42 USC 1395cc-1 - Demonstration of application of physician volume increases to group practices

U.S Code last checked for updates: Jan 30, 2025

§ 1395cc–1.

Demonstration of application of physician volume increases to group practices

(a)

Demonstration program authorized

(1)

In general

The Secretary shall conduct demonstration projects to test and, if proven effective, expand the use of incentives to health care groups participating in the program under this subchapter that—

(A)

encourage coordination of the care furnished to individuals under the programs under parts A and B by institutional and other providers, practitioners, and suppliers of health care items and services;

(B)

encourage investment in administrative structures and processes to ensure efficient service delivery; and

(C)

reward physicians for improving health outcomes.

Such projects shall focus on the efficiencies of furnishing health care in a group-practice setting as compared to the efficiencies of furnishing health care in other health care delivery systems.

(2)

Administration by contract

(3)

Definitions

For purposes of this section, terms have the following meanings:

(A)

Physician

(B)

Health care group

(b)

Eligibility criteria

(1)

In general

(2)

Payment method

A health care group participating in the demonstration under this section shall agree with respect to services furnished to beneficiaries within the scope of the demonstration (as determined under subsection (c))—

(A)

to be paid on a fee-for-service basis; and

(B)

that payment with respect to all such services furnished by members of the health care group to such beneficiaries shall (where determined appropriate by the Secretary) be made to a single entity.

(3)

Data reporting

(c)

Patients within scope of demonstration

(1)

In general

(2)

Other criteria

(3)

Notice requirements

(d)

Incentives

(1)

Performance target

The Secretary shall establish for each health care group participating in a demonstration under this section—

(A)

a base expenditure amount, equal to the average total payments under parts A and B for patients served by the health care group on a fee-for-service basis in a base period determined by the Secretary; and

(B)

an annual per capita expenditure target for patients determined to be within the scope of the demonstration, reflecting the base expenditure amount adjusted for risk and expected growth rates.

(2)

Incentive bonus

(3)

Additional bonus for process and outcome improvements

(4)

Limitation

(Aug. 14, 1935, ch. 531, title XVIII, § 1866A, as added Pub. L. 106–554, § 1(a)(6) [title IV, § 412(a)], Dec. 21, 2000, 114 Stat. 2763, 2763A–509.)

cite as: 42 USC 1395cc-1