ACO Assignment Improvement Act of 2025
Summary
The "ACO Assignment Improvement Act of 2025" aims to modify the Medicare shared savings program by including primary care services furnished by nurse practitioners, physician assistants, and clinical nurse specialists in the assignment of beneficiaries. This would broaden the scope of healthcare providers considered when assigning beneficiaries to Accountable Care Organizations (ACOs). The bill seeks to amend Section 1899(c)(1) of the Social Security Act to reflect this change, effective for performance years beginning on or after January 1, 2026.
Expected Effects
The primary effect of this bill would be to expand the criteria for assigning Medicare beneficiaries to ACOs. By including services provided by nurse practitioners, physician assistants, and clinical nurse specialists, the bill could lead to a more comprehensive and potentially more accurate assignment process. This could incentivize greater utilization of these healthcare professionals within the Medicare system.
Potential Benefits
- Improved Access to Care: By recognizing nurse practitioners, physician assistants, and clinical nurse specialists, the bill could improve access to primary care services, especially in underserved areas.
- Enhanced Care Coordination: Including a broader range of providers in beneficiary assignment may lead to better care coordination within ACOs.
- Potential Cost Savings: Utilizing these professionals may offer cost-effective alternatives to physician-led primary care.
- Modernization of Medicare: The bill updates Medicare regulations to reflect the evolving roles of healthcare professionals.
- Increased Efficiency: By expanding the pool of eligible primary care providers, the bill could streamline the assignment process.
Potential Disadvantages
- Potential for Fragmentation of Care: Expanding the assignment criteria could lead to fragmentation of care if not properly coordinated.
- Administrative Complexity: Implementing the new assignment rules may create administrative challenges for ACOs and the Centers for Medicare & Medicaid Services (CMS).
- Unintended Consequences: There is a risk of unintended consequences related to beneficiary assignment and ACO performance metrics.
- Possible Gaming of the System: ACOs might attempt to manipulate the assignment process to their advantage.
- Lack of Clarity on Implementation: The bill lacks specific details on how the new assignment rules will be implemented and enforced.
Constitutional Alignment
The bill appears to align with the general welfare clause of the Constitution, as it aims to improve healthcare access and efficiency within the Medicare system. Specifically, the preamble of the Constitution mentions promoting the "general Welfare." Additionally, Article I, Section 8 grants Congress the power to lay and collect taxes to provide for the general welfare of the United States. This bill falls under Congress's authority to legislate on matters related to healthcare and social security.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).