Earlier this Summer, the National Association of ACOs (NAACOS) sent a letter to Chiquita Brooks-LaSure, Administrator of the Centers for Medicare and Medicaid Services (CMS), asking for a time extension for the Medicare Shared Savings Program (MSSP) application date and deadlines.
The letter opens with congratulatory language to Brooks-LaSure, following her confirmation as CMS Administrator, while acknowledging that her “tenure comes at a critical time, dealing with issues from spending and costs to coverage and access.” Clif Gaus, Sc.D., President and CEO of NAACOS, then began to express “concern regarding abbreviated and narrow deadlines” for accountable care organizations (ACOs) to apply to participate in the MSSP for 2022 with CMS asking ACOs for critical information like lists of participant providers earlier in the calendar year than has historically been required. NAACOS is worried that such a change, coupled with narrow windows in which to submit documents like a Notice of Intent to Apply (NOIA), participation will suffer in a program that is already operating under declining participation.
The letter notes that ACOs have just one week to submit NOIAs, which are required to be eligible to apply later. In 2017, ACOs were given an entire month and in 2019, two weeks. Gaus also raised concern over the early August deadline to add ACO participants – a nearly six-week change from when the information was due in 2019.
Gaus believes that “[a]dditional time is needed to ensure ACOs may work with potential participant providers and work through scenarios in which adding providers might change participation options,” citing to an example such as adding practices that may cause an ACOs revenue status to change to “high” or “low,” which determines which level of risk on MSSP’s glidepath an ACO can enter. He further noted that “there is little reason to require such early deadlines this year.”
Gaus and NAACOS also made sure to note that there is precedent to this request and CMS’ subsequent extension – in 2017, CMS extended the application window by five business days from July 31 to August 4, and then subsequently extended the application process by an additional week.
In the letter, Gaus concluded by noting that President Biden inherits fewer ACOs than the Obama Administration left in 2017, and that “given the track record of success ACOs have in improving outcomes, bettering quality, and overall improving the value that traditional Medicare beneficiaries receive,” NAACOS is hoping that the trend will be reversed under the Biden Administration.
Gaus noted that to start 2021, 477 ACOs are participating in the MSSP, down from a high of 561 in 2018 and the lowest since 480 participated in 2017. Despite the decrease, in ACOs, the MSSP continued to produce greater savings every year and saw its best year yet in 2019, the most recent year for which data are available. Serving 11.2 million seniors in 2019, the MSSP saved Medicare $2.6 billion and $1.2 billion after accounting for shared savings bonuses and collecting shared loss payments.
Unfortunately, CMS did not amend the timeline, and the NOIA window closed on June 7, 2021, the first phase of the application had to be submitted by June 28, 2021, and the last opportunity to add ACO participants is August 3, 2021, at noon. The final opportunity to withdraw or delete ACO participants is September 10, 2021, at noon.