Proposed Rule Issued on Medicare Shared Savings Program for ACOs

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Proposed Rule Issued on Medicare Shared Savings Program for ACOs

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After an almost three-year delay, on December 1, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule which would modify the regulatory requirements for Accountable Care Organizations (“ACOs”) that participate in the Medicare Shared Savings Program (“MSSP”). The proposed rule, 114 pages in length, was published in the Federal Register on December 8, 2014. Since the inception of the MSSP, participants have addressed concerns about the framework of ACOs. CMS is hoping that the proposed rule will improve the framework and encourage more participation in the MSSP.

Medicare Shared Savings Program Background

As noted in the Federal Register, “The Centers for Medicare and Medicaid Services define an Accountable Care Organization as an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries assigned to it. The ACO payment and delivery reform model is an alternative to traditional fee-for-service programs. Section 3022 of the Patient Protection and Affordable Care Act creates the Medicare Shared Savings Program, allowing ACOs to contract with Medicare by January 2012. According to the ACA, the Medicare Shared Savings Program promotes accountability for a patient population and coordinates items and services under Part A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery.”

Major Provisions

The proposed rule addresses changes to the MSSP, including provisions relating to the payment of ACOs participating in the MSSP. Under the MSSP proposed rule, providers of services and suppliers that participate in an ACO continue to receive traditional Medicare fee-for-service payments under Parts A and B; however, the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements.

The proposed rule is intended to bring structure to the current guidance while reducing the administrative burden and improving the MSSP’s function and transparency. The following ten areas are addressed in the proposed rule with the aim of accomplishing this intention:

  1. Data-sharing requirements;
  2. Requirements for ACO participant agreements, the ACO application process, and review of applications;
  3. Identification and reporting of ACO participants and ACO providers/suppliers, including managing changes to the list of ACO participants and ACO provider/suppliers;
  4. Eligibility requirements related to the ACO’s number of beneficiaries, required processes, the ACO’s legal structure and governing body, and its leadership and management structure;
  5. Modification to assignment methodology;
  6. Repayment mechanisms for ACOs in two-sided performance-based risk tracks;
  7. Alternatives to encourage participation in risk-based models;
  8. ACO public reporting and transparency;
  9. The ACO termination process; and
  10. The reconsideration review process.

Conclusion

According to CMS, the MSSP now includes more than 330 ACOs and more than 125,000 Medicare enrolled practitioners. They function in 47 states, in addition to DC and Puerto Rico. Roughly 4.9 million beneficiaries are assigned to these ACOs.

CMS allowed for comments with respect to the proposed rule for a period of sixty days after publication in the Federal Register via mail or electronic submission. It is expected that these comments will lead to changes and adjustments prior to the issuance of the final rule. The changes will impact new ACOs entering the MSSP in 2016 or those renewing their agreements for another three-year period.

Learn More About the Proposed Rule

Ask Our Experts

Please contact a member of WS+B’s Healthcare Services Group at [email protected] for further questions or assistance.

The information contained herein is not necessarily all inclusive, does not constitute legal or any other advice, and should not be relied upon without first consulting with appropriate qualified professionals for your individual facts and circumstances.

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