{
  "legislationId": "119_HR_8129",
  "lastUpdate": "2026-04-29T11:23:46.324Z",
  "history": [
    {
      "timestamp": "2026-04-29T11:23:46.324Z",
      "source_url": "https://www.congress.gov/119/bills/hr8129/BILLS-119hr8129ih.htm",
      "model": "gemini-flash-lite-latest",
      "prompt_sent": "\nROLE: Fact Checker.\nZADANIE: Porównaj SOURCE (oryginał) i SUMMARY (streszczenie przygotowane przez inne AI).\n\nTwoim celem jest wykrycie \"ZMYŚLONYCH KONKRETÓW\" (Fabricated Entities) w SUMMARY.\n\nSOURCE:\n[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 8129 Introduced in House (IH)] <DOC> 119th CONGRESS 2d Session H. R. 8129 To amend title XVIII of the Social Security Act to establish a full risk ACO program. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES March 26, 2026 Ms. Tenney (for herself and Mr. Schneider) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned _______________________________________________________________________ A BILL To amend title XVIII of the Social Security Act to establish a full risk ACO program. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. FULL RISK ACO PROGRAM. Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following new section: ``full risk accountable care organization program ``Sec. 1899B. ``(a) Findings.--Congress finds as follows: ``(1) Successful pilots over the last decade have demonstrated that full risk accountable care organizations (ACOs), including full risk ACOs that focus on a complex care population are successful at improving health outcomes while lowering costs in traditional Medicare. ``(2) Traditional Medicare lacks a permanent program that allows providers flexibility to engage in full risk models outside of time-limited pilot projects. ``(3) A wide range of organizations serving a range of traditional Medicare beneficiaries, including rural and underserved areas, would benefit from permanent options for full risk accountable care. ``(4) Full risk models can transform care by allowing more flexible and diverse payment options beyond fee-for-service reimbursement, impact cash flow, and tailor experiences for clinicians and beneficiaries. ``(5) ACO options must encourage better care coordination for complex care beneficiaries, those with six or more chronic conditions. ``(b) Establishment.--By June 30, 2026, the Secretary shall establish a full risk ACO program (in this section referred to as the `program') that adopts proven provider incentives to deliver high- quality care to better meet the needs of Traditional Medicare beneficiaries (as defined in subsection (l)). Under such program-- ``(1) groups of health care professionals shall work together to manage and coordinate care for Medicare fee-for- service beneficiaries through a `standard' or `complex care' full risk ACO. ``(2) providers and suppliers participating in this program shall be paid in a manner that incentivizes furnishing items and services in such practice to provide high-quality care tailored to meet the needs of Medicare fee-for-service beneficiaries while reducing the cost of care. ``(c) Full Risk ACO Program With Standard and Complex Care Track Options.-- ``(1) In general.--An ACO participating in this program is a group of providers and suppliers focused on individualizing care to meet the specific needs of Traditional Medicare beneficiaries by emphasizing advanced primary care, care coordination, and the delivery of care in alternate settings for beneficiaries needing medical and nonmedical assistance in managing their health. ``(2) Requirements.--In order to participate in the program under this program, an ACO: ``(A) Must be formed by the following ACO participants or combinations of ACO participants, consistent with the Medicare Shared Savings Program: ``(i) ACO professionals in group practice arrangements. ``(ii) Networks of individual practices of ACO professionals. ``(iii) Partnerships or joint venture arrangements between hospitals and ACO professionals. ``(iv) Hospitals employing ACO professionals. ``(v) CAHs that bill under Method II (as described in section 413.70(b)(3) of this chapter). ``(vi) RHCs. ``(vii) FQHCs. ``(viii) Teaching hospitals that have elected under section 415.160 of this subchapter to receive payment on a reasonable cost basis for the direct medical and surgical services of their physicians. ``(B) Shall be structured to allow the organization to receive and distribute payments for services and performance incentives to participant and preferred providers and suppliers. ``(C) Shall include a sufficient number and type of providers for the Medicare fee-for-service beneficiaries aligned or assigned to the ACO, as determined by the Secretary. ``(D) Shall serve a required minimum number of aligned and/or attributed beneficiaries. ``(i) A Standard Full Risk ACO shall have at least 2,500 aligned and/or assigned beneficiaries. ``(ii) A complex care full risk ACO shall have at least 250 aligned and/or assigned beneficiaries in the first year; at least 500 aligned or assigned beneficiaries in the second year; and at least 1,000 aligned and/or assigned beneficiaries in the third year and in every participation year after that. ``(E) May establish `preferred provider' relationships, and may pay such providers a portion or all of the provider's fee-for-service claims in lieu of fee-for-service reimbursement from CMS. ``(F) Shall have a financial guarantee mechanism in place commensurate with the financial arrangement selected in this program. ``(G) Shall enter into an agreement with the Secretary to participate in the program for a five-year period. The agreement may be renewed for additional performance periods. ``(H) Shall permit participation in the program at the TIN-NPI level. ``(3) Clinical services.