Friday, June 5, 2020

CMS Creates Flexibilities for Certain CMMI Models to Mitigate COVID-19 Impact

On June 3, CMS released a table outlining the new flexibilities and adjustments to current and future Center for Medicare and Medicaid Innovation (CMMI) models. The model adjustments are categorized according to financial, quality and model timeline modifications. CMS used specific principles such as flexibilities currently offered in model design, minimizing reporting burden, maintaining financial incentives to promote quality outcomes and entice continued participation in value-based arrangements, leveraging COVID-19 flexibilities outlined in regulation and waivers, etc. to identify apposite flexibilities. Some of the notable flexibilities include:

  • The opportunity for BPCI-A participants to opt out of upside and downside risk by excluding Clinical Episodes from Reconciliation for Model Year 3 (2020), and for those that choose to continue in two-sided risk to remove episodes with a COVID-19 diagnosis from reconciliation. 
  • Model extension of CJR Year 5 until March 2021 along with removal of downside risk by capping actual episode payments at the target price for anchor hospitalizations with an admission date between January 31, 2020 through the termination of the PHE. 
  • Postponement of the start of the first performance period of Professional and Global Direct Contracting Model to April 1, 2021 and creation of a second cohort application cycle during 2021 for launch January 1, 2022. 

 The chart also includes previously adopted flexibilities to the MSSP and Next Gen ACO models.

Please email COVID19@ahca.org for additional questions, or visit ahcancal.org/coronavirus for more information.

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