The Centers for Medicare & Medicaid Services (CMS) has released the proposed rule for the 2026 Medicare Physician Fee Schedule, which includes significant changes to the Medicare Shared Savings Program. These changes aim to improve program policies and operations.
The Trump Administration emphasizes that participation in the Shared Savings Program should enhance chronic disease management, resource efficiency, innovation, and savings for the Medicare Trust Fund. As of January 1, 2025, there are 477 Accountable Care Organizations (ACOs) with over 650,000 healthcare providers serving more than 11.2 million Traditional Medicare beneficiaries.
One key proposal is reducing the time an ACO can participate in a one-sided model of the BASIC track from seven to five performance years. This change is intended to encourage ACOs to transition to two-sided risk models starting January 1, 2027.
CMS also proposes modifications regarding eligibility and financial reconciliation requirements. The agency suggests increasing flexibility concerning the minimum number of assigned beneficiaries required in benchmark years while safeguarding Medicare Trust Funds against expenditure variations.
Further proposals include changes to quality performance standards and reporting requirements. Notably, CMS plans to remove the health equity adjustment from an ACO’s quality score beginning in performance year 2025 and revise related terminology for previous years.
Additionally, CMS intends to update the Alternative Payment Model Performance Pathway Plus quality measure set by removing certain measures and expanding survey modes for performance year 2027. The agency also proposes extending extreme and uncontrollable circumstances policies to cover cyberattacks affecting ACOs.
Other suggested changes involve requiring ACOs to report specific changes during a performance year related to ownership or affiliate lists and revising primary care service definitions used for beneficiary assignment.
Public comments on these proposals are invited until September 12, 2025. Interested parties can submit feedback through regulations.gov using file code CMS-1832-P.
Information from this article can be found here.
