Title: Shared Accountability for Improved Patient Outcomes Act of 2018
Policy area: Health

Summary:
Shared Accountability for Improved Patient Outcomes Act of 2018
This bill makes a series of changes relating to value-based arrangements for health care, including exempting certain such arrangements from prohibitions against illegal remunerations and physician self-referrals.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7122 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 7122

 To amend title III of the Public Health Service Act and titles XI and 
 XVIII of the Social Security Act to accelerate the adoption of value-
based payment and delivery arrangements among health care stakeholders 
     intended to coordinate care, improve patient outcomes, share 
        accountability, or lower costs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 13, 2018

 Mr. Paulsen introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend title III of the Public Health Service Act and titles XI and 
 XVIII of the Social Security Act to accelerate the adoption of value-
based payment and delivery arrangements among health care stakeholders 
     intended to coordinate care, improve patient outcomes, share 
        accountability, or lower costs, and for other purposes.

    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 ``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 January 1, 2019, the 
Secretary shall conduct annual education campaigns targeted to health 
care providers and payers to encourage the development of value-based 
arrangements (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 patient populations, 
        including patient populations that receive services which are 
        reimbursed by various health care payers.
            ``(2) Improvement of management and coordination of care 
        for patients through such arrangements approved by the parties 
        to the arrangement.
            ``(3) Encouragement of investment in health care 
        infrastructure and redesigned care processes for high-quality 
        and efficient service delivery for patients, 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 
        expenditures 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 ARRANGEMENTS.

    (a) In General.--Section 1128B(b) of the Social Security Act (42 
U.S.C. 1320a-7b(b)) is amended by adding at the end the following new 
paragraph:
    ``(5)(A) Paragraphs (1) and (2) shall not apply to any remuneration 
exchanged under a value-based arrangement (as defined in subparagraph 
(B)) directly or indirectly between, among, or on behalf of one or more 
parties paid under such arrangement.
    ``(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 transaction (as 
                defined in subparagraph (C));
                    ``(II) provides for payment for items and services 
                furnished under the arrangement between, among, or on 
                behalf of one or more parties participating in a value-
                based risk-sharing network arrangement (as defined in 
                subparagraph (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 liable for payment 
        through a specified methodology that may include shared 
        savings, withholds, or bonuses.
            ``(ii) The term `value-based risk-sharing network 
        arrangement' means an arrangement under which an entity is 
        established between or organized and operated by two or more 
        parties (which may include providers, suppliers, corporations, 
        or individuals)--
                    ``(I) to accept capitation payments with respect 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 arrangement, 
                        to be returned to all parties to the 
                        arrangement if such parties meet their 
                        utilization management or cost-containment 
                        goals for a specified time period, or to be 
                        distributed among all parties if the 
                        arrangement meets its utilization management or 
                        cost-containment goals for a specified time 
                        period;
                            ``(bb) arrangements where such parties 
                        agree to preestablished cost or utilization 
                        targets and to subsequent significant financial 
                        rewards or penalties (which may include a 
                        reduction in payments to downstream providers 
                        or suppliers in the network) based on the 
                        performance of all such parties with respect to 
                        such targets; or
                            ``(cc) other mechanisms that demonstrate 
                        significant shared financial risk (as defined 
                        in clause (i)) or significantly assist such 
                        parties in meeting risk-sharing targets, 
                        including shared-savings payments, 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 required to place the parties 
        to such arrangement at financial risk (as defined in clause 
        (i)).
            ``(iii) The term `value-based risk-sharing transaction' 
        means a payment made under an arrangement 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 delivery without 
                negatively affecting patient outcomes;
                    ``(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 financial 
                risk (as defined in clause (i)) assumed by each party 
                based on the participant's relative contribution to the 
                achievement of targeted outcomes.''.
    (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.

SEC. 4. STARK LAW EXCEPTION FOR VALUE-BASED ARRANGEMENTS.

    (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.--Remuneration 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 entered into on or after the date of 
enactment of this Act.
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