The Centers for Medicare and Medicaid Services (CMS) issued a final rule in December that sets a new direction for the Medicare Shared Savings Program. Specifically, the final rule redesigns the participation options available under the program to encourage Accountable Care Organizations (ACOs) to transition to two-sided models that include not only shared savings, but shared risk, beginning with agreement periods starting on July 1, 2019 and in subsequent years.

In response to comments from the ACC and others, CMS is modifying the proposal to allow all ACOs participating in the redesigned program's BASIC track's glide path the opportunity for greater potential reward through relatively higher shared savings rates based on quality performance: up to 40 percent for one-sided models (Levels A and B) and up to 50 percent for all two-sided models (Levels, C, D and E).

This final rule redesigns the program's participation options to offer, for agreement periods beginning on July 1 and in subsequent years, two tracks that eligible ACOs would enter into for an agreement period of not less than five years:

• BASIC track, which allows eligible ACOs to begin under a one-sided model and incrementally phase-in higher levels of risk that, at the highest level, would qualify as an Advanced Alternative Payment Model under the Quality Payment Program.
• ENHANCED track, based on the program's existing Track 3, which provides additional tools and flexibility for ACOs that take on the highest level of risk and potential reward.

CMS is also finalizing several proposals meant to ease regulatory and administrative burden on participating ACOs. These include: expanding the use of telehealth in two-sided risk models, expanding eligibility for the three-day skilled nursing facility waiver and allowing certain beneficiary incentives.

Of note, ACOs with a participation agreement that ended Dec. 31, 2018 have an opportunity to extend their current agreement period for an additional six-month performance year and could apply for a new agreement beginning on July 1. CMS will resume the annual application cycle for the performance year starting on Jan. 1, 2020 and subsequent years.

Keywords: ACC Publications, Cardiology Magazine, Health Policy, Accountable Care Organizations, Skilled Nursing Facilities, Centers for Medicare and Medicaid Services, U.S., Medicare, Motivation, Medicaid, Reward, Eligibility Determination, Telemedicine

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