Bill Would Establish Permanent Full-Risk ACO Program

U.S. Reps. Claudia Tenney (R-N.Y.) and Brad Schneider (D-Ill.) have introduced legislation to establish a permanent, full-risk accountable care organization (ACO) program in Medicare.
 
The Center for Medicare and Medicaid Innovation (CMMI) has tested full-risk accountable care models, including ACO REACH, Direct Contracting, Next Generation, and Pioneer ACO models. These models have repeatedly generated cost savings and improved health outcomes for Medicare beneficiaries.
 
According to policy and advocacy group Accountable for Health, CMMI ACOs differ from the Medicare Shared Savings Program (MSSP) in key aspects. The new bill would codify these features, including:
• Full financial risk for participating organizations
• Options for capitated payment
• Ability to enter into unique payment arrangements with downstream providers
• Concurrent risk adjustment tailored to patient populations
• Streamlined quality measurement focused on outcomes and patient experience
• A dedicated complex care track for beneficiaries with six or more chronic conditions
 
Under the legislation, CMS would establish both Standard and Complex Care tracks, ensuring providers caring for the most medically complex Medicare beneficiaries have a stable platform to deliver coordinated, individualized care.
 
The legislation comes as CMS continues to refine its accountable care portfolio, including the upcoming Long-Term Enhanced ACO Design (LEAD) Model. Accountable for Health emphasized that the new bill complements these efforts.
 
“LEAD is an exciting new development and we strongly support the Innovation Center’s direction for offering a 10-year model,” said Mara McDermott, CEO of Accountable for Health, in a statement.  “We believe there is sufficient evidence now to justify making these offerings a permanent payment option in the future.”

Accountable for Health adds that by embedding a full-risk model in law, Congress would provide continuity for ACOs participating in Innovation Center models, while creating a durable glide path for others seeking to take on greater accountability.