Page:United States Statutes at Large Volume 124.djvu/428

 124 STAT. 402 PUBLIC LAW 111–148—MAR. 23, 2010 services under this title (including payment for services described in subparagraph (B)) for applicable bene- ficiaries for a year shall be established in a manner that does not result in spending more for such entity for such beneficiaries than would otherwise be expended for such entity for such beneficiaries for such year if the pilot program were not implemented, as estimated by the Secretary. ‘‘(B) INCLUSION OF CERTAIN SERVICES.—A payment methodology tested under the pilot program shall include payment for the furnishing of applicable services and other appropriate services, such as care coordination, medication reconciliation, discharge planning, transitional care serv- ices, and other patient-centered activities as determined appropriate by the Secretary. ‘‘(C) BUNDLED PAYMENTS.— ‘‘(i) IN GENERAL.—A bundled payment under the pilot program shall— ‘‘(I) be comprehensive, covering the costs of applicable services and other appropriate services furnished to an individual during an episode of care (as determined by the Secretary); and ‘‘(II) be made to the entity which is partici- pating in the pilot program. ‘‘(ii) REQUIREMENT FOR PROVISION OF APPLICABLE SERVICES AND OTHER APPROPRIATE SERVICES.— Applicable services and other appropriate services for which payment is made under this subparagraph shall be furnished or directed by the entity which is partici- pating in the pilot program. ‘‘(D) PAYMENT FOR POST-ACUTE CARE SERVICES AFTER THE EPISODE OF CARE.—The Secretary shall establish proce- dures, in the case where an applicable beneficiary requires continued post-acute care services after the last day of the episode of care, under which payment for such services shall be made. ‘‘(4) QUALITY MEASURES.— ‘‘(A) IN GENERAL.—The Secretary shall establish quality measures (including quality measures of process, outcome, and structure) related to care provided by entities participating in the pilot program. Quality measures estab- lished under the preceding sentence shall include measures of the following: ‘‘(i) Functional status improvement. ‘‘(ii) Reducing rates of avoidable hospital readmis- sions. ‘‘(iii) Rates of discharge to the community. ‘‘(iv) Rates of admission to an emergency room after a hospitalization. ‘‘(v) Incidence of health care acquired infections. ‘‘(vi) Efficiency measures. ‘‘(vii) Measures of patient-centeredness of care. ‘‘(viii) Measures of patient perception of care. ‘‘(ix) Other measures, including measures of patient outcomes, determined appropriate by the Sec- retary. ‘‘(B) REPORTING ON QUALITY MEASURES.— Procedures.