Program for such items and services fur-
nished with respect to all individuals by 
such qualified group practice during such 
year; and 
‘‘(ii) in the case of a qualified skilled 
nursing facility that is not described in 
clause (i), retain in the Federal Hospital 
Insurance Trust Fund under section 1817 
the amount that the facility would have 
been paid pursuant to clause (i) if the fa-
cility were described in such clause until 
such time as the facility has at least a 
three-star rating under the Five Star Qual-
ity Rating System (or a successor system), 
at which point the Secretary shall pay such 
amount to the facility. 
‘‘(3) ADVANCED ALTERNATIVE PAYMENT MOD-
ELS.—Paragraph (2) shall not apply to items and 
services furnished to an individual entitled to bene-
fits under part A and enrolled under Part B for 
whom shared savings would otherwise be attributed 
through an advanced alternative payment model as 
authorized under section 1115A or section 1899. 
‘‘(e) EVALUATION.— 
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‘‘(1) IN GENERAL.—With respect to a qualified 
group practice and a qualified skilled nursing facil-
ity, not later than 6 months after such group prac-
tice begins furnishing items and services under the 
Program (or, in the case of a qualified skilled nurs-
ing facility, not less than 6 months after a qualified 
group practice first furnishes such items and serv-
ices at such facility), and not less than once every 
2 years thereafter, the Secretary shall evaluate such 
qualified group practice and such qualified facility 
using information received under paragraph (2) on 
such criteria as determined appropriate by the Sec-
retary. 
‘‘(2) REPORTING OF INFORMATION.—In a time 
and manner specified by the Secretary, a qualified 
group practice and a qualified skilled nursing facility 
shall submit to the Secretary a report containing the 
following information with respect to items and serv-
ices furnished under the Program during a reporting 
period (as specified by the Secretary): 
‘‘(A) The number of individuals with re-
spect to whom such group practice furnished 
such items and services in such period (or, in 
the case of a qualified skilled nursing facility, 
the number of individuals with respect to whom 
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such a group practice furnished such items and 
services at such facility in such period). 
‘‘(B) The number of such individuals who 
were admitted to a hospital or treated in the 
emergency department of a hospital within 24 
hours of being furnished such items and serv-
ices. 
‘‘(C) Other information determined appro-
priate by the Secretary. 
‘‘(3) LOSS OF QUALIFIED CERTIFICATION.— 
‘‘(A) IN
GENERAL.—Not later than 3 
months after a determination described in this 
sentence is made, the Secretary may revoke the 
certification of a qualified skilled nursing facil-
ity or a qualified group practice made under 
subsection (c) if— 
‘‘(i) the Chief Actuary of the Centers 
for Medicare & Medicaid Services deter-
mines that the participation of such skilled 
nursing facility or such group practice in 
the Program during a year resulted in 
total expenditures under this title for such 
period being greater than total expendi-
tures under such title would have been 
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during such period without such participa-
tion; or 
‘‘(ii) a facility is selected for the Spe-
cial Focus Facility program or, if the facil-
ity is a candidate for the Special Focus 
Facility program, the Secretary determines 
that the participation of such facility in the 
Program should be terminated. 
‘‘(B) EXCLUSION FROM CERTIFICATION.— 
‘‘(i) IN GENERAL.—In the case that 
the Secretary revokes the certification of a 
qualified skilled nursing facility or a quali-
fied group practice under subparagraph 
(A), such skilled nursing facility or such 
group practice shall be ineligible for certifi-
cation as a qualified skilled nursing facility 
or a qualified group practice (as applica-
ble) under subsection (c) for the applicable 
period (as defined under clause (ii)). 
‘‘(ii) 
APPLICABLE
PERIOD
DE-
FINED.—In this subparagraph, the term 
‘applicable period’ means— 
‘‘(I) if the revocation of a facility 
or group practice under subparagraph 
(A) is due to the application of clause 
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(i) of such subparagraph, a 1-year pe-
riod beginning on the date of such 
revocation; and 
‘‘(II) in the revocation of a facil-
ity under subparagraph (A) is due to 
the application of clause (ii) of such 
subparagraph, the period beginning 
on the date of such revocation and 
ending on the date on which the facil-
ity graduates from the Special Focus 
Facility program (or, in the case of a 
facility that is a candidate for such 
program, the date on which the facil-
ity is no longer such a candidate, as 
determined by the Secretary). 
‘‘(f) DETERMINATION
OF BUDGET NEUTRALITY; 
TERMINATION OF PROGRAM.— 
‘‘(1) DETERMINATION.—Not later than July 1, 
2026, the Chief Actuary of the Centers for Medicare 
& Medicaid Services shall determine whether the 
Program has resulted in an increase in total expend-
itures under this title with respect to the period be-
ginning on January 1, 2021, and ending on Decem-
ber 31, 2025, compared to what such expenditures 
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would have been during such period had the Pro-
gram not been in operation. 
‘‘(2) TERMINATION.—If the Chief Actuary 
makes a determination under paragraph (1) that the 
Program has resulted in an increase in total expend-
itures under this title, the Secretary shall terminate 
the Program as of January 1 of the first year begin-
ning after such determination.’’. 
Æ 
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