I 

116TH CONGRESS 

2D SESSION H. R. 7791 

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 program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 24, 2020 

Mr. WELCH (for himself, Ms. DELBENE, and MR. LAHOOD) introduced the 

following bill; which was referred to the Committee on Ways and Means, 

and in addition to the Committee on Energy and Commerce, for a period 

to be subsequently determined by the Speaker, 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 

program, and for other purposes. 

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 ‘‘Value in Health Care 

5 Act of 2020’’. 


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1 SEC. 2. ENCOURAGING PARTICIPATION IN THE MEDICARE 

2 SHARED SAVINGS PROGRAM. 

3 (a) INCREASING SHARED SAVINGS RATES FOR CER4 TAIN ACCOUNTABLE CARE ORGANIZATIONS.—Prior to the 

5 beginning of the first performance year (as defined in sec6 tion 425.20 of title 42, Code of Federal Regulations (or 

7 a successor regulation)) that begins after the date of the 

8 enactment of this Act, the Secretary of Health and 

9 Human Services shall revise section 425.605(d)(1) of title 

10 42, Code of Federal Regulations (or a successor regula11 tion), to provide that the shared savings rate for an ac12 countable care organization participating in— 

13 (1) Level A (as described in paragraph (i)(A) of 

14 such section) or Level B (as described in paragraph 

15 (ii)(A) of such section) of the BASIC track shall be 

16 at least 50 percent of all the savings under the up17 dated benchmark (as so described), as determined 

18 on the basis of such organization’s quality perform19 ance; 

20 (2) Level C (as described in paragraph (iii)(A) 

21 of such section) or Level D (as described in para22 graph (iv)(A) of such section) of the BASIC track 

23 shall be at least 55 percent of all the savings under 

24 the updated benchmark (as so described), as deter25 mined on the basis of such organization’s quality 

26 performance; or 


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1 (3) Level E (as described in paragraph (v)(A) 

2 of such section) shall be at least 60 percent of all 

3 the savings under the updated benchmark (as so de4 scribed), as determined on the basis of such organi5 zation’s quality performance. 

6 (b) MODIFYING RISK ADJUSTMENT METHOD7 OLOGY.—Prior to the beginning of the first performance 

8 year (as defined for purposes of subsection (a)) that be9 gins after the date of the enactment of this Act, the Sec10 retary of Health and Human Services shall revise— 

11 (1) section 425.605(a)(1)(i) of title 42, Code of 

12 Federal Regulations, or a successor regulation, to 

13 provide that positive adjustments, if applicable, in 

14 prospective HCC risk scores (as applied for purposes 

15 of such section) are subject to a cap of no less than 

16 5 percent, and any negative adjustments, if applica17 ble, in prospective HCC risk scores (as applied for 

18 purposes of such section) shall be between 0 and 

19 negative 5 percent; 

20 (2) section 425.610(a)(2)(i) of title 42, Code of 

21 Federal Regulations, or a successor regulation, to 

22 provide that positive adjustments, if applicable, in 

23 prospective HCC risk scores (as applied for purposes 

24 of such section) are subject to a cap of no less than 

25 5 percent, and any negative adjustments, if applicaVerDate Sep 11 2014 00:04 Aug 26, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H7791.IH H7791

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1 ble, in prospective HCC risk scores (as applied for 

2 purposes of such section) shall be between 0 and 

3 negative 5 percent; and 

4 (3) section 425.609(c)(3)(i)(A) of title 42, Code 

5 of Federal Regulations, or a successor regulation, to 

6 provide that the cap described in such section ref7 erences no less than 5 percent, and any negative ad8 justments, if applicable, in prospective HCC risk 

9 scores (as applied for purposes of such section) shall 

10 be between 0 and negative 5 percent. 

