SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Shared Accountability 
for Improved Patient Outcomes Act of 2018’’. 
SEC. 2. VALUE-BASED ARRANGEMENTS. 
Subpart I of part S of title III of the Public Health 
Service Act (42 U.S.C. 280j et seq.) is amended by adding 
at the end the following new section: 
‘‘SEC. 399LL. EDUCATIONAL CAMPAIGNS TO ENCOURAGE 
VALUE-BASED HEALTH CARE DELIVERY AND 
QUALITY IMPROVEMENT. 
‘‘(a) IN GENERAL.—Beginning not later than Janu-
ary 1, 2019, the Secretary shall conduct annual education 
campaigns targeted to health care providers and payers 
to encourage the development of value-based arrange-
ments (as defined in section 1128B(b)(5)(B) of the Social 
Security Act) that are designed to meet one or more of 
the following goals: 
‘‘(1) Promotion of accountability with respect to 
quality, cost, coordination, and overall care of pa-
tient populations, including patient populations that 
receive services which are reimbursed by various 
health care payers. 
‘‘(2) Improvement of management and coordi-
nation of care for patients through such arrange-
ments approved by the parties to the arrangement. 
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‘‘(3) Encouragement of investment in health 
care infrastructure and redesigned care processes for 
high-quality and efficient service delivery for pa-
tients, including individuals entitled to benefits 
under part A of title XVIII of the Social Security 
Act or enrolled under part B of such title, such as 
appropriate reduction of costs or growth in expendi-
tures for items and services provided to patients, 
consistent with quality of care, physician medical 
judgment, and patient freedom of choice. 
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2019 through 2023.’’. 
SEC. 3. ANTIKICKBACK EXCEPTION FOR VALUE-BASED AR-
RANGEMENTS. 
(a) IN GENERAL.—Section 1128B(b) of the Social 
Security Act (42 U.S.C. 1320a–7b(b)) is amended by add-
ing at the end the following new paragraph: 
‘‘(5)(A) Paragraphs (1) and (2) shall not apply to 
any remuneration exchanged under a value-based arrange-
ment (as defined in subparagraph (B)) directly or indi-
rectly between, among, or on behalf of one or more parties 
paid under such arrangement. 
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‘‘(B) For purposes of this paragraph, the term ‘value- 
based arrangement’ means an arrangement that meets the 
following criteria: 
‘‘(i) The arrangement is set out in writing in 
advance of the execution of the arrangement and 
specifies the health care items and services covered 
by the arrangement. 
‘‘(ii) The arrangement is reasonably related to 
one or more of the goals described in section 
399LL(a) of the Public Health Service Act. 
‘‘(iii) The arrangement— 
‘‘(I) is a value-based risk-sharing trans-
action (as defined in subparagraph (C)); 
‘‘(II) provides for payment for items and 
services furnished under the arrangement be-
tween, among, or on behalf of one or more par-
ties participating in a value-based risk-sharing 
network arrangement (as defined in subpara-
graph (C)); or 
‘‘(III) is another arrangement determined 
appropriate by the Secretary. 
‘‘(C) In this paragraph: 
‘‘(i) The term ‘financial risk’ means upside or 
downside risk such that each party is eligible or lia-
ble for payment through a specified methodology 
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that may include shared savings, withholds, or bo-
nuses. 
‘‘(ii) The term ‘value-based risk-sharing net-
work arrangement’ means an arrangement under 
which an entity is established between or organized 
and operated by two or more parties (which may in-
clude providers, suppliers, corporations, or individ-
uals)— 
‘‘(I) to accept capitation payments with re-
spect to certain items and services furnished to 
an individual; 
‘‘(II) to accept as payment for such items 
and services a predetermined percentage of the 
value-based 
risk-sharing 
network’s 
revenue 
under the arrangement; or 
‘‘(III) to provide financial incentives to 
parties to the arrangement for purposes of 
achieving one or more of the goals described in 
section 399LL(a) of the Public Health Service 
Act through the use of— 
‘‘(aa) arrangements under which such 
parties agree to a withhold of a significant 
amount of the compensation due them, to 
be used to cover losses of the arrangement, 
to cover losses of other parties within the 
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arrangement, to be returned to all parties 
to the arrangement if such parties meet 
their utilization management or cost-con-
tainment goals for a specified time period, 
or to be distributed among all parties if 
the arrangement meets its utilization man-
agement or cost-containment goals for a 
specified time period; 
‘‘(bb) arrangements where such par-
ties agree to preestablished cost or utiliza-
tion targets and to subsequent significant 
financial rewards or penalties (which may 
include a reduction in payments to down-
stream providers or suppliers in the net-
work) based on the performance of all such 
parties with respect to such targets; or 
‘‘(cc) other mechanisms that dem-
onstrate significant shared financial risk 
(as defined in clause (i)) or significantly 
assist such parties in meeting risk-sharing 
targets, 
including 
shared-savings 
pay-
ments, withholds, or bonuses. 
Remuneration to parties who participate in a value- 
based risk-sharing network arrangement may be in- 
kind or monetary payments, which may but are not 
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required to place the parties to such arrangement at 
financial risk (as defined in clause (i)). 
‘‘(iii) The term ‘value-based risk-sharing trans-
action’ means a payment made under an arrange-
ment under which each party agrees— 
‘‘(I) to contribute to the achievement of 
preidentified clinical or economic target metrics 
that are specifically tailored to improve patient 
outcomes or reduce the costs of health care de-
livery without negatively affecting patient out-
comes; 
‘‘(II) to implement processes or procedures 
that otherwise optimize the delivery, efficiency, 
or quality of patient-centered care; and 
‘‘(III) to predetermine the allocation of fi-
nancial risk (as defined in clause (i)) assumed 
by each party based on the participant’s relative 
contribution to the achievement of targeted out-
comes.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to arrangements entered into on 
or after the date of enactment of this Act. 
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SEC. 4. STARK LAW EXCEPTION FOR VALUE-BASED AR-
RANGEMENTS. 
(a) Section 1877(e) of the Social Security Act (42 
U.S.C. 1395nn(e)) is amended by adding at the end the 
following new paragraphs: 
‘‘(9) VALUE-BASED
ARRANGEMENTS.—Remu-
neration to a physician (or an immediate family 
member of such physician) paid under a value-based 
arrangement 
(as 
defined 
in 
section 
1128B(b)(5)(B)).’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply with respect to arrangements en-
tered into on or after the date of enactment of this Act. 
Æ 
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