What a yes vote endorsed
Health Care Efficiency Through Flexibility Act
What this does
This bill adjusts how Accountable Care Organizations report quality data under the Medicare Shared Savings Program. For performance years 2025 through 2029, it requires the Secretary of Health and Human Services to keep three specific quality-measure collection types available to ACOs for each required measure. For years beginning in 2026, it bars the Secretary from treating an ACO's data as unrepresentative of its performance solely because the data leaves out a participant that could not collect it through the ACO's chosen collection type, so long as the data otherwise meets completeness rules and the ACO shows the participant could not collect it. It also directs the Secretary to run a digital quality measure reporting pilot for performance years 2028 through 2032, under which selected ACOs report two specified measures digitally and are excused from reporting the others. It appropriates $8,000,000 for fiscal year 2026 to run these changes and offsets that by cutting the Medicare Improvement Fund from $2,062,000,000 to $2,054,000,000.
Passed the House by voice vote
How we know · 7 sourced claims
- For performance years 2025 through 2029, the Secretary must ensure three collection types (electronic clinical quality measures, MIPS clinical quality measures, and Medicare Clinical Quality Measures for ACOs) are available for each measure an ACO is required to report.Source: Sec. 2, clause (ii)
- For performance years beginning on or after January 1, 2026, the Secretary may not find an ACO's data unrepresentative of its performance solely because it excludes a participant's data, provided the data otherwise meets completeness requirements and the ACO shows the participant could not collect the data through the selected collection type.Source: Sec. 2, clause (iii)
- The Secretary must establish a digital quality measure reporting pilot program for performance years 2028 through 2032, under which selected ACOs report two specified measures through a digital collection type.Source: Sec. 3, clause (iv)(I) and (iv)(III)
- ACOs selected for the pilot are not required to report other measures otherwise required, aside from the two specified pilot measures.Source: Sec. 3, clause (iv)(IV)
- The bill appropriates $8,000,000 for fiscal year 2026 to the CMS Program Management Account to implement the changes made by sections 2 and 3.Source: Sec. 4(a)
- The bill reduces the Medicare Improvement Fund from $2,062,000,000 to $2,054,000,000.Source: Sec. 4(b)
- Every provision concerns quality reporting by ACOs under the Medicare Shared Savings Program, including the appropriation and the fund reduction that fund it.Source: Sec. 2, Sec. 3, Sec. 4