,i #aaeth ,,congress #ast ,session ,h4 ,r4 #dehj ,,in ,,the ,,house ,,of ,,representatives ,december #f1 #bjag,mr4 ,welch 7for himself and ,mrs4 ,black7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to improve the ,medicare accountable care organization 7,,aco7 program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,,aco ,improvement ,act of #bjag4 #b4 ,medicare ,,aco program improvements 7a7 ,improving outcomes through greater beneficiary engagement 7#a7 ,in general ,section #ahii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7 is amended by adding at the end the following new subsection3 7l7 ,improving outcomes through greater beneficiary engagement 7#a7 ,use of beneficiary incentives ,subject to approval of the ,secretary1 the ,secretary shall permit an ,,aco-- 7,a7 to reduce or eliminate cost-sharing otherwise applicable under part ,b for some or all primary care services 7as identified by the ,,aco7 furnished by health care professionals 7including1 as applicable1 professionals furnishing services through a rural health clinic or ,federally qualified health center7 within the network of the ,,aco2 and 7,b7 to develop additional incentives to encourage patient engagement and participation in their own wellness4 ,the cost of the incentives under this paragraph shall be borne by the ,,aco and shall not affect the payments to the ,,aco under subsection 7d74 7#b7 ,fostering stronger patient-provider ties 7,a7 ,permitting prospective assignment of beneficiaries ,in carrying out subsection 7c7 with respect to any agreement with an ,,aco under this section1 the ,,aco may elect under any such agreement prospective assignment of ,medicare fee-for-service beneficiaries before the beginning of a year to the ,,aco and a primary care ,,aco professional4 7,b7 ,inclusion of aco information in welcome to medicare visit and annual wellness visits ,the ,secretary may encourage a primary care ,,aco professional to include1 as part of the initial preventive physical examination under section #ahfa7ww77#a7 or personalized prevention plan services under section #ahfa7;hhh77#a7 for a ,medicare fee-for-service beneficiary assigned to that professional under this section1 to provide the beneficiary with information concerning the ,,aco program under this section1 including information on any cost-sharing reductions allowed under this section4 7#c7 ,moving from volume to value ,subject to paragraph 7#d7-- 7,a7 ,regulatory relief for moving to two-sided risk ,in the case of an ,,aco that has elected a two-sided risk model 7as provided for under regulations71 in addition to the authority provided under paragraph 7#a71 the ,secretary shall provide the following regulatory relief3 7i7 #c-;day prior hospitalization waiver for snf services ,waiver of the #c-;day prior hospitalization requirement for coverage of skilled nursing facility services4 7ii7 ,homebound requirement waiver for home health services ,waiver of the homebound requirement for coverage of home health services4 7,b7 ,improving care coordination through access to telehealth 7i7 ,flexibility in furnishing telehealth services ,in applying section #ahcd7m7 in the case of an ,,aco1 the ,secretary shall grant a waiver1 and the ,,aco may elect1 to have the limitations on originating site 7under paragraph 7#d77;,c7 of such section7 and on the use of store-and-forward technologies 7under paragraph 7#a7 of such section7 not apply4 ,the previous sentence shall not be construed as affecting the authority of the ,secretary under subsection 7f7 to waive other provisions of such section4 7ii7 ,provision of remote monitoring in connection with home health services ,nothing in this section shall be construed as preventing an ,,aco from paying for remote patient monitoring and home-based video conferencing services in connection with the provision of home health services 7under conditions for which payment for such services would not be made under section #ahie for such services7 in a manner that is financially not more expensive than the furnishing of a home health visit4 7,c7 ,moving up risk track annually ,each year of an agreement period1 the ,secretary shall permit an ,,aco to make an election to assume greater risk4 7#d7 ,discretionary revocation ,the ,secretary may revoke1 at the ,secretary's discretion1 a waiver granted under paragraph 7#c74 7#e7 ,provisions for sharing of internal cost savings 7,a7 ,in general ,subject to the succeeding provisions of this paragraph1 the ,secretary shall permit an ,,aco to distribute internal cost savings among ,,aco participants pursuant to an internal cost savings sharing arrangement if the arrangement meets the requirements of subparagraph 7,b7 and the ,,aco meets the reporting requirements of subparagraph 7,c7 with respect to such arrangement4 7,b7 ,requirements relating to design of arrangement ,the requirements of this subparagraph for an internal cost savings sharing arrangement of an ,,aco are as follows3 7i7 ,no reduction in medically necessary care ,,aco participants may not reduce or limit medically necessary items and services furnished to ,medicare fee-for-service beneficiaries4 7ii7 ,voluntary participation ,participation by providers of services and suppliers in the arrangement is voluntary4 7iii7 ,transparency ,the arrangement is transparent and subject to audit by the ,secretary4 7iv7 ,quality of care ,,aco participants participating in the arrangement meet quality performance standards established by the ,secretary under subsection 7b77#c74 7v7 ,payment methodology ,distributions of internal cost savings under the arrangement is not based on the volume or value of referrals or business otherwise generated4 7,c7 ,reporting requirements ,the requirements of this