Section 3022 of the Affordable Care Act (ACA) established the MSSP based on concepts developed by existing ACOs. The ACA recognizes nurse practitioners (NP) as authorized “ACO professionals. ACOs create incentives for health care providers to work together to treat an individual patient across care settings. MSSP participants agree to lower the cost of health care while meeting identified performance standards by sharing resources and care in a coordinated manner. ACOs that are able to accomplish these goals are eligible for financial benefits (shared savings). To count towards the shared savings, a patient must be assigned to an ACO based on their claims information (claims-based assignment) or by selecting an ACO professional as their primary care provider (voluntary alignment).
Despite being recognized as ACO professionals, the claims-based assignment pathway requires an NP’s patient to receive at least one primary care service provided by a primary care physician each year for the patient to be assigned to an ACO. While this restriction does not prevent individual nurse practitioners from joining an ACO, it prevents their patients from being assigned to an ACO through claims-based assignment, and any benefits that result from such participation, unless the NP sends their patient to receive a primary care service from a primary care physician.
Effective in 2019, CMS amended the voluntary alignment pathway to allow a patient to select an NP as their primary care provider in an MSSP ACO and be assigned to the ACO without requiring that duplicative physician visit. This change will provide greater opportunity for NPs and their patients to join and establish MSSP ACOs. However, the claims-based assignment barrier still exists. It is important to note that in its FY 2021 Budget in Brief, HHS estimates that basing ACO-assignment on a broader set of primary care providers, including nurse practitioners, will better reflect our current primary care workforce and lead to $80 million in savings for the Medicare program over ten years.
H.R. 900 will amend Section 1899(c) of the Social Security Act to authorize NPs’ patients to be assigned to an MSSP ACO through claims-based assignment without the unnecessary physician visit. The MSSP has demonstrated cost-savings for the Medicare program while maintaining high-quality care. As of 2018, NPs are the largest and fastest growing Medicare designated provider specialty a trend we expect to continue with nearly 70% of all NPs delivering primary care. It is imperative to fully include NPs and their patients in the MSSP in order to continue to improve patient access, quality and cost-effectiveness.
AANP calls on Members of Congress to cosponsor H.R. 900 to improve the way beneficiaries are assigned under the Medicare Shared Savings Program (MSSP). This legislation will allow the claims-based assignment of patients seen only by nurse practitioners to MSSP ACOs.
For additional information, please contact the AANP Government Affairs Office at 703-740-2529 or firstname.lastname@example.org.