CMS proposes changes to Medicare Shared Savings Program

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would make changes to the Medicare Shared Savings Program (MSSP) beginning in July 2019.

CMS proposes a “BASIC track” that would allow eligible accountable care organizations (ACO) to participate under a one-sided, upside-only agreement for one to two years; after that period, risk levels would be incrementally increased. At the highest level of risk, the BASIC track would qualify as an Advanced Alternative Payment Model under the Quality Payment Program. CMS also would offer an “ENHANCED track” based on the program’s existing Track 3. Both tracks would include agreement periods of no fewer than five years.

The current Track 1, Track 1+ and Track 2 would be discontinued for future applications. CMS proposes a six-month extension for current ACOs with agreements that expire Dec. 31 along with a special one-time start date of July 1, 2019. Applications for new participation options would be accepted in spring 2019.

The proposed rule also implements a number of Bipartisan Budget Act of 2018 provisions, including flexibility in beneficiary assignment methods, expansion of telehealth services, expansion of skilled-nursing facility three-day rule waivers and establishment of a beneficiary incentive program. CMS proposes a methodology for determining quality performance that is generally consistent with the existing MSSP but solicits input on ways to enhance the program’s measure set, including how to address opioid use. CMS also proposes to require ACOs to attest that a certain percentage of clinicians are using 2015 edition certified electronic health record technology.

Comments on the proposed rule are due Oct. 16. Additional information is available in the CMS fact sheet and in their press release. A graphic depiction of the proposed changes is also available.