---
kind: "section"
citation: "42 U.S.C. § 1395cc–5"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1395cc–5"
heading: "Independence at home medical practice demonstration program"
release: "119-102"
url: "https://uscodex.org/usc/42/1395cc-5"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XVIII — Health Insurance for Aged and Disabled"
  - "Part E — Miscellaneous Provisions"
---

# §1395cc–5. Independence at home medical practice demonstration program

- (a) **Establishment—**
  - (1) **In general—** The [Secretary](/usc/42/1301.md?p=a-6) shall conduct a demonstration [program](/usc/42/274l–1.md?p=4) (in this section referred to as the “demonstration [program](/usc/42/274l–1.md?p=4)”) to test a payment incentive and service delivery model that utilizes [physician](#b-1-B) and [nurse practitioner](/usc/42/1395x.md?p=aa-5-A) directed home-based primary care teams designed to reduce expenditures and improve health outcomes in the provision of items and services under this subchapter to [applicable beneficiaries](#d-1) (as defined in [subsection (d)](#d)).
  - (2) **Requirement—** The demonstration [program](/usc/42/274l–1.md?p=4) shall test whether a model described in [paragraph (1)](#a-1), which is accountable for providing comprehensive, coordinated, continuous, and accessible care to high-need populations at home and coordinating health care across all [treatment](/usc/42/11851.md?p=11) settings, results in—
    - (A) reducing preventable [hospitalizations](/usc/42/1301.md?p=a-7);
    - (B) preventing [hospital](/usc/42/1395dd.md?p=e-5) [readmissions](/usc/42/1395cc–4.md?p=a-2-H);
    - (C) reducing emergency room visits;
    - (D) improving health outcomes commensurate with the beneficiaries’ stage of chronic illness;
    - (E) improving the efficiency of care, such as by reducing duplicative diagnostic and [laboratory](/usc/42/300jj.md?p=10) tests;
    - (F) reducing the cost of health care services covered under this subchapter; and
    - (G) achieving beneficiary and [family](/usc/42/290ff–4.md?p=d-2) [caregiver](/usc/42/1397j.md?p=3) satisfaction.
- (b) **Independence at home medical practice—**
  - (1) **Independence at home medical practice defined—** In this section:
    - (A) **In general—** The term “independence at home medical practice” means a legal entity that—
      - (i) is comprised of an individual [physician](#b-1-B) or [nurse practitioner](/usc/42/1395x.md?p=aa-5-A) or group of [physicians](/usc/42/1395cc–4.md?p=a-2-E) and [nurse practitioners](/usc/42/1395x.md?p=aa-5-A) that provides care as part of a team that [includes](/usc/42/1301.md?p=b) [physicians](/usc/42/1395cc–4.md?p=a-2-E), nurses, [physician assistants](/usc/42/1395x.md?p=aa-5-A), pharmacists, and other health and [social](/usc/42/1397j.md?p=20) services staff as appropriate who have experience providing home-based primary care to [applicable beneficiaries](#d-1), make in-home visits, and are available 24 hours per day, 7 days per week to carry out plans of care that are tailored to the individual beneficiary’s chronic conditions and designed to achieve the results in [subsection (a)](#a);
      - (ii) is organized at least in part for the purpose of providing [physicians](/usc/42/1395cc–4.md?p=a-2-E)’ services;
      - (iii) has documented experience in providing home-based [primary care services](/usc/42/1395u.md?p=i-4) to high-cost chronically ill beneficiaries, as determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6);
      - (iv) furnishes services to at least 200 [applicable beneficiaries](#d-1) (as defined in [subsection (d)](#d)) during each year of the demonstration [program](/usc/42/274l–1.md?p=4);
      - (v) has entered into an [agreement](/usc/42/1320b–8.md?p=a-3-A) with the [Secretary](/usc/42/1301.md?p=a-6);
      - (vi) uses electronic [health information](/usc/42/300jj.md?p=4) systems, remote monitoring, and mobile diagnostic technology; and
      - (vii) meets such other criteria as the [Secretary](/usc/42/1301.md?p=a-6) determines to be appropriate to participate in the demonstration [program](/usc/42/274l–1.md?p=4).

