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June 2015


CMS Encourages Continued Participation in Medicare Shared Savings Program with Final Rule






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The Centers for Medicare & Medicaid Services (CMS) issued a final rule to the Medicare Shared Savings Program (MSSP) regulations to encourage continued and enhanced accountable care organization (ACO) participation in the MSSP, including participation in performance-based risk arrangements.

In finalizing the modifications to the MSSP regulations, CMS considered more than 270 comments received in response to its December 2014 notice of proposed rulemaking. Some key changes to the MSSP regulations in the Final Rule include:

  • Creating a new two-sided risk model (Track 3) with certain features of the Pioneer ACO Model such as prospective beneficiary assignment and higher shared savings rates;
  • Establishing a waiver of the three-day skilled nursing facility (SNF) rule for beneficiaries prospectively assigned to Track 3 ACOs;
  • Removing the requirement for an ACO to transition to a two-sided model for the second agreement period by permitting eligible ACOs to renew participation in the one-sided risk model (Track 1);
  • Adding new requirements related to renewal of an ACO's participation agreement in the MSSP, changes to the ACO participant list and ACO provider/supplier list, and required terms in the ACO participant agreement between an ACO and an ACO participant;
  • Increasing emphasis on primary care services by adding transitional care management and chronic care management codes to the definition of primary care services, clarifying the use of non-physician provider services and specialist physicians in the beneficiary assignment methodology, and clarifying ACO participant exclusivity requirements; and
  • Streamlining the process for ACOs to access Medicare beneficiary claims data and the opportunity for the beneficiaries to decline data sharing.

General Summary and Other Changes

Below is a general summary of these and other primary changes made by CMS in the Final Rule:

  1. ACO Eligibility Requirements
  2. Establishing and Maintaining the ACO Participation Agreement
  3. Data Sharing and Assignment of Beneficiaries
  4. Shared Savings and Losses
  5. Waivers of Payment Requirements and Other Options to Encourage ACO Participation in Performance-Based Risk Arrangements
  6. Additional Program Requirements and Beneficiary Protections

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