NAACOS Newsletter for Members and Partners June 04, 2020

NAACOS ADVOCACY SECURES KEY CHANGES IN IFR TO MITIGATE COVID-19 IMPACT On April 30, CMS released a second interim final rule (IFR) with comment making additional policy changes for the Medicare Shared Savings Program (MSSP) in light of the COVID-19 public health emergency (PHE). This follows a March 30 interim final rule which activated the MSSP extreme and uncontrollable circumstances policy for the COVID-19 pandemic. NAACOS has created a summary of the latest rule, available here. As a result of NAACOS advocacy, CMS makes several important updates to the extreme and uncontrollable circumstances policy to provide additional support and relief to ACOs. Key updates include: Adjustments to MSSP calculations to mitigate the impact of COVID-19 on ACOs by removing payment amounts for episodes of care (as identified by inpatient care for treatment of COVID-19) from MSSP performance year expenditures, while making updates to the historical benchmarks and revenue calculations for determining loss sharing limits for certain ACOs, Canceling the application cycle for new ACOs to enter the MSSP in 2021, Allowing ACOs whose current agreement periods expire on December 31, 2020, the option to extend their existing agreement periods by one year (ACOs extending their agreements for an additional year would remain under their existing historical benchmarks for an additional year), Allowing ACOs in the Basic Track’s glide path the option to elect to maintain their current level of participation for performance year (PY) 2021, therefore not assuming higher levels of risk, Altering the extreme and uncontrollable circumstances policy to specify that the PHE began in January 2020, Including services provided virtually through telehealth, virtual check-ins, e-visits or telephone in the definition of primary care services used in the MSSP assignment methodology, effective January 1, 2020, and for any subsequent performance year that starts during the PHE, Increasing reimbursement for newly introduced audio-only telehealth services, Waiving the video requirement for certain evaluation and management services delivered via telehealth, and Easing regulatory requirements for COVID-19 testing, while increasing the availability to get reimbursed for COVID-19 testing. The rule also expands coverage for certain telehealth services and expands payment rule waivers available to healthcare providers during the PHE. The changes follow weeks of work by NAACOS staff to raise awareness of the support ACOs need in the fight against the COVID-19 pandemic. Senators recently wrote CMS asking that ACOs be held harmless from shared losses in 2020. NAACOS has also supported broader coverage of telehealth services. We thank all of you who have engaged with your members of Congress, which also raised awareness of the issue. NAACOS WEBINAR: UNDERSTANDING THE LATEST ROUND OF COVID-19 RELIEF FROM CMS On May 15 at 2:00 p.m. ET, NAACOS will host a webinar, Understanding the Latest Round of COVID-19 Relief From CMS. This webinar will review the impact of CMS’s recent changes made in light of the COVID-19 pandemic, including new policies to exclude COVID-19 costs from 2020 spending, counting telehealth visits in ACO attribution, and cancelling the 2021 application cycle. The webinar will also review increasing payment rates for telehealth, expansion of audio-only telehealth, and key decision dates for ACOs in 2020. Finally, two ACOs will share their perspectives around adapting their ACO to COVID-19 and provide reactions to these important policy changes. Register today! UPCOMING SPONSORED WEBINARS Join NAACOS sponsors for two upcoming webinars. The first is Milliman’s “Assessing the Impact of COVID-19 on Risk Contracts” on Thursday, May 14 from 2:00–3:00 p.m. ET. During this time of national uncertainty, health care providers are fully engrossed in maintaining daily operations and ensuring continuity of care for their patients amid the COVID-19 crisis. COVID-19 creates a myriad of uncertainties for ACOs, which can seem overwhelming. Understanding the economic and clinical impact of COVID-19 requires innovative and flexible analytic methodologies. Please join our team of experts — Charlie Mills, FSA, MAAA; Melody Craff, PhD, MBA, MD; and Francesca Hammerstrom, MPP — to gain insights into how to assess and anticipate the impact of COVID-19 on your risk contracts. This webinar is