alternative payment model

(3) Additional definitions In this subsection: (A) Covered professional services The term “covered professional services” has the meaning given that term in section 1395w–4(k)(3)(A) of this title . (B) Eligible professional The term “eligible professional” has the meaning given that term in section 1395w–4(k)(3)(B) of this title and includes a group that includes such professionals. (C) Alternative payment model (APM) The term “alternative payment model” means, other than for purposes of subparagraphs (B)(ii)(I)(bb) and (C)(ii)(I)(bb) of paragraph (2), any of the following: (i) A model under section 1315a of this title (other than a health care innovation award). (ii) The shared savings program under section 1395jjj of this title . (iii) A demonstration under section 1395cc–3 of this title . (iv) A demonstration required by Federal law. (D) Eligible alternative payment entity The term “eligible alternative payment entity” means, with respect to a year, an entity that— (i) participates in an alternative payment model that— (I) requires participants in such model to use certified EHR technology (as defined in subsection (o)(4)); and (II) provides for payment for covered professional services based on quality measures comparable to measures under the performance category described in section 1395w–4(q)(2)(B)(i) of this title ; and (ii) (I) bears financial risk for monetary losses under such alternative payment model that are in excess of a nominal amount; or (II) is a medical home expanded under section 1315a(c) of this title .


42 USC § 1395l(z)(3)

Scoping language

In this subsection
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