August 11, 2021

Center for Medicare and Medicaid Innovation Releases 2020 Report to Congress

The Centers for Medicare and Medicaid Services (CMS) published the Center for Medicare and Medicaid Innovation (CMMI) 2020 Report to Congress (RTC) Aug. 4. CMMI is required by statue to report its activities to Congress at least every other year. The 2020 RTC covers CMMI activities October 2018–September 2020.

During the two-year period, CMMI proposed, announced or tested rulemaking for 38 payment models that serve about 28 million beneficiaries and involve more than 528,000 healthcare providers. However, internal review shows that only five models have produced statistically significant savings to Medicare, and there are issues with models, including: selection bias created by voluntary models; benchmark inaccuracy; quality measure misalignment and the need for greater data transparency.

While some models are congressionally mandated, others result from stakeholder suggestions, research, strategic priority and need. The secretary of the U.S. Department of Health and Human Services has the authority to expand models through scope and duration, but must determine that expansion will either decrease cost without compromising quality or improve quality without increasing cost. To date, three models have met the criteria to be expanded.

During the COVID-19 public health emergency, CMMI delayed the implementation of several new models and made changes to existing models to allow greater flexibility, including payment design, quality measures and reporting requirements.

If you have questions or would like more information, contact Samantha Porter.