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Provisions in the Bipartisan Budget Act of 2018 Pertaining to Accountable Care Organizations 

Providing ACOs expanded use of telehealth
This provision provides a telehealth waiver to the Medicare Shared Savings Program (MSSP) for:

  • Track 2 ACOs that choose prospective assignment (see section below),
  • Track 3 ACOs, and
  • Two-sided risk ACO models with prospective assignment that are tested or expanded through CMMI as determined appropriate by the Secretary of HHS (such as Track 1+). 

This provision would: (1) eliminate the geographic component of the originating site requirement; (2) allow beneficiaries assigned to the qualifying ACO to receive currently allowable telehealth services in the home; and (3) ensure that ACO providers are only allowed to furnish telehealth services as currently specified under Medicare’s physician fee schedule, with limited exceptions. To be eligible for Medicare payment, the beneficiary must be located at an originating site that is either: (1) one of the approved sites listed in Section 1834(m)(4)(C)(ii) of the Social Security Act; or (2) the beneficiary’s place of residence. Medicare would not provide a separate payment for the originating site fee if the service is furnished in the home. This will be effective January 1, 2020. 

Beneficiary assignment changes
ACOs in the MSSP operating under retrospective assignment (Track 1 and 2) will be given the choice to have their beneficiaries assigned prospectively at the beginning of a performance year. Effective for agreements entered into or renewed on or after January 1, 2020. Additionally, this provision would give a beneficiary the option to voluntarily align to the MSSP ACO in which the beneficiary’s main primary care provider is participating. The Secretary of HHS would establish a process by which beneficiaries are notified of their ability to make such an election as well as the process by which they may change such election. The beneficiary would retain his or her freedom of choice to see any provider.  (Note: CMS implemented voluntary alignment effective beginning with performance year 2018, and it is unclear how significantly this provision would affect the existing process.) 

Eliminating barriers to care coordination under ACOs
This provision creates a voluntary ACO Beneficiary Incentive Program that allows certain two-sided ACOs to make incentive payments to beneficiaries who receive qualifying primary care services. Eligible ACOs include those in MSSP Track 2 or 3, but it is unclear if Track 1+ would be included. Eligible beneficiaries are those who are preliminarily prospectively assigned or prospectively assigned. The qualifying services are primary care services, defined in the Code of Federal Regulations here, to which Part B coinsurance applies and that are furnished by an ACO primary care provider. ACOs participating in the Beneficiary Incentive Program would be allowed to offer a flat payment, of up to $20 per qualifying service, directly to the beneficiary. These ACOs would not be provided additional Medicare reimbursement to cover the primary care incentive payment costs, and the incentive payments would not be factored into ACO benchmarks or expenditures. The Secretary of HHS will implement this program between January 1, 2019 and January 1, 2020. Additionally, this section requires HHS to conduct an evaluation of the Beneficiary Incentive Program. The report must include an analysis of the impact of this program’s implementation on expenditures and beneficiary health outcomes. A report to Congress is due no later October 1, 2023.