The Centers for Medicare & Medicaid Services (“CMS”) is now accepting applications from ACOs to participate in the Medicare Shared Savings Program (“MSSP” or “Program”) for the agreement period beginning January 1, 2024. The application process is split into two phases. Phase 1 of the application submission process opened May 18, 2023, and closes June 15, 2023. ACOs that submit information during the application’s Phase 1 submission period will submit additional information during the application’s Phase 2 submission period, which is currently scheduled to open on October 19, 2023, and will close on October 30, 2023. For ACOs new to the MSSP, recent changes to the Program designed to advance CMS’s broader strategy of growth, alignment and equity may make participation in the Program more attractive than in prior years. ACOs currently participating in the MSSP should also consider whether to submit a renewal or early renewal application to begin a new agreement period and take advantage of these changes.
Background
The MSSP is CMS’s largest ACO program, covering more than 11 million Medicare beneficiaries and including more than 500,000 health care providers. On November 1, 2022, CMS published a final rule implementing significant reforms to the MSSP impacting payment, beneficiary assignment, quality reporting, performance requirements and other aspects of the Program. These policies are intended to incentivize more Medicare providers and suppliers to join the MSSP and promote long-term participation in the Program, both of which are necessary for CMS to reach its stated goal of having 100% of traditional Medicare beneficiaries treated by a provider in a value-based care model by 2030. Key changes to the MSSP include the following:
- Advanced Investment Payments (“AIPs”): ACOs that are new to the MSSP and meet certain eligibility requirements will be able to receive AIPs, including a one-time fixed payment of $250,000 and quarterly payments for the first two years of the five-year agreement period. AIP eligibility is limited to new, low-revenue ACOs that are inexperienced with performance-based risk and are applying to participate in the Program under any level of the BASIC track’s glide path; re-entering and renewing ACOs (as defined under 42 CFR § 425.20) are not eligible to receive AIPs.
- Longer Glidepath to Risk: Starting January 1, 2024, certain ACOs inexperienced with performance-based risk (as defined under 42 CFR § 425.20) will be allowed to participate under a one-sided model (upside only) for up to seven years before being required to take on risk. This option is only available for those ACOs that are participating in their first agreement period under the BASIC track and are inexperienced with performance-based risk.
- Quality Performance and Reporting: CMS has implemented changes to how the agency establishes, updates and adjusts ACO benchmarks that are designed to reduce the impact of an ACO’s performance on its benchmark, address the impact of ACO market penetration on regional expenditures used to calculate ACO benchmarks and incentivize ACOs to serve high-risk and dual-eligible populations.
- Low-revenue ACOs: CMS finalized policies that allow for certain low-revenue ACOs (as defined under 42 CFR § 425.20) participating in the BASIC track to share in savings without first meeting the minimum savings rate to allow for investments in care redesign and quality improvement.
Application
During Phase 1, applicants will need to: (1) provide information on the ACO’s legal entity; (2) select the ACO’s program participation track, beneficiary assignment methodology, and minimum savings rate/minimum loss rate (if applicable); and (3) provide a complete list of the ACO’s participants. ACOs applying to participate in Levels C, D, or E of the BASIC track or the ENHANCED track (i.e., a two-sided model) must also submit information on the establishment of an adequate repayment mechanism to repay potential shared losses and, if applying to take advantage of the SNF 3-Day Rule Waiver, must submit their SNF 3-Day Rule Waiver application along with all proposed SNF affiliates and executed SNF Affiliate Agreements. Prior to Phase 2 of the application process, CMS plans to conduct two rounds of requests for information (RFI). During each round, ACOs will have the opportunity to respond to feedback from CMS and make any necessary corrections to their application.
Key Deadlines (Dates subject to change by CMS)
- May 18, 2023 – Phase 1 Application Period Opens
- June 15, 2023, at 12:00 p.m. ET – Phase 1 Application Period Closes
- July 11, 2023 – Phase 1 RFI-1 Begins
- August 1, 2023, at 12:00 p.m. ET – Phase 1 RFI-1 Closes
- August 22, 2023 – Phase 1 RFI-2 Begins
- September 5, 2023, at 12:00 p.m. ET – Phase 1 RFI-2 Closes
- October 19, 2023 – Phase 2 Submission Period Begins
- October 30, 2023, at 12:00 p.m. ET – Phase 2 Submission Period Closes
- November 9, 2023 – Phase 2 RFI Begins
- November 16, 2023, at 12:00 p.m. ET – Phase 2 RFI Closes
- December 5, 2023 – Final Application Dispositions
Practical Takeaways and Next Steps
- Phase 1 of the MSSP application submission process for the performance year beginning January 1, 2024, is now open.
- Certain changes to the Program may make participation more attractive and sustainable for ACOs, especially ACOs that are not currently comfortable taking on risks.
- Low-revenue ACOs may be able to take advantage of new policies to provide ACOs with up-front and ongoing capital to offset necessary investments in care delivery and quality.
- Initial applicants interested in participating in the MSSP beginning on January 1, 2024, as well as ACOs currently participating in the Program that decide to voluntarily terminate their current participation agreement with CMS to participate under a new agreement period beginning on January 1, 2024, should submit an application during Phase 1 of the application submission process.
- Phase 1 submissions must be submitted to CMS by 12:00 p.m. ET on June 15, 2023.
Hall Render will continue to monitor the MSSP application process as well as how recent changes to the Program will impact new ACOs and those ACOs currently participating in the MSSP. If you have any questions or would like additional information on this topic, please contact:
- Scott Strickland at (919) 447-4965 or sstrickland@hallrender.com;
- Laetitia Cheltenham at (919) 447-4968 or lcheltenham@hallrender.com;
- Brian Bauer at (248) 457-7821 or bbauer@hallrender.com;
- Megan Culp at (317) 429-3644 or mculp@hallrender.com; or
- Your regular Hall Render attorney.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot give legal advice outside of an attorney-client relationship.
