II 

115TH CONGRESS 

1ST SESSION S. 2051 

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 

NOVEMBER 1, 2017 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Care Coordi5 nation Improvement Act of 2017’’. 


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1 SEC. 2. MODERNIZATION OF LIMITATIONS ON PHYSICIAN 

2 SELF-REFERRAL. 

3 (a) FACILITATION OF PARTICIPATION IN ALTER4 NATIVE PAYMENT MODELS.— 

5 (1) IN GENERAL.—Section 1833 of the Social 

6 Security Act (42 U.S.C. 1395l) is amended— 

7 (A) in subsection (z), as added by section 

8 101(e)(2) of the Medicare Access and CHIP 

9 Reauthorization Act of 2015 (Public Law 114– 

10 10), by adding at the end the following para11 graph: 

12 ‘‘(5) WAIVER AUTHORITY.— 

13 ‘‘(A) IN GENERAL.—The provisions of sub14 section (f) of section 1899 shall apply with re15 spect to covered APM entities to the same ex16 tent and in the same manner as such provisions 

17 apply with respect to accountable care organiza18 tions under such section. 

19 ‘‘(B) COVERED APM ENTITIES.—For pur20 poses of subparagraph (A), the term ‘covered 

21 APM entity’ means, subject to subparagraph 

22 (C), each of the following: 

23 ‘‘(i) An eligible alternative payment 

24 entity as defined in paragraph (3)(D). 

25 ‘‘(ii) An entity participating in an al26 ternative payment model as defined in 


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1 paragraph (3)(C), including such participa2 tion that qualifies as a clinical practice im3 provement activity under section 

4 1848(q)(2)(B)(iii)(VI). 

5 ‘‘(iii) An entity participating in a phy6 sician-focused payment model for which 

7 comments and recommendations have, 

8 under subparagraph (C) of section 

9 1868(c)(2), been submitted indicating that 

10 such model meets the criteria described in 

11 subparagraph (A) of such section. 

12 ‘‘(iv) An entity participating in any 

13 other model that the Secretary determines 

14 is a covered APM for purposes of subpara15 graph (A), including such a determination 

16 made pursuant to physicians submitting a 

17 proposal to the Secretary for an alternative 

18 payment model. 

19 ‘‘(v) An entity engaging in activities 

20 that the Secretary has determined con21 stitute significant progress toward estab22 lishing a model referred to in any of 

23 clauses (i) through (iv). 

24 ‘‘(C) CERTAIN REQUIREMENTS.—A model 

25 referred to in any of clauses (i) through (iv) of 


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1 subparagraph (B) may not be considered a cov2 ered APM entity for purposes of subparagraph 

3 (A) unless the model meets the requirements 

4 described in section 1877(b)(6)(B).’’; and 

5 (B) by redesignating subsection (z), as 

6 added by section 514(a) of the Medicare Access 

7 and CHIP Reauthorization Act of 2015 (Public 

8 Law 114–10), as subsection (aa). 

9 (2) CONFORMING AMENDMENT.—Section 

10 514(c)(1) of the Medicare Access and CHIP Reau11 thorization Act of 2015 (Public Law 114–10) is 

12 amended by striking ‘‘subsection (z)’’ and inserting 

13 ‘‘subsection (aa)’’. 

14 (b) EXPANSION OF ADMINISTRATIVE AUTHORITY TO

15 PROVIDE EXCEPTIONS TO PHYSICIAN OWNERSHIP AND

16 COMPENSATION ARRANGEMENT PROHIBITIONS TO PRO17 MOTE CARE COORDINATION.— 

18 (1) PROMOTING CARE COORDINATION.—Section 

19 1877(b)(4) of the Social Security Act (42 U.S.C. 

20 1395nn(b)(4)) is amended by striking ‘‘risk of pro21 gram or patient abuse’’ and inserting the following: 

22 ‘‘significant risk of program or patient abuse, in23 cluding those that would promote care coordination, 

24 quality improvement, or resource conservation by 

25 physician practices under part B’’. 


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1 (2) CARE COORDINATION IN MIPS AND PARTICI2 PATION IN APMS.—Section 1877(a) of the Social Se3 curity Act (42 U.S.C. 1395nn(a)) is amended by 

4 adding at the end the following new paragraph: 

5 ‘‘(3) LIMITATION.—The Secretary may not im6 pose requirements under this section that could ad7 versely affect— 

8 ‘‘(A) physician care coordination in the 

9 merit-based incentive payment system under 

10 section 1848(q); or 

11 ‘‘(B) physician participation in an alter12 native payment model under 1833(z).’’. 

13 (c) EXCEPTION FACILITATING THE DEVELOPMENT

14 AND OPERATION OF ALTERNATIVE PAYMENT MODELS.— 

15 Section 1877(b) of the Social Security Act (42 U.S.C. 

16 1395nn(b)) is amended by adding at the end the following 

17 new paragraph: 

18 ‘‘(6) DEVELOPMENT AND OPERATION OF AL19 TERNATIVE PAYMENT MODELS.— 

20 ‘‘(A) IN GENERAL.—In the case of services 

21 furnished pursuant to an arrangement that 

22 meets the requirements described in subpara23 graph (B) entered into for the purpose of devel24 oping or operating an alternative payment 

25 model, including— 


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1 ‘‘(i) advanced alternative payment 

2 models described in section 1833(z) (in3 cluding physician-focused payment models 

4 referred to in section 1868(c)); 

5 ‘‘(ii) MIPS APMs (as defined by the 

6 Secretary); and 

7 ‘‘(iii) any other alternative payment 

8 model that the Secretary may, by regula9 tion, specify. 

10 ‘‘(B) REQUIREMENTS.—The requirements 

11 described in this subparagraph with respect to 

12 an arrangement relating to an alternative pay13 ment model are as follows: 

14 ‘‘(i) The arrangement is in writing, 

15 identifies the services, items, or actions 

16 subject to the arrangement and is signed 

17 by the parties to the arrangement. 

18 ‘‘(ii) Items and services furnished sub19 ject to the arrangement are furnished at 

20 fair market value. In this clause, the term 

21 ‘fair market value’ has the meaning given 

22 such term in subsection (h)(3), except that 

23 the Secretary may not take into account 

24 the volume or value of referrals in deterVerDate Sep 11 2014 23:42 Nov 02, 2017 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2051.IS S2051

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1 mining such value for purposes of this 

2 clause. 

3 ‘‘(iii) The arrangement includes a de4 scription of the alternative payment model. 

5 ‘‘(iv) Under the arrangement written 

6 reports are submitted to the Secretary on 

7 a semi-annual basis on the progress 

8 achieved in the development and operation 

9 of the alternative payment model. 

10 ‘‘(v) The arrangement meets such 

11 other requirements as the Secretary may 

12 impose by regulation as needed to protect 

13 against a significant risk of program pa14 tient abuse.’’. 

Æ 


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