July 7, 2022 – The Centers for Medicare & Medicaid Services (CMS) is proposing changes in CMS’s annual Physician Fee Schedule (PFS) proposed rule to significantly expand access to behavioral health services and move the health system closer to achieving equitable outcomes through high quality, affordable, person-centered care. These proposed changes will ensure CMS continues to deliver on our goals of advancing health equity, driving accountable care, and protecting the sustainability of the Medicare program.

Building on the CMS Innovation Center’s successful ACO Investment Model (AIM), CMS is proposing changes to the Medicare Shared Savings Program to incorporate advanced shared savings payments for certain ACOs that could be used to address Medicare beneficiaries’ social needs. This opportunity may support the development of new Accountable Care Organizations (ACOs) in rural and underserved areas, continuing efforts to advance health equity. Additionally, we are proposing a health equity payment adjustment for ACOs that reward them for providing excellent care to underserved populations. For more information, please see the MSSP fact sheet.

The CMS Innovation Center is also seeking comment on an alternative approach to calculating ACO historical benchmarks that would use administratively set benchmarks that are decoupled from ongoing observed FFS spending, as described in the Request for Information (RFI). CMS has observed that the benchmarking methodology for the Shared Savings Program and CMS Innovation Center models may reduce benchmarks for successful ACOs, make it potentially difficult for providers serving medically complex, high cost populations to participate and jeopardize continued participation over multiple agreement periods. The RFI seeks to gather information regarding the future use of administrative benchmarking to increase participation in ACO initiatives, which would help to expand the reach of accountable care to more people with Traditional Medicare.

CMS is also issuing a number of RFIs to solicit feedback on the future of the Quality Payment Program (QPP), including an RFI on QPP Incentives to seek comment on how the end of lump-sum Alternative Payment Model (APM) Incentive Payments and the move to conversion factors will impact participation in MIPS and Advanced APMs. For more information, please see the QPP fact sheet (ZIP).

For more information, please see the PFS press release.

View or download the proposed rule on the Federal Register.

Download the PFS fact sheet.