CMS extends ACO patient notification deadline to Oct. 1

billing statement from a doctor's office
CMS has extended a deadline for accountable care organizations to notify beneficiaries they are in an ACO. (9dream studio/Shutterstock)

The Trump administration extended a deadline to Oct. 1 for accountable care organizations to notify beneficiaries they are in an ACO.

The decision announced last week by the Centers for Medicare & Medicaid Services applies for ACOs whose performance years started on July 1 under the new “Pathways to Success” program. ACOs had complained to the agency that the requirement was confusing and had a short turnaround time.

CMS at first required an ACO to notify a beneficiary they were in one when the program started in 2014, but the agency scrapped the requirement due to the extra staff time and confusion the notices caused seniors.

However, CMS reinstituted the requirement when it set up “Pathways to Success,” an overhaul of the Medicare Shared Savings Program. Pathways requires an ACO to take on financial risk earlier compared to the MSSP.

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Pathways started on July 1, and CMS said that ACOs which started on that date had to ensure each beneficiary gets a notice before their first primary care visit since July 1. 

But the National Association of ACOs (NAACOS) told CMS in a letter in late June that the requirement was too burdensome.

“As of today, CMS has not yet issued any guidance to ACOs on these new requirements,” the letter dated June 25 said.

NAACOS suggested that CMS delay the notification requirement until Jan. 1, 2020.

“As you know, ACOs will need to provide the notification to beneficiaries again in 2020 and delaying the effective date of the requirement will be less confusing to patients who will receive the same notification just six months later,” the group said.

CMS eventually sent out form letters in the last week of June that ACOs could send to beneficiaries.

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But the agency reversed course in a newsletter to ACOs on Aug. 28 that was obtained by FierceHealthcare. CMS said it won’t penalize an ACO that fails to comply with the notification requirement before Oct. 1.

"ACOs should ensure that, by no later than Oct. 1, 2019, their ACO participants have posted updated signs in their facilities using the new poster template and in settings where beneficiaries receive primary care services, that the new standardized written notices are available upon request,” the newsletter said.

An ACO still also needs to provide notice to a beneficiary before their first primary care visit of the performance year that started on July 1, but CMS will not punish an ACO if that visit occurred before Oct. 1.

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NAACOS said in a statement Tuesday it was pleased with the delay, but CMS needs to go further.

“While we continue to feel that communicating to patients about their care and the work of ACOs is important, sending a form letter is not the best mechanism and causes more confusion among beneficiaries than benefit," the group said. "It should be permanently removed because of that."