NAACOS CONTINUES TO ADVOCATE FOR FAIR AND ACCURATE BENCHMARKS
ACPT in MSSP. Earlier this week, NAACOS submitted a letter to CMS asking that the Accountable Care Prospective Trend (ACPT) be reweighted to 0%. The ACPT significantly underestimated Medicare cost growth. While the 2024 ACPT estimated Medicare cost growth to be 4.9%, actual growth was nearly double (8%). This means that the ACPT will artificially and unfairly reduce ACO benchmarks by 1.03%, which, for the average ACO, could reduce revenue earned by 25%.
RTA in ACO REACH. Recently, CMS released the ACO REACH Retrospective Trend Adjustment (RTA), which is 1.00967, and noted that the RTA now accounts for expenditures in other models that were previously excluded and may change due to significant anomalous and highly suspect (SAHS) billing activity policies. The RTA is only applied over 1.01, and CMS previously rounded to the hundredth decimal point; however, it has now indicated that there is not a rounding policy for the RTA. This policy will arbitrarily lower benchmarks and lacks transparency. NAACOS continues to advocate for more transparency in this process and for improved calculation of the RTA (e.g., eliminating the corridors for application of RTA, changing the timeline for calculating the RTA).
For more information, please contact Aisha Pittman.
| NAACOS SUBMITS FEEDBACK ON DEREGULATION
This week NAACOS submitted comments in response to a request for information (RFI) from the U.S. Office of Management and Budget (OMB) on eliminating federal regulations that create unnecessary burden. Our comments focused on repealing regulations to reduce administrative burdens for health care providers and improve innovations in value-based care including restoring benchmark approaches, simplifying quality reporting and beneficiary communications, increasing data access, and expanding waivers. |
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• • •Congressional Updates |
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E&C RELEASES RECONCILIATION BILL, ACT NOW TO PROTECT ACCOUNTABLE CARE INCENTIVES
The House Energy and Commerce (E&C) Committee released budget reconciliation bill text ahead of their scheduled markup on Tuesday, May 13, at 2pm ET. The House budget resolution instructed the committee to find a minimum of $880 billion in savings. The bill includes a wide range of Medicaid reforms that will produce $625 billion in savings but would result in nearly 10.3 million people losing health coverage according to the Congressional Budget Office (CBO). A section-by-section of the bill is available. Meanwhile, the House Ways and Means Committee also released a bill to extend expiring tax policies from the Tax Cuts and Jobs Act of 2017, which extends the use of Health Savings Accounts (HSAs) in Medicare.
Implications for Accountable Care. This E&C bill would eliminate key financial incentives for clinicians participating in advanced Alternative Payment Models (APMs). Specifically, the bill would eliminate Medicare’s differential conversion factor that provides higher payment updates for clinicians in advanced APMs and provide a uniform inflationary update. Under the proposal, physicians would receive payment updates equal to 75 percent of the Medicare Economic Index (MEI) in 2026 and 10 percent of MEI in 2027 and subsequent years.
The proposed changes to Medicare’s conversion factor, along with the expiration of Medicare’s advanced APM incentives, would eliminate all financial incentives for value. An inflationary update for physician payment is necessary; however, we should not be forced to choose between fair physician reimbursement and continued progress toward a more effective, patient-centered health care system. Lawmakers have indicated that it is their intention to address advanced APM incentives outside of the reconciliation process. It is imperative that we convey that continuation of advanced APM incentives is critical. We need your voice to protect the future of accountable care, so act today by:
Signing our letter to Congress asking lawmakers to extend Medicare’s advanced APM incentives. Reach out to your Members of Congress and ask them to protect clinicians in value-based care models by continuing to incent participation in advanced APMs. Register for the NAACOS Fall Advocacy Summit and Hill Day on September 10th and 11th to engage with Washington lawmakers.
Please contact @Robert Daley with questions or for Congressional staff contact. | ADMINISTRATION OFFICIALS ON THE HILL
Health and Human Services (HHS) Secretary Robert F. Kennedy testified before the House Appropriations Committee and Senate Health, Education, Labor, and Pensions (HELP) this week to discuss President Trump’s fiscal 2026 budget request, which includes a 26 percent reduction in funding for health programs with significant restructuring of health departments. The Trump administration is expected to release a more detailed budget request in the coming weeks. The Senate Finance Committee also advanced the nominations of James O’Neill to be Deputy Secretary of HHS and Gary Andres to be Assistant Secretary of HHS.
