Bipartisan Bill Expands Medicare ACO Assignments to Nurse Practitioners and PAs

The ACO Assignment Improvement Act, introduced by Senators Sheldon Whitehouse and John Barrasso, aims to broaden Medicare’s Accountable Care Organization (ACO) participation by incorporating nurse practitioners, physician assistants, and clinical nurse specialists into patient assignment criteria. This legislation addresses a significant gap in Medicare policy that currently limits ACO assignment largely to patients receiving care from physicians, although many, especially in rural areas, primarily see advanced practice clinicians for their primary care needs. ACOs, which are collaborative groups of healthcare providers including hospitals and physicians, focus on delivering coordinated, high-quality care while reducing costs. Medicare data reflects the efficacy of ACOs, which saved the program approximately $2.4 billion in 2024, marking the eighth consecutive year of net savings and the highest to date since the program’s establishment. By recognizing advanced practice clinicians in patient assignment, the bill supports a more inclusive and accurate attribution of Medicare beneficiaries to ACOs. Stakeholders such as health systems, primary care organizations, and professional associations underscore the legislation's potential to enhance care coordination, close gaps in preventive services, and improve patient outcomes without additional cost burdens. The legislation carries implications for the transition to value-based care, where nurse practitioners and physician assistants play increasingly critical roles. Removing statutory barriers that exclude these providers from contributing to ACO metrics aligns with the evolving landscape of primary care delivery, particularly amid provider shortages and growing demand for accessible, timely healthcare. This bipartisan effort represents a strategic policy adjustment to Medicare’s coordinated care models, reinforcing established patient-provider relationships and aiming to ensure more seamless healthcare coordination for Medicare beneficiaries across the United States.