--An ACO participating in this program shall provide individualized care to meet the specific needs of Medicare fee-for-service beneficiaries attributed or aligned to the ACO. This may include the following: ``(A) Coordinated care across the care continuum, including transitions. ``(B) Social support services. ``(C) Behavioral health services. ``(D) Nonvisit-based care (including email, text, phone, video, or other technology). ``(E) Extended care access options and technology platforms enabling patient stratification, outcomes tracking, and practice-based population management. ``(F) In-home care. ``(G) Palliative care. ``(H) Other items and services as determined appropriate by the Secretary. ``(4) Quality and reporting requirements.--The Secretary shall develop quality performance standards for full risk ACOs. ``(A) Standard full risk acos.--The Secretary shall deploy a limited set of quality measures that prioritize patient experience and health outcomes while reducing clinician burden. ``(B) Additional requirement for quality performance for complex care full risk acos.--The Secretary shall deploy the quality measures in (c)(4)(A) and include a Days at Home measure. ``(C) Overlap with medicare access and chip reauthorization act.--All full risk ACO program participants shall be exempt from the Merit-Based Incentive Payment System (MIPS). ``(5) Beneficiary communications.--The Secretary shall promulgate requirements for ACO marketing to Medicare fee-for- service beneficiaries that educates and informs beneficiaries about their care options. ``(d) Payment Arrangements for ACOs, Participant and Preferred Providers.-- ``(1) In general.--A full risk ACO is eligible to receive the following payments under the program under this section: ``(A) Primary care capitation.--A per-beneficiary, per-month capitated payment for primary care services provided by Participant Providers and preferred providers who have opted into the capitated arrangement with the full risk ACO reflective of the predicted Medicare Part B costs representing professional services for which the ACO is directly responsible. In a given year, such payment may be up to 7 percent of the total health care spending for the beneficiary under this title for the year. The program shall include a repayment mechanism for the primary care capitation to ensure that this does not result in additional Medicare spending. ``(B) Total care capitation.--A per-beneficiary, per-month capitated payment for all Medicare Part A and Part B services provided to aligned beneficiaries by all Participant Providers and by preferred providers who have opted into the capitated arrangement. The TCC payment amount will reflect the estimated total cost of care for the full risk ACO's aligned population for services provided by the providers participating in the capitation mechanism. Providers that elect to participate in Total Care Capitation will agree to a 100 percent reduction of their fee-for-service claims. ``(C) Option for claims reduction and population- based payment.--Full Risk ACOs can enter into arrangements whereby CMS would reduce claims payments for aligned beneficiaries for Participant and Preferred Providers and CMS would make a monthly payment to the ACO equivalent to the estimated value of the FFS claims reductions for those services. ``(2) Financial arrangements.-- ``(A) In general.--This program shall offer full financial risk for participant ACOs. ``(B) Financial arrangements.--The Secretary shall make multiple financial arrangements available to ACOs, reflecting varying experience with and ability to assume risk for Medicare fee-for-service beneficiaries. The Secretary shall make one or more financial arrangements available to ACOs under both of the following solutions: ``(i) Full risk arrangement.--ACOs participating in full risk arrangements shall share in 100 percent of savings and losses, subject to a discount and risk corridors. ``(ii) Discount.--The Secretary shall determine and apply a discount to the full risk ACO's benchmark. ``(C) Benchmark for standard full risk acos.--The benchmark for Standard Full Risk ACOs shall be developed by-- ``(i) calculating the ACOs historical baseline spending for its aligned beneficiary population; ``(ii) trending the historical baseline expenditures forward based on an adjusted version of the U.S. Per Capita Cost growth trend; ``(iii) blending the historical baseline expenditures with regional expenditures using an adjusted Medicare Advantage rate book; ``(iv) risk adjust the blended expenditures; and ``(v) apply the discount. ``(D) Benchmark for complex care full risk acos.