H.R. 5347 — Health Care Efficiency Through Flexibility Act, as amended
Executive Summary
H.R. 5347, the 'Health Care Efficiency Through Flexibility Act,' amends the Medicare Shared Savings Program (MSSP) to provide Accountable Care Organizations (ACOs) with critical flexibility in how they report quality measures. Currently, CMS is pushing ACOs toward mandatory all-payer digital quality reporting, which threatens to penalize ACOs that include smaller or rural providers lacking advanced interoperable EHR systems. This bipartisan bill mandates that CMS maintain multiple quality reporting pathways (including MIPS and Medicare CQMs) through 2029, creates a 'safe harbor' for ACOs if a single participant cannot report digitally, and establishes a pilot program to test digital quality measure reporting from 2028 to 2032. The bill's $8 million implementation cost is fully offset by a corresponding reduction to the Medicare Improvement Fund.
Arguments For
- Prevents ACO Dropout: By providing regulatory relief and extending flexible reporting options, the bill prevents smaller, rural, or safety-net providers from being forced out of value-based care arrangements due to onerous digital reporting mandates.
- Fiscally Responsible: The bill's $8 million implementation cost is fully offset by tapping the Medicare Improvement Fund, making it an easy 'pay-for' that avoids adding to the deficit.
- Creates a Glide Path: Instead of a hard mandate, the 2028-2032 pilot program allows CMS and providers to test and refine digital quality reporting, ensuring the technology and workflows are actually viable before system-wide implementation.
Likely Supporters
Arguments Against
- Delays Modernization: Critics may argue that extending legacy reporting options through 2029 delays the administration's goal of achieving fully interoperable, all-payer digital quality reporting.
- Data Fragmentation: Allowing ACOs to exclude certain participants' data under the 'safe harbor' provision could temporarily reduce the comprehensiveness and comparability of quality data across the Medicare program.
- Raids the Medicare Improvement Fund: While a standard offset, some members may object to drawing down the Medicare Improvement Fund for administrative implementation rather than direct patient care enhancements.
Likely Opponents
📋 Key Provisions
- Mandates that the Secretary of HHS ensure the availability of three specific collection types (eCQMs, MIPS CQMs, and Medicare CQMs) for MSSP ACOs for performance years 2025 through 2029.
- Establishes a data completeness 'safe harbor' preventing CMS from deeming an ACO's data unrepresentative solely because it excludes data from one or more participants unable to collect data via the selected reporting type.
- Creates a Digital Quality Measure Reporting Pilot Program for performance years 2028 through 2032, allowing selected ACOs to report two specified measures digitally while waiving other reporting requirements.
- Appropriates $8 million to the CMS Program Management Account for FY 2026 to implement the bill, fully offset by reducing the Medicare Improvement Fund from $2,062,000,000 to $2,054,000,000.
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Mandates availability of specific collection types for performance years 2025 through 2029.
"For performance years 2025 through 2029"
Prevents CMS from penalizing ACOs solely because a participant cannot collect data through the selected type.
"based solely on the fact that"
Establishes a digital quality measure reporting pilot program for 2028-2032.
"performance years 2028 through 2032"
Appropriates $8 million for FY 2026 implementation.
"$8,000,000 for fiscal year 2026"
Offsets the cost by reducing the Medicare Improvement Fund to $2,054,000,000.
"striking ‘‘$2,062,000,000’’ and inserting"