Accountable Care in Rural America Act

Accountable Care in Rural America 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]
[H.R. 5212 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 5212

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 21, 2019

 Mr. Arrington (for himself, Ms. DelBene, Mr. Marshall, and Mr. Bera) 
 introduced the following bill; which was referred to the Committee on 
    Ways and Means, and in addition to the Committee on Energy and 
Commerce, 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 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 ``Accountable Care in Rural America 
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 the date of the enactment of this 
                subparagraph, 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.''.
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