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Medicare Shared Savings Program (MSSP) Changes During COVID-19

May 5, 2020

Last week, The Centers for Medicare & Medicaid Services (CMS) issued another round of updates to assist providers during the COVID-19 public health emergency. Health Quality Innovators (HQI) compiled a summary of those updates relevant to physician practices for your convenience. Please note that this information is updated as of May 1, 2020.

CMS is making changes to the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs) to allow for greater financial stability and predictability during the COVID-19 pandemic.

Shared losses will be mitigated for all ACOs participating in a performance-based risk track, prorated based on the length of the Public Health Emergency (PHE). For example, at this time the PHE has covered 4 months (Jan-Apr 2020), meaning any shared losses an ACO incurs for performance year 2020 will be reduced by at least one-third. If the PHE extends to include the full year (Jan-Dec 2020), the ACO would not owe any shared losses.

CMS will skip the 2020 application cycle, forgoing a January 1, 2021 start date and will instead offer a voluntary one-year extension for those ACOs with agreement periods ending December 31, 2020.

ACOs that are required to increase their financial risk over the course of their current agreement period in the program have the option to maintain their current risk level for next year, instead of being automatically advanced to the next risk level. ACOs will be able to begin making these elections June 18, 2020. Additional guidance will be provided by CMS on the MSSP website.

To avoid rewarding or penalizing ACOs for having higher/lower COVID-19 spread in their communities, CMS will remove all payment amounts for episodes of care for treatment of COVID-19 from the determination of benchmark year and performance year expenditures.

More information on MSSP flexibilities during COVID-19 can be found here.

Please contact HQI with any questions or for assistance.

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