124 STAT. 397 PUBLIC LAW 111–148—MAR. 23, 2010 ACOs over time by specifying higher standards, new meas- ures, or both for purposes of assessing such quality of care. ‘‘(D) OTHER REPORTING REQUIREMENTS.—The Secretary may, as the Secretary determines appropriate, incorporate reporting requirements and incentive payments related to the physician quality reporting initiative (PQRI) under sec- tion 1848, including such requirements and such payments related to electronic prescribing, electronic health records, and other similar initiatives under section 1848, and may use alternative criteria than would otherwise apply under such section for determining whether to make such pay- ments. The incentive payments described in the preceding sentence shall not be taken into consideration when calcu- lating any payments otherwise made under subsection (d). ‘‘(4) NO DUPLICATION IN PARTICIPATION IN SHARED SAVINGS PROGRAMS.—A provider of services or supplier that participates in any of the following shall not be eligible to participate in an ACO under this section: ‘‘(A) A model tested or expanded under section 1115A that involves shared savings under this title, or any other program or demonstration project that involves such shared savings. ‘‘(B) The independence at home medical practice pilot program under section 1866E. ‘‘(c) ASSIGNMENT OF MEDICARE FEE-FOR-SERVICE BENEFICIARIES TO ACOS.—The Secretary shall determine an appropriate method to assign Medicare fee-for-service beneficiaries to an ACO based on their utilization of primary care services provided under this title by an ACO professional described in subsection (h)(1)(A). ‘‘(d) PAYMENTS AND TREATMENT OF SAVINGS.— ‘‘(1) PAYMENTS.— ‘‘(A) IN GENERAL.—Under the program, subject to para- graph (3), payments shall continue to be made to providers of services and suppliers participating in an ACO under the original Medicare fee-for-service program under parts A and B in the same manner as they would otherwise be made except that a participating ACO is eligible to receive payment for shared savings under paragraph (2) if— ‘‘(i) the ACO meets quality performance standards established by the Secretary under subsection (b)(3); and ‘‘(ii) the ACO meets the requirement under subparagraph (B)(i). ‘‘(B) SAVINGS REQUIREMENT AND BENCHMARK.— ‘‘(i) DETERMINING SAVINGS.—In each year of the agreement period, an ACO shall be eligible to receive payment for shared savings under paragraph (2) only if the estimated average per capita Medicare expendi- tures under the ACO for Medicare fee-for-service bene- ficiaries for parts A and B services, adjusted for bene- ficiary characteristics, is at least the percent specified by the Secretary below the applicable benchmark under clause (ii). The Secretary shall determine the appro- priate percent described in the preceding sentence to account for normal variation in expenditures under Determination.
