On June 3, 2020, CMS announced changes to the Center for Medicare and Medicaid Innovation (CMMI) value-based care payment models. Notably, the changes include delaying the start date for new models that would test government payments to providers based on patients’ health and coordination of care. Deadlines for existing models are also postponed. In addition, CMS is delaying certain quality and financial reporting deadlines and or modifying benchmarks.
The changes focus on value-based care model adjustments related to financial methodologies, quality reporting, and model timelines. With respect to timeline changes, the Comprehensive ESRD Care (CEC) Model, Comprehensive Care for Joint Replacement (CJR) Model, Next Generation ACO Model and Oncology Care Model have been extended. In addition, the start date of the following models has been delayed: Direct Contracting Model (Global and Professional), Emergency Triage, Treat and Transport Model, Kidney Care Choices Model, Maternal Opioid Misuse Model and the Serious Illness Component of the Primary Care First Model. In addition to other flexibilities set forth in CMS’s chart, CMS is reducing or removing downside risk for 2020, or a portion of the year, for a few models, such as the CEC Model, the CJR Model and the Next Generation ACO Model. CMS is also granting participants in the Bundled Payments for Care Improvement Advanced Model the option to eliminate upside and downside risk by excluding clinical episodes from reconciliation for 2020.
The changes are intended to address challenges to value-based care models that have arisen from the pandemic. Namely, the new models cannot operate without provider participation and the existing models require providers to sign new contracts, but providers face clear obstacles to taking on new obligations and extending existing commitments during the pandemic. Therefore, the delay is intended to give providers additional time to transition to value-based care. In addition, CMS aims to give providers more time to focus on patient care, rather than paperwork, and to mitigate providers’ financial risk.
CMS will provide additional information to model participants regarding the changes. CMS indicated that the changes may involve amendments to participation agreements and other CMS model documents. CMS also noted that the implementation date of new models may be further delayed due to the pandemic and that further changes are possible. King & Spalding will continue tracking this issue.
CMS’s chart describing the specific COVID-19 flexibilities is available here. Details about additional model-specific flexibilities will be released on a rolling basis on CMS’s CMMI webpage here. Also available on CMMI’s website is a link to CMS Administrator Verma’s announcement of the various program changes in a Health Affairs blog.
