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CMS Extends, Changes Bundled Payments Model

The Centers for Medicare & Medicaid Services (CMS) extended for two years the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model. Set to end Dec. 31, 2023, the model now will conclude on Dec. 31, 2025.

Introduced in January 2018, BPCI Advanced is a voluntary payment model under which a single bundled payment covers services furnished by various health care providers across care settings. Participants can earn additional payment if they reduce costs over the course of the beneficiary’s 90-day episode of care while meeting quality benchmarks.

The two-year extension will include a new Request for Applications in early 2023 for Medicare-enrolled providers and suppliers and Medicare accountable care organizations.

Changes for Model Year 6 (2023)

In addition to pricing methodology changes for Model Year 6, CMS also will change how beneficiaries with a COVID-19 diagnosis during the episode of care are accounted for during the biannual reconciliation process.

Previously, CMS excluded beneficiaries who had a COVID-19 diagnosis during the episode of care from model reconciliation to eliminate the participant’s financial liability associated with COVID-19 clinical episodes. After three years of this policy, beginning in Model Year 6 (2023), participants will be accountable for clinical episodes where the BPCI Advanced beneficiaries have a COVID-19 diagnosis during the episode of care.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with additional questions.


About the Author

Maryellen Guinan is a principal policy analyst at America's Essential Hospitals.

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