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 participa-
tion 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 consider-
ation 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. 
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 2020’’. 
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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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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)— 
(A) in subparagraph (B)— 
(i) by striking the header and insert-
ing ‘‘2021 AND SUBSEQUENT YEARS’’; 
(ii) in the matter preceding clause (i), 
by striking ‘‘2021 and 2022’’ and inserting 
‘‘2021 or a subsequent year’’; 
(iii) in clause (i), by striking ‘‘50 per-
cent’’ and ‘‘the applicable percent (as de-
fined in clause (iv)) for such year’’; 
(iv) in clause (ii)(I)— 
(I) in the matter preceding item 
(aa), by striking ‘‘50 percent’’ and in-
serting ‘‘the applicable percent (as de-
fined in clause (iv)) for such year’’; 
and 
(II) in item (bb)— 
(aa) by striking ‘‘and other 
than payments made under title 
XIX’’ and inserting ‘‘other than 
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payments made under title XIX’’; 
and 
(bb) by striking ‘‘State pro-
gram under that title),’’ and in-
serting ‘‘State program under 
that title, and other than pay-
ments made by payers in which 
no payment or program meeting 
the requirements described in 
clause (iii)(II) is available from 
the payer for participation by the 
eligible professional)’’; and 
(v) 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 2021, 50 percent; 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 
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specified under this clause for such 
preceding year.’’; 
(B) by striking subparagraph (C); and 
(C) by redesignating subparagraph (D) as 
subparagraph (C). 
(b) PARTIAL QUALIFYING APM PARTICIPANT MODI-
FICATIONS.—Section 1848(q)(1)(C)(iii) of the Social Se-
curity Act (42 U.S.C. 1395w–4(q)(1)(C)(iii)) is amend-
ed— 
(1) in subclause (I), by adding ‘‘and’’ at the 
end; 
(2) in subclause (II)— 
(A) in the matter preceding item (aa), by 
striking ‘‘2022’’ and inserting ‘‘subsequent 
years’’; 
(B) in item (aa), by striking ‘‘50 percent 
was instead a reference to 40 percent’’ and in-
serting ‘‘the applicable percent were instead a 
reference to 10 percentage points less than the 
applicable percent’’; and 
(C) in item (bb)— 
(i) by striking ‘‘50 percent’’ and in-
serting ‘‘the applicable percent’’; and 
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