Although the sweeping changes to the Medicare Shared Savings Program (MSSP) were only finalized on December 21, 2018, just before the holiday season and government shutdown, aspiring and currently participating accountable care organizations (ACOs) must complete and digitally submit a non-binding Notice of Intent to Apply (NOIA) by noon, January 18, 2019, in order to participate in this cycle.

 The new final rule, referred to as “Pathways to Success,” basically scraps the existing MSSP tracks in favor of a BASIC track, with graduating levels of risk and reward, and an ENHANCED, highest level, track. All MSSP ACOs will have to assume financial risk for medical losses eventually. There are also numerous improvements in the program. The initial start date for the new programs has been moved to July 1, 2019, but failing to submit a NOIA by January 18 will bar an ACO from participating on that start date. ACOs currently participating in the MSSP may choose to complete the remainder of their agreement term or voluntarily terminate the agreement effective June 30, 2019 and apply for the July 1, 2019 start as an early renewal. However, ACOs must also submit a NOIA to be considered for the SNF 3-Day Rule waiver or to establish a Beneficiary Incentive Program.

The substance of the NOIA filing can be considerable. CMS strongly encourages including a draft participation agreement, for example. ACOs that select a level that contains two-sided risk should include a proposed repayment mechanism, though the mechanism can be modified at a later date. The NOIA must be electronically submitted using the new ACO Management System (ACO-MS). CMS has provided a fact sheet on the new rule, guidance on how to file the NOIA, expectations for the participation agreement, and the requirements for an approvable repayment mechanism.