H. R. 3590—822 
provide health services for patients with chronic 
complex conditions. 
‘‘(xx) Utilizing a diverse network of providers of 
services and suppliers to improve care coordination 
for applicable individuals described in subsection 
(a)(4)(A)(i) with 2 or more chronic conditions and a 
history of prior-year hospitalization through interven-
tions developed under the Medicare Coordinated Care 
Demonstration Project under section 4016 of the Bal-
anced Budget Act of 1997 (42 U.S.C. 1395b–1 note).’’; 
and 
(C) in subparagraph (C), by adding at the end the 
following new clause: 
‘‘(viii) Whether the model demonstrates effective 
linkage with other public sector or private sector 
payers.’’; 
(3) in subsection (b)(4), by adding at the end the following 
new subparagraph: 
‘‘(C) MEASURE SELECTION.—To the extent feasible, the 
Secretary shall select measures under this paragraph that 
reflect national priorities for quality improvement and 
patient-centered 
care 
consistent 
with 
the 
measures 
described in 1890(b)(7)(B).’’; and 
(4) in subsection (c)— 
(A) in paragraph (1)(B), by striking ‘‘care and reduce 
spending; and’’ and inserting ‘‘patient care without 
increasing spending;’’; 
(B) in paragraph (2), by striking ‘‘reduce program 
spending under applicable titles.’’ and inserting ‘‘reduce 
(or would not result in any increase in) net program 
spending under applicable titles; and’’; and 
(C) by adding at the end the following: 
‘‘(3) the Secretary determines that such expansion would 
not deny or limit the coverage or provision of benefits under 
the applicable title for applicable individuals. 
In determining which models or demonstration projects to expand 
under the preceding sentence, the Secretary shall focus on models 
and demonstration projects that improve the quality of patient 
care and reduce spending.’’. 
SEC. 10307. IMPROVEMENTS TO THE MEDICARE SHARED SAVINGS PRO-
GRAM. 
Section 1899 of the Social Security Act, as added by section 
3022, is amended by adding at the end the following new sub-
sections: 
‘‘(i) OPTION TO USE OTHER PAYMENT MODELS.— 
‘‘(1) IN GENERAL.—If the Secretary determines appropriate, 
the Secretary may use any of the payment models described 
in paragraph (2) or (3) for making payments under the program 
rather than the payment model described in subsection (d). 
‘‘(2) PARTIAL CAPITATION MODEL.— 
‘‘(A) IN
GENERAL.—Subject to subparagraph (B), a 
model described in this paragraph is a partial capitation 
model in which an ACO is at financial risk for some, 
but not all, of the items and services covered under parts 
A and B, such as at risk for some or all physicians’ services 
or all items and services under part B. The Secretary
H. R. 3590—823 
may limit a partial capitation model to ACOs that are 
highly integrated systems of care and to ACOs capable 
of bearing risk, as determined to be appropriate by the 
Secretary. 
‘‘(B) NO
ADDITIONAL
PROGRAM
EXPENDITURES.—Pay-
ments to an ACO for items and services under this title 
for beneficiaries for a year under the partial capitation 
model shall be established in a manner that does not 
result in spending more for such ACO for such beneficiaries 
than would otherwise be expended for such ACO for such 
beneficiaries for such year if the model were not imple-
mented, as estimated by the Secretary. 
‘‘(3) OTHER PAYMENT MODELS.— 
‘‘(A) IN
GENERAL.—Subject to subparagraph (B), a 
model described in this paragraph is any payment model 
that the Secretary determines will improve the quality 
and efficiency of items and services furnished under this 
title. 
‘‘(B) 
NO
ADDITIONAL
PROGRAM
EXPENDITURES.— 
Subparagraph (B) of paragraph (2) shall apply to a payment 
model under subparagraph (A) in a similar manner as 
such subparagraph (B) applies to the payment model under 
paragraph (2). 
‘‘(j) INVOLVEMENT IN PRIVATE PAYER AND OTHER THIRD PARTY 
ARRANGEMENTS.—The Secretary may give preference to ACOs who 
are participating in similar arrangements with other payers. 
