I 
117TH CONGRESS 
1ST SESSION H. R. 4587 
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 participa-
tion in such program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 20, 2021 
Mr. WELCH (for himself, Ms. DELBENE, Mr. LAHOOD, and Mr. WENSTRUP) 
introduced the following bill; which was referred to the Committee on 
Ways and Means, and in addition to the Committee on Energy and Com-
merce, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Value in Health Care 
Act of 2021’’. 
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SEC. 2. ENCOURAGING PARTICIPATION IN THE MEDICARE 
SHARED SAVINGS PROGRAM. 
(a) INCREASING SHARED SAVINGS RATES FOR CER-
TAIN ACCOUNTABLE CARE ORGANIZATIONS.—Prior to the 
beginning of the first performance year (as defined in sec-
tion 425.20 of title 42, Code of Federal Regulations (or 
a successor regulation)) that begins after the date of the 
enactment of this Act, the Secretary of Health and 
Human Services shall revise section 425.605(d)(1) of title 
42, Code of Federal Regulations (or a successor regula-
tion), to provide that the shared savings rate for an ac-
countable care organization participating in— 
(1) Level A (as described in paragraph (i)(A) of 
such section) or Level B (as described in paragraph 
(ii)(A) of such section) of the BASIC track shall be 
at least 50 percent of all the savings under the up-
dated benchmark (as so described), as determined 
on the basis of such organization’s quality perform-
ance; 
(2) Level C (as described in paragraph (iii)(A) 
of such section) or Level D (as described in para-
graph (iv)(A) of such section) of the BASIC track 
shall be at least 55 percent of all the savings under 
the updated benchmark (as so described), as deter-
mined on the basis of such organization’s quality 
performance; or 
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(3) Level E (as described in paragraph (v)(A) 
of such section) shall be at least 60 percent of all 
the savings under the updated benchmark (as so de-
scribed), as determined on the basis of such organi-
zation’s quality performance. 
(b) 
MODIFYING
RISK
ADJUSTMENT
METHOD-
OLOGY.—Prior to the beginning of the first performance 
year (as defined for purposes of subsection (a)) that be-
gins after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall revise— 
(1) section 425.605(a)(1)(i) of title 42, Code of 
Federal Regulations, or a successor regulation, to 
provide that positive adjustments, if applicable, in 
prospective HCC risk scores (as applied for purposes 
of such section) are subject to a cap of no less than 
5 percent, and any negative adjustments, if applica-
ble, in prospective HCC risk scores (as applied for 
purposes of such section) shall be between 0 and 
negative 5 percent; 
(2) section 425.610(a)(2)(i) of title 42, Code of 
Federal Regulations, or a successor regulation, to 
provide that positive adjustments, if applicable, in 
prospective HCC risk scores (as applied for purposes 
of such section) are subject to a cap of no less than 
5 percent, and any negative adjustments, if applica-
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ble, in prospective HCC risk scores (as applied for 
purposes of such section) shall be between 0 and 
negative 5 percent; and 
(3) section 425.609(c)(3)(i)(A) of title 42, Code 
of Federal Regulations, or a successor regulation, to 
provide that the cap described in such section ref-
erences no less than 5 percent, and any negative ad-
justments, if applicable, in prospective HCC risk 
scores (as applied for purposes of such section) shall 
be between 0 and negative 5 percent. 
(c) REMOVING BARRIERS TO SHARED SAVINGS PRO-
GRAM PARTICIPATION.—Prior to the beginning of the first 
performance year (as defined for purposes of subsection 
(a)) that begins after the date of the enactment of this 
Act, the Secretary of Health and Human Services shall 
revise part 425 of title 42, Code of Federal Regulations, 
or any successor regulation, to— 
(1) eliminate any distinction in requirements in 
such part between a low revenue ACO and a high 
revenue ACO (as such terms are defined in section 
425.20 of title 42, Code of Federal Regulations, or 
a successor regulation) and, with respect to such a 
low revenue ACO or high revenue ACO and except 
as otherwise modified in this Act, apply the require-
ments of such part as such requirements applied to 
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low revenue ACOs on July 1, 2019, except that the 
Secretary of Health and Human Services may, if the 
Secretary determines appropriate, apply less strin-
gent requirements than those requirements that ap-
plied to low revenue ACOs as of such date; and 
(2) remove any provision requiring an account-
able 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 3 years in any program sub-
ject to the provisions of part 425 of title 42, Code 
of Federal Regulations, or any successor regulation, 
provided that such an organization shall be allowed 
to elect to participate in such two-sided risk models 
or models requiring repayment of such losses. 
