CMS Releases MSSP Final Rule

January 2019 ~

On December 21, CMS published a final rule that has been designed to overhaul the Medicare Shared Savings Program (MSSP) and take a new approach to transition providers to performance-based risk arrangements in traditional Medicare. In exchange for this shift in financial accountability, Accountable Care Organizations (ACOs) participating in two-sided risk contracts will receive waivers from certain burdensome regulatory requirements and additional flexibility.

Referred to as “Pathways to Success,” this new direction for the Shared Savings Program redesigns the participation options available under the program to encourage ACOs to transition to performance-based risk more quickly and, for eligible ACOs, incrementally, to increase savings for the trust funds.

The final rule includes:

  • Final policy for extreme and uncontrollable circumstances for the performance year 2017
  • New BASIC and ENHANCED tracks and five-year agreement periods
  • Updated repayment mechanism requirements for two-sided model ACOs
  • Rigorous benchmarking using regional benchmarks for all agreement periods
  • Reduced opportunities for gaming to ensure program integrity
  • Annual choice of assignment methodology
  • Expanded use of telehealth for practitioners in ACOs in performance-based risk arrangements
  • Expanded eligibility for Skilled Nursing Facility Three-Day Rule Waiver
  • Beneficiary incentive programs
  • Beneficiary notification
  • Claims-based assignment with beneficiary opt-in

Relating to the program redesign, CMS will offer an application cycle for a one-time new agreement period start date of July 1, 2019, that:

  • Avoids an interruption in participation by ACOs with a participation agreement ending on December 31, 2018, that elected to extend their current agreement period for an additional 6-month performance year
  • Provides new and currently participating ACOs time to review new policies, make business and investment decisions, and complete and submit an application under the new BASIC or ENHANCED track

New and existing ACOs interested in applying must complete the non-binding Notice of Intent to Apply, which will be available January 2-18. CMS will resume the usual annual application cycle for agreement periods starting on January 1, 2020, and in subsequent years.

For more information, eligibility requirements, key timelines, and detailed instructions on the submission process, refer to the Application Types & Timeline.

Source(s): Federal Register; McDermott Consulting; Super Coder; HealthLeaders Media;