After much anticipation over the past few weeks, the Federal Register from Tuesday, June 9th contains the Final Rule proposing changes to the Medicare Shared Savings Program (MSSP) from the Centers for Medicare & Medicaid Services (CMS). The finalized changes to the MSSP provide additional flexibility and choice to Accountable Care Organizations (ACOs) currently participating in the program, but much uncertainty remains for future participants or those determining whether to continue their involvement in this initiative to control health care costs while improving quality for Medicare beneficiaries.
As expected, CMS established a “Track 3” model for MSSP ACOs with prospective beneficiary assignment that will not require ACOs that participated in the Track 1 one-sided risk model to transition to two-sided risk after the first three-year MSSP participation period. In contrast to the proposed rule, second-time Track 1 participants will have continued eligibility for 50 percent of the shared savings they earn during the subsequent MSSP agreement period. Other helpful changes that CMS finalized for ACOs participating in the MSSP include, but are not limited to:
- clarifying key MSSP-related definitions in section 42 C.F.R. § 425.20;
- revising the annual benchmark-setting methodology in 42 C.F.R. § 425.602 to equally weight each benchmark year and to account for shared savings in prior ACO agreement periods when resetting the historical benchmarks;
- creating multiple Minimum Savings Rate (MSR)/Minimum Loss Rate (MLR) options for Track 2 (two-sided risk) ACOs beginning their MSSP agreement periods in January 2016; and
- counting primary care services performed by Nurse Practitioners, Physician Assistants, and Clinical Nurse Specialists at the beginning of the beneficiary assignment process (without distinguishing whether such professionals are performing primary or specialty services).