subparagraph for an arrangement of an ,,aco is that the ,,aco provides the following information to the ,secretary for purposes of evaluating the arrangement3 7i7 ,methodology ,the methodology for distributions of internal cost savings under the arrangement among all ,,aco participants1 including the frequency of and the criteria for such distributions4 7ii7 ,care redesign ,a detailed explanation of how the arrangement will achieve improved quality and patient experience1 as well as the anticipated cost savings4 7iii7 ,eligibility to participate in arrangement ,the criteria for participation by ,,aco participants1 particularly professionals1 in the arrangement4 7iv7 ,distribution plan ,a comprehensive plan for distributions of internal cost savings under the arrangement4 7,d7 ,waivers ,the ,secretary shall waive such provisions of this title and title ,,xi as may be necessary to carry out this paragraph4 7,e7 ,definitions ,in this paragraph3 7i7 ,internal cost savings sharing arrangement ,the term internal cost savings sharing arrangement means an arrangement among ,,aco participants of an ,,aco for the distributions of internal cost savings to such ,,aco participants1 including to ,,aco professionals1 solely from gains or savings that are a direct result of collaborative efforts among ,,aco participants of an ,,aco to improve the quality and efficiency of care furnished to ,medicare fee-for-service beneficiaries1 but does not include shared savings under subsection 7d77#b74 7ii7 ,distribution of internal cost savings ,the term distribution of internal cost savings means a payment of a percentage of the gains or savings from an internal cost savings sharing arrangement to ,,aco participants4 7iii7 ,,aco participants ,the term ,,aco participants means providers of services and suppliers participating in an ,,aco who voluntarily participate in an internal cost savings sharing arrangement under this paragraph4 4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall apply as if included in the enactment of section #cjbb of ,public ,law #aaa-adh4 7#c7 ,conforming amendment ,effective as if included in the enactment of section #cjba of ,public ,law #aaa-adh1 the provisions of section #ahii7l77#e7 of the ,social ,security ,act 7relating to authority for distributions of internal cost savings under internal cost savings sharing arrangements71 as added by paragraph 7#a71 shall apply to participants in accountable care organization payment and service delivery models 7and other appropriate models7 tested pursuant to section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a74 7b7 ,study and report on feasibility on providing electronic access to ,medicare claims data 7#a7 ,study ,the ,secretary of ,health and ,human ,services shall conduct a study regarding the feasibility of establishing a system of electronic access of providers of services and suppliers to in-process and complete patient claims data4 ,such system may be a modification of an existing database1 such as the ,virtual ,research ,data ,center4 ,the study shall take into account the measures needed to ensure the security and privacy of beneficiary and provider information4 7#b7 ,report ,not later than six months after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on such study4 ,the ,secretary shall include in such report such recommendations as the ,secretary deems appropriate4 7c7 ,permitting de minimis variation from minimum enrollment requirement ,section #ahii7;b77#b77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7b77#b77;,d77 is amended by inserting before the period at the end the following3 1 except that the ,secretary may permit an ,,aco with fewer than #e1jjj participants by a de minimis number 7not to exceed #ajj7 to be eligible to continue to participate in cases where such fewer number does not negatively impact the ,,aco's participation in the program and the ,,aco meets other conditions to be so eligible4 7d7 ,payments for shared savings ,section #ahii7;d77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7d77#b77 is amended by adding at the end the following3 ,for years beginning on or after ,january #a1 #bjah1 the ,secretary may use a sliding scale to increase by up to #aj percentage points the appropriate percent otherwise applied under this paragraph for an ,,aco that achieves the median of quality performance standards1 or achieves quality improvement scores above such median1 established under subsection 7b77#c74 ,the ,secretary shall not decrease such appropriate percent otherwise applied to an ,,aco because of the application of an increase under the previous sentence for another ,,aco44 7e7 ,demonstration for allowing growth of ,,hcc scores ,section #ahii7;d77#a77;,b77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7d77#a77;,b77ii77 is amended by adding at the end the following3 ,in carrying out this subsection1 the ,secretary shall establish a #c-year demonstration project that develops and applies a methodology1 similar to the ,medicare ,advantage normalization factor applied under section #ahec7;a77#c71 that allows growth of ,,hcc scores for those who are continuously enrolled with an ,,aco4 ,the ,secretary shall submit to ,congress a report on the results of such demonstration project44 7f7 ,creating incentives for ,,aco development ,the ,secretary of ,health and ,human ,services may develop a mechanism to make permanent those ,,aco-related pilot programs1 including the ,advance ,payment ,,aco ,model1 that the ,secretary determines have been successful4 ,the ,secretary shall submit to ,congress a report on the mechanism and shall include in the report such recommendations1 including such changes in legislation1 as the ,secretary determines appropriate4