CMS Finalizes Shared Savings Program Final Rule

January 2019 ~

On December 21, CMS issued a final rule intended to “dramatically redesign” participation options available under the Medicare Shared Savings Program (MSSP).

The new direction for the MSSP, referred to as “Pathways to Success,” redesigns the participation options available under the program to encourage Accountable Care Organizations (ACOs) to transition to performance based risk more quickly and, for eligible ACOs, incrementally, to increase savings for the Trust Funds.

According to CMS, the policies include changes to address the additional tools and flexibilities for ACOs established by the Bipartisan Budget Act of 2018 (BBA of 2018), specifically in the areas of new beneficiary incentives, telehealth services, and choice of beneficiary assignment methodology. The final rule also finalizes the program’s policy for extreme and uncontrollable circumstances for performance year 2017, initially established with an interim final rule with comment period in December 2017.

Other changes to be implemented under Pathways to Success include:

  • Accountability and Competition: The final rule reduces the amount of time that an ACO can remain in the program without taking accountability for healthcare spending from six years to two years for new ACOs and three years for new “low revenue” (physician-led) ACOs, including some rural ACOs. The rule also strengthens incentives by providing higher shared savings rates as ACOs transition and accept greater levels of risk.
  • Quality:To increase flexibility for ACOs taking on risk, Pathways to Success expands access to high-quality telehealth services that are convenient for patients, including telehealth services provided at a patient’s place of residence.
  • Beneficiary Engagement:Pathways to Success promotes beneficiary engagement and improved health outcomes by allowing ACOs to offer new incentive payments to beneficiaries for taking steps to achieve good health, such as obtaining primary care services and necessary follow-up care. In addition, this rule requires ACOs to provide beneficiaries with a written explanation in person or via email or patient portal of what it means to be in an ACO to put patients in the driver seat.
  • Integrity:This rule establishes rigorous benchmarks by incorporating factors from regional Medicare spending to establish an ACO’s benchmark during all agreement periods, providing a more accurate point of comparison for evaluating ACO performance. In addition, ACOs that terminate their participation will be accountable for prorated shared losses.

With regard to the MSSP redesign, CMS will offer an application cycle for a special one-time new ACO agreement period start date of July 1, 2019. Ninety percent of eligible ACOs with participation agreements expiring on December 31, 2018 have elected to extend their agreement for six months, so they have the option to renew their agreement under the new policies and continue to participate in the program uninterrupted.

The Notice of Intent to Apply will be available January 2, 2019 through January 18, 2019. The application submission due dates will be posted on the Medicare Shared Savings Program website in the coming days. For more information, see the Application Types & Process webpage for eligibility requirements, key timelines, and detailed instructions on the submission process.

And for more information regarding Medicare Shared Savings Program Notice of Final Rulemaking (CMS-1701-F2), “Accountable Care Organizations‑‑Pathways to Success,” see the CMS Fact Sheet and view the final rule on the Federal Register.


Source(s): CMS Fact Sheet; CMS Press Release; Federal Register December 2018 Final Rule; CMS Shared Savings Program; CMS Shared Savings Program Statutes & Regulations; Health Industry Washington Watch; Modern Healthcare;