section (q)(5)(B)(ii)(II)’’ after ‘‘Subject to subpara-
graph (B)(ii)’’. 
(e) PROMOTING ALTERNATIVE PAYMENT MODELS.— 
(1) INCREASING TRANSPARENCY OF PHYSICIAN- 
FOCUSED PAYMENT MODELS.—Section 1868 of the 
Social Security Act (42 U.S.C. 1395ee) is amended 
by adding at the end the following new subsection: 
‘‘(c) PHYSICIAN-FOCUSED PAYMENT MODELS.— 
‘‘(1) TECHNICAL ADVISORY COMMITTEE.— 
‘‘(A) ESTABLISHMENT.—There is estab-
lished an ad hoc committee to be known as the 
‘Physician-Focused Payment Model Technical 
Advisory Committee’ (referred to in this sub-
section as the ‘Committee’). 
‘‘(B) MEMBERSHIP.— 
‘‘(i) NUMBER
AND
APPOINTMENT.— 
The Committee shall be composed of 11 
members appointed by the Comptroller 
General of the United States. 
‘‘(ii) QUALIFICATIONS.—The member-
ship of the Committee shall include indi-
viduals with national recognition for their 
expertise in physician-focused payment 
models and related delivery of care. No 
more than 5 members of the Committee
shall be providers of services or suppliers, 
or representatives of providers of services 
or suppliers. 
‘‘(iii) PROHIBITION ON FEDERAL EM-
PLOYMENT.—A member of the Committee 
shall not be an employee of the Federal 
Government. 
‘‘(iv) 
ETHICS
DISCLOSURE.—The 
Comptroller General shall establish a sys-
tem for public disclosure by members of 
the Committee of financial and other po-
tential conflicts of interest relating to such 
members. Members of the Committee shall 
be treated as employees of Congress for 
purposes of applying title I of the Ethics 
in Government Act of 1978 (Public Law 
95–521). 
‘‘(v) DATE
OF
INITIAL
APPOINT-
MENTS.—The initial appointments of mem-
bers of the Committee shall be made by 
not later than 180 days after the date of 
enactment of this subsection. 
‘‘(C) TERM; VACANCIES.— 
‘‘(i) TERM.—The terms of members of 
the Committee shall be for 3 years except
that the Comptroller General shall des-
ignate staggered terms for the members 
first appointed. 
‘‘(ii) VACANCIES.—Any member ap-
pointed to fill a vacancy occurring before 
the expiration of the term for which the 
member’s predecessor was appointed shall 
be appointed only for the remainder of that 
term. A member may serve after the expi-
ration of that member’s term until a suc-
cessor has taken office. A vacancy in the 
Committee shall be filled in the manner in 
which the original appointment was made. 
‘‘(D) DUTIES.—The Committee shall meet, 
as needed, to provide comments and rec-
ommendations to the Secretary, as described in 
paragraph (2)(C), on physician-focused pay-
ment models. 
‘‘(E) COMPENSATION OF MEMBERS.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), a member of the Com-
mittee shall serve without compensation. 
‘‘(ii) TRAVEL EXPENSES.—A member 
of the Committee shall be allowed travel 
expenses, including per diem in lieu of sub-
sistence, at rates authorized for an em-
ployee of an agency under subchapter I of 
chapter 57 of title 5, United States Code, 
while away from the home or regular place 
of business of the member in the perform-
ance of the duties of the Committee. 
‘‘(F) OPERATIONAL AND TECHNICAL SUP-
PORT.— 
‘‘(i) IN
GENERAL.—The Assistant 
Secretary for Planning and Evaluation 
shall provide technical and operational sup-
port for the Committee, which may be by 
use of a contractor. The Office of the Ac-
tuary of the Centers for Medicare & Med-
icaid Services shall provide to the Com-
mittee actuarial assistance as needed. 
‘‘(ii) FUNDING.—The Secretary shall 
provide for the transfer, from the Federal 
Supplementary Medical Insurance Trust 
Fund under section 1841, such amounts as 
are necessary to carry out this paragraph 
(not to exceed $5,000,000) for fiscal year 
2015 and each subsequent fiscal year. Any 
amounts transferred under the preceding
sentence for a fiscal year shall remain 
available until expended. 
‘‘(G) APPLICATION.—Section 14 of the 
Federal Advisory Committee Act (5 U.S.C. 
App.) shall not apply to the Committee. 
‘‘(2) CRITERIA AND PROCESS FOR SUBMISSION 
AND
REVIEW
OF
PHYSICIAN-FOCUSED
PAYMENT 
MODELS.— 
‘‘(A) CRITERIA FOR ASSESSING PHYSICIAN- 
FOCUSED PAYMENT MODELS.— 
‘‘(i) RULEMAKING.—Not later than 
November 1, 2016, the Secretary shall, 
through notice and comment rulemaking, 
following a request for information, estab-
lish criteria for physician-focused payment 
models, including models for specialist phy-
sicians, that could be used by the Com-
mittee for making comments and rec-
ommendations 
pursuant 
to 
paragraph 
(1)(D). 
