CMS issues final rule on ACOs

On October 20, 2011, CMS published the final rule on Accountable Care Organizations (ACOs) or, as it is formally known, the Medicare Shared Savings Program (the "Program"), enacted as part of the Patient Protection and Affordable Care Act (ACA) of 2010. According to CMS chief Don Berwick, MD, the Program represents an "opportunity to coordinate care among providers," which could "greatly improve the quality of care Medicare beneficiaries receive," and produce substantial savings for the federal government. The Program creates incentives for providers to collaborate in treating an individual patient across care settings, in order to receive a portion of the savings generated from providing such care. 

CMS has substantially relaxed the requirements for ACOs originally provided in the proposed rule. Some of the key changes include (among many others):

  • Adding a "one-side" risk model, allowing providers to participate in the program without risking a loss in the event their ACO did not produce savings
  • "Preliminary perspective assignment" of Medicare beneficiaries, giving ACOs more control over their Medicare beneficiary population
  • Reducing the number of performance measures from 65 to 33
  • Eliminating the two percent threshold for being eligible for shared savings

CMS will begin taking applications for the program on January 1, 2012, with start dates of April 1 and July 1, 2012.

 Important links via HHS press release:

The Shared Savings Program final rule can be found at: http://www.HealthCare.gov/law/resources/regulations/index.html. (See Final Rule on Shared Savings Program: Accountable Care Organizations)

The Advanced Payment solicitation is posted at: http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment/.

For more information, fact sheets are posted at: http://www.HealthCare.gov/news/factsheets/2011/10/accountable-care10202011a.html and http://www.cms.gov/ACO/.

The joint CMS and Department of Health and Human Services Office of Inspector General (OIG) Interim Final Rule with Comment Period addressing waivers of certain fraud and abuse laws in connection with the Shared Savings Program can be found at: http://www.HealthCare.gov/law/resources/regulations/index.html. (See Request for Public Comment on Final Waivers in Connection with the Shared Savings Program).

The Antitrust Policy Statement is posted at: www.ftc.gov/opp/aco/ andhttp://www.justice.gov/atr/public/health_care/aco.html.

The Internal Revenue Service (IRS) Fact Sheet, Tax-Exempt Organizations Participating in the Medicare Shared Savings Program through Accountable Care (FS-2001-11), is posted at: http://www.irs.gov/newsroom/article/0,,id=248490,00.html.

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