NAACOS Newsletter for Members and Partners April 23, 2020
| COVID-19 AND ACOS ON-DEMAND WEBINAR NAACOS recently held a webinar, ACOs and COVID-19: NAACOS Advocacy and Recent Policy Changes. This webinar is now available on-demand and reviews Medicare Shared Savings Program (MSSP) extreme and uncontrollable circumstances policies made in a recent Interim Final Rule as well as other laws and policy changes affecting ACOs in light of the COVID-19 pandemic. NAACOS has developed a COVID-19 webpage with additional resources and updates for ACOs. CONGRESS FUNDS SMALL BUSINEESES AND HEALTHCARE PROVIDERS On Tuesday, April 21, the U.S. Senate met in a pro forma session and passed a nearly $500 billion “interim” COVID-19 stimulus package by voice vote. The bill, named the Paycheck Protection Program and Health Care Enhancement Act (H.R. 266), includes an additional $310 billion in funding for the small business Paycheck Protection Program, an additional $75 billion for hospitals and healthcare providers to support the need for COVID-19 related expenses and lost revenue, and $25 billion for increased testing capacity. The U.S. House of Representatives reconvened Thursday morning to consider and vote on the package. President Trump is expected to sign the package into law before the end of the week. NAACOS expects Congress to debate the next round of relief legislation in May, presenting additional opportunities to continue working with our Congressional champions to ensure CMS waives the shared loss repayment for ACOs during the COVID-19 public health emergency. SENATORS SUPPORT NAACOS’ POSITION ON COVID-19 RELIEF Sens. Sheldon Whitehouse and Bill Cassidy, two members of the Senate Finance Committee, recently wrote CMS Administrator Seema Verma supporting NAACOS’ position to hold ACOs harmless from shared losses in 2020, while delaying MSSP’s termination deadline for risk-based ACOs. NAACOS has been working with Sens. Whitehouse and Cassidy on policies to support ACOs and is glad to see the influential senators take action to stand-up for ACOs nationwide. In their letter to Verma, they cite NAACOS’ survey of two-sided ACOs who said they were likely to drop from the program without additional relief. They also quoted the NAACOS analysis that found COVID-related expenses could cost Medicare between $38.5 billion and $115.4 billion over the next year. We urge ACOs to use our Take Action page to send a message to Congress asking to hold ACOs harmless for losses and still allow 2020 shared savings opportunities for eligible ACOs. 2021 APPLICATION DEADLINES CMS’s and the broader health system’s response to the COVID-19 pandemic is causing delays in application cycles for 2021 participation for multiple programs, including MSSP and Direct Contracting. Sites to submit a notice of intent to apply for MSSP and a formal application for Direct Contracting are not yet open, despite having been scheduled to open on April 20 and March 31, respectively. While NAACOS did ask for a delay in the application cycle for both programs, we know this lack of clarity or communication might cause frustration or anxiety for those anticipating to appy for either program. NAACOS has reached out to staff at both the MSSP and the Center for Medicare and Medicaid Innovation, and we have been told the agency is working on new dates for the application period. CMS wants to align applications for the two as much as possible. We will share more information when it becomes available. CMS TO ALLOW RISK ADJUSTMENT ON TELEHEALTH VISITS Following NAACOS advocacy, CMS released an April 10 memo stating that it will incorporate submitted risk diagnoses from telehealth visits into risk scores. This change applies to ACOs. Previously, CMS didn’t acknowledge risk scores from non-face-to-face services. NAACOS had asked CMS to reverse that policy since so many services are taking place via telehealth during the COVID-19 pandemic. However, CMS will only incorporate codes for visits that use live, interactive video into risk scores. NAACOS provides more information on telehealth services during this public health emergency in this resource. UPCOMING WEBINAR: ACO BEST PRACTICES IN SERIOUS ILLNESS CARE The care of people with serious illness has a significant impact on ACO cost and quality – and often has much need for improvement. Join Diane Meier, MD, Director of the Center to Advance Palliative Care, on Tuesday, May 5 from 2:00-3:00 pm ET, as she shares tips and best practices collected from ACOs across the country. Learn how organizations are improving early identification of this population, how expanding the role of existing care managers results in better outcomes, and when and where specialty palliative care teams should be deployed. Members and partners are free and non-members are charged $195. Register Now! 2019 QUALITY REPORTING, MIPS REPORTING DUE APRIL 30 ACOs have until April 30, 2020, to report MSSP 2019 quality data. Previously, ACOs were