Request for information; Episode-based payment model

July 19, 2023
A Proposed Rule by the Centers for Medicare & Medicaid Services on 07/18/2023.

The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) seeks feedback regarding a potential new episode-based payment model that would be designed with a goal to improve beneficiary care and lower Medicare expenditures by reducing fragmentation and increasing care coordination across healthcare settings.

The Innovation Center is releasing this request for information (RFI) to gather feedback on testing a new model design, built on previous experience with episode-based payment models, and to further the goals of improved outcomes and reduced Medicare spending. Whenever possible, respondents are requested to draw their responses from objective, empirical, and actionable evidence and to cite this evidence within their responses.

This episode-based payment model is expected to be implemented no earlier than 2026, ensuring participants have sufficient time to prepare for the model.

The Innovation Center acknowledges that the role of clinical episodes will grow and evolve as more patients are cared for by providers in accountable care arrangements. To help them ensure all accountable entities provide patients with the highest value care, they seek input on the following questions:

  • How can CMS structure episodes of care to increase specialty and primary care integration and improve patient experience and clinical outcomes?
  • How can CMS support providers who may be required to participate in this episode-based payment model?
  • How can CMS ensure patient choice and rights will not be compromised as they transition between health care settings and providers?
  • How can CMS promote person-centered care in episodes, which includes mental health, behavioral health, and non-medical determinants of health?
  • How can CMS support multi-payer alignment for providers and suppliers in episode-based and population-based models?
  • For population-based entities currently engaging specialists in episodic care management, what are the key factors driving improvements in cost, quality, and outcomes?
  • How does the nature of the relationship (that is, employment, affiliation, etc.) between a population-based entity and a specialist influence integration?
  • What should CMS consider in the design of this model to effectively incorporate health information technology (health IT) standards and functionality, including interoperability, to support the aims of the model?

To be assured consideration, comments must be received by August 17, 2023.

Visit the Federal Register for more information

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