ACO Final Rule Released

On June 4, the Centers for Medicare & Medicaid Services (CMS) released a final rule detailing program changes for the Medicare Shared Savings Program (MSSP) in response to feedback and aimed at making the program more viable to current and potential participants. CMS made significant changes to the program requirements, including allowing for an additional 3-year contract term with no downside risk for current ACO participants, maintaining the 50 percent sharing rate for those who choose this option. There were a number of other notable changes made including:

  • An additional downside risk option including a 75 percent shared savings rate, prospective assignment of patients to the ACO, and an opportunity to apply for waiver of the current 3-day Skilled Nursing Facility rule.
  • A new benchmarking policy, resetting the benchmark in a second or subsequent agreement period by integrating previous financial performance and equally weighting benchmarks for subsequent agreement periods.
  • Clarifications to the patient assignment process, including an updated list of CPT codes that will be considered primary care services to include Transitional Care Management codes and the Chronic Care Management code. This rule also finalizes a policy to use primary care services furnished by NPs, PAs and CNSs under step 1 of assignment (in addition to physicians).
  • Expanding the types of patient data to be made available to ACOs in various reports provided by CMS to assist in care coordination activities.
  • Simplifying the process for patients to decline claims data sharing to reduce the burden for current ACOs (effective Nov. 1, 2015).

The NCMS is pleased to see CMS make these much needed improvements to the MSSP program. CMS indicates that it will continue to make updates and improvements to the program in future rulemaking. If you are interested in learning more about the MSSP program, please visit our Toward Accountable Care (TAC) Consortium and Initiative website.

Watch the NCMS website and future Bulletins for a more thorough analysis of the rule.


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