S. 5249 — Introduced in Senate

II 117th CONGRESS 2d Session S. 5249 IN THE SENATE OF THE UNITED STATES December 14, 2022Mr. Barrasso (for himself and Mr. Whitehouse) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to encourage participation in advanced payment models. 1. Short title This Act may be cited as the Preserving Patient Access to Value-Based Care Act. 2. Advanced payment model incentive, participation, and threshold modifications (a) In general Section 1833(z) of the Social Security Act (42 U.S.C. 1395l(z)) is amended— (1) in paragraph (1)(A), by striking 2024 and inserting 2026; and (2) in paragraph (2)(C)— (A) in clause (i), by striking 75 percent and inserting the applicable percent (as defined in clause (iv)) for such year; (B) in clause (ii)(I)— (i) in the matter preceding item (aa), by striking 75 percent and inserting the applicable percent (as defined in clause (iv)) for such year; and (ii) in item (bb)— (I) by striking and other than payments made under title XIX and inserting other than payments made under title XIX; and (II) by striking State program under that title), and inserting State program under that title, and other than payments made by payers in which no payment or program meeting the requirements described in clause (iii)(II) is available from the payer for participation by the eligible professional); and (C) by adding at the end the following new clause: (iv) Applicable percent defined For purposes of clauses (i) and (ii), the term applicable percent means— (I) for 2025, a percent specified by the Secretary, but in no case less than 50 percent or more than 55 percent; and (II) for a subsequent year, a percent specified by the Secretary, but in no case less than the percent specified under this clause for the preceding year or more than 5 percentage points higher than the percent specified under this clause for such preceding year. . (b) Partial qualifying apm participant modifications Section 1848(q)(1)(C)(iii)(III) of the Social Security Act (42 U.S.C. 1395w–4(q)(1)(C)(iii)(III)) is amended— (1) in item (aa), by striking 75 percent was instead a reference to 50 percent and inserting the applicable percent was instead a reference to 10 percentage points less than the applicable percent; and (2) in item (bb)— (A) by striking 75 percent and inserting the applicable percent; (B) by striking 50 percent and inserting 10 percentage points less than the applicable percent.