CHA News Article

CMS Proposes Significant Changes to Medicare Shared Savings Program
ACOs would be required to take on downside risk

The Centers for Medicare & Medicaid Services (CMS) has issued the attached proposed rule that would make significant changes to the Medicare Shared Savings Program (MSSP) beginning in July 2019. The updated program would phase out tracks with no financial risk for shared losses and offer two accountable care organization (ACO) tracks.

Specifically, CMS proposes a “BASIC track” that would allow eligible ACOs to participate under a one-sided, upside-only agreement for one to two years; after that period, risk levels would be incrementally increased. At the highest level of risk, the BASIC track would qualify as an Advanced Alternative Payment Model under the Quality Payment Program. CMS also would offer an “ENHANCED track” based on the program’s existing Track 3. Both tracks would include agreement periods of no fewer than five years.

The current Track 1, Track 1+ and Track 2 would be discontinued for future applications. CMS proposes a six-month extension for current ACOs with agreements that expire Dec. 31, 2018, along with a special one-time start date of July 1, 2019. Applications for new participation options would be accepted in spring 2019.

The proposed rule also implements a number of Bipartisan Budget Act of 2018 provisions, including flexibility in beneficiary assignment methods, expansion of telehealth services, expansion of skilled-nursing facility three-day rule waivers and establishment of a beneficiary incentive program. CMS proposes a methodology for determining quality performance that is generally consistent with the existing MSSP program but solicits input on ways to enhance the program’s measure set, including how to address opioid use. CMS also proposes to require ACOs to attest that a certain percentage of clinicians are using 2015 edition certified electronic health record technology.

CHA is currently reviewing the proposed rule and will provide members with a more detailed summary in the coming weeks. Comments on the proposed rule are due Oct. 16. Additional information is available in a CMS fact sheet and in the attached press release.