I 
111TH CONGRESS 
1ST SESSION H. R. 2959 
To amend title XVIII of the Social Security Act to establish an accountable 
care organization pilot program to reduce the growth of expenditures 
and improve health outcomes under the Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 18, 2009 
Mr. WELCH (for himself, Mr. POMEROY, Mr. VAN HOLLEN, Mr. CARNEY, Mr. 
KIND, Mr. LEVIN, Ms. LINDA T. SA´NCHEZ of California, Mr. INSLEE, 
Mr. HIGGINS, Mr. THOMPSON of California, Mr. LEWIS of Georgia, Mr. 
PASCRELL, Ms. SCHWARTZ, Mr. SPACE, Mr. MARKEY of Massachusetts, 
Mr. 
COOPER, 
Mr. 
PERLMUTTER, 
Mr. 
BRALEY
of 
Iowa, 
Mr. 
BLUMENAUER, Mr. YARMUTH, and Mr. TANNER) introduced the fol-
lowing bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend title XVIII of the Social Security Act to establish 
an accountable care organization pilot program to reduce 
the growth of expenditures and improve health outcomes 
under the Medicare Program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Accountable Care Pro-
motion Act of 2009’’. 
SEC. 2. ACCOUNTABLE CARE ORGANIZATION PILOT PRO-
GRAM. 
Title XVIII of the Social Security Act is amended by 
inserting after section 1866C the following new section: 
‘‘ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM 
‘‘SEC. 1866D. (a) IN GENERAL.—The Secretary shall 
conduct a pilot program (in this section referred to as the 
‘pilot program’) to test different payment incentive mod-
els, including (to the extent practicable) the specific pay-
ment incentive models described in subsection (c), de-
signed to reduce the growth of expenditures and improve 
health outcomes in the provision of items and services 
under this title to applicable beneficiaries (as defined in 
subsection (d)) by qualifying accountable care organiza-
tions (as defined in subsection (b)(1)) in order to— 
‘‘(1) promote accountability for a patient popu-
lation and coordinate items and services under parts 
A and B; 
‘‘(2) encourage investment in infrastructure and 
redesigned care processes for high quality and effi-
cient service delivery; and 
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‘‘(3) reward physician practices for the provi-
sion of high quality and efficient health care serv-
ices. 
‘‘(b) QUALIFYING ACCOUNTABLE CARE ORGANIZA-
TIONS (ACOS).— 
‘‘(1) QUALIFYING ACO DEFINED.— 
‘‘(A) IN
GENERAL.—In this section, the 
terms ‘qualifying accountable care organization’ 
and ‘qualifying ACO’ mean a group of physi-
cians that— 
‘‘(i) is organized at least in part for 
the purpose of providing physicians’ serv-
ices; and 
‘‘(ii) meets such criteria as the Sec-
retary determines to be appropriate to par-
ticipate in the pilot program, including the 
criteria specified in paragraph (2). 
‘‘(B) INCLUSION OF OTHER PROVIDERS.— 
Nothing in this subsection shall be construed as 
preventing a qualifying ACO from including a 
hospital or any other provider of services or 
supplier furnishing items or services for which 
payment may be made under this title that is 
affiliated with the ACO under an arrangement 
structured so that such provider or supplier 
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participates in the pilot program and shares in 
any incentive payments under the pilot pro-
gram. 
‘‘(C) PHYSICIAN.—In this section, the 
term ‘physician’ includes, except as the Sec-
retary may otherwise provide, any individual 
who furnishes services for which payment may 
be made as physicians’ services. 
‘‘(D) OTHER SERVICES.—Nothing in this 
paragraph shall be construed as preventing a 
qualifying ACO from furnishing items or serv-
ices, for which payment may not made under 
this title, for purposes of achieving performance 
goals under the pilot program. 
‘‘(2) QUALIFYING CRITERIA.—The following are 
criteria described in this paragraph for an organized 
group of physicians to be a qualifying ACO: 
‘‘(A) The group has a legal structure that 
would allow the group to receive and distribute 
incentive payments under this section. 
‘‘(B) The group includes a sufficient num-
ber of primary care physicians for the applica-
ble beneficiaries for whose care the group is ac-
countable (as determined by the Secretary). 
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‘‘(C) The group is comprised of only par-
ticipating physicians. 
‘‘(D) The group reports on quality meas-
ures in such form, manner, and frequency as 
specified by the Secretary (which may be for 
the group, for providers of services and sup-
pliers, or both). 
‘‘(E) The group reports to the Secretary 
(in a form, manner, and frequency as specified 
by the Secretary) such data as the Secretary 
determines appropriate to monitor and evaluate 
the pilot program. 
‘‘(F) The group provides notice to applica-
ble beneficiaries regarding the pilot program (as 
determined appropriate by the Secretary). 
‘‘(G) The group contributes to a best prac-
tices network or website, that shall be main-
tained by the Secretary for the purpose of shar-
ing strategies on quality improvement, care co-
ordination, and efficiency that the groups be-
lieve are effective. 
‘‘(H) The group utilizes patient-centered 
processes of care, including those that empha-
size patient and caregiver involvement in plan-
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