‘‘(I) measures endorsed by a con-
sensus-based entity; 
‘‘(II) measures developed under 
subsection (s); and 
‘‘(III) measures submitted under 
clause (ii)(I). 
Any measure selected for inclusion in such 
list that is not endorsed by a consensus- 
based entity shall have a focus that is evi-
dence-based. 
‘‘(vi) EXCEPTION
FOR
QUALIFIED 
CLINICAL
DATA
REGISTRY
MEASURES.— 
Measures used by a qualified clinical data 
registry under subsection (m)(3)(E) shall 
not be subject to the requirements under 
clauses (i), (iv), and (v). The Secretary 
shall publish the list of measures used by 
such qualified clinical data registries on 
the Internet website of the Centers for 
Medicare & Medicaid Services. 
‘‘(vii) 
EXCEPTION
FOR
EXISTING 
QUALITY
MEASURES.—Any quality meas-
ure specified by the Secretary under sub-
section (k) or (m), including under sub-
section (m)(3)(E), and any measure of
quality of care established under sub-
section (p)(2) for the reporting period 
under the respective subsection beginning 
before the first performance period under 
the MIPS— 
‘‘(I) shall not be subject to the 
requirements under clause (i) (except 
under items (aa) and (cc) of subclause 
(II) of such clause) or to the require-
ment under clause (iv); and 
‘‘(II) shall be included in the 
final list of quality measures pub-
lished under clause (i) unless removed 
under clause (i)(II)(aa). 
‘‘(viii) CONSULTATION
WITH
REL-
EVANT ELIGIBLE PROFESSIONAL ORGANI-
ZATIONS
AND
OTHER
RELEVANT
STAKE-
HOLDERS.—Relevant eligible professional 
organizations and other relevant stake-
holders, including State and national med-
ical societies, shall be consulted in carrying 
out this subparagraph. 
‘‘(ix) OPTIONAL
APPLICATION.—The 
process under section 1890A is not re-
quired to apply to the selection of meas-
ures under this subparagraph. 
‘‘(3) PERFORMANCE STANDARDS.— 
‘‘(A) ESTABLISHMENT.—Under the MIPS, 
the Secretary shall establish performance stand-
ards with respect to measures and activities 
specified under paragraph (2)(B) for a perform-
ance period (as established under paragraph 
(4)) for a year. 
‘‘(B) CONSIDERATIONS IN ESTABLISHING 
STANDARDS.—In establishing such performance 
standards with respect to measures and activi-
ties specified under paragraph (2)(B), the Sec-
retary shall consider the following: 
‘‘(i) Historical performance standards. 
‘‘(ii) Improvement. 
‘‘(iii) The opportunity for continued 
improvement. 
‘‘(4) PERFORMANCE
PERIOD.—The Secretary 
shall establish a performance period (or periods) for 
a year (beginning with the year described in para-
graph (1)(B)). Such performance period (or periods) 
shall begin and end prior to the beginning of such 
year and be as close as possible to such year. In this 
subsection, such performance period (or periods) for
a year shall be referred to as the performance period 
for the year. 
‘‘(5) COMPOSITE PERFORMANCE SCORE.— 
‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding provisions of this paragraph and taking 
into account, as available and applicable, para-
graph (1)(G), the Secretary shall develop a 
methodology for assessing the total performance 
of each MIPS eligible professional according to 
performance standards under paragraph (3) 
with respect to applicable measures and activi-
ties specified in paragraph (2)(B) with respect 
to each performance category applicable to such 
professional for a performance period (as estab-
lished under paragraph (4)) for a year. Using 
such methodology, the Secretary shall provide 
for a composite assessment (using a scoring 
scale of 0 to 100) for each such professional for 
the performance period for such year. In this 
subsection such a composite assessment for 
such a professional with respect to a perform-
ance period shall be referred to as the ‘com-
posite performance score’ for such professional 
for such performance period.
‘‘(B) INCENTIVE
TO
REPORT; ENCOUR-
AGING USE OF CERTIFIED EHR TECHNOLOGY 
FOR REPORTING QUALITY MEASURES.— 
‘‘(i) INCENTIVE TO REPORT.—Under 
the methodology established under sub-
paragraph (A), the Secretary shall provide 
that in the case of a MIPS eligible profes-
sional who fails to report on an applicable 
measure or activity that is required to be 
reported by the professional, the profes-
sional shall be treated as achieving the 
lowest potential score applicable to such 
measure or activity. 
‘‘(ii) ENCOURAGING
USE
OF
CER-
TIFIED EHR TECHNOLOGY AND QUALIFIED 
CLINICAL DATA REGISTRIES FOR REPORT-
ING
QUALITY
MEASURES.—Under 
the 
methodology established under subpara-
graph (A), the Secretary shall— 
‘‘(I) encourage MIPS eligible 
professionals to report on applicable 
measures with respect to the perform-
ance category described in paragraph 
(2)(A)(i) through the use of certified
EHR technology and qualified clinical 
data registries; and 
‘‘(II) with respect to a perform-
ance period, with respect to a year, 
for which a MIPS eligible professional 
reports such measures through the 
use of such EHR technology, treat 
such professional as satisfying the 
clinical quality measures reporting re-
quirement described in subsection 
(o)(2)(A)(iii) for such year. 
‘‘(C) CLINICAL
PRACTICE
IMPROVEMENT 
ACTIVITIES PERFORMANCE SCORE.— 
‘‘(i) RULE
FOR
ACCREDITATION.—A 
MIPS eligible professional who is in a 
practice that is certified as a patient-cen-
tered medical home or comparable spe-
cialty practice pursuant to subsection 
(b)(8)(B)(i) with respect to a performance 
period shall be given the highest potential 
score for the performance category de-
scribed in paragraph (2)(A)(iii) for such 
period. 
‘‘(ii) APM PARTICIPATION.—Partici-
pation by a MIPS eligible professional in
an alternative payment model (as defined 
in section 1833(z)(3)(C)) with respect to a 
performance period shall earn such eligible 
professional a minimum score of one-half 
of the highest potential score for the per-
formance category described in paragraph 
(2)(A)(iii) for such performance period. 
‘‘(iii) SUBCATEGORIES.—A MIPS eli-
gible professional shall not be required to 
perform activities in each subcategory 
under paragraph (2)(B)(iii) or participate 
in an alternative payment model in order 
to achieve the highest potential score for 
the performance category described in 
paragraph (2)(A)(iii). 
‘‘(D) 
ACHIEVEMENT
AND
IMPROVE-
MENT.— 
‘‘(i) TAKING INTO ACCOUNT IMPROVE-
MENT.—Beginning with the second year to 
which the MIPS applies, in addition to the 
achievement of a MIPS eligible profes-
sional, if data sufficient to measure im-
provement is available, the methodology 
developed under subparagraph (A)—
‘‘(I) in the case of the perform-
ance score for the performance cat-
egory described in clauses (i) and (ii) 
of paragraph (2)(A), shall take into 
account the improvement of the pro-
fessional; and 
‘‘(II) in the case of performance 
scores for other performance cat-
egories, may take into account the im-
provement of the professional. 
