Newsletter for Members
and Partners
March 26, 2020
Table of Contents
Webinar Today: New Telehealth Flexibilities
NAACOS Persists During Pandemic
COVID-19 Stimulus Bill Passes with NAACOS-Supported Data and Telehealth Changes
NAACOS-Led Letters to Congress and CMS Seek Relief for ACOs from COVID-19
NAACOS Secures Delay of ACO 2019 Reporting Deadlines
New Resource: Summary of Final Interoperability Rules
NAACOS Letter Asks HHS to Consider ACOs in Health IT Work
Direct Contracting Application Portal Opens Next Week
CMS to Provide PY 2020 Preliminary/Adjusted Historical Benchmark Report Packages

WEBINAR TODAY: NEW TELEHEALTH FLEXIBILITIES

Register Now for the Thursday March 26, 2:00pm ET webinar!

Members and business partners will have on-demand access to this NAACOS webinar about how ACOs can use telehealth during the ongoing COVID-19 pandemic. Congress and CMS have been quick to offer providers tools like expanded use of telehealth to better handle COVID-19 and address the needs of the broader health system. This webinar gathers telehealth and ACO leaders to share the latest on the rapidly moving policy developments and how leaders are using telehealth in these times.

This webinar will be available on-demand on our website 24 hours after completion. Check out our other on-demand webinars!


NAACOS PERSISTS DURING PANDEMIC
The good news is, NAACOS has always been a virtual organization so we have lots of experience working from home, and the COVID-19 pandemic is not going to stop us. While our ACO members and business partners focus on serving patients and fighting on the front line of the pandemic, we are fighting to maintain and strengthen the ACO movement. Although we have had to postpone the Spring 2020 Conference for your safety and ours, we are responding with increased advocacy for policies and regulations that support the ACO community and address the challenges of the coronavirus. We are also developing new webinars and online resources related to the impact of the coronavirus as well as other critical issues for ACOs. As you will read in our other articles below, our staff is fighting this pandemic and working for ACOs via phone, email, and web convening. We will have more details on the rescheduled conference soon, and in the meantime, we appreciate your continued collaboration and support of our work. If you have questions about anything, contact us at [email protected] or 202-640-1985.

COVID-19 STIMULUS BILL PASSES WITH NAACOS SUPPORTED DATA & TELEHEALTH CHANGES
On Wednesday night, the U.S. Senate passed a third economic stimulus package, the Coronavirus Aid, Relief and Economic Security (CARES) Act, by a unanimous vote of 96-0. The stimulus package includes over $2 trillion in spending and tax relief to assist the American public and healthcare providers responding to the COVID-19 pandemic. The CARES Act allows for additional care coordination by modernizing regulations (42 CFR Part 2) to make it easier to share the medical records of people with substance use disorders, a change long – called for by NAACOS. The bill provides a further expansion of telehealth services, policies NAACOS has advocated for on Capitol Hill. The legislation also provides $100 billion in grants for hospitals and health providers, temporarily suspends Medicare’s 2 percent sequestration cuts, and increases Medicare payments for COVID-19 patient care.

A section-by-section summary of the CARES Act is available, and the final text is available.

The House has announced that it will vote on the CARES Act Friday morning. The vote is expected to be by “voice vote”, due to limited flight options, Members practicing self-quarantine, and several states mandating stay-at-home orders. President Trump has announced he will sign the bill into law as soon as possible after it’s passed by the House. House Speaker Nancy Pelosi (D-CA) reiterated throughout the day Wednesday that the House is planning further rounds of stimulus and recovery legislation to address COVID-19. This commitment from House leaders presents additional opportunities for NAACOS to continue working with our Congressional champions to ensure CMS waives the shared loss repayment for ACOs and other APMs and makes additional adjustments for ACOs in response to the COVID-19 public health emergency.


NAACOS-LED LETTERS TO CONGRESS AND CMS SEEK RELIEF FOR ACOS FROM COVID-19
Last week, NAACOS and nine other leading provider organizations asked Congress and the Trump administration to act quickly to ensure clinicians focused on value-based care are not inappropriately penalized for the extreme costs of handling the COVID-19 pandemic and can continue to focus their energy on patient care. In letters to House and Senate leaders, the organizations asked lawmakers to shield participants in ACOs and other value-based payment models from financial penalties because of costs incurred responding to the COVID-19 pandemic. The letters emphasize how ACOs are judged against their spending from previous years, which will likely be an inappropriate comparison for Performance Year (PY) 2020 expenditures with the expected spike resulting from the COVID-19 pandemic.

