HealthLaw_stethoscope2The Trump administration is considering releasing a rule to ease the burden that small practices are facing in trying to comply with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), according to a recent report in The Hill.

By way of background, MACRA consolidates a number of existing reporting programs into a two-track system under which eligible clinicians will receive incentive reimbursement payments through either the Merit-Based Incentive Payment Systems (MIPS) or through certain alternative payment models (APMs). Under MIPS, eligible clinicians can receive incentive payment (or penalties) based on their reporting of various measures. (For a detailed discussion of MACRA and these reporting requirements, see our prior post.) Alternatively, clinicians can be reimbursed under the second track if they participate in an “Advanced APM,” which include certain accountable care organizations (ACOs) and patient-centered medical homes. Continue Reading Insiders Say New MACRA Rule Likely as Providers Look to Sec. Price to Ease Burden

Last week, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services released a report analyzing CMS’ readiness to implement major parts of the Medicare Access and CHIP Reauthorization Act  of 2015 (MACRA). The report provides an inside look at the steps CMS is taking to implement MACRA’s Quality Payment Program (QPP), which is an ambitious transformation of the way in which the federal government reimbursements health care providers. The report highlights two key vulnerabilities for the MACRA transition, a process that will hopefully be smoother than the troubled roll out of HealthCare.gov.

Continue Reading OIG Report Offers Glimpse into CMS Progress Towards MACRA Implementation

Most of the post-election discussion of the ACA has focused on how promises to repeal the law could impact the newly insured. But one priority area of the ACA that has received very little discussion is the federal government’s strategy to try to reign in health care costs by reducing volume and promoting quality.  Complicating the push to fully repeal the ACA is the fact that key elements of the ACA’s cost control strategy have found their way into the Medicare and CHIP Reauthorization Act (MACRA) passed by Congress in 2015.

MACRA was passed on a bipartisan, bicameral basis, creating a two-track system for Medicare provider reimbursement incentive payments. On one track is the more traditional fee-for-service reimbursement structure that will be subject to payment adjustments under a consolidated quality reporting system called the Merit-Based Incentive Payment System (MIPS). The second track, which entails greater incentive payments, addresses reimbursement for providers participating in alternative payment models (APMs) like accountable care organizations (ACOs) and other demonstration programs that have been created under CMS’s Center for Medicare & Medicaid Innovation (CMMI). We discussed these changes at length in our post last month.

While the sweeping Republican election victory portends extensive changes in many areas of health care, MACRA is not likely to see extensive changes–at least not directly.  Moving payment policy away from volume and towards quality was a goal for all the Congressional offices participating in the construction of MACRA. However, the implementation of MACRA could still face challenges if Congressional Republicans decide to repeal or constrain the ACA sections that give CMS the authority to operate the CMMI. Such a move would not be outside the realm of possibility; as we previously discussed, the CMMI has been a frequent target of criticism by Congressional Republicans. A full repeal of the ACA, or even limitations to the CMMI’s authority or budget, could cripple the government’s ability to operate the demonstration projects that are the cornerstones of MACRA.

Stakeholders need to engage with CMS moving forward, albeit a CMS under new management, to ensure that changes to the ACA do not have unintended consequences on MACRA’s implementation.  CMS may seek to streamline the numerous payment policies that have been proposed under the current Administration. Alternatively, it is possible that CMS will be active in creating its own versions of alternative payment models. One area of potential focus for further reform might be the so-called ACO Track 2 and 3 under the Medicare Shared Savings Program (MSSP), participation in which will now make providers eligible to receive APM incentive payments. Yet CMMI to date has struggled to find the right mix of payment reform, such as requiring two-sided risk, with payment incentives to show significant MSSP savings. In either case, the provider community will be closely watching the developments related to this already complex and daunting transition.

ML Strategies has posted its weekly Health Care Update. This publication provides timely information on implementation of the Affordable Care Act, Congressional initiatives affecting the health care industry, and federal and state health regulatory developments.

