Health Care Efficiency Through Flexibility Act

119 HR 5347 EH: Health Care Efficiency Through Flexibility Act U.S. House of Representatives text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. I 119th CONGRESS2d Session H. R. 5347

IN THE HOUSE OF REPRESENTATIVES AN ACT To amend title XVIII of the Social Security Act to ensure the availability of appropriate collection types for quality reporting under the Medicare Shared Savings Program, and for other purposes.

1.Short titleThis Act may be cited as the Health Care Efficiency Through Flexibility Act.

2.Ensuring availability of appropriate collection types for quality reporting under the Medicare Shared Savings ProgramSection 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 generalAn ACO shall submit; and (2)by adding at the end the following new clauses: (ii)Required availability of collection types for certain yearsFor 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 generalIn 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)DefinitionIn 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)ImplementationThe Secretary may implement this clause by program instruction or otherwise..

3.Pilot program for digital quality measure reportingSection 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 generalFor 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)SelectionThe 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 measuresFor 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 measuresThe 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 measuresThe 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 assistanceThe Secretary shall provide such technical assistance to ACOs selected to participate in the program as is practicable. (VII)Provision of informationNot 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..

4.Implementation funding (a)In generalThere 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 FundSection 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. Passed the House of Representatives June 29, 2026.Kevin F. McCumber,Clerk.

119 HR 5347 IH: Health Care Efficiency Through Flexibility Act U.S. House of Representatives 2025-09-15 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. I119th CONGRESS1st SessionH. R. 5347IN THE HOUSE OF REPRESENTATIVESSeptember 15, 2025Mr. Buchanan (for himself, Mr. Panetta, Mr. Crenshaw, and Mr. LaHood) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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 concernedA BILLTo amend title XVIII of the Social Security Act to ensure the availability of appropriate collection types for quality reporting under the Medicare Shared Savings Program, and for other purposes.

1.Short title This Act may be cited as the Health Care Efficiency Through Flexibility Act.

2.Ensuring availability of appropriate collection types for quality reporting under the Medicare Shared Savings Program 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 generalAn ACO shall submit; and (2)by adding at the end the following new clauses: (ii)Required availability of collection types for certain yearsFor 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 generalIn 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, 2025, 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)DefinitionIn 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)ImplementationThe Secretary may implement this clause by program instruction or otherwise. .

3.Pilot program for digital quality measure reportingSection 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 generalFor 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 collection type specified by the Secretary. (II)SelectionThe Secretary shall select ACOs to participate in the program for a performance year from among ACOs that submit an application at such time and in such form and manner as specified by the Secretary. (III)Specification of quality measuresFor 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 measuresThe Secretary may not require an ACO selected under subclause (II) for a performance year to report data on any measure described in subparagraph (A) 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 measuresThe 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 assistanceThe Secretary shall provide such technical assistance to ACOs selected to participate in the program as is practicable. (VII)Provision of informationNot 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). (cc)A proposed timeline for requiring such measures to be submitted through such collection type..

119 HR 5347 : Health Care Efficiency Through Flexibility Act U.S. House of Representatives 2026-07-13 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. IIB119th CONGRESS2d SessionH. R. 5347IN THE SENATE OF THE UNITED STATESJuly 13, 2026 Received; read twice and referred to the Committee on FinanceAN ACTTo amend title XVIII of the Social Security Act to ensure the availability of appropriate collection types for quality reporting under the Medicare Shared Savings Program, and for other purposes.1.Short titleThis Act may be cited as the Health Care Efficiency Through Flexibility Act.2.Ensuring availability of appropriate collection types for quality reporting under the Medicare Shared Savings ProgramSection 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 generalAn ACO shall submit; and(2)by adding at the end the following new clauses:(ii)Required availability of collection types for certain yearsFor 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 generalIn 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)DefinitionIn 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)ImplementationThe Secretary may implement this clause by program instruction or otherwise..3.Pilot program for digital quality measure reportingSection 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 generalFor 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)SelectionThe 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 measuresFor 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 measuresThe 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 measuresThe 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 assistanceThe Secretary shall provide such technical assistance to ACOs selected to participate in the program as is practicable.(VII)Provision of informationNot 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..4.Implementation funding(a)In generalThere 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 FundSection 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.Passed the House of Representatives June 29, 2026.Kevin F. McCumber,Clerk.