The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would set a new direction for the Medicare Shared Savings Program. Specifically, the proposed rule would redesign 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.

Under the proposed program redesign, eligible ACOs would enter an agreement period of not less than five years and be able to choose from two tracks. A "basic" track would allow ACOs to begin under a one-sided model (also referred to as glide path) and incrementally phase-in higher levels of risk that, at the highest level, would qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program. An "enhanced" track – based on Track 3 of the existing Shared Savings Program – would provide additional tools and flexibility to those ACOs that take on the highest risk from the start.

If finalized, the rule would result in the discontinuation of Track 1 and Track 2 of the current program, as well as the deferred renewal option. Future application cycles for the Track 1+ would also be eliminated. In addition, CMS would not offer an application cycle for new agreement periods starting on Jan. 1, 2019. Rather, the Agency would offer an application for a one-time new agreement period with a July 1, 2019 start date.

Of note, if the proposed rule is finalized, ACOs with a participation agreement ending Dec. 31, would 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, 2019. CMS would resume the usual annual application cycle for the performance year starting on January 1, 2020 and subsequent years.

ACC Advocacy leaders and staff are reviewing the proposed rule and will submit formal comments as part of the 60-day comment period ending Oct. 16. Additional details, along with the comments, will be posted to ACC.org/Advocacy as they are available. Read more about the rule on the CMS website.

Keywords: ACC Advocacy, Quality Payment Program, Accountable Care Organizations, Centers for Medicare and Medicaid Services, U.S., Medicare, Medicaid, Publications, Health Expenditures

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