required to submit this data by March 31, 2020. Additionally, CMS has extended the Merit-Based Incentive Payment System (MIPS) reporting deadline to April 30. This announcement comes after NAACOS and nine other healthcare organizations submitted a NAACOS-led letter to CMS requesting a delay of the upcoming deadline for 2019 reporting. NAACOS also asked for relief around participation in and data reporting options for 2020, and CMS has noted the agency is evaluating options for providing relief around participation and data submission for 2020. NAACOS will keep members updated of any further changes as we continue our advocacy efforts to provide ACOs with relief from regulatory requirements due to COVID-19. NAACOS REACTS TO MEDPAC’S COVID-19 RECOMMENDATIONS On April 14, NAACOS issued a statement reacting to recommendations from the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare payment policy. MedPAC recommended several actions to mitigate the effect of COVID-19 on ACOs, including that CMS not pay shared savings in 2020. While there were other recommendations that NAACOS agreed with, including an extension of the Next Generation ACO Model, NAACOS felt that ignoring generated shared savings would be detrimental to ACOs and wanted to quickly issue a statement reiterating its support of its position of holding ACOs harmless from shared losses while still offering an opportunity for providers to earn shared savings in 2020. ACO SUCCESS STORIES WITH COVID-19 PATIENTS To help in the fight against COVID-19, ACOs have utilized their pre-existing infrastructure for care coordination and data analysis and are redeploying staff who previously managed the ACO’s patient population. To help educate policymakers and the broader healthcare community, including ACOs, on the value NAACOS members are bringing their communities, NAACOS developed this resource to better share those stories. Examples include rapidly deploying telehealth or using ACO care managers to help treat COVID-19 patients. If you have stories about treating COVID-19 that you want to share, NAACOS wants to hear from you. Please reach out to advocacy@naacos.com about how your ACO is well-positioned to addressing the pandemic. CMS TO PROVIDE ACCELERATED CPC+ PAYMENTS In response to advocacy from NAACOS and others, CMS is offering Comprehensive Primary Care Plus (CPC+) Track 1 and 2 participants the opportunity to request Program Year 2020 Quarter 3 non-claims based payments in advance to provide financial relief to participating CPC+ Medicare providers working to treat patients and combat the COVID-19 pandemic. This advance payment opportunity applies only to non-claims based payments and is separate from the broader CMS Accelerated and Advance Payment Program for Providers and Suppliers During COVID-19 Emergency which provides qualified Medicare Part A and B providers advanced payment equal to the historical 3-month maximum of net fee-for-service (FFS) payments. CPC+ participants should have received a form from CMS to request the advanced CPC+ payments and forms to request them are due back by April 28.  APPLY FOR 2019 MIPS HARDSHIP EXCEPTIONS BY APRIL 30 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 Merit-based Incentive Payment System (MIPS) Alternative Payment Model (APM) Scoring Standard. As a result, if ACO practices have concerns that they will not be able to submit Promoting Interoperability data by the April 30 deadline, practice Tax Identification Number (TINs) should submit a hardship exception. This can be done at the practice TIN level via the Quality Payment Program webpage. CMS UPDATES COVID-19 GUIDELINES ON DELAYING ELECTIVE PROCEDURES On April 19, CMS issued updated guidance providing flexibility on delaying non-essential procedures. To expand capacity to care for patients and conserve staff and supplies, on March 18 CMS recommended limiting non-essential care. However, this updated guidance notes some areas may have low and stable incidence of COVID-19, and therefore CMS is allowing flexibility if states or regions have passed certain criteria outlined by the White House. More information is available. Keep up to date on these changes by visiting our COVID-19 webpage. NAACOS SUBMITS COMMENTS ON CJR MODEL EXTENSION On April 20, NAACOS submitted comments to CMS on a rule that proposes a three-year extension of the Comprehensive Care for Joint Replacement (CJR) model, among making other model changes. A summary of this proposed rule is available. In the comments, NAACOS reiterated its request to urge CMS to adopt a policy across all APMs to give priority to population-focused health care by excluding all ACO beneficiaries from bundled payment programs, unless a collaborative agreement exists between the bundler and the ACO. To learn more about NAACOS advocacy on this issue, please visit our Bundled Payments page. THINK TANK SUPPORTS NAACOS-BACKED POLICIES NAACOS was pleased to see that this week the Bipartisan