CMS Innovation Center Models — COVID-19 Related Adjustments (June 3, 2020)
Summary
A CMS Innovation Center Models COVID-19 Related Adjustments document dated 06/03/2020. It states that the table describes adjustments made or to be made to certain Centers for Medicare & Medicaid Services Innovation Center models to address the COVID-19 public health emergency (PHE), focusing on financial methodologies, quality reporting and model timelines. It lists principles used to determine appropriate changes, including utilizing existing flexibilities, minimizing reporting burden and aligning with national value based and quality payment programs. The table lists models, including one abbreviated CEC, with their financial methodology, quality reporting and timeline changes.
Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used
Cite this document
“CMS Innovation Center Models — COVID-19 Related Adjustments (June 3, 2020).”
Original at www.cms.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/ppr-int-69ed2691c4ddaad8-innovation-model-covid-19-adjustments-pdf-918-59161e0695/
, SHA-256 10b04398eaa0347afd8e487ea71e77427134daea28d216d877db95fae5b90512.Full text
CMS Innovation Center Models COVID-19 Related Adjustments
The table below describes adjustments that have been made or that CMS will be making to
certain Centers for Medicare & Medicaid Services (CMS) Innovation Center Models to address the
COVID-19 public health emergency (PHE). The table specifically focuses on model adjustments
related to financial methodologies, quality reporting, and model timelines. The Innovation Center
model adjustments described here are not exhaustive; Innovation Center has already implemented
several changes and there is the potential for future adjustments, as the COVID-19 PHE continues to
evolve. Additional information about each of these model adjustments is available here
(https://innovation.cms.gov/innovation-models/covid-19-flexibilities).
We used the following principles to determine which changes are appropriate:
• Utilize flexibilities that already exist in current model design
• Continue sufficient financial incentives that encourage higher quality outcomes to
participate in value based arrangements
• Ensure equity and consistency across models
• Align as much as possible with national value based and quality payment programs.
• Minimize risk to both model participants, the Medicaid program, and the Medicare
Trust Funds
• Minimize delays in new model implementation while providing additional opportunities
for participation in new models
• Minimize reporting burden
• Complements and builds off of new CMS COVID-19 PHE flexibilities as outlined in
regulation and waivers
Additional information regarding the implementation of these changes will be provided to model
participants by CMS, and such changes may involve amendments to participation agreements and
other model documents. We also note that, based on the future evolution of the COVID-19 PHE,
there is a possibility that the implementation of new models may be further delayed.
This document supplements emergency rules and waivers granted under section 1135 of the Act
specifically to address the COVID-19 PHE. Additional information is available at:
https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/
Current-Emergencies-page
1
06/03/2020
Innovation Financial Quality Model
Center Model Methodology Changes Reporting Changes Timeline Changes
Bundled • Option for Participants to • No Change • No Change
Payments eliminate upside and downside
for Care risk by excluding Clinical
Improvement Episodes from Reconciliation
Advanced for Model Year 3 (2020)
• For BPCI-Advanced Participants
that choose to remain in
two-sided risk, exclude
certain Clinical Episodes from
Reconciliation with a COVID-19
diagnosis during the episode
Comprehensive • Reduce 2020 downside risk • Quality measure validation • Extend model until
ESRD Care by reducing shared losses by deadline extended to May 4, March 31, 2021
Model (CEC) proportion of months during 2020
the PHE • Continue to monitor impact
• Cap ESCOs’ gross savings on 2020 quality reporting
upside potential at 5% gross
savings
• Remove COVID-19 inpatient
episodes
• Remove 2020 financial
guarantee requirement
Comprehensive • Remove downside risk by • No Change • Extend
Care for Joint capping actual episode Performance
Replacement payments at the target price Year 5 through
(CJR) Model for episodes with a date of March 2021
admission to the anchor
hospitalization between
January 31, 2020 through the
termination of the emergency
period (as described in section
1135(e) of the Social Security
Act) (see CMS1744-IFC)
• Extend the appeals timeline for
Performance Year (PY) 3 and PY
4 from 45 days to 120 days
Direct • Adjust model to reflect • Adjust quality benchmarks, • Delay start of the
Contracting change in duration of 2021 if necessary, to reflect first Performance
(Global and Performance Period due to change in duration of 2021 Period for cohort
Professional) April 1, 2021 start Performance Period due to #1 to April 1, 2021
April 1, 2021 start • Create application
cycle during 2021
for second cohort
to launch
January 1, 2022
2
06/03/2020
Innovation Financial Quality Model
Center Model Methodology Changes Reporting Changes Timeline Changes
Emergency • No Change • No Change • Delay model start
Triage, Treat, from May 1, 2020
and Transport to Fall 2020
(ET3)
Home Health • No Change • Align HHVBP Model data • No Change
Value-Based submission requirements
Purchasing with exceptions or
Model (HHVBP) extensions granted for the
HH QRP during the PHE for
COVID-19
• Grant exceptions to the New
Measures data reporting
requirements under the
HHVBP Model during the
PHE for COVID-19. HHAs
are not required to report
New Measures data for
the following submission
periods: April 2020 and
July 2020.