‘‘(ii) ASSIGNING HIGHER WEIGHT FOR 
ACHIEVEMENT.—Beginning 
with 
the 
fourth year to which the MIPS applies, 
under the methodology developed under 
subparagraph (A), the Secretary may as-
sign a higher scoring weight under sub-
paragraph (F) with respect to the achieve-
ment of a MIPS eligible professional than 
with respect to any improvement of such 
professional applied under clause (i) with 
respect to a measure, activity, or category 
described in paragraph (2). 
‘‘(E) WEIGHTS
FOR
THE
PERFORMANCE 
CATEGORIES.—
‘‘(i) IN GENERAL.—Under the meth-
odology developed under subparagraph (A), 
subject to subparagraph (F)(i) and clauses 
(ii) and (iii), the composite performance 
score shall be determined as follows: 
‘‘(I) QUALITY.— 
‘‘(aa) IN
GENERAL.—Sub-
ject to item (bb), thirty percent 
of such score shall be based on 
performance with respect to the 
category described in clause (i) of 
paragraph (2)(A). In applying 
the previous sentence, the Sec-
retary shall, as feasible, encour-
age the application of outcome 
measures within such category. 
‘‘(bb) FIRST 2 YEARS.—For 
the first and second years for 
which the MIPS applies to pay-
ments, the percentage applicable 
under item (aa) shall be in-
creased in a manner such that 
the total percentage points of the 
increase under this item for the 
respective year equals the total
number of percentage points by 
which the percentage applied 
under subclause (II)(bb) for the 
respective year is less than 30 
percent. 
‘‘(II) RESOURCE USE.— 
‘‘(aa) IN
GENERAL.—Sub-
ject to item (bb), thirty percent 
of such score shall be based on 
performance with respect to the 
category described in clause (ii) 
of paragraph (2)(A). 
‘‘(bb) FIRST 2 YEARS.—For 
the first year for which the MIPS 
applies to payments, not more 
than 10 percent of such score 
shall be based on performance 
with respect to the category de-
scribed in clause (ii) of para-
graph (2)(A). For the second 
year for which the MIPS applies 
to payments, not more than 15 
percent of such score shall be 
based on performance with re-
spect to the category described in 
clause (ii) of paragraph (2)(A). 
‘‘(III) CLINICAL
PRACTICE
IM-
PROVEMENT
ACTIVITIES.—Fifteen 
percent of such score shall be based 
on performance with respect to the 
category described in clause (iii) of 
paragraph (2)(A). 
‘‘(IV) MEANINGFUL USE OF CER-
TIFIED
EHR
TECHNOLOGY.—Twenty- 
five percent of such score shall be 
based on performance with respect to 
the category described in clause (iv) of 
paragraph (2)(A). 
‘‘(ii) AUTHORITY
TO
ADJUST
PER-
CENTAGES IN CASE OF HIGH EHR MEAN-
INGFUL USE ADOPTION.—In any year in 
which the Secretary estimates that the pro-
portion of eligible professionals (as defined 
in subsection (o)(5)) who are meaningful 
EHR users (as determined under sub-
section (o)(2)) is 75 percent or greater, the 
Secretary may reduce the percent applica-
ble under clause (i)(IV), but not below 15 
percent. If the Secretary makes such re-
duction for a year, subject to subclauses 
(I)(bb) and (II)(bb) of clause (i), the per-
centages applicable under one or more of 
subclauses (I), (II), and (III) of clause (i) 
for such year shall be increased in a man-
ner such that the total percentage points 
of the increase under this clause for such 
year equals the total number of percentage 
points reduced under the preceding sen-
tence for such year. 
‘‘(F) 
CERTAIN
FLEXIBILITY
FOR 
WEIGHTING PERFORMANCE CATEGORIES, MEAS-
URES, AND
ACTIVITIES.—Under the method-
ology under subparagraph (A), if there are not 
sufficient measures and clinical practice im-
provement activities applicable and available to 
each type of eligible professional involved, the 
Secretary shall assign different scoring weights 
(including a weight of 0)— 
‘‘(i) which may vary from the scoring 
weights specified in subparagraph (E), for 
each performance category based on the 
extent to which the category is applicable 
to the type of eligible professional involved; 
and
‘‘(ii) for each measure and activity 
specified under paragraph (2)(B) with re-
spect to each such category based on the 
extent to which the measure or activity is 
applicable and available to the type of eli-
gible professional involved. 
‘‘(G) RESOURCE
USE.—Analysis of the 
performance category described in paragraph 
(2)(A)(ii) shall include results from the method-
ology described in subsection (r)(5), as appro-
priate. 
‘‘(H) INCLUSION
OF
QUALITY
MEASURE 
DATA FROM OTHER PAYERS.—In applying sub-
sections (k), (m), and (p) with respect to meas-
ures described in paragraph (2)(B)(i), analysis 
of the performance category described in para-
graph (2)(A)(i) may include data submitted by 
MIPS eligible professionals with respect to 
items and services furnished to individuals who 
are not individuals entitled to benefits under 
part A or enrolled under part B. 
‘‘(I) USE OF VOLUNTARY VIRTUAL GROUPS 
FOR CERTAIN ASSESSMENT PURPOSES.— 
‘‘(i) IN
GENERAL.—In the case of 
MIPS eligible professionals electing to be a
virtual group under clause (ii) with respect 
to a performance period for a year, for 
purposes of applying the methodology 
under subparagraph (A)— 
‘‘(I) the assessment of perform-
ance provided under such methodology 
with respect to the performance cat-
egories described in clauses (i) and 
(ii) of paragraph (2)(A) that is to be 
applied to each such professional in 
such group for such performance pe-
riod shall be with respect to the com-
bined performance of all such profes-
sionals in such group for such period; 
and 
‘‘(II) the composite score pro-
vided under this paragraph for such 
performance period with respect to 
each such performance category for 
each such MIPS eligible professional 
in such virtual group shall be based 
on the assessment of the combined 
performance under subclause (I) for 
the performance category and per-
formance period.
‘‘(ii) ELECTION OF PRACTICES TO BE 
A VIRTUAL GROUP.—The Secretary shall, 
in accordance with clause (iii), establish 
and have in place a process to allow an in-
dividual MIPS eligible professional or a 
group practice consisting of not more than 
10 MIPS eligible professionals to elect, 
with respect to a performance period for a 
year, for such individual MIPS eligible pro-
fessional or all such MIPS eligible profes-
sionals in such group practice, respectively, 
to be a virtual group under this subpara-
graph with at least one other such indi-
vidual MIPS eligible professional or group 
practice making such an election. Such a 
virtual group may be based on geographic 
areas or on provider specialties defined by 
nationally recognized multispecialty boards 
of certification or equivalent certification 
boards and such other eligible professional 
groupings in order to capture classifica-
tions of providers across eligible profes-
sional organizations and other practice 
areas or categories.
‘‘(iii) REQUIREMENTS.—The process 
under clause (ii)— 
‘‘(I) shall provide that an election 
under such clause, with respect to a 
performance period, shall be made be-
fore or during the beginning of such 
performance period and may not be 
changed during such performance pe-
riod; 
‘‘(II) shall provide that a practice 
described in such clause, and each 
MIPS eligible professional in such 
practice, may elect to be in no more 
than one virtual group for a perform-
ance period; and 
‘‘(III) may provide that a virtual 
group may be combined at the tax 
identification number level. 
