Sec 1301. ... (C) PHYSICIAN.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (b) (1) (C)
Automated Concept:
Automated Concept:
PAYMENT to be made as physicians' services under title ; Individual furnishing services For which
Index of Sec 1301. ...Payments
Sec 1301. -- Accountable Care Organization Pilot Program.
(i) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (C) (i)
Automated Concept:
Automated Concept:
PAYMENTS under title for year estimated below performance target for year as determined by Secretary ; Qualifying ACO meeting or exceeding annual quality and performance targets for year receiving incentive payment for year equal to portion of amount by which
Index of Sec 1301. ... (B) NO ADDITIONAL PROGRAM EXPENDITURES.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (2) (B)
Automated Concept:
Automated Concept:
CAPITATION model to be established in manner not resulting in spending more for ACO for beneficiaries ; Payments to qualifying ACO for items and services under title for applicable beneficiaries for year under partial
Index of Sec 1301. ... (5) FUNDING.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (k) (5)
Automated Concept:
Automated Concept:
INCENTIVE payments under subsection ; Other than payments for items and services furnished under title and
Index of Sec 1301. ... (6) NO DUPLICATION IN PAYMENTS TO PHYSICIANS IN MULTIPLE PILOTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (k) (6)
Automated Concept:
Automated Concept:
PAYMENTS under section to physician group paid under section 1866f or section 1866g ; Secretary not making
Index of Sec 1301. ...Payment: average total
Sec 1301. -- Accountable Care Organization Pilot Program.
(ii) BASE AMOUNT.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (B) (ii)
Automated Concept:
Automated Concept:
PAYMENTS under parts A and B for applicable beneficiaries qualifying ACO furnishing items and services in base period determined by Secretary ; Base amount in subparagraph being equal to average total
Index of Sec 1301. ...Payment incentive model
Sec 1301. -- Accountable Care Organization Pilot Program.
(1) REPORTS TO CONGRESS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (g) (1)
Automated Concept:
Automated Concept:
INCENTIVE model for qualifying ACO under pilot program to assess impacts on beneficiaries, providers of services, suppliers and program under title ; Secretary evaluating payment
Index of Sec 1301. ...Payment incentive models
Sec 1301. -- Accountable Care Organization Pilot Program.
(1) EXTENSION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (i) (1)
Automated Concept:
Automated Concept:
INCENTIVE models with respect to qualifying ACOS ; Secretary entering into agreements under pilot program with additional qualifying ACOS to furthing test and refining payment
Index of Sec 1301. ...Payment incentive model: different
Sec 1301. -- Accountable Care Organization Pilot Program.
(a) ESTABLISHMENT. - paragraph (1)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (a) (1)
Automated Concept:
Automated Concept:
INCENTIVE models ; Secretary conducting pilot program to test different payment
Index of Sec 1301. ...Payment incentive model: specific
Sec 1301. -- Accountable Care Organization Pilot Program.
(a) ESTABLISHMENT. - paragraph (1)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (a) (1)
Automated Concept:
Automated Concept:
INCENTIVE models described in subsection ; Including specific payment
Index of Sec 1301. ... (c) SPECIFIC PAYMENT INCENTIVE MODELS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c)
Automated Concept:
Automated Concept:
INCENTIVE models described in subsection following ; Specific payment
Index of Sec 1301. ...Payment model
Sec 1301. -- Accountable Care Organization Pilot Program.
(B) NO ADDITIONAL PROGRAM EXPENDITURES.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (3) (B)
Automated Concept:
Automated Concept:
PAYMENT model under paragraph ; Subparagraph of paragraph applying to payment model under subparagraph in similar manner as subparagraph applying to
Index of Sec 1301. ...Payment model: other
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (3) (A)
Automated Concept:
Automated Concept:
PAYMENT models meeting goals of pilot program to improve quality and efficiency ; Secretary developing other
Index of Sec 1301. ...Payment model: use of ACO
Sec 1301. -- Accountable Care Organization Pilot Program.
(1) TESTING AND REFINEMENT OF PAYMENT INCENTIVE MODELS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (h) (1)
Automated Concept:
Automated Concept:
PAYMENT models under pilot program ; Not later than 2 years after date first agreement entered under section and biennially for six years Secretary submitting to Congress and making publicly available report on use of ACO
Index of Sec 1301. ...Primary care
Sec 1301. -- Accountable Care Organization Pilot Program.
