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CMS Issues Accountable Care Organization (ACO) Proposed Rule

  
  
  

CMS recently posted the much-anticipated proposed rule covering Accountable Care Organizations (ACOs). ACOs are intended to create incentives for health care providers to work together to treat an individual patient across care settings. Medicare will reward ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting patients first. Patient and provider participation in an ACO is purely voluntary. In order to participate, an ACO must agree to accept responsibility for at least 5,000 beneficiaries.

A CMS fact sheet on ACOs and the proposed rule is available here.

The Affordable Care Act (ACA), which became law a year ago, requires CMS to establish the ACO Shared Savings Program by January 1, 2012. The ACA specified that an ACO may include the following types of groups of providers and suppliers of Medicare-covered services:

• ACO professionals (physicians and hospitals meeting the statutory definition) in group practice arrangements

• Networks of individual practices of ACO professionals

• Partnerships or joint ventures arrangements between hospitals and ACO professionals

• Hospitals employing ACO professionals

• Other Medicare providers and suppliers as determined by the Secretary

 

SNFs and other post acute settings are not specifically specified as ACO participants in the proposed rule. However, long term and post acute providers would be able to participate in an ACO that was established by one or more of the statutorily designated participants. NASL is reviewing the proposed rule and will be providing additional information shortly.

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