‘‘(6) MIPS PAYMENTS.— 
‘‘(A) MIPS ADJUSTMENT FACTOR.—Tak-
ing into account paragraph (1)(G), the Sec-
retary shall specify a MIPS adjustment factor 
for each MIPS eligible professional for a year. 
Such MIPS adjustment factor for a MIPS eligi-
ble professional for a year shall be in the form 
of a percent and shall be determined— 
‘‘(i) by comparing the composite per-
formance score of the eligible professional 
for such year to the performance threshold 
established under subparagraph (D)(i) for 
such year; 
‘‘(ii) in a manner such that the ad-
justment factors specified under this sub-
paragraph for a year result in differential 
payments under this paragraph reflecting 
that— 
‘‘(I) MIPS eligible professionals 
with composite performance scores for 
such year at or above such perform-
ance threshold for such year receive 
zero or positive incentive payment ad-
justment factors for such year in ac-
cordance with clause (iii), with such 
professionals having higher composite 
performance scores receiving higher 
adjustment factors; and 
‘‘(II) MIPS eligible professionals 
with composite performance scores for 
such year below such performance
threshold for such year receive nega-
tive payment adjustment factors for 
such year in accordance with clause 
(iv), with such professionals having 
lower composite performance scores 
receiving lower adjustment factors; 
‘‘(iii) in a manner such that MIPS eli-
gible professionals with composite scores 
described in clause (ii)(I) for such year, 
subject to clauses (i) and (ii) of subpara-
graph (F), receive a zero or positive ad-
justment factor on a linear sliding scale 
such that an adjustment factor of 0 per-
cent is assigned for a score at the perform-
ance threshold and an adjustment factor of 
the applicable percent specified in subpara-
graph (B) is assigned for a score of 100; 
and 
‘‘(iv) in a manner such that— 
‘‘(I) subject to subclause (II), 
MIPS eligible professionals with com-
posite performance scores described in 
clause (ii)(II) for such year receive a 
negative payment adjustment factor 
on a linear sliding scale such that an
adjustment factor of 0 percent is as-
signed for a score at the performance 
threshold and an adjustment factor of 
the negative of the applicable percent 
specified in subparagraph (B) is as-
signed for a score of 0; and 
‘‘(II) MIPS eligible professionals 
with composite performance scores 
that are equal to or greater than 0, 
but not greater than 1⁄4 of the per-
formance threshold specified under 
subparagraph (D)(i) for such year, re-
ceive a negative payment adjustment 
factor that is equal to the negative of 
the applicable percent specified in 
subparagraph (B) for such year. 
‘‘(B) APPLICABLE
PERCENT
DEFINED.— 
For purposes of this paragraph, the term ‘ap-
plicable percent’ means— 
‘‘(i) for 2018, 4 percent; 
‘‘(ii) for 2019, 5 percent; 
‘‘(iii) for 2020, 7 percent; and 
‘‘(iv) for 2021 and subsequent years, 
9 percent.
‘‘(C) ADDITIONAL MIPS ADJUSTMENT FAC-
TORS FOR EXCEPTIONAL PERFORMANCE.— 
‘‘(i) IN GENERAL.—In the case of a 
MIPS eligible professional with a com-
posite performance score for a year at or 
above the additional performance threshold 
under subparagraph (D)(ii) for such year, 
in addition to the MIPS adjustment factor 
under subparagraph (A) for the eligible 
professional for such year, subject to the 
availability of funds under clause (ii), the 
Secretary shall specify an additional posi-
tive MIPS adjustment factor for such pro-
fessional and year. Such additional MIPS 
adjustment factors shall be determined by 
the Secretary in a manner such that pro-
fessionals having higher composite per-
formance scores above the additional per-
formance threshold receive higher addi-
tional MIPS adjustment factors. 
‘‘(ii) ADDITIONAL FUNDING POOL.— 
For 2018 and each subsequent year 
through 2023, there is appropriated from 
the Federal Supplementary Medical Insur-
ance Trust Fund $500,000,000 for MIPS
payments under this paragraph resulting 
from the application of the additional 
MIPS adjustment factors under clause (i). 
‘‘(D) ESTABLISHMENT OF PERFORMANCE 
THRESHOLDS.— 
‘‘(i) PERFORMANCE
THRESHOLD.— 
For each year of the MIPS, the Secretary 
shall compute a performance threshold 
with respect to which the composite per-
formance score of MIPS eligible profes-
sionals shall be compared for purposes of 
determining adjustment factors under sub-
paragraph (A) that are positive, negative, 
and zero. Such performance threshold for 
a year shall be the mean or median (as se-
lected by the Secretary) of the composite 
performance scores for all MIPS eligible 
professionals with respect to a prior period 
specified by the Secretary. The Secretary 
may reassess the selection under the pre-
vious sentence every 3 years. 
‘‘(ii) 
ADDITIONAL
PERFORMANCE 
THRESHOLD FOR EXCEPTIONAL PERFORM-
ANCE.—In addition to the performance 
threshold under clause (i), for each year of
the MIPS, the Secretary shall compute an 
additional performance threshold for pur-
poses of determining the additional MIPS 
adjustment factors under subparagraph 
(C)(i). For each such year, the Secretary 
shall apply either of the following methods 
for computing such additional performance 
threshold for such a year: 
‘‘(I) The threshold shall be the 
score that is equal to the 25th per-
centile of the range of possible com-
posite performance scores above the 
performance threshold with respect to 
the prior period described in clause 
(i). 
‘‘(II) The threshold shall be the 
score that is equal to the 25th per-
centile of the actual composite per-
formance scores for MIPS eligible 
professionals with composite perform-
ance scores at or above the perform-
ance threshold with respect to the 
prior period described in clause (i). 
‘‘(iii) SPECIAL RULE FOR INITIAL 2 
YEARS.—With respect to each of the first
two years to which the MIPS applies, the 
Secretary shall, prior to the performance 
period for such years, establish a perform-
ance threshold for purposes of determining 
MIPS adjustment factors under subpara-
graph (A) and a threshold for purposes of 
determining additional MIPS adjustment 
factors under subparagraph (C)(i). Each 
such performance threshold shall— 
‘‘(I) be based on a period prior to 
such performance periods; and 
‘‘(II) take into account— 
‘‘(aa) data available with re-
spect to performance on meas-
ures and activities that may be 
used under the performance cat-
egories 
under 
subparagraph 
(2)(B); and 
‘‘(bb) other factors deter-
mined appropriate by the Sec-
retary. 
‘‘(E) APPLICATION OF MIPS ADJUSTMENT 
FACTORS.—In the case of items and services 
furnished by a MIPS eligible professional dur-
ing a year (beginning with 2018), the amount
otherwise paid under this part with respect to 
such items and services and MIPS eligible pro-
fessional for such year, shall be multiplied by— 
‘‘(i) 1, plus 
‘‘(ii) the sum of— 
‘‘(I) the MIPS adjustment factor 
determined under subparagraph (A) 
divided by 100, and 
‘‘(II) as applicable, the additional 
MIPS adjustment factor determined 
under subparagraph (C)(i) divided by 
100. 
