Sec. 5. Tier 1 of pilot program
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Not later than 270 days after the date of the enactment of this Act, the Secretary shall publish in the Federal Register a request for proposals from eligible entities to conduct VISIT pay for results projects under Tier 1 of the pilot program. To qualify as a VISIT pay for results project under Tier 1 of the pilot program, a project must effectively use participants to meet unmet social isolation or loneliness needs of eligible individuals through interventions described in the application and agreed upon by the Secretary, in consultation with the Federal Interagency Council on Social Impact Partnerships and the Secretary of Defense, to improve one or more measurable performance indicators, including better mental or physical health outcomes that lower risk of mortality for the target population of the project.
The notice published under subsection
(a)shall require an eligible entity seeking to participate in Tier 1 of the pilot program to submit to the Secretary, not later than 180 days after the date of such publication, an application for a VISIT pay for results project that addresses each of the following: A description of each proposed intervention under the project and anticipated outcomes of the intervention, including expected benefits to the target population of the intervention, the participants working on the project, and other individuals who may be affected by the invention. A summary of the unmet need in the area where the intervention will be delivered or among the target population of the intervention. The criteria used to determine the eligibility of an individual to be served by the project, including how selected populations will be identified and referred to and enrolled in the project. The anticipated number of participants needed to implement the project. The criteria used to determine the eligibility of a participant for the project, including how the potential participants will be identified, recruited for the project, and trained for their roles in the project. A plan for implementing each intervention through the use of participants. Rigorous evidence demonstrating that the intervention can be expected to produce the desired outcome or outcomes or, if the eligible entity lacks such rigorous evidence but demonstrates promising evidence that the intervention can be expected to produce the desired outcome or outcomes, a plan described in subsection (d)(4)(B). The target population that will be served by the project. The projected cost to the eligible entity to carry out the project, and any costs to the Federal, State, or local government associated with the project. Projected costs avoided by the Federal Government and State and local governments if the project is implemented and the outcomes are achieved as a result of the intervention. A description of the expertise of the eligible entity, including a summary of the experience of the eligible entity in delivering the proposed intervention or a similar intervention, or demonstrating the capacity of the eligible entity to deliver the intervention to the number of eligible individuals the eligible entity proposes to serve under the project. The proposed payment terms, the methodology used to calculate outcome payments, the payment schedule, and performance thresholds. The budget for the project. Subject to subsection (g), the timeline for the project. The design for the evaluation required by subsection (i), including the metrics that will be used in the evaluation to determine whether the outcomes have been achieved as a result of the intervention and how the metrics will be measured. An explanation of how the metrics described in paragraph
(15)are independent, objective indicators of impact and are not subject to manipulation by the eligible entity or any investor. An explanation of the independence of the evaluator who will conduct the evaluation required by subsection
(i)from the other entities involved in the project and the experience of the evaluator in conducting rigorous evaluations of program effectiveness including, where available, well-implemented randomized controlled trials on the intervention or similar interventions. An explanation of how any potential payment disputes related to the outcomes of the evaluation will be managed. Not later than 90 days after the deadline for applications under subsection
(c)has expired, the Secretary, in consultation with the Federal Interagency Council on Social Impact Partnerships and the Secretary of Defense, shall enter into an agreement with not fewer than eight eligible entities to participate in Tier 1 of the pilot program. Notwithstanding paragraph (1), if the Secretary determines that fewer than eight eligible entities meet the requirements for participation in Tier 1 of the pilot program, the Secretary, in consultation with the Federal Interagency Council on Social Impact Partnerships and the Secretary of Defense, may enter into an agreement with fewer than eight eligible entities to participate in Tier 1 of the pilot program. Notwithstanding paragraph (1), if the Secretary determines that an insufficient number of eligible entities meet the requirements for participation in Tier 1 of the pilot program, the Secretary may— publish in the Federal Register a second request for proposals from eligible entities to conduct VISIT pay for results projects