The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Primary Care Flex Model (“Flex Model”), a new voluntary model within MSSP for low-revenue ACOs, that begins January 1, 2025. The Flex Model will utilize a prospective primary care payment option to increase flexibility for low-revenue ACOs to increase access to high-quality primary care for Medicare beneficiaries. Additionally, a one-time advanced shared savings payment will be distributed to help with the formation and administrative costs of participating ACOs. To participate in the Flex Model, low-revenue ACOs (as defined under 42 CFR § 425.20) must first apply to participate in the Medicare Shared Savings Program (“MSSP” or “Program”) and indicate their interest in participating in Phase 1 of the Program application for the agreement period beginning January 1, 2025. ACOs currently participating in the MSSP may also participate in the Flex Model by applying to the MSSP as a renewal applicant.
The application process for the MSSP is split into two phases. Phase 1 of the application submission process opens on May 20, 2024, and closes on June 17, 2024. ACOs that submit information during the Phase 1 submission period will submit additional information during the application’s Phase 2 submission period, which is currently scheduled to open on October 18, 2024, and close on October 29, 2024.
Background
The MSSP is CMS’s largest ACO program, covering more than 10 million Medicare beneficiaries and including more than 500,000 health care providers. On November 18, 2022, CMS published a final rule implementing significant reforms to the MSSP impacting payment, beneficiary assignment, quality reporting, performance requirements and other aspects of the Program. These policies are intended to incentivize more Medicare providers and suppliers to join the MSSP and promote long-term participation in the Program, both of which are necessary for CMS to reach its stated goal of having 100% of traditional Medicare beneficiaries treated by a provider in a value-based care model by 2030. The Flex Model is another step toward reaching this goal with its focus on expanding access to high-quality care; improving the patient experience for people with Medicare; enhancing primary care; reducing Program expenditures; and strengthening incentives for new and low-revenue ACO’s participating in the MSSP.
Key MSSP Application Deadlines (Dates subject to change by CMS)
- May 20, 2024 – Phase 1 MSSP Application Period Opens
- June 17, 2024, at 12:00 PM ET – Phase 1 MSSP Application Period Closes
- July 11, 2024 – Phase 1 Request for Information (“RFI”)-1 Begins
- August 1, 2024, at 12:00 PM ET – Phase 1 RFI-1 Closes
- August 22, 2024 – Phase 1 RFI-2 Begins
- September 5, 2024, at 12:00 PM ET – Phase 1 RFI-2 Closes
- October 18, 2024 – Phase 2 Submission Period Begins
- October 29, 2024, at 12:00 PM ET – Phase 2 Submission Period Closes
- November 8, 2024 – Phase 2 RFI Begins
- November 18, 2024, at 12:00 PM ET – Phase 2 RFI Closes
- December 5, 2024 – Final Application Dispositions
Practical Takeaways and Next Steps
- The Flex Model aims to increase access to high-quality primary care for Medicare beneficiaries and decrease health disparities by incentivizing development of new ACOs (particularly in underserved communities) and improving funding and other resources to enhance primary care in ACOs.
- In order to participate in the Flex Model, the applicant must first apply to participate in the MSSP.
- Phase 1 of the MSSP application submission process for the performance year beginning January 1, 2025, is not open yet; however, deadlines are quickly approaching.
- Phase 1 submissions for MSSP must be submitted to CMS by 12:00 PM ET on June 17, 2024.
- Applications for the Flex Model are expected to be released in the second quarter of 2024.
- Organizations that are considering applying to join the Flex Model should watch for further technical detail on the model, which CMS will likely release in advance of the application period.
If you have questions related to the MSSP or the Flex Model or would like assistance preparing for participation, please contact:
- Laetitia Cheltenham at (919) 447-4968 or lcheltenham@hallrender.com;
- Scott Strickland at (919) 447-4965 or sstrickland@hallrender.com;
- Brian Bauer at (248) 457-7824 or bbauer@hallrender.com; or
- Your primary Hall Render contact.
Special thanks to Nikkia Jacques, Summer Associate, for her assistance with the preparation of this article.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot give legal advice outside of an attorney-client relationship.
