H.R. 5841 · 114th Congress
To amend title XVIII of the Social Security Act to establish a population based payment demonstration project…
Full title
To amend title XVIII of the Social Security Act to establish a population based payment demonstration project under which Patient Care Networks are paid prospective monthly capitated payments for coordinated care furnished to Medicare beneficiaries.
Key: what the circles and colors mean
Each circle is a bill. The ring fills as it moves through Congress:
Under the number: the Yea · Nay count of its final (or latest) recorded vote. On a member's page, the small badge is how that member voted: Y Yea / Aye, N Nay / No, P Present, – Not voting.
Gold and violet are only for Yea and Nay; they never mean a party. A member's party is the letter on their photo.
Never voted on. It didn't reach a floor vote before the 114th Congress ended, so it expired. A bill has to be introduced again to be considered in a new Congress.
R
KellySponsor1 cosponsor · 1 D
1 signed on when it was introduced; the rest joined later. Cosponsors who withdrew aren't shown.
This bill amends title XVIII (Medicare) of the Social Security Act to establish a five-year, population-based payment demonstration project through which provider networks are prospectively paid monthly capitated payments for coordinated care furnished to Medicare beneficiaries.
What it does: CRS summary · Introduced in House · Jul 14, 2016
This bill amends title XVIII (Medicare) of the Social Security Act to establish a five-year, population-based payment demonstration project through which provider networks are prospectively paid monthly capitated payments for coordinated care furnished to Medicare beneficiaries.
To be eligible to participate in the project, a provider network must:
- be an integrated care system that provides Medicare services directly;
- include physicians in group practice arrangements, a federally qualified health center, and at least one hospital;
- enter into, and be responsible for making payments to providers under, appropriate contractual arrangements;
- be accountable for the quality, cost, and overall care of the network's participating beneficiaries;
- enter into a participation agreement with the Centers for Medicare & Medicaid Services (CMS); and
- meet other specified requirements.
CMS shall establish a process for prospectively assigning Medicare fee-for-service beneficiaries to a participating provider network. This process must allow beneficiaries to opt out of such assignment.
The bill limits Medicare payment for out-of-network services furnished to a participating beneficiary.
To calculate payments to participating networks, CMS shall: (1) determine a base annual prospective population health budget, (2) adjust such budget to account for the number and characteristics of participating beneficiaries with respect to each network, and (3) annually update the budget to account for population changes and Medicare program growth.
The bill establishes certain limits on total program expenditures for the program's initial three years.
CMS may expand the project's duration and scope under specified circumstances.
Written by the nonpartisan Congressional Research Service. All summary versions on Congress.gov
About this bill and sources
Official title: To amend title XVIII of the Social Security Act to establish a population based payment demonstration project under which Patient Care Networks are paid prospective monthly capitated payments for coordinated care furnished to Medicare beneficiaries.
Latest action (Aug 2, 2016): Referred to the Subcommittee on Health.
Policy area: Health · Origin: House · Introduced: Jul 14, 2016
Official page on Congress.gov · Bill text (GovInfo) · Status record (XML)
No recorded floor vote found.