Society Comments on CMS ACO Proposed Rule

October 18, 2018
Health Policy

This week the Society submitted comments on the Centers for Medicare & Medicaid Services (CMS) proposed rule for Medicare Shared Savings Program; Accountable Care Organizations—Pathways to Success.

The Society commented on the following areas of the proposed rule:

  • Expanding skilled nursing facility three-day rule waiver eligibility—The Society requested that CMS remove the requirement that skilled nursing facility (SNF) affiliates must have and maintain an overall rating of at least three stars in the Quality Rating System to partner with accountable care organizations (ACOs) for purposes of the SNF three-day waiver. The Society noted that the waiver is available to advanced alternative payment models (APMs) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that take downside risk that builds in safeguards against potential abuse. Other “bundled” payment arrangement such as Medicare Advantage plans, including institutional special needs plans, have had the three-day wavier for both SNF and NF for many years and it has served as a powerful tool to improve costs.
  • The Society supported the expanded use of telehealth for practitioners in ACOs and urged CMS to consider expanding the use of telehealth in the SNF and rescind the limitation of one subsequent telehealth nursing facility care visit every 30 days reported by CPT Codes 99307 through 99310.
  • The Society supported CMS’ revisions to the definition of primary care services to change the methodology for exclusion of SNF visits from primary care definition for the purposes of beneficiary attribution. CMS proposed to use the related Part A reimbursement rather than rely on the place of service (POS) code on the claims.

 

Click here to read the Society’s letter.