CMS introduces new Medicare-Medicaid ACO model

CMS headquarters-Maryland

The Innovation Center of the Centers for Medicare and Medicaid Services announced a new model to allow clinicians to participate in advanced alternative payment models under the Medicare Access and CHIP Reauthorization Act. 

The Medicare-Medicaid ACO model builds on the current Medicare shared savings program and advances efforts to partner with states on delivery system reform.

CMS announced the Medicare-Medicaid accountable care organization model Thursday. It is open to all states and the District of Columbia that have a sufficient number of enrollees in fee-for-service Medicare and Medicaid.

[Also: CMS Innovation Center to test 2 new Medicare models tied to shared decision making]

CMS will enter into participation agreements with up to six states with preference given to states with low Medicare ACO saturation.

CMS's Innovation Center, or CMMI, is among Affordable Care Act initiatives threatened by President-elect Donald Trump's promise to repeal and replace the ACA, and some legislators who question whether its directives - not approved by Congress - have overstepped its bounds.

However, MACRA is here to stay for the near future, as the 2015 replacement to the sustainable growth rate formula received overwhelming bipartisan support.

[Also: CMS goes after dialysis facilities that steer patients away from Medicare]

"This model aims to provide improved care coordination for those enrolled in both Medicare and Medicaid, allowing providers to focus more on providing care for their patients rather than administrative work," said Patrick Conway, MD, CMS acting principal deputy administrator. "CMS continues to partner with and leverage the best ideas from states to transform our healthcare system to improve quality and care coordination."

In current Medicare ACO initiatives, beneficiaries who are Medicare-Medicaid enrollees may be attributed to ACOs.

[Also: Court sets 2020 deadline for HHS to resolve Medicare claims backlog]

However, Medicare ACOs often do not have financial accountability for the Medicaid expenditures for those beneficiaries. The new model will allow Medicare shared savings program ACOs to take on accountability for the quality of care and both Medicare and Medicaid costs for the enrollees.

CMS is accepting letters of intent from states that wish to work with the agency to design certain state-specific elements of the model.

Once a state is approved to participate in the model, a request for application will be released to ACOs and health care providers in that state.

Twitter: @SusanJMorse