Preserving Patient Access to Value-Based Care Act
Bill: S.5249 | Sponsor: Sen. Barrasso, John (R-WY)
Policy area: Health

Summary:
Preserving Patient Access to Value-Based Care Act
This bill extends certain incentive payments for health professionals who participate in eligible alternative payment models under Medicare.

To amend title XVIII of the Social Security Act to encourage 
               participation in advanced payment models.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Preserving Patient Access to Value-
Based Care Act''.

SEC. 2. ADVANCED PAYMENT MODEL INCENTIVE, PARTICIPATION, AND THRESHOLD 
              MODIFICATIONS.

    (a) In General.--Section 1833(z) of the Social Security Act (42 
U.S.C. 1395l(z)) is amended--
            (1) in paragraph (1)(A), by striking ``2024'' and inserting 
        ``2026''; and
            (2) in paragraph (2)(C)--
                    (A) in clause (i), by striking ``75 percent'' and 
                inserting ``the applicable percent (as defined 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 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 defined.--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 
                                percent; and
                                    ``(II) for a subsequent year, a 
                                percent specified by the Secretary, but 
                                in no case less than the percent 
                                specified under this clause for the 
                                preceding year or more than 5 
                                percentage points higher than the 
                                percent specified under this clause for 
                                such preceding year.''.
    (b) Partial Qualifying Apm Participant Modifications.--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--
            (1) in item (aa), by striking ``75 percent was instead a 
        reference to 50 percent'' and inserting ``the applicable 
        percent was instead a reference to 10 percentage points less 
        than the applicable percent''; 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''.
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