‘‘(F) AGGREGATE
APPLICATION
OF
MIPS 
ADJUSTMENT FACTORS.— 
‘‘(i) APPLICATION OF SCALING FAC-
TOR.— 
‘‘(I) IN GENERAL.—With respect 
to positive MIPS adjustment factors 
under subparagraph (A)(ii)(I) for eli-
gible professionals whose composite 
performance score is above the per-
formance threshold under subpara-
graph (D)(i) for such year, subject to 
subclause (II), the Secretary shall in-
crease or decrease such adjustment
factors by a scaling factor in order to 
ensure that the budget neutrality re-
quirement of clause (ii) is met. 
‘‘(II) SCALING FACTOR LIMIT.— 
In no case may be the scaling factor 
applied under this clause exceed 3.0. 
‘‘(ii) BUDGET NEUTRALITY REQUIRE-
MENT.— 
‘‘(I) IN
GENERAL.—Subject to 
clause (iii), the Secretary shall ensure 
that the estimated amount described 
in subclause (II) for a year is equal to 
the estimated amount described in 
subclause (III) for such year. 
‘‘(II) AGGREGATE INCREASES.— 
The amount described in this sub-
clause is the estimated increase in the 
aggregate allowed charges resulting 
from the application of positive MIPS 
adjustment factors under subpara-
graph (A) (after application of the 
scaling factor described in clause (i)) 
to MIPS eligible professionals whose 
composite performance score for a 
year is above the performance thresh-
old under subparagraph (D)(i) for 
such year. 
‘‘(III) 
AGGREGATE
DE-
CREASES.—The amount described in 
this subclause is the estimated de-
crease 
in 
the 
aggregate 
allowed 
charges resulting from the application 
of negative MIPS adjustment factors 
under subparagraph (A) to MIPS eli-
gible professionals whose composite 
performance score for a year is below 
the performance threshold under sub-
paragraph (D)(i) for such year. 
‘‘(iii) EXCEPTIONS.— 
‘‘(I) In the case that all MIPS el-
igible professionals receive composite 
performance scores for a year that are 
below 
the 
performance 
threshold 
under subparagraph (D)(i) for such 
year, the negative MIPS adjustment 
factors under subparagraph (A) shall 
apply with respect to such MIPS eligi-
ble professionals and the budget neu-
trality requirement of clause (ii) shall 
not apply for such year.
‘‘(II) In the case that, with re-
spect to a year, the application of 
clause (i) results in a scaling factor 
equal to the maximum scaling factor 
specified in clause (i)(II), such scaling 
factor shall apply and the budget neu-
trality requirement of clause (ii) shall 
not apply for such year. 
‘‘(iv) ADDITIONAL
INCENTIVE
PAY-
MENT
ADJUSTMENTS.—In specifying the 
MIPS additional adjustment factors under 
subparagraph (C)(i) for each applicable 
MIPS eligible professional for a year, the 
Secretary shall ensure that the estimated 
increase in payments under this part re-
sulting from the application of such addi-
tional adjustment factors for MIPS eligible 
professionals in a year shall be equal (as 
estimated by the Secretary) to the addi-
tional funding pool amount for such year 
under subparagraph (C)(ii). 
‘‘(7) ANNOUNCEMENT OF RESULT OF ADJUST-
MENTS.—Under the MIPS, the Secretary shall, not 
later than 30 days prior to January 1 of the year 
involved, make available to MIPS eligible profes-
sionals the MIPS adjustment factor (and, as appli-
cable, the additional MIPS adjustment factor) under 
paragraph (6) applicable to the eligible professional 
for items and services furnished by the professional 
for such year. The Secretary may include such infor-
mation in the confidential feedback under paragraph 
(12). 
‘‘(8) NO EFFECT IN SUBSEQUENT YEARS.—The 
MIPS adjustment factors and additional MIPS ad-
justment factors under paragraph (6) shall apply 
only with respect to the year involved, and the Sec-
retary shall not take into account such adjustment 
factors in making payments to a MIPS eligible pro-
fessional under this part in a subsequent year. 
‘‘(9) PUBLIC REPORTING.— 
‘‘(A) IN GENERAL.—The Secretary shall, 
in an easily understandable format, make avail-
able on the Physician Compare Internet website 
of the Centers for Medicare & Medicaid Serv-
ices the following: 
‘‘(i) Information regarding the per-
formance of MIPS eligible professionals 
under the MIPS, which— 
‘‘(I) shall include the composite 
score for each such MIPS eligible pro-
fessional and the performance of each 
such MIPS eligible professional with 
respect to each performance category; 
and 
‘‘(II) may include the perform-
ance of each such MIPS eligible pro-
fessional with respect to each measure 
or activity specified in paragraph 
(2)(B). 
‘‘(ii) The names of eligible profes-
sionals in eligible alternative payment mod-
els (as defined in section 1833(z)(3)(D)) 
and, to the extent feasible, the names of 
such eligible alternative payment models 
and performance of such models. 
‘‘(B) 
DISCLOSURE.—The 
information 
made available under this paragraph shall indi-
cate, where appropriate, that publicized infor-
mation may not be representative of the eligible 
professional’s entire patient population, the va-
riety of services furnished by the eligible profes-
sional, or the health conditions of individuals 
treated. 
‘‘(C) OPPORTUNITY TO REVIEW AND SUB-
MIT
CORRECTIONS.—The Secretary shall pro-
vide for an opportunity for a professional de-
scribed in subparagraph (A) to review, and sub-
mit corrections for, the information to be made 
public with respect to the professional under 
such subparagraph prior to such information 
being made public. 
‘‘(D) 
AGGREGATE
INFORMATION.—The 
Secretary shall periodically post on the Physi-
cian Compare Internet website aggregate infor-
mation on the MIPS, including the range of 
composite scores for all MIPS eligible profes-
sionals and the range of the performance of all 
MIPS eligible professionals with respect to each 
performance category. 
‘‘(10) CONSULTATION.—The Secretary shall 
consult with stakeholders in carrying out the MIPS, 
including for the identification of measures and ac-
tivities under paragraph (2)(B) and the methodolo-
gies developed under paragraphs (5)(A) and (6) and 
regarding the use of qualified clinical data registries. 
Such consultation shall include the use of a request 
for information or other mechanisms determined ap-
propriate.
‘‘(11) TECHNICAL ASSISTANCE TO SMALL PRAC-
TICES AND PRACTICES IN HEALTH PROFESSIONAL 
SHORTAGE AREAS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
enter into contracts or agreements with appro-
priate entities (such as quality improvement or-
ganizations, regional extension centers (as de-
scribed in section 3012(c) of the Public Health 
Service Act), or regional health collaboratives) 
to offer guidance and assistance to MIPS eligi-
ble professionals in practices of 15 or fewer pro-
fessionals (with priority given to such practices 
located in rural areas, health professional short-
age areas (as designated under in section 
332(a)(1)(A) of such Act), and medically under-
served areas, and practices with low composite 
scores) with respect to— 
‘‘(i) the performance categories de-
scribed in clauses (i) through (iv) of para-
graph (2)(A); or 
‘‘(ii) how to transition to the imple-
mentation of and participation in an alter-
native payment model as described in sec-
tion 1833(z)(3)(C). 
‘‘(B) FUNDING FOR IMPLEMENTATION.—
‘‘(i) IN
GENERAL.—For purposes of 
implementing subparagraph (A), the Sec-
retary shall provide for the transfer from 
the Federal Supplementary Medical Insur-
ance Trust Fund established under section 
1841 to the Centers for Medicare & Med-
icaid Services Program Management Ac-
count of $40,000,000 for each of fiscal 
years 2015 through 2019. Amounts trans-
ferred under this subparagraph for a fiscal 
year shall be available until expended. 
