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
Creates a permanent full-risk Medicare ACO program that would let groups of clinicians and hospitals take full financial responsibility to manage care for traditional Medicare patients. The program offers two tracks, Standard and Complex Care, to expand coordinated, nonvisit, and in-home services.
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- Eligible providers and organizations include group practices, networks of individual practices, hospital-ACO arrangements, critical access hospitals that bill Method II, rural health clinics, federally qualified health centers, and certain teaching hospitals. Standard Full Risk ACOs must have at least 2,500 assigned beneficiaries. Complex Care Full Risk ACOs must have 250 beneficiaries in year 1, 500 in year 2, and 1,000 in year 3 and after.
- Beneficiaries would see more individualized care focused on advanced primary care, care coordination, transitions, social and behavioral health services, nonvisit contacts like phone or video, in-home care, and palliative care. Beneficiaries may opt out and the Secretary must set marketing standards to explain options. Participating ACOs are exempt from MIPS reporting.
- Payment choices include Primary Care Capitation up to 7% of a beneficiary's annual Medicare spending, Total Care Capitation covering Part A and Part B where providers waive fee-for-service, or claims-reduction plus monthly population payments. ACOs may enter full financial risk arrangements taking up to 100 percent of savings and losses and would use benchmark, risk-adjustment, and risk-corridor methods to set payments.
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 2 benefits, 0 costs, 4 mixed.
New ACO payment choices and caps
If enacted, the bill would let full-risk ACOs choose payment options: population-based monthly payments, primary care capitation, or total care capitation. Primary care capitation could be up to 7% of a beneficiary's annual Medicare spending and must include a repayment rule to avoid increasing Medicare spending. Total care capitation would replace fee-for-service payments for participating providers with a per-member per-month payment that covers all Part A and B services.
New permanent Medicare full-risk ACOs
If enacted, the bill would require HHS to create a permanent full-risk Medicare ACO program by June 30, 2026. Provider groups would sign five-year agreements and must post a financial guarantee. ACOs could take 100% of savings and losses subject to a Secretary-set discount and risk corridors. The Secretary could waive other Medicare rules to run the program.
Rules for ACO tracks and benchmarks
If enacted, the bill would create two ACO tracks: Standard and Complex Care. Standard ACOs must have at least 2,500 aligned beneficiaries. Complex Care ACOs must have 250 aligned beneficiaries in year 1, 500 in year 2, and 1,000 in year 3 and thereafter. The Secretary would use different benchmarking and risk-adjustment methods for each track, including at least a 50% regional weight for Complex Care and different prospective or concurrent adjustments.
Beneficiary opt-out and data rules
If enacted, the bill would let Medicare beneficiaries opt out of ACO participation and allow signed voluntary alignment that takes effect monthly. The Secretary would issue marketing rules to explain ACO enrollment and choices to beneficiaries. Participating ACOs would also get regular claims and payment data for their aligned beneficiaries so they can manage care and report performance.
Who can form and join ACOs
If enacted, the bill would allow many types of provider groups to form ACOs. Allowed groups include group practices, networks of individual practices, hospitals and joint ventures with clinicians, critical access hospitals billing under Method II, rural health clinics, federally qualified health centers, and certain teaching hospitals. ACOs could organize and be paid at the tax ID and clinician NPI level and must have a financial guarantee that matches their risk choice.
Quality rules and MIPS exemption
If enacted, the bill would require the Secretary to set a small set of quality measures for ACOs focused on patient experience and outcomes. Complex Care ACOs would also report a 'Days at Home' measure. Clinicians in the program would be exempt from the Merit-Based Incentive Payment System and the program would count as an advanced alternative payment model under MACRA.
Sponsors & CoSponsors
Sponsor
Tenney, Claudia [R-NY-24]
NY • R
Cosponsors
Rep. Schneider, Bradley Scott [D-IL-10]
IL • D
Sponsored 3/26/2026
Roll Call Votes
No roll call votes available for this bill.
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