CMS Extends Application Period for Next Generation ACO Model

April 22, 2016 - Providers interested in participating in the Next Generation Accountable Care Organization (ACO) program now have until May 20, 2016 to submit their letters of intent, CMS announced this week.

In order to apply to the Next Generation ACO Model, all organizations are required to submit a letter of intent and a request for application. Organizations can complete and submit their letter of intent online on the Next Generation ACO Model webpage. After submitting it, ACOs will receive a letter of intent identification number that they can use to access the online application, which is also located on the webpage. The site also includes 2017 application materials in PDF format.

The application deadline for the narrative portion is still May 25, 2016. The application for the 2017 Participant List is June 3, 2016.

In order to qualify for acceptance into the Next Generation ACO Model, an ACO must have at least 10,000 aligned beneficiaries unless it is located in a designated rural area.

Current Medicare Shared Savings Program (MSSP) participants will need to decide later this year whether or not to join the Next Generation Model or continue in their current ACO initiative for 2017. An ACO is not allowed to participate in the Next Generation Model and the MSSP simultaneously, CMS said previously.  

The Next Generation ACO Model differs from the Medicare Shared Savings Program because it allows participants to assume higher levels of risk and reward. Participants are permitted to choose a risk option of 80 percent savings/losses or 100 percent savings/losses. Also, Next Generation models offer the potential for capitation payment, while MSSPs do not.

“A guaranteed shared loss rate of 80 percent or 100 percent for Next Generation organizations may make the model unattractive compared to the different MSSP tracks. However, organizations with more advanced care management models and analytics capabilities may find Next Generation to be an attractive program,” Deloitte said.

“The goal of the model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for original Medicare FFS beneficiaries” CMS stated.

MSSP ACOs will continue to receive FFS payments throughout the year and shared savings or losses will be applied later. For Next Generation ACOs, organizations have the option of selecting one of four payment mechanisms. These forms of payments include normal FFS, normal FFS plus an additional per-member-per month payment, population-based payments and capitation.

The Next Generation models also have strong patient protections, CMS said. This model is supposed to ensure that patients receive and have access to high-quality care. Participants will be evaluated based on their ability to deliver better healthcare to individuals and populations. ACOs will also be evaluated on how well they reduce growth in expenditures.

Next Generation ACOs will be measured against the same quality standards as MSSP ACOs, except for the EHR use requirement currently in use for MSSP organizations. All of the Next Generation ACOs will be required to demonstrate EHR capabilities in their program applications.

CMS has a number of open door forums available on its website to provide more information on the Next Generation ACO Model and help guide applicants through the application process. On April 26, CMS will be hosting a final open door forum that will focusing on population based payments and all-inclusive population based payments.

Interested parties may learn more about the requirements of the Next Generation ACO program by visiting the CMS webpage here.