The CMS has alerted accountable care organizations participating in the Medicare Shared Savings Program that they have more time to comply with a new requirement to notify assigned beneficiaries that their physician participates in the program.
The new requirement, which was originally slated to go into effect July 1, has been delayed to Oct. 1 for ACOs that started the revised program on July 1. ACOs that started their performance year in January 2019 will have until Jan. 1, 2020, to meet the notification mandate.
In a letter to CMS Administrator Seema Verma in late June, the National Association of ACOs claimed the CMS hadn't yet provided ACOs with any information about how to comply with the policy. The CMS said in the final rule outlining the new requirement that it would publish materials ACOs must use to notify patients "to mitigate the burden of this additional notification."
In an email, a CMS spokesman didn't offer details about why the agency didn't provide materials ACOs needed prior to the July 1 effective date. Instead, the spokesman said the agency "understands" that ACOs may need more time to implement the new requirements.
Clif Gaus, CEO of the National Association of ACOs, said the requirement delay for some ACOs is "too little too late." Some ACOs went ahead and mailed notification letters before the CMS offered guidance because they were concerned about potential repercussions from the agency.
In the early years of the Medicare ACO program, the CMS required ACOs to notify beneficiaries when their physician was part of the program through written notices at the point of care. But the policy was rescinded due to ACOs' complaints that it was too administratively burdensome and complex. As a replacement, ACOs were required to have posters in their offices explaining their participation and offer written notices to beneficiaries upon request.
The CMS reinstated the notification requirement in December as part of the Pathways to Success final rule. The agency said it would "empower beneficiary choice and further program transparency." Notification of physician participation in the program enables beneficiaries to opt out of allowing ACOs to use their medical data.
Under the new requirements, ACOs must notify prospectively assigned beneficiaries of their participation prior to or at the patient's first primary-care visit in the beginning of each performance year. ACOs have to notify patients through individual written notices using language provided by the CMS. The requirement to have posters displayed in the offices remained.
While ACOs can offer the written notices during the first visit of the performance year, Gaus said ACOs will likely end up mailing the notices out of fear they won't be in compliance with the requirement because patients may fail to attend appointments. Gaus said ACOs are concerned that the mailed letters will be confusing to patients and will be costly to mail.
"Also, remember that the average ACO has 20 to 30 different medical groups … so just tracking who has or has not been notified is a challenge," Gaus added in an email.
