June 10, 2020

CMMI Updates Payment Model Flexibilities in Response to COVID-19

The Center for Medicare and Medicaid Innovation (CMMI) released updated flexibilities to various payment model programs June 3 in response to the COVID-19 pandemic and public health emergency.

In her blog, Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), identified principles that were used to determine these changes. They included the desire of CMS to minimize risk to model participants, the Medicaid program and Medicare trust funds, and to minimize reporting burden.

Verma also noted CMMI is adjusting the implementation date of new models and deadlines for various existing models along with mitigating risk and modifying benchmarks where possible.

CMS released a chart describing the adjustments and flexibilities for each payment model. Of note, the Oncology Care Model (OCM) was extended for one year through June 2022. OCM participants will also have the option to elect to forgo upside and downside risk for performance periods affected by the public health emergency. OCM practices that remain in one- or two-sided risk for the performance periods affected by the public health emergency may remove COVID-19 episodes from reconciliation for those performance periods.

Bundled Payments for Care Improvement Advanced participants will have the option to eliminate upside and downside risk by excluding clinical episodes from reconciliation for Model Year 3 (2020). Model participants who choose to continue with the two-sided risk option can exclude certain clinical episodes from reconciliation with a COVID-19 diagnosis during the episode.

Additionally, Next Generation ACOs have been extended through December 2021.Participants in the Medicare ACO Track 1+ Model may voluntarily elect to extend their agreement for one year through December 2021.

CMS emphasized its commitment to its partners through ongoing efforts to advance value-based care. Moving forward, CMMI will reach out to model participants with specific model updates and processes for implementation.