,i #aagth ,,congress #ast ,session ,h4 ,r4 #dehg ,,in ,,the ,,house ,,of ,,representatives ,july #bj1 #bjba,mr4 ,welch 7for himself1 ,ms4 ,del,bene1 ,mr4 ,la,hood1 and ,mr4 ,wenstrup7 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 direct the ,secretary of ,health and ,human ,services to revise certain regulations in relation to the ,medicare shared savings program and other advanced alternative payment arrangements to encourage participation in such program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,value in ,health ,care ,act of #bjba4 #b4 ,encouraging participation in the ,medicare shared savings program 7a7 ,increasing shared savings rates for certain accountable care organizations ,prior to the beginning of the first performance year 7as defined in section #dbe4bj of title #db1 ,code of ,federal ,regulations 7or a successor regulation77 that begins after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall revise section #dbe4fje7;d77#a7 of title #db1 ,code of ,federal ,regulations 7or a successor regulation71 to provide that the shared savings rate for an accountable care organization participating in-- 7#a7 ,level ,a 7as described in paragraph 7i77,a7 of such section7 or ,level ,b 7as described in paragraph 7ii77,a7 of such section7 of the ,,basic track shall be at least #ej percent of all the savings under the updated benchmark 7as so described71 as determined on the basis of such organization's quality performance2 7#b7 ,level ,c 7as described in paragraph 7iii77,a7 of such section7 or ,level ,d 7as described in paragraph 7iv77,a7 of such section7 of the ,,basic track shall be at least #ee percent of all the savings under the updated benchmark 7as so described71 as determined on the basis of such organization's quality performance2 or 7#c7 ,level ,e 7as described in paragraph 7v77,a7 of such section7 shall be at least #fj percent of all the savings under the updated benchmark 7as so described71 as determined on the basis of such organization's quality performance4 7b7 ,modifying risk adjustment methodology ,prior to the beginning of the first performance year 7as defined for purposes of subsection 7a77 that begins after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall revise-- 7#a7 section #dbe4fje7;a77#a77;i7 of title #db1 ,code of ,federal ,regulations1 or a successor regulation1 to provide that positive adjustments1 if applicable1 in prospective ,,hcc risk scores 7as applied for purposes of such section7 are subject to a cap of no less than #e percent1 and any negative adjustments1 if applicable1 in prospective ,,hcc risk scores 7as applied for purposes of such section7 shall be between #j and negative #e percent2 7#b7 section #dbe4faj7;a77#b77;i7 of title #db1 ,code of ,federal ,regulations1 or a successor regulation1 to provide that positive adjustments1 if applicable1 in prospective ,,hcc risk scores 7as applied for purposes of such section7 are subject to a cap of no less than #e percent1 and any negative adjustments1 if applicable1 in prospective ,,hcc risk scores 7as applied for purposes of such section7 shall be between #j and negative #e percent2 and 7#c7 section #dbe4fji7;c77#c77;i77,a7 of title #db1 ,code of ,federal ,regulations1 or a successor regulation1 to provide that the cap described in such section references no less than #e percent1 and any negative adjustments1 if applicable1 in prospective ,,hcc risk scores 7as applied for purposes of such section7 shall be between #j and negative #e percent4 7c7 ,removing barriers to shared savings program participation ,prior to the beginning of the first performance year 7as defined for purposes of subsection 7a77 that begins after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall revise part #dbe of title #db1 ,code of ,federal ,regulations1 or any successor regulation1 to-- 7#a7 eliminate any distinction in requirements in such part between a low revenue ,,aco and a high revenue ,,aco 7as such terms are defined in section #dbe4bj of title #db1 ,code of ,federal ,regulations1 or a successor regulation7 and1 with respect to such a low revenue ,,aco or high revenue ,,aco and except as otherwise modified in this ,act1 apply the requirements of such part as such requirements applied to low revenue ,a,c,os on ,july #a1 #bjai1 except that the ,secretary of ,health and ,human ,services may1 if the ,secretary determines appropriate1 apply less stringent requirements than those requirements that applied to low revenue ,a,c,os as of such date2 and 7#b7 remove any provision requiring an accountable care organization to assume responsibility for repayment of any shared losses or participate in a two-sided risk model before the organization has participated for at least #c years in any program subject to the provisions of part #dbe of title #db1 ,code of ,federal ,regulations1 or any successor regulation1 provided that such an organization shall be allowed to elect to participate in such two-sided risk models or models requiring repayment of such losses4 7d7 ,ensuring fair and accurate benchmarks ,prior to the beginning of the first performance year 7as defined for purposes of subsection 7a77 that begins after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall revise part #dbe of title #db1 ,code of ,federal ,regulations1 to remove ,medicare beneficiaries who are assigned to an accountable care organization from