Sponsors (2)
The bill aims to expand and make permanent capitated ACOs that can improve coordinated care and access—especially for Medicare beneficiaries and rural areas—but shifts financial risk and incentives toward capitation, raising risks of reduced services, taxpayer exposure, and potential loss of some beneficiary protections.
Medicare beneficiaries (including those with multiple chronic conditions) gain more coordinated, individualized care (in‑home services, palliative and behavioral health, social supports) through permanent full‑risk ACOs.
Underserved and rural communities (including FQHCs, RHCs, CAHs) and their patients can access advanced payment models permanently, potentially expanding care options in areas that previously lacked such programs.
Providers (hospitals, health systems, primary care practices) can receive predictable monthly per‑beneficiary capitated payments (primary care capitation or Total Care Capitation), improving cash flow and payment flexibility.
Medicare beneficiaries face a risk of reduced services or care denials because full capitation/100% reduction of FFS claims can create financial incentives for providers to limit care if oversight and financial safeguards are insufficient.
Taxpayers and the Medicare program may incur higher costs if capitation benchmarks, discounts, or repayment mechanisms are poorly calibrated, or if primary care capitation repayments are not enforced, shifting costs to the government.
Broad waiver authority to waive provisions of Title XVIII and XI could reduce existing beneficiary protections and oversight, exposing beneficiaries to weaker safeguards depending on how waivers are used.
Based on analysis of 1 section of legislative text.
Creates a permanent Full Risk ACO Program for Traditional Medicare with Standard and Complex Care tracks and sets eligibility, payment, and operational rules.
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
Creates a permanent Full Risk Accountable Care Organization (ACO) Program for Traditional Medicare that the Secretary must establish by June 30, 2026. The program authorizes two tracks — a Standard track (large panels) and a Complex Care track (smaller panels for high-need patients) — under which provider groups take full financial risk, receive prospective payments or portions of fee-for-service claims, and are paid using incentives to promote advanced primary care, care coordination, and services in alternative settings for beneficiaries with medical and nonmedical needs.