# 114-hr-5841: To amend title XVIII of the Social Security Act to establish a population based payment demonstration project under which Patient Care Networks are paid prospective monthly capitated payments for coordinated care furnished to Medicare beneficiaries.

114-hr-5841, To amend title XVIII of the Social Security Act to establish a population based payment demonstration project under which Patient Care Networks are paid prospective monthly capitated payments for coordinated care furnished to Medicare beneficiaries., is a 114th Congress bill sponsored by Rep. Kelly, Mike [R-PA-16] (R-PA); status Referred to the Subcommittee on Health. (as of 2025-11-18).

- Canonical: https://policyrisk.com/legislation/114-hr-5841
- As of: 2025-11-18
- Plain-text twin of the page above; the HTML and this file carry the same facts.

## Facts
- Bill: 114-hr-5841
- Congress: 114
- Title: To amend title XVIII of the Social Security Act to establish a population based payment demonstration project under which Patient Care Networks are paid prospective monthly capitated payments for coordinated care furnished to Medicare beneficiaries.
- Status: Referred to the Subcommittee on Health.
- Introduced: 2016-07-14
- Sponsor: Rep. Kelly, Mike [R-PA-16] (R-PA)
- Cosponsors: 1
- Policy area: Health
- Touches household money: no
- Last recorded action: 2025-11-18

## Summary

This bill amends title XVIII (Medicare) of the Social Security Act to establish a five-year, population-based payment demonstration project through which provider networks are prospectively paid monthly capitated payments for coordinated care furnished to Medicare beneficiaries. To be eligible to participate in the project, a provider network must: be an integrated care system that provides Medicare services directly; include physicians in group practice arrangements, a federally qualified health center, and at least one hospital; enter into, and be responsible for making payments to providers under, appropriate contractual arrangements; be accountable for the quality, cost, and overall care of the network's participating beneficiaries; enter into a participation agreement with the Centers for Medicare & Medicaid Services (CMS); and meet other specified requirements. CMS shall establish a process for prospectively assigning Medicare fee-for-service beneficiaries to a participating provider network. This process must allow beneficiaries to opt out of such assignment. The bill limits Medicare payment for out-of-network services furnished to a participating beneficiary. To calculate payments to participating networks, CMS shall: (1) determine a base annual prospective population health budget, (2) adjust such budget to account for the number and characteristics of participating beneficiaries with respect to each network, and (3) annually update the budget to account for population changes and Medicare program growth. The bill establishes certain limits on total program expenditures for the program's initial three years. CMS may expand the project's duration and scope under specified circumstances.

## Cosponsors (1)

- Rep. Neal, Richard E. [D-MA-1] (D-MA), 2016-07-14T00:00:00.000Z

## Related bills

- 114-hr-6045: STOP Act of 2016
- 114-hr-5722: John F. Kennedy Centennial Commission Act
- 114-hr-5621: To posthumously award a Congressional Gold Medal to Lawrence Eugene "Larry" Doby in recognition of his achievements and contributions to American major league…
- 114-hr-5361: To amend the Internal Revenue Code of 1986 to provide for the tax-exempt financing of certain government-owned buildings.
- 114-hr-5007: Philanthropic Enterprise Act of 2016
- 114-hr-4938: Free File Act of 2016

## Sources
- [114-hr-5841 on Congress.gov](https://www.congress.gov/bill/114th-congress/house-bill/5841)

## Related
- [114-hr-6045: STOP Act of 2016](https://policyrisk.com/legislation/114-hr-6045)
- [114-hr-5722: John F. Kennedy Centennial Commission Act](https://policyrisk.com/legislation/114-hr-5722)
- [114-hr-5621: To posthumously award a Congressional Gold Medal to Lawrence Eugene "Larry" Dob…](https://policyrisk.com/legislation/114-hr-5621)
- [114-hr-5361: To amend the Internal Revenue Code of 1986 to provide for the tax-exempt financ…](https://policyrisk.com/legislation/114-hr-5361)
- [114-hr-5007: Philanthropic Enterprise Act of 2016](https://policyrisk.com/legislation/114-hr-5007)
- [114-hr-4938: Free File Act of 2016](https://policyrisk.com/legislation/114-hr-4938)
- [All bills in Congress](https://policyrisk.com/legislation)

Source: PRIA, https://policyrisk.com/legislation/114-hr-5841 (as of 2025-11-18).