(2) QUALIFYING CRITERIA. - paragraph (B)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (b) (2) (B)
Automated Concept:
Automated Concept:
PRIMARY care physicians for applicable beneficiaries for whose care group being accountable ; Group including sufficient number of
Index of Sec 1301. ...Pursuant
Sec 1301. -- Accountable Care Organization Pilot Program.
(2) ENCOURAGEMENT OF PARTICIPATION OF SMALLER ORGANIZATIONS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (j) (2)
Automated Concept:
Automated Concept:
INCENTIVE payment being made under subsection ; Secretary treating receipt of incentive payment for year by organization under physician group practice demonstration pursuant to section 1866a as year For which
Index of Sec 1301. ...Risk
Sec 1301. -- Accountable Care Organization Pilot Program.
(i) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (B) (i)
Automated Concept:
Automated Concept:
RISK ; Target to be established on per capita basis or adjusted for
Index of Sec 1301. ... (ii) BASE AMOUNT.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (B) (ii)
Automated Concept:
Automated Concept:
RISK ; Base amount to be determined on per capita basis or adjusted for
Index of Sec 1301. ... (A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (2) (A)
Automated Concept:
Automated Concept:
RISK as determined to be appropriate by Secretary ; Risk physicians' services or items and services under part B Secretary limiting partial capitation model to ACOS highly integrated systems of care and ACOS capable of bearing
Index of Sec 1301. ...Risk physicians' services or items and services
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (2) (A)
Automated Concept:
Automated Concept:
CAPITATION model to ACOS highly integrated systems of care and ACOS capable of bearing risk as determined to be appropriate by Secretary ; Risk physicians' services or items and services under part B Secretary limiting partial
Index of Sec 1301. ...Savings
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (A)
Automated Concept:
Automated Concept:
SAVINGS being greater ; Incentive payment to be made only if
Index of Sec 1301. ... (4) LIMITATIONS ON REVIEW. - paragraph (C)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (f) (4) (C)
Automated Concept:
Automated Concept:
SAVINGS achieved and amount of savings ; Determinations with respect whether
Index of Sec 1301. ...Savings: amount of
Sec 1301. -- Accountable Care Organization Pilot Program.
(4) LIMITATIONS ON REVIEW. - paragraph (C)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (f) (4) (C)
Automated Concept:
Automated Concept:
SAVINGS ; Determinations with respect whether savings achieved and amount of
Index of Sec 1301. ...Title
Sec 1301. -- Accountable Care Organization Pilot Program.
(a) ESTABLISHMENT. - paragraph (1)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (a) (1)
Automated Concept:
Automated Concept:
TITLE to applicable beneficiaries by qualifying accountable care organizations in order ; Designing to reduce growth of expenditures and improving health outcomes in provision of items and services under
Index of Sec 1301. ... (B) INCLUSION OF OTHER PROVIDERS OF SERVICES AND SUPPLIERS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (b) (1) (B)
Automated Concept:
Automated Concept:
INCENTIVE payments under pilot program ; Nothing in subsection to be construed as preventing qualifying ACO from including hospital or other provider of services or supplier furnishing items or services For which payment to be made under title affiliated with ACO under arrangement structured so that provider or supplier participating in pilot program and shares in
Index of Sec 1301. ... (C) PHYSICIAN.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (b) (1) (C)
Automated Concept:
Automated Concept:
TITLE ; Individual furnishing services For which payment to be made as physicians' services under
Index of Sec 1301. ... (i) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (C) (i)
Automated Concept:
Automated Concept:
TITLE for year estimated below performance target for year as determined by Secretary ; Qualifying ACO meeting or exceeding annual quality and performance targets for year receiving incentive payment for year equal to portion of amount by which payments under
Index of Sec 1301. ... (ii) LIMITATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (1) (C) (ii)
Automated Concept:
Automated Concept:
TITLE not exceeding amount ; Secretary limiting incentive payments to qualifying ACO under paragraph as necessary to ensure that aggregate expenditures with respect to applicable beneficiaries for ACOS under
Index of Sec 1301. ... (B) NO ADDITIONAL PROGRAM EXPENDITURES.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (c) (2) (B)
Automated Concept:
Automated Concept:
CAPITATION model to be established in manner not resulting in spending more for ACO for beneficiaries ; Payments to qualifying ACO for items and services under title for applicable beneficiaries for year under partial
Index of Sec 1301. ... (2) WAIVER.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (e) (2)
Automated Concept:
Automated Concept:
TITLE after applicable beneficiary discontinuing receiving services under title through qualifying ACO ; Secretary monitoring data on expenditures and quality of services under
Index of Sec 1301. ... (1) REPORTS TO CONGRESS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (g) (1)
Automated Concept:
Automated Concept:
TITLE ; Secretary evaluating payment incentive model for qualifying ACO under pilot program to assess impacts on beneficiaries, providers of services, suppliers and program under
Index of Sec 1301. ... (1) TESTING AND REFINEMENT OF PAYMENT INCENTIVE MODELS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (h) (1)
Automated Concept:
Automated Concept:
TITLE ; Report addressing impact of use of models on expenditures, access and quality under
Index of Sec 1301. ...Title and incentive payments
Sec 1301. -- Accountable Care Organization Pilot Program.
