II 

117TH CONGRESS 

2D SESSION S. 5249 

To amend title XVIII of the Social Security Act to encourage participation 

in advanced payment models. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 14, 2022 

Mr. 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 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Preserving Patient Ac5 cess to Value-Based Care Act’’. 

6 SEC. 2. ADVANCED PAYMENT MODEL INCENTIVE, PARTICI7 PATION, AND THRESHOLD MODIFICATIONS. 

8 (a) IN GENERAL.—Section 1833(z) of the Social Se9 curity Act (42 U.S.C. 1395l(z)) is amended— 


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•S 5249 IS

1 (1) in paragraph (1)(A), by striking ‘‘2024’’ 

2 and inserting ‘‘2026’’; and 

3 (2) in paragraph (2)(C)— 

4 (A) in clause (i), by striking ‘‘75 percent’’ 

5 and inserting ‘‘the applicable percent (as de6 fined in clause (iv)) for such year’’; 

7 (B) in clause (ii)(I)— 

8 (i) in the matter preceding item (aa), 

9 by striking ‘‘75 percent’’ and inserting 

10 ‘‘the applicable percent (as defined in 

11 clause (iv)) for such year’’; and 

12 (ii) in item (bb)— 

13 (I) by striking ‘‘and other than 

14 payments made under title XIX’’ and 

15 inserting ‘‘other than payments made 

16 under title XIX’’; and 

17 (II) by striking ‘‘State program 

18 under that title),’’ and inserting 

19 ‘‘State program under that title, and 

20 other than payments made by payers 

21 in which no payment or program 

22 meeting the requirements described in 

23 clause (iii)(II) is available from the 

24 payer for participation by the eligible 

25 professional)’’; and 


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1 (C) by adding at the end the following new 

2 clause: 

3 ‘‘(iv) APPLICABLE PERCENT DE4 FINED.—For purposes of clauses (i) and 

5 (ii), the term ‘applicable percent’ means— 

6 ‘‘(I) for 2025, a percent specified 

7 by the Secretary, but in no case less 

8 than 50 percent or more than 55 per9 cent; and 

10 ‘‘(II) for a subsequent year, a 

11 percent specified by the Secretary, but 

12 in no case less than the percent speci13 fied under this clause for the pre14 ceding year or more than 5 percent15 age points higher than the percent 

16 specified under this clause for such 

17 preceding year.’’. 

18 (b) PARTIAL QUALIFYING APM PARTICIPANT MODI19 FICATIONS.—Section 1848(q)(1)(C)(iii)(III) of the Social 

20 Security Act (42 U.S.C. 1395w–4(q)(1)(C)(iii)(III)) is 

21 amended— 

22 (1) in item (aa), by striking ‘‘75 percent was 

23 instead a reference to 50 percent’’ and inserting 

24 ‘‘the applicable percent was instead a reference to 


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1 10 percentage points less than the applicable per2 cent’’; and 

3 (2) in item (bb)— 

4 (A) by striking ‘‘75 percent’’ and inserting 

5 ‘‘the applicable percent’’; 

6 (B) by striking ‘‘50 percent’’ and inserting 

7 ‘‘10 percentage points less than the applicable 

8 percent’’. 

Æ 


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