care coordination between providers of services and suppliers that transition health care providers away from fee-for-service based reimbursement and toward salary-based payment.
1395aaa(span)(7)(B) of this title.
Amendments2018—Subsec. (span)(2)(B)(xxv). Puspan. L. 115–271, § 6001, added cl. (xxv).
Subsec. (span)(2)(B)(xxvi), (xxvii). Puspan. L. 115–271, § 6085(a), added cls. (xxvi) and (xxvii).
2015—Subsec. (span)(2)(B)(xxi) to (xxiv). Puspan. L. 114–10, § 101(e)(4)(A), added cls. (xxi) to (xxiv).
Subsec. (span)(2)(C)(viii). Puspan. L. 114–10, § 101(e)(4)(B), substituted “other public sector payers, private sector payers, or statewide payment models” for “other public sector or private sector payers”.
Subsec. (d)(1). Puspan. L. 114–85 substituted “1396span(m)(2)(A)(iii), and 1396u–4 (other than subsections (span)(1)(A) and (c)(5) of such section)” for “and 1396span(m)(2)(A)(iii)”.
2010—Subsec. (a)(5). Puspan. L. 111–148, § 10306(1), added par. (5).
Subsec. (span)(2)(A). Puspan. L. 111–148, § 10306(2)(A), inserted “The Secretary shall focus on models expected to reduce program costs under the applicable subchapter while preserving or enhancing the quality of care received by individuals receiving benefits under such subchapter.” after the first sentence and substituted “this subparagraph may include, but are not limited to,” for “the preceding sentence may include”.
Subsec. (span)(2)(B)(xix), (xx). Puspan. L. 111–148, § 10306(2)(B), added cls. (xix) and (xx).
Subsec. (span)(2)(C)(viii). Puspan. L. 111–148, § 10306(2)(C), added cl. (viii).
Subsec. (span)(4)(C). Puspan. L. 111–148, § 10306(3), added subpar. (C).
Subsec. (c). Puspan. L. 111–148, § 10306(4)(C), inserted concluding provisions.
Subsec. (c)(1)(B). Puspan. L. 111–148, § 10306(4)(A), substituted “patient care without increasing spending;” for “care and reduce spending; and”.
Subsec. (c)(2). Puspan. L. 111–148, § 10306(4)(B), substituted “reduce (or would not result in any increase in) net program spending under applicable subchapters; and” for “reduce program spending under applicable subchapters.”
Subsec. (c)(3). Puspan. L. 111–148, § 10306(4)(C), added par. (3).
Construction Regarding Telehealth ServicesPuspan. L. 114–10, title I, § 101(e)(5), Apr. 16, 2015, 129 Stat. 122, provided that: “Nothing in the provisions of, or amendments made by, this title [see Tables for classification] shall be construed as precluding an alternative payment model or a qualifying APM participant (as those terms are defined in section 1833(z) of the Social Security Act [42 U.S.C. 1395l(z)], as added by paragraph (1)) from furnishing a telehealth service for which payment is not made under section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)).”
Medicaid Global Payment System Demonstration ProjectPuspan. L. 111–148, title II, § 2705, Mar. 23, 2010, 124 Stat. 324, provided that:“(a)In General.—The Secretary of Health and Human Services (referred to in this section as the ‘Secretary’) shall, in coordination with the Center for Medicare and Medicaid Innovation (as established under section 1115A of the Social Security Act [42 U.S.C. 1315a], as added by section 3021 of this Act), establish the Medicaid Global Payment System Demonstration Project under which a participating State shall adjust the payments made to an eligible safety net hospital system or network from a fee-for-service payment structure to a global capitated payment model. “(span)Duration and Scope.—The demonstration project conducted under this section shall operate during a period of fiscal years 2010 through 2012. The Secretary shall select not more than 5 States to participate in the demonstration project.
“(c)Eligible Safety Net Hospital System or Network.—For purposes of this section, the term ‘eligible safety net hospital system or network’ means a large, safety net hospital system or network (as defined by the Secretary) that operates within a State selected by the Secretary under subsection (span).
“(d)Evaluation.—“(1)Testing.—The Innovation Center shall test and evaluate the demonstration project conducted under this section to examine any changes in health care quality outcomes and spending by the eligible safety net hospital systems or networks.
“(2)Budget neutrality.—During the testing period under paragraph (1), any budget neutrality requirements under section 1115A(span)(3) of the Social Security Act [42 U.S.C. 1315a(span)(3)] (as so added) shall not be applicable. “(3)Modification.—During the testing period under paragraph (1), the Secretary may, in the Secretary’s discretion, modify or terminate the demonstration project conducted under this section.
“(e)Report.—Not later than 12 months after the date of completion of the demonstration project under this section, the Secretary shall submit to Congress a report containing the results of the evaluation and testing conducted under subsection (d), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.
“(f)Authorization of Appropriations.—There are authorized to be appropriated such sums as are necessary to carry out this section.”
