Medicare Shared Savings Program – 2020

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Medicare Shared Savings Program
2020
CMS is proposing changes to the Medicare Shared
Savings Program (Shared Savings Program) quality
performance standard and quality reporting
requirements for performance years beginning on
January 1, 2021, to align with Meaningful
Measures, reduce reporting burden and specialize
in patient outcomes. For the performance year
2020, CMS is proposing to share automatic full
credit for CAHPS patient experience of care
surveys under the acute and Uncontrollable
Circumstances Policy and seeking to discuss
modifications to the policy for determining
quality performance scores for ACOs impacted by
extreme and uncontrollable circumstances for the
performance year 2020. For more information,
please reference the QPP Fact Sheet 2021 Quality
Payment Program Proposed Rule Overview Fact
Sheet. CMS is additionally proposing to
incorporate new evaluation and management and
care management CPT and HCPCS codes, including
new telehealth codes, within the methodology,
need to assign beneficiaries to ACOs, exclude
additional codes when delivered in skilled
nursing facilities and inpatient care settings,
codify in regulation the adjustment thats made
to an ACOs historical benchmark to reflect any
regulatory changes to the beneficiary assignment
methodology, and proposing to lower required
repayment mechanism amounts for surely renewing
ACOs. As part of CMSs efforts to scale back
burden related to with repayment mechanisms, CMS
is proposing to determine a policy that might
allow renewing ACOs that wish to continue the use
of their existing repayment mechanism to decrease
their repayment mechanism amount if a good amount
isnt needed to support their new agreement
period.
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Medicare Shared Savings Program
2020

• This proposed approach includes a revised
  methodology for calculation of repayment
  mechanism amounts beginning with the application
  cycle for an agreement period starting on January
  1, 2022, and in subsequent years, also as a
  one-time opportunity for eligible ACOs that
  renewed their agreement periods beginning on July
  1, 2019, or January 1, 2020, to elect to decrease
  the amount of their repayment mechanisms.
• In response to new telehealth code proposals and
  to update the definition of primary care services
  to reflect services for cognitive impairment and
  chronic care management, CMS is proposing to
  include new evaluation and management and care
  management CPT and HCPCS codes in the methodology
  used to assign beneficiaries to ACOs.
• In addition, CMS is proposing to exclude certain
  services furnished in skilled nursing facilities
  from the assignment methodology when provided by
  clinicians in FQHCs and RHCs and to modify the
  definition of primary care services to exclude
  advance care planning CPT code 99497 and the
  add-on code 99498 when billed in an inpatient
  care setting. CMS is also codifying in
  regulations our policy of adjusting an ACOs
  historical benchmark to reflect any regulatory
  changes to the beneficiary assignment
  methodology.
• For more information, refer to
• PFS Fact Sheet Proposed Policy, Payment, and
  Quality Provisions Changes to the Medicare
  Physician Fee Schedule for Calendar Year 2021

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Medicare Shared Savings Program
2020

• QPP Fact Sheet 2021 Quality Payment Program
  Proposed Rule Overview Fact Sheet
• Press Release Trump Administration Proposes to
  Expand Telehealth Benefits Permanently for
  Medicare Beneficiaries Beyond the COVID-19 Public
  Health Emergency and Advances Access to Care in
  Rural Areas
• CY 2021 Physician Fee Schedule Notice of Proposed
  Rule Making