CMS extends Next Gen ACO program + 4 other payment model updates

CMS extended its Next Generation ACO model through 2021 and made other updates to payment models in light of the COVID-19 pandemic.

Here are five changes that CMS outlined in a June 3 chart. Some have been previously announced.

1. Next Generation ACO

Financial methodology changes: CMS is reducing downside risk by lowering shared losses by proportion of months during the public health emergency. The agency is capping gross savings upside potential for Next Generation ACOs at 5 percent. Episodes of care that include treatment for COVID-19 will be removed, and a retrospective regional trend will be used for 2020, rather than a prospective methodology. Additionally, the 2020 financial guarantee requirement will be removed. 

Changes will be made to quality reporting requirements. CMS previously extended the web interface quality measure reporting deadline from March 31 to April 30, and is canceling the 2019 quality audit. It is also continuing to monitor the effect on 2020 quality reporting. 

The model will be extended through December 2021.

2. Direct Contracting Model

Financial methodology changes: CMS will adjust the model to reflect the program's new start date, which is April 1. That's three months later than expected.

For quality reporting, CMS said it will adjust quality benchmarks if necessary to reflect the changed start date. 

CMS will also create an application cycle during 2021 for the second cohort to launch Jan. 1, 2022.

3. Bundled Payments for Care Improvement Advanced

Financial methodology changes: Participants have the option to eliminate upside and downside risk. This can be done by excluding clinical episodes from reconciliation for model year three, or 2020. BPCI-Advanced participants who want to stay in two-sided risk agreements can exclude certain clinical episodes from reconciliation with a COVID-19 diagnosis during the episode. 

No changes were made to the model's quality reporting and model timeline.

4. Comprehensive Care for Joint Replacement Model

Financial methodology changes: CMS is removing downside risk by capping actual episode payments at the target price for episodes with admission dates from Jan. 31 through the public health emergency period. The appeals timeline for performance years three and four will also be extended to 120 days.

No changes will be made for quality reporting. However, the model timeline will be extended. Performance year five will run through March 2021.

5. Oncology Care Model

Financial methodology changes: CMS is giving participants the option to elect to forgo upside and downside risk for performance periods affected by the public health emergency. Participants that remain in one- or two-sided risk for performance periods that are affected by the public health emergency will see COVID-19 episodes removed from reconciliation for the performance period. 

In terms of quality reporting, CMS is allowing the following to be optional for the affected performance periods: aggregate-level reporting of quality measures and beneficiary-level reporting of clinical and staging data. The agency is also removing the requirement for cost and resource use reporting and practices transformation plan reporting in July and August of this year.

The Oncology Care Model will be extended one year through June 2022. 

To see all the adjustments the CMS Innovation Center is making to its models because of COVID-19, click here.

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