This is the sixth post in Health Care Law Today’s series on the final rule. This post addresses additional program requirements and beneficiary protections.
The Medicare Shared Savings Program (“MSSP”) final rule published on June 4, 2015 finalized all proposed additional program requirements and beneficiary protections outlined in the December 2014 proposed rule. The specific additional public reporting obligations that ACOs must fulfill to participate in the MSSP that CMS finalized include:
Lawrence Limited Jersey Trevor College 16 Tigers Stitched Lawrence Limited Jersey Trevor College 16 Tigers Stitched Additionally, CMS finalized the requirement that ACOs must report the webpage address to CMS and apprise CMS of any changes to the website address. The final rule also makes an exception for information reported on a public reporting webpage in standardized format from the otherwise required CMS review and approval of marketing materials.
With the finalization of these proposed changes to the MSSP requirements, CMS is allowed to publicly report ACO-specific information, including any of the information outlined above that the ACO is required to publicly report as necessary to support program goals and transparency. This additional transparency should provide better information to the public concerning an ACO and its effectiveness.
Terminating Program Participation
CMS also adopted the proposals related to how program participation may be terminated. In addition to existing grounds on which CMS may terminate ACO program participation, CMS added the following two grounds:
Lawrence Limited Jersey Trevor College 16 Tigers Stitched Under the final rule, an ACO whose participation agreement is terminated prior to its expiration, either voluntarily or by CMS, must implement the following close-out procedures in a form, manner and deadline specified by CMS:
CMS has also adopted the proposed qualifications for when an ACO may still qualify for shared savings for the performance year during which a voluntary termination becomes effective. These conditions include:
With respect to voluntary terminations, CMS finalized the requirement that in order to be eligible for shared savings for the prior performance year, the ACO must provide notice termination to CMS that specifies that its termination effective date is December 31 and obtain approval from CMS.
Reconsideration Review Process
CMS also finalized its proposal to permit only on-the-record reviews of reconsideration requests to achieve its goal of greater transparency. As proposed and finalized, the reconsideration review process allows the ACO and CMS to submit one brief each in support of its position, and based on comments received, CMS had added a provision for the submission of additional briefs or evidence at the sole discretion of the reconsideration official.
Quality Performance Standards
All proposed requirements in relation to quality performance standards were adopted with some minor modification. The changes involved only technical changes to ensure that the ACO report quality measures accurately, completely and timely and in a manner consistent with other standards in the rule.
The final version of additional program requirements and beneficiary protections have been adopted exactly as they were proposed. Other than the additional briefs or evidence that may be submitted at the sole discretion of a reconsideration official with respect to the reconsideration review process, the proposed version of the additional program requirements and beneficiary protections sections has been adopted as is. ACOs should take these final requirements into consideration when forming or voluntarily terminating an ACO.