NAACOS-SUPPORTED VALUE IN HEALTH CARE ACT INTRODUCED IN HOUSE A bipartisan bill to incentivize ACO and Advanced Alternative Payment Model (APM) participation was introduced in the House on July 24. The Value in Health Care Act (H.R. 7791), or Value Act for short, was drafted in consultation with NAACOS over the last year and reflects several of our legislative priorities. The legislation is summarized. Specifically, the bill:
Encourages participation in the Medicare Shared Savings Program (MSSP) by increasing shared savings rates, addressing risk adjustment, eliminating CMS’s “high” and “low” revenue distinction for ACOs, and removing an ACO’s beneficiaries from the regional benchmark adjustment;
Provides at least three years before ACOs must assume risk and makes MSSP’s Enhanced Track voluntary;
Restarts the ACO Investment Model;
Extends the 5 percent bonus for Advanced APM participation and makes those bonuses available for an additional six years;
Lowers the Qualifying APM Participant (QP) thresholds for Performance Year (PY) 2021 and thereafter;
Forces the U.S. Department of Health ∓ Human Services (HHS) to review APM overlap policies and report back to Congress; and
Removes CMS’s statutory restriction to pay shared savings to providers participating in multiple shared savings initiatives.
NAACOS also led circulation of a letter of support for the bill that was signed by 13 leading provider organizations. A press release quoting all supporting organizations was also issued. We thank Reps. Peter Welch (D-Vt.), Suzan DelBene (D-Wash.), and Rep. Darin LaHood (R-Ill.) for their leadership of this issue and recognizing its importance.
NAACOS is working with Senate offices to introduce a Senate-version of the bill, which is expected in the coming weeks. Bill introduction is a notable step in the legislative process, and NAACOS will work to garner support for the legislation while focusing on advancing timely key provisions such as those related to revising the QP thresholds and fixing ACO benchmarks. Members are encouraged to email us at advocacy@naacos.com with any questions on how to support our advocacy efforts to advance this legislation.
HHS EXTENDS COVID-19 PHE On July 23, the Department of Health and Human Services announced it extended the COVID-19 Public Health Emergency (PHE) by 90 days. The PHE should run through late October. NAACOS had advocated for this extension and is pleased to see this important announcement, which will be critical in helping to protect ACOs from losses tied to the PHE. As a reminder, an April Interim Final Rule with Comment (IFC) activated the MSSP extreme and uncontrollable circumstances policy for the COVID-19 pandemic which will mitigate the losses owed by ACOs during the length of the PHE. Subsequently, a May Interim Final Rule with Comment (IFC) provided additional support to ACOs during the COVID-19 pandemic by adjusting MSSP calculations by removing COVID-19 episode costs from all ACO financial expenditure calculations and benchmark calculations during the duration of the PHE. The Next Generation (Next Gen) Model also made similar, optional contractual changes for Next Gen ACOs. These adjustments will only be made during the duration of the PHE; therefore, this announcement is critical for continuing to support ACOs during this challenging time. More information on these policies are available in our analysis of the May 8 IFC.
CMMI SMITH CONFIRMED TO OPEN FALL CONFERENCE Mark your calendars for the NAACOS Fall 2020 Conference on September 22 through October 2. We will build on the success of our recent virtual conference and apply several lessons learned. This unique opportunity will take place Tuesdays through Fridays, with up to 22 sessions and opportunities to interact with peers and vendors. As in the past, all of the content will be available to access for the following six months.
Join us September 22 as Brad Smith, CMMI director and senior advisor for value-based transformation, delivers the opening keynote. A successful healthcare entrepreneur with a proven history of improving care for some of our nation’s most vulnerable patients, he will share CMMI’s role in supporting health care’s transformation to value along with details on new opportunities for ACOs and other population-health focused models.
Register before August 7 at a discount of $100 per person! Registration is open to all individuals, regardless of membership status.
New Feature: Virtual Exhibit Hall The Fall 2020 Conference will feature a virtual exhibit hall where attendees will be able to meet with exhibitors online! The virtual exhibit hall is complementary to all business partners in good standing. All business partners must reserve a virtual space to be included. Features will include virtual meet-ups, virtual networking, product photos, raffles, live chat and MUCH more! Sponsorship packages are also available and designed to maximize this virtual format.
Packages available include:
$25K Level with a 30-minute live session on Tuesday or Wednesday of the virtual conference
$10K Level with a 12-minute recorded commercial played between sessions during the virtual conference
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COVID STIMULUS NEGOTIATIONS PICK UP On July 27, Senate Republicans released a series of COVID-19 relief bills. The package of bills provides an additional $25 billion for the HHS provider relief fund, makes adjustments to the repayment terms for Medicare’s advanced payment program, provides additional time for telehealth flexibilities, adjusts small business loan programs, extends unemployment benefits, and provides liability protections for employers and health care providers. The package of bills was crafted by the Senate Majority with input from the White House. These proposals are being viewed as a starting point for negotiations with Congressional leaders in the House. Negotiations are expected to continue for a number of days with leaders looking to reach agreement next week.
