CMS Announces Open Application Period for Bundled Payments for Care Improvement Initiative
The Centers for Medicare & Medicaid Services (CMS) published an article in the Federal Register on February 14 announcing the open period for providers to apply for participation in its Bundled Payments for Care Improvement (BPCI) initiative. Intake forms for Models 2, 3, and 4 must be submitted by April 18, 2014.
In August 2011, CMS requested its first round of applications for providers interested in participating in one of four episode payment models through the BPCI initiative; the first round of selected providers were announced on January 31, 2013.
A summary of the four models of care follow. Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) are specifically included in both Models 2 and 3, according to the Bundled Payments for Care Improvement Initiative Fact Sheet. While not specifically mentioned, O&P care and devices will be covered under Model 4 if provided during that model’s criteria, according to a CMS spokesperson: “Model 4 includes Medicare payments for all services during an inpatient admission (which would include devices used during a surgery), Part B professional services provided during that inpatient hospitalization, and all Part A and Part B services during clinically related readmissions that may follow within 30 days of that inpatient stay.”
- Model 1: Retrospective Acute Care Hospital Stay Only. The episode of care is defined as the inpatient stay in the acute care hospital.
- Model 2: Retrospective Acute Care Hospital Stay plus Post-Acute Care. The episode of care will include the inpatient stay in the acute care hospital and all related services during the episode.
- Model 3: Retrospective Post-Acute Care Only. The episode of care will be triggered by an acute care hospital stay and will begin at initiation of post-acute care services with a participating skilled nursing facility, inpatient rehabilitation facility, long-term care hospital, or home health agency.
- Model 4: Acute Care Hospital Stay Only. CMS will make a single, prospectively determined bundled payment to the hospital that would encompass all services furnished during the inpatient stay by the hospital, physicians, and other practitioners.
The announcement includes the selection of 32 awardees in Model 1 that will begin testing bundled payments for acute-care hospital stays as early as April 2013. In the coming weeks, CMS will also announce a second opportunity for providers to participate in Model 1, with an anticipated start date of early 2014.
