S.Amdt. 3262

SA 3262. Mr. WHITEHOUSE submitted an amendment intended to be
proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr.
Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the
Internal Revenue Code of 1986 to modify the first-time homebuyers
credit in the case of members of the Armed Forces and certain other
Federal employees, and for other purposes; which was ordered to lie on
the table; as follows:

On page 796, between lines 5 and 6, insert the following:

SEC. 3028. VOLUNTARY ACCELERATED SHARED SAVINGS PROGRAM.

(a) Establishment.--
(1) In general.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall
establish the Voluntary Accelerated Shared Savings Program
(referred to in this section as the ``shared savings
program'') under which health care providers that voluntarily
report on quality measures, adopt quality-improving protocols
or strategies, and achieve quality benchmarks are eligible
for a shared savings payment.
(2) Duration.--The shared savings program shall be
conducted during the following periods:
(A) The hospital readmission reduction program, as
described under subsection (d), shall--
(i) begin on such date as determined appropriate by the
Secretary for implementation of the program, but not later
than 6 months after the date of enactment of this Act; and
(ii) end not later than October 1, 2012.
(B) The hospital-acquired conditions reduction program, as
described under subsection (e), shall--
(i) begin on such date as determined appropriate by the
Secretary for implementation of the program, but not later
than 6 months after the date of enactment of this Act; and
(ii) shall end not later than October 1, 2015.
(b) Eligibility; Participation Requirements.--
(1) Eligibility.--A hospital described in section
1886(q)(5)(C) of the Social Security Act, as added by section
3025, shall be eligible to participate in the shared savings
program.
(2) Application.--A provider seeking to participate in the
shared savings program shall submit an application to the
Secretary, in such manner and containing such information as
the Secretary may require, that includes a detailed
description of the methods through which the provider expects
to--
(A) reduce readmissions or hospital-acquired condition
rates, as applicable;
(B) reduce costs; and
(C) integrate and coordinate such quality improvement
efforts with post-acute providers.
(3) Participation requirements.--A participating provider
shall be required to--
(A) report on quality measures (as determined by the
Secretary under subsection (c));
(B) satisfy applicable benchmarks for such quality
measures; and
(C) demonstrate savings (as described in subsection (f)).
(c) Quality and Other Reporting Requirements.--
(1) In general.--The Secretary shall determine appropriate
measures to assess the quality of care furnished by
participating providers, such as measures of--
(A) clinical processes and outcomes;
(B) patient and, where practicable, caregiver experience of
care; and
(C) utilization rates.
(2) Incorporation of measures.--For purposes of the
measures described under paragraph (1), the Secretary may
incorporate measures established--
(A) under sections 1848(k) and 1886(b) of the Social
Security Act; and
(B) pursuant to any provision of this Act or amendment made
by this Act.
(3) Reporting requirement.--A participating provider shall
submit data in a form and manner specified by the Secretary
on measures the Secretary determines necessary for the
participating provider to report in order to evaluate the
quality of care furnished by such provider.
(4) Quality performance standards.--The Secretary shall
establish quality performance standards to assess the quality
of care furnished by participating providers. The Secretary
shall seek to improve the quality of care furnished by
participating providers over time by specifying higher
standards, new measures, or both for purposes of assessing
such quality of care.
(d) Hospital Readmission Reduction Program.--

[[Page S13397]]