-- The benchmarking methodology for Complex Care Full Risk ACOs shall be developed separately, taking into account the appropriate weighting of the regional component (at least half) and remove the ceiling on the regional blend. ``(E) Risk corridors.--The Secretary shall develop risk corridors appropriate to this program. ``(e) Risk Adjustment.-- ``(1) Prospective risk adjustment.--Subject to paragraph (2), the Secretary shall use prospective risk adjustment for a standard full risk ACO. Risk adjustment methodologies should be identical to Medicare Advantage to the extent practical. ``(2) Concurrent risk adjustment for complex care full risk aco.--The Secretary shall use concurrent risk adjustment to adjust the benchmark for a complex care full risk ACO. ``(f) Beneficiary Assignment.-- ``(1) In general.--Full Risk ACO program participants shall use the Medicare Shared Savings Program alignment and assignment methodologies, including a choice of prospective assignment or prospective assignment with retrospective reconciliation. ``(2) Signed voluntary alignment.--In addition to the methodology in subsection (f)(1), Standard and Complex Care Full Risk ACOs shall be permitted to use signed voluntary alignment. Such alignment shall take effect on a monthly basis. ``(3) Opt-out.--Medicare beneficiaries shall have the ability to opt out of participating in the full risk ACO program. ``(g) Waivers.--The Secretary may waive such provisions of this title and title XI as the Secretary determines necessary in order to implement the demonstration program. ``(h) Data.--The Secretary shall provide to program participants under this section regular reports with up-to-date provider claims data and payment information with respect to Medicare fee-for-service beneficiaries attributed or aligned in the ACO and shall provide other data to ACOs as necessary. ``(i) Treatment Under the Medicare Access and CHIP Reauthorization Act.--An ACO participating in this program shall be considered an `advanced alternative payment model'. ``(j) Definitions.--In this section: ``(1) Concurrent risk adjustment.--The term `concurrent risk adjustment' means a risk adjustment model that uses current year diagnoses, demographics, and other factors to predict cost in that same year. ``(2) Medicare fee-for-service beneficiary.--The term `Medicare fee-for-service beneficiary' means an individual who is enrolled in the original Medicare fee-for-service program under parts A and B and is not enrolled in a Medicare Advantage plan under part C, an eligible organization under section 1876, or a PACE program under section 1894. ``(3) Physician.--The term `physician' means a physician as defined in section 1861(r)(1). ``(4) Standard full risk aco.--The term `standard full risk ACO' means an ACO composed of Medicare fee-for-service beneficiaries, less than two-thirds of which have six or more chronic co-morbidities. ``(5) Complex care full risk aco.--The term `complex care full risk ACO' means an ACO composed of Medicare fee-for- services beneficiaries, at least two-thirds of which have six or more chronic co-morbidities.''. <all>\n\nSUMMARY TO EVALUATE:\nTitle: New Medicare Full Risk Program for Better Coordinated Patient Care\nSummary: This bill creates a permanent program where healthcare providers take full responsibility for patient outcomes in exchange for more flexibility. It aims to provide seniors with more personalized care, including home visits and digital health options.\nKey Points: Focus on better care coordination for patients with six or more chronic conditions., Expanded access to telehealth, home care, and social support services., Providers are paid based on quality and efficiency rather than per-visit fees., Patients can choose to join or opt-out of the program at any time.\n\nZASADY OCENY:\n1. Sprawdź wszystkie LICZBY, DATY i KWOTY w SUMMARY. Jeśli którejś brakuje w SOURCE -> is_valid: false.\n2. Sprawdź wszystkie NAZWISKA, ORGANIZACJE i MIEJSCA w SUMMARY. Jeśli którejś brakuje w SOURCE -> is_valid: false.\n3. Sprawdź wszystkie konkretne DZIAŁANIA PRAWNE . Jeśli tego mechanizmu nie ma w SOURCE -> is_valid: false.\n\nWAŻNE: Abstrakcyjne pojęcia (np. \"transparentność\", \"zaufanie\") są dozwolone jako wnioski.\n\nOUTPUT (JSON):\n{\n  \"is_valid\": true/false,\n  \"issue\": \"fabricated_entity\" / \"contradiction\" / \"none\"\n}\n\nWYMAGANIA FORMATOWANIA:\n1. Odpowiedz WYŁĄCZNIE surowym obiektem JSON.\n2. NIE używaj bloków kodu Markdown.\n3. NIE dodawaj żadnych wstępów ani wyjaśnień przed ani po JSONie.\n4. JSON musi być poprawny i gotowy do parsowania.\n\n",
      "ai_response_raw": "{\n  \"is_valid\": true,\n  \"issue\": \"none\"\n}"
    },
    {
      "timestamp": "2026-04-29T11:13:11.507Z",
      "source_url": "https://www.congress.gov/119/bills/hr8129/BILLS-119hr8129ih.htm",
      "model": "gemini-flash-latest",
