CMS’ proposed rule for the 2026 Medicare Physician Fee Schedule comprises key updates to the Medicare Shared Savings Program, according to a July 14 news release from the agency.
The proposals aim to increase accountable care organization participation flexibility, improve program operations and encourage faster two-sided risk transitions. Proposed rule public comments are due Sept. 12.
Here are eight things to know:
1. The proposed rule updates include reducing the duration that ACOs can take part in a one-sided risk model under the BASIC track from seven to five years, starting with agreement periods on or after Jan. 1, 2027, to promote a faster two-sided risk transition.
2. ACOs could enter new agreements on or after Jan. 1, 2027, to meet the 5,000 beneficiary minimum in the third benchmark year only, not all three. ACOs that fall below the threshold in any year may see shared savings and losses caps and face limits to participation in BASIC track.
3. CMS proposes removing health equity adjustment to ACOs’ quality scores in 2025, highlighting overlap with incentives such as the electronic Clinical Quality Measure/MIPS CQM and the Complex Organization Adjustment.
“Our proposal to remove the health equity adjustment would deduplicate scoring factors and further simplify our quality scoring methodology,” the release said.
4. The Medicare Clinical Quality Measure-eligible beneficiaries definition would be updated in 2025 to align better with ACO-assignable populations in an attempt to ease burdens in patient matching needed to report Medicare CQMs.
5. CMS proposed multiple updates to the APP Plus quality measure set for Shared Savings Program ACOs. This includes the removal of the “Screening for Social Drivers of Health” from the APP Plus quality measure set. It also suggests updating CAHPS survey modes to feature a web-mail-phone protocol beginning in 2027.
6. ACOs affected by attacks such as ransomware would have extreme and uncontrollable circumstances relief extended to them beginning in performance year 2025. The extension would be pending MIPS EUC application approval.
7. During the performance year, ACOs would be required to report skilled nursing facility or participant affiliate changes should there be a change of ownership, with a goal to improve program participation continuity.
8. CMS also aims to revise the definition of primary care services for beneficiary assignment, rename “health equity benchmark adjustment” to “population adjustment,” and monitor quality and alternative quality performance compliance standards beginning in 2026.