(1) Hospital readmissions rate measures.--For purposes of
establishing measures under subsection (c) for the hospital
readmission reduction program, the Secretary shall include
measures for readmission rates established under 1886(b) of
the Social Security Act (42 U.S.C. 1395ww(b)).
(2) Benchmark.--The Secretary shall establish a benchmark
for reduction in the readmission rate for a hospital that is
adjusted for geographic area, patient population
characteristics, and such other factors as determined
appropriate by the Secretary. The Secretary may establish a
higher benchmark for hospitals with an annual readmission
rate that is above the mean nationwide readmission rate.
(3) Shared savings requirements.--A participating provider
shall be eligible for a shared savings payment under
subsection (f) if such provider--
(A) achieves the applicable benchmark established by the
Secretary under paragraph (2); and
(B) has an annual readmission rate that is below the risk
adjusted expected readmissions rate as determined under
section 1886(q)(4)(C)(i)(II) of the Social Security Act (as
added by section 3025).
(4) Community-based organizations.--The Secretary may
permit a community-based organization, as described in
section 3026(b)(1)(B), to receive shared savings payments
under the hospital readmission reduction program if such an
organization--
(A) satisfies the requirements described under section
3026; and
(B) is associated with a subsection (d) hospital (as
described in section 3026(b)(1)(A)) that would be eligible
for a shared savings payment under this section.
(e) Hospital-Acquired Conditions Reduction Program.--
(1) Hospital-acquired conditions rate measures.--For
purposes of establishing measures under subsection (c) for
the hospital-acquired conditions program, the Secretary shall
establish measures that accurately determine rates of
hospital-acquired conditions (as defined in section 1886(p)
of the Social Security Act, as added by section 3008).
(2) Reduction in hospital-acquired conditions benchmark.--
The Secretary shall establish a benchmark for reduction in
the hospital-acquired conditions rate for a participating
provider that is adjusted for geographic area, patient
population characteristics, and such other factors as
determined appropriate by the Secretary. The Secretary may
establish a higher benchmark for hospitals with an annual
hospital-acquired conditions rate that is above the mean
nationwide hospital-acquired conditions rate.
(3) Shared savings requirements.--A participating provider
shall eligible for a shared savings payment under subsection
(f) if such provider achieves the applicable benchmark
established by the Secretary under paragraph (2).
(f) Shared Savings Payments.--
(1) In general.--Under the shared savings program, payments
shall continue to be made to participating providers under
the original Medicare fee-for-service program under parts A
and B in the same manner as they would otherwise be made
except that a participating provider is eligible to receive
payment for shared savings under paragraph (3) if--
(A) the provider meets quality performance standards
established by the Secretary under subsection (c); and
(B) the provider meets the requirement under paragraph
(2)(A).
(2) Savings requirement and benchmark.--
(A) Determining savings.--Subject to subparagraph (C), in
each year of the period under subsection (a)(2), a
participating provider shall be eligible to receive payment
for shared savings under paragraph (3) only if the estimated
average per capita Medicare expenditures for such provider
for Medicare fee-for-service beneficiaries for parts A and B
services, adjusted for beneficiary characteristics, is at
least the percent specified by the Secretary below the
applicable benchmark under subparagraph (B).
(B) Establish and update benchmark.--The Secretary shall
estimate a benchmark for each period under subsection (a)(2)
for each participating provider using the most recent
available 3 years of per-beneficiary expenditures for parts A
and B services for Medicare fee-for-service beneficiaries
served by the provider. Such benchmark shall be adjusted for
beneficiary characteristics and such other factors as the
Secretary determines appropriate and updated by the projected
absolute amount of growth in national per capita expenditures
for parts A and B services under the original Medicare fee-
for-service program, as estimated by the Secretary.
(C) Higher benchmark.--For purposes of subparagraph (A),
the Secretary may require a greater percentage in savings
below the benchmark established under subparagraph (B) for a
participating provider with an annual readmission or
hospital-acquired conditions rate, as applicable, that is
above the mean nationwide rate (as described in subsections
(e)(2) and (f)(2)).
(3) Payments for shared savings.--Subject to performance
with respect to the quality performance standards established
by the Secretary under subsection (c), if a participating
provider meets the requirements under paragraphs (1) and (2),
a percent (as determined appropriate by the Secretary) of the
difference between such estimated average per capita Medicare
expenditures in a year, adjusted for beneficiary
characteristics, for the provider and such benchmark for the
provider may be paid to the provider as shared savings and
the remainder of such difference shall be retained by the
Medicare program under title XVIII of the Social Security
Act. The Secretary shall establish limits on the total amount
of shared savings that may be paid to a participating
provider under this paragraph.
(g) Early Participation in Medicare Shared Savings Program
and National Pilot Program on Payment Bundling.--
(1) In general.--For purposes of section 1866D of the
Social Security Act (as added by section 3023) and section
1899 of such Act (as added by section 3022), the Secretary
may establish a program to provide for early participation
payments under such sections to eligible providers or groups
of providers.
(2) Eligibility.--
(A) In general.--Providers eligible for the early
participation program under this subsection shall include--
(i) providers described under section 1866D(a)(2)(G) of the
Social Security Act; and
(ii) providers that meet the requirements in section
1899(b) of such Act.
(B) Waiver of requirements.--Subject to subparagraph (C),
for purposes of the early participation program under this
subsection, the Secretary may waive--
(i) any requirements under section 1899 of the Social
Security Act, except that the Secretary shall not waive--

(I) the requirements under subsection (b) of such section
(with the exception of subparagraphs (B) and (D) of
subsection (b)(2)); or
(II) the provisions under subsection (d) of such section.

(ii) any requirements under section 1866D of the Social
Security Act, provided that the proposal submitted by the
provider (as described under subparagraph (C)) adequately
provides for--

(I) a plan for quality improvement that is consistent with
subsection (c)(4) of such section; and
(II) a valid payment methodology that is consistent with
subsection (c)(3) of such section.

(C) Application.--Providers seeking to participate in the
early participation program under this section shall submit a
proposal, in such manner and containing such information as
the Secretary may require, that includes, for purposes of
determining applicable payments under this section, a
methodology for calculation of savings or determination of
bundled payments.
(3) Medicare shared savings program.--For purposes of
section 1899 of the Social Security Act, a provider seeking
to participate in the early participation program under this
section shall, as part of the proposal described under
paragraph (2)(C), provide a detailed plan for quality
improvement that is consistent with the goals described under
subsections (a) and (b)(3) of section 1899 of the Social
Security Act.
(4) National pilot program on payment bundling.--For
purposes of section 1866D of the Social Security Act, a
provider seeking to participate in the early participation
program under this section shall, as part of the proposal
described under paragraph (2)(C), provide a detailed plan in
regard to the methods by which such provider will satisfy the
objectives described under subsection (a)(1) of section 1866D
of the Social Security Act, which shall include--
(A) a bundled payment methodology;
(B) methods by which quality of care will be improved; and
(C) a description of the conditions and services that are
to be covered through the bundled payment.
(5) Applicable period.--Any payments made to providers
pursuant to early participation program under this section
shall cease upon establishment of the programs described
under sections 1866D and 1899 of the Social Security Act,
except to the extent that providers are determined to be
eligible for, and continue to participate in, the programs
established under such sections.
______