(5) FUNDING.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (k) (5)
Automated Concept:
Automated Concept:
INCENTIVE payments under subsection ; Other than payments for items and services furnished under title and
Index of Sec 1301. ...Title: provisions of
Sec 1301. -- Accountable Care Organization Pilot Program.
(2) MONITORING.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (f) (2)
Automated Concept:
Automated Concept:
TITLE and title XI in manner Secretary determining necessary in order implement pilot program ; Secretary waiving provisions of
Index of Sec 1301. ...Title 44: chapter 35 of
Sec 1301. -- Accountable Care Organization Pilot Program.
(5) ADMINISTRATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866E. (f) (5)
Automated Concept:
Automated Concept:
TITLE 44, United States Code not applying to section ; Chapter 35 of
Index of Sec 1301. ...Title xviii
Title xviii
Sec 1301. -- Accountable Care Organization Pilot Program.
SEC 1301. -- ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM.
DIVISION B TITLE III SEC 1301.
Automated Concept:
Automated Concept:
TITLE XVIII of Social Security Act amended by inserting after section 1866d as added by section 1152(f) ;
Index of Sec 1301. ...The Index is © 2009 healthcarebillindex.com
1st Session |
To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.
Mr. Dingell (for himself, Mr. Rangel, Mr. Waxman, Mr. George Miller of California, Mr. Stark, Mr. Pallone, and Mr. Andrews) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, Oversight and Government Reform, and the Budget, 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
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SEC. 1301. Accountable Care Organization pilot program.
Title XVIII of the Social Security Act is amended by inserting after section 1866D, as added by section 1152(f), the following new section:
“Accountable Care Organization pilot program
“Sec. 1866E. (a) Establishment.—
“(1) In general.— The Secretary shall conduct a pilot program (in this section referred to as the ‘pilot program’) to test different payment incentive models, including (to the extent practicable) the specific payment incentive models described in subsection (c), designed to reduce the growth of expenditures and improve health outcomes in the provision of items and services under this title to applicable beneficiaries (as defined in subsection (e)) by qualifying accountable care organizations (as defined in subsection (b)(1)) in order to—
“(A) promote accountability for a patient population and coordinate items and services under parts A and B (and may include Part D, if the Secretary determines appropriate);
“(B) encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery; and
“(C) reward physician practices and other physician organizational models for the provision of high quality and efficient health care services.
“(2) Scope.—The Secretary shall set specific goals for the number of accountable care organizations, participating practitioners, and patients served in the initial tests under the pilot program to ensure that the pilot program is of sufficient size and scope to—
“(A) test the approach involved in a variety of settings, including urban, rural, and underserved areas; and
“(B) subject to subsection (g)(1), disseminate such approach rapidly on a national basis.
To the extent that the Secretary finds a qualifying accountable care organization model to be successful in improving quality and reducing costs, the Secretary shall seek to implement such models on as large a geographic scale as practical and economical.
The information contained here is believed to be correct, but healthcarebillindex.com cannot guarantee or warrant the accuracy of this information.
Back to the Index
The Index is © 2009 healthcarebillindex.com