      "prompt_sent": "\nJesteś ekspertem od prawa Stanów Zjednoczonych, który ma za zadanie analizować dokumenty ustaw, uchwał oraz innych dokumentów legislacyjnych, a następnie przygotowywać z nich informacje w przystępny sposób dla obywateli. Twoim celem jest przedstawienie informacji tak, aby obywatele mogli sami ocenić wpływ legislacji na ich życie, nawet bez posiadania specjalistycznej wiedzy legislacyjnej. Skup się na faktach i obiektywnych skutkach wprowadzanych zmian, unikając wartościowania i osobistych opinii. Wszelki żargon prawny jest zabroniony. Prezentuj informacje w jasny, zwięzły i angażujący sposób, tak aby były zrozumiałe dla osoby bez wykształcenia prawniczego. Unikaj długich, złożonych zdań. Zamiast pisać \"projekt ma na celu nowelizację kodeksu podatkowego...\", napisz \"Zmiany w podatkach: nowe ulgi i obowiązki dla...\". Kontynuuj swoją pracę, dopóki nie rozwiążesz swojego zadania. Jeśli nie masz pewności co do generowanej treści, przeanalizuj dokument ponownie – nie zgaduj. Rozplanuj dobrze swoje zadanie przed przystąpieniem do niego. W podsumowaniu i kluczowych punktach, jeśli to możliwe i uzasadnione, podkreśl, jakie konkretne korzyści lub skutki (pozytywne lub negatywne) wprowadza ustawa dla życia codziennego obywateli, ich praw i obowiązków, finansów osobistych, bezpieczeństwa i innych ważnych kwestii (np. kategorycznych zakazów i nakazów czy najważniejszych konkretnych alokacji finansowych i terytorialnych).\n\nTwoja odpowiedź MUSI być w formacie JSON - i zawierać następujące klucze.\nZanim zwrócisz odpowiedź, dokładnie zweryfikuj, czy cała struktura JSON jest w 100% poprawna, włącznie ze wszystkimi przecinkami, nawiasami klamrowymi, kwadratowymi oraz cudzysłowami. Błędny JSON jest nieakceptowalny i uniemożliwi przetworzenie Twojej pracy.\n\nPrzeanalizuj dokładnie poniższy tekst dokumentu prawnego. To jest treść, na podstawie której masz wygenerować podsumowanie i kluczowe punkty:\n--- POCZĄTEK DOKUMENTU ---\n[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 8129 Introduced in House (IH)] <DOC> 119th CONGRESS 2d Session H. R. 8129 To amend title XVIII of the Social Security Act to establish a full risk ACO program. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES March 26, 2026 Ms. Tenney (for herself and Mr. Schneider) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned _______________________________________________________________________ A BILL To amend title XVIII of the Social Security Act to establish a full risk ACO program. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. FULL RISK ACO PROGRAM. Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following new section: ``full risk accountable care organization program ``Sec. 1899B. ``(a) Findings.--Congress finds as follows: ``(1) Successful pilots over the last decade have demonstrated that full risk accountable care organizations (ACOs), including full risk ACOs that focus on a complex care population are successful at improving health outcomes while lowering costs in traditional Medicare. ``(2) Traditional Medicare lacks a permanent program that allows providers flexibility to engage in full risk models outside of time-limited pilot projects. ``(3) A wide range of organizations serving a range of traditional Medicare beneficiaries, including rural and underserved areas, would benefit from permanent options for full risk accountable care. ``(4) Full risk models can transform care by allowing more flexible and diverse payment options beyond fee-for-service reimbursement, impact cash flow, and tailor experiences for clinicians and beneficiaries. ``(5) ACO options must encourage better care coordination for complex care beneficiaries, those with six or more chronic conditions. ``(b) Establishment.--By June 30, 2026, the Secretary shall establish a full risk ACO program (in this section referred to as the `program') that adopts proven provider incentives to deliver high- quality care to better meet the needs of Traditional Medicare beneficiaries (as defined in subsection (l)). Under such program-- ``(1) groups of health care professionals shall work together to manage and coordinate care for Medicare fee-for- service beneficiaries through a `standard' or `complex care' full risk ACO. ``(2) providers and suppliers participating in this program shall be paid in a manner that incentivizes furnishing items and services in such practice to provide high-quality care tailored to meet the needs of Medicare fee-for-service beneficiaries while reducing the cost of care. ``(c) Full Risk ACO Program With Standard and Complex Care Track Options.-- ``(1) In general.--An ACO participating in this program is a group of providers and suppliers focused on individualizing care to meet the specific needs of Traditional Medicare beneficiaries by emphasizing advanced primary care, care coordination, and the delivery of care in alternate settings for beneficiaries needing medical and nonmedical assistance in managing their health. ``(2) Requirements.