(d) ENSURING
FAIR
AND
ACCURATE
BENCH-
MARKS.—Prior to the beginning of the first performance 
year (as defined for purposes of subsection (a)) that be-
gins after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall revise part 425 
of title 42, Code of Federal Regulations, to remove Medi-
care beneficiaries who are assigned to an accountable care 
organization from the methodology for calculating the re-
gional expenditures used to establish, adjust, and update 
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the benchmark expenditures for ACO performance periods 
beginning on or after July 1, 2019. 
SEC. 3. PROVIDING EDUCATIONAL AND TECHNICAL SUP-
PORT FOR THE MEDICARE SHARED SAVINGS 
PROGRAM. 
Section 1899 of the Social Security Act (42 U.S.C. 
1395jjj) is amended by adding at the end the following 
new subsection: 
‘‘(n) EDUCATIONAL AND TECHNICAL SUPPORT.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a program to assist eligible ACOs in meeting 
start-up and ongoing operational costs associated 
with establishing and participating in the shared 
savings program established under subsection (a). 
The Secretary shall establish through notice-and- 
comment rulemaking the requirements for participa-
tion and use of funds in the program established in 
the preceding sentence. 
‘‘(2) REDUCTION
IN
SHARED
SAVINGS
PAY-
MENTS.—The Secretary shall reduce any shared sav-
ings payment owed to an ACO under subsection (d) 
in an amount equal to any funds provided to such 
ACO under the program established under para-
graph (1).’’. 
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SEC. 4. ADVANCED PAYMENT MODEL INCENTIVE, PARTICI-
PATION, AND THRESHOLD MODIFICATIONS. 
(a) IN GENERAL.—Section 1833(z) of the Social Se-
curity Act (42 U.S.C. 1395l(z)) is amended— 
(1) in paragraph (1)(A), by striking ‘‘2024’’ 
and inserting ‘‘2030’’; and 
(2) in paragraph (2)(C)— 
(A) in clause (i), by striking ‘‘75 percent’’ 
and inserting ‘‘the applicable percent (as de-
fined 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 
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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
DE-
FINED.—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 per-
cent; and 
‘‘(II) for a subsequent year, a 
percent specified by the Secretary, but 
in no case less than the percent speci-
fied under this clause for the pre-
ceding year or more than 5 percent-
age points higher than the percent 
specified under this clause for such 
preceding year.’’. 
(b) PARTIAL QUALIFYING APM PARTICIPANT MODI-
FICATIONS.—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— 
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(1) in item (aa), by striking ‘‘50 percent was 
instead a reference to 40 percent’’ and inserting 
‘‘the applicable percent were instead a reference to 
10 percentage points less than the applicable per-
cent’’; 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’’. 
SEC. 5. ADDRESSING OVERLAP IN VALUE BASED CARE PRO-
GRAMS. 
(a) IN GENERAL.— 
(1) CMI.—Section 1115A(a)(5) of the Social 
Security Act (42 U.S.C. 1315a(a)(5)) is amended by 
adding at the end the following new sentence: ‘‘In 
establishing such limits, the Secretary shall take into 
account payment and service delivery models in 
progress in such geographic areas.’’. 
(2) REPEAL OF MEDICARE DUPLICATION PRO-
HIBITION.—Section 1899(b) of the Social Security 
Act (42 U.S.C. 1395jjj(b)) is amended by striking 
paragraph (4). 
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(b) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, 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 program. Such report shall include a de-
scription of and recommendations relating to— 
(1) any issues regarding the existence of mul-
tiple alternative payment model participation oppor-
tunities for health care providers; and 
(2) obstacles created by competing incentives 
with respect to alternative payment models. 
SEC. 6. STUDY ON RACIAL HEALTH DISPARITIES. 
Not later than 18 months after the date of enactment 
of this Act, 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 bene-
ficiaries receiving care from fee-for-service providers. Such 
report shall include, to the extent to which data is avail-
able, an analysis comparing the beneficiaries assigned to 
a provider participating in the Medicare shared savings 
program to beneficiaries not participating in Medicare Ad-
vantage and not assigned to any provider reimbursed 
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under an alternative payment model with respect to at 
least the following individual outcomes measures: 
(1) Control of hypertension. 
(2) Colorectal cancer screenings. 
(3) Influenza immunization. 
(4) Completion of an annual wellness visit. 
(5) Breast cancer screening. 
(6) Screening for depression and performance 
of a follow-up plan (if appropriate). 
(7) Hemoglobin A1c control. 
(8) Emergency room visits. 
(9) Such other measures as the Comptroller 
General determines appropriate. 
Æ 
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