Section-by-section summaries of the relief package are available below.
EARLY 2021 DIRECT CONTRACTING PARTICIPATION CLARIFIED BY CMS With lingering questions about how MSSP and Next Gen ACOs can participate in Direct Contracting starting April 1, 2021, given their current ACO participation, the CMS Innovation Center answered that question in a recent announcement. CMS now says that given complexities of the program that ACOs will not be able to start 2021 in MSSP or Next Gen and then “switch” to Direct Contracting on April 1. This means current ACOs will not be participating in any accountable care model from January through March 2021, if they want to start in Direct Contracting in 2021.
For Next Gen ACOs, the deadline to decide between Direct Contracting and Next Gen is October 23, when final Direct Contracting participant lists are due for 2021. For MSSP ACOs, the deadline is September 22, when final MSSP participant lists are due. Especially since we don’t expect financial methodology papers to be released until September through November, NAACOS notes this is not the decision we wanted to hear since it puts ACOs in a bad position to make participation choices without all the information on Direct Contracting. Please share feedback at DirectContracting@naacos.com about your feelings on CMS’s announcement.
QUALITY PY 2020 MEASURE SCORING CHANGE On July 14, 2020, CMS announced for PY 2020, CMS is modifying the scoring of the CMS Web Interface measure, Screening for Depression and Follow-Up Plan (PREV-12). The modifications removed the Systematized Nomenclature of Medicine (SNOMED) codes that recognized the rescreening of a patient using an additional standardized depression screening tool as a means of meeting the performance criteria for implementing an appropriate follow-up plan to a patient with a positive depression screening. As a result, the measure no longer allows clinicians to meet the performance criteria of implementing a follow-up plan without providing an appropriate follow-up plan to the patient. The measure will therefore be made pay-for-reporting in 2020 MSSP ACOs and excluded from the MIPS scoring. CMS instructs ACOs to contact the Quality Payment Program (QPP) with any questions regarding this change at QPP@cms.hhs.gov or 1-866-288-8292.
QPP LOOKUP TOOL UPDATED TO INCLUDE FIRST SNAPSHOT 2020 On July 20, CMS updated the QPP Participation Status Tool, or Lookup Tool, based on the first snapshot of data for 2020 for APM entities. This snapshot will include dates from Medicare Part B claims with dates of service between January 1, 2020, and March 31, 2020. As a reminder, QP status can be viewed at the individual National Provider Identifier (NPI) level or at the APM entity level. More information is available in the CMS QPP Access User Guide. For more information on how to obtain QP status and how CMS calculations are conducted, visit our MACRA webpage.
KEY DEADLINES FOR 2021 MSSP PARTICIPATION CMS’s initial change request submission period for 2021 is now closed, and ACOs can expect to receive the first request for information on August 11. ACOs still have time to “freeze” participation on the Basic Track’s glidepath, elect an additional performance year if your contract is set to expire at the end of 2020, add or delete ACO participants, apply for a Skilled Nursing Facility Three-Day Stay Waiver, choose assignment methodology, and select a minimum savings rate (MSR)/minimum loss rate (MLR) if moving to a risk-based track. Corrections to deficiencies identified by CMS are due by August 24. More information can be found on CMS’s website on MSSP application.
OCR ISSUES GUIDANCE ON CIVIL RIGHTS PROTECTION DURING COVID-19 The Office for Civil Rights (OCR) has issued a bulletin detailing guidance to ensure recipients of federal financial assistance during the COVID-19 PHE understand the applicable federal civil rights laws and regulations that prohibit discrimination on the basis of race, color, national origin, disability, age and sex. Among other things, the guidelines recommend those receiving federal funding ensure they have policies in place preventing and addressing discrimination and harassment. The guidelines also recommend existing policies are reviewed to ensure care related to COVID-19 does not exclude individuals on the basis of race, color or national origin. The Centers for Disease Control and Prevention (CDC) has reported that current data suggest a disproportionate burden of illness and death among racial and ethnic minority groups and as a result, CDC has appointed a COVID-19 Chief Health Equity Officer and taken steps to augment nationwide data collection to track cases, hospitalizations and deaths by race and ethnicity. More information is available.
NEW ROADMAP ADDRESSES LOW-VALUE CARE The Going Below the Surface (GBTS) Forum is launching The Roadmap for Addressing Low-Value Care. This step-by-step guide was outlined by a group of experts and academics convened by the GBTS Forum to identify critical considerations for ensuring effective health care resources. Using their real-world experience and academic expertise, this task force compiled an array of considerations and illustrative examples stemming from peer-reviewed sources. The Roadmap focuses efforts on prorating high-value care and eliminating wasteful spending to give funds back to the system and ensure our resources are effective during this unprecedented time.
