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 modifies certain 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. The Secretary must also remove provisions requiring an ACO to assume shared losses or participate in a two-sided risk model before participating for at least 3 years, though ACOs may elect to do so earlier. The Secretary must ensure benchmark methodology is clear and transparent, allow ACOs to appeal benchmark accuracy in a hearing before an administrative law judge within 90 days, and require that regional contributions used for benchmarks exclude the expenditure impact of ACOs in that region. The Secretary must establish a voluntary full-risk option under the program with 100% shared savings and commensurate loss risk. The CMS Administrator must submit a report to Congress 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 bill amends the Social Security Act to extend the 5% incentive payment for qualifying APM participants through 2027, with a scaled percentage amount for 2026 and 2027. It modifies the threshold for qualifying APM participants, setting the applicable percent at 50% for 2026 and 2027, and for 2028 onward at a percent specified by the Secretary but not less than the prior year or more than 75% or 5 percentage points higher. The Secretary may set a lower applicable percent for good cause. The bill also provides for education and technical assistance to ACOs and providers in rural or underserved areas, including small practices and safety net groups. It modifies the definition of a partial qualifying APM participant by adjusting the percentage thresholds.

Sec. 4, Study on alternative payment models and Medicare Advantage: The Comptroller General must conduct a study and report to Congress within 18 months evaluating the benefits and flexibilities provided to support alternative payment models and Medicare Advantage organizations, to understand the effect of different Medicare policies on beneficiaries and providers, including specialty, safety net, small practice, and rural providers, with the goal of identifying areas to enhance alignment and encourage value-based arrangements.