Health Care Efficiency Through Flexibility Act

This Act may be cited as the “Health Care Efficiency Through Flexibility Act”.

Section 1899(b)(3)(B) of the Social Security Act (42 U.S.C. 1395jjj(b)(3)(B)) is amended—

(1) by striking “An ACO shall submit” and inserting the following:

“(i) In general.— An ACO shall submit”; and

(2) by adding at the end the following new clauses:

“(ii) Required availability of collection types for certain years.— For performance years 2025 through 2029, the Secretary shall ensure that the following collection types (as described in section 414.1305 of title 42, Code of Federal Regulations (or a successor regulation)) are available with respect to each measure described in subparagraph (A)(i) required to be reported by an ACO under this paragraph:

(I) Electronic clinical quality measures.

(II) MIPS clinical quality measures.

(III) Medicare Clinical Quality Measures for Accountable Care Organizations Participating in the Medicare Shared Savings Program.

(iii) Clarification on application of data completeness requirements in certain cases.—

(I) In general.— In determining whether data submitted by an ACO with respect to a measure described in subparagraph (A)(i) for a performance year beginning on or after January 1, 2026, satisfies the data completeness requirements applicable to such measure under section 414.1340 of title 42, Code of Federal Regulations (or a successor regulation) (as applied pursuant to section 425.512 of title 42, Code of Federal Regulations (or a successor regulation)), the Secretary may not find such data to be unrepresentative of such ACO’s performance for such year (as described in paragraph (e) of such section 414.1340) based solely on the fact that such data excludes applicable data from 1 or more ACO participants in such ACO if—

(aa) such data submitted by the ACO otherwise complies with the data completeness requirements of such section 414.1340; and

(bb) such ACO demonstrates to the satisfaction of the Secretary that such ACO participant was unable to collect such data through the collection type (as described in clause (ii)) selected by the ACO for the submission of such data.

(II) Definition.— In this clause, the term “ACO participant” has the meaning given such term in section 425.20 of title 42, Code of Federal Regulations (or a successor regulation).

(III) Implementation.— The Secretary may implement this clause by program instruction or otherwise.”.

Section 1899(b)(3)(B) of the Social Security Act (42 U.S.C. 1395jjj(b)(3)(B)), as amended by section 2, is further amended by adding at the end the following new clause:

“(iv) Pilot program for digital quality measure reporting.—

(I) In general.— For each of performance years 2028 through 2032, the Secretary shall establish a digital quality measure reporting pilot program (in this clause referred to as the “program”) under which ACOs selected under subclause (II) for such performance year report quality measures specified by the Secretary under subclause (III) for such performance year through a digital quality measure (as defined by the Secretary) collection type specified by the Secretary.

(II) Selection.— The Secretary shall select ACOs to participate in the program for a performance year from ACOs that submit an application at such time and in such form and manner as specified by the Secretary.

(III) Specification of quality measures.— For each performance year of the program, the Secretary shall specify 2 measures described in subparagraph (A)(i) otherwise required to be reported by ACOs for such performance year for which an ACO selected under subclause (II) shall submit data through the collection type specified in subclause (I).

(IV) Waiver of requirement to report other measures.— The Secretary may not require an ACO selected under subclause (II) for a performance year to report data on any measure described in subparagraph (A)(i) otherwise required to be reported by an ACO under this paragraph for such performance year, other than such a measure specified under subclause (III) for such performance year.

(V) Disregard of data for certain measures.— The Secretary may not take into account any data for a measure specified under subclause (III) for a performance year submitted by an ACO selected under subclause (II) for such performance year, or any data for a measure with respect to which such ACO is not required to report data for such performance year under subclause (IV), in determining—

(aa) whether such ACO has met quality performance standards established by the Secretary under subparagraph (C) for such performance year; or

(bb) any score for the quality performance category (as described in section 1848(q)(2)(A)(i)) for an ACO participant (as defined in clause (iii)(II)) in such ACO for such performance year.

(VI) Technical assistance.— The Secretary shall provide such technical assistance to ACOs selected to participate in the program as is practicable.

(VII) Provision of information.— Not later than December 31, 2032, the Secretary shall publicly post (or include as part of annual rulemaking for this section) the following:

(aa) An analysis of the program.

(bb) Any recommendations for increasing submissions of data for measures described in subparagraph (A)(i) through the collection type specified in subclause (I); and

(cc) A proposed timeline for requiring such measures to be submitted through such collection type.”.

(a) In general.— There are appropriated, out of any funds in the Treasury not otherwise obligated, $8,000,000 for fiscal year 2026, to remain available until expended, to the Centers for Medicare & Medicaid Services Program Management Account for purposes of implementing the amendments made by sections 2 and 3.

(b) Medicare Improvement Fund.— Section 1898(b)(1) of the Social Security Act (42 U.S.C. 1395iii(b)(1)) is amended by striking “$2,062,000,000” and inserting “$2,054,000,000”.