‘‘(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) and includes 
a group that includes such professionals. 
‘‘(C) 
ALTERNATIVE
PAYMENT
MODEL 
(APM).—The term ‘alternative payment model’ 
means, other than for purposes of subpara-
graphs (B)(ii)(I)(bb) and (C)(ii)(I)(bb) of para-
graph (2), any of the following: 
‘‘(i) A model under section 1115A 
(other than a health care innovation 
award). 
‘‘(ii) The shared savings program 
under section 1899. 
‘‘(iii) A demonstration under section 
1866C. 
‘‘(iv) A demonstration required by 
Federal law.
100 
‘‘(D) ELIGIBLE
ALTERNATIVE
PAYMENT 
ENTITY.—The term ‘eligible alternative pay-
ment entity’ means, with respect to a year, an 
entity that— 
‘‘(i) participates in an alternative pay-
ment model that— 
‘‘(I) requires participants in such 
model to use certified EHR tech-
nology (as defined in subsection 
(o)(4)); and 
‘‘(II) provides for payment for 
covered professional services based on 
quality measures comparable to meas-
ures under the performance category 
described in section 1848(q)(2)(B)(i); 
and 
‘‘(ii)(I) bears financial risk for mone-
tary losses under such alternative payment 
model that are in excess of a nominal 
amount; or 
‘‘(II) is a medical home expanded 
under section 1115A(c). 
‘‘(4) LIMITATION.—There shall be no adminis-
trative or judicial review under section 1869, 1878, 
or otherwise, of the following:
101 
‘‘(A) The determination that an eligible 
professional is a qualifying APM participant 
under paragraph (2) and the determination 
that an entity is an eligible alternative payment 
entity under paragraph (3)(D). 
‘‘(B) The determination of the amount of 
the 5 percent payment incentive under para-
graph (1)(A), including any estimation as part 
of such determination.’’. 
(3) 
COORDINATION
CONFORMING
AMEND-
MENTS.—Section 1833 of the Social Security Act 
(42 U.S.C. 1395l) is further amended— 
(A) in subsection (x)(3), by adding at the 
end the following new sentence: ‘‘The amount 
of the additional payment for a service under 
this subsection and subsection (z) shall be de-
termined without regard to any additional pay-
ment for the service under subsection (z) and 
this subsection, respectively.’’; and 
(B) in subsection (y)(3), by adding at the 
end the following new sentence: ‘‘The amount 
of the additional payment for a service under 
this subsection and subsection (z) shall be de-
termined without regard to any additional pay-
102 
ment for the service under subsection (z) and 
this subsection, respectively.’’. 
(4) ENCOURAGING DEVELOPMENT AND TEST-
ING OF CERTAIN MODELS.—Section 1115A(b)(2) of 
the Social Security Act (42 U.S.C. 1315a(b)(2)) is 
amended— 
(A) in subparagraph (B), by adding at the 
end the following new clauses: 
‘‘(xxi) Focusing primarily on physi-
cians’ services (as defined in section 
1848(j)(3)) furnished by physicians who 
are not primary care practitioners. 
‘‘(xxii) Focusing on practices of 15 or 
fewer professionals. 
‘‘(xxiii) Focusing on risk-based models 
for small physician practices which may in-
volve two-sided risk and prospective patient 
assignment, and which examine risk-ad-
justed decreases in mortality rates, hos-
pital readmissions rates, and other relevant 
and appropriate clinical measures. 
‘‘(xxiv) Focusing primarily on title 
XIX, working in conjunction with the Cen-
ter for Medicaid and CHIP Services.’’; and
103 
(B) in subparagraph (C)(viii), by striking 
‘‘other public sector or private sector payers’’ 
and inserting ‘‘other public sector payers, pri-
vate sector payers, or statewide payment mod-
els’’. 
(5) CONSTRUCTION
REGARDING
TELEHEALTH 
SERVICES.—Nothing in the provisions of, or amend-
ments made by, this title shall be construed as pre-
cluding an alternative payment model or a qualifying 
APM participant (as those terms are defined in sec-
tion 1833(z) of the Social Security Act, as added by 
paragraph (1)) from furnishing a telehealth service 
for which payment is not made under section 
1834(m) of the Social Security Act (42 U.S.C. 
1395m(m)). 
(6) INTEGRATING
MEDICARE
ADVANTAGE
AL-
TERNATIVE PAYMENT MODELS.—Not later than July 
1, 2016, the Secretary of Health and Human Serv-
ices shall submit to Congress a study that examines 
the feasibility of integrating alternative payment 
models in the Medicare Advantage payment system. 
The study shall include the feasibility of including a 
value-based modifier and whether such modifier 
should be budget neutral.