SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Care Coordi-
nation Improvement Act of 2019’’. 
SEC. 2. MODERNIZATION OF LIMITATIONS ON PHYSICIAN 
SELF-REFERRAL. 
(a) FACILITATION
OF PARTICIPATION
IN ALTER-
NATIVE PAYMENT MODELS.— 
(1) IN GENERAL.—Section 1833 of the Social 
Security Act (42 U.S.C. 1395l) is amended— 
(A) in subsection (z), as added by section 
101(e)(2) of the Medicare Access and CHIP 
Reauthorization Act of 2015 (Public Law 114– 
10), by adding at the end the following para-
graph: 
‘‘(5) WAIVER AUTHORITY.— 
‘‘(A) IN GENERAL.—The provisions of sub-
section (f) of section 1899 shall apply with re-
spect to covered APM entities to the same ex-
tent and in the same manner as such provisions 
apply with respect to accountable care organiza-
tions under such section. 
‘‘(B) COVERED APM ENTITIES.— 
‘‘(i) IN
GENERAL.—For purposes of 
subparagraph (A), the term ‘covered APM 
entity’ means, subject to clause (ii) of this 
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subparagraph and subparagraph (C), each 
of the following: 
‘‘(I) An eligible alternative pay-
ment entity as defined in paragraph 
(3)(D). 
‘‘(II) An entity participating in 
an alternative payment model as de-
fined in paragraph (3)(C), including 
such participation that qualifies as a 
clinical practice improvement activity 
under section 1848(q)(2)(B)(iii)(VI). 
‘‘(III) An entity participating in 
a physician-focused payment model 
for which comments and recommenda-
tions have, under subparagraph (C) of 
section 1868(c)(2), been submitted in-
dicating that such model meets the 
criteria described in subparagraph (A) 
of such section. 
‘‘(IV) An entity participating in 
any other model that the Secretary 
determines is a covered APM entity 
for purposes of subparagraph (A), in-
cluding such a determination made 
pursuant to one or more physicians 
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submitting a proposal to the Secretary 
for an alternative payment model. 
‘‘(ii) INCLUSION
OF
CERTAIN
ENTI-
TIES.—Such term may include an entity 
engaging in activities that the Secretary 
has 
determined 
constitute 
significant 
progress toward establishing a model re-
ferred to in any of subclauses (I) through 
(IV). Any waiver under this paragraph 
with respect to an entity described in the 
preceding sentence may only be approved 
for three years. 
‘‘(C) CERTAIN REQUIREMENTS.—A model 
referred to in any of subclauses (I) through 
(IV) of subparagraph (B)(i) may not be consid-
ered a covered APM entity for purposes of sub-
paragraph (A) unless the model meets the re-
quirements 
described 
in 
section 
1877(b)(6)(B).’’; and 
(B) by redesignating subsection (z), as 
added by section 514(a) of the Medicare Access 
and CHIP Reauthorization Act of 2015 (Public 
Law 114–10), as subsection (aa). 
(2) 
CONFORMING
AMENDMENT.—Section 
514(c)(1) of the Medicare Access and CHIP Reau-
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thorization Act of 2015 (Public Law 114–10) is 
amended by striking ‘‘subsection (z)’’ and inserting 
‘‘subsection (aa)’’. 
(b) EXCEPTION FACILITATING THE DEVELOPMENT 
AND OPERATION OF ALTERNATIVE PAYMENT MODELS.— 
Section 1877(b) of the Social Security Act (42 U.S.C. 
1395nn(b)) is amended by adding at the end the following 
new paragraph: 
‘‘(6) DEVELOPMENT AND OPERATION OF AL-
TERNATIVE PAYMENT MODELS.— 
‘‘(A) IN GENERAL.—In the case of items 
and services furnished pursuant to an arrange-
ment that meets the requirements described in 
subparagraph (B) entered into for the purpose 
of developing or operating a covered APM enti-
ty (as defined in section 1833(z)(5)(B)), includ-
ing— 
‘‘(i) an advanced alternative payment 
model described in section 1833(z) (includ-
ing a physician-focused payment model re-
ferred to in section 1868(c)); 
‘‘(ii) a MIPS APM (as defined by the 
Secretary); and 
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‘‘(iii) any other alternative payment 
model that the Secretary may, by regula-
tion, specify. 
‘‘(B) REQUIREMENTS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the requirements described in this sub-
paragraph with respect to an arrangement 
relating to an alternative payment model 
are as follows: 
‘‘(I) The arrangement is in writ-
ing, identifies the services, items, or 
actions subject to the arrangement 
and is signed by the parties to the ar-
rangement. 
‘‘(II) The arrangement includes a 
description of the alternative payment 
model. 
‘‘(III) Under the arrangement 
written reports are submitted to the 
Secretary on a semi-annual basis on 
the progress achieved in the develop-
ment and operation of the alternative 
payment model. 
‘‘(IV) The arrangement meets 
such other requirements as the Sec-
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retary may impose by regulation as 
needed to protect against a significant 
risk of program or patient abuse. 
‘‘(ii) CLARIFICATION.—The Secretary 
shall not prohibit or restrict an arrange-
ment from meeting the requirements de-
scribed in this subparagraph on the basis 
that the arrangement takes into account 
the volume or value of referrals if such ar-
rangement otherwise meets the require-
ments described in clause (i).’’. 
Æ 
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