‘‘(ii) 
TECHNICAL
ASSISTANCE.—Of 
the amounts transferred pursuant to clause 
(i) for each of fiscal years 2015 through 
2019, not less than $10,000,000 shall be 
made available for each such year for tech-
nical assistance to small practices in health 
professional shortage areas (as so des-
ignated) and medically underserved areas. 
‘‘(12) FEEDBACK
AND
INFORMATION
TO
IM-
PROVE PERFORMANCE.— 
‘‘(A) PERFORMANCE FEEDBACK.— 
‘‘(i) IN GENERAL.—Beginning July 1, 
2016, the Secretary—
‘‘(I) shall make available timely 
(such as quarterly) confidential feed-
back to MIPS eligible professionals on 
the performance of such professionals 
with respect to the performance cat-
egories under clauses (i) and (ii) of 
paragraph (2)(A); and 
‘‘(II) may make available con-
fidential feedback to each such profes-
sional on the performance of such 
professional with respect to the per-
formance categories under clauses (iii) 
and (iv) of such paragraph. 
‘‘(ii) MECHANISMS.—The Secretary 
may use one or more mechanisms to make 
feedback available under clause (i), which 
may include use of a web-based portal or 
other mechanisms determined appropriate 
by the Secretary. With respect to the per-
formance category described in paragraph 
(2)(A)(i), feedback under this subpara-
graph shall, to the extent an eligible pro-
fessional chooses to participate in a data 
registry for purposes of this subsection (in-
cluding registries under subsections (k)
and (m)), be provided based on perform-
ance on quality measures reported through 
the use of such registries. With respect to 
any other performance category described 
in paragraph (2)(A), the Secretary shall 
encourage provision of feedback through 
qualified clinical data registries as de-
scribed in subsection (m)(3)(E)). 
‘‘(iii) USE OF DATA.—For purposes of 
clause (i), the Secretary may use data, 
with respect to a MIPS eligible profes-
sional, from periods prior to the current 
performance period and may use rolling 
periods in order to make illustrative cal-
culations about the performance of such 
professional. 
‘‘(iv) 
DISCLOSURE
EXEMPTION.— 
Feedback made available under this sub-
paragraph shall be exempt from disclosure 
under section 552 of title 5, United States 
Code. 
‘‘(v) RECEIPT
OF
INFORMATION.— 
The Secretary may use the mechanisms es-
tablished under clause (ii) to receive infor-
mation from professionals, such as infor-
mation with respect to this subsection. 
‘‘(B) ADDITIONAL INFORMATION.— 
‘‘(i) IN GENERAL.—Beginning July 1, 
2017, the Secretary shall make available to 
each MIPS eligible professional informa-
tion, with respect to individuals who are 
patients of such MIPS eligible professional, 
about items and services for which pay-
ment is made under this title that are fur-
nished to such individuals by other sup-
pliers and providers of services, which may 
include information described in clause (ii). 
Such information may be made available 
under the previous sentence to such MIPS 
eligible professionals by mechanisms deter-
mined appropriate by the Secretary, which 
may include use of a web-based portal. 
Such information may be made available in 
accordance with the same or similar terms 
as data are made available to accountable 
care organizations participating in the 
shared savings program under section 
1899, including a beneficiary opt-out.
‘‘(ii) TYPE
OF
INFORMATION.—For 
purposes of clause (i), the information de-
scribed in this clause, is the following: 
‘‘(I) With respect to selected 
items and services (as determined ap-
propriate by the Secretary) for which 
payment is made under this title and 
that are furnished to individuals, who 
are patients of a MIPS eligible profes-
sional, by another supplier or provider 
of services during the most recent pe-
riod for which data are available (such 
as the most recent three-month pe-
riod), such as the name of such pro-
viders furnishing such items and serv-
ices to such patients during such pe-
riod, the types of such items and serv-
ices so furnished, and the dates such 
items and services were so furnished. 
‘‘(II) Historical data, such as 
averages and other measures of the 
distribution if appropriate, of the 
total, and components of, allowed 
charges (and other figures as deter-
mined appropriate by the Secretary).
‘‘(13) REVIEW.— 
‘‘(A) TARGETED REVIEW.—The Secretary 
shall establish a process under which a MIPS 
eligible professional may seek an informal re-
view of the calculation of the MIPS adjustment 
factor applicable to such eligible professional 
under this subsection for a year. The results of 
a review conducted pursuant to the previous 
sentence shall not be taken into account for 
purposes of paragraph (6) with respect to a 
year (other than with respect to the calculation 
of such eligible professional’s MIPS adjustment 
factor for such year or additional MIPS adjust-
ment factor for such year) after the factors de-
termined in subparagraph (A) and subpara-
graph (C) of such paragraph have been deter-
mined for such year. 
‘‘(B) LIMITATION.—Except as provided for 
in subparagraph (A), there shall be no adminis-
trative or judicial review under section 1869, 
section 1878, or otherwise of the following: 
‘‘(i) The methodology used to deter-
mine the amount of the MIPS adjustment 
factor under paragraph (6)(A) and the 
amount of the additional MIPS adjustment
factor under paragraph (6)(C)(i) and the 
determination of such amounts. 
‘‘(ii) The establishment of the per-
formance standards under paragraph (3) 
and the performance period under para-
graph (4). 
‘‘(iii) The identification of measures 
and activities specified under paragraph 
(2)(B) and information made public or 
posted on the Physician Compare Internet 
website of the Centers for Medicare & 
Medicaid Services under paragraph (9). 
‘‘(iv) 
The 
methodology 
developed 
under paragraph (5) that is used to cal-
culate performance scores and the calcula-
tion of such scores, including the weighting 
of measures and activities under such 
methodology.’’. 
(2) GAO REPORTS.— 
(A) EVALUATION
OF
ELIGIBLE
PROFES-
SIONAL MIPS.—Not later than October 1, 2019, 
and October 1, 2022, the Comptroller General 
of the United States shall submit to Congress 
a report evaluating the eligible professional 
Merit-based Incentive Payment System under
subsection (q) of section 1848 of the Social Se-
curity Act (42 U.S.C. 1395w–4), as added by 
paragraph (1). Such report shall— 
(i) examine the distribution of the 
composite performance scores and MIPS 
adjustment factors (and additional MIPS 
adjustment factors) for MIPS eligible pro-
fessionals 
(as 
defined 
in 
subsection 
(q)(1)(c) of such section) under such pro-
gram, and patterns relating to such scores 
and adjustment factors, including based on 
type of provider, practice size, geographic 
location, and patient mix; 
(ii) provide recommendations for im-
proving such program; 
(iii) evaluate the impact of technical 
assistance 
funding 
under 
section 
1848(q)(11) of the Social Security Act, as 
added by paragraph (1), on the ability of 
professionals to improve within such pro-
gram or successfully transition to an alter-
native payment model (as defined in sec-
tion 1833(z)(3) of the Social Security Act, 
as added by subsection (e)), with priority 
for such evaluation given to practices lo-
cated in rural areas, health professional 
shortage areas (as designated in section 
332(a)(1)(a) of the Public Health Service 
Act), and medically underserved areas; and 
(iv) provide recommendations for opti-
mizing the use of such technical assistance 
funds. 
