Sec. 3. Antikickback exception for value-based arrangements

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Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a–7b(b)) is amended by adding at the end the following new paragraph: Paragraphs

(1)and

(2)shall not apply to any remuneration exchanged under a value-based arrangement (as defined in subparagraph (B)) directly or indirectly between, among, or on behalf of one or more parties paid under such arrangement. For purposes of this paragraph, the term value-based arrangement means an arrangement that meets the following criteria: The arrangement is set out in writing in advance of the execution of the arrangement and specifies the health care items and services covered by the arrangement. The arrangement is reasonably related to one or more of the goals described in section 399LL(a) of the Public Health Service Act. The arrangement— is a value-based risk-sharing transaction (as defined in subparagraph (C)); provides for payment for items and services furnished under the arrangement between, among, or on behalf of one or more parties participating in a value-based risk-sharing network arrangement (as defined in subparagraph (C)); or is another arrangement determined appropriate by the Secretary. In this paragraph: The term financial risk means upside or downside risk such that each party is eligible or liable for payment through a specified methodology that may include shared savings, withholds, or bonuses. The term value-based risk-sharing network arrangement means an arrangement under which an entity is established between or organized and operated by two or more parties (which may include providers, suppliers, corporations, or individuals)— to accept capitation payments with respect to certain items and services furnished to an individual; to accept as payment for such items and services a predetermined percentage of the value-based risk-sharing network’s revenue under the arrangement; or to provide financial incentives to parties to the arrangement for purposes of achieving one or more of the goals described in section 399LL(a) of the Public Health Service Act through the use of— arrangements under which such parties agree to a withhold of a significant amount of the compensation due them, to be used to cover losses of the arrangement, to cover losses of other parties within the arrangement, to be returned to all parties to the arrangement if such parties meet their utilization management or cost-containment goals for a specified time period, or to be distributed among all parties if the arrangement meets its utilization management or cost-containment goals for a specified time period; arrangements where such parties agree to preestablished cost or utilization targets and to subsequent significant financial rewards or penalties (which may include a reduction in payments to downstream providers or suppliers in the network) based on the performance of all such parties with respect to such targets; or other mechanisms that demonstrate significant shared financial risk (as defined in clause (i)) or significantly assist such parties in meeting risk-sharing targets, including shared-savings payments, withholds, or bonuses. Remuneration to parties who participate in a value-based risk-sharing network arrangement may be in-kind or monetary payments, which may but are not required to place the parties to such arrangement at financial risk (as defined in clause (i)). The term value-based risk-sharing transaction means a payment made under an arrangement under which each party agrees— to contribute to the achievement of preidentified clinical or economic target metrics that are specifically tailored to improve patient outcomes or reduce the costs of health care delivery without negatively affecting patient outcomes; to implement processes or procedures that otherwise optimize the delivery, efficiency, or quality of patient-centered care; and to predetermine the allocation of financial risk (as defined in clause (i)) assumed by each party based on the participant’s relative contribution to the achievement of targeted outcomes. . The amendment made by this section shall apply to arrangements entered into on or after the date of enactment of this Act.

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42 USC 1320a–7b(b)

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Sec. 3

Antikickback exception for value-based arrangements

Cite42 USC 1320a–7b(b)

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