CMS BPCI-A Model Year 3 FAQ | fusion5

Q1. How can a current Non-Convener Participant become a Convener Participant for Model Year 3?

A1. Current Non-Convener Participants have one of two options in order to switch roles for Model Year 3:

  • Option 1: During the application submission period (April 24th, 2019-June 24th, 2019), submit an EI Addition Template in the Participant Portal, listing all the potential Episode Initiators, for their current BPID. This would result in all potential Episode Initiators being under one Participation Agreement if selected for participation. Under this option, the Participant would not be able to restructure to have its Episode Initiators under separate Participation Agreements following the submission of the EI Addition Template. 

  • Option 2: During the application submission period, submit a Convener Participant application(s) in the Application Portal, listing all the potential Episode Initiators on the Participating Organizations attachment. The Application Portal gives Applicants and current Participants greater flexibility to apply in different ways and permutations. Therefore Applicants/Participants have the option of submitting separate applications for each potential Episode Initiator or submitting an application containing all potential Episode Initiators, or any combination thereof, based on how they would want to structure for Model Year 3. Applicants and Participants should submit an application for each potential Participation Agreement they would like to have if selected for participation. 

  • Important Note: For a Non-Convener Participant to become a Convener Participant, they must have at least one Downstream Episode Initiator. A Non-Convener Participant cannot simply apply as a Convener Participant and only put themselves on the Participating Organizations attachment or submit an EI Addition Template only listing themselves. Doing so, would not satisfy the definition of a Convener Participant and would not result in a role change.  

 

 

Q2. How can a current Convener Participant become a Non-Convener Participant for Model Year 3?

A2. Current Convener Participants, who are Episode Initiators, but no longer wish to have any Downstream Episode Initiators, have one of two options in order to switch roles for Model Year 3:

  • Option 1: Submit an updated Participant Profile, due in November 2019, indicating only themselves as "Active" with at least one "Active" Clinical Episode, and withdraw all Downstream Episode Initiators and their corresponding Clinical Episodes. For this option, no action is required during the application submission period, however, other Model timeline milestones are applicable, including but not limited to submission of a Participation Agreement, and Model deliverables. 

  • Option 2: During the application submission period, submit a Non-Convener Participant application in the Application Portal. When Participation Agreements and Participant Profiles are due in November 2019, the Participant should not submit a Participation Agreement for their existing Convener Participant BPID (for Model Years 1 &2) and must submit a Participant Profile withdrawing all Episode Initiators (including themselves) and Clinical Episodes. For their new Non-Convener BPID (for Model Year 3), the Participant must submit a Participation Agreement and submit their Participant Profile indicating  themselves as an “Active” Episode Initiator and have at least one “Active” Clinical Episode. 

 

 

Q3. How can a current Downstream Episode Initiator become a Participant for Model Year 3?

A3. Current Downstream Episode Initiators only have one option to switch roles for Model Year 3During the application submission period, the Downstream Episode Initiator must submit either a Convener or Non-Convener Participant application in the Application Portal. If selected for participation, the Downstream Episode Initiator will need to ensure their existing Convener Participant (for Model Years 1 & 2) withdraws them as a Downstream Episode Initiator and all their Clinical Episodes on the Participant Profile due in November 2019.

 

 

Q4. How can a current Participant become a Downstream Episode Initiator for Model Year 3?

A4. Current Convener Participants who themselves are Episode Initiators, and no longer wish to have any Downstream Episode Initiators and Non-Convener Participants, only have one option in order to switch roles for Model Year 3, The Participant must submit an updated Participant Profile, due in November 2019, withdrawing all Episode Initiators (including themselves) and Clinical Episodes and not submit a Participation Agreement. During the application submission period, the new potential Convener Participant (for Model Year 3) must submit either an application listing the Participant on the Participating Organization’s attachment in the Application Portal or submit an EI Addition Template listing the Participant in the Participant Portal.

 

Q5. How can a Downstream Episode Initiator switch Convener Participants for Model Year 3?

A5. If a Downstream Episode Initiator would like to switch Convener Participants for Model Year 3,During the application submission period, the new Convener Participant (for Model Year 3) would need to submit either an application listing the Downstream Episode Initiator on the Participating Organization’s attachment in the Application Portal or an EI Addition Template listing the Downstream Episode Initiator in the Participant Portal. When Participant Profiles are due in November 2019, the existing Convener Participant (for Model Years 1 & 2) would need to select "withdraw" for the Downstream Episode Initiator and all their corresponding Clinical Episodes. The new Convener Participant (for Model Year 3) would have to submit their Participant Profile, ensuring to select "Active" for the Downstream Episode Initiator and “Active” for at least one Clinical Episode.  

 

 

Q6. What does a current Participant, who would like to continue participating as is, need to do during the application submission period?

A6. Current Participants that would like to continue participating as is for Model Year 3, do not need to take any action during the application period. However, they will need to submit a Participation Agreement and Participant Profile in November 2019 and other Model deliverables in December 2019.

 

 

Q7. Can a Downstream Episode Initiator withdraw from their current Convener Participant, prior to the end of Model Year 2 (12/31/2019)?

A7. CMS is not privy to the agreement a Participant has with their Downstream Episode Initiators, however, a Participant shall not take steps to prohibit Downstream Episode Initiators that have formerly participated in BPCI Advanced pursuant to an agreement with the Participant from rejoining BPCI Advanced pursuant to an agreement with another Convener Participant or Non-Convener Participant or as a Convener Participant or Non-Convener Participant themselves. If a Downstream Episode withdraws from their agreement with their Convener Participant prior to December 31st, 2019, the Convener Participant will still be held accountable for that Downstream Episode Initiator’s Clinical Episodes for the remainder of Model Year 2, unless the Convener Participant provides 90 Days advance written notice to CMS to terminate their entire Participation Agreement with CMS. Further, the Downstream Episode Initiator may take the steps discussed previously in order to be able to participate under a different Convener Participant or as a Participant itself.   

 

Thank you,

CMS BPCI Advanced Team

5/9/2019

 

 

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