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CMS makes changes to ACO program: 5 things to know

| Jun 12, 2020 | Health Care Investigations |

The United States Centers for Medicare and Medicaid Services (CMS) recently announced changes to its Next Generation Accountable Care Organization (ACO) program. CMS explains these changes are an attempt to continue sufficient financial incentives to encourage higher quality outcomes for organizations that participate in value based arrangements.

Another goal of these changes: to minimize the reporting burden. The COVID-19 pandemic has resulted in many stressors for hospital officials and care providers. The agency is hopeful these changes will help ease the strain that can result from use of their programs.

What are the changes?

The organization has extended the Next Generation ACO program through 2021. Additional changes include:

  • Lowering shared loss. The federal organization is lowering shared loss during the months that were impacted by the coronavirus pandemic.
  • Cap gross savings. It has also announced it will cap gross savings upside potential at 5%.
  • Removal of guarantee requirement. The agency is also removing the 2020 financial guarantee requirement.
  • Cancellation of audit. The agency is also cancelling its previous planned 2019 quality audit.
  • Monitoring impact throughout 2020. CMS has also stated it will continue to monitor the impact throughout the year — signaling the agency may be open to additional changes as needed.

Navigating these and any future changes to CMS systems can be complex. A failure to abide by their rules could result in allegations of wrongdoing and a potential investigation. Anyone subject to such an investigation is wise to seek legal counsel to advocate for their interests and better ensure a favorable outcome.

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