This week’s update focuses on developments around the 21st Century Cures Initiative and the expansion of the Pioneer ACO Program. The new draft legislation for the 21st Century Cures Initiative includes increased funding for the National Institutes of Health (NIH) and a new version of the Sensible Oversight for Technology which Advances Regulatory Efficiency (SOFTWARE) Act. The SOFTWARE Act would exempt health software products from FDA regulation except where FDA determines the product would pose a “significant risk to patient safety.” The draft legislation currently includes only placeholders on interoperability and telemedicine, key issues that lawmakers will need to work through. On the ACO front, The Pioneer ACO program is the first program to meet the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary’s approval for expansion.  HHS Secretary Sylvia Burwell formalized the administration’s intention to expand the program.

Past Health Care Updates are available here.

On December 8th, the Centers for Medicare & Medicaid Services published its proposal for long-awaited changes to the Medicare Shared Savings Program (MSSP).  Our colleagues Daria Niewenhous, Andrew Shin, Lauren Moldawer *, and Stephanie Willis have authored an Advisory that provides an in-depth analysis of key provisions of the proposed changes and how they may impact current and future MSSP accountable care organizations created under the authority of the Affordable Care Act.

The Advisory is a prelude to upcoming blog posts and publications on the proposed rule and evolving stakeholder reactions to its potential effects.

* Lauren Moldawer is a law clerk, acting under the guidance and supervision of Members of the D.C. office.

ML Strategies has posted its weekly Health Care Update. This publication provides timely information on implementation of the Affordable Care Act, Congressional initiatives affecting the health care industry, and federal and state health regulatory developments.

This past week, the Pioneer ACO quality and financial data was finally released with mixed results. The evolution of ACOs continues to be a leading issue for the Obama Administration heading into the end of the year. As policymakers continue to consider programmatic changes to the ACO programs, stakeholders from drug manufacturers to telehealth companies are all becoming heavily invested in the next iteration of the most high profile delivery system reform initiative created by the Affordable Care Act.

Click here to read this week’s full Health Care Update.

Written by: Stephanie D. Willis

The Centers for Medicare & Medicaid Services (CMS) is preparing to open its doors for another round of Accountable Care Organizations (ACOs) to participate in the Medicare Shared Savings Program (MSSP).  This year, CMS is requiring prospective ACOs to declare their intent to apply and to submit applications earlier than last year’s cycle, presumably to give prospective ACOs and CMS more lead time before the start of the three-year participation agreement periods.

Concurrently with this announcement, CMS has also updated its Frequently Asked Questions to address lingering questions about the requirement that individual and group providers offering a majority of primary care services to assigned Medicare beneficiaries and billing for those services using a single Tax Identification Number only join one ACO – a concept known as “exclusivity.”  CMS maintains that exclusivity is necessary to ensure that it properly attributes the care, and improvements thereto, that beneficiaries receive from ACO Participants, and that the ACO receives its duly earned proportion of shared savings. 

The MSSP has been through three application cycles since January 2012.  Over 200 MSSP ACOs are currently participating in the MSSP and providing services for as many as four million Medicare beneficiaries.  See our prior posts about the MSSP and related CMS initiatives here

The deadlines for the 2014 cycle of prospective ACOs are: 

  •          Notices of Intent accepted:       May 1, 2013 to May 31, 2013
  •          CMS User ID forms accepted: May 3, 2013 to June 6, 2013
  •          MSSP Applications accepted: July 1, 2013 to July 31, 2013
  •          Application Approval or Denial decisions: Fall 2013
  •          Reconsideration review deadline: Fall 2013

Prospective ACOs that have been looking forward to this upcoming cycle should confirm that they have the infrastructure and capacity to participate in the MSSP.  In addition, applicants should make final revisions to the participation and business associate agreements that they will require participating providers to sign and should develop and adopt the ACO policies with which the ACO Suppliers and Providers must comply. 

ML Strategies has posted its weekly Health Care Reform Update.  This publication provides timely and concise information on the Obama Administration’s FY 2013 federal budget totaling $3.8 trillion, implementation of the Affordable Care Act, and other state and federal administrative and legislative activities related to health care reform.