I 
113TH CONGRESS 
2D SESSION 
H. R. 5558 
To amend title XVIII of the Social Security Act to improve the Medicare 
accountable care organization (ACO) program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 18, 2014 
Mrs. BLACK (for herself and Mr. WELCH) 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 provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to improve 
the Medicare accountable care organization (ACO) pro-
gram, 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 ‘‘ACO Improvement Act 
of 2014’’. 
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SEC. 2. MEDICARE ACO PROGRAM IMPROVEMENTS. 
(a) IN GENERAL.—Section 1899 of the Social Secu-
rity Act (42 U.S.C. 1395jjj) is amended by adding at the 
end the following new subsection: 
‘‘(l) IMPROVING OUTCOMES THROUGH GREATER 
BENEFICIARY ENGAGEMENT.— 
‘‘(1) USE OF BENEFICIARY INCENTIVES.—Sub-
ject to approval of the Secretary and in the case of 
an ACO that has elected a two-sided risk model (as 
provided for under regulations), the Secretary shall 
permit the ACO— 
‘‘(A) to reduce or eliminate cost-sharing 
otherwise applicable under part B for some or 
all primary care services (as identified by the 
ACO) furnished by health care professionals 
(including, as applicable, professionals fur-
nishing services through a rural health clinic or 
Federally qualified health center) within the 
network of the ACO; and 
‘‘(B) to develop additional incentive pro-
grams to encourage patient engagement and 
participation in their own wellness. 
The cost of the such incentives shall be borne by the 
ACO and shall not affect the payments under sub-
section (d). 
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‘‘(2) FOSTERING STRONGER PATIENT-PROVIDER 
TIES.— 
‘‘(A) PROVIDING
PROSPECTIVE
ASSIGN-
MENT OF BENEFICIARIES.— 
‘‘(i) IN
GENERAL.—In carrying out 
subsection (c), the Secretary shall provide 
for a prospective assignment of Medicare 
fee-for-service beneficiaries before the be-
ginning of a year to an ACO and primary 
care ACO professional in accordance with 
the practice under this section for Pioneer 
ACOs, subject to clause (ii). 
‘‘(ii) CHANGING PRIMARY CARE ACO 
PROFESSIONALS.—An ACO shall permit a 
beneficiary to select the primary care ACO 
professional within the ACO to which the 
beneficiary is assigned. 
‘‘(B) INCLUSION OF ACO INFORMATION IN 
WELCOME
TO
MEDICARE
VISIT
AND
ANNUAL 
WELLNESS VISITS.—The Secretary shall require 
a primary care ACO professional to include, as 
part of the initial preventive physical examina-
tion under section 1861(ww)(1) or personalized 
prevention 
plan 
services 
under 
section 
1861(hhh)(1) for a Medicare fee-for-service 
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beneficiary assigned to that professional under 
this section, to provide the beneficiary with in-
formation concerning the ACO program under 
this section, including information on any cost- 
sharing reductions allowed under this section. 
‘‘(C) STAKEHOLDER ADVISORY GROUP.— 
The Secretary shall form a stakeholder group, 
including representatives of ACOs, health care 
providers (including ACO professionals), Medi-
care beneficiaries, and ACO experts, to advise 
the Secretary with recommendations to improve 
the process of ACO-to-beneficiary communica-
tion. 
‘‘(3) MOVING FROM VOLUME TO VALUE.— 
‘‘(A) REGULATORY
RELIEF
FOR
MOVING 
TO TWO-SIDED RISK.—In the case of an ACO 
that has elected a two-sided risk model (as de-
scribed in paragraph (1)), in addition to the au-
thority provided under paragraph (1), the Sec-
retary shall provide the following regulatory re-
lief: 
‘‘(i) 3-DAY
PRIOR
HOSPITALIZATION 
WAIVER
FOR
SNF
SERVICES.—Waiver of 
the 3-day prior hospitalization requirement 
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