NAACOS asks CMS to give ACOs more time to sign up for MSSP amid decline in participation

Accountable care organizations need more time to meet key deadlines to apply for the Medicare Shared Savings Program for 2022, an advocacy group warns.

The National Association of ACOs sent a letter to the Centers for Medicare & Medicaid Services Tuesday calls for additional flexibility in the application cycle for MSSP. The letter to newly confirmed CMS Administrator Chiquita Brooks-LaSure comes as the group is working to reverse a slide in ACO participation that started in the Trump administration.

“NAACOS fears that without additional flexibilities, participation will suffer in a program that is already operating under declining participation,” the letter said.

A major concern is that ACOs who want to participate in MSSP for the 2022 performance year have a shrinking turnaround time for application information.

“For example, ACOs have just a week to submit [Notice of Intent to Apply], which are required to be eligible to apply later,” the letter said. “ACOs were given a month in 2017 and two weeks in 2019.”

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Another issue is that the application window will close on June 29 but has previously closed in late July or later in the summer, the letter added.

“NAACOS is also concerned with the early August deadline to add ACO participants,” wrote NAACOS President and CEO Clif Gaus. “This comes nearly six weeks sooner than when this information was due in 2019.”

The group wants CMS to give ACOs another week to submit NOIAs and extend the application window into next month.

“There is little reason to require such early deadlines this year,” the letter said.

MSSP calls on ACOs to take on financial risk and repay Medicare if they do not meet quality or savings targets. However, ACOs get a share of any savings they generate.

The letter comes as NAACOS is hoping the Biden administration will make several changes to stem a slide in ACO participation.

This year there are 477 ACOs participating in MSSP compared to a high of 561 in 2018.

NAACOS has criticized the Trump-era program “Pathways to Success” which called for ACOs to take on financial risk at an earlier date compared to MSSP. The program also cut a share of the savings ACOs can achieve, another factor in chilling participation.

The call for more time also comes as CMS has taken steps to pause value-based care payment models as it completes a review of model performance.

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For instance, CMS pulled a controversial geographic direct contracting model that ties spending and quality benchmarks to an entire region’s health outcome.

The Center for Medicare & Medicaid Innovation, which oversees payment models, also is reviewing several models that have not gone into effect yet. The agency, for instance, pulled the seriously ill population component of the Primary Care First model.

CMMI Director Liz Fowler said in April that the Biden administration is still committed to value-based care, but wants to evaluate models that may have overlap and force providers to compete for benchmarks and savings.