This is the second post in Health Care Law Today’s series on the final rule. This post addresses Eligibility Requirements, and the Application and the Renewal Process.
Under the Medicare Shared Savings Program (“MSSP”) ACO Final Rule, CMS finalized new regulations that will change ACO eligibility requirements. The final rule will include new requirements for participation agreements with ACO participants and ACO providers/suppliers, a new process for reporting changes concerning ACO participants and providers/suppliers, as well as clarifications related to the structure and governance of ACOs. Additionally, the final rule requires an ACO to describe in its application for participation how it will encourage and promote the use of enabling technologies for improving care coordination for beneficiaries and how the ACO intends to partner with long-term care and post-acute care providers to improve care coordination for the ACO’s assigned beneficiaries.
CMS acknowledges that it will be difficult for ACOs to incorporate these requirements into their ACO participant agreements for the 2016 performance year, so the requirements will not take effect until the 2017 performance year.
The final rule addresses two issues concerning the renewal and application process that were not addressed in the initial regulations. The first deals with the process and timing for CMS’ acceptance of an initial application for participation in the MSSP. The second is to rectify the silence in the current regulations concerning the procedure by which an ACO renews its participation in the MSSP.
CMS makes it clear that an application may be denied if the applicant fails to submit information by the required deadlines.
The new regulations also specify that CMS will evaluate a renewal based on the following factors:
The final rule also specifies that ACOs are subject to all regulatory changes that “become effective during the agreement period” except for specified program areas. In the current regulations, one of the program areas that has been an exception is a regulatory change applicable to beneficiary assignment. The final rule eliminates this exception, such that changes regarding beneficiary assignment will apply to all ACOs in the middle of their 3-year agreement period, but such change is not to be effective until the start of next performance year.