under Tier 1 of the pilot program; and include in such request application requirements that are broader than the requirements under subsection (c); or carry out Tier 2 of the pilot program, in accordance with section 6. In determining whether to enter into an agreement with an eligible entity under paragraph (1), the Secretary shall— seek to ensure geographic diversity among selected entities, including by selecting not fewer than one eligible entity that plans to serve a rural community and not fewer than one eligible entity that plans to serve an urban community; and consider— the anticipated use of participants, and whether the eligible entity plans to use participants who come from a high-risk background; the value to the Federal Government of the outcomes expected to be achieved by the eligible entity under the pilot program, which the Secretary shall define to include— measurable costs avoided; and other outcomes of intrinsic value such as the health, well-being, and prosperity of eligible individuals; the likelihood, based on evidence provided in the application and other evidence, that the eligible entity will achieve those outcomes, balanced with the need to develop more rigorous evidence if the Secretary decides such evidence is necessary; the value to State and local governments if those outcomes are achieved; and the expected quality of the evaluation that would be conducted with respect to the VISIT pay for results project under subsection (i). The Secretary may enter into an agreement with an eligible entity under paragraph
(1)if the Secretary determines that each of the following requirements are met: Except as provided in subsection (f), the eligible entity agrees to achieve one or more outcomes as a result of the project, as specified in the agreement and validated by independent evaluation, in order to receive payment. Such outcomes shall be significant metrics closely correlated with intervention under the project. Except as provided in subsection (f), payment from the Federal Government to the eligible entity for each specified outcome achieved as a result of the project will be less than or equal to the value of the outcome to the Federal Government over a period not to exceed ten years, as determined by the Secretary, in consultation with the eligible entity. The eligible entity meets the requirement under subparagraph (B). The project will begin not later than one year after the eligible entity has entered into the agreement with the Secretary. The duration of the project will not exceed five years. The eligible entity has shown that it has experience delivering the intervention used in the project, a similar intervention, or has otherwise demonstrated the capability necessary to deliver the intervention. The project will use participants to implement the project. The eligible entity has made such other assurances as the Secretary may require. The requirement described in this subparagraph is that the eligible entity has demonstrated, through the application submitted under subsection (c), that there is— a clear and feasible plan to evaluate the VISIT pay for results project with a rigorous experimental or quasi-experimental study or other rigorous methodology that can establish a clear causal connection between the intervention and performance indicators; and a strong circumstantial case, based on existing measurable outcomes associated with the project, that the study or methodology is likely to establish such a connection. To the extent that the eligible entity does not have experience raising private or philanthropic capital to fund social service investments or is unable to secure such capital prior to submittal of the application under subsection (c), the Secretary may assist the entity in attaining such funding. The Secretary— shall take all practicable steps to ensure a pool of eligible entities enrolled in the pilot program that reflects the diversity of the population of eligible individuals; and shall not permit historical lack of access to private or philanthropic capital by any eligible entity to limit inclusion of the eligible entity in the pilot program. Not later than 180 days after the date on which an eligible entity enters into an agreement with the Secretary under subsection
(d)for a VISIT pay for results project under Tier 1 of the pilot program, the entity shall provide to the Secretary a plan demonstrating that the entity— has the capability to fund at least 50 percent of the up-front costs of the project, with or without funds from partner investors or philanthropic entities; and will have the funds described in subparagraph
(A)available and reserved for the project not later than one year after the date of such agreement. The Secretary may terminate an agreement entered into under subsection
(d)with an eligible entity for a VISIT pay for results project under Tier 1 of the pilot program if— the Secretary determines that the eligible entity is not likely to have the capability to fund at least 50 percent of the up-front costs of the project; or the eligible entity does not have the funds available and reserved to fund at least 50 percent of the up-front costs of the project. Each VISIT pay for results project conducted under Tier 1 of the pilot program shall be limited to a duration of not more than five years. The Secretary shall have discretion in determining the amount of funds awarded for each VISIT pay for results project under Tier 1 of the pilot program, except that such amount shall be specified as part of the agreement with each eligible entity under subsection (d). An eligible entity with which the Secretary enters into an agreement under subsection
