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119-hr-8129119th CongressWALLET

To amend title XVIII of the Social Security Act to establish a full risk ACO program.

Sponsored By: Representative Tenney, Claudia [R-NY-24]

Introduced

Summary

**This bill would create a permanent Medicare program for *full-risk Accountable Care Organizations* to push care toward coordinated, whole-person management and new payment options.** It focuses on complex patients and rural or underserved areas while letting ACOs choose capitation and other full-risk payment arrangements.

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Bill Overview

Analyzed Economic Effects

6 provisions identified: 3 benefits, 0 costs, 3 mixed.

Required coordinated services for patients

If enacted, ACOs would have to provide individualized, coordinated care for aligned Medicare FFS patients. Required care can include care transitions, social supports, behavioral health, non‑visit care (phone, video, email), extra access and tech for population management, in‑home care, and palliative care. The Secretary could add other items and services as appropriate.

How ACO payments are benchmarked

If enacted, the bill would set different benchmark rules for the two ACO tracks. Standard ACOs would use their past spending trended forward, blended with regional costs from an adjusted Medicare Advantage rate book, risk‑adjusted, and discounted by the Secretary. Complex Care ACO benchmarks would weight regional costs at least 50% and would not cap regional blending. Standard ACOs would use prospective risk adjustment; Complex Care ACOs would use concurrent risk adjustment.

New ACO payment and risk choices

If enacted, the bill would let ACOs pick different payment models. Options include primary care capitation (PMPM up to 7% of a beneficiary's yearly Medicare spending), total care capitation that replaces CMS fee‑for‑service payments, and a monthly payment tied to reduced FFS claims. ACOs could take 100% of savings and losses under full‑risk deals, but the Secretary would set required discounts, risk corridors, and repayment rules. ACOs may also pay preferred providers instead of direct CMS FFS payments.

New Medicare full-risk ACOs

If enacted, the bill would require the HHS Secretary to set up a permanent full‑risk ACO program for Original Medicare by June 30, 2026. ACOs would sign five‑year contracts, must show a financial guarantee, and join at the TIN–NPI level using the listed provider types. Standard ACOs would need at least 2,500 aligned Medicare fee‑for‑service beneficiaries. Complex Care ACOs would need 250 in year 1, 500 in year 2, and 1,000 in year 3 and after. A Complex Care ACO would be one with at least two‑thirds of patients having six or more chronic conditions.

Rules for ACO notices and data

If enacted, the Secretary would set marketing and communication rules so Medicare FFS patients learn about ACO care options and their right to opt out. The Secretary would also provide ACOs regular reports with up‑to‑date claims and payment data for aligned patients to support care coordination.

Simpler quality rules and MIPS exemption

If enacted, the bill would use a small set of quality measures focused on patient experience and outcomes. Complex Care ACOs would also report a "Days at Home" measure. All full‑risk ACO participants would be exempt from MIPS reporting.

Sponsors & CoSponsors

Sponsor

Tenney, Claudia [R-NY-24]

NY • R

Cosponsors

  • Rep. Schneider, Bradley Scott [D-IL-10]

    IL • D

    Sponsored 3/26/2026

  • Rep. Clarke, Yvette D. [D-NY-9]

    NY • D

    Sponsored 8/6/2026

Roll Call Votes

No roll call votes available for this bill.

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