Section 10307

SEC. 10307. IMPROVEMENTS TO THE MEDICARE SHARED SAVINGS PROGRAM.

Section 1899 of the Social Security Act, as added by section 3022, is amended by adding at the end the following new subsections:

'[i] Option To Use Other Payment Models-

'[1] IN GENERAL- If the Secretary determines appropriate, the Secretary may use any of the payment models described in paragraph [2] or [3] for making payments under the program rather than the payment model described in subsection [d].

'[2] PARTIAL CAPITATION MODEL-

'[A] IN GENERAL- Subject to subparagraph [B], a model described in this paragraph is a partial capitation model in which an ACO is at financial risk for some, but not all, of the items and services covered under parts A and B, such as at risk for some or all physicians' services or all items and services under part B. The Secretary may limit a partial capitation model to ACOs that are highly integrated systems of care and to ACOs capable of bearing risk, as determined to be appropriate by the Secretary.

'[B] NO ADDITIONAL PROGRAM EXPENDITURES- Payments to an ACO for items and services under this title for beneficiaries for a year under the partial capitation model shall be established in a manner that does not result in spending more for such ACO for such beneficiaries than would otherwise be expended for such ACO for such beneficiaries for such year if the model were not implemented, as estimated by the Secretary.

'[3] OTHER PAYMENT MODELS-

'[A] IN GENERAL- Subject to subparagraph [B], a model described in this paragraph is any payment model that the Secretary determines will improve the quality and efficiency of items and services furnished under this title.

'[B] NO ADDITIONAL PROGRAM EXPENDITURES- Subparagraph [B] of paragraph [2] shall apply to a payment model under subparagraph [A] in a similar manner as such subparagraph [B] applies to the payment model under paragraph [2].

'[j] Involvement in Private Payer and Other Third Party Arrangements- The Secretary may give preference to ACOs who are participating in similar arrangements with other payers.

'[k] Treatment of Physician Group Practice Demonstration- During the period beginning on the date of the enactment of this section and ending on the date the program is established, the Secretary may enter into an agreement with an ACO under the demonstration under section 1866A, subject to rebasing and other modifications deemed appropriate by the Secretary.'.