--In order to participate in the program under this program, an ACO: ``(A) Must be formed by the following ACO participants or combinations of ACO participants, consistent with the Medicare Shared Savings Program: ``(i) ACO professionals in group practice arrangements. ``(ii) Networks of individual practices of ACO professionals. ``(iii) Partnerships or joint venture arrangements between hospitals and ACO professionals. ``(iv) Hospitals employing ACO professionals. ``(v) CAHs that bill under Method II (as described in section 413.70(b)(3) of this chapter). ``(vi) RHCs. ``(vii) FQHCs. ``(viii) Teaching hospitals that have elected under section 415.160 of this subchapter to receive payment on a reasonable cost basis for the direct medical and surgical services of their physicians. ``(B) Shall be structured to allow the organization to receive and distribute payments for services and performance incentives to participant and preferred providers and suppliers. ``(C) Shall include a sufficient number and type of providers for the Medicare fee-for-service beneficiaries aligned or assigned to the ACO, as determined by the Secretary. ``(D) Shall serve a required minimum number of aligned and/or attributed beneficiaries. ``(i) A Standard Full Risk ACO shall have at least 2,500 aligned and/or assigned beneficiaries. ``(ii) A complex care full risk ACO shall have at least 250 aligned and/or assigned beneficiaries in the first year; at least 500 aligned or assigned beneficiaries in the second year; and at least 1,000 aligned and/or assigned beneficiaries in the third year and in every participation year after that. ``(E) May establish `preferred provider' relationships, and may pay such providers a portion or all of the provider's fee-for-service claims in lieu of fee-for-service reimbursement from CMS. ``(F) Shall have a financial guarantee mechanism in place commensurate with the financial arrangement selected in this program. ``(G) Shall enter into an agreement with the Secretary to participate in the program for a five-year period. The agreement may be renewed for additional performance periods. ``(H) Shall permit participation in the program at the TIN-NPI level. ``(3) Clinical services.--An ACO participating in this program shall provide individualized care to meet the specific needs of Medicare fee-for-service beneficiaries attributed or aligned to the ACO. This may include the following: ``(A) Coordinated care across the care continuum, including transitions. ``(B) Social support services. ``(C) Behavioral health services. ``(D) Nonvisit-based care (including email, text, phone, video, or other technology). ``(E) Extended care access options and technology platforms enabling patient stratification, outcomes tracking, and practice-based population management. ``(F) In-home care. ``(G) Palliative care. ``(H) Other items and services as determined appropriate by the Secretary. ``(4) Quality and reporting requirements.--The Secretary shall develop quality performance standards for full risk ACOs. ``(A) Standard full risk acos.--The Secretary shall deploy a limited set of quality measures that prioritize patient experience and health outcomes while reducing clinician burden. ``(B) Additional requirement for quality performance for complex care full risk acos.--The Secretary shall deploy the quality measures in (c)(4)(A) and include a Days at Home measure. ``(C) Overlap with medicare access and chip reauthorization act.--All full risk ACO program participants shall be exempt from the Merit-Based Incentive Payment System (MIPS). ``(5) Beneficiary communications.--The Secretary shall promulgate requirements for ACO marketing to Medicare fee-for- service beneficiaries that educates and informs beneficiaries about their care options. ``(d) Payment Arrangements for ACOs, Participant and Preferred Providers.-- ``(1) In general.--A full risk ACO is eligible to receive the following payments under the program under this section: ``(A) Primary care capitation.--A per-beneficiary, per-month capitated payment for primary care services provided by Participant Providers and preferred providers who have opted into the capitated arrangement with the full risk ACO reflective of the predicted Medicare Part B costs representing professional services for which the ACO is directly responsible. In a given year, such payment may be up to 7 percent of the total health care spending for the beneficiary under this title for the year. The program shall include a repayment mechanism for the primary care capitation to ensure that this does not result in additional Medicare spending. ``(B) Total care capitation.--A per-beneficiary, per-month capitated payment for all Medicare Part A and Part B services provided to aligned beneficiaries by all Participant Providers and by preferred providers who have opted into the capitated arrangement. The TCC payment amount will reflect the estimated total cost of care for the full risk ACO's aligned population for services provided by the providers participating in the capitation mechanism. Providers that elect to participate in Total Care Capitation will agree to a 100 percent reduction of their fee-for-service claims. ``(C) Option for claims reduction and population- based payment.--Full Risk ACOs can enter into arrangements whereby CMS would reduce claims payments for aligned beneficiaries for Participant and Preferred Providers and CMS would make a monthly payment to the ACO equivalent to the estimated value of the FFS claims reductions for those services. ``(2) Financial arrangements.-- ``(A) In general.