‘‘(II) The population of individ-
uals who will be served by the rural 
hospital under the model. 
‘‘(III) The types of services that 
will be included in the global payment 
under the model. 
‘‘(IV) How the rural hospital in-
tends to improve quality and health 
outcomes under the model, including 
which population health outcomes the 
hospital will assess on an annual 
basis. 
‘‘(V) How the rural hospital will 
achieve patient engagement and in-
volvement in the model. 
‘‘(VI) How the rural hospital will 
identify, partner with, and pay other 
entities participating in the model. 
‘‘(VII) How private payers will be 
included in the model. 
‘‘(VIII) Plans to account for any 
market share changes under the 
model. 
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‘‘(IX) How access to preventive 
care will be increased under the 
model. 
‘‘(X) How the rural hospital will 
sustain the changes made under the 
model. 
‘‘(XI) How savings under the 
model will accrue to the Medicare pro-
gram under title XVIII. 
‘‘(XII) Any other information re-
quired by the implementing State or 
the Secretary. 
‘‘(vi) OPPORTUNITY FOR PUBLIC COM-
MENT.—In order for the Secretary or an 
implementing State to approve a Rural 
Hospital 
Transformation 
Plan 
under 
clause (iv), the Secretary in consultation 
with the implementing State, shall— 
‘‘(I) provide the public with a 
meaningful opportunity, as deter-
mined by the Secretary, to provide 
comments on the plan; and 
‘‘(II) make a summary of com-
ments provided available to the public 
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on the internet website of the Centers 
for Medicare & Medicaid Services. 
‘‘(vii) TECHNICAL ASSISTANCE.—The 
Secretary shall designate an entity to pro-
vide technical assistance to participating 
rural hospitals as they redesign the care 
they deliver under the model. 
‘‘(viii) 
ACCOUNTING
FOR
UNCER-
TAINTY.—In order for implementing States 
and participating rural hospitals to receive 
unanticipated additional resources needed 
to implement the model, the Secretary 
shall establish procedures for implementing 
States and participating rural hospitals to 
submit to the Secretary a request for addi-
tional resources, should variations in serv-
ices outside of normally planned volume 
occur or should new technologies be devel-
oped, or in such other circumstances as the 
Secretary determines appropriate. 
‘‘(ix) MONITORING
OUTCOMES.—The 
Secretary, in conjunction with imple-
menting States and participating rural 
hospitals, shall develop a plan to— 
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‘‘(I) identify, using a partici-
pating rural hospital’s approved Rural 
Hospital Transformation Plan de-
scribed in clause (v), the relevant local 
population of patients attributable to 
the hospital, the data points the hos-
pital may need to guide care redesign 
for that population, and how the hos-
pital may use such data; 
‘‘(II) annually monitor outcomes 
under the model, which may include 
financial, quality, access, and utiliza-
tion outcomes; 
‘‘(III) annually monitor the spe-
cific population health outcomes listed 
in 
the 
approved 
Rural 
Hospital 
Transformation Plan of each partici-
pating rural hospital pursuant to 
clause (v)(IV); and 
‘‘(IV) any other outcomes as de-
termined by the Secretary. 
‘‘(x) RISK
MITIGATION.—As part of 
the model, the Secretary, in conjunction 
with implementing States and participating 
rural hospitals, shall develop appropriate 
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mechanisms to mitigate risks, including 
the use of reinsurance. 
‘‘(xi) REPORTING REQUIREMENTS.— 
‘‘(I) REPORT
TO
SECRETARY.— 
An implementing State, as a condition 
of implementing the model, shall part-
ner with an independent entity to re-
port to the Secretary on the ability of 
a participating rural hospital to carry 
out 
the 
Rural 
Hospital 
Trans-
formation Plan described in clause 
(v). 
‘‘(II) REPORT
TO
CONGRESS.— 
Not less frequently than every 5 years 
(for the duration of the implementa-
tion of the model under this subpara-
graph), the Secretary shall submit to 
Congress a report on the implementa-
tion of the model under this subpara-
graph. The report shall include best 
practices for future implementation 
efforts and any other information the 
Secretary determines appropriate, in-
cluding 
the 
information 
reported 
under subclause (I), together with rec-
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