      The entity shall report on quality measures (in such form, manner, and frequency as specified by the [Secretary](/usc/42/1301.md?p=a-6), which may be for the group, for providers of services and [suppliers](/usc/42/1395x.md?p=d), or both) and report to the [Secretary](/usc/42/1301.md?p=a-6) (in a form, manner, and frequency as specified by the [Secretary](/usc/42/1301.md?p=a-6)) such data as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate to monitor and evaluate the demonstration [program](/usc/42/274l–1.md?p=4).

    - (B) **Physician—** The term “physician” [includes](/usc/42/1301.md?p=b), except as the [Secretary](/usc/42/1301.md?p=a-6) may otherwise provide, any individual who furnishes services for which payment may be made as [physicians](/usc/42/1395cc–4.md?p=a-2-E)’ services and has the medical [training](/usc/42/285e–2.md?p=b-2) or experience to fulfill the physician’s role described in [subparagraph (A)(i)](#b-1-A-i).
  - (2) **Participation of nurse practitioners and physician assistants—** Nothing in this section shall be construed to prevent a [nurse practitioner](/usc/42/1395x.md?p=aa-5-A) or [physician assistant](/usc/42/1395x.md?p=aa-5-A) from participating in, or leading, a home-based primary care team as part of an [independence at home medical practice](#b-1-A) if—
    - (A) all the requirements of this section are met;
    - (B) the [nurse practitioner](/usc/42/1395x.md?p=aa-5-A) or [physician assistant](/usc/42/1395x.md?p=aa-5-A), as the case may be, is acting consistent with [State](/usc/42/1397n–12.md?p=6) law; and
    - (C) the [nurse practitioner](/usc/42/1395x.md?p=aa-5-A) or [physician assistant](/usc/42/1395x.md?p=aa-5-A) has the medical [training](/usc/42/285e–2.md?p=b-2) or experience to fulfill the [nurse practitioner](/usc/42/1395x.md?p=aa-5-A) or [physician assistant](/usc/42/1395x.md?p=aa-5-A) role described in [paragraph (1)(A)(i)](#b-1-A-i).
  - (3) **Inclusion of providers and practitioners—** Nothing in this subsection shall be construed as preventing an [independence at home medical practice](#b-1-A) from [including](/usc/42/1301.md?p=b) a [provider of services](/usc/42/1395n.md?p=a-2) or a participating [practitioner](/usc/42/1395a.md?p=b-6-C) described in [section 1395u(b)(18)(C) of this title](/usc/42/1395u.md?p=b-18-C) that is affiliated with the practice under an arrangement structured so that such [provider of services](/usc/42/1395n.md?p=a-2) or [practitioner](/usc/42/1395a.md?p=b-6-C) participates in the demonstration [program](/usc/42/274l–1.md?p=4) and shares in any savings under the demonstration [program](/usc/42/274l–1.md?p=4).
  - (4) **Quality and performance standards—** The [Secretary](/usc/42/1301.md?p=a-6) shall develop quality performance [standards](/usc/42/1320d.md?p=7) for [independence at home medical practices](#b-1-A) participating in the demonstration [program](/usc/42/274l–1.md?p=4).
- (c) **Payment methodology—**
  - (1) **Establishment of target spending level—** The [Secretary](/usc/42/1301.md?p=a-6) shall establish an estimated annual spending target, for the amount the [Secretary](/usc/42/1301.md?p=a-6) estimates would have been spent in the absence of the demonstration, for items and services covered under parts A and B furnished to [applicable beneficiaries](#d-1) for each qualifying [independence at home medical practice](#b-1-A) under this section. Such spending targets shall be determined 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](#d-1) furnished services by each [independence at home medical practice](#b-1-A). The spending targets may also be adjusted for other factors as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate.
  - (2) **Incentive payments—** Subject to performance on quality measures, a qualifying [independence at home medical practice](#b-1-A) is eligible to receive an incentive payment under this section if actual expenditures for a year for the [applicable beneficiaries](#d-1) it enrolls are less than the estimated spending target established under [paragraph (1)](#c-1) for such year. An incentive payment for such year shall be equal to a portion (as determined by the [Secretary](/usc/42/1301.md?p=a-6)) of the amount by which actual expenditures ([including](/usc/42/1301.md?p=b) incentive payments under this paragraph) for [applicable beneficiaries](#d-1) 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)](#c-1).
