The Centers for Medicare – Medicaid Services (CMS) has issued an amendment to the Advanced Participation Agreement (BPCI) Advanced Participation Agreement (Amendment). The amendments made by the 18-part amendment were largely based on stakeholder input and streamlined aspects of the program and eased the burden on convening participants and non-organizers. If CMS includes the amendment in a revised and revised participation agreement, participants have until October 1, 2019 (or any other date, if the CMS indicates) to accept the terms of this agreement and extend the duration of the agreement until 2022. New applicants have until June 24, 2019 to apply. Current BPCI Advanced participants have had until June 1, 2019 to make an optional amendment to the original BPCI Advanced agreement, recently published by CMS. BPCI Advanced is an initiative of the CMS Center for Medicare – Medicaid Innovation that aims to increase participation in voluntary bundled payment models.2 BPCI Advanced began for the first cohort of participants on October 1, 2018 and the second cohort will begin on January 1, 2020 with participation for Model Year 3.3, CMS does not expect to submit additional applications for model years 4 (2021) until 6 (2023). This may be the last opportunity for stakeholders to participate in BPCI Advanced as conventers or non-organizers who enter into contracts with CMS. Some interested parties may apply to become a „participant,“ a company that concludes the BPCI Advanced model agreement with CMS. CMS requires all participants to take a financial risk from the outset (i.e. to pay the amount of the refund when the actual expenses per service exceed the target prices) and categorizes them into two categories: participants and non-organizers. Both categories of participants may establish relationships with downstream physicians and non-medical physicians to share net payment compensation or, if necessary, to apportion responsibility for reimbursement amounts. However, there are differences between those who are not summoned and those who are not summoned, for whom we provide a high-level synthetic summary below.
September 2019: CMS distributes participation agreements for Model Year 3 to selected candidates. The amendment further expanded the opportunities for participants to spread financial risks among their downstream episode initiators and eliminated some administrative burdens associated with cmS refund collection. The initial BPCI Advanced agreement made participants directly liable for repayment amounts and imposed incriminating requirements to ensure that participants had adequate access to capital on their behalf and to their downstream episode initiators for the duration of the agreement. However, the amendment now allows downstream episode initiators to give CMS the explicit right to recover claims by reducing independent Medicare payments. To the extent that all contractual initiator agreements contain such provisions, CMS has reduced the requirements for the source of secondary reimbursement imposed on the participants concerned. In addition, it is noted that this amendment is included in the Model 3 BPCI Advanced agreement, participation in the program as a participant or not could be attractive to organizations with more limited financial resources. Conversely, networks that do not require direct acceptance of risks by downstream episode initiators may become more attractive to physician group offices and acute hospitals. When cms indicated that the one-year wait would effectively apply to participants wishing to participate with different downstream episode initiators, 15 participants quickly objected. CMS issued guidelines again before March 1, 2019, deadline of the single „retroactive payment directive“ that the waiting period would not prohibit conveners from applying for Model Year 3, which would not require convening participants, many of whom have several ADVANCED BPCI agreements with CMS, to terminate the latter (retroactively until March 1). ,