‘‘(ii) MEDPAC SUBMISSION OF COM-
MENTS.—During the comment period for 
the proposed rule described in clause (i), 
the Medicare Payment Advisory Commis-
sion may submit comments to the Sec-
retary on the proposed criteria under such 
clause. 
‘‘(iii) UPDATING.—The Secretary may 
update the criteria established under this 
subparagraph through rulemaking. 
‘‘(B) STAKEHOLDER SUBMISSION OF PHY-
SICIAN-FOCUSED
PAYMENT
MODELS.—On an 
ongoing basis, individuals and stakeholder enti-
ties may submit to the Committee proposals for 
physician-focused payment models that such in-
dividuals and entities believe meet the criteria 
described in subparagraph (A). 
‘‘(C) COMMITTEE
REVIEW
OF
MODELS 
SUBMITTED.—The Committee shall, on a peri-
odic basis, review models submitted under sub-
paragraph (B), prepare comments and rec-
ommendations regarding whether such models 
meet the criteria described in subparagraph 
(A), and submit such comments and rec-
ommendations to the Secretary. 
‘‘(D) 
SECRETARY
REVIEW
AND
RE-
SPONSE.—The Secretary shall review the com-
ments and recommendations submitted by the 
Committee under subparagraph (C) and post a 
detailed response to such comments and rec-
ommendations on the Internet website of the 
Centers for Medicare & Medicaid Services. 
‘‘(3) RULE
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed to impact the de-
velopment or testing of models under this title or ti-
tles XI, XIX, or XXI.’’. 
(2) INCENTIVE PAYMENTS FOR PARTICIPATION 
IN
ELIGIBLE
ALTERNATIVE
PAYMENT
MODELS.— 
Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(z) INCENTIVE PAYMENTS FOR PARTICIPATION IN 
ELIGIBLE ALTERNATIVE PAYMENT MODELS.— 
‘‘(1) PAYMENT INCENTIVE.— 
‘‘(A) IN GENERAL.—In the case of covered 
professional services furnished by an eligible 
professional during a year that is in the period 
beginning with 2019 and ending with 2024 and 
for which the professional is a qualifying APM 
participant with respect to such year, in addi-
tion to the amount of payment that would oth-
erwise be made for such covered professional 
services under this part for such year, there 
also shall be paid to such professional an 
amount equal to 5 percent of the estimated ag-
payment model and for purposes of determining 
or rebasing any benchmarks used under the al-
ternative payment model. 
‘‘(D) COORDINATION.—The amount of the 
additional payment under this subsection or 
subsection (m) shall be determined without re-
gard to any additional payment under sub-
section (m) and this subsection, respectively. 
The amount of the additional payment under 
this subsection or subsection (x) shall be deter-
mined without regard to any additional pay-
ment under subsection (x) and this subsection, 
respectively. The amount of the additional pay-
ment under this subsection or subsection (y) 
shall be determined without regard to any addi-
tional payment under subsection (y) and this 
subsection, respectively. 
‘‘(2) QUALIFYING APM PARTICIPANT.—For pur-
poses of this subsection, the term ‘qualifying APM 
participant’ means the following: 
‘‘(A) 2019 AND
2020.—With respect to 
2019 and 2020, an eligible professional for 
whom the Secretary determines that at least 25 
percent of payments under this part for covered 
professional services furnished by such profes-
sional during the most recent period for which 
data are available (which may be less than a 
year) were attributable to such services fur-
nished under this part through an eligible alter-
native payment entity. 
‘‘(B) 2021 AND
2022.—With respect to 
2021 and 2022, an eligible professional de-
scribed in either of the following clauses: 
‘‘(i) MEDICARE PAYMENT THRESHOLD 
OPTION.—An 
eligible 
professional 
for 
whom the Secretary determines that at 
least 50 percent of payments under this 
part for covered professional services fur-
nished by such professional during the 
most recent period for which data are 
available (which may be less than a year) 
were attributable to such services furnished 
under this part through an eligible alter-
native payment entity. 
‘‘(ii) COMBINATION
ALL-PAYER
AND 
MEDICARE
PAYMENT
THRESHOLD
OP-
TION.—An eligible professional— 
‘‘(I) for whom the Secretary de-
termines, with respect to items and 
services furnished by such professional
during the most recent period for 
which data are available (which may 
be less than a year), that at least 50 
percent of the sum of— 
‘‘(aa) payments described in 
clause (i); and 
‘‘(bb) all other payments, re-
gardless of payer (other than 
payments made by the Secretary 
of Defense or the Secretary of 
Veterans Affairs and other than 
payments made under title XIX 
in a State in which no medical 
home or alternative payment 
model is available under the 
State program under that title), 
meet the requirement described in 
clause (iii)(I) with respect to pay-
ments described in item (aa) and meet 
the requirement described in clause 
(iii)(II) with respect to payments de-
scribed in item (bb); 
‘‘(II) for whom the Secretary de-
termines at least 25 percent of pay-
ments under this part for covered pro-
fessional services furnished by such 
professional during the most recent 
period for which data are available 
(which may be less than a year) were 
attributable to such services furnished 
under this part through an eligible al-
ternative payment entity; and 
‘‘(III) who provides to the Sec-
retary such information as is nec-
essary for the Secretary to make a de-
termination under subclause (I), with 
respect to such professional. 