(B) STUDY TO EXAMINE ALIGNMENT OF 
QUALITY MEASURES USED IN PUBLIC AND PRI-
VATE PROGRAMS.— 
(i) IN GENERAL.—Not later than 18 
months after the date of the enactment of 
this Act, the Comptroller General of the 
United States shall submit to Congress a 
report that— 
(I) compares the similarities and 
differences in the use of quality meas-
ures under the original Medicare fee- 
for-service program under parts A and 
B of title XVIII of the Social Security 
Act, the Medicare Advantage program 
under part C of such title, selected 
State Medicaid programs under title 
XIX of such Act, and private payer 
arrangements; and
(II) makes recommendations on 
how to reduce the administrative bur-
den involved in applying such quality 
measures. 
(ii) 
REQUIREMENTS.—The 
report 
under clause (i) shall— 
(I) consider those measures ap-
plicable to individuals entitled to, or 
enrolled for, benefits under such part 
A, or enrolled under such part B and 
individuals under the age of 65; and 
(II) focus on those measures that 
comprise the most significant compo-
nent of the quality performance cat-
egory of the eligible professional 
MIPS incentive program under sub-
section (q) of section 1848 of the So-
cial Security Act (42 U.S.C. 1395w– 
4), as added by paragraph (1). 
(C) STUDY
ON
ROLE
OF
INDEPENDENT 
RISK MANAGERS.—Not later than January 1, 
2016, the Comptroller General of the United 
States shall submit to Congress a report exam-
ining whether entities that pool financial risk 
for physician practices, such as independent
risk managers, can play a role in supporting 
physician practices, particularly small physician 
practices, in assuming financial risk for the 
treatment of patients. Such report shall exam-
ine barriers that small physician practices cur-
rently face in assuming financial risk for treat-
ing patients, the types of risk management enti-
ties that could assist physician practices in par-
ticipating in two-sided risk payment models, 
and how such entities could assist with risk 
management and with quality improvement ac-
tivities. Such report shall also include an anal-
ysis of any existing legal barriers to such ar-
rangements. 
(D) STUDY
TO
EXAMINE
RURAL
AND 
HEALTH
PROFESSIONAL
SHORTAGE
AREA
AL-
TERNATIVE PAYMENT MODELS.—Not later than 
October 1, 2020, and October 1, 2022, the 
Comptroller General of the United States shall 
submit to Congress a report that examines the 
transition of professionals in rural areas, health 
professional shortage areas (as designated in 
section 332(a)(1)(A) of the Public Health Serv-
ice Act), or medically underserved areas to an 
alternative payment model (as defined in sec-
tion 1833(z)(3) of the Social Security Act, as 
added by subsection (e)). Such report shall 
make recommendations for removing adminis-
trative barriers to practices, including small 
practices consisting of 15 or fewer profes-
sionals, in rural areas, health professional 
shortage areas, and medically underserved areas 
to participation in such models. 
(3) FUNDING
FOR
IMPLEMENTATION.—For 
purposes of implementing the provisions of and the 
amendments made by this section, the Secretary of 
Health and Human Services shall provide for the 
transfer of $80,000,000 from the Supplementary 
Medical Insurance Trust Fund established under 
section 1841 of the Social Security Act (42 U.S.C. 
1395t) to the Centers for Medicare & Medicaid Pro-
gram Management Account for each of the fiscal 
years 2014 through 2018. Amounts transferred 
under this paragraph shall be available until ex-
pended. 
(d) IMPROVING QUALITY REPORTING
FOR COM-
POSITE SCORES.— 
(1) CHANGES
FOR
GROUP
REPORTING
OP-
TION.—
(A) 
IN
GENERAL.—Section 
1848(m)(3)(C)(ii)) of the Social Security Act 
(42 U.S.C. 1395w–4(m)(3)(C)(ii)) is amended 
by inserting ‘‘and, for 2015 and subsequent 
years, may provide’’ after ‘‘shall provide’’. 
(B) CLARIFICATION OF QUALIFIED CLIN-
ICAL
DATA
REGISTRY
REPORTING
TO
GROUP 
PRACTICES.—Section 1848(m)(3)(D) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1395w– 
4(m)(3)(D)) is amended by inserting ‘‘and, for 
2015 and subsequent years, subparagraph (A) 
or (C)’’ after ‘‘subparagraph (A)’’. 
(2) CHANGES FOR MULTIPLE REPORTING PERI-
ODS
AND
ALTERNATIVE
CRITERIA
FOR
SATISFAC-
TORY
REPORTING.—Section 1848(m)(5)(F) of the 
Social Security Act (42 U.S.C. 1395w–4(m)(5)(F)) 
is amended— 
(A) by striking ‘‘and subsequent years’’ 
and inserting ‘‘through reporting periods occur-
ring in 2014’’; and 
(B) by inserting ‘‘and, for reporting peri-
ods occurring in 2015 and subsequent years, 
the Secretary may establish’’ following ‘‘shall 
establish’’.
(3) PHYSICIAN FEEDBACK PROGRAM REPORTS 
SUCCEEDED
BY
REPORTS
UNDER
MIPS.—Section 
1848(n) of the Social Security Act (42 U.S.C. 
1395w–4(n)) is amended by adding at the end the 
following new paragraph: 
‘‘(11) REPORTS ENDING WITH 2016.—Reports 
under the Program shall not be provided after De-
cember 31, 2016. See subsection (q)(12) for reports 
under the eligible professionals Merit-based Incentive 
Payment System.’’. 
(4) COORDINATION WITH SATISFYING MEANING-
FUL EHR USE CLINICAL QUALITY MEASURE REPORT-
ING
REQUIREMENT.—Section 1848(o)(2)(A)(iii) of 
the Social Security Act (42 U.S.C. 1395w– 
4(o)(2)(A)(iii)) is amended by inserting ‘‘and sub-
section (q)(5)(B)(ii)(II)’’ after ‘‘Subject to subpara-
graph (B)(ii)’’. 
(e) PROMOTING ALTERNATIVE PAYMENT MODELS.— 
(1) INCREASING TRANSPARENCY OF PHYSICIAN 
FOCUSED PAYMENT MODELS.—Section 1868 of the 
Social Security Act (42 U.S.C. 1395ee) is amended 
by adding at the end the following new subsection: 
‘‘(c) PHYSICIAN FOCUSED PAYMENT MODELS.— 
‘‘(1) TECHNICAL ADVISORY COMMITTEE.—
‘‘(A) ESTABLISHMENT.—There is estab-
lished an ad hoc committee to be known as the 
‘Payment Model Technical Advisory Committee’ 
(referred to in this subsection as the ‘Com-
mittee’). 
‘‘(B) MEMBERSHIP.— 
‘‘(i) NUMBER
AND
APPOINTMENT.— 
The Committee shall be composed of 11 
members appointed by the Comptroller 
General of the United States. 
‘‘(ii) QUALIFICATIONS.—The member-
ship of the Committee shall include indi-
viduals with national recognition for their 
expertise in payment models and related 
delivery of care. No more than 5 members 
of the Committee shall be providers of 
services or suppliers, or representatives of 
providers of services or suppliers. 
‘‘(iii) PROHIBITION ON FEDERAL EM-
PLOYMENT.—A member of the Committee 
shall not be an employee of the Federal 
Government. 
