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ACO REACH LEARNING DISCUSSION DIVES INTO CAPITATED PAYMENTS
NAACOS’s next ACO REACH Learning Discussion will take place February 17 from 12:00–1:00 pm ET. This month the topic is processing claims and payments under both capitation payment options the
model offers. Participation is limited to those participating in ACO REACH, and advance registration is required. If you have questions or additional topics you want discussed, please share
them in advance by emailing [email protected].
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Welcome New ACO Member
Tri-Shield Health
Nashville, TN
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NAACOS PUBLISHES FIRST ANNUAL PAC REPORT
The NAACOS Action Fund is a political action committee (PAC) that collects personal contributions from NAACOS members and staff to support congressional candidates who support value-based
care. The PAC helps supplement NAACOS’ congressional advocacy by allowing NAACOS to interact directly with key members of Congress at political events and fundraisers. The
annual PAC report is now available. For more information on getting involved with the PAC, please reach
out to Aisha Pittman or
Robert Daley.
JOIN NAACOS ECQM IMPLEMENTATION GROUP
NAACOS is convening a small working group of ACOs who are currently actively reporting or trying to report electronic clinical quality measures (eCQMs). This group will allow for shared
learning and also provide feedback to CMS regarding implementation challenges and successes. Interested ACOs should email
Jennifer Gasperini for more information.
NAACOS SUBMITS COMMENTS ON PRIVACY PARITY FOR SUD DATA
NAACOS asked HHS to make clear that if substance use disorder (SUD) data, such as a claim, has been shared for purposes of treatment, payment, and health care operations that it should operate
as though patient consent was given. This would mean that CMS and other payers could release SUD-related claims data to ACOs. The proposed rule from HHS seeks to better align the
confidentiality of SUD patient records regulated under 42 CFR part 2 with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA). Currently, ACOs
have SUD-related claims removed from data CMS share. Read our
submitted comments.
CONGRESS BEGINS LEGISLATIVE BUSINESS
Committee assignments in the House and Senate have been finalized. Over the last few years, NAACOS has developed relationships with many key lawmakers, and we are encouraged to see that
roughly 50 percent of lawmakers on Congress’ health committees are champions or supporters of value-based care. With rosters now set, committees are beginning to move forward with legislative
business and oversight hearings.
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House Votes on COVID Bills. The House has been debating bills on COVID-19 and recently passed legislation to end the Public Health Emergency (PHE) and other COVID-19
policies, including vaccine mandates. The bills are not expected to be considered in the Senate.
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Debt Ceiling. President Biden met last week with House Speaker Kevin McCarthy (R-CA) to begin discussing raising the national debt ceiling for the federal government.
Congressional Republicans are asking for spending reductions in exchange for agreeing to increase the debt ceiling. Congressional Democrats have expressed opposition to spending
reductions. Negotiations are expected to continue through the spring and will have a significant impact on the congressional agenda. The White House is also scheduled to release the
President’s budget request on March 9. While non-binding, the budget request will outline the administration’s priorities for the upcoming year.
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Medicare Payment Reform. A growing number of physicians and lawmakers in Congress are calling for hearings on Medicare payment reforms, including oversight of the
Medicare Access and CHIP Reauthorization Act (MACRA) and Medicare Advantage. NAACOS looks forward to being involved in this process and will be working with lawmakers to reintroduce
legislation incentivizing value. NAACOS will also be working with our stakeholder partners to educate lawmakers and their staff about value.
PHE TO END ON MAY 11
The COVID-19 PHE will end on May 11 per an announcement from the Biden-Harris
administration. The PHE has been in place since early 2020 and renewed every 90 days. It will be extended one more time on April 11 and end a month later. This will have large impacts on
Medicare ACO programs, including:
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Covering of shared losses. Unless another national or local PHE is issued before the end of the year, MSSP ACOs will have five-twelfths of their shared losses waived
(the percentage of months the PHE would be in place in 2023) should shared losses be incurred.
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Removing of COVID-related claims. CMS will stop removing a beneficiary’s Part A and B expenditures in months triggered by an episode of care (identified by inpatient
care for treatment of COVID-19) from MSSP’s performance year expenditures. Those expenditures were also removed from benchmarks and trend updates.
