15 Key Provisions of CMS Proposed Rule for Pathways to Success - Redesigned Medicare ACOs

1. 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).
2. 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.
3. The length of ACO participation agreements would expand from three years to five years.
4. 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.
5. Year five in BASIC track meets standard to qualify as an Advanced Alternative Payment Model (APM) under MACRA.
6. The ENHANCED track would allow providers to take on risk and qualify as an Advanced APM immediately.
7. 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
8. 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
9. High revenue ACOs would be required to move to the ENHANCED track and take on additional risk at renewal
10. Each ACO would provide a standardized written disclosure notice to its Medicare beneficiaries
11. 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
12. Physicians in ACOs that take on risk could receive payment for telehealth services provided to patients regardless of the patient’s location.
13. Benchmark and risk adjustment Methodology would be refined, including Regional (county-level) spending benchmarks
14. ACOs in two-sided models would be accountable for losses even if they exit mid-way through a performance year.
15. Termination of ACOs with multiple years of poor financial performance would be authorized.

Notes: Compiled from MCOLBlog post: 25 Things to Know About The CMS Medicare ACO Proposed Rule: Pathways to Success
Source: Mcol Blog
Source URL: http://www.mcolblog.com/kcblog/2018/8/10/25-things-to-know-a...

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