11 (c) REMOVING BARRIERS TO SHARED SAVINGS PRO12 GRAM PARTICIPATION.—Prior to the beginning of the first 

13 performance year (as defined for purposes of subsection 

14 (a)) that begins after the date of the enactment of this 

15 Act, the Secretary of Health and Human Services shall 

16 revise part 425 of title 42, Code of Federal Regulations, 

17 or any successor regulation, to— 

18 (1) eliminate any distinction in requirements in 

19 such part between a low revenue ACO and a high 

20 revenue ACO (as such terms are defined in section 

21 425.20 of title 42, Code of Federal Regulations, or 

22 a successor regulation) and, with respect to such a 

23 low revenue ACO or high revenue ACO and except 

24 as otherwise modified in this Act, apply the require25 ments of such part as such requirements applied to 


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1 low revenue ACOs on July 1, 2019, except that the 

2 Secretary of Health and Human Services may, if the 

3 Secretary determines appropriate, apply less strin4 gent requirements than those requirements that ap5 plied to low revenue ACOs as of such date; and 

6 (2) remove any provision requiring an account7 able care organization to assume responsibility for 

8 repayment of any shared losses or participate in a 

9 two-sided risk model before the organization has 

10 participated for at least 3 years in any program sub11 ject to the provisions of part 425 of title 42, Code 

12 of Federal Regulations, or any successor regulation, 

13 provided that such an organization shall be allowed 

14 to elect to participate in such two-sided risk models 

15 or models requiring repayment of such losses. 

16 (d) ENSURING FAIR AND ACCURATE BENCH17 MARKS.—Prior to the beginning of the first performance 

18 year (as defined for purposes of subsection (a)) that be19 gins after the date of the enactment of this Act, the Sec20 retary of Health and Human Services shall revise part 425 

21 of title 42, Code of Federal Regulations, to remove Medi22 care beneficiaries who are assigned to an accountable care 

23 organization from the methodology for calculating the re24 gional expenditures used to establish, adjust, and update 


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1 the benchmark expenditures for ACO performance periods 

2 beginning on or after July 1, 2019. 

3 SEC. 3. PROVIDING EDUCATIONAL AND TECHNICAL SUP4 PORT FOR THE MEDICARE SHARED SAVINGS 

5 PROGRAM. 

6 Section 1899 of the Social Security Act (42 U.S.C. 

7 1395jjj) is amended by adding at the end the following 

8 new subsection: 

9 ‘‘(n) EDUCATIONAL AND TECHNICAL SUPPORT.— 

10 ‘‘(1) IN GENERAL.—The Secretary shall estab11 lish a program to assist eligible ACOs in meeting 

12 start-up and ongoing operational costs associated 

13 with establishing and participating in the shared 

14 savings program established under subsection (a). 

15 The Secretary shall establish through notice-and16 comment rulemaking the requirements for participa17 tion and use of funds in the program established in 

18 the preceding sentence. 

19 ‘‘(2) REDUCTION IN SHARED SAVINGS PAY20 MENTS.—The Secretary shall reduce any shared sav21 ings payment owed to an ACO under subsection (d) 

22 in an amount equal to any funds provided to such 

23 ACO under the program established under para24 graph (1).’’. 


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1 SEC. 4. ADVANCED PAYMENT MODEL INCENTIVE, PARTICI2 PATION, AND THRESHOLD MODIFICATIONS. 

3 (a) IN GENERAL.—Section 1833(z) of the Social Se4 curity Act (42 U.S.C. 1395l(z)) is amended— 

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

6 and inserting ‘‘2030’’; and 

7 (2) in paragraph (2)— 

8 (A) in subparagraph (B)— 

9 (i) by striking the header and insert10 ing ‘‘2021 AND SUBSEQUENT YEARS’’; 

11 (ii) in the matter preceding clause (i), 

12 by striking ‘‘2021 and 2022’’ and inserting 

13 ‘‘2021 or a subsequent year’’; 

14 (iii) in clause (i), by striking ‘‘50 per15 cent’’ and ‘‘the applicable percent (as de16 fined in clause (iv)) for such year’’; 

