Citizen Media Watch

december 4th, 2020

Bpci Advanced Model Participation Agreement

Posted by lotta

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. 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. 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.

Participants must bear the total financial risk to the CMS on behalf of at least one acute hospital or medical practice and enter into an agreement with a medical practice or acute hospital requiring the medical office or acute hospital to comply with the terms of the BPCI Advanced type agreement. CmS classifies group practices and acute hospitals participating in BPCI Advanced as ”downstream episode initiators” responsible for triggering the clinical episode for which the participant is ultimately financially responsible. Prior to the amendment, cms would impose a one-year waiting period before that participant could reapply to participate in BPCI Advanced if, for whatever reason, a participant decided to terminate the BPCI Advanced agreement prematurely. However, it was not clear whether the one-year waiting period for ”replication” is to ask a participant for the summonses to apply with a completely different group of downstream episode initiators. On April 24, 2019, the Centers for Medicare – Medicaid Services issued an application for the Bundled Payments for Care Improvement Advanced model for its second candidate cohort since the program`s inception1. In particular, there are more clinical episodes available for Model Year 3 (37 instead of 32)11 and stakeholders have more flexibility in quality measurements.



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