H.R. 5347 — Health Care Efficiency Through Flexibility Act

This section requires the Secretary to ensure that electronic clinical quality measures, MIPS clinical quality measures, and Medicare Clinical Quality Measures for Accountable Care Organizations are available for each quality measure that ACOs must report under the Medicare Shared Savings Program for performance years 2025 through 2029. For performance years beginning on or after January 1, 2026, it prohibits the Secretary from deeming an ACO’s data submission unrepresentative solely because it excludes data from one or more ACO participants, provided the submission otherwise meets data completeness requirements and the ACO demonstrates that the excluded participant could not collect the data through the selected collection type.

This section establishes a digital quality measure reporting pilot program for performance years 2028 through 2032. Selected accountable care organizations report only two Secretary-specified quality measures via digital collection, receive a waiver from reporting all other measures, and have pilot and waived data disregarded in quality performance standards and scores; the Secretary must provide technical assistance and, by December 31, 2032, publicly post an analysis, recommendations for broader digital submissions, and a proposed implementation timeline.

This section appropriates $8,000,000 for fiscal year 2026 to the Centers for Medicare & Medicaid Services Program Management Account to implement the amendments made by sections 2 and 3. It reduces the amount available to the Medicare Improvement Fund to $2,054,000,000 (from $2,062,000,000) for expenditures on services furnished during and after fiscal year 2026 under the original Medicare fee-for-service program.