1. Short title
This Act may be cited as the “Preserving Patient Access to Value-Based Care Act”.
Preserving Patient Access to Value-Based Care Act
A BILL
To amend title XVIII of the Social Security Act to encourage participation in advanced payment models.
2. Advanced payment model incentive, participation, and threshold modifications
in paragraph (1)(A), by striking “2024” and inserting “2026”; and
in paragraph (2)(C)—
in clause (i), by striking “75 percent” and inserting “the applicable percent (as defined in clause (iv)) for such year”;
in clause (ii)(I)—
in the matter preceding item (aa), by striking “75 percent” and inserting “the applicable percent (as defined in clause (iv)) for such year”; and
in item (bb)—
by striking “and other than payments made under title XIX” and inserting “other than payments made under title XIX”; and
by striking “State program under that title),” and inserting “State program under that title, and other than payments made by payers in which no payment or program meeting the requirements described in clause (iii)(II) is available from the payer for participation by the eligible professional)”; and
by adding at the end the following new clause:
“(iv) Applicable percent defined—For purposes of clauses (i) and (ii), the term applicable percent means—
“(I) for 2025, a percent specified by the Secretary, but in no case less than 50 percent or more than 55 percent; and
“(II) for a subsequent year, a percent specified by the Secretary, but in no case less than the percent specified under this clause for the preceding year or more than 5 percentage points higher than the percent specified under this clause for such preceding year.”
Partial qualifying apm participant modifications— Section 1848(q)(1)(C)(iii)(III) of the Social Security Act (42 U.S.C. 1395w–4(q)(1)(C)(iii)(III)) is amended—
in item (aa), by striking “75 percent was instead a reference to 50 percent” and inserting “the applicable percent was instead a reference to 10 percentage points less than the applicable percent”; and
in item (bb)—
by striking “75 percent” and inserting “the applicable percent”;
by striking “50 percent” and inserting “10 percentage points less than the applicable percent”.