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News Release
December 21, 2021 

New Bill Expands Accountable Care Through NPs, PAs
NAACOS Endorses the ACO Assignment Improvement Act 

WASHINGTON — The National Association of Accountable Care Organizations (NAACOS) today sent a letter endorsing the ACO Assignment Improvement Act of 2021, H.R. 6308. The bill would both improve patients’ access to care, especially in rural America, and reduce inequities by allowing more patients to receive accountable care from ACOs. 

The bill is sponsored by Reps. Derek Kilmer (D-Wash.), Kathleen Rice (D-N.Y.), Adrian Smith (R-Neb.), and Mike Gallagher (R-Wis.). Specifically, it removes the statutory requirement that patients have at least one primary care visit with a physician during the year in order to be assigned to an ACO. 

Nurse practitioners and physician assistants already play an important role in ACOs. They meaningfully contribute to ACOs’ comprehensive care delivery in a variety of ways such as by following up with patients recently discharged from the hospital or in post-acute care settings and managing patients’ chronic diseases. They are also instrumental in providing home-based visits. “This bill recognizes the important work of ACO non-physician providers providing high quality coordinated care to patients and will enhance their role in ACOs, which is why NAACOS supports this bill” said Clif Gaus, Sc.D., President and CEO of the National Association of ACOs. 

However, NAACOS is concerned that CMS’s inability to differentiate between nurse practitioners and physician assistants practicing primary care compared to those practicing specialty care. We continue to advocate that ACOs be permitted to remove specialty-focused non-physician providers from assignment. We look forward to working with the congressional offices sponsoring this bill as it undergoes review by committees of jurisdictions to make necessary changes to distinguish NPPs who practice primary care and those who practice specialty care. 

“Non-physician providers play a prominent role in our healthcare system, and those that deliver primary care, as opposed to specialty care, should play a prominent role in ACO assignment,” Gaus said. “We greatly appreciate Congress’s efforts to expand accountable care to more patients.” 

ACOs have saved Medicare $13.3 billion in gross savings and $4.7 billion in net savings since 2012. Importantly, data show these ACOs continued to provide high-quality care and yield satisfied patients. Today, ACOs care for nearly 20 percent of all Medicare patients and nearly a third of traditional Medicare patients.  



David Pittman
Senior Policy Advisor
202-640-2689 or [email protected]