The Centers for Medicare and Medicaid Services (CMS) has proposed several changes and clarifications to the Ambulatory Specialty Model (ASM) for heart failure (HF) in the 2027 Medicare Physician Fee Schedule proposed rule.

Several exception processes have been proposed, including for certain HF subspecialty redesignations and ASM participants moving TINs. ASM participants with an outdated specialty designation are encouraged to update their Medicare enrollment information promptly via PECOS or CMS-855.

The agency is also proposing to score the Risk-Standardized Acute Unplanned Cardiovascular-Related Admission Rates for Patients with HF (MIPS Q492), one of the model's five quality measures, at the individual (TIN/NPI) level beginning in 2027.

Additional updates are intended to reduce administrative burden and provide additional flexibility to ASM participants, including:

• Multiple ASM participants billing under the same TIN could participate in a single collaborative care agreement (CCA) with a primary care practice, rather than requiring separate agreements for each clinician.
• The shared-beneficiary requirement would be satisfied if at least one ASM beneficiary is shared between the primary care provider and any ASM participant named in the CCA. CMS also proposes removing the requirement that the beneficiary be an "established" patient.
• CMS proposes to broaden references from "payment" to "remuneration," allowing both monetary and in-kind support arrangements under a CCA, subject to program requirements.

CMS has also proposed several updates to align ASM with MIPS promoting interoperability requirements. Key proposals include:

• Removal of the Security Risk Analysis and ONC direct review attestations.
• Addition of a voluntary electronic prior authorization measure under the Health Information Exchange objective, which would become required in 2028.
• Clarification of exclusions for Public Health and Clinical Data Exchange measures.
• Adoption of a promoting interoperability measure suppression policy.

Navigate to ACC's ASM For HF webpage for more resources, including a new readiness guide.

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Centers for Medicare and Medicaid Services, U.S., Quality Indicators, Health Care, Primary Health Care, Health Information Exchange, Fee Schedules, Risk Assessment, ACC Advocacy, Heart Failure, Physicians, Policy