- (d) **Applicable beneficiaries—**
  - (1) **Definition—** In this section, the term “applicable beneficiary” means, with respect to a qualifying [independence at home medical practice](#b-1-A), 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](/usc/42/274l–1.md?p=4) under [section 1395eee of this title](/usc/42/1395eee.md);
    - (C) has 2 or more chronic illnesses, such as congestive heart failure, diabetes, other dementias designated by the [Secretary](/usc/42/1301.md?p=a-6), chronic obstructive pulmonary disease, ischemic heart disease, stroke, Alzheimer’s Disease and neurodegenerative diseases, and other diseases and conditions designated by the [Secretary](/usc/42/1301.md?p=a-6) which result in high costs under this subchapter;
    - (D) within the past 12 months has had a nonelective [hospital](/usc/42/1395dd.md?p=e-5) 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](/usc/42/1301.md?p=a-3) (such as bathing, dressing, toileting, walking, or feeding); and
    - (G) meets such other criteria as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate.
  - (2) **Patient election to participate—** The [Secretary](/usc/42/1301.md?p=a-6) shall determine an appropriate method of ensuring that [applicable beneficiaries](#d-1) have agreed to enroll in an [independence at home medical practice](#b-1-A) under the demonstration [program](/usc/42/274l–1.md?p=4). Enrollment in the demonstration [program](/usc/42/274l–1.md?p=4) shall be voluntary.
  - (3) **Beneficiary access to services—** Nothing in this section shall be construed as encouraging [physicians](/usc/42/1395cc–4.md?p=a-2-E) or [nurse practitioners](/usc/42/1395x.md?p=aa-5-A) to limit [applicable beneficiary](#d-1) access to services covered under this subchapter and [applicable beneficiaries](#d-1) shall not be required to relinquish access to any benefit under this subchapter as a condition of receiving services from an [independence at home medical practice](#b-1-A).
- (e) **Implementation—**
  - (1) **Starting date—** The demonstration [program](/usc/42/274l–1.md?p=4) shall begin no later than January 1, 2012. [Agreements](/usc/42/1320b–8.md?p=a-3-A) with an [independence at home medical practice](#b-1-A) under the demonstration [program](/usc/42/274l–1.md?p=4) may cover not more than a 10-year period.
  - (2) **No physician duplication in demonstration participation—** The [Secretary](/usc/42/1301.md?p=a-6) shall not pay an [independence at home medical practice](#b-1-A) under this section that participates in [section 1395jjj of this title](/usc/42/1395jjj.md).
  - (3) **No beneficiary duplication in demonstration participation—** The [Secretary](/usc/42/1301.md?p=a-6) shall ensure that no [applicable beneficiary](#d-1) enrolled in an [independence at home medical practice](#b-1-A) under this section is participating in the [programs](/usc/42/274l–1.md?p=4) under [section 1395jjj of this title](/usc/42/1395jjj.md).
  - (4) **Preference—** In approving an [independence at home medical practice](#b-1-A), the [Secretary](/usc/42/1301.md?p=a-6) shall give preference to [practices](/usc/42/17061.md?p=19) that are—
    - (A) located in high-cost areas of the country;
    - (B) have experience in furnishing health care services to [applicable beneficiaries](#d-1) in the home; and
    - (C) use electronic medical records, [health information](/usc/42/300jj.md?p=4) technology, and individualized plans of care.
  - (5) **Limitation on number of practices—** In selecting qualified [independence at home medical practices](#b-1-A) to participate under the demonstration [program](/usc/42/274l–1.md?p=4), the [Secretary](/usc/42/1301.md?p=a-6) shall limit the number of such [practices](/usc/42/17061.md?p=19) so that the number of [applicable beneficiaries](#d-1) that may participate in the demonstration [program](/usc/42/274l–1.md?p=4) does not exceed 20,000. An [applicable beneficiary](#d-1) that participates in the demonstration [program](/usc/42/274l–1.md?p=4) by reason of the increase from 10,000 to 15,000 in the preceding sentence pursuant to the amendment made by section 50301(a)(1)(B)(i) of the Advancing Chronic Care, Extenders, and [Social](/usc/42/1397j.md?p=20) Services Act shall be considered in the spending target estimates under [paragraph (1)](#c-1) of subsection (c) and the incentive payment calculations under [paragraph (2)](#e-2) of such subsection for the sixth through tenth years of such [program](/usc/42/274l–1.md?p=4). An [applicable beneficiary](#d-1) that participates in the demonstration [program](/usc/42/274l–1.md?p=4) by reason of the increase from 15,000 to 20,000 in the first sentence of this paragraph pursuant to the amendment made by section 105 of division CC of the Consolidated Appropriations Act, 2021 shall be considered in the spending target estimates under [paragraph (1)](#c-1) of subsection (c) and the incentive payment calculations under [paragraph (2)](#e-2) of such subsection for the eighth through tenth years of such [program](/usc/42/274l–1.md?p=4).
