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CMS Finalizes MSSP Redesign

The Centers for Medicare & Medicaid Services (CMS) released a final rule with updates to the Medicare Shared Savings Program (MSSP) that creates a pathway for accountable care organizations (ACOs) to transition more rapidly to performance-based risk.

The MSSP aims to facilitate coordination and cooperation among providers to improve the quality of care for Medicare fee-for-service beneficiaries and reduce growth in health care costs. Eligible providers in this voluntary program create or join ACOs, through which they share savings with Medicare by demonstrating efficient care delivery and meeting quality performance benchmarks.

For ACOs applying to participate in the MSSP in 2019, CMS finalized its restructuring of participation options by:

  • discontinuing Track 1 (one-sided shared savings only model) and Track 2 (two-sided risk model with shared savings and losses);
  • maintaining Track 3 (two-sided model with highest risk) and renaming it the ENHANCED track; and
  • introducing a new BASIC track, offering a path from the one-sided risk model to phase in risk and potential reward incrementally over the course of a single agreement (i.e., a glide path).

CMS finalized other changes in the MSSP redesign, including:

  • allowing agreement periods of at least five years, versus the current three-year agreement periods;
  • differentiating low-revenue versus high-revenue ACOs, based on degree of control over total Medicare Part A and B fee-for-service expenditures for assigned beneficiaries;
  • reducing the time ACOs can remain in program under the savings-only track to:
    • three years for new low-revenue ACOs;
    • two years for all other new ACOs; and
    • one year for existing Track 1 ACOs;
  • requiring high-revenue ACOs to enter the ENHANCED track after no more than one agreement period under the BASIC track;
  • modifying proposals to increase the final shared savings rate by 25 percent to 40 percent for one-sided levels in BASIC track and 50 percent for two-sided levels; and
  • permitting annual election of beneficiary assignment methodology for ACOs in BASIC or ENHANCED tracks.

The rule also requires ACOs to provide beneficiaries with notice — in written, in person, or electronically through email or a patient portal — that they are participating in this new approach to care delivery, and explain what participating in an ACO means for their care.

CMS finalized a July 1, 2019 start date for the first agreement period under the new participation options, to allow ACOs time to consider the new options and prepare for program changes.

The Notice of Intent to Apply will be available Jan. 2 to Jan. 18, 2019. Application submission due dates will be posted on the Medicare Shared Savings Program website in the coming days.

America’s Essential Hospitals is analyzing the final rule and will send members a detailed Action Update.

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


About the Author

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

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