sponsored by Milliman and is not available to business partners. Register Now! The second is Olio Health’s “How Indiana University Health (IUH) uses technology to actively engage with its post-acute network” on Wednesday, May 20 from 3:00–4:00 p.m. ET. Join NAACOS and Olio Health for a fire-side chat with IUH’s Anthony Sorkin, MD, medical director for IUH’s ACO and health plan, and Tori Bratcher, MHA, director of populations health services, on how they used Olio to engage with 228 nursing homes, long term acute care hospitals, and acute rehabs, and over 1,000 post-acute caregivers, to support their most vulnerable patient populations. Their discussion will include how IUH used technology, data, and evolved their team’s approach to actively engage with post-acute clinicians before and during COVID-19. This webinar is sponsored by Olio Health and is not available to business partners. Register Now! Both of these webinars are free to NAACOS ACO members. If you have trouble registering for the webinar, please email Anna LaFayette. CMS CANCELS 2021 APPLICATIONS FOR MSSP In CMS’s recent interim final rule, the agency unfortunately said it would not offer an application cycle for ACOs to start in MSSP in 2021. The agency will, however, allow ACOs whose agreements are set to end later this year an option to extend for another year. Also, ACOs on schedule for an increase to their financial risk in 2021 will be able to maintain their current risk level for another year rather than automatically moving to the next risk level. NAACOS is disappointed there will not be an application cycle offered this year and will push CMS to open at least a partial PY 2021 as the healthcare industry stabilizes. CMS will allow MSSP ACOs the opportunity to make updates through the annual change request cycle starting June 18. Updates this year include the option to add a fourth performance year for agreements set to expire after this year, selection of ACO level of risk for 2021 under the Basic Track, applying for a skilled nursing facility three-day rule waiver and/or to operate a Beneficiary Incentive Program, and selecting beneficiary assignment methodology. This CMS webpage includes details on the schedule for actions and decisions ACOs must make related to their PY 2021. SENATE RETURNS TO WASHINGTON The Senate reconvened this week after being out of session for more than a month. The House is working remotely this week with tentative plans to return the week of May 11. Lawmakers will be looking to pass another stimulus package with negotiations expected to continue through late May or early June. Although Congressional leaders have highlighted a number of policy disagreements, the next stimulus package will likely include additional relief for healthcare providers, businesses, and states. NAACOS will be working with Congressional offices and Administration officials throughout this process to continue advocating for policies that benefit ACOs. CMS OFFERS FLEXIBILITY ON BENEFICIARY NOTIFICATION REQUIREMENT In light of the COVID-19 PHE, on May 1 CMS updated its FAQs to note the agency is exercising its enforcement discretion to adopt a temporary policy of relaxed enforcement in connection with the deadline for furnishing the standardized written beneficiary notifications required of ACOs, as long as they are completed by the end of the current performance year. Another FAQ notes ACOs can use electronic transmission (such as email or secure portal) in conjunction with e-visits and telehealth visits when completing the beneficiary notification. The new FAQs are listed on page 38. NAACOS has advocated repeatedly for the removal of the burdensome beneficiary notification requirement. DIRECT CONTRACTING OUTLOOK UNCERTAIN The scheduled application deadline for the new Direct Contracting Model passed last week, but the application portal for the model never actually opened. There is still considerable uncertainty about key details of the model as CMS is working hard to support our health system during the COVID-19 pandemic. NAACOS has asked CMS to provide clarity for those who have already applied for the Implementation Period or are interested in applying to start in 2021. We also continue to strongly advocate for CMS to announce another opportunity to apply to start in 2022 and to extend the Next Generation (Next Gen) ACO Model for at least another year. NEXT GEN MODEL ANNOUNCES QUALITY CHANGES FOR COVID-19 