United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2018_register executive 2018-12-29 article Part II Rules and Regulations D09002ee1c7dce46d D09002ee1c7dce5db United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency Under the Medicare Shared Savings Program (Shared Savings Program), providers of services and suppliers that participate in an Accountable Care Organization (ACO) continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. The policies included in this final rule provide a new direction for the Shared Savings Program by establishing pathways to success through redesigning the participation options available under the program to encourage ACOs to transition to two-sided models (in which they may share in savings and are accountable for repaying shared losses). These policies are designed to increase savings for the Trust Funds and mitigate losses, reduce gaming opportunities, and promote regulatory flexibility and free-market principles. This final rule also provides new tools to support coordination of care across settings and strengthen beneficiary engagement; and ensure rigorous benchmarking. In this final rule, we also respond to public comments we received on the extreme and uncontrollable circumstances policies for the Shared Savings Program that were used to assess the quality and financial performance of ACOs that were subject to extreme and uncontrollable events, such as Hurricanes Harvey, Irma, and Maria, and the California wildfires, in performance year 2017, including the applicable quality data reporting period for performance year 2017. 83 FR 67816 https://www.govinfo.gov/app/details/FR-2018-12-31/2018-27981 2018-27981 fr31de18-9 4120-01-P CMS-1701-F2 and CMS-1702-F https://www.govinfo.gov/app/details/FR-2018-12-31/2018-27981 https://www.govinfo.gov/content/pkg/FR-2018-12-31/html/2018-27981.htm https://www.govinfo.gov/content/pkg/FR-2018-12-31/pdf/2018-27981.pdf Administrative Practice and Procedure Health Facilities Health Professions Medicare Reporting and Recordkeeping Requirements 267 p. 67816 68082 83 FR 67816 Title 42 Part 425 42 CFR Part 425 Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations-Pathways to Success and Extreme and Uncontrollable Circumstances Policies for Performance Year 2017; Federal Register Vol. 83, Issue RULE 2018-27981 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2019-02-14 CMS-1701-F2 and CMS-1702-F 4120-01-P 2018-27981 Final rules.

Under the Medicare Shared Savings Program (Shared Savings Program), providers of services and suppliers that participate in an Accountable Care Organization (ACO) continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. The policies included in this final rule provide a new direction for the Shared Savings Program by establishing pathways to success through redesigning the participation options available under the program to encourage ACOs to transition to two-sided models (in which they may share in savings and are accountable for repaying shared losses). These policies are designed to increase savings for the Trust Funds and mitigate losses, reduce gaming opportunities, and promote regulatory flexibility and free-market principles. This final rule also provides new tools to support coordination of care across settings and strengthen beneficiary engagement; and ensure rigorous benchmarking. In this final rule, we also respond to public comments we received on the extreme and uncontrollable circumstances policies for the Shared Savings Program that were used to assess the quality and financial performance of ACOs that were subject to extreme and uncontrollable events, such as Hurricanes Harvey, Irma, and Maria, and the California wildfires, in performance year 2017, including the applicable quality data reporting period for performance year 2017.

Effective Date: This rule is effective February 14, 2019. Elizabeth November, (410) 786-8084 or via email at aco@cms.hhs.gov. Administrative Practice and Procedure Health Facilities Health Professions Medicare Reporting and Recordkeeping Requirements Medicare Program: Medicare Shared Savings Program; Accountable Care Organizations Pathways to Success and Extreme and Uncontrollable Circumstances Policies for Performance Year 2017 , aco@cms.hhs.gov SharedSavingsProgram@cms.hhs.gov Data.CMS.gov http://www.sba.gov/content/small-business-size-standards https://catalyst.nejm.org/aco-spillover-effects-opportunity-not-missed/ https://data.cms.gov https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Saving/Performance-Year-2018-Medicare-Shared-Savings-Prog/28n4-k8qs/data https://doi.org/10.1177/1077558717727834 https://innovation.cms.gov/Files/Migrated-Medicare-Demonstration-x/PGP_TD_Fact_Sheet.pdf https://innovation.cms.gov/Files/reports/nextgenaco-firstannrpt.pdf https://innovation.cms.gov/Files/x/nextgenaco-telehealthwaiver.pdf https://innovation.cms.gov/initiatives/ACO-Investment-Model/ https://innovation.cms.gov/initiatives/Advance-Payment-ACO-Model/ https://innovation.cms.gov/initiatives/Pioneer-aco-model/ https://oig.hhs.gov/FRAUD/REPORT-FRAUD/INDEX.ASP https://www.bls.gov/oes/current/oes_nat.htm https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/EPRO-Home.html https://www.cms.gov/About-CMS/Components/CPI/CPIReportingFraud.html https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/CY_2018_MA_Enrollment_and_Disenrollment_Guidance_6-15-17.pdf https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/index.html https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/Downloads/2019-Pre-Participation-Waiver-Guidance.pdf https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/Fraud-and-Abuse-Waivers.html https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/FinalPartCMarketingGuidelines.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/PPS_Exc_Cancer_Hospasp.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/ https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/2018-reporting-year-narrative-specifications.pdf https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/ACO-Participant-List-Agreement.pdf https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/MSSP-Reference-Table.pdf https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/New-Accountable-Care-Organization-Model-Opportunity-Fact-Sheet.pdf https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/Repayment-Mechanism-Guidance.pdf https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/SSP-2018-Fast-Facts.pdf https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/track-1plus-model-par-agreement.pdf https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/vol-alignment-bene-fact-sheet.pdf https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/program-guidance-and-specifications.html https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.html https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Interim-Final-Rule-with-Comment-fact-sheet.pdf https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-01-18.html https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c13.pdf https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/SSPACO/index.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/SSPACO/SSP_Benchmark_Rebasing.html https://www.fiscal.treasury.gov/fsreports/ref/suretyBnd/c570_a-z.htm https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf https://www.medicare.gov/Pubs/pdf/11588-Accountable-Care-Organizations-FAQs.pdf https://www.naacos.com/assets/docs/pdf/Study_of_MSSP_Savings_2012-2015.pdf https://www.naacos.com/press-release-may-2-2018 https://www.regulations.gov https://www.regulations.gov/docketBrowser?rpp=25&so=DESC&sb=commentDueDate&po=0&dct=PS&D=CMS-2016-0060 MyMedicare.gov oig.hhs.gov qpp.cms.gov www.resdac.org Vol. 83, no. 249 Office of the Federal Register, National Archives and Records Administration 2018-12-31 continuing daily deposited born digital 415 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2018-12-31 P0b002ee19e4dee3d 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr31de18 https://www.govinfo.gov/app/details/FR-2018-12-31 https://www.govinfo.gov/content/pkg/FR-2018-12-31/pdf/FR-2018-12-31.pdf https://www.govinfo.gov/content/pkg/FR-2018-12-31/xml/FR-2018-12-31.xml fdlp 67677 68082 DGPO 2018-12-29 2024-05-31 FR-2018-12-31 machine generated eng FR FR-2018-12-31 83 249