A4H has prepared a comparison table showing the different legislative proposals to extend the Medicare Access and CHIP Reauthorization Act advanced alternative payment model (APM) bonus. As a reminder, the 5% bonus expired last year and Congress extended the bonus for a single year at 3.5%. Absent Congressional action, the bonus will expire. A4H is urging lawmakers to pass an extension of the bonus for the 2024 performance/2026 payment year by the end of the year.

A4H APM Bonus Extension Legislation Comparison Table (Download PDF)

Value in Health Care Act (H.R. 5013)To amend title XVIII of the Social Security Act to extend incentive payments for participation in eligible alternative payment models under the Medicare program (H.R. 6310)Physician Fee Schedule Update and Improvements Act (H.R. 6545)Value in Health Care Act (S. 3505)Better Mental Health Care, Lower-Cost Drugs, and Extenders Act (Chairman’s Mark)Incentivizing Value-Based Care for Providers in Medicare Advanced Payment Models (Amendment)
BillBillBillBillBillAmendment
House Energy and CommerceHouse Energy and CommerceHouse Energy and CommerceSenate FinanceSenate FinanceSenate Finance
Reps. Darin LaHood (R-IL), Suzan DelBene (D-WA), Brad Wenstrup (R-OH), Earl Blumenauer (D-OR), Larry Bucshon (R-IN), Kim Schrier (D-WA)Rep. Raul Ruiz (D-CA)Reps. Mariannette Miller-Meeks (R-IA), Kim Schrier (D-WA), Larry Bucshon (R-IN), Robin Kelly (D-IL)Sens. Sheldon Whitehouse (D-RI), John Barrasso (R-WY), Peter Welch (D-VT), Thom Tillis (R-NC), Bill Cassidy (R-LA), John Thune (R-SD), Marsha Blackburn (R-TN)Sen. Ron Wyden (D-OR)Sens. Sheldon Whitehouse (D-RI), Mark Warner (D-VA), John Thune (R-SD), John Barrasso (R-WY), Ben Cardin (D-MD), Bill Cassidy (R-LA)
No movement; Companion to Senate billNo movementPassed 46-0 out of the House Energy and Commerce Committee on 12/6.No movement; Companion to House billPassed 26-0 out of the Senate Finance Committee on 11/8.Offered as an amendment to the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act on 11/8; withdrawn with commitment from Chair Ron Wyden (D-OR) to work on advancing the amendment’s provisions.
  • Extends the 5% advanced APM incentive payments for 2 years.
  • Establishes guardrails for CMS so financial benchmarks are transparent and account for regional spending variations.
  • Eliminates arbitrary program distinctions for ACO participants.
  • Modifies performance metrics to ensure participants do not have to compete against their own successes in providing better care.
  • Provides greater technical support to ACO participants to cover the significant startup costs associated with program participation.
  • Extends the annual A-APM lump sum participation bonus for an additional two years.
  • Corrects arbitrary thresholds for A-APM qualification to reflect existing progress of the value-based movement and to encourage bringing more patients into this model of care.
Extends 3.5% APM incentive payments through 2027.
  • Extends APM incentive payments at 3.5% through 2025 and 2.5% for 2026, and establishes a tiered approach to reducing the payment after 2026, with a 34 percent reduction for those who have participated between 4 and 7 years and 67 percent for those who have participated for more than 7 years.
  • Provides an exception for increased financial risk for 2026.
  • Changes the 1.25% the statutory payment increase for MPFS to 2.5%.
  • Updates the budget neutrality threshold.
  • Provides for timely updates to direct costs used to calculate practice expense RVUs.

The amended version of this bill incorporates H.R. 6369.

  • Extends the 5% advanced APM incentive payments for 2 years.
  • Establishes guardrails for CMS so financial benchmarks are transparent and account for regional spending variations.
  • Eliminates arbitrary program distinctions for ACO participants.
  • Modifies performance metrics to ensure participants do not have to compete against their own successes in providing better care.
  • Provides greater technical support to ACO participants to cover the significant startup costs associated with program participation.
  • Extends the annual A-APM lump sum participation bonus for an additional two years.

Corrects arbitrary thresholds for A-APM qualification to reflect existing progress of the value-based movement and to encourage bringing more patients into this model of care.

  • Extends the APM incentive payment at 1.75% for payment year 2026 (based on performance year 2024).
  • Extends Qualifying APM Participants (QPs) payment and patient thresholds in place with respect to payment year 2025 through payment year 2026 (based on performance year 2024).
Amends the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act:

  • Provides a 3.5% APM Incentive Payment for Qualifying APM Participants (QPs) for the payment year 2026 (based on the performance year 2024).
  • Extends the QP payment and patient thresholds for payment year 2025 through the payment year 2026 (based on the performance year 2024).
  • Cost offset via the Medicare Improvement Fund.

Share

Related Posts

  • A4H Newsletter – June 14, 2024

    Welcome to the Accountable for Health (A4H) newsletter, including legislative and Administration updates, accountable care news, and resources.

  • A4H Submits Response on Bolstering Chronic Care through Physician Payment

    Accountable for Health submitted feedback on the Senate Finance Committee White Paper on Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B.

  • A4H Submits Comments on TEAM Proposal

    Accountable for Health submitted comments in response to the proposed Transforming Episode Accountability Model (TEAM).