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CMS Seeks to Modify Rules for ACOs

Posted in Accountable Care Organizations, Affordable Care Act, Home Healthcare, Hospitals and Institutions, Legislation and Public Policy, Medