CMS RELEASES 2021 PROPOSED MPFS RULE On August 4, the Centers for Medicare & Medicaid Services (CMS) released the proposed 2021 Medicare Physician Fee Schedule (MPFS) Rule. The rule includes proposed updates to Medicare physician payment policies and updates to the Quality Payment Program (QPP) for 2021. Additionally, the rule includes significant proposed changes to how quality assessments for Medicare Shared Savings Program (MSSP) ACOs are conducted. Comments on these proposals will be accepted until October 5th. Key issues affecting ACOs in the regulation include CMS proposals to:
Replace the current quality assessment structure and measures by:
Removing the Web Interface reporting mechanism and current ACO quality assessment structure and instead replacing it with a new APM Performance Pathway (APP)
Reducing the quality measures an ACO must report from 23 to six measures (three clinical quality measures, the Consumer Assessment of Healthcare Provider and Systems [CAHPS] for the Merit-based Incentive Payment System [MIPS] survey measures and two admissions/readmissions measures specified for MIPS)
Removing the pay-for-reporting year provided to new ACOs
Providing automatic full credit for CAHPS for ACOs measures for 2020
Increasing the minimum attainment standard to the 40th percentile, using a MIPS benchmark, and removing the current domain-based scoring approach, and
Making changes to the way quality scores contribute to shared savings and loss calculations
Consider an alternative approach for quality scores in 2020 in response to COVID-19, providing ACOs with the higher of their 2019 or 2020 quality score, so long as the ACO fully reports quality in 2020
Revise the policy for determining the amount of repayment mechanism arrangements for certain renewing ACOs
Add new codes to the definition of primary care services used in the MSSP assignment methodology
Decrease the Medicare conversion factor to $32.26, which is a decrease of 10 percent from $36.09 finalized in the 2020 MPFS rule
Continue implementation of significantly revising payment and coding for office/outpatient Evaluation and Management (E/M) services
Replace the MIPS APM Scoring Standard with a new APP for MIPS APMs, including ACOs
Revise aspects of the Qualifying APM Participant (QP) calculation and add a targeted review process
Permanently add new services to those eligible for telehealth, including those for home health, while making other changes and clarifications to remote patient monitoring
Establish new payment rates for immunization administration services
The CMS factsheet is available. The QPP factsheet is available here. NAACOS staff are currently reviewing the regulation and will provide a more thorough analysis to members and will submit detailed comments to the agency. Should you have any questions, please email us at advocacy@naacos.com.
Don’t miss our webinar reviewing these critical changes for ACOs on August 19th from 2:00 – 3:00 pm ET. In this webinar, NAACOS staff will explain these key issues for ACOs and solicit audience feedback to help shape our advocacy in response to these proposals. Register today!
REGISTRATION NOW OPEN FOR FALL 2020 VIRTUAL CONFERENCE Mark your calendars for September 22 through October 2 for the NAACOS Fall 2020 Conference. We plan to build on the successes of our recent virtual June Conference and apply several lessons learned. This unique opportunity will take place Tuesdays through Fridays of those weeks, with more sessions as well as opportunities to interact with peers and vendors. Content will feature topics around operational tactics, clinical best practices, and updates on policy and regulation from ACO experts and CMS officials. The program will also feature strategies for adapting to the COVID pandemic. As in the past, all the content will be available to access for the following six months.
Register before August 14 at a discount of $100 per person! Registration is open to all individuals, regardless of membership status.
New This Conference: 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. Features will include virtual meet-ups, virtual networking, product photos, and MUCH more! Sponsorship packages are available and designed to maximize this virtual format.
Packages available include:
$25K Level with 30-minute live session on Tuesday or Wednesday of the virtual conference
$10K Level with 12-minute recorded commercial played between sessions during the virtual conference
READY TO GET ON-BOARD? Do you have new staff or leadership at your ACO? Perhaps you yourself are new to the organization? When was the last time your ACO had an on-boarding session with NAACOS? Chances are it’s been a while, and now would be a great time to get a refresh on all the great member resources available to you and your team. Learn about the educational and networking benefits to improve your ACO. Schedule your on-boarding session with NAACOS membership today. Simply send an email to membership@naacos.com with the subject line “On-board Me” and our team will be in contact to schedule the session at a time that works for you.
CMS RELEASES OPPS RULE On August 4, 2020, CMS released the Changes to Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems and Quality Reporting Programs; Addition of New Categories for Hospital Outpatient Department Prior Authorization Process [CMS-1736-P], which proposes payment updates and policy changes affecting Medicare’s OPPS and ASC Payment Systems for calendar year (CY) 2021, including:
Increasing OPPS and ASC payments by a factor of 2.6 percent, while also continuing to implement the statutory 2.0 percent reduction in payments for entities failing to meet quality reporting requirements;
Updating the methodology used to calculate the Overall Hospital Quality Star Ratings;
Updating and refining requirements under the Hospital Outpatient Quality Reporting (OQR) and Ambulatory Surgical Center Quality Reporting (ASCQR) Programs (CMS did not propose any measure additions or removals for either program);
Eliminating the inpatient only list over the course of three calendar years beginning with the removal of approximately 300 musculoskeletal-related services; and
Reducing payments for 340B drugs to a net payment rate of ASP minus 28.7 percent (previously ASP minus 22.5 percent).
Public comments must be submitted to CMS no later than 5:00 pm ET on October 5, 2020. CMS is also waiving the 60-day publication requirement for the Final Rule and replacing it with a 30-day notification citing that the agency may not complete rulemaking in accordance with typical rulemaking schedules. Get the CMS Fact Sheet.
CMS ANNOUNCES NEW RURAL-FOCUSED ACO TRACK This week, CMS announced a new ACO Transformation Track that will be run out of the CMS Innovation Center (CMMI). Twenty rural-focused ACOs will be selected to receive advanced payments as part of joining the MSSP. Those ACOs will receive a one-time, upfront payment of $200,000 plus $36 per beneficiary to participate in a five-year agreement period. Additionally, ACOs will be able to receive a prospective per beneficiary per month payment equal to a minimum of $8 for up to 24 months. A majority of its ACO providers and suppliers must be located within rural counties or census tracts. Requests for applications will be made available in the Spring of 2021. A fact sheet and press release are available.
NAACOS issued a supportive statement on the announcement and has been pushing for CMMI to restart the successful ACO Investment Model, on which today’s announcement is based. NAACOS will provide additional member education on this new opportunity.
COVID RELIEF NEGOTIATIONS AT IMPASSE Congressional leaders and White House officials were unable to reach agreement last week on a fifth COVID-19 relief package. With negotiations at an impasse, President Trump signed executive orders over the weekend to direct disaster funding to boost unemployment insurance, suspend the collection of payroll taxes for some workers, assist homeowners and renters, and defer student loan payments. The majority of lawmakers have departed Washington for the August district work period, but negotiations are possible throughout the month. Congressional leaders will give Senators and House Members 24 hours’ notice if votes are scheduled on a bipartisan relief package.
NEXT GENS RECEIVE 2019 SETTLEMENT AND 2020 Q2 BENCHMARK REPORTS Participants in the Next Generation (Next Gen) ACO Model should have received two important financial reports from CMMI. Next Gens should have received their 2019 Final Settlement Report and ACOs’ 2019 result. Results are embargoed until they’re made public by CMS. On Friday, August 14, ACOs will receive their Q2 Quarterly Benchmark Report, which runs from April through June. These reports should give ACOs an idea of the pandemic’s effect on spending and utilization. Within the next few days, Next Gens should also receive the optional 2020 Participation Agreement addressing the COVID-19 impacts, and they will have 30 days to review and execute.
2019 MIPS FEEDBACK NOW AVAILABLE CMS has now made 2019 MIPS scores available to ACOs via the QPP website. Under the MIPS APM Scoring Standard, the performance feedback will be based on the APM Entity score and is applicable to all MIPS eligible clinicians within the APM Entity. CMS notes some ACOs have been assigned two different 2019 MIPS final scores in their performance feedback if they participated in both performance periods (January 1, 2019, to June 30, 2019, and July 1, 2019, to December 31, 2019) during CY 2019. ACOs who have concerns with the accuracy of their scores can submit a targeted review until October 5. For more information about how to request a targeted review, refer to the 2019 Targeted Review User Guide or contact the QPP team at QPP@cms.hhs.gov or 1-866-288-8292.
KEY DATES FOR DIRECT CONTRACTING APPROACHING For Direct Contracting Entities (DCEs) that applied to participate in the Direct Contracting Model starting in its Implementation Period (IP), CMMI extended the deadline to update Participant and Preferred Provider lists and provided additional guidance for submitting updates. The new deadline is August 13 to account for technical difficulties with provider list management in the new 4innovation (4i) data platform. Participation Agreements for the IP are expected in early September.
NAACOS ENDORSES POST-COVID-19 TELEHEALTH ACT NAACOS joined dozens of other organizations in a letter supporting the recently introduced Protecting Access to Post-COVID-19 Telehealth Act of 2020. The bill removes geographic and originating site restrictions on where a patient must be located in order to receive telehealth visits, ensures patients can receive telehealth services in their homes, and allows federally qualified health centers and rural health centers to furnish telehealth, among other policies.
NAACOS continues to work with Congress and other organizations on a permanent solution to expanding telehealth. If ACOs are willing to share their experiences with using telehealth or have utilization data they are willing to share, please email advocacy@naacos.com because your stories and data would be helpful in our advocacy.
OTHER ANNUAL CMS PAYMENT RULES RELEASED In recent weeks, CMS published other payment rules that ACOs should be aware of. The prospective payment system for skilled nursing facilities (SNFs) projects aggregate Medicare payments to SNFs will increase by $750 million or 2.2 percent in 2021 compared to 2020. This increase is because of a 2.2 percent market basket increase and 0 percent productivity adjustment. The rule and factsheet are available.
Additionally, CMS estimates payments to inpatient psychiatric facilities will increase by 2.3 percent or $95 million in 2021. The rule and factsheet for that are also available. The prospective payment system for inpatient rehabilitation facilities will increase payment rates by 2.8 percent or $260 million relative to 2020, CMS estimates. This results from a 2.4 percent market basket increase and a 0.4 percent increase in aggregate payments from updates to outlier thresholds. The rule and factsheet are available.
Finally, hospice payments will increase by 2.4 percent or $540 million in 2021 compared to 2020. This increase in driven entirely by the 2.4 percent increase in market basket. Hospices that fail to meet quality reporting requirements receive a 2-percentage point reduction to the annual market basket percentage increase for the year. The rule and factsheet are available.
NEXT STEPS ON 2021 CHANGE REQUEST FOR MSSP MSSP ACOs should have received from CMS the first request for information in the performance year (PY) 2021 change request cycle. Responses are due by Monday, August 24, at 12:00 pm ET. 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 SNF Three-Day Waiver, choose assignment methodology, and select a minimum savings rate (MSR)/minimum loss rate (MLR) if moving to a risk-based track. The final opportunity to make these elections is during the second request for information response period, which ends September 22. More information can be found on CMS’s website on MSSP application.
