CMS Issues Final Rule for Medicare Shared Savings Program

June 30, 2015 | By
Anthony Knapp

Anthony Knapp

This month, the Centers for Medicare and Medicaid Services (“CMS”) issued a final rule (the “Final Rule”) regarding an update to the Medicare Shared Savings Program (the “Program”). The Final Rule will seek to enhance primary care services, reduce administrative burdens, and provide flexibility in the Program in order to maintain and enhance participation in the Program.

The Program was created in part to encourage the formation of Accountable Care Organizations (“ACOs”), where health care providers and suppliers would work collectively to reduce costs while maintaining high quality care. Any savings accrued as a result of the increased efficiency would be shared by the participants of the ACO.

Early results show an increased quality of care for the 7 million beneficiaries collectively served by the ACOs, with more than 400 ACOs participating in the Program.  CMS Acting Administrator, Andy Slavitt, stated in a press release: “Accountable Care Organizations have shown early but exciting progress in improving quality of care, while providing more patient-centered care at a lower cost. The ACO rules today strengthen our ability to reward better care and lay the groundwork for more providers to become successful ACOs.”

The Final Rule encourages increased participation in the Program by implementing several beneficial changes, including, but not limited to:

  • Creating a new payment track which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;
  • Streamlining the data sharing between CMS and ACOs, by helping ACOs more easily access data on their patients in a secure way for quality improvement and care coordination that can drive critical improvements in beneficiaries’ care;
  • Establishing a waiver of the 3-day stay Skilled Nursing Facility rule for beneficiaries that are prospectively assigned to ACOs under the new payment track;
  • Refining the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings; and
  • Allowing an applicant in the Program to participate in other shared savings programs (i.e., Pioneer ACOs may now apply into the Program).

It comes as no surprise that ACOs are heavily involved in the initiative to increase quality of care, reduce cost, and broaden access given the Administration’s goal of tying 30% of Medicare payments to alternative payment models by 2016.

This post is only a brief summary of the Final Rule that spans over 500 pages, for additional information see the links below.

For more information about the Program, click here.

To read the CMS press release, click here.

To read the entire Final Rule, click here.

Anthony Knapp is a guest contributor to Health Law Gurus™. He received his J.D. from Widener University School of Law, where he was editor of the Health Law Colloquium. He previously clerked in the Philadelphia Court of Common Pleas and worked as a Navigator to facilitate consumer access to health insurance in Delaware.