‘‘(iv) 
ETHICS
DISCLOSURE.—The 
Comptroller General shall establish a sys-
tem for public disclosure by members of
the Committee of financial and other po-
tential conflicts of interest relating to such 
members. Members of the Committee shall 
be treated as employees of Congress for 
purposes of applying title I of the Ethics 
in Government Act of 1978 (Public Law 
95–521). 
‘‘(v) DATE
OF
INITIAL
APPOINT-
MENTS.—The initial appointments of mem-
bers of the Committee shall be made by 
not later than 180 days after the date of 
enactment of this subsection. 
‘‘(C) TERM; VACANCIES.— 
‘‘(i) TERM.—The terms of members of 
the Committee shall be for 3 years except 
that the Comptroller General shall des-
ignate staggered terms for the members 
first appointed. 
‘‘(ii) VACANCIES.—Any member ap-
pointed to fill a vacancy occurring before 
the expiration of the term for which the 
member’s predecessor was appointed shall 
be appointed only for the remainder of that 
term. A member may serve after the expi-
ration of that member’s term until a suc-
cessor has taken office. A vacancy in the 
Committee shall be filled in the manner in 
which the original appointment was made. 
‘‘(D) DUTIES.—The Committee shall meet, 
as needed, to provide comments and rec-
ommendations to the Secretary, as described in 
paragraph (2)(C), on physician-focused pay-
ment models. 
‘‘(E) COMPENSATION OF MEMBERS.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), a member of the Com-
mittee shall serve without compensation. 
‘‘(ii) TRAVEL EXPENSES.—A member 
of the Committee shall be allowed travel 
expenses, including per diem in lieu of sub-
sistence, at rates authorized for an em-
ployee of an agency under subchapter I of 
chapter 57 of title 5, United States Code, 
while away from the home or regular place 
of business of the member in the perform-
ance of the duties of the Committee. 
‘‘(F) OPERATIONAL AND TECHNICAL SUP-
PORT.— 
‘‘(i) IN
GENERAL.—The Assistant 
Secretary for Planning and Evaluation
shall provide technical and operational sup-
port for the Committee, which may be by 
use of a contractor. The Office of the Ac-
tuary of the Centers for Medicare & Med-
icaid Services shall provide to the Com-
mittee actuarial assistance as needed. 
‘‘(ii) FUNDING.—The Secretary shall 
provide for the transfer, from the Federal 
Supplementary Medical Insurance Trust 
Fund under section 1841, such amounts as 
are necessary to carry out clause (i) (not 
to exceed $5,000,000) for fiscal year 2014 
and each subsequent fiscal year. Any 
amounts transferred under the preceding 
sentence for a fiscal year shall remain 
available until expended. 
‘‘(G) APPLICATION.—Section 14 of the 
Federal Advisory Committee Act (5 U.S.C. 
App.) shall not apply to the Committee. 
‘‘(2) CRITERIA AND PROCESS FOR SUBMISSION 
AND
REVIEW
OF
PHYSICIAN-FOCUSED
PAYMENT 
MODELS.— 
‘‘(A) CRITERIA FOR ASSESSING PHYSICIAN- 
FOCUSED PAYMENT MODELS.—
‘‘(i) RULEMAKING.—Not later than 
November 1, 2015, the Secretary shall, 
through notice and comment rulemaking, 
following a request for information, estab-
lish criteria for physician-focused payment 
models, including models for specialist phy-
sicians, that could be used by the Com-
mittee for making comments and rec-
ommendations 
pursuant 
to 
paragraph 
(1)(D). 
‘‘(ii) MEDPAC SUBMISSION OF COM-
MENTS.—During the comment period for 
the proposed rule described in clause (i), 
the Medicare Payment Advisory Commis-
sion may submit comments to the Sec-
retary on the proposed criteria under such 
clause. 
‘‘(iii) UPDATING.—The Secretary may 
update the criteria established under this 
subparagraph through rulemaking. 
‘‘(B) STAKEHOLDER SUBMISSION OF PHY-
SICIAN
FOCUSED
PAYMENT
MODELS.—On an 
ongoing basis, individuals and stakeholder enti-
ties may submit to the Committee proposals for 
physician-focused payment models that such in-
dividuals and entities believe meet the criteria 
described in subparagraph (A). 
‘‘(C) TAC 
REVIEW
OF
MODELS
SUB-
MITTED.—The Committee shall, on a periodic 
basis, review models submitted under subpara-
graph (B), prepare comments and recommenda-
tions regarding whether such models meet the 
criteria described in subparagraph (A), and 
submit such comments and recommendations to 
the Secretary. 
‘‘(D) 
SECRETARY
REVIEW
AND
RE-
SPONSE.—The Secretary shall review the com-
ments and recommendations submitted by the 
Committee under subparagraph (C) and post a 
detailed response to such comments and rec-
ommendations on the Internet Website of the 
Centers for Medicare & Medicaid Services. 
‘‘(3) RULE
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed to impact the de-
velopment or testing of models under this title or ti-
tles XI, XIX, or XXI.’’. 
(2) INCENTIVE PAYMENTS FOR PARTICIPATION 
IN
ELIGIBLE
ALTERNATIVE
PAYMENT
MODELS.— 
Section 1833 of the Social Security Act (42 U.S.C.
1395l) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(z) INCENTIVE PAYMENTS FOR PARTICIPATION IN 
ELIGIBLE ALTERNATIVE PAYMENT MODELS.— 
‘‘(1) PAYMENT INCENTIVE.— 
‘‘(A) IN GENERAL.—In the case of covered 
professional services furnished by an eligible 
professional during a year that is in the period 
beginning with 2018 and ending with 2023 and 
for which the professional is a qualifying APM 
participant, in addition to the amount of pay-
ment that would otherwise be made for such 
covered professional services under this part for 
such year, there also shall be paid to such pro-
fessional an amount equal to 5 percent of the 
payment amount for the covered professional 
services under this part for the preceding year. 
For purposes of the previous sentence, the pay-
ment amount for the preceding year may be an 
estimation for the full preceding year based on 
a period of such preceding year that is less than 
the full year. The Secretary shall establish poli-
cies to implement this subparagraph in cases 
where payment for covered professional services 
furnished by a qualifying APM participant in
an alternative payment model is made to an en-
tity participating in the alternative payment 
model rather than directly to the qualifying 
APM participant. 
‘‘(B) 
FORM
OF
PAYMENT.—Payments 
under this subsection shall be made in a lump 
sum, on an annual basis, as soon as practicable. 
‘‘(C) TREATMENT
OF
PAYMENT
INCEN-
TIVE.—Payments under this subsection shall 
not be taken into account for purposes of deter-
mining actual expenditures under an alternative 
payment model and for purposes of determining 
or rebasing any benchmarks used under the al-
ternative payment model. 
‘‘(D) COORDINATION.—The amount of the 
additional payment for an item or service under 
this subsection or subsection (m) shall be deter-
mined without regard to any additional pay-
ment for the item or service under subsection 
(m) and this subsection, respectively. The 
amount of the additional payment for an item 
or service under this subsection or subsection 
(x) shall be determined without regard to any 
additional payment for the item or service 
under subsection (x) and this subsection, re-
spectively. The amount of the additional pay-
ment for an item or service under this sub-
section or subsection (y) shall be determined 
without regard to any additional payment for 
the item or service under subsection (y) and 
this subsection, respectively. 