--This program shall offer full financial risk for participant ACOs. ``(B) Financial arrangements.--The Secretary shall make multiple financial arrangements available to ACOs, reflecting varying experience with and ability to assume risk for Medicare fee-for-service beneficiaries. The Secretary shall make one or more financial arrangements available to ACOs under both of the following solutions: ``(i) Full risk arrangement.--ACOs participating in full risk arrangements shall share in 100 percent of savings and losses, subject to a discount and risk corridors. ``(ii) Discount.--The Secretary shall determine and apply a discount to the full risk ACO's benchmark. ``(C) Benchmark for standard full risk acos.--The benchmark for Standard Full Risk ACOs shall be developed by-- ``(i) calculating the ACOs historical baseline spending for its aligned beneficiary population; ``(ii) trending the historical baseline expenditures forward based on an adjusted version of the U.S. Per Capita Cost growth trend; ``(iii) blending the historical baseline expenditures with regional expenditures using an adjusted Medicare Advantage rate book; ``(iv) risk adjust the blended expenditures; and ``(v) apply the discount. ``(D) Benchmark for complex care full risk acos.-- The benchmarking methodology for Complex Care Full Risk ACOs shall be developed separately, taking into account the appropriate weighting of the regional component (at least half) and remove the ceiling on the regional blend. ``(E) Risk corridors.--The Secretary shall develop risk corridors appropriate to this program. ``(e) Risk Adjustment.-- ``(1) Prospective risk adjustment.--Subject to paragraph (2), the Secretary shall use prospective risk adjustment for a standard full risk ACO. Risk adjustment methodologies should be identical to Medicare Advantage to the extent practical. ``(2) Concurrent risk adjustment for complex care full risk aco.--The Secretary shall use concurrent risk adjustment to adjust the benchmark for a complex care full risk ACO. ``(f) Beneficiary Assignment.-- ``(1) In general.--Full Risk ACO program participants shall use the Medicare Shared Savings Program alignment and assignment methodologies, including a choice of prospective assignment or prospective assignment with retrospective reconciliation. ``(2) Signed voluntary alignment.--In addition to the methodology in subsection (f)(1), Standard and Complex Care Full Risk ACOs shall be permitted to use signed voluntary alignment. Such alignment shall take effect on a monthly basis. ``(3) Opt-out.--Medicare beneficiaries shall have the ability to opt out of participating in the full risk ACO program. ``(g) Waivers.--The Secretary may waive such provisions of this title and title XI as the Secretary determines necessary in order to implement the demonstration program. ``(h) Data.--The Secretary shall provide to program participants under this section regular reports with up-to-date provider claims data and payment information with respect to Medicare fee-for-service beneficiaries attributed or aligned in the ACO and shall provide other data to ACOs as necessary. ``(i) Treatment Under the Medicare Access and CHIP Reauthorization Act.--An ACO participating in this program shall be considered an `advanced alternative payment model'. ``(j) Definitions.--In this section: ``(1) Concurrent risk adjustment.--The term `concurrent risk adjustment' means a risk adjustment model that uses current year diagnoses, demographics, and other factors to predict cost in that same year. ``(2) Medicare fee-for-service beneficiary.--The term `Medicare fee-for-service beneficiary' means an individual who is enrolled in the original Medicare fee-for-service program under parts A and B and is not enrolled in a Medicare Advantage plan under part C, an eligible organization under section 1876, or a PACE program under section 1894. ``(3) Physician.--The term `physician' means a physician as defined in section 1861(r)(1). ``(4) Standard full risk aco.--The term `standard full risk ACO' means an ACO composed of Medicare fee-for-service beneficiaries, less than two-thirds of which have six or more chronic co-morbidities. ``(5) Complex care full risk aco.--The term `complex care full risk ACO' means an ACO composed of Medicare fee-for- services beneficiaries, at least two-thirds of which have six or more chronic co-morbidities.''. <all>\n--- KONIEC DOKUMENTU ---\n\nPAMIĘTAJ: Twoja odpowiedź MUSI być wyłącznie poprawnym obiektem JSON. Nie dodawaj żadnych dodatkowych znaków, komentarzy ani tekstu przed znacznikiem '{' ani po znaczniku '}'. Cała odpowiedź musi być parsowalna jako JSON.\nNa podstawie POWYŻSZEGO dokumentu, wypełnij poniższą strukturę JSON:\nOto struktura JSON, której oczekuję (wypełnij ją treścią):\n{\n  \"pl_ai_title\": \"Nowy, krótki tytuł dla aktu prawnego po polsku, oddający sedno wprowadzanych zmian (np. maksymalnie 10-12 słów).\",\n  \"pl_summary\": \"2-3 zdania zwięzłego podsumowania treści aktu prawnego po polsku, napisane z perspektywy wpływu na życie codzienne obywateli.\",\n  \"pl_key_points\": [\n    \"Pierwszy krótki punkt po polsku dotyczący najważniejszych wprowadzanych rozwiązań lub zmian.\",\n    \"Drugi krótki punkt po polsku...