On June 9, 2015, the Centers for Medicare and Medicaid Services (CMS) published a final rule in the Federal Register making changes to the Medicare Shared Savings Program for Accountable Care Organizations (ACOs). These changes were intended to encourage increased participation by hospitals, rural health centers, federally qualified health centers, physicians, and other eligible health care providers in the Shared Savings Program and incentivize ACOs to be willing to share in potential losses (in addition to potential savings) under the program.
Among other revisions made to accomplish these goals, CMS has modified the two original program “tracks” and added a third “track,” with each track having different risk models and program requirements. A selection of the key risk-sharing provisions that now pertain to each track is shown below.
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The changes to the performance-based risk options are good news for health care providers and others interested in the success of ACOs. The three tracks allow providers developing ACOs to enter the program at a level commensurate with their experience and risk tolerance, and the ability for ACOs to remain on Track 1 for an additional three-year term gives ACOs that are still adjusting to this new care-delivery model the chance to remain part of the program as their ACO-expertise continues to develop.
In addition to these changes to the performance-based risk options available to participating ACOs, CMS also finalized provisions related to resetting financial benchmarks, ACO access to beneficiary claims data, beneficiary assignment, establishing and maintaining participation agreements, governance and leadership, and other program requirements.