Official Summaries

Health Care Efficiency Through Flexibility Act

This bill requires the Centers for Medicare & Medicaid Services (CMS) to delay certain requirements relating to the reporting of quality measures by accountable care organizations (ACOs) under the Medicare Shared Savings Program and to also test alternative reporting methods for ACOs. (The Medicare Shared Savings Program enables ACOs to receive payments for savings stemming from care coordination and management.)

Specifically, the CMS must delay the requirement that ACOs use a specified electronic system for reporting quality measures until January 1, 2030. Additionally, the CMS must establish a pilot program to test other digital reporting methods; ACOs that participate in the pilot program are exempt from using the existing electronic system. 

The CMS must also implement standards for digital reporting by January 1, 2030, that ensure all electronic health record systems used by ACOs are able to support reporting across a range of practice sizes, specialties, and geographic locations. ACOs may use existing reporting methods until the standards are implemented.

Current Full Text

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 483 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 483

   To direct the Secretary of Health and Human Services to delay the 
 implementation of electronic clinical quality metrics for accountable 
              care organizations, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 16, 2025

 Mr. Buchanan (for himself, Mr. Panetta, and Mr. Crenshaw) introduced 
 the following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committee on Ways and Means, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
   To direct the Secretary of Health and Human Services to delay the 
 implementation of electronic clinical quality metrics for accountable 
              care organizations, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Care Efficiency Through 
Flexibility Act''.

SEC. 2. DELAY IN IMPLEMENTATION OF ECQMS FOR ACOS.

    (a) Delay of ECQM Implementation.--The Secretary of Health and 
Human Services (in this section referred to as the ``Secretary'') shall 
delay the implementation of the requirement for ACOs to transition from 
reporting quality measures via the Centers for Medicare & Medicare 
Services Web Interface portal to electronic Clinical Quality Metrics 
(eCQMs), as described in the rule titled ``Medicare and Medicaid 
Programs; CY 2025 Payment Policies under the Physician Fee Schedule and 
Other Changes to Part B Payment and Coverage Policies; Medicare Shared 
Savings Program Requirements; Medicare Prescription Drug Inflation 
Rebate Program; and Medicare Overpayments'' (89 Fed. Reg. 97710 
(December 9, 2024)), until January 1, 2030.
    (b) Pilot Program for Digital Reporting Methods.--
            (1) In general.--Not later than January 1, 2026, the 
        Secretary shall establish and commence a pilot program to test 
        digital reporting methods for quality measures on a subset of 
        ACOs and ACO participants that submit an application to 
        participate in such pilot program at such time and in such form 
        as the Secretary determines appropriate.
            (2) Temporary exemption from ecqm requirements.--An ACO or 
        an ACO participant participating in the pilot program shall be 
        exempt from mandatory eCQM reporting requirements during the 
        duration of the pilot program.
            (3) No effect on payment incentives.--Participation in the 
        pilot program shall have no effect on the eligibility of an ACO 
        or an ACO participant to qualify for or earn an incentive 
        payment under section 1833(z) of the Social Security Act (42 
        U.S.C. 1395l(z)) or a payment adjustment under section 1848(q) 
        of such Act (42 U.S.C. 1395w-4(q)).
            (4) Technical assistance.--The Secretary shall provide 
        technical assistance, including waivers from any applicable 
        quality reporting requirements, to ACOs and providers 
        participating in the pilot program to incentivize their 
        participation and to evaluate the efficacy of digital reporting 
        methods.
            (5) Report.--Not later than January 1, 2028, the Secretary 
        shall submit to Congress a report that includes--
                    (A) the findings and results of the pilot program 
                carried out under paragraph (1); and
                    (B) any recommendations for increasing the adoption 
                by additional ACOs of the digital reporting methods 
                tested under such pilot program.
    (c) Development of Long-Term Digital Quality Reporting Standards.--
            (1) In general.--Not later than January 1, 2030, the 
        Secretary shall implement standards for digital quality 
        reporting metrics and formats. Such standards shall ensure that 
        all EHR systems used by an ACO are capable of supporting 
        digital reporting methods across a diverse range of practice 
        sizes, specialties, and geographic locations.
            (2) Consultation.--In developing the standards described in 
        paragraph (1), the Secretary shall collaborate with relevant 
        stakeholders, including representatives of the National 
        Committee for Quality Assurance, EHR vendors, ACOs, payers, and 
        national medical and specialty physician groups.
    (d) Continued Use of Existing Reporting Methods.--
            (1) In general.--An ACO or ACO participant may use the CMS 
        Web Interface portal, MIPS CQMs, Medicare CQMs, eCQMs, or any 
        other previously established quality reporting methods, for the 
        purpose of meeting such requirements until the date on which 
        the Secretary promulgates the standardized digital quality 
        reporting methods under subsection (c).
            (2) Exemption.--No penalties shall be imposed on ACOs or 
        ACO participants for failure to comply with eCQM requirements 
        during the period prior to January 1, 2030, provided they are 
        in compliance with existing reporting methods.
    (e) Definitions.--In this section:
            (1) ACO.--The term ``ACO'' has the meaning given the term 
        ``accountable care organization'' in section 425.20 of title 
        42, Code of Federal Regulations.
            (2) ACO participant.--The term ``ACO participant'' has the 
        meaning given such term in section 425.20 of title 42, Code of 
        Federal Regulations.
            (3) EHR.--The term ``EHR'' has the meaning given the term 
        ``certified EHR technology'' in section 1848(o) of the Social 
        Security Act (42 U.S.C. 1395w-4(o)).
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