Congress Advances Short-Term Government Funding Extension. Congress passed a short-term stop-gap bill to fund the government through December 20, 2024, preventing a government shutdown. When lawmakers return for the post-election Lame Duck session, they will need to address several expiring programs and reauthorizations, including the expiration of popular COVID-era telehealth flexibilities, extending Advanced Alternative Payment Model (APM) bonuses, and addressing the proposed FY25 Medicare physician pay cut. A4H continues to engage with lawmakers, push them to mitigate cuts this year, and consider additional actions to strengthen accountable care as Congress looks to 2025.

CMS Update on Efforts to Expand Access to Accountable Care. In a Health Affairs blog, CMS describes recent efforts to expand traditional Medicare beneficiaries’ access to accountable care in pursuit of the goal of 100% participation in accountable care by 2030. In the article, CMS discusses past and future changes to the Medicare Shared Savings Program (MSSP), including incorporating lessons learned from CMS Innovation Center Models. The authors recap several proposals from this year’s Medicare Physician Fee Schedule proposed rule, including a request for information about a full-risk track and a proposal for Advanced Primary Care Management Codes intended to better recognize the broader range of resources needed for person-centered care management. A4H’s comments on the CY25 PFS proposed rule advocate for policies that will expand and encourage the adoption of accountable care. We expect to see the final rule later this fall.

CMS Finalizes Rule on Mitigating the Impact of Anomalous and Highly Suspect Billing Activity on MSSP. The rule holds ACOs harmless for anomalous billing related to urinary catheters in 2023. CMS states the rule is part of a larger strategy to address significant, anomalous, and highly suspect (SAHS) billing within ACOs. CMS’ fact sheet on the final rule can be found here. A4H welcomes CMS’ progress on these issues and will continue engaging with the agency and lawmakers, including on ongoing concerns related to billing for skin substitutes. We expect to see additional policies on SAHS in the Medicare Physician Fee Schedule final rule.

CMS Report to Congress on Hospital at Home Initiative. The Centers for Medicare and Medicaid Services (CMS) released a report to Congress, on the Acute Hospital Care at Home (AHCAH) initiative, which allows certain Medicare-certified hospitals to treat patients with inpatient-level care at home. The report evaluates several aspects of the AHCAH initiative, including showing promising preliminary results in terms of quality of care, beneficiary and caregiver experiences, and lowering costs. The AHCAH initiative is slated to expire at the end of the year absent Congressional action to extend it.

Health Affairs Forefront Article on Evaluating the Innovation Center’s Impact on Care Delivery Transformation. The article considers a framework to evaluate CMMI’s success and contribution to the overall health system. The article discusses how early ACO models like the Pioneer ACO Model contributed value beyond short-term savings by informing the structure of the current ACO REACH Model and MSSP. The authors also weigh the balance between valuing short-term and long-term spending impacts. The article concludes by emphasizing the need for a comprehensive framework to enable policymakers to evaluate the Innovation Center’s contributions to the health care system and to continue progressing towards a value-based care delivery system. A4H continues to work with stakeholders, including CMS to assess the model evaluation process and ensure that evaluations are comprehensive in their review of cost and quality impacts.

Women’s Health Virtual Hill Briefing. A4H, along with the National Partnership for Women & Families and the United States of Care, invites you to a virtual Congressional briefing on October 17 at 2:00 PM Eastern. The briefing will demonstrate how innovations in payment and care delivery show great promise to improve women’s health and experiences overall. You can register for the event here.