The letter to CMS made similar, but more detailed requests:
  • Hold clinicians harmless from performance-related penalties for 2020, particularly those in two-sided risk alternative payment models (APMs);
  • Make appropriate adjustments to spending targets, performance scores, patient attribution and risk adjustment;
  • Consider additional options to support APM participants, including financial support and reinsurance;
  • Hold clinicians harmless from quality assessments and reporting obligations for 2020; and
  • Delay program deadlines such as those related to APM applications and quality reporting.
NAACOS will keep members updated on changes as we continue our advocacy and education efforts to provide ACOs with relief from COVID-19. To stay up-to-date on COVID-19, visit our new dedicated web-page, including resources to assist ACOs during this challenging time.
Welcome New ACO Members
Best Care Collaborative
Fort Myers, FL

Integrated Medical Staff of Jackson, P.C.
Jackson, TN
NAACOS SECURES DELAY OF ACO 2019 REPORTING DEADLINES
CMS recently announced ACOs have until April 30, 2020, to report 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, and those that do not submit any MIPS data by this time will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year. This announcement comes after NAACOS and other organizations submitted a letter, described in the above article, including a request to delay the upcoming deadline for 2019 reporting. NAACOS also asked for relief around participation in and data reporting options for 2020, and in this new announcement CMS notes the agency is evaluating options for providing relief around participation and data submission for 2020.

NEW RESOURCE: SUMMARY OF FINAL INTEROPERABILITY RULES
NAACOS has summarized two important final rules that together aim to make it easier to share patients’ health records and data among healthcare providers, plans and patients and should help the work of ACOs. Importantly, the final rule from CMS will require hospitals to share electronic notifications of patients’ admission, discharge and transfer (ADT) from an inpatient facility, as well emergency department presentations, with patients established primary care providers. In a companion rule, HHS’s Office of the National Coordinator for Health IT (ONC) outlines exceptions from rules around “information blocking,” with the expectation that those in health care must share patient information with others unless one of eight exceptions in this final rule are met. The new NAACOS resource summarizes those policies and more. If you have feedback or comments on the final rules, please reach out by emailing [email protected].

NAACOS LETTER ASKS HHS TO CONSIDER ACOS IN HEALTH IT WORK
NAACOS recently submitted comments in response to HHS’s draft 2020–2025 Federal Health IT Strategic Plan. Led by the ONC, this plan is intended to guide federal health information technology (IT) activities. Providers operating in APMs have unique interests and needs in health IT that ONC should help address. If HHS’s goal is moving all Medicare payments into APMs by 2025, then it is imperative HHS listen to the needs of providers in ACOs and other value-based payment models. NAACOS asked ONC to reprioritize provider-to-provider data exchange, keep a focus on burden reduction, integrate social determinants and health data, advance work on population-level transfer of health data, and connect data across the care continuum.

DIRECT CONTRACTING APPLICATION PORTAL OPENS NEXT WEEK
The CMS Innovation Center will start fielding applications for Performance Year 1 of the Direct Contracting Model starting next week, March 31. The application period has been extended to May 29; it was scheduled to close on May 1. Given the ongoing response to the COVID-19 pandemic, NAACOS and others asked CMS to extend application timelines, and we are pleased that CMS listened. We also asked CMS to provide additional application opportunities such as an application cycle to start in Direct Contracting for the 2022 performance year.

The NAACOS Direct Contracting Taskforce is still going strong. If you have feedback on what we should be working on next or questions, reach out to [email protected]. Our listserv remains a good way to stay in touch with your peers who are also interested in the model. Sign up to be on the ListServ so you can start a discussion.


CMS TO PROVIDE PY 2020 PRELIMINARY/ADJUSTED HISTORICAL BENCHMARK REPORT PACKAGES
In the coming days CMS will provide MSSP ACOs with PY 2020 benchmark reports. The packages include an ACO’s PY 2020 Preliminary or Adjusted Historical Benchmark Report along with informational files for each of the ACO’s three benchmark years. The PY 2020 Preliminary Historical Benchmark Reports are for ACOs that entered into agreement periods beginning January 1, 2020, and the Adjusted Historical Benchmark Reports are for ACOs that modified their ACO participant lists or assignment methodologies for PY 2020. ACOs that began initial or subsequent agreement periods starting in 2020 should refer to this NAACOS resource for details on the MSSP benchmarking methodology, which was revised through CMS’s Pathways to Success final rule.