Proposed Accountable Care Organization Regulations

| April 25, 2011

On April 7, 2011, the Centers for Medicare & Medicaid Services ("CMS") issued its proposed regulations covering Accountable Care Organizations ("ACOs"). When adopted in final form, this rule will implement Section 3022 of the Patient Protection and Affordable Care Act, which requires CMS to establish a Shared Savings Program by January 1, 2012. These proposed regulations are the first in a series, and set forth the basic eligibility requirements for ACOs to participate in the Shared Savings Program; quality of care and other reporting measures; the methodology for assigning Medicare beneficiaries to ACOs; the payment methodologies under the Shared Savings Program; monitoring of ACOs for compliance with applicable criteria; and the sanctions for non-compliance. Comments regarding the proposed regulations are due by June 6, 2011. This alert is intended to provide only a high level summary of the proposed regulations.

The proposed regulations define an ACO as a legal entity recognized to conduct business under state law, with a governance structure that will enable it to receive and distribute shared savings, establish and report compliance with the ACO quality and reporting requirements, and perform other tasks set forth in the regulations. An ACO may be established by: (a) professionals in group practices, (b) networks of individual practices, (c) ventures between hospitals and professionals, (d) hospitals who employ professionals, and (d) critical access hospitals. Other health care providers and suppliers may participate in an ACO, but they cannot establish an ACO. It is important to note that primary care professionals (which include professionals in the specialties of general practice, family practice, internal medicine or geriatric medicine) can only be ACO participants in a single ACO, whereas other types of providers, such as specialist physicians, may participate in multiple ACOs.    

Click here for full text of the alert.

Courtesy of McDonald Hopkins

Category: Pathology News

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