CMS proposes 6 updates to its Ambulatory Specialty Model for heart failure

CMS has proposed a number of changes to the Ambulatory Specialty Model (ASM) for heart failure in the 2027 Medicare Physician Fee Schedule proposed rule, according to an Aug. 12 news release from the American College of Cardiology.

Here are six things to know:

1. CMS has proposed scoring the Risk-Standardized Acute Unplanned Cardiovascular-Related Admission Rates for Patients with heart failure, one of the model’s five quality measures, at the individual level beginning in 2027. 
2. The proposal adds exceptions for participants whose specialty designation is outdated or who are changing their Tax Identification Number. CMS has encouraged participants to keep their Medicare enrollment info current through the Provider Enrollment, Chain and Ownership System or the CMS-855 form.
3. Under the proposal, multiple ASM participants under the same Tax Identification Number would be allowed to operate under a single collaborative care agreement with a primary care practice rather than separate agreements per clinician.
4. CMS proposed loosening the shared-beneficiary requirement so it only requires at least one shared ASM beneficiary instead of multiple beneficiaries. The proposal also drops the requirement that the beneficiary be an “established” patient.
5. CMS also proposed broadening the definition of allowable support under a collaborative care agreement from “payment” to “remuneration,” opening the door for in-kind arrangements, such as staff support or equipment, in addition to monetary compensation, subject to program requirements.
6. The agency proposed aligning ASM’s interoperability requirements with MIPS Promoting Interoperability standards by removing certain attestation requirements, adding a voluntary electronic prior authorization measure and clarifying exclusions for clinical data exchange. 

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