  - (6) **Waiver—** The [Secretary](/usc/42/1301.md?p=a-6) may waive such provisions of this subchapter and subchapter XI as the [Secretary](/usc/42/1301.md?p=a-6) determines necessary in order to implement the demonstration [program](/usc/42/274l–1.md?p=4).
  - (7) **Administration—** [Chapter 35](/usc/44/ch35.md) of title 44 shall not apply to this section.
- (f) **Evaluation and monitoring—**
  - (1) **In general—** The [Secretary](/usc/42/1301.md?p=a-6) shall evaluate each [independence at home medical practice](#b-1-A) under the demonstration [program](/usc/42/274l–1.md?p=4) to assess whether the practice achieved the results described in [subsection (a)](#a).
  - (2) **Monitoring applicable beneficiaries—** The [Secretary](/usc/42/1301.md?p=a-6) may monitor data on expenditures and quality of services under this subchapter after an [applicable beneficiary](#d-1) discontinues receiving services under this subchapter through a qualifying [independence at home medical practice](#b-1-A).
- (g) **Reports to Congress—** The [Secretary](/usc/42/1301.md?p=a-6) shall conduct an independent evaluation of the demonstration [program](/usc/42/274l–1.md?p=4) and submit to Congress a final report, [including](/usc/42/1301.md?p=b) best [practices](/usc/42/17061.md?p=19) under the demonstration [program](/usc/42/274l–1.md?p=4), [including](/usc/42/1301.md?p=b), to the extent practicable, with respect to the use of electronic [health information](/usc/42/300jj.md?p=4) systems, as described in [subsection (b)(1)(A)(vi)](#b-1-A-vi). Such report shall include an analysis of the demonstration [program](/usc/42/274l–1.md?p=4) on coordination of care, expenditures under this subchapter, [applicable beneficiary](#d-1) access to services, and the quality of health care services provided to [applicable beneficiaries](#d-1).
- (h) **Funding—** For purposes of administering and carrying out the demonstration [program](/usc/42/274l–1.md?p=4), other than for payments for items and services furnished under this subchapter and incentive payments under [subsection (c)](#c), in addition to [funds](/usc/42/12854.md?p=3) otherwise appropriated, there shall be transferred to the [Secretary](/usc/42/1301.md?p=a-6) for the Center for Medicare & Medicaid Services [Program](/usc/42/274l–1.md?p=4) Management Account from the Federal [Hospital](/usc/42/1395dd.md?p=e-5) Insurance [Trust](/usc/42/12854.md?p=6) [Fund](/usc/42/12854.md?p=3) under [section 1395i of this title](/usc/42/1395i.md) and the Federal Supplementary Medical Insurance [Trust](/usc/42/12854.md?p=6) [Fund](/usc/42/12854.md?p=3) under [section 1395t of this title](/usc/42/1395t.md) (in proportions determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6)) $5,000,000 for each of fiscal years 2010 through 2015 and $9,000,000 for fiscal year 2021. Amounts transferred under this subsection for a fiscal year shall be available until expended.
- (i) **Termination—**
  - (1) **Mandatory termination—** The [Secretary](/usc/42/1301.md?p=a-6) shall terminate an [agreement](/usc/42/1320b–8.md?p=a-3-A) with an [independence at home medical practice](#b-1-A) if—
    - (A) the [Secretary](/usc/42/1301.md?p=a-6) estimates or determines that such practice did not achieve savings for the third of 3 consecutive years under the demonstration [program](/usc/42/274l–1.md?p=4); or
    - (B) such practice fails to meet quality [standards](/usc/42/1320d.md?p=7) during any year of the demonstration [program](/usc/42/274l–1.md?p=4).
  - (2) **Permissive termination—** The [Secretary](/usc/42/1301.md?p=a-6) may terminate an [agreement](/usc/42/1320b–8.md?p=a-3-A) with an [independence at home medical practice](#b-1-A) for such other reasons determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6).