‘‘(2) QUALIFYING APM PARTICIPANT.—For pur-
poses of this subsection, the term ‘qualifying APM 
participant’ means the following: 
‘‘(A) 2018 AND
2019.—With respect to 
2018 and 2019, an eligible professional for 
whom the Secretary determines that at least 25 
percent of payments under this part for covered 
professional services furnished by such profes-
sional during the most recent period for which 
data are available (which may be less than a 
year) were attributable to such services fur-
nished under this part through an entity that 
participates in an eligible alternative payment 
model with respect to such services. 
‘‘(B) 2020 AND
2021.—With respect to 
2020 and 2021, an eligible professional de-
scribed in either of the following clauses: 
‘‘(i) MEDICARE REVENUE THRESHOLD 
OPTION.—An 
eligible 
professional 
for
whom the Secretary determines that at 
least 50 percent of payments under this 
part for covered professional services fur-
nished by such professional during the 
most recent period for which data are 
available (which may be less than a year) 
were attributable to such services furnished 
under this part through an entity that par-
ticipates in an eligible alternative payment 
model with respect to such services. 
‘‘(ii) COMBINATION
ALL-PAYER
AND 
MEDICARE
REVENUE
THRESHOLD
OP-
TION.—An eligible professional— 
‘‘(I) for whom the Secretary de-
termines, with respect to items and 
services furnished by such professional 
during the most recent period for 
which data are available (which may 
be less than a year), that at least 50 
percent of the sum of— 
‘‘(aa) payments described in 
clause (i); and 
‘‘(bb) all other payments, re-
gardless of payer (other than 
payments made by the Secretary
of Defense or the Secretary of 
Veterans Affairs under chapter 
55 of title 10, United States 
Code, or title 38, United States 
Code, or any other provision of 
law, and other than payments 
made under title XIX in a State 
in which no medical home or al-
ternative payment model is avail-
able under the State program 
under that title), 
meet the requirement described in 
clause (iii)(I) with respect to pay-
ments described in item (aa) and meet 
the requirement described in clause 
(iii)(II) with respect to payments de-
scribed in item (bb); 
‘‘(II) for whom the Secretary de-
termines at least 25 percent of pay-
ments under this part for covered pro-
fessional services furnished by such 
professional during the most recent 
period for which data are available 
(which may be less than a year) were 
attributable to such services furnished
under this part through an entity that 
participates in an eligible alternative 
payment model with respect to such 
services; and 
‘‘(III) who provides to the Sec-
retary such information as is nec-
essary for the Secretary to make a de-
termination under subclause (I), with 
respect to such professional. 
‘‘(iii) REQUIREMENT.—For purposes 
of clause (ii)(I)— 
‘‘(I) the requirement described in 
this subclause, with respect to pay-
ments described in item (aa) of such 
clause, is that such payments are 
made under an eligible alternative 
payment model; and 
‘‘(II) the requirement described 
in this subclause, with respect to pay-
ments described in item (bb) of such 
clause, is that such payments are 
made 
under 
an 
arrangement 
in 
which— 
‘‘(aa) quality measures com-
parable to measures under the
performance category described 
in section 1848(q)(2)(B)(i) apply; 
‘‘(bb) certified EHR tech-
nology is used; and 
‘‘(cc) the eligible profes-
sional (AA) bears more than 
nominal financial risk if actual 
aggregate expenditures exceeds 
expected aggregate expenditures; 
or (BB) is a medical home (with 
respect to beneficiaries under 
title XIX) that meets criteria 
comparable to medical homes ex-
panded under section 1115A(c). 
‘‘(C) BEGINNING IN 2022.—With respect to 
2022 and each subsequent year, an eligible pro-
fessional described in either of the following 
clauses: 
‘‘(i) MEDICARE REVENUE THRESHOLD 
OPTION.—An 
eligible 
professional 
for 
whom the Secretary determines that at 
least 75 percent of payments under this 
part for covered professional services fur-
nished by such professional during the 
most recent period for which data are
available (which may be less than a year) 
were attributable to such services furnished 
under this part through an entity that par-
ticipates in an eligible alternative payment 
model with respect to such services. 
‘‘(ii) COMBINATION
ALL-PAYER
AND 
MEDICARE
REVENUE
THRESHOLD
OP-
TION.—An eligible professional— 
‘‘(I) for whom the Secretary de-
termines, with respect to items and 
services furnished by such professional 
during the most recent period for 
which data are available (which may 
be less than a year), that at least 75 
percent of the sum of— 
‘‘(aa) payments described in 
clause (i); and 
‘‘(bb) all other payments, re-
gardless of payer (other than 
payments made by the Secretary 
of Defense or the Secretary of 
Veterans Affairs under chapter 
55 of title 10, United States 
Code, or title 38, United States 
Code, or any other provision of
law, and other than payments 
made under title XIX in a State 
in which no medical home or al-
ternative payment model is avail-
able under the State program 
under that title), 
meet the requirement described in 
clause (iii)(I) with respect to pay-
ments described in item (aa) and meet 
the requirement described in clause 
(iii)(II) with respect to payments de-
scribed in item (bb); 
‘‘(II) for whom the Secretary de-
termines at least 25 percent of pay-
ments under this part for covered pro-
fessional services furnished by such 
professional during the most recent 
period for which data are available 
(which may be less than a year) were 
attributable to such services furnished 
under this part through an entity that 
participates in an eligible alternative 
payment model with respect to such 
services; and
‘‘(III) who provides to the Sec-
retary such information as is nec-
essary for the Secretary to make a de-
termination under subclause (I), with 
respect to such professional. 
‘‘(iii) REQUIREMENT.—For purposes 
of clause (ii)(I)— 
‘‘(I) the requirement described in 
this subclause, with respect to pay-
ments described in item (aa) of such 
clause, is that such payments are 
made under an eligible alternative 
payment model; and 
‘‘(II) the requirement described 
in this subclause, with respect to pay-
ments described in item (bb) of such 
clause, is that such payments are 
made 
under 
an 
arrangement 
in 
which— 
‘‘(aa) quality measures com-
parable to measures under the 
performance category described 
in section 1848(q)(2)(B)(i) apply; 
‘‘(bb) certified EHR tech-
nology is used; and
‘‘(cc) the eligible profes-
sional (AA) bears more than 
nominal financial risk if actual 
aggregate expenditures exceeds 
expected aggregate expenditures; 
or (BB) is a medical home (with 
respect to beneficiaries under 
title XIX) that meets criteria 
comparable to medical homes ex-
panded under section 1115A(c). 
‘‘(3) ADDITIONAL DEFINITIONS.—In this sub-
section: 
‘‘(A) 
COVERED
PROFESSIONAL
SERV-
ICES.—The term ‘covered professional services’ 
has the meaning given that term in section 
1848(k)(3)(A). 
‘‘(B) ELIGIBLE PROFESSIONAL.—The term 
‘eligible professional’ has the meaning given 
that term in section 1848(k)(3)(B). 
‘‘(C) 
ALTERNATIVE
PAYMENT
MODEL 
(APM).—The term ‘alternative payment model’ 
means any of the following: 
‘‘(i) A model under section 1115A 
(other than a health care innovation 
award).