Rural ACO Improvement Act

II 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 Sav- ings Program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Rural ACO Improve- 4 ment Act’’. 5 VerDate Sep 11 2014 03:36 Oct 22, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2648.IS S2648 kjohnson on DSK79L0C42 with BILLS 2 •S 2648 IS SEC. 2. EXCLUSION OF MEDICARE FEE-FOR-SERVICE BENE- 1 FICIARIES ASSIGNED TO AN ACO FROM AS- 2 PECTS OF OTHER PAYMENT MODELS IN CER- 3 TAIN CIRCUMSTANCES INCLUDING DETER- 4 MINATION OF REGIONAL ADJUSTMENTS. 5 Section 1899(i)(3) of the Social Security Act (42 6 U.S.C. 1395jjj(i)(3)) is amended— 7 (1) in subparagraph (A), by striking ‘‘subpara- 8 graph (B)’’ and inserting ‘‘subparagraphs (B) and 9 (C)’’; and 10 (2) by adding at the end the following new sub- 11 paragraph: 12 ‘‘(C) EXCLUSION OF ASSIGNED BENE- 13 FICIARIES IN CERTAIN CIRCUMSTANCES IN- 14 CLUDING DETERMINATION OF REGIONAL AD- 15 JUSTMENTS.—For performance periods begin- 16 ning on or after July 1, 2019, in determining 17 any shared savings for any ACO under a model 18 described in this paragraph, the Secretary 19 shall— 20 ‘‘(i) remove Medicare fee-for-service 21 beneficiaries who are assigned to that ACO 22 from the methodology for calculating re- 23 gional expenditures used to establish, up- 24 date, and adjust the benchmark expendi- 25 tures; and 26 VerDate Sep 11 2014 03:36 Oct 22, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2648.IS S2648 kjohnson on DSK79L0C42 with BILLS 3 •S 2648 IS ‘‘(ii) otherwise ensure that no such 1 ACO is in a less favorable financial posi- 2 tion due to differences between the share 3 of Medicare fee-for-service beneficiaries as- 4 signed to the ACO of all such beneficiaries 5 in the counties an ACO operates in com- 6 pared to the share of such beneficiaries as- 7 signed to other ACOs.’’. 8 Æ VerDate Sep 11 2014 03:36 Oct 22, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6301 E:\BILLS\S2648.IS S2648 kjohnson on DSK79L0C42 with BILLS