\"\n  ],\n  \"eng_ai_title\": \"A new, short title for the legal act in English, capturing the essence of the changes (e.g., max 10-12 words).\",\n  \"eng_summary\": \"2-3 sentences summarizing the legal act in English, from the perspective of its impact on citizens' daily lives.\",\n  \"eng_key_points\": [\n    \"First short bullet point in English regarding the most important solutions or changes being introduced.\",\n    \"Second short bullet point in English...\"\n  ],\n  \"de_ai_title\": \"Ein neuer, kurzer Titel für das Rechtsdokument auf Deutsch, der den Kern der Änderungen erfasst (z.B. max. 10-12 Wörter).\",\n  \"de_summary\": \"2-3 Sätze Zusammenfassung des Rechtsdokuments auf Deutsch, aus der Perspektive seiner Auswirkungen auf das tägliche Leben der Bürger.\",\n  \"de_key_points\": [\n    \"Erster kurzer Stichpunkt auf Deutsch zu den wichtigsten eingeführten Lösungen oder Änderungen.\",\n    \"Zweiter kurzer Stichpunkt auf Deutsch...\"\n  ],\n  \"fr_ai_title\": \"Un nouveau titre court pour l'acte juridique en français, saisissant l'essence des changements (par exemple, 10-12 mots maximum).\",\n  \"fr_summary\": \"Résumé de 2-3 phrases de l'acte juridique en français, du point de vue de son impact sur la vie quotidienne des citoyens.\",\n  \"fr_key_points\": [\n    \"Premier court point en français concernant les solutions ou changements les plus importants introduits.\",\n    \"Deuxième court point en français...\"\n  ],\n  \"es_ai_title\": \"Un nuevo título breve para el acto jurídico en español, que recoja la esencia de los cambios (por ejemplo, máximo 10-12 palabras).\",\n  \"es_summary\": \"Resumen de 2-3 frases del acto jurídico en español, desde la perspectiva de su impacto en la vida cotidiana de los ciudadanos.\",\n  \"es_key_points\": [\n    \"Primer punto breve en español sobre las soluciones o cambios más importantes que se introducen.\",\n    \"Segundo punto breve en español...\"\n  ],\n  \"it_ai_title\": \"Un nuovo titolo breve per l'atto giuridico in italiano, che colga l'essenza delle modifiche (ad es. massimo 10-12 parole).\",\n  \"it_summary\": \"Riepilogo di 2-3 frasi dell'atto giuridico in italiano, dal punto di vista del suo impatto sulla vita quotidiana dei cittadini.\",\n  \"it_key_points\": [\n    \"Primo breve punto in italiano riguardante le soluzioni o le modifiche più importanti introdotte.\",\n    \"Secondo breve punto in italiano...\"\n  ],\n  \"nl_ai_title\": \"Een nieuwe, korte titel voor de rechtshandeling in het Nederlands, die de essentie van de wijzigingen weergeeft (bijv. max. 10-12 woorden).\",\n  \"nl_summary\": \"Samenvatting van 2-3 zinnen van de rechtshandeling in het Nederlands, vanuit het perspectief van de impact op het dagelijks leven van burgers.\",\n  \"nl_key_points\": [\n    \"Eerste korte punt in het Nederlands betreffende de belangrijkste geïntroduceerde oplossingen of wijzigingen.\",\n    \"Tweede korte punt in het Nederlands...\"\n  ],\n  \"pt_ai_title\": \"Um novo título curto para o ato jurídico em português, capturando a essência das mudanças (por exemplo, máx. 10-12 palavras).\",\n  \"pt_summary\": \"Resumo de 2-3 frases do ato jurídico em português, na perspetiva do seu impacto na vida quotidiana dos cidadãos.\",\n  \"pt_key_points\": [\n    \"Primeiro ponto curto em português sobre as soluções ou alterações mais importantes introduzidas.\",\n    \"Segundo ponto curto em português...\"\n  ],\n  \"category\": [\"Categorize the document into one category by default, based on the field it primarily concerns. Choose up to 3 if the document also touches upon SIGNIFICANT issues from other categories. You MUST select categories ONLY from the following list: Health, Education, Family, Taxes, Labor, Security, Environment, Courts and Law, Transport, Benefits, Real Estate, Media and Culture, Local Government, Migration, Agriculture, Public Investments, Informatization, Economy. If the document does not definitively fit any of these, you MUST use \"Other\". If you use \"Other\", it should be the ONLY category selected. Do NOT invent new categories. The response must be an array of strings, e.g., [\"Taxes\", \"Family\"].\"]\n}\n\n",
      "ai_response_raw": "{\n  \"pl_ai_title\": \"Nowy program opieki koordynowanej dla seniorów w ramach Medicare\",\n  \"pl_summary\": \"Ustawa wprowadza stały program dla organizacji opieki zdrowotnej, które biorą pełną odpowiedzialność za leczenie pacjentów w Medicare. Dzięki temu seniorzy, zwłaszcza ci z wieloma chorobami, otrzymają lepiej dopasowaną opiekę, w tym wizyty domowe i wsparcie cyfrowe.\",\n  \"pl_key_points\": [\n    \"Lepsza koordynacja leczenia dla osób z sześcioma lub większą liczbą przewlekłych chorób.\",\n    \"Możliwość korzystania z porad lekarskich przez e-mail, telefon lub wideo.\",\n    \"Większy dostęp do opieki domowej, paliatywnej oraz wsparcia społecznego.\",\n    \"Pacjenci zachowują prawo do dobrowolnego przystąpienia lub rezygnacji z udziału w programie.\"\n  ],\n  \"eng_ai_title\": \"New Medicare Full Risk Program for Better Coordinated Patient Care\",\n  \"eng_summary\": \"This bill creates a permanent program where healthcare providers take full responsibility for patient outcomes in exchange for more flexibility. It aims to provide seniors with more personalized care, including home visits and digital health options.