the methodology for calculating the regional expenditures used to establish1 adjust1 and update the benchmark expenditures for ,,aco performance periods beginning on or after ,july #a1 #bjai4 #c4 ,providing educational and technical support for the ,medicare shared savings program ,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 7n7 ,educational and technical support 7#a7 ,in general ,the ,secretary shall establish a program to assist eligible ,a,c,os in meeting start-up and ongoing operational costs associated with establishing and participating in the shared savings program established under subsection 7a74 ,the ,secretary shall establish through notice-and-comment rulemaking the requirements for participation and use of funds in the program established in the preceding sentence4 7#b7 ,reduction in shared savings payments ,the ,secretary shall reduce any shared savings payment owed to an ,,aco under subsection 7d7 in an amount equal to any funds provided to such ,,aco under the program established under paragraph 7#a74 4 #d4 ,advanced payment model incentive1 participation1 and threshold modifications 7a7 ,in general ,section #ahcc7z7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7z77 is amended-- 7#a7 in paragraph 7#a77;,a71 by striking #bjbd and inserting #bjcj2 and 7#b7 in paragraph 7#b77;,c7-- 7,a7 in clause 7i71 by striking #ge percent and inserting the applicable percent 7as defined in clause 7iv77 for such year2 7,b7 in clause 7ii77,i7-- 7i7 in the matter preceding item 7aa71 by striking #ge percent and inserting the applicable percent 7as defined in clause 7iv77 for such year2 and 7ii7 in item 7bb7-- 7,i7 by striking and other than payments made under title ,,xix and inserting other than payments made under title ,,xix2 and 7,,ii7 by striking ,state program under that title71 and inserting ,state program under that title1 and other than payments made by payers in which no payment or program meeting the requirements described in clause 7iii77,,ii7 is available from the payer for participation by the eligible professional72 and 7,c7 by adding at the end the following new clause3 7iv7 ,applicable percent defined ,for purposes of clauses 7i7 and 7ii71 the term applicable percent means-- 7,i7 for #bjbe1 a percent specified by the ,secretary1 but in no case less than #ej percent or more than #ee percent2 and 7,,ii7 for a subsequent year1 a percent specified by the ,secretary1 but in no case less than the percent specified under this clause for the preceding year or more than #e percentage points higher than the percent specified under this clause for such preceding year4 4 7b7 ,partial qualifying ,,apm participant modifications ,section #ahdh7q77#a77;,c77iii77,,iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77#a77;,c77iii77,,iii77 is amended-- 7#a7 in item 7aa71 by striking #ej percent was instead a reference to #dj percent and inserting the applicable percent were instead a reference to #aj percentage points less than the applicable percent2 and 7#b7 in item 7bb7-- 7,a7 by striking #ge percent and inserting the applicable percent2 7,b7 by striking #ej percent and inserting #aj percentage points less than the applicable percent4 #e4 ,addressing overlap in value based care programs 7a7 ,in general 7#a7 ,,cmi ,section #aaae;,a7a77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7a77#e77 is amended by adding at the end the following new sentence3 ,in establishing such limits1 the ,secretary shall take into account payment and service delivery models in progress in such geographic areas44 7#b7 ,repeal of ,medicare duplication prohibition ,section #ahii7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7b77 is amended by striking paragraph 7#d74 7b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall conduct an assessment and submit to ,congress a report on alternative payment model overlap in the ,medicare program4 ,such report shall include a description of and recommendations relating to-- 7#a7 any issues regarding the existence of multiple alternative payment model participation opportunities for health care providers2 and 7#b7 obstacles created by competing incentives with respect to alternative payment models4 #f4 ,study on racial health disparities ,not later than #ah months after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the appropriate committees of ,congress a report on health outcomes and racial disparities among ,medicare beneficiaries assigned to providers reimbursed under alternative payment models compared to such beneficiaries receiving care from fee-for-service providers4 ,such report shall include1 to the extent to which data is available1 an analysis comparing the beneficiaries assigned to a provider participating in the ,medicare shared savings program to beneficiaries not participating in ,medicare ,advantage and not assigned to any provider reimbursed under an alternative payment model with respect to at least the following individual outcomes measures3 7#a7 ,control of hypertension4 7#b7 ,colorectal cancer screenings4 7#c7 ,influenza immunization4 7#d7 ,completion of an annual wellness visit4 7#e7 ,breast cancer screening4 7#f7 ,screening for depression and performance of a follow-up plan 7if appropriate74 7#g7 ,hemoglobin ,a#a;c control4 7#h7 ,emergency room visits4 7#i7 ,such other measures as the ,comptroller ,general determines appropriate4