Policy Update: An Attempt to Level the Playing Field between Rural and Urban ACOs

The cicadas are singing at full volume in DC. Seriously, it is difficult to hold a conversation outside. I do not know what the ICD-10 code is for being hit by a cicada, but if it exists it is probably in use. That is the main noise coming out of DC right now where things are otherwise pretty quiet in health policy.

Payment Increased for COVID Vaccination in the Home

Medicare is raising the vaccine administration payment from about $40 a dose to about $75 a
dose when the vaccine is administered in the patient’s home. In order to receive a vaccine at
home, the patient does need to have an extenuating circumstance such as greater susceptibility
to COVID-19, difficulty leaving home due to a clinical or socioeconomic reason, or other barriers
that significantly reduce a patient’s ability to receive a vaccine outside of their home. The patient
does not have to be homebound. The code for the extra payment is M0201.

Congress Introduces Bill to Increase Savings and Level the Playing Field between Rural and Urban ACOs

Back in 2018, Aledade identified a policy challenge with regional trends in MSSP where an ACO
would lower its savings by lowering its regional year-over-year inflation increases in costs. This
problem can be explained using the example that 10,000 beneficiaries in Kansas make up a larger percentage of the region than 10,000 beneficiaries in Washington, D.C. Therefore, Kansas ACOs are much more affected than D.C. ACOs simply because they serve a larger piece of the total market, having nothing to do with performance. Due to this disparity, Aledade coined the term “rural glitch.” CMS should fix this directly, but so far they have not. So, we worked with AAFP,
NAACOS, Premier, and many others to have Congress introduce a fix in a bipartisan fashion today.