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Quality reporting. ACOs that fail to report quality data will have their quality score set to the quality performance standard (i.e., achieves the maximum shared
savings rate). ACOs who do report quality data will receive the higher of their own score or the quality performance standard score (the 30th percentile MIPS quality performance
category score). In 2024, this policy will no longer apply unless another national or local PHE is issued.
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SNF 3-day waiver. CMS will stop waiving Medicare’s requirement that patients have a 3-day inpatient hospitalization prior to admission to a skilled nursing facility
(SNF). On May 11, the SNF 3-day waiver will only be available to two-sided ACOs who have applied to CMS and approved to use it.
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Telehealth and Hospital at Home. Congress recently extended until December 31, 2024, the Acute Hospital Care at Home initiative and numerous telehealth-related
flexibilities, including making care possible wherever the patient is located, covering audio-only services, extending coverage to federally qualified health centers (FQHCs) and rural
health clinics (RHCs), among others.
NAACOS is working on additional education to help ACOs understand and navigate the post-PHE landscape. NAACOS provides a number of
COVID-related resources, including
CMS guidance that covers all Medicare fee-for-service billing questions and the
MSSP.
DOJ WITHDRAWS ACO-RELATED HEALTH CARE ANTITRUST STATEMENTS
On February 6 the Department of Justice (DOJ) unexpectedly
announced its withdrawal from three health care antitrust
policy statements, including the 2011
Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program
. The Federal Trade Commission (FTC), which had jointly authored these statements with DOJ, has not announced whether it also was withdrawing from them, but it is anticipated that it will take
similar action. The statements were issued to furnish guidance to health care providers across a range of antitrust issues, including mergers, joint ventures, purchasing arrangements,
information exchanges, and the formation of clinically integrated networks. DOJ provided little information regarding its reason for withdrawing the statements, other than commenting that
since their promulgation the health care landscape has changed significantly, and that as a result the statements are overly permissive on certain subjects. We do not believe that this was
targeted towards ACOs but rather part of a much broader and more aggressive antitrust enforcement posture of the Biden administration. While the impact of the changes remains to be seen, the
decision signals the potential for increased antitrust scrutiny of ACOs and other health care collaborations. We are working with our legal counsel to consider the implications of this
announcement. If you are closely reviewing, please contact Aisha Pittman, we would like to understand our members
perspectives.
CMS FINALIZES CHANGES ON RECOVERING IMPROPER MA PAYMENTS
CMS published a final rule that will allow it to recoup some overpayments to MA plans made because of findings in risk adjustment data validation audits. That program finds improper risk
adjustments to MA plans where medical diagnoses were not supported in the beneficiary’s medical record. Under the final rule, CMS will now extrapolate audit findings to plans’ full MA patient
panels starting with Payment Year 2018. CMS will not apply a fee-for-service adjustor. The agency projects the rule will save $4.7 billion over a decade. More information is available in the
CMS fact sheet and
final rule.
MA PROPOSED TO RECEIVE SMALL RATE INCREASE IN 2024
MA plans stand to see a 1.03 percent increase in payments in 2024 under the proposed advanced rate notice. This is much lower than the 8 percent plans received in 2023 and 4 percent in 2022.
Reductions are driven by cuts in both risk adjustment and star ratings policies. Comments on the proposal are due March 3 with the final notice published by April 3. More information can be
found on both the fact sheet and
advance notice.
PRE-CONFERENCE WORKSHOPS ANNOUNCED FOR SPRING 2023 CONFERENCE
Join us May 3–5 for our Spring 2023 Conference at the Hilton Baltimore Inner Harbor. In addition to plenaries with CMS officials and other value-based care leaders, this two-day, in-person
event will feature 16 breakout sessions with actionable knowledge for new ACOs joining the MSSP and REACH models, rural ACOs,
independent primary care ACOs, and ACOs with experience in all models. Pre-conference workshops will be held
Wednesday, May 3 from 1:00–5:00 pm ET. We are offering three workshops at the spring conference. These workshops require separate registration from the main meeting and run concurrently.
