CHA News

CMS Finalizes Changes to Medicare Shared Savings Program

Organizations must submit notice of intent to apply by Jan. 18

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The Centers for Medicare & Medicaid Services (CMS) has issued a rule finalizing significant changes to the Medicare Shared Savings Program (MSSP), intending to accelerate the timeline for accountable care organizations (ACOs) to take on downside risk.

The changes finalized are effective for MSSP agreements beginning July 1. Notably, CMS requires all organizations that intend to apply for the MSSP program in 2019 to complete the Notice of Intent to Apply by Jan. 18. CHA is interested in hearing from members considering participation.

In addition to policies previously 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 two or 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.

CHA will issue a detailed summary of the final rule in the coming weeks. Additional information is available in a CMS fact sheet.