17 (iv) in clause (ii)(I)— 

18 (I) in the matter preceding item 

19 (aa), by striking ‘‘50 percent’’ and in20 serting ‘‘the applicable percent (as de21 fined in clause (iv)) for such year’’; 

22 and 

23 (II) in item (bb)— 

24 (aa) by striking ‘‘and other 

25 than payments made under title 

26 XIX’’ and inserting ‘‘other than 


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1 payments made under title XIX’’; 

2 and 

3 (bb) by striking ‘‘State pro4 gram under that title),’’ and in5 serting ‘‘State program under 

6 that title, and other than pay7 ments made by payers in which 

8 no payment or program meeting 

9 the requirements described in 

10 clause (iii)(II) is available from 

11 the payer for participation by the 

12 eligible professional)’’; and 

13 (v) by adding at the end the following 

14 new clause: 

15 ‘‘(iv) APPLICABLE PERCENT DE16 FINED.—For purposes of clauses (i) and 

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

18 ‘‘(I) for 2021, 50 percent; and 

19 ‘‘(II) for a subsequent year, a 

20 percent specified by the Secretary, but 

21 in no case less than the percent speci22 fied under this clause for the pre23 ceding year or more than 5 percent24 age points higher than the percent 


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1 specified under this clause for such 

2 preceding year.’’; 

3 (B) by striking subparagraph (C); and 

4 (C) by redesignating subparagraph (D) as 

5 subparagraph (C). 

6 (b) PARTIAL QUALIFYING APM PARTICIPANT MODI7 FICATIONS.—Section 1848(q)(1)(C)(iii) of the Social Se8 curity Act (42 U.S.C. 1395w–4(q)(1)(C)(iii)) is amend9 ed— 

10 (1) in subclause (I), by adding ‘‘and’’ at the 

11 end; 

12 (2) in subclause (II)— 

13 (A) in the matter preceding item (aa), by 

14 striking ‘‘2022’’ and inserting ‘‘subsequent 

15 years’’; 

16 (B) in item (aa), by striking ‘‘50 percent 

17 was instead a reference to 40 percent’’ and in18 serting ‘‘the applicable percent were instead a 

19 reference to 10 percentage points less than the 

20 applicable percent’’; and 

21 (C) in item (bb)— 

22 (i) by striking ‘‘50 percent’’ and in23 serting ‘‘the applicable percent’’; and 


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1 (ii) by striking ‘‘40 percent’’ and in2 serting ‘‘10 percentage points less than the 

3 applicable percent’’; and 

4 (3) by striking subclause (III). 

5 (c) EFFECTIVE DATE.—The amendments made by 

6 this section shall apply with respect to years beginning on 

7 or after January 1, 2021. 

8 SEC. 5. ADDRESSING OVERLAP IN VALUE BASED CARE PRO9 GRAMS. 

10 (a) IN GENERAL.— 

11 (1) CMI.—Section 1115A(a)(5) of the Social 

12 Security Act (42 U.S.C. 1315a(a)(5)) is amended by 

13 adding at the end the following new sentence: ‘‘In 

14 establishing such limits, the Secretary shall take into 

15 account payment and service delivery models in 

16 progress in such geographic areas.’’. 

17 (2) REPEAL OF MEDICARE DUPLICATION PRO18 HIBITION.—Section 1899(b) of the Social Security 

19 Act (42 U.S.C. 1395jjj(b)) is amended by striking 

20 paragraph (4). 

21 (b) REPORT.—Not later than 1 year after the date 

22 of the enactment of this Act, the Secretary of Health and 

23 Human Services shall conduct an assessment and submit 

24 to Congress a report on alternative payment model overlap 


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1 in the Medicare program. Such report shall include a de2 scription of and recommendations relating to— 

3 (1) any issues regarding the existence of mul4 tiple alternative payment model participation oppor5 tunities for health care providers; and 

6 (2) obstacles created by competing incentives 

7 with respect to alternative payment models. 

Æ 


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