Monday Morning Rounds with CMS

ICYMI, here is recent communication from CMS.

CMS Releases 2021 Final Rule for the Quality Payment Program – CMS published the final policies for the 2021 performance year of the Quality Payment Program (QPP) via the Medicare Physician Fee Schedule (PFS) Final Rule.

Reminder: Upcoming MIPS Important Dates and Deadlines
CMS would like to remind clinicians of important upcoming Merit-based Incentive Payment System (MIPS) dates and deadlines:

  • December 312020 Promoting Interoperability Hardship Exception Application period closes. Clinicians, groups, and virtual groups who believe they are eligible for this exception may apply, and if approved, will qualify for a re-weighting of the MIPS Promoting Interoperability performance category. CMS will notify applicants via email whether their requests are approved or denied. If approved, the exception will also be added to the QPP Participation Status Tool (note: may not appear in the tool until the submission window opens in 2021).
  • December 31 – 2021 virtual group election period closes. Solo practitioners and groups with 10 or fewer clinicians (including at least one MIPS eligible clinician) who want to participate in MIPS as a virtual group for the 2021 performance year must submit their election to CMS.
  • January 4, 2021 – 2020 MIPS performance year data submission window opens.
  • February 1, 20212020 Extreme and Uncontrollable Circumstances Application period closes. Clinicians, groups, and virtual groups who believe they are eligible for this exception may apply, and if approved, will qualify for a re-weighting of one or more MIPS performance categories. CMS will notify applicants via email whether their requests are approved or denied. If approved, the exception will be added to the QPP Participation Status Tool.
    • New: CMS has finalized that for the 2020 performance year, Alternative Payment Model (APM) Entities may submit Extreme and Uncontrollable Circumstances applications as a result of COVID-19. For more information about the impact of COVID-19 on Quality Payment Program participation, see the Quality Payment Program COVID-19 Response webpage.
  • March 1, 2021 – Deadline for CMS to receive 2020 claims for the Quality performance category. Claims must be received by CMS within 60 days of the end of the performance period. Deadline dates vary to submit claims to the MACs. Check with the MACs for more specific instructions.
  • March 31, 2021 – 2020 MIPS performance year data submission window closes.

CMS will be hosting a virtual Town Hall meeting on January 7th to share updates on the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) policy considerations. The event will also be an opportunity for stakeholders to provide feedback on MVP considerations for future implementation.

To further support clinicians during the COVID-19 public health emergency, CMS is extending the 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception application deadline to February 1, 2021. For the 2020 performance year, CMS will be using our Extreme and Uncontrollable Circumstances policy to allow MIPS eligible clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories to 0% due to the current COVID-19 public health emergency.

CMS Announces New Model to Advance Regional Value-Based Care in Medicare – CMS announced a new and transformative voluntary payment model that builds on CMS’ focus to deliver Medicare beneficiaries value through better care and improved quality. The Geographic Direct Contracting Model (the Model) will test an approach to improving health outcomes and reducing the cost of care for Medicare beneficiaries in multiple regions and communities across the country. Through the model, participants will take responsibility for beneficiaries’ health outcomes, giving participants a direct incentive to improve care across entire geographic regions.

In the 2021 Medicare Physician Fee Schedule (PFS) Final Rule, CMS has finalized its previous proposal to allow Alternative Payment Model (APM) Entities to submit an application to reweight Merit-based Incentive Payment System (MIPS) performance categories as a result of extreme and uncontrollable circumstances. In addition, CMS has extended the application deadline to February 1, 2021.

CQMC Releases Additional Core Measure Sets Aimed at Improving Transition to Value-Based Care – As the nation’s health care system transforms from one that pays for volume to one that pays for value, there is a growing need for useful performance measures to help assess the quality of care being delivered by physicians in a value-based payment (VBP) arrangements. The Core Quality Measures Collaborative (CQMC) released four revised core measure sets as well as two new core sets tailored to specific specialties and designed to improve patient outcomes, reduce the burden on health care providers, and give consumers and payer information on which to assess physician performance.

CMS has added new performance information to the Doctors & Clinicians section of Medicare Care Compare and in the Provider Data Catalog (PDC), the successor websites to Physician Compare and the Physician Compare Downloadable Database. Medicare patients and caregivers can use the Care Compare website to search for and compare doctors, clinicians and groups who are enrolled in Medicare. Publicly reporting 2018 Quality Payment Program performance helps empower patients to select and access the right care from the right provider.

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From CMS Innovation Center

The Centers for Medicare & Medicaid Services Innovation Center, also known as “CMMI,” develops and tests new healthcare payment and service delivery models.

Announced: Comprehensive ESRD Care Model
The Comprehensive ESRD Care (CEC) Model is designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD). Through the CEC Model, CMS will partner with health care providers and suppliers to test the effectiveness of a new payment and service delivery model in providing beneficiaries with person-centered, high-quality care. The Model builds on Accountable Care Organization experience from the Pioneer ACO Model, Next Generation ACO Model, and the Medicare Shared Savings Program to test Accountable Care Organizations for ESRD beneficiaries.

Announced: Comprehensive Primary Care Plus
Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. CPC+ includes two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States (U.S.).

Announced: Accountable Health Communities Model
The Accountable Health Communities Model addresses a critical gap between clinical care and community services in the current health care delivery system by testing whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries’ through screening, referral, and community navigation services will impact health care costs and reduce health care utilization.

Announced: Direct Contracting Model Options
Update: The Center for Medicare and Medicaid Innovation (Innovation Center) is excited to announce that 51 Direct Contracting Entities (DCEs) are participating in the Implementation Period of the Direct Contracting Model for Global and Professional Options, which runs from October 1, 2020 through March 31, 2021. The Innovation Center has also accepted applicants seeking to begin participation in Performance Year 2021 (PY2021). Once participation in PY2021 has been finalized in April 2021, subject to the signing of the Participation Agreement, the Innovation Center will publish a list of all PY2021 participating DCEs (including DCEs continuing participation from the Implementation Period and DCEs beginning participation in PY2021).