\",\n  \"eng_key_points\": [\n    \"Focus on better care coordination for patients with six or more chronic conditions.\",\n    \"Expanded access to telehealth, home care, and social support services.\",\n    \"Providers are paid based on quality and efficiency rather than per-visit fees.\",\n    \"Patients can choose to join or opt-out of the program at any time.\"\n  ],\n  \"de_ai_title\": \"Neues Medicare-Programm für koordinierte Versorgung und volle Kostenverantwortung\",\n  \"de_summary\": \"Dieses Gesetz führt ein dauerhaftes Programm ein, bei dem Gesundheitsdienstleister die volle Verantwortung für die Behandlungsergebnisse der Patienten übernehmen. Senioren profitieren von einer besser abgestimmten Betreuung, einschließlich Hausbesuchen und digitalen Gesundheitsdiensten.\",\n  \"de_key_points\": [\n    \"Verbesserte Versorgung für Patienten mit sechs oder mehr chronischen Erkrankungen.\",\n    \"Erweiterter Zugang zu Telemedizin, häuslicher Pflege und sozialer Unterstützung.\",\n    \"Zahlungen an Ärzte basieren auf der Qualität der Behandlung statt auf Einzelabrechnungen.\",\n    \"Patienten können frei entscheiden, ob sie am Programm teilnehmen oder es verlassen.\"\n  ],\n  \"fr_ai_title\": \"Nouveau programme Medicare pour une prise en charge globale et coordonnée\",\n  \"fr_summary\": \"Cette loi établit un programme permanent permettant aux prestataires de soins de mieux coordonner le suivi des patients Medicare. L'objectif est d'offrir aux seniors des soins personnalisés, incluant des visites à domicile et un suivi numérique.\",\n  \"fr_key_points\": [\n    \"Coordination renforcée pour les patients souffrant de multiples maladies chroniques.\",\n    \"Accès facilité à la télémédecine, aux soins à domicile et au soutien social.\",\n    \"Rémunération des médecins basée sur la qualité des soins plutôt que sur l'acte.\",\n    \"Liberté pour les patients de rejoindre ou de quitter le programme à tout moment.\"\n  ],\n  \"es_ai_title\": \"Nuevo programa de Medicare para una atención médica coordinada y personalizada\",\n  \"es_summary\": \"Esta ley crea un programa permanente donde los proveedores de salud asumen la responsabilidad total del cuidado de los pacientes de Medicare. Busca ofrecer a los adultos mayores una atención más flexible, incluyendo visitas domiciliarias y servicios digitales.\",\n  \"es_key_points\": [\n    \"Mejor coordinación para pacientes con seis o más enfermedades crónicas.\",\n    \"Mayor acceso a telemedicina, cuidados en el hogar y apoyo social.\",\n    \"Los médicos reciben pagos basados en la calidad del servicio y no solo por consulta.\",\n    \"Los pacientes mantienen el derecho de elegir si participan o no en el programa.\"\n  ],\n  \"it_ai_title\": \"Nuovo programma Medicare per un'assistenza sanitaria coordinata e completa\",\n  \"it_summary\": \"Questa legge istituisce un programma permanente in cui i medici e gli ospedali collaborano per gestire l'intera cura dei pazienti Medicare. L'obiettivo è offrire ai cittadini anziani servizi più flessibili, come l'assistenza domiciliare e il supporto digitale.\",\n  \"it_key_points\": [\n    \"Migliore coordinamento per i pazienti con sei o più patologie croniche.\",\n    \"Accesso esteso a telemedicina, cure a domicilio e servizi di supporto sociale.\",\n    \"I fornitori di cure sono pagati in base ai risultati e alla qualità, non per singola prestazione.\",\n    \"I pazienti possono scegliere liberamente di aderire o rinunciare al programma.\"\n  ],\n  \"nl_ai_title\": \"Nieuw Medicare-programma voor gecoördineerde zorg en volledige verantwoordelijkheid\",\n  \"nl_summary\": \"Deze wet voert een permanent programma in waarbij zorgverleners de volledige verantwoordelijkheid nemen voor de resultaten van Medicare-patiënten. Het doel is om senioren meer gepersonaliseerde zorg te bieden, inclusief huisbezoeken en digitale opties.\",\n  \"nl_key_points\": [\n    \"Betere zorgcoördinatie voor patiënten met zes of meer chronische aandoeningen.\",\n    \"Ruimere toegang tot telegeneeskunde, thuiszorg en sociale ondersteuning.\",\n    \"Zorgverleners worden betaald op basis van kwaliteit in plaats van per verrichting.\",\n    \"Patiënten hebben de vrijheid om deel te nemen of zich af te melden voor het programma.\"\n  ],\n  \"pt_ai_title\": \"Novo programa do Medicare para cuidados de saúde coordenados e personalizados\",\n  \"pt_summary\": \"Esta lei estabelece um programa permanente onde os prestadores de saúde assumem a responsabilidade total pelos resultados dos pacientes do Medicare. O objetivo é oferecer aos idosos cuidados mais flexíveis, incluindo visitas ao domicílio e apoio digital.\",\n  \"pt_key_points\": [\n    \"Melhor coordenação para pacientes com seis ou mais doenças crónicas.\",\n    \"Acesso alargado a telemedicina, cuidados domiciliários e apoio social.\",\n    \"Os médicos são pagos com base na qualidade do serviço e não por cada consulta.\",\n    \"Os pacientes podem escolher livremente entrar ou sair do programa.\"\n  ],\n  \"category\": [\"Health\"]\n}"
    }
  ]
}