January 29, 2021

NEWS YOU CAN USE

Innovation Payment Contractor (IPC) Operations for PY2021 DCEs

To accommodate DCEs who initiated a late change to their Legal Business Name (LBN) and / or Tax Identification Number (TIN), DCEs will now have until February 26, 2021 to submit their validated banking information into the IPC Portal. If your DCE changes your LBN or TIN after responding to the initial IPC Portal Access Survey (due January 14^th), your DCE’s DO should 1) submit another new and accurate response to the IPC Portal Access Survey, accessible via the link below, and 2) submit the new and accurate data into the IPC Portal once your banking information has been established. Should you have any questions regarding the IPC Portal Access Survey or gaining access to the IPC Portal, please reach out to the Direct Contracting Model Team at [email protected]. If your DO experiences any issues with the submission of banking information in the IPC Portal, please write to [email protected].

Please note, if your DCE is not changing its LBN or TIN from its initial response to the IPC Portal Access Survey, no further action is required.

Link to the IPC Portal Access

Survey:https://cms.gov1.qualtrics.com/jfe/form/SV_eLKxzdfmokyWDvo

PY2021 Reporting and Data Sharing Publication

The Direct Contracting Model’s Reporting and Data Sharing Publication will be shared with PY2021 DCEs today via the Knowledge Library in the 4i Portal. This publication outlines the cadence, content, and structure of reports and data files that will be transmitted to DCEs during PY2021 that will be available in the 4i Data Hub. This is an informational report and may be subject to change. Further reporting-related documentation will be provided during the performance year.

PY2021 Aggregate Alignment Estimate

An aggregate alignment estimate for DCEs participating in PY2021 will be available early next week in the 2021 Reports folder in the Data Hub in 4i.  Please see the attached guidance that provides more explanation on how we reached this estimate.

Drivers for Direct Contracting Model Success

Driver diagrams are structured logic models that can serve as a planning and communication tool to engage staff in designing and implementing programs to support model implementation. We strongly encourage model participants use the driver diagram guidance and templates to develop driver diagrams, focusing on goals and activities related to Direct Contracting and submit them to the Learning System. These resources can be found in the Supporting Documents section under Learning System Resources in the 4i Knowledge Library. CMS and the Learning System will use the driver diagrams to help shape future curriculum topics tailored to meet model participants’ needs.

We welcome your questions and feedback at [email protected].

Are Your Contacts Updated in 4i?

Beginning February 26, 2021, the Direct Contracting Newsletter will only be sent to active contacts in 4i for Implementation Period and PY2021 DCEs.  Please be sure to update your contacts in 4i to ensure you will continue to receive this and other important communications.

REMINDERS

New Exceptions Released For Adding Mid-Year DC Participant Providers

DC Participant Providers and Preferred Providers can be added mid-Performance Year as part of an ad hoc process; however, DC Participant Providers that are added mid-Performance Year will not contribute to claims-based alignment for that PY and neither DC Participant Providers nor Preferred Providers added mid-Performance Year will be eligible to participate in payment mechanisms (Total Care Capitation, Primary Care Capitation, and Advanced Payment) for that PY. Further, DC Participant Providers can only be added if the provider in question (1) bills (at the time of the addition) for items and services he or she furnishes under a TIN that is used by a provider in the same DCE, and (2) did not bill under that TIN when the DCE submitted its provider list. However, new exceptions to the above two requirements are now available: 

If the DC Participant Provider bills under a TIN that has been acquired by or merged with an existing TIN on your DC Participant Provider list since the window to add provider closed (i.e., since 10/23/20),

or

If the DC Participant Provider was dropped from the DCE’s final DC Participant Provider list due to overlaps with another CMMI model or the shared savings initiative (e.g., Medicare Shared Savings Program) and that overlap has since been resolved.

Additional guidance will be released in the coming weeks to further explain the ad hoc process (including compliance and documentation protocols) as well as provide instructions on how to update a TIN for a provider that is on your current approved provider list.

Timing of Stop-Loss Charge Information

For DCEs participating in PY2021, CMS does not expect to be able to calculate and release each DCE’s PY2021 stop-loss charge until early April, shortly after the start of the Performance Year (and therefore after the deadline to sign your Participation Agreement). Once DCEs receive their stop-loss reinsurance information, you will be provided with ~30 days to review and determine whether to elect the stop-loss reinsurance option for PY2021. Other details of the stop-loss methodology, such as the attachment points, will be provided in advance of the Performance Year – only the stop-loss charge information based on historical experience will be outstanding.

Direct Contracting “Standard Password” for Submitting PII

CMS IT Security Policy does not allow us to exchange encryption passwords via email. In Direct Contracting, we have opted to use a standard password with a calendar year embedded in the code: DXXXX$2021dce. The first letter of the standard password is capitalized. The last three letters are lower case. Use the 2021 password even if the file concerns prior year data or issues. The password changes with the calendar year, not the underlying data within the file.

UPCOMING EVENTS

Introducing the VBC Learning System’s Activities and Resources for Benefit Enhancement and Beneficiary Engagement Incentives

Please join us March 4, from 3:00 – 4:00 PM ET, for the Value Based Care Learning System Benefit Enhancement (BE) and Beneficiary Engagement Incentives (BEI) onboarding webinar. In this event, we will: 

Orient DC and KCC model participants to the role of the learning system in supporting them with launch and growth of BE and BEI operations.

Preview the cross-model approach to BE/BEI products and events under the learning system.

Share lessons learned from the Next Generation Accountable Care Organization model to enhance DC and KCC model participants’ understanding of possible implementation approaches. 

As part of this event, we will also describe learning system resources designed to support model participants with BE/BEI implementation and strategic planning. The webinar will include a Q&A session and conclude with overview of upcoming events. We welcome your questions to inform this and future learning system events at [email protected]. 

Click here to register for this event.

HELPDESK QUESTION OF THE WEEK

Q: Some of our returned PVA forms are incomplete. Some are missing dates or signatures. May we complete the date field with the date it was mailed to the beneficiary or returned to the DCE? Or, may we contact the beneficiary to collect missing information? 

A: No, please request that beneficiaries or their legal representatives complete the entire PVA form before you submit the PVA Template, due February 24.

DATES TO KNOW

Date(s)	Activity
October 1, 2020	Implementation Period Began
February 24, 2021	IP-Paper based voluntarily aligned beneficiary list due to CMS, 2nd collection
February 26, 2021	Confirm Banking Information in the IPC Portal
Early March, 2021	PY2021 Benchmarks released along with PY2021 Participation Agreement
March 4, 2021	Learning System Webinar on BEs and BEIs
April 1, 2021	PY2021 Begins

Centers for Medicare & Medicaid Services (CMS) has sent this update. To contact Centers for Medicare & Medicaid Services (CMS) go to our contact us page.   Questions?   Direct Contracting Model Website: https://innovation.cms.gov/innovation-models/direct-contracting-model-options  Contact DC Model Helpdesk at [email protected] or call us at 1-888-734-6433 (Option 1, 3) from 8:30 AM to 7:30 PM ET.  TTY: 1-888-734-6563