The Centers for Medicare and Medicaid Services (CMS) issued a final rule (the Rule) on December 21, 2018, which reshapes the Medicare Shared Savings Program (MSSP). Termed “Pathways to Success,” the Rule, among other things,
The Rule also allows greater flexibility for accountable care organizations (ACOs) in the areas of new beneficiary incentives, telehealth services, and choice of beneficiary assignment methodology, all as established in the Bipartisan Budget Act of 2018.
The Rule follows the proposed rule issued in August of 2018 and reflects CMS’ responses to comments received by CMS on such proposal.
In announcing the Rule, CMS indicated there will be a one-time start date of July 1, 2019 for new applicants. That start date allows continuation by ACOs who had elected to continue their current agreements and provides an opportunity for new and currently participating ACOs to apply for the reshaped MSSP. Such applicants must file a non-binding Notice of Intent to Apply between January 2, 2019 and January 18, 2019, with application submission dates thereafter still to be determined. There will also be opportunities to commence participation on January 1, 2020 and annually thereafter.
The MSSP has been the most utilized alternative payment program with some 560 ACOs and more than 10.5 million beneficiaries involved. CMS believes the provisions of the Rule will be a Pathway to Success by promoting accountability, flexibility and beneficiary engagement in the MSSP. Given that few ACOs have been willing to commit to downside risk models, it will be interesting to observe how participation in the MSSP is affected by the Rule. If participation drops significantly, CMS will need to consider use of more mandatory downside risk models if it is serious about moving the health care payment and delivery systems to full accountable, value-based care.
The More Significant Changes to the MSSP in the Rule Include: