To amend title XVIII of the Social Security Act to establish a full risk ACO program.

Key Points

• This bill creates a permanent full risk Accountable Care Organization (ACO) program within traditional Medicare, replacing time-limited pilot projects. Groups of healthcare providers would coordinate care for Medicare patients and take on full financial risk for the cost and quality of that care.
• The program has two tracks: a "standard" track for general Medicare patients (requiring at least 2,500 beneficiaries) and a "complex care" track for patients with six or more chronic conditions (starting at just 250 beneficiaries). This ensures the sickest patients get specialized attention.
• Instead of traditional fee-for-service payment, ACOs can receive monthly per-patient payments covering primary care or total care. Under total care capitation, providers agree to a 100% reduction of their fee-for-service claims in exchange for a bundled monthly payment.
• ACOs must provide a wide range of services including behavioral health, social support, in-home care, palliative care, and nonvisit-based care like phone, video, email, and text. This broadens what Medicare traditionally covers for patients in these programs.
• Medicare beneficiaries can opt out of the program and stay in regular fee-for-service Medicare. Providers in the program are exempt from the Merit-Based Incentive Payment System (MIPS), reducing their reporting burden.