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

This bill amends the Social Security Act to establish a permanent full risk Accountable Care Organization (ACO) program within traditional Medicare, with standard and complex care track options, to improve care coordination and reduce costs through provider incentives and flexible payment models.

Sec. 1, Full risk ACO program: The Secretary must establish a full risk ACO program by June 30, 2026, where groups of health care professionals manage and coordinate care for Medicare fee-for-service beneficiaries through standard or complex care ACOs, with payments that incentivize high-quality, cost-reducing care.

Sec. 1(c), Full risk ACO program with standard and complex care track options: ACOs must be formed by specified provider types, serve a minimum number of beneficiaries (2,500 for standard, 250-1,000 for complex care over three years), have a financial guarantee, and enter a five-year agreement. They may offer coordinated care, social support, behavioral health, non-visit care, in-home care, and palliative care. Quality measures prioritize patient experience and outcomes, with complex care ACOs also using a Days at Home measure, and all participants are exempt from MIPS.

Sec. 1(d), Payment arrangements: Full risk ACOs can receive primary care capitation (up to 7% of total health care spending per beneficiary per year), total care capitation for all Part A and B services, or a population-based payment with claims reduction. Financial arrangements include full risk with 100% savings and losses sharing, a discount on the benchmark, and risk corridors. Benchmarks are based on historical spending, trended forward, blended with regional costs, risk-adjusted, and discounted, with separate methodology for complex care ACOs.

Sec. 1(e), Risk adjustment: Standard ACOs use prospective risk adjustment similar to Medicare Advantage; complex care ACOs use concurrent risk adjustment based on current year diagnoses.

Sec. 1(f), Beneficiary assignment: ACOs use Medicare Shared Savings Program alignment methods, including prospective assignment with or without retrospective reconciliation, and may use signed voluntary alignment on a monthly basis. Beneficiaries can opt out.

Sec. 1(g)-(i), Waivers, data, and MACRA treatment: The Secretary may waive certain provisions as needed, provide regular claims data to ACOs, and participating ACOs are considered advanced alternative payment models under MACRA.

Sec. 1(j), Definitions: Defines concurrent risk adjustment, Medicare fee-for-service beneficiary, physician, standard full risk ACO (less than two-thirds with six or more chronic conditions), and complex care full risk ACO (at least two-thirds with six or more chronic conditions).