Independence • No Change • Allow IAH practices to utilize • No Change
at Home telehealth to meet quality
(Section 3024 metric requirements for 2 (of
of the ACA) the 6 required) measures: 1)
48-hour follow-up visit post
hospital or ED discharge and
2) medication reconciliation in
the home.
Integrated Care • No Change • No Change • Delay first
for Kids (InCK) quarterly
Model progress report
and associated
deliverables to
July 30, 2020.
Kidney Care • Adjust model to reflect • Adjust quality benchmarks, • Delay start of the
Choices change in duration of 2021 if necessary, to reflect first Performance
Performance Period due to change in duration of 2021 Period for cohort
April 1, 2021 start Performance Period due to #1 to April 1, 2021
April 1, 2021 start • Create application
cycle during
2021 for second
cohort to launch
January 1, 2022
3
06/03/2020
Innovation Financial Quality Model
Center Model Methodology Changes Reporting Changes Timeline Changes
Maternal • No Change • No Change • Delayed start
Opioid Misuse of beneficiary
Model (MOM) enrollment by six
months, until
July 1, 2021
Medicare Care • No Change • No Change • No Change
Choices Model
Medicare • No Change • Extend deadline to submit • No Change
Diabetes quarterly Crosswalk file to
Prevention July 15, 2020
Program
Expanded
Model (MDPP)
Medicare ACO • Remove episodes of care for • 2019 Web Interface quality • Voluntary
Track 1+ Model treatment of COVID-19 measure reporting deadline election to extend
• Medicare Shared Savings extended from March 31, 2020 agreement for
Program Extreme and to April 30, 2020 1 year through
Uncontrollable Circumstances • Medicare Shared Savings December 2021
policy applies to 2020 financial Program Extreme
reconciliation and Uncontrollable
Circumstances policy applies
to 2019 and 2020 reporting
• Continue to monitor impact
on 2020 quality reporting
Next • Reduce 2020 downside risk • 2019 Web Interface quality • Extend
Generation by reducing shared losses by measure reporting deadline model through
ACO (NGACO) proportion of months during extended from March 31, 2020 December 2021
the PHE. to April 30, 2020
• Cap NGACOs’ gross savings • 2019 quality audit canceled
upside potential at 5% gross • Continue to monitor impact
savings on 2020 quality reporting
• Remove episodes of care for
treatment of COVID-19
• Use retrospective regional
trend, rather than prospective,
for 2020
• Remove 2020 financial
guarantee requirement
4
06/03/2020
Innovation Financial Quality Model
Center Model Methodology Changes Reporting Changes Timeline Changes
Oncology Care • Option for OCM practices Make the following optional • Extend model for
Model (OCM) to elect to forgo upside and for the affected performance 1 year through
downside risk for performance periods: June 2022
periods affected by the PHE • Aggregate-level reporting of
• For OCM practices that remain quality measures
in one- or two-sided risk for the • Beneficiary-level reporting
performance periods affected of clinical and staging data
by the PHE, remove COVID-19 Remove the requirement for
episodes from reconciliation cost and resource utilization
for those performance periods reporting and practice
transformation plan reporting
in July/August 2020
Primary • No Change • No Change • Delay
Care First— implementation
Serious Illness of the start of
Component the Performance
Period for the
Serious Illness
component until
April 1, 2021;
Primary Care First
only component
will still start on
January 1, 2021
5
06/03/2020
File and source
- File
- ppr-int-69ed2691c4ddaad8-Innovation-Model-COVID-19-Adjustments-PDF-91885f7454.pdf
- Size
- 175,634 bytes
- SHA-256
- 10b04398eaa0347afd8e487ea71e77427134daea28d216d877db95fae5b90512
- Original
- www.cms.gov