Model eligibility and quality of care

(a) Clarification of model eligibility Section 1115A of the Social Security Act (42 U.S.C. 1315a) is amended— (1) in subsection (a)(1), by striking also before improve; and (2) in subsection (b)(2)(A), by inserting after the second sentence the following new sentence: The Secretary may also focus on models solely aimed at implementing practices to demonstrate ways to significantly improve the care, patient safety, and health outcomes of individuals receiving benefits under the applicable title in anticipation that quality of care benefits and potential direct or indirect savings will over time accrue to the Medicare or Medicaid program.. (b) Additional opportunity Section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the end the following new clause: (xxviii) Implementing newly recognized and evidence-based, professionally supported care delivery practices and bundles to improve the efficient and effective delivery of hospital-based care and lead to enhanced patient outcomes, reductions in readmissions, or avoidance of costly medical errors or complications.. (c) Inclusion of indirect savings Section 1115A(b)(3)(A) of the Social Security Act (42 U.S.C. 1315a(b)(3)(A)) is amended by inserting or that savings cannot be made indirectly over time when testing quality of care delivery models before the period at the end. (d) Availability of actuarial assumptions and data Section 1115A of the Social Security Act (42 U.S.C. 1315a) is amended— (1) in subsection (b)(3)(B)— (A) by redesignating clauses (i) through (iii) as subclauses (I) through (III), respectively, and adjusting the margins accordingly; (B) by striking The Secretary shall and inserting the following: (i) In general The Secretary shall; and (C) by adding at the end the following new clause: (ii) Publicly available information The Secretary shall provide to each provider of services and supplier participating in a model, and include in any rules promulgated with respect to the consideration of such model for termination or modification, the assumptions and data used by the Chief Actuary of the Centers for Medicare & Medicaid Services as the basis for making (or declining to make) the certification described in clause (i) with respect to such model.; and (2) in subsection (c), in the flush-left text at the end, by adding at the end the following new sentence: The Secretary shall provide to each provider of services and supplier participating in a model or demonstration project, and include in any rules promulgated with respect to the consideration of such model for expansion, the assumptions and data used by the Chief Actuary of the Centers for Medicare & Medicaid Services as the basis for making (or declining to make) the certification described in paragraph (2) with respect to such model.. (e) Evaluating quality of care Section 1115A(b)(4) of the Social Security Act (42 U.S.C. 1315a(b)(4)) is amended— (1) in subparagraph (A), by amending clause (i) to read as follows: (i) the quality of care furnished under the model, including the measurement of patient-level outcomes, patient-centeredness, and any unintended consequences, such as access to services, using criteria determined appropriate by the Secretary for each model; and; and (2) in subparagraph (C), by striking and before patient-centered care and inserting, are appropriate to issues of quality outcomes related to the medical conditions under study, and are.