This legislation mandates the establishment of a permanent full risk Accountable Care Organization (ACO) program within Traditional Medicare by June 30, 2026. The program's core purpose is to incentivize groups of healthcare professionals to deliver high-quality, coordinated care to Medicare fee-for-service beneficiaries, ultimately aiming to improve health outcomes and reduce overall costs. It addresses the current lack of a permanent full risk model in Traditional Medicare, building on the success of previous pilot projects. The program offers two distinct tracks: a "standard" full risk ACO for general populations and a "complex care" full risk ACO specifically designed for beneficiaries with six or more chronic conditions. Participating ACOs must meet specific requirements, including minimum beneficiary alignment (e.g., 2,500 for standard ACOs) and a commitment to individualized care, advanced primary care, and care coordination. Services may include social support, behavioral health, non-visit-based care, and in-home care. Financially, the program introduces options such as primary care capitation and total care capitation , where ACOs receive per-beneficiary, per-month payments for services, or can opt for claims reduction with population-based payments. A key feature is the requirement for ACOs to assume full financial risk , sharing 100% of savings and losses, subject to discounts and risk corridors. Benchmarks for both standard and complex care ACOs will be developed, incorporating historical spending and regional expenditures. To support these models, the bill includes provisions for prospective or concurrent risk adjustment, and allows for both standard Medicare Shared Savings Program alignment methodologies and signed voluntary alignment by beneficiaries. Importantly, ACOs participating in this program will be recognized as an advanced alternative payment model under MACRA, exempting them from the Merit-Based Incentive Payment System (MIPS). The Secretary is also authorized to waive certain provisions of the Social Security Act as necessary for implementation.