Medicare Shared Savings Program Final Rule Released

January 3, 2019
Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Accountable Care Organization (ACO), Practice Management, Practitioners

On December 21, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that sets a new direction for the Medicare Shared Savings Program. Referred to as “Pathways to Success,” this new direction for the Shared Savings Program redesigns the participation options available under the program to encourage Accountable Care Organizations (ACOs) to transition to performance-based risk more quickly and, for eligible ACOs, incrementally, to increase savings for the trust funds.

In connection with the program redesign, CMS will offer an application cycle for a one-time new agreement period start date of July 1, 2019 that:

  • Avoids an interruption in participation by ACOs with a participation agreement ending on December 31, 2018, that elected to extend their current agreement period for an additional 6-month performance year
  • Provides new and currently participating ACOs time to review new policies, make business and investment decisions, and complete and submit an application under the new BASIC or ENHANCED track.

New and existing ACOs interested in applying must complete the non-binding Notice of Intent to Apply, which will be available January 2-18. See the Application Types & Timeline webpage for eligibility requirements, key timelines, and detailed instructions on the submission process. CMS will resume the usual annual application cycle for agreement periods starting on January 1, 2020, and in subsequent years.

The final rule includes:

  • Final policy for extreme and uncontrollable circumstances for performance year 2017
  • New BASIC and ENHANCED tracks and five-year agreement periods
  • Updated repayment mechanism requirements for two-sided model ACOs
  • Rigorous benchmarking using regional benchmarks for all agreement periods
  • Reduced opportunities for gaming to ensure program integrity
  • Annual choice of assignment methodology
  • Expanded use of telehealth for practitioners in ACOs in performance-based risk arrangements
  • Expanded eligibility for Skilled Nursing Facility Three-Day Rule Waiver
  • Beneficiary incentive programs
  • Beneficiary notification
  • Claims-based assignment with beneficiary opt-in