CMS on Thursday finalized a wide range of temporary Medicare and Medicaid changes in response to the COVID-10 pandemic, including some big wins for accountable care organizations.
State-approved Medicare providers can now order COVID-19 serology tests, and Medicare will pay providers to collect specimens for COVID-19 testing under the physician fee schedule and outpatient prospective payment system. Other changes include new exceptions for the hospital value-based purchasing program; delayed reporting requirements for post-acute care facilities; and a one-year delay of some requirements for the merit-based incentive payment system, or MIPS.
ACOs also earned important victories. Provider groups, including the American Hospital Association and the National Association of ACOs, asked Congress and the Trump administration last month "to shield participants in ACOs and other value-based payment models from financial penalties because of costs incurred responding to the COVID-19 pandemic," according to a NAACOS statement.
CMS heeded their calls for help in its interim final rule.
"COVID-19 ... has created a lack of predictability for many ACOs regarding the impact of expenditure and utilization changes on historical benchmarks and financial performance, created uncertainty around future program participation, and disrupted population health activities as clinicians, care coordinators, and financial and other resources are diverted to address immediate acute care needs," CMS said in the rule.
The agency made several changes that should help providers continue to participate in ACO models throughout the crisis, including allowing ACOs to carry over their current level of risk for an extra year.
"We're appreciative of the thoughtful ways CMS will modify the shared savings program during the public health emergency, especially by removing spending associated with COVID-19 patients from performance calculations," NAACOS said in a statement.
But providers in risk-based arrangements want additional relief, including "providing a one-time incentive to two-sided risk ACO entities and a MACRA bonuses to all clinicians in those ACOs," consultancy and group purchasing organization Premier Inc. said in a statement.
They're also asking for a 2021 application period for new ACOs.
We "hope CMS will be open to a partial 2021 performance year as the healthcare industry stabilizes," NAACOS said.