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CHA Issues Summary of Medicare Shared Savings Program Final Rule

CHA has issued a summary, prepared by Health Policy Alternatives, of the Centers for Medicare & Medicaid Services’ (CMS) final rule that accelerates the timeline for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) to take on downside risk.

In addition to policies that were finalized in the calendar year 2019 physician fee schedule final rule, CMS finalizes the following changes to the MSSP:

  • Redesign the MSSP to include only two tracks – Basic and Enhanced.
  • Allow a maximum of three years of participation in upside-only risk.
  • Reduce shared savings rates for upside-only models from 50 to 40 percent.
  • Differentiate between “low-revenue” and “high-revenue” ACOs, and require high-revenue ACOs to take on more risk more quickly.
  • Increase the length of agreement periods to at least five years.
  • Allow all ACOs to elect prospective beneficiary assignment or preliminary prospective assignment with retrospective reconciliation.
  • Expand the use of regional factors in the benchmarking methodology.
  • Allow ACOs’ risk scores to decrease by an unlimited amount, without the proposed 3 percent cap.
  • Increase access to waivers of telehealth and other Medicare payment requirements.

The deadline for organizations to apply for the MSSP program in 2019 was Jan. 18.