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    January 18, 2019   

    The Honorable Seema Verma
    Centers for Medicare & Medicaid Services
    U.S. Department of Health and Human Services
    Hubert H. Humphrey Building, Room 445–G
    200 Independence Avenue, SW
    Washington, DC 20201 
    Re: Extending the Medicare Shared Savings Program Application Deadline 
    Dear Administrator Verma,  

    The undersigned organizations write today to express our concern with the application deadline of February 19, 2019 for Accountable Care Organizations (ACOs) applying to participate in the Medicare Shared Savings Program (MSSP) beginning July 1, 2019. Due to the complexity of CMS’s new final rule for the program published in the Federal Register on December 31, 2018, many existing ACOs and those in the process of formation are still actively working to understand how they may successfully participate in the program. Additional time is needed to ensure ACOs may evaluate their options and complete the administrative and legal requirements of the application. Without additional time, participation in this voluntary program will suffer.  
    While we appreciate the Agency’s effort to provide a six-month participation period in the latter half of 2019 for MSSP ACOs, many have informed us it will be challenging, if not impossible, to meet CMS’s February 19 deadline. ACOs are not typically a single entity but rather a network of different providers affiliated under the legal umbrella of the ACO including physician groups, hospitals, and skilled nursing facilities. To be successful, ACOs need time to obtain buy-in from ACO entity participants, boards and leadership regarding new or continued participation. Some ACOs can include nearly 200 unique sets of providers and must secure sign-on from multiple boards and governing bodies before finalizing applications. ACOs must engage with actuaries to determine participation options under the agency’s final rule, options which are difficult to determine given the complexity of the changes and the agency’s decision to move ACOs into risk faster. Further, the accelerated pathway to risk requires many applicants to seek guarantees with financial organizations unfamiliar with the MSSP and requiring personal guarantees from often hundreds of signers.  

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