Sponsors (3)
The bill creates a permanent full‑risk ACO pathway intended to expand coordinated, flexible Medicare care and stabilize provider payments, but does so by shifting financial risk and regulatory authority in ways that could reduce services, exclude small/rural providers, and transfer costs or oversight burdens if safeguards and calibration are inadequate.
Medicare beneficiaries, including people with multiple chronic conditions, gain access to more coordinated, individualized care (in‑home, palliative, behavioral health, and social supports) through permanent full‑risk ACOs.
Providers (hospitals, health systems, and primary care clinicians) can receive predictable monthly per‑beneficiary capitated payments (primary care capitation or Total Care Capitation), improving cash flow and payment flexibility.
The program is permanent and includes multiple track options plus explicit eligibility for rural providers (FQHCs, RHCs, CAHs), which can expand advanced payment models to underserved and rural communities.
Medicare beneficiaries face increased risk of service limitations or care denials because full capitation or a 100% reduction of FFS claims can create incentives for providers to restrict care if financial safeguards and oversight are insufficient.
Taxpayers and providers risk higher Medicare spending or lower provider payments if capitated payment benchmarks, discounts, or repayment mechanisms are poorly calibrated, shifting costs to the government or squeezing provider revenue.
Small or rural provider groups and nascent ACOs may be excluded by high minimum beneficiary thresholds (e.g., 2,500 for standard tracks and higher for complex care), limiting participation and local access to ACO resources.
Based on analysis of 1 section of legislative text.
Establishes a permanent Medicare Full Risk ACO Program with standard and complex care tracks, participation rules, payment flexibilities, and five‑year agreements, effective June 30, 2026.
Official title: To amend title XVIII of the Social Security Act to establish a full risk ACO program.
Introduced March 26, 2026 by Claudia Tenney · Last progress March 26, 2026
Establishes a permanent Full Risk Accountable Care Organization (ACO) Program for Traditional Medicare that the Secretary must create by June 30, 2026. The program creates two track types—"standard" and "complex care"—and sets rules for which provider groups can participate, minimum beneficiary thresholds, payment flexibility to support advanced primary care and care coordination, five‑year renewable participation agreements, and the ability for ACOs to receive and distribute Medicare payments (including paying providers in lieu of fee‑for‑service claims). The law expands access to permanent full‑risk models beyond temporary pilots, targets beneficiaries with high chronic care needs, and adds specific pathways for rural and teaching providers. It sets organizational, financial, and beneficiary minimums for participation and phases higher minimums for the complex care track over the first three years.