According to an email sent to Next Generation Model participants on April 28, Next Generation ACOs will be given their 2018 quality performance scores if measures are not reported for 2019 due to the COVID-19 public health emergency. Specifically, the email notes: “If the ACO participating in the NGACO Model is unable to complete reporting on the Web Interface (WI) measures, CMS will apply the ACO’s 2018 performance rates to calculate the ACO’s 2019 overall quality score used in determining shared savings and losses. If the ACO completed reporting on some of the WI measures but not all, the 2019 performance rates will be applied to the completely reported measures and 2018 performance rates will be applied to the incompletely reported measures.” There have been no model announcements thus far on how quality assessments will be handled for 2020 for Next Gen. NAACOS ASKS FOR SPEEDY RULEMAKING ON SUBSTANCE USE DISORDER RULE NAACOS was part of a letter recently sent to HHS Secretary Alex Azar asking for expediency in publishing a rule that would make it easier to share the treatment records of patients with substance use disorder. Section 3221 of the Coronavirus Aid, Relief, and Economic Safety (CARES) Act allows such records to be shared with others following patients’ one-time written consent. It also allows for redisclosures similar to that of the Health Insurance Portability and Accountability Act after that initial consent. NAACOS has been a long-time supporter of the change and wants to see regulations adopted as soon as possible to allow for the improved care coordination that the CARES Act change would provide. CMS ALTERS ACCELERATED AND ADVANCED PAYMENTS CMS recently issued an updated fact sheet on the expansion of the Accelerated and Advance Payments Program for providers and suppliers during the COVID-19 PHE. In the updated fact sheet CMS notes that in light of the $175 billion appropriated for healthcare provider relief payments, CMS is suspending its Advance Payment Program to Part B suppliers and beginning on April 26, CMS will not be accepting any new applications for the Advance Payment Program. CMS notes significant additional funding will continue to be made available through other programs. For more information, visit the CARES Act Provider Relief Fund page. Updates on polices related to COVID-19 are available on our website. NAACOS ASKS FCC TO RECONSIDER TELEHEALTH GRANT ELIGIBILITY NAACOS recently wrote the Federal Communications Commission (FCC) asking to expand eligibility in its $200 million telehealth grant program to for-profit healthcare providers. Currently, the FCC’s COVID-19 Telehealth Program is limited to non-profit and public providers, but that unfortunately excludes most physician practices. NAACOS wrote the FCC in support of an American Hospital Association petition, asking the FCC the reverse its position. CMS CLARIFIES 2019 MIPS EXCEPTIONS FOR ACOS IN NEW FAQ In a recent Interim Final Rule, CMS clarified that the 2019 automatic extreme and uncontrollable circumstances policy for MIPS will not apply to eligible clinicians participating in MSSP ACOs and instead these clinicians will continue to be scored under the existing MIPS APM Scoring Standard. As a result of NAACOS advocacy, CMS recently clarified in a new FAQ (see pages 32-33), that if a MIPS clinician or Tax Identification Number (TIN) does not report Promoting Interoperability (PI), they will be excluded from the average ACO PI calculation and will not negatively impact the ACO’s overall PI performance category score. CMS ADDS FOURTH QUARTER SNAPSHOT RESULTS TO QPP PORTAL CMS recently updated its Quality Payment Program (QPP) portal’s participation status tool to include data from the 2019 fourth snapshot period, which includes dates of service from January 1, 2019 through December 31, 2019. The fourth snapshot period does not pertain to qualifying for Advanced Alternative Payment Model (APM) bonuses, which is based on three snapshot dates earlier in the year. The fourth snapshot is only for full-TIN APMs who joined after August 31 to benefit from the APM Scoring Standard for the Merit-based Incentive Payment System (MIPS). Examples of full-TIN APMs include the Medicare Shared Savings Program and the Bundled Payments for Care Improvement Advanced Model (BPCI Advanced). More details on the APM Scoring Standard for MIPS are included in NAACOS’s ACO Guide to MACRA, with annual editions is available.