Medicare Compliance & Reimbursement

ACOs must notify beneficiaries in writing about MSSP participation.

In an effort to boost value-based care and provide greater Medicare savings, CMS issued the Medicare Shared Savings Program (MSSP) final rule last month. The MSSP change-ups modify policies, restructure payment models, and revise benchmarking methodologies for Accountable Care Organizations (ACOs).

Check out these MSSP final rule specifics that go into effect on Feb. 14, 2019:

• Track change: CMS went ahead and reduced the previous three-track system to two — Basic and Enhanced.

○ Basic: This lower-level path offers five levels, A through E, that glide from one-sided options (A and B) to incrementally higher-risk two-sided models (C,D, and E). The final level is the only one that qualifies as an Advanced Alternative Payment Model (APM) in the Quality Payment Program (QPP).
○ Enhanced: This high-risk path is basically the old Track 3 model. It “provides ACOs the highest level of risk and potential reward (up to 75 percent shared savings and up to 75 percent of loss sharing, with the loss sharing percentage being dependent on the shared savings percentage among other factors),” explain Boston-based attorneys Andrew P. Rusczek and Sarah L. Trautz of Verrill Dana LLP in online legal analysis.

• Longer agreement period: The three-year timeline was replaced with a five-year agreement period. “ACOs with agreement periods that would have ended December 31, 2018 were able to opt for a six-month extension period,” advise attorneys Alex Stoflet and Claire H. Topp of Dorsey and Whitney LLP in the Dorsey Health Law Blog. “ACOs in a three-year agreement period not expiring in 2018” are able “to voluntarily terminate existing participation agreements and enter a new agreement period starting July 1, 2019 under one of the new tracks,” Stoflet and Topp note.
• Patient-first policies: The final rule now requires ACOs to alert beneficiaries of their MSSP status in writing from the get-go. Plus, ACOs can offer an “incentive payment of up to $20 to an assigned beneficiary for each qualifying primary care service,” CMS says.

In addition, a beneficiary opt-in methodology based on claims assessment is in the works, the final rule fact sheet suggests.

• Benchmarking rebuild: CMS has revised its benchmarking methodologies to take into account both regional and national Fee-for-Service trends and factors. The changes are meant to entice ACOs to take on more risk while also incentivizing them to care for more complex, high-risk patients, the final rule fact sheet indicates.
• Innovation overload: The final rule adds more tech and more efficiency to the MSSP. One Bipartisan Budget Act of 2018 (BBA 2018) add-in includes the finalization of telehealth for “certain ACOs under performance-based risk tracks,” the fact sheet says. Only Basic Tracks C,D, and E and the Enhanced Track are eligible for this option starting on Jan. 1, 2020.
• SNF 3-day waiver: The MSSP changes will now allow performance-based ACOs the option of applying for a “[Skilled Nursing Facility] SNF 3-day rule waiver, regardless of their choice of prospective assignment or preliminary prospective assignment with retrospective reconciliation, to support ACO efforts to increase quality and decrease costs,” mentions the MSSP rule guidance. “Critical access hospitals and other small, rural hospitals operating under a swing bed agreement” are also able to work with ACOs under this three-day rule waiver, the fact sheet suggests.

Deadline alert: CMS is offering a one-time-only, new agreement period with a start date of July 1, 2019. The agency recommends that interested ACOs begin the “application cycle activities” immediately to get their applications in by the Feb. 22, 2019 deadline.

Resource: Read the Pathways to Success/MSSP final rule fact sheet at www.cms.gov/newsroom/fact-sheets/final-rule-creates-pathways-success-medicare-shared-savings-program.