CMS Delays Serious Illness Population Model to April 2021

The U.S. Centers for Medicare & Medicaid Services (CMS) is delaying the start of the performance period for the Serious Illness Population payment model, which is part of the agency’s Primary Care First initiative. The program, previously set to begin January 1, will begin April 1, 2021.

The Primary Care First general option is still scheduled to begin on January 1 of next year. The performance period for CMS direct contracting models, which also fall under the auspices of Primary Care First, will likewise be delayed until April 1. The agency made these moves in response to the fallout of the COVID-19 pandemic. 

“When it comes to a pandemic of the proportion we’re now experiencing, as part of ensuring that value-based payments are sustainable, the models must be adjustable to address the uniqueness of the current situation,” CMS Administrator Seema Verma wrote in Health Affairs. “That’s why, in response to COVID-19, CMS is providing new flexibilities and adjustments to current and future [Center for Medicare & Medicaid Innovation] models to address the emergency.”

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CMS announced Primary Care First in April 2019 and will implement the models in phases, initially in 26 regions throughout the United States. Hospices and palliative care organizations are eligible to participate in the payment models provided they meet the program’s criteria. The program is designed to control costs, reduce avoidable hospitalizations and improve care coordination.

The Seriously Ill Population payment option, a component of that larger initiative, is designed to serve patients with complex, chronic needs who have received fragmented care.

The direct contracting options include three voluntary payment models that are designed to help CMS and health care providers reduce the cost of care and improve quality within Medicare fee-for-service programs. The models adapt and integrate concepts from other programs such as Accountable Care Organizations, the Medicare Shared Savings Program, and Medicare Advantage, as well as strategies used in the private sector.

“While many of our recent efforts have focused on driving the system toward value-based care faster, we’re adjusting the model implementation date for some of our new models and adjusting various deadlines for some of our existing models, to give providers additional time to transition to value-based care. We’re also delaying certain model reporting requirements so that providers can focus on patients instead of paperwork,” Verma said in Health Affairs.