To amend title XVIII of the Social Security Act to establish a full risk ACO program.
- Bill Number
- H.R. 8129
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Status
- Introduced
- Latest Action
- 2026-03-26: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-04-29T05:03:53Z
AI-Generated Summary
Purpose
This bill establishes a permanent full risk Accountable Care Organization (ACO) program in Traditional Medicare (the original fee-for-service Medicare Parts A and B). ACOs are groups of doctors, hospitals, and other providers that coordinate patient care to improve health outcomes and lower costs. The program builds on successful pilots by offering flexible payment models that shift providers from fee-for-service (paid per visit or service) to full financial risk (providers bear gains or losses based on total care costs).
Key Provisions
- Program Tracks:
- Standard Full Risk ACO: Serves at least 2,500 Medicare beneficiaries.
- Complex Care Full Risk ACO: Focuses on patients with 6+ chronic conditions (at least two-thirds of beneficiaries); starts with 250 beneficiaries in year 1, scaling to 1,000+ by year 3.
- ACO Requirements:
- Formed by groups like physician practices, hospitals, rural health clinics (RHCs), federally qualified health centers (FQHCs), and others.
- 5-year agreement (renewable); financial guarantees required.
- Must provide coordinated care, including social supports, behavioral health, in-home care, palliative care, and tech-enabled services.
- Payments (full financial risk with 100% sharing of savings/losses):
- Primary care capitation: Monthly fixed payment per beneficiary for primary care (up to 7% of total spending), with repayment to avoid extra costs.
- Total care capitation: Monthly fixed payment covering all Parts A/B services; participating providers get no fee-for-service claims.
- Alternative: CMS reduces claims and pays ACOs equivalent amount monthly.
- Benchmarks (spending targets) blend historical, regional, and risk-adjusted data; discounts and risk corridors (limits on extreme losses/savings) apply.
- Quality Measures: Limited set focused on patient experience/outcomes (adds "Days at Home" for complex track); exempt from Merit-based Incentive Payment System (MIPS, a doctor quality-reporting program).
- Beneficiary Protections: Opt-out option; voluntary alignment via signed agreement; marketing rules to inform choices.
- Other: Prospective risk adjustment (predicting costs upfront) for standard track; concurrent (using current-year data) for complex; data sharing and waivers for implementation.
Significant Changes to Existing Law
- Adds new Section 1899B to Title XVIII of the Social Security Act, creating a permanent program (vs. time-limited pilots like Medicare Shared Savings Program).
- Treats participants as Advanced Alternative Payment Models (APMs) under Medicare Access and CHIP Reauthorization Act, exempting them from MIPS.
- Introduces capitated payments and full-risk options not widely available in Traditional Medicare, with tailored benchmarks for complex patients.
Potential Impacts
- Government Agencies (CMS/Secretary of HHS): Must implement by June 30, 2026; provides data/tools; potential Medicare savings via risk-sharing and capitated payments (with safeguards like repayments).
- Citizens (Medicare Beneficiaries): Improved care coordination, especially for complex/chronic cases and rural/underserved areas; more non-visit care options; ability to opt out or voluntarily join.
- No direct international relations impact.
- Overall: Shifts toward value-based care, potentially reducing total spending while enhancing outcomes.
Main Stakeholders Affected
- Providers/ACOs: Doctors, hospitals, RHCs, FQHCs, critical access hospitals (CAHs)—gain payment flexibility, incentives for coordination, but assume full financial risk.
- Medicare Fee-for-Service Beneficiaries: Assigned/aligned patients (not in Medicare Advantage); benefit from tailored care.
- CMS/HHS: Oversees program, benchmarks, quality, and waivers.
Notable Legal, Constitutional, or Political Implications
- Legal: Broad waiver authority for CMS to adapt rules; uses existing Shared Savings methodologies for fairness/consistency.
- Constitutional: None highlighted; aligns with Congress's spending power under Medicare.
- Political: Bipartisan introduction (Reps. Tenney and Schneider); promotes permanent innovation in Medicare without mandating participation.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Tenney, Claudia [R-NY-24]
Cosponsors (1)
Rep. Schneider, Bradley Scott [D-IL-10]
Recent Actions
- 2026-03-26: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-03-26: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-03-26: Introduced in House
- 2026-03-26: Introduced in House
Bill Versions
- To amend title XVIII of the Social Security Act to establish a full risk ACO program. — issued 2026-03-26 — PDF (14 pages)