- ACO REACH Implementation and Sustainability led by Gary Jacobs and Andrea Osborne, VillageMD
- Building the Foundation for ACO Success: MSSP Basics led by Jessica Martensen, Essentia Health
- Annual Wellness Visits led by Jen Perloff, Institute for Accountable Care
Virtual and in-person registration options are available and, as always, the entire main conference will be recorded.
Register early and save! Register before March 17 for the in-person or virtual conference and receive a discount.
Exhibitor and sponsor opportunities are now available! The conference will feature exhibitors with products and services specifically for the accountable care community.
Partners reserve your space today!
SHARE YOUR QUESTIONS WITH CMS AT TOWN HALL SESSION
Leaders from CMS and its Innovation Center will join us at Spring Conference Town Hall on Friday, May 5 from 1:15 to 3:00 pm ET. This is an opportunity for ACOs to raise issues of concern and
importance to their work directly with CMS. Share your questions in advance by emailing [email protected].
NEW COMPLIANCE MANUALS, FREE WEBINAR FOR MEMBERS
NAACOS has once again partnered with Wilems Resource Group to offer ACO members compliance manuals consisting of robust
policies and procedures that organizations can customize to meet their individual needs. The MSSP manual has been updated, and a new ACO REACH manual issued. The manuals are available on an
annual subscription basis. Everyone who subscribes to a manual will receive any updates made during the subscription year. The DCE manual will not be updated in 2023, but those who purchased
it may obtain the ACO REACH manual by renewing.
NAACOS members may also join ACO compliance expert, Kimberly Busenbark, as she details the keys to implementing and operating effective compliance programs.
Webinars will be held on March 14 from 2:00 to 3:00 pm ET for the MSSP compliance manual and on March 16 from
2:00 to 3:00 pm ET for the REACH manual. Get actionable advice on best practices for required documentation as well as how to successfully navigate audits, avoid high risk areas, and work with
operations to set up compliant processes for your ACO. For the REACH webinar, Ms. Busenbark will also discuss updates from Direct Contracting to ACO REACH and the impact on operational
compliance. It’s easy to be compliant, join us to find out how to prove it when it matters most.
VIRTUAL AFFINITY GROUP MEETINGS CONTINUE ON FEBRUARY 16
These virtual peer-to-peer opportunities are offered to NAACOS members throughout the year in addition to the in-person sessions at our spring and fall conferences. Like the conference
sessions, these virtual meetings provide peers in similar positions in a value-based care setting with a forum to meet and discuss hot topics, network, and exchange ideas.
The meeting link will be provided in the confirmation e-mail when you sign up for each group, and it will work for all future meetings. You may sign up for as many groups as
you are interested in. NAACOS ACO members who have not yet signed up can register for NAACOS Affinity Groups via the links below.
STILL TIME TO REGISTER FOR THE MEDICAID LEARNING LAB, EARN CEUS
The Medicaid Learning Lab continues in March with more information on patient management services that can positively affect the Medicaid population. Future monthly meetings will provide
information on the various Medicaid models throughout the states, workflow options for value-based care related to primary care, social determinants of health, behavioral health, and
high-needs populations, plus how to improve quality and how to enhance patient engagement in the Medicaid population. The Medicaid Learning Lab virtual series began in December 2022 and will
run through December 2023. Anyone attending 75 percent of the meetings will receive CEUs upon completion. In addition, this series will offer a platform not only to gain knowledge on these
topics but also to create a strategic plan for implementation within your ACO. Those who create and submit a plan will receive a certificate of completion. The virtual meetings will continue
with monthly 90-minute sessions over the next 12 months. The next meeting is scheduled for March 3 from 2:00 pm to 3:30 pm ET.
Sign up today to learn more about patient management and contract needs for Medicaid populations and beyond.
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WHAT WE’RE WATCHING: NEWS ABOUT ACOS AND HEALTH CARE
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The Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment Access Commission (MACPAC) released the
February 2023 Data Book for beneficiaries dually
eligible for Medicare and Medicaid.
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CMS will host a webinar, “From Data to Action: How CMS and its Stakeholders are Addressing Inequities in Health Care” to discuss CMS’s Health Equity Framework and stakeholder work to
leverage changes in quality measurement and data to drive progress toward more equitable care for all. The webinar will be held
February 28 from 3:00 to 4:00 pm ET and
March 8 from 12:00 to 1:00 pm ET.
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