Important Information about New Legislation Involving APM Bonus

Important Information About New Legislation Involving APM Model Bonuses

Important Information about New Legislation Involving the APM Bonus: On December 21, The U.S. Congress passed a year-end package and COVID relief bill that included a $900 billion and a $1.4 trillion government spending package. Within the new bill is a two-year freeze of the payment amount and patient count thresholds required to grant Advanced Alternative Payment Model (APM) bonuses. Prior to passage of this legislation, current Qualifying APM Participant (QP) thresholds were set to rise to unrealistic levels in 2021. This is no longer the case.

What happened?

  • Congress passed the $900B COVID-19 relief bill. Included in this new law is a revision to freeze the QP thresholds for the next two years.

Why is it important?

  • This freeze of the thresholds makes it highly likely that Advanced APMs, like CHESS NextGen, will pass the thresholds for 2021 and 2022.
  • For 2021, the patient count threshold was set to increase to 50% and payment amount to 75%.
  • This freeze sets payment amount thresholds at 50% through 2022.
  • The legislation also explicitly tells the Secretary to use the same percentage criteria for counts of patients (35%) for 2021 and 2022.

How does this impact you?

  • Those in CHESS NextGen will likely receive the 5% lump sum bonus for their participation in a full risk model.
  • CHESS is very pleased that advocacy efforts through multiple organizations, like the NGACO Coalition and NAACOS, led to this much-needed change.

The new bill also includes additional funding to stave off Medicare Physician Fee Schedule cuts for 2021. Other notable health care provisions include protections from surprise medical billing and funding for COVID-19 vaccines, testing and tracing.

This major change is likely the result of extensive advocacy work done by over 500 ACOs, health systems and medical practices, including CHESS Health Solutions.