‘‘(k) TREATMENT OF PHYSICIAN GROUP PRACTICE DEMONSTRA-
TION.—During the period beginning on the date of the enactment 
of this section and ending on the date the program is established, 
the Secretary may enter into an agreement with an ACO under 
the demonstration under section 1866A, subject to rebasing and 
other modifications deemed appropriate by the Secretary.’’. 
SEC. 10308. REVISIONS TO NATIONAL PILOT PROGRAM ON PAYMENT 
BUNDLING. 
(a) IN GENERAL.—Section 1866D of the Social Security Act, 
as added by section 3023, is amended— 
(1) in paragraph (a)(2)(B), in the matter preceding clause 
(i), by striking ‘‘8 conditions’’ and inserting ‘‘10 conditions’’; 
(2) by striking subsection (c)(1)(B) and inserting the fol-
lowing: 
‘‘(B) EXPANSION.—The Secretary may, at any point 
after January 1, 2016, expand the duration and scope of 
the pilot program, to the extent determined appropriate 
by the Secretary, if— 
‘‘(i) the Secretary determines that such expansion 
is expected to— 
‘‘(I) reduce spending under title XVIII of the 
Social Security Act without reducing the quality 
of care; or 
‘‘(II) improve the quality of care and reduce 
spending; 
‘‘(ii) the Chief Actuary of the Centers for Medicare 
& Medicaid Services certifies that such expansion 
would reduce program spending under such title XVIII; 
and
H. R. 3590—824 
‘‘(iii) the Secretary determines that such expansion 
would not deny or limit the coverage or provision of 
benefits under this title for individuals.’’; and 
(3) by striking subsection (g) and inserting the following 
new subsection: 
‘‘(g) APPLICATION OF PILOT PROGRAM TO CONTINUING CARE HOS-
PITALS.— 
‘‘(1) IN GENERAL.—In conducting the pilot program, the 
Secretary shall apply the provisions of the program so as to 
separately pilot test the continuing care hospital model. 
‘‘(2) SPECIAL RULES.—In pilot testing the continuing care 
hospital model under paragraph (1), the following rules shall 
apply: 
‘‘(A) Such model shall be tested without the limitation 
to the conditions selected under subsection (a)(2)(B). 
‘‘(B) Notwithstanding subsection (a)(2)(D), an episode 
of care shall be defined as the full period that a patient 
stays in the continuing care hospital plus the first 30 
days following discharge from such hospital. 
‘‘(3) CONTINUING
CARE
HOSPITAL
DEFINED.—In this sub-
section, the term ‘continuing care hospital’ means an entity 
that has demonstrated the ability to meet patient care and 
patient safety standards and that provides under common 
management the medical and rehabilitation services provided 
in inpatient rehabilitation hospitals and units (as defined in 
section 1886(d)(1)(B)(ii)), long term care hospitals (as defined 
in section 1886(d)(1)(B)(iv)(I)), and skilled nursing facilities (as 
defined in section 1819(a)) that are located in a hospital 
described in section 1886(d).’’. 
(b) TECHNICAL AMENDMENTS.— 
(1) Section 3023 is amended by striking ‘‘1886C’’ and 
inserting ‘‘1866C’’. 
(2) Title XVIII of the Social Security Act is amended by 
redesignating section 1866D, as added by section 3024, as sec-
tion 1866E. 
SEC. 10309. REVISIONS TO HOSPITAL READMISSIONS REDUCTION PRO-
GRAM. 
Section 1886(q)(1) of the Social Security Act, as added by section 
3025, in the matter preceding subparagraph (A), is amended by 
striking ‘‘the Secretary shall reduce the payments’’ and all that 
follows through ‘‘the product of’’ and inserting ‘‘the Secretary shall 
make payments (in addition to the payments described in paragraph 
(2)(A)(ii)) for such a discharge to such hospital under subsection 
(d) (or section 1814(b)(3), as the case may be) in an amount equal 
to the product of’’. 
SEC. 10310. REPEAL OF PHYSICIAN PAYMENT UPDATE. 
