15 Key Provisions of CMS Proposed Rule for Pathways to Success - Redesigned Medicare ACOs
Submitted By Anonymous, Created 08/10/2018 - 11:42
- The amount of time that an ACO can remain in the program with upside-only risk would be limited to two years (or one year for ACOs previously in MSSP under upside-only risk).
- The number of tracks would be reduced to two, the “BASIC” track and the “ENHANCED” track, and would allow providers to pick between these two tracks.
- The length of ACO participation agreements would expand from three years to five years.
- The BASIC track would feature a glide path for taking risk, with up to two years of upside-only risk and then transition to increasing levels of performance risk.
- Year five in BASIC track meets standard to qualify as an Advanced Alternative Payment Model (APM) under MACRA.
- The ENHANCED track would allow providers to take on risk and qualify as an Advanced APM immediately.
- Eligible ACOs inexperienced with two-sided risk would be able to enter at any level of risk in BASIC track’s glide path or go straight to ENHANCED track
- After completing a 5 year agreement under BASIC track, low revenue ACOs could renew for a second agreement period at highest level of risk in BASIC track
- High revenue ACOs would be required to move to the ENHANCED track and take on additional risk at renewal
- Each ACO would provide a standardized written disclosure notice to its Medicare beneficiaries
- CMS would allow certain two-sided ACOs to provide an incentive payment of up to $20 to each assigned beneficiary for taking steps to achieve and maintain good health
- Physicians in ACOs that take on risk could receive payment for telehealth services provided to patients regardless of the patient’s location.
- Benchmark and risk adjustment Methodology would be refined, including Regional (county-level) spending benchmarks
- ACOs in two-sided models would be accountable for losses even if they exit mid-way through a performance year.
- Termination of ACOs with multiple years of poor financial performance would be authorized.
Source: Mcol Blog
Source URL: http://www.mcolblog.com/kcblog/2018/8/10/25-things-to-know-a...
Notes: Compiled from MCOLBlog post: 25 Things to Know About The CMS Medicare ACO Proposed Rule: Pathways to Success