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119-hr-5347119th CongressWALLET

Health Care Efficiency Through Flexibility Act

Sponsored By: Representative Buchanan, Vern [R-FL-16]

Passed House

Summary

Makes Medicare ACO quality reporting more flexible and launches a timed pilot to test digital measure submission for accountable care organizations (ACOs). It preserves required measure reporting while allowing multiple collection types and limited partial data where a participant cannot collect it.

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  • ACOs gain more ways to submit quality data for performance years 2025–2029, including electronic clinical quality measures, MIPS clinical quality measures, and Medicare clinical quality measures for ACOs. This reduces technical barriers for groups using different collection systems.
  • ACO participants that cannot collect certain data can be excused from including that participant's data if the ACO otherwise meets data completeness rules and documents the problem to the Secretary. This creates a narrow safety valve for missing participant data starting in 2026.
  • A digital reporting pilot runs 2028–2032. Selected ACOs will submit two specified measures digitally each year, get technical help, and those pilot-submitted measures will not count toward general reporting or quality scores for that year.
  • Implementation is funded with an $8.0 million appropriation to CMS for FY2026 and a corresponding $8.0 million reduction in the Medicare Improvement Fund.

*Shifts $8.0 million within federal accounts by appropriating $8.0 million for CMS implementation and reducing the Medicare Improvement Fund by $8.0 million.*

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 2 benefits, 0 costs, 1 mixed.

Easier quality reporting for Medicare ACOs

For 2025–2029, CMS would let ACOs use three collection types for each required measure: electronic clinical quality measures, MIPS clinical quality measures, and Medicare Clinical Quality Measures for ACOs. Starting with performance years on or after January 1, 2026, CMS would not call ACO data unrepresentative just because one or more ACO participants are missing. The ACO would need to meet data completeness rules and show the missing participant could not collect data through the chosen type.

Test digital reporting for Medicare ACOs

From 2028 to 2032, CMS would run a pilot for digital quality reporting. Selected ACOs would apply and report exactly two required measures each year using a CMS-defined digital method. CMS would not use the pilot-submitted data to judge quality performance for that year. CMS would not use data on other measures to set scores for participating ACOs that year. CMS would provide technical help and post an analysis and a proposed timeline by December 31, 2032.

CMS gets $8M, Medicare fund cut

CMS would receive $8 million in fiscal year 2026 to carry out the bill’s reporting changes. The money would stay available until spent. To offset this, the Medicare Improvement Fund would drop by $8 million, from $2.062 billion to $2.054 billion.

Sponsors & CoSponsors

Sponsor

Buchanan, Vern [R-FL-16]

FL • R

Cosponsors

  • Rep. Panetta, Jimmy [D-CA-19]

    CA • D

    Sponsored 9/15/2025

  • Rep. Crenshaw, Dan [R-TX-2]

    TX • R

    Sponsored 9/15/2025

  • Rep. LaHood, Darin [R-IL-16]

    IL • R

    Sponsored 9/15/2025

  • Rep. Lawler, Michael [R-NY-17]

    NY • R

    Sponsored 1/12/2026

Roll Call Votes

No roll call votes available for this bill.

View on Congress.gov
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