The provisions of, and the amendment made by, section 3101 
are repealed. 
SEC. 10311. REVISIONS TO EXTENSION OF AMBULANCE ADD-ONS. 
(a) GROUND AMBULANCE.—Section 1834(l)(13)(A) of the Social 
Security Act (42 U.S.C. 1395m(l)(13)(A)), as amended by section 
3105(a), is further amended— 
(1) in the matter preceding clause (i)— 
(A) by striking ‘‘2007, for’’ and inserting ‘‘2007, and 
for’’; and
H. R. 3590—825 
(B) by striking ‘‘2010, and for such services furnished 
on or after April 1, 2010, and before January 1, 2011’’ 
and inserting ‘‘2011’’; and 
(2) in each of clauses (i) and (ii)— 
(A) by striking ‘‘, and on or after April 1, 2010, and 
before January 1, 2011’’ each place it appears; and 
(B) by striking ‘‘January 1, 2010’’ and inserting 
‘‘January 1, 2011’’ each place it appears. 
(b) AIR
AMBULANCE.—Section 146(b)(1) of the Medicare 
Improvements for Patients and Providers Act of 2008 (Public Law 
110–275), as amended by section 3105(b), is further amended by 
striking ‘‘December 31, 2009, and during the period beginning on 
April 1, 2010, and ending on January 1, 2011’’ and inserting 
‘‘December 31, 2010’’. 
(c) SUPER RURAL AMBULANCE.—Section 1834(l)(12)(A) of the 
Social Security Act (42 U.S.C. 1395m(l)(12)(A)), as amended by 
section 3105(c), is further amended by striking ‘‘2010, and on or 
after April 1, 2010, and before January 1, 2011’’ and inserting 
‘‘2011’’. 
SEC. 10312. CERTAIN PAYMENT RULES FOR LONG-TERM CARE HOS-
PITAL SERVICES AND MORATORIUM ON THE ESTABLISH-
MENT OF CERTAIN HOSPITALS AND FACILITIES. 
(a) CERTAIN PAYMENT RULES.—Section 114(c) of the Medicare, 
Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 1395ww 
note), as amended by section 4302(a) of the American Recovery 
and Reinvestment Act (Public Law 111–5) and section 3106(a) of 
this Act, is further amended by striking ‘‘4-year period’’ each place 
it appears and inserting ‘‘5-year period’’. 
(b) MORATORIUM.—Section 114(d) of such Act (42 U.S.C. 
1395ww note), as amended by section 3106(b) of this Act, in the 
matter preceding subparagraph (A), is amended by striking ‘‘4- 
year period’’ and inserting ‘‘5-year period’’. 
SEC. 10313. REVISIONS TO THE EXTENSION FOR THE RURAL COMMU-
NITY HOSPITAL DEMONSTRATION PROGRAM. 
(a) IN GENERAL.—Subsection (g) of section 410A of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 
(Public Law 108–173; 117 Stat. 2272), as added by section 3123(a) 
of this Act, is amended to read as follows: 
‘‘(g) FIVE-YEAR EXTENSION OF DEMONSTRATION PROGRAM.— 
‘‘(1) IN GENERAL.—Subject to the succeeding provisions of 
this subsection, the Secretary shall conduct the demonstration 
program under this section for an additional 5-year period 
(in this section referred to as the ‘5-year extension period’) 
that begins on the date immediately following the last day 
of the initial 5-year period under subsection (a)(5). 
‘‘(2) EXPANSION
OF
DEMONSTRATION
STATES.—Notwith-
standing subsection (a)(2), during the 5-year extension period, 
the Secretary shall expand the number of States with low 
population densities determined by the Secretary under such 
subsection to 20. In determining which States to include in 
such expansion, the Secretary shall use the same criteria and 
data that the Secretary used to determine the States under 
such subsection for purposes of the initial 5-year period. 
‘‘(3) INCREASE IN MAXIMUM NUMBER OF HOSPITALS PARTICI-
PATING
IN
THE
DEMONSTRATION
PROGRAM.—Notwithstanding 
subsection (a)(4), during the 5-year extension period, not more