CMS Issues Proposed Rule on Medicare Shared Savings Program

On August 9, CMS issued a proposed rule that would set a new direction for the Medicare Shared Savings Program. Referred to as “Pathways to Success,” this proposed new direction for the program would redesign the participation options available to:

• Encourage Accountable Care Organizations (ACOs) to transition to two-sided models (in which they may share in savings and are accountable for repaying shared losses)
• Increase savings for the trust funds and mitigate losses
• Reduce gaming opportunity and increase program integrity
• Promote regulatory flexibility and free-market principles

This proposed rule would also aim at strengthening beneficiary engagement, ensuring rigorous benchmarking, and helping to improve care for Medicare beneficiaries, with an emphasis on combatting opioid addiction and expanding the use of interoperable electronic health record technology among ACO providers/suppliers. The proposed policies also include changes to address the additional tools and flexibilities for ACOs established by the Bipartisan Budget Act of 2018, specifically in the areas of new beneficiary incentives, telehealth services, choice of beneficiary assignment methodology, and voluntary alignment refinements.

The proposed rule also includes:

• New basic and enhanced tracks and 5-year agreement periods
• Six-month agreement period extension and mid-year 2019 start date that will allow ACOs to prepare
• Updates to repayment mechanism requirements for two-sided model ACOs

The comment period closes on October 16. Please see the proposed rule, the full text of this excerpted CMS fact sheet (issued August 9), or this press release for more information.