Policy Center (BPC), an independent, Washington-based think tank, urged policymakers to take action on two NAACOS priorities. In a report from its Rural Health Task Force, the BPC recommended Congress pass the Rural ACO Improvement Act (S. 2648) and the Accountable Care in Rural America Act (H.R. 5212), which would exclude ACO-assigned beneficiaries from an ACO’s regional reference population. The BPC also recommended CMS extend rural-specific CMS Innovation Center demonstrations that have proven successful, including the ACO Investment Model. NAACOS sent a letter to the task force last fall, offering our recommendations, including two the BPC recommended action on. COVID-19 TRACKER PROJECTIONS A COVID-19 Tracker has been developed by the Institute for Health Metrics and Evaluation based on a recent analysis to determine the extent and timing of deaths and excess demand for hospital services due to COVID-19 in the United States. This tool uses data on confirmed COVID-19 deaths from the World Health Organization website, local and national governments, as well as data on hospital capacity and utilization for U.S. states, and observed COVID-19 utilization data from select locations to develop a statistical model forecasting deaths and hospital utilization against capacity by state for each state within the United States over the next four months. Other COVID-19 resources can be found on our resource page. HHS DELAYS IMPLEMENTATION OF DATA-SHARING RULES Because of the healthcare industry’s ongoing response to the COVID-19 pandemic, CMS and HHS’s health information technology (IT) office will push back implementation of final rules that aim to make it easier to share patients’ medical records. The so-called “information blocking” or interoperability rules implement parts of the 21st Century Cures Act of 2015, which allow HHS to punish entities that block the flow of patient data. Provisions would have kicked in starting this fall but will be delayed anywhere from three to six months. Hospitals will now be required to share electronic notifications of patients’ admission, discharge and transfer (ADT) to inpatient facilities in May 2021. HHS also published a proposed rule outlining how the Inspector General will handle enforcement of rules against unreasonable blocking of health information. CMS provides a summary of delayed provisions, and HHS’s Office of the National Coordinator for Health IT also provided a summary. NAACOS has updated its member resource that summarizes the changes. UPDATED FQHC AND RHC TELEHEALTH GUIDANCE On April 17, CMS published guidance on how it will pay federally qualified health centers (FQHCs) and rural health centers (RHCs) for telehealth services during the COVID-19 public health emergency. For telehealth distant site services furnished between January 27, 2020, and June 30, 2020, RHCs will be paid at their all-inclusive rate, and FQHCs will be paid based on their Prospective Payment System rate. For telehealth distant site services furnished between July 1, 2020, and the end of the public health emergency, RHCs and FQHCs will use an RHC/FQHC specific G-code, G2025, to identify services that were furnished via telehealth and will be paid $92 per service, which is the average amount for all of CMS’s telehealth-approved services, weighted by volume. NAACOS had asked that CMS retroactively reimburse FQHCs and RHCs for telehealth and is pleased to see this information released. NAACOS ADVOCATES FOR SUPPORT OF MA PROVIDERS As part of our ongoing advocacy to support providers in the face of COVID-19, NAACOS and other leading healthcare organizations recently sent a letter to Congress asking for support for those treating Medicare Advantage (MA) beneficiaries. Many ACOs participate with MA payers in accountable care arrangements, and NAACOS is encouraging Congress to deliver financial assistance to these providers. Specifically, the letter recommends that CMS include MA beneficiaries in the calculation of patients with respect to providers who are given relief funding under the Coronavirus Aid, Relief, and Economic Security Act (CARES). The letter also requests that distressed providers serving MA beneficiaries are able to participate in Medicare’s financial assistance programs, such as the Accelerated Payments Program, and seeks to extend business loans and grants, including the Paycheck Protection Program, to providers with more than 500 employees that serve multiple locations. MSSP PY2020 HISTORICAL EXPENDITURE AND ASSIGNMENT REPORTS AVAILABLE CMS recently made available the Expenditure/Utilization (EXPU) and Assignment Summary Report (ASR) data for Performance Year (PY) 2020 historical benchmarks years. These reports are available to MSSP ACOs via the SSP ACO Portal and include drill down information such as tables on beneficiary demographics and eligibility characteristics and expenditure comparisons for ACOs to the all-ACO median and fee-for-service population. |
