Title: Rural ACO Improvement Act
Policy area: Health

Summary:
Rural ACO Improvement Act
This bill requires the Centers for Medicare & Medicaid Services (CMS) to exclude certain components from a methodology used under the Medicare Shared Savings Program. The program enables accountable care organizations (ACOs) to receive payments for savings stemming from care coordination and management.
Specifically, the bill requires the CMS to exclude an ACO's assigned Medicare fee-for-service beneficiaries from certain regional adjustments to the ACO's benchmark for savings determinations, and to otherwise ensure that an ACO is not in a less favorable financial position due to its share of assigned beneficiaries in the region.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2648 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                S. 2648

    To amend title XVIII of the Social Security Act to improve the 
     benchmarking process for the Medicare Shared Savings Program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            October 21, 2019

Ms. Cortez Masto (for herself and Mr. Roberts) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to improve the 
     benchmarking process for the Medicare Shared Savings Program.

    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 ``Rural ACO Improvement Act''.

SEC. 2. EXCLUSION OF MEDICARE FEE-FOR-SERVICE BENEFICIARIES ASSIGNED TO 
              AN ACO FROM ASPECTS OF OTHER PAYMENT MODELS IN CERTAIN 
              CIRCUMSTANCES INCLUDING DETERMINATION OF REGIONAL 
              ADJUSTMENTS.

    Section 1899(i)(3) of the Social Security Act (42 U.S.C. 
1395jjj(i)(3)) is amended--
            (1) in subparagraph (A), by striking ``subparagraph (B)'' 
        and inserting ``subparagraphs (B) and (C)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(C) Exclusion of assigned beneficiaries in 
                certain circumstances including determination of 
                regional adjustments.--For performance periods 
                beginning on or after July 1, 2019, in determining any 
                shared savings for any ACO under a model described in 
                this paragraph, the Secretary shall--
                            ``(i) remove Medicare fee-for-service 
                        beneficiaries who are assigned to that ACO from 
                        the methodology for calculating regional 
                        expenditures used to establish, update, and 
                        adjust the benchmark expenditures; and
                            ``(ii) otherwise ensure that no such ACO is 
                        in a less favorable financial position due to 
                        differences between the share of Medicare fee-
                        for-service beneficiaries assigned to the ACO 
                        of all such beneficiaries in the counties an 
                        ACO operates in compared to the share of such 
                        beneficiaries assigned to other ACOs.''.
                                 <all>