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• • •Administration Updates |
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CMS INNOVATION CENTER STRATEGY RELEASED The Centers for Medicare and Medicaid Services Innovation Center (CMS Innovation Center) announced its strategy, Making America Healthy Again: Innovation for Healthier Lives, which outlines a three-pronged strategy for establishing payment systems that incentivize healthier lives. Highlights of the strategy include:
Promote evidence-based prevention
Designing models to increase the access and uptake of primary, secondary, and tertiary prevention, including incentives for both people and providers Options for working directly with individual people as well as with community-based organizations to resolve nutrition needs, provide disease management counseling and lifestyle education and services (e.g., exercise and nutrition support), or offer access to evidence-based alternative medicine. Empower people to achieve their health goals
Focus on providing patients with relevant data to understand health and costs by testing approaches for shared decision-making tools and health education Support patient-centered payments (e.g., cost sharing) within Medicare Advantage and ACOs Drive choice and competition
Ensure stability by allowing models to operate until final evaluation results are available, if no successor model is designed and early results do not preclude certification Design models to increase competition in market–advanced payments for independent practices, reinvesting hospital capacity in community-based care leveraging certificate of need, standardizing design features to reduce burden Focus on patient choice and testing payment changes (e.g., inferred risk, regional benchmarks, quality changes) in Medicare Advantage. Protect taxpayer dollars by requiring:
Requiring all models bear financial risk Requiring some providers bear some financial risk Reducing role of state government in rate setting Refining benchmarks Prioritizing high-value services
Find more on the strategy here:
NAACOS is continuing to engage with CMS on our priorities for existing and new models. For more information, contact @Aisha Pittman. |
2026 MSSP APPLICATIONS AND CHANGE REQUESTS OPEN THIS MONTH
Phase 1 of the application cycle for new, renewing, or re-entering ACOs seeking to participate in MSSP with a start date of January 1, 2026, will be open from May 29 through June 12 at 12:00 pm ET. Additional application deadlines are available on the MSSP Application Types & Timeline webpage. This is also the timeline for currently participating ACOs to submit change requests for Performance Year 2026. More information on change request cycle actions and deadlines can be found in the ACO-MS Knowledge Library. Application guidance and sample applications are available on the Application Toolkit & Change Request Cycle Resources webpage.
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OPPORTUNITY FOR REACH ACOS TO TEST PATIENT OUTREACH APPROACHES
CMS recently announced an opportunity for REACH ACOs to partner with CMS through the Rapid Cycle Innovation Program (RCIP). RCIP’s first rapid randomized controlled trial (RRCT) will evaluate whether changes to patient outreach can improve preventive care receipt. There will be a webinar on May 21 from 3:00-4:00 pm ET with more information on this opportunity. To sign up to conduct the Outreach for Preventive Care test at your organization, ACOs must complete this form by May 30.
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• • •Education Opportunities |
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JOIN NAACOS CONNECT TODAY
NAACOS is excited to announce our brand new and improved listserv – NAACOS Connect! ACO and value-based care provider group members can communicate with each other, share information, and ask questions related to their work in value-based care in this highly anticipated communication tool.
NAACOS Connect runs on the Telegram platform, which is a free messaging app you can access on your phone or computer. To access this members-only benefit, you’ll first need to install Telegram. We have a quick and easy guide available on our website.
To join the conversation, click the link in the invitation email you received on April 17, or contact [email protected] for assistance. Please make sure your IT team whitelists emails from *@mg.naacos.com to prevent these emails from being blocked.
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BOOT CAMP 101 EVENTS ARE THIS JUNE
Register today for Boot Camp 101 events. Join us on June 17 and 18 for NAACOS Data and Analytics Boot Camp 101 and June 24 and 25 for NAACOS Clinical Operations Camp 101. The Data and Analytics Boot Camp will feature topics including data validation, creating provider supplier lists and population health data stratification with presentations from Health Choice Network, UNC Health Alliance, Ardent Health, Advocate Health, and Village MD. The Clinical Operations Boot Camp will feature topics including ACO staffing, evaluating regulatory, quality reporting documentation, and provider engagement. These topics will be covered by subject matter experts from Ascension, Commonwealth Health, Advocate Health, and Ardent Heath.
| REGISTRATION IS OPEN FOR FALL 2025 CONFERENCE
Join us at the Marriott Marquis Washington, D.C. on October 8-10 for the Fall 2025 Conference! The agenda will feature insights from CMS officials, leading health care experts, and policy insiders, along with networking opportunities for participants, speakers, and vendors. Registration is now open for both in person and virtual participation. Register early and save!
Exhibit/sponsor program applications are now being accepted. Reserve your space today! Please note, all sponsorships and exhibit space are on a first-come first-served basis, and space is assigned in the order we receive applications.
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VIEW WEBINAR ON CY26 MA FINAL RULE AND RATE NOTICE
In case you missed it, NAACOS held a webinar discussing the Calendar Year 26 Medicare Advantage (MA) Final Rule and Rate Notice on May 13. This webinar featured policy expert Peter Fise from TDY presenting highlights from the rule and Sarah Mokover, SVP Payer Engagement, sharing agilon’s MA experiences and perspectives on rate notice impact. |
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