,i #aaeth ,,congress #b;d ,session ,h4 ,r4 #gabb ,,in ,,the ,,house ,,of ,,representatives ,november #ac1 #bjah,mr4 ,paulsen introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 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 ,,iii of the ,public ,health ,service ,act and titles ,,xi and ,,xviii of the ,social ,security ,act to accelerate the adoption of value-based payment and delivery arrangements among health care stakeholders intended to coordinate care1 improve patient outcomes1 share accountability1 or lower costs1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,shared ,accountability for ,improved ,patient ,outcomes ,act of #bjah4 #b4 ,value-based arrangements ,subpart ,i of part ,s of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;j et seq47 is amended by adding at the end the following new section3 #cii,,ll4 ,educational campaigns to encourage value-based health care delivery and quality improvement 7a7 ,in general ,beginning not later than ,january #a1 #bjai1 the ,secretary shall conduct annual education campaigns targeted to health care providers and payers to encourage the development of value-based arrangements 7as defined in section #aabh;,b7b77#e77;,b7 of the ,social ,security ,act7 that are designed to meet one or more of the following goals3 7#a7 ,promotion of accountability with respect to quality1 cost1 coordination1 and overall care of patient populations1 including patient populations that receive services which are reimbursed by various health care payers4 7#b7 ,improvement of management and coordination of care for patients through such arrangements approved by the parties to the arrangement4 7#c7 ,encouragement of investment in health care infrastructure and redesigned care processes for high-quality and efficient service delivery for patients1 including individuals entitled to benefits under part ,a of title ,,xviii of the ,social ,security ,act or enrolled under part ,b of such title1 such as appropriate reduction of costs or growth in expenditures for items and services provided to patients1 consistent with quality of care1 physician medical judgment1 and patient freedom of choice4 7b7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjai through #bjbc4 4 #c4 ,antikickback exception for value-based arrangements 7a7 ,in general ,section #aabh;,b7b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77 is amended by adding at the end the following new paragraph3 7#e7 7,a7 ,paragraphs 7#a7 and 7#b7 shall not apply to any remuneration exchanged under a value-based arrangement 7as defined in subparagraph 7,b77 directly or indirectly between1 among1 or on behalf of one or more parties paid under such arrangement4 7,b7 ,for purposes of this paragraph1 the term value-based arrangement means an arrangement that meets the following criteria3 7i7 ,the arrangement is set out in writing in advance of the execution of the arrangement and specifies the health care items and services covered by the arrangement4 7ii7 ,the arrangement is reasonably related to one or more of the goals described in section #cii,,ll7a7 of the ,public ,health ,service ,act4 7iii7 ,the arrangement-- 7,i7 is a value-based risk-sharing transaction 7as defined in subparagraph 7,c772 7,,ii7 provides for payment for items and services furnished under the arrangement between1 among1 or on behalf of one or more parties participating in a value-based risk-sharing network arrangement 7as defined in subparagraph 7,c772 or 7,,iii7 is another arrangement determined appropriate by the ,secretary4 7,c7 ,in this paragraph3 7i7 ,the term financial risk means upside or downside risk such that each party is eligible or liable for payment through a specified methodology that may include shared savings1 withholds1 or bonuses4 7ii7 ,the term value-based risk-sharing network arrangement means an arrangement under which an entity is established between or organized and operated by two or more parties 7which may include providers1 suppliers1 corporations1 or individuals7-- 7,i7 to accept capitation payments with respect to certain items and services furnished to an individual2 7,,ii7 to accept as payment for such items and services a predetermined percentage of the value-based risk-sharing network's revenue under the arrangement2 or 7,,iii7 to provide financial incentives to parties to the arrangement for purposes of achieving one or more of the goals described in section #cii,,ll7a7 of the ,public ,health ,service ,act through the use of-- 7aa7 arrangements under which such parties agree to a withhold of a significant amount of the compensation due them1 to be used to cover losses of the arrangement1 to cover losses of other parties within the arrangement1 to be returned to all parties to the arrangement if such parties meet their utilization management or cost-containment goals for a specified time period1 or to be distributed among all parties if the arrangement meets its utilization management or cost-containment goals for a specified time period2 7bb7 arrangements where such parties agree to preestablished cost or utilization targets and to subsequent significant financial rewards or penalties 7which may include a reduction in payments to downstream providers or suppliers in the network7 based on the performance of all such parties with respect to such targets2 or 7cc7 other mechanisms that demonstrate significant shared financial risk 7as defined in clause 7i77 or significantly assist such parties in meeting risk-sharing targets1 including shared-savings payments1 withholds1 or bonuses4 ,remuneration to parties who participate in a value-based risk-sharing network arrangement may be in-kind or monetary payments1 which may but are not required to place the parties to such arrangement at financial risk 7as defined in clause 7i774 7iii7 ,the term value-based risk-sharing transaction means a payment made under an arrangement under which each party agrees-- 7,i7 to contribute to the achievement of preidentified clinical or economic target metrics that are specifically tailored to improve patient outcomes or reduce the costs of health care delivery without negatively affecting patient outcomes2 7,,ii7 to implement processes or procedures that otherwise optimize the delivery1 efficiency1 or quality of patient-centered care2 and 7,,iii7 to predetermine the allocation of financial risk 7as defined in clause 7i77 assumed by each party based on the participant's relative contribution to the achievement of targeted outcomes4 4 7b7 ,effective date ,the amendment made by this section shall apply to arrangements entered into on or after the date of enactment of this ,act4 #d4 ,stark law exception for value-based arrangements 7a7 ,section #ahgg7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acienn7e77 is amended by adding at the end the following new paragraphs3 7#i7 ,value-based arrangements ,remuneration to a physician 7or an immediate family member of such physician7 paid under a value-based arrangement 7as defined in section #aabh;,b7b77#e77;,b774 4 7b7 ,effective date ,the amendment made by this section shall apply with respect to arrangements entered into on or after the date of enactment of this ,act4