HR-5347-119
Motion to reconsider laid on the table Agreed to without objection.
Sponsored by Vern Buchanan (R-FL)
What it does
This bill would delay a 2024 CMS rule requiring accountable care organizations (ACOs) to report quality measures through a specific electronic system, allowing ACOs to continue using prior reporting methods through 2029. It would also require CMS to run a pilot program from 2028 to 2032 that tests alternative digital reporting methods, with participating ACOs exempt from other reporting requirements during that period. CMS would be required to publicly post an analysis of the pilot program and any recommendations for broader adoption of the tested methods.
Who benefits
ACOs — networks of doctors, hospitals, and other providers coordinating care for Medicare patients — that would avoid the cost and administrative burden of transitioning to the new electronic reporting system by 2025. Smaller or rural ACOs with limited IT infrastructure would benefit most from the delay. Medicare beneficiaries enrolled in ACOs could indirectly benefit if the delay allows ACOs to focus resources on care coordination rather than compliance. Health IT vendors participating in the pilot program may gain a testing ground for new reporting technologies.
Who is hurt
Medicare beneficiaries and policymakers who rely on timely, standardized quality data to evaluate ACO performance could face a gap in comparable reporting through 2029. CMS and federal oversight bodies would have reduced ability to enforce uniform quality standards during the delay period. Health IT vendors that developed systems specifically for the 2025 requirement may lose expected contracts. Taxpayers could bear costs if the delay makes it harder to identify underperforming ACOs and recoup savings.
Supporters argue
Supporters argue that the 2024 CMS rule imposed a rapid and costly transition to a new electronic reporting system, giving ACOs — particularly smaller and rural ones — insufficient time to adapt without disrupting patient care operations. They contend that a phased approach, including a structured pilot program, is a more responsible path to modernizing quality reporting, ensuring that any new system is tested and proven before mandatory nationwide adoption.
Opponents argue
Opponents argue that delaying standardized quality reporting through 2029 creates a multi-year blind spot in Medicare's ability to assess whether ACOs are actually improving care and generating savings for the program. They contend that CMS already conducted a rulemaking process before issuing the 2024 rule, and that a legislative override of that process — without demonstrated evidence of ACO harm — undermines the regulatory framework designed to protect Medicare beneficiaries and taxpayers.
Constitutional context
No significant constitutional issue is raised by this bill. Congress has broad authority under the Taxing and Spending Clause (Art. I, §8, cl. 1) to set conditions on Medicare payments, and directing CMS to modify reporting requirements falls squarely within that authority. Post-Loper Bright (2024), courts would independently review any future CMS rulemaking under the pilot program, but the bill itself does not present an active constitutional dispute.
Checks and balances
Congress gains authority by overriding a CMS administrative rule through statute; CMS retains implementation authority over the pilot program and must publicly report findings, providing a transparency check on the executive branch.
Historical precedent
Congress has previously delayed or modified CMS quality reporting requirements for other Medicare providers, such as the repeated delays to the Sustainable Growth Rate formula for physician payments before its repeal in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.