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"Pathways to Success" Proposed Rule Outlines Redesign of the ACO Program


On August 9, 2018, CMS issued a proposed rule that would set a new direction for the Medicare Shared Savings Program (MSSP). Referred to as "Pathways to Success," this proposed new direction for the Shared Savings Program would redesign the participation options available under the program to encourage Accountable Care Organizations (ACOs) to transition to two-sided models (in which they may share in savings and are accountable for repaying shared losses), increase savings for the Trust Funds and mitigate losses, reduce gaming opportunity and increase program integrity, and promote regulatory flexibility and free-market principles
In connection with the proposed program redesign, CMS does not intend to offer an application cycle during 2018 for new agreement periods that would start on January 1, 2019, and instead proposes to offer an application cycle for a one-time new agreement period start date of July 1, 2019. To avoid an interruption in their participation, if the proposed policies are finalized, ACOs with a participation agreement ending on December 31, 2018, would have an opportunity to extend their current agreement period for an additional 6-month performance year and may apply for a new agreement beginning on July 1, 2019.
This Fact Sheet summarizes the major proposed changes that are included in this proposed rule. CMS encourages all interested members of the public, including ACOs, providers, suppliers, and Medicare beneficiaries to submit comments. The 60-day comment period closes on October 16, 2018. Comments can be submitted here.
In addition to finding ACO and APM resources on the website, there is also state specific information from the CMS Innovation Center.