aggregate spending target for that quali-
fied entity for all applicable conditions and 
all discharging hospitals for that year. 
‘‘(h) PROSPECTIVE BUNDLED PAYMENT MODEL FOR 
ADVANCED QUALIFIED ENTITIES.— 
‘‘(1) IN GENERAL.—Subject to approval by the 
Secretary, if the payment model under this sub-
section is selected, a qualified entity may elect to re-
ceive a prospective bundled payment for each episode 
of care for each applicable condition and discharging 
hospital in the agreement year equal to the spending 
target for such episode, year, and hospital under 
subsection (f)(2) and the provisions of subsection (g) 
do not apply. Such spending target shall be ad-
justed, in the same manner described in subsection 
(g)(2)(B), in order to take into account outlier epi-
sodes of care and standardized adjustments for pro-
vider location and provider type of the type de-
scribed in subsection (f)(2)(B)(ii)(II). 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed as prohibiting a quali-
fied entity that receives bundled payments under 
this subsection from participating in an accountable 
care organization under section 1899. 
VerDate Sep 11 2014 
02:53 May 28, 2015
Jkt 049200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H2502.IH
H2502
emcdonald on DSK67QTVN1PROD with BILLS
‘‘(3) RELATIONSHIP TO BPCI.—The Secretary 
may not terminate the Bundled Payments for Care 
Improvement initiative conducted pursuant to sec-
tion 1115A until the prospective bundled payment 
model is implemented under this subsection. 
‘‘(i) QUALITY AND EFFICIENCY ARRANGEMENTS.— 
‘‘(1) IN
GENERAL.—Subject to subsection 
(c)(1)(D) (relating to application requirements for 
notice of quality and efficiency arrangements and 
their structure) and subsection (j)(3) (relating to 
minimum quality performance thresholds), qualified 
entities participating in either the fee-for-service 
bundled payment model under subsection (g) or the 
prospective bundled payment model under subsection 
(h) may enter into quality and efficiency arrange-
ments under which physicians and other health care 
practitioners work to improve the quality and effi-
ciency of care under this title. 
‘‘(2) TYPES OF ARRANGEMENTS.—The arrange-
ments under paragraph (1) shall take into account 
the utilization of the resources of providers of serv-
ices and suppliers and may provide for a distribution 
of a portion of any shared savings (or internal sav-
ing, as the case may be) realized under this section 
to qualifying providers and suppliers. 
VerDate Sep 11 2014 
02:53 May 28, 2015
Jkt 049200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H2502.IH
H2502
emcdonald on DSK67QTVN1PROD with BILLS
‘‘(j) QUALITY MEASURES.— 
‘‘(1) SELECTION; DEVELOPMENT.— 
‘‘(A) SELECTION.—For each applicable 
condition, the Secretary shall select quality 
measures related to care provided by providers 
of services and suppliers through qualified enti-
ties to which bundled payments are made under 
this section. In selecting quality measures, to 
the extent appropriate and practicable, the Sec-
retary shall choose measures that— 
‘‘(i) are endorsed and validated by the 
entity with a contract under section 1890; 
‘‘(ii) pertain to the National Quality 
Strategy’s six priorities; 
‘‘(iii) are used by the Secretary under 
other provisions of this title; and 
‘‘(iv) minimize the incremental data 
extraction and reporting burden on pro-
viders and suppliers. 
‘‘(B) DEVELOPMENT OF ELECTRONICALLY 
SPECIFIED
EPISODIC
MEASURES.—The Sec-
retary shall develop longitudinal quality and ef-
ficiency measures to assess performance of 
qualified entities with respect to patient out-
comes and the care provided for each applicable 
VerDate Sep 11 2014 
02:53 May 28, 2015
Jkt 049200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H2502.IH
H2502
emcdonald on DSK67QTVN1PROD with BILLS
condition across the associated episodes of care. 
Such measures shall be electronically specified 
for submittal through the use of qualified elec-
tronic health records (as defined in section 
3000(13) of the Public Health Service Act (42 
U.S.C. 300jj(13))). 
‘‘(2) REPORTING ON QUALITY MEASURES.— 
‘‘(A) IN
GENERAL.—A qualified entity 
shall submit data to the Secretary on quality 
measures selected under paragraph (1) for each 
agreement year in a form and manner specified 
by the Secretary consistent with the succeeding 
provisions of this paragraph. 
‘‘(B) SUBMISSION
OF
DATA
THROUGH 
ELECTRONIC HEALTH RECORD.—To the extent 
practicable, such data shall be submitted 
through the use of a qualified electronic health 
record (as defined in section 3000(13) of the 
Public 
Health 
Service 
Act 
(42 
U.S.C. 
300jj(13))). 
‘‘(C) SUBMISSION
OF
DATA
USED
IN 
OTHER
PROGRAMS.—Insofar as quality meas-
ures established under paragraph (1) are the 
same as those measures used by the Secretary 
under other provisions of this title, such as 
VerDate Sep 11 2014 
02:53 May 28, 2015
Jkt 049200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H2502.IH
H2502
emcdonald on DSK67QTVN1PROD with BILLS
those selected under section 1886(b)(3)(B)(viii), 
the Secretary shall use existing processes for 
the submission of data for such measures under 
this paragraph. 
‘‘(3) QUALITY PERFORMANCE THRESHOLDS.— 
‘‘(A) ESTABLISHMENT.—For each applica-
ble condition, the Secretary shall establish min-
imum quality performance thresholds for the 
measures established under paragraph (1). In 
the case of a quality and efficiency arrange-
ment, such performance thresholds shall be de-
veloped using the quality measures identified by 
the qualified entity in its application under sub-
section (c)(1)(D) if approved by the Secretary. 
‘‘(B) LOSS OF SHARED SAVINGS PAYMENT 
AND QUALITY AND EFFICIENCY ARRANGEMENTS 
FOR FAILURE TO MEET MINIMUM QUALITY PER-
FORMANCE THRESHOLDS.—If a qualified entity 
fails to meet the minimum quality performance 
thresholds established under subparagraph (A) 
for an agreement year— 
‘‘(i) no payment may be made to the 
entity under subsection (g)(2)(C)(ii) with 
respect to that year; and 
VerDate Sep 11 2014 
02:53 May 28, 2015
Jkt 049200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H2502.IH
H2502
emcdonald on DSK67QTVN1PROD with BILLS