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New CMMI Model Options for COVID-19

The Centers for Medicare & Medicaid Services’ Center or Medicare and Medicaid Innovation (CMMI) announced new flexible options and adjustments to current and future CMMI models to address the COVID-19 public health emergency.

The new options are detailed in a comprehensive table for each payment model, including the Bundled Payments for Care Improvement Advanced, Comprehensive Care for Joint Replacement, Oncology Care, Kidney Care Choices, and Comprehensive ESRD Care models and others.

Notably, CMS will extend the Next Generation (Next Gen) Accountable Care Organization (ACO) model through December 2021; it was originally set to sunset at the end of this year. Similar to the Medicare Shared Savings Program (MSSP), CMS will reduce losses by the percentage of months for which the COVID-19 public health emergency is in effect and will remove episodes of care for the treatment of COVID-19. The potential upside of Next Gen ACOs will be capped at 5 percent gross savings.

Additional adjustments to CMMI models include:

  • aligning the Track 1+ ACO model updates for COVID-19 with MSSP updates and allowing for voluntary election to extend agreement for one year through December 2021; and
  • delaying implementation of the start of the Serious Illness component of Primary Care First to April 1, 2021, while starting the Primary Care First only component on time on Jan. 1, 2021.

In a Health Affairs Blog post, CMS leadership notes “models must be adjustable to address the uniqueness of the current situation” and commits to working directly with model participants on specific model changes and the processes for their implementation.

Visit the America’s Essential Hospitals coronavirus resource page for more information about the outbreak.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

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

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