CMS issued a final rule Dec. 21 that makes sweeping changes to the Medicare Shared Savings Program, including overhauling the way ACOs share in risks and rewards.
Here are seven takeaways from the final rule:
1. There are currently four MSSP tracks. The final rule streamlines the program by discontinuing Track 1, a one-sided risk model, and Track 2, a two-sided model. The CMS Innovation Center is also discontinuing the Track 1+ model, under which ACOs assume limited downside risk.
2. The redesigned program —which CMS has dubbed "Pathways to Success" — offers ACOs two participation options: basic and enhanced. It also expands ACO participation agreements from three years to five years.
3. The basic track allows ACOs to participate in an upside-only agreement for one to two years before gradually phasing in higher levels of risk. MSSP ACOs are currently permitted to participate in the upside-only track for up to six years.
4. At the highest level of risk, the basic track will qualify as an Advanced Alternative Payment Model under the Quality Payment Program.
5. ACOs in the enhanced track, which is based on the program's existing Track 3, will take on risk and qualify as an Advanced APM immediately.
6. Under the final rule, ACOs in two-sided models will be accountable for losses if they exit more than midway through a performance year. ACOs that are involuntarily terminated by CMS will also be liable for pro-rated, shared losses. The final rule authorizes termination of ACOs with multiple years of poor financial performance.
7. Instead of beginning new agreements Jan. 1, CMS finalized a one-time agreement period start date of July 1, 2019, to give ACOs time to transition to the new basic or enhanced track. CMS will resume the usual annual application cycle for agreement periods starting on Jan. 1, 2020.
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