‘‘(iii) REQUIREMENT.—For purposes 
of clause (ii)(I)— 
‘‘(I) the requirement described in 
this subclause, with respect to pay-
ments described in item (aa) of such 
clause, is that such payments are 
made to an eligible alternative pay-
ment entity; and 
‘‘(II) the requirement described 
in this subclause, with respect to pay-
ments described in item (bb) of such 
clause, is that such payments are 
made under arrangements in which—
‘‘(aa) quality measures com-
parable to measures under the 
performance category described 
in section 1848(q)(2)(B)(i) apply; 
‘‘(bb) certified EHR tech-
nology is used; and 
‘‘(cc) the eligible profes-
sional participates in an entity 
that— 
‘‘(AA) bears more than 
nominal financial risk if ac-
tual aggregate expenditures 
exceeds expected aggregate 
expenditures; or 
‘‘(BB) with respect to 
beneficiaries 
under 
title 
XIX, is a medical home that 
meets criteria comparable to 
medical 
homes 
expanded 
under section 1115A(c). 
‘‘(C) BEGINNING IN 2023.—With respect to 
2023 and each subsequent year, an eligible pro-
fessional described in either of the following 
clauses:
‘‘(i) MEDICARE PAYMENT THRESHOLD 
OPTION.—An 
eligible 
professional 
for 
whom the Secretary determines that at 
least 75 percent of payments under this 
part for covered professional services fur-
nished by such professional during the 
most recent period for which data are 
available (which may be less than a year) 
were attributable to such services furnished 
under this part through an eligible alter-
native payment entity. 
‘‘(ii) COMBINATION
ALL-PAYER
AND 
MEDICARE
PAYMENT
THRESHOLD
OP-
TION.—An eligible professional— 
‘‘(I) for whom the Secretary de-
termines, with respect to items and 
services furnished by such professional 
during the most recent period for 
which data are available (which may 
be less than a year), that at least 75 
percent of the sum of— 
‘‘(aa) payments described in 
clause (i); and 
‘‘(bb) all other payments, re-
gardless of payer (other than
payments made by the Secretary 
of Defense or the Secretary of 
Veterans Affairs and other than 
payments made under title XIX 
in a State in which no medical 
home or alternative payment 
model is available under the 
State program under that title), 
meet the requirement described in 
clause (iii)(I) with respect to pay-
ments described in item (aa) and meet 
the requirement described in clause 
(iii)(II) with respect to payments de-
scribed in item (bb); 
‘‘(II) for whom the Secretary de-
termines at least 25 percent of pay-
ments under this part for covered pro-
fessional services furnished by such 
professional during the most recent 
period for which data are available 
(which may be less than a year) were 
attributable to such services furnished 
under this part through an eligible al-
ternative payment entity; and
‘‘(III) who provides to the Sec-
retary such information as is nec-
essary for the Secretary to make a de-
termination under subclause (I), with 
respect to such professional. 
‘‘(iii) REQUIREMENT.—For purposes 
of clause (ii)(I)— 
‘‘(I) the requirement described in 
this subclause, with respect to pay-
ments described in item (aa) of such 
clause, is that such payments are 
made to an eligible alternative pay-
ment entity; and 
‘‘(II) the requirement described 
in this subclause, with respect to pay-
ments described in item (bb) of such 
clause, is that such payments are 
made under arrangements in which— 
‘‘(aa) quality measures com-
parable to measures under the 
performance category described 
in section 1848(q)(2)(B)(i) apply; 
‘‘(bb) certified EHR tech-
nology is used; and
‘‘(cc) the eligible profes-
sional participates in an entity 
that— 
‘‘(AA) bears more than 
nominal financial risk if ac-
tual aggregate expenditures 
exceeds expected aggregate 
expenditures; or 
‘‘(BB) with respect to 
beneficiaries 
under 
title 
XIX, is a medical home that 
meets criteria comparable to 
medical 
homes 
expanded 
under section 1115A(c). 
‘‘(D) USE OF PATIENT APPROACH.—The 
Secretary may base the determination of wheth-
er an eligible professional is a qualifying APM 
participant under this subsection and the deter-
mination of whether an eligible professional is a 
partial qualifying APM participant under sec-
tion 1848(q)(1)(C)(iii) by using counts of pa-
tients in lieu of using payments and using the 
same or similar percentage criteria (as specified 
in this subsection and such section, respec-
tively), as the Secretary determines appropriate.