Value in Health Care Act of 2023

This bill directs the Secretary of Health and Human Services to revise Medicare shared savings program regulations to encourage participation, and makes changes to alternative payment model incentives and thresholds.

Sec. 2, Encouraging participation in the Medicare Shared Savings Program: The Secretary must revise regulations to eliminate distinctions between low and high revenue ACOs, applying requirements that applied to low revenue ACOs as of July 1, 2024 (or less stringent ones), and remove any requirement that an ACO assume shared losses or join a two-sided risk model before participating for at least 3 years, though ACOs may elect such models earlier. The Secretary must also ensure benchmark methodology is clear and transparent, allow ACOs to appeal benchmark accuracy before an administrative law judge within 90 days, and require that regional expenditure calculations exclude the impact of ACOs in that region. A voluntary full-risk option must be established where shared savings are 100% with commensurate loss risk. The CMS Administrator must report to Congress within 90 days on mechanisms to avoid penalizing ACOs for cost savings and account for regional spending variations.

Sec. 3, Advanced payment model incentive, participation, and threshold modifications: The Social Security Act is amended to extend the 5% incentive payment through 2027, with a scaled percentage amount for 2026 and later years. The threshold for qualifying as an advanced APM participant is reduced to 50% for 2026-2027, with a minimum of 50% for later years, and the Secretary may set a lower alternative applicable percent for certain models. The Secretary must provide education and technical assistance to ACOs and providers in rural or underserved areas, small practices, or safety net groups. The partial qualifying APM participant threshold is modified so that the applicable percent is reduced by 10 percentage points.

Sec. 4, Study on alternative payment models and Medicare+Choice: The Comptroller General must study and report within 18 months on the benefits and flexibilities supporting alternative payment models and Medicare+Choice Organizations, focusing on effects on different patient and provider types, to identify areas for policy alignment and encourage value-based arrangements.