119th (2025–2027)
H.R. 8129
This bill establishes a new permanent program in Medicare for Accountable Care Organizations (ACOs) that assume full financial risk for patient care costs. Starting June 30, 2026, the program creates two tracks: a standard ACO serving at least 2,500 beneficiaries and a complex care ACO starting with just 250 beneficiaries (those with six or more chronic conditions). Participating groups of doctors and hospitals would receive capitated payments (fixed monthly amounts per patient) instead of traditional fee-for-service reimbursement, allowing them to keep savings if they reduce costs while sharing losses if costs exceed targets, with protections through risk corridors and discounts applied to spending benchmarks. The program offers flexibility in payment options, waives certain Medicare reporting requirements like MIPS quality measures, and requires ACOs to provide expanded services such as care coordination, behavioral health, in-home care, and telehealth. ACOs participating in this program would be treated as advanced payment models under Medicare, and Medicare beneficiaries would retain the ability to opt out, though the bill does not specify dedicated federal funding amounts or enforcement mechanisms.