## Source credit

(Aug. 14, 1935, ch. 531, title XVIII, § 1866E, formerly § 1866D, as added and renumbered § 1866E, Pub. L. 111–148, title III, § 3024, title X, § 10308(b)(2), Mar. 23, 2010, 124 Stat. 404, 942; amended Pub. L. 114–39, § 2, July 30, 2015, 129 Stat. 440; Pub. L. 115–123, div. E, title III, § 50301(a), Feb. 9, 2018, 132 Stat. 190; Pub. L. 116–260, div. CC, title I, § 105(a), Dec. 27, 2020, 134 Stat. 2944.)

## Notes

### Editorial Notes

### References in Text

Parts A, B, and C, referred to in subsecs. (c) and (d)(1)(A), (B), are classified to sections 1395c et seq., 1395j et seq., and 1395w–21 et seq., respectively, of this title.

Section 50301(a)(1)(B)(i) of the Advancing Chronic Care, Extenders, and Social Services Act, referred to in subsec. (e)(5), probably means section 50301(a)(1)(B)(i) of the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act, div. E of Pub. L. 115–123, which amended this section.

Section 105 of division CC of the Consolidated Appropriations Act, 2021, referred to in subsec. (e)(5), is section 105 of div. CC of Pub. L. 116–260, which amended this section.

### Amendments

2020—Subsec. (e)(1). Pub. L. 116–260, § 105(a)(1)(A), substituted “10-year” for “7-year”.

Subsec. (e)(5). Pub. L. 116–260, § 105(a)(1)(B), substituted “20,000” for “15,000” in first sentence and “sixth through tenth” for “sixth and seventh” in second sentence and inserted at end “An applicable beneficiary that participates in the demonstration program by reason of the increase from 15,000 to 20,000 in the first sentence of this paragraph pursuant to the amendment made by section 105 of division CC of the Consolidated Appropriations Act, 2021 shall be considered in the spending target estimates under paragraph (1) of subsection (c) and the incentive payment calculations under paragraph (2) of such subsection for the eighth through tenth years of such program.”

Subsec. (h). Pub. L. 116–260, § 105(a)(2), inserted “and $9,000,000 for fiscal year 2021” after “2015”.

2018—Subsec. (e)(1). Pub. L. 115–123, § 50301(a)(1)(A), substituted “Agreements” for “An agreement” and “7-year” for “5-year”.

Subsec. (e)(5). Pub. L. 115–123, § 50301(a)(1)(B), substituted “15,000” for “10,000” and inserted at end “An applicable beneficiary that participates in the demonstration program by reason of the increase from 10,000 to 15,000 in the preceding sentence pursuant to the amendment made by section 50301(a)(1)(B)(i) of the Advancing Chronic Care, Extenders, and Social Services Act shall be considered in the spending target estimates under paragraph (1) of subsection (c) and the incentive payment calculations under paragraph (2) of such subsection for the sixth and seventh years of such program.”

Subsec. (g). Pub. L. 115–123, § 50301(a)(2), inserted “, including, to the extent practicable, with respect to the use of electronic health information systems, as described in subsection (b)(1)(A)(vi)” after “under the demonstration program”.

Subsec. (i)(1)(A). Pub. L. 115–123, § 50301(a)(3), substituted “did not achieve savings for the third of 3” for “will not receive an incentive payment for the second of 2”.

2015—Subsec. (e)(1). Pub. L. 114–39 substituted “5-year” for “3-year”.

### Statutory Notes and Related Subsidiaries

### Effective Date of 2020 Amendment

Pub. L. 116–260, div. CC, title I, § 105(b), Dec. 27, 2020, 134 Stat. 2944, provided that: “The amendments made by subsection (a) [amending this section] shall take effect as if included in the enactment of Public Law 111–148.”

### Effective Date of 2018 Amendment

Pub. L. 115–123, div. E, title III, § 50301(b), Feb. 9, 2018, 132 Stat. 190, provided that: “The amendment made by subsection (a)(3) [amending this section] shall take effect as if included in the enactment of Public Law 111–148.”