(d)for a VISIT pay for results project under Tier 1 of the pilot program shall pay for at least 50 percent of the entire up-front costs of the project. After completion of a VISIT pay for results project under the pilot program, the Secretary shall pay the remaining obligation of the Secretary under the agreement entered into between the Secretary and the eligible entity only if the independent evaluator described in subsection
(i)determines that the project has— met the requirements specified in the agreement with respect to such project; and has achieved an outcome as a result of the intervention used in such project, as specified in the agreement and validated by the independent evaluator. Notwithstanding subparagraph (A), the Secretary may pay up to 50 percent of costs of a VISIT pay for results project under Tier 1 of the pilot program— before completion of the evaluation conducted by the independent evaluator under subsection (i); and before the measurements of value described in subsection (d)(4)(A)(ii) are made. The Secretary shall enter into an agreement with each eligible entity carrying out a VISIT pay for results project under the pilot program to pay for all or part of an independent evaluation to determine whether the project has achieved a specific outcome in order for the entity to receive outcome payments under subsection (h)(3). The Secretary may waive the requirement under subparagraph
(A)for up to 20 percent of all VISIT pay for results projects under Tier 1 of the pilot program if the Secretary determines that such a waiver is necessary for ensuring robust diversity of project geography and focus. The Secretary may not enter into an agreement with an eligible entity under paragraph
(1)unless the Secretary determines that— the evaluator is independent of the other parties to the agreement; and the evaluator has demonstrated substantial experience in conducting rigorous evaluations of program effectiveness, including, as available and appropriate, well-implemented randomized controlled trials on the intervention used in the VISIT pay for results project covered by the agreement or a similar intervention. Subject to subparagraph (B), the evaluation used to determine whether an eligible entity will receive outcome payments under subsection (h)(3) shall use experimental designs using random assignment, or other reliable, evidence-based research methodologies that allow for the strongest possible causal inferences when random assignment is not feasible. The Secretary may waive the requirement under subparagraph
(A)if— multiple evaluations or one large, multi-site evaluation have been conducted with respect to an intervention used in a VISIT pay for results project; and such evaluations or evaluation established substantial and statistically significant effects of the intervention. An eligible entity shall ensure that the independent evaluator conducting the evaluation under this subsection with respect to a VISIT pay for results project conducted by the entity under the pilot program— not later than two years after the project has been approved by the Secretary, and annually thereafter until the project is concluded, submits to the Secretary and the Federal Interagency Council on Social Impact Partnerships a written report summarizing the progress that has been made in achieving each outcome specified in the agreement under subsection (d); and before the scheduled time of each payment under subsection (h)(3) to be made to the eligible entity with respect to such project, submits to the Secretary and the Federal Interagency Council on Social Impact Partnerships a written report that includes— the results of the evaluation conducted to determine whether a payment should be made; and information on— the unique factors that contributed to achieving or failing to achieve the outcome; the challenges faced in attempting to achieve the outcome; and the improved future delivery of the intervention used in the project or a similar intervention. Not later than 30 days after receipt of the written report under subparagraph (A)(ii), the Secretary shall transmit the report to Congress. An eligible entity shall ensure that the independent evaluator conducting the evaluation under this subsection with respect to a VISIT pay for results project conducted by the entity under the pilot program, not later than 180 days after the VISIT pay for results project is completed— evaluates the effects of the activities undertaken pursuant to the agreement under subsection
(d)with regard to each outcome specified in the agreement; and submits to the President a written report that includes— the results of the evaluation and the conclusion of the evaluator as to whether the eligible entity has fulfilled each obligation of the agreement; and information on— the unique factors that contributed to the success or failure of the project; the challenges faced in attempting to achieve the outcome; and the improved future delivery of the intervention used in the project or a similar intervention. Not later than 30 days after receipt of the written report under subparagraph (A)(ii), the Secretary shall transmit the report to Congress.