Page:United States Statutes at Large Volume 124.djvu/432

 124 STAT. 406 PUBLIC LAW 111–148—MAR. 23, 2010 covered under parts A and B furnished to applicable bene- ficiaries for each qualifying independence at home medical prac- tice under this section. Such spending targets shall be deter- mined on a per capita basis. Such spending targets shall include a risk corridor that takes into account normal variation in expenditures for items and services covered under parts A and B furnished to such beneficiaries with the size of the corridor being related to the number of applicable beneficiaries furnished services by each independence at home medical prac- tice. The spending targets may also be adjusted for other factors as the Secretary determines appropriate. ‘‘(2) INCENTIVE PAYMENTS.—Subject to performance on quality measures, a qualifying independence at home medical practice is eligible to receive an incentive payment under this section if actual expenditures for a year for the applicable beneficiaries it enrolls are less than the estimated spending target established under paragraph (1) for such year. An incen- tive payment for such year shall be equal to a portion (as determined by the Secretary) of the amount by which actual expenditures (including incentive payments under this para- graph) for applicable beneficiaries under parts A and B for such year are estimated to be less than 5 percent less than the estimated spending target for such year, as determined under paragraph (1). ‘‘(d) APPLICABLE BENEFICIARIES.— ‘‘(1) DEFINITION.—In this section, the term ‘applicable bene- ficiary’ means, with respect to a qualifying independence at home medical practice, an individual who the practice has determined— ‘‘(A) is entitled to benefits under part A and enrolled for benefits under part B; ‘‘(B) is not enrolled in a Medicare Advantage plan under part C or a PACE program under section 1894; ‘‘(C) has 2 or more chronic illnesses, such as congestive heart failure, diabetes, other dementias designated by the Secretary, chronic obstructive pulmonary disease, ischemic heart disease, stroke, Alzheimer’s Disease and neurodegenerative diseases, and other diseases and condi- tions designated by the Secretary which result in high costs under this title; ‘‘(D) within the past 12 months has had a nonelective hospital admission; ‘‘(E) within the past 12 months has received acute or subacute rehabilitation services; ‘‘(F) has 2 or more functional dependencies requiring the assistance of another person (such as bathing, dressing, toileting, walking, or feeding); and ‘‘(G) meets such other criteria as the Secretary deter- mines appropriate. ‘‘(2) PATIENT ELECTION TO PARTICIPATE.—The Secretary shall determine an appropriate method of ensuring that applicable beneficiaries have agreed to enroll in an independ- ence at home medical practice under the demonstration pro- gram. Enrollment in the demonstration program shall be vol- untary. ‘‘(3) BENEFICIARY ACCESS TO SERVICES.—Nothing in this section shall be construed as encouraging physicians or nurse Determination.