On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released its 2019 Physician Fee Schedule Final Rule (PFS Rule), which contains a number of significant substantive changes to Medicare payment practices and policies. The PFS Rule will be officially published in the Federal Register on November 23, 2018. The PFS Rule also includes an interim final rule implementing amendments to federal telehealth regulations to maintain consistency with recent changes to the Social Security Act to address the opioid crisis enacted in October 2018 through the SUPPORT for Patients and Communities Act.

The PFS Rule changes to the Medicare Physician Fee Schedule and other CMS programs include updates to evaluation and management (E&M) documentation, coding, and payment practices, increased payment for physician use of communications technology, expanded use of telehealth services to address the opioid crisis and for other substance use disorder treatment, and solicitation of comments regarding a bundled payment program for substance use disorder treatment. These changes, and others, will be addressed in a series of upcoming blog posts published here.

Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP) should be aware that, among other things, the PFS Rule finalizes an important policy affecting ACOs that was proposed in August as part of CMS’s proposal to significantly overhaul the MSSP (August Proposed MSSP Rule; see our analysis of that Rule here).

The PFS Rule formally adopts CMS’s proposal to allow ACOs currently participating in the MSSP whose participation agreements are scheduled to expire December 31, 2018, to elect to extend those agreements for six months (through June 30, 2019) while CMS finalizes and implements its revisions to the MSSP. In the PFS Rule, CMS explains that it is finalizing the voluntary extension period now to enable ACOs to maintain continuity of participation in the MSSP and facilitate the transition to the new MSSP that is anticipated to occur July 1, 2019.  CMS plans to address the rest of the issues raised in the August Proposed MSSP Rule in separate rulemaking this fall.

Under the PFS Rule, ACOs that elect to participate in the MSSP for the six-month extension period in 2019 must extend all current ACO participant and/or SNF affiliate participation agreements before December 31, 2018, to assure continued participation through June 30, 2019. ACOs will also be permitted to add ACO participants effective January 1, 2019 to participate in the MSSP through the ACO during the extension period. CMS has issued guidance to ACOs with currently expiring MSSP participation agreements on how to elect to participate in the MSSP during the extension period. That guidance is available in the Resources Section of the CMS SSP ACO Portal.

The foregoing change, and other changes in the PFS Rule affecting the MSSP (including those related to beneficiary assignment, quality measure reporting, and the methodology for assessing performance during the 2019 extension period), take effect December 31, 2018.

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