Health Care Efficiency Through Flexibility Act
Officially: “Health Care Efficiency Through Flexibility Act” Read the full text
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1Short title
This section says the Act may be called the "Health Care Efficiency Through Flexibility Act."
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1. Short title This Act may be cited as the Health Care Efficiency Through Flexibility Act .
2Ensuring availability of appropriate collection types for quality reporting under the Medicare Shared Savings Program
This section would amend the part of the Social Security Act that governs how Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program report quality measures. For performance years 2025 through 2029, it would require the Secretary of Health and Human Services to make sure that, for each quality measure an ACO is required to report, the ACO can use any of three data collection types: electronic clinical quality measures, MIPS clinical quality measures, and Medicare Clinical Quality Measures for Accountable Care Organizations participating in the Shared Savings Program. It would also add a rule on data completeness: for performance years beginning on or after January 1, 2025, when the Secretary is deciding whether an ACO's submitted quality data meets the data completeness requirements, the Secretary could not find the data unrepresentative of the ACO's performance solely because the data leaves out applicable data from one or more of the ACO's participants, as long as (1) the data the ACO submitted otherwise complies with the completeness requirements, and (2) the ACO shows the Secretary that the excluded participant was unable to collect the data through the collection type the ACO had selected for that submission. The section says "ACO participant" has the meaning given in the existing federal regulation on that term, and it lets the Secretary carry out this data completeness rule through program instructions or other means.
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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 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, 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) 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. .
3Pilot program for digital quality measure reporting
This section would further amend the same Social Security Act provision to add a digital quality measure reporting pilot program. For each performance year from 2028 through 2032, the Secretary would have to establish the program, in which ACOs selected for that year report quality measures the Secretary specifies, using a digital quality measure collection type the Secretary specifies. The Secretary would select participating ACOs from among ACOs that submit an application at a time and in a form and manner the Secretary specifies. For each performance year of the program, the Secretary would specify two of the quality measures that ACOs are otherwise required to report, and each selected ACO would submit data on those two measures through the digital collection type. The Secretary could not require a selected ACO to report any other otherwise-required quality measure for that performance year besides the two measures specified for the program. When determining whether a selected ACO met the quality performance standards the Secretary set for that performance year, or when determining a quality performance category score for one of that ACO's participants, the Secretary could not count data for the two specified measures submitted by the selected ACO, or data for any measure the ACO was not required to report because of its selection for the program. The Secretary would have to provide technical assistance to ACOs selected for the program to the extent practicable. By December 31, 2032, the Secretary would have to publicly post, or include as part of the annual rulemaking for this provision, an analysis of the program, any recommendations for increasing submissions of quality measure data through the digital collection type, and a proposed timeline for requiring those measures to be submitted through that collection type.
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3. Pilot program for digital quality measure reporting 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 collection type specified by the Secretary. (II) Selection The 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 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) 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). (cc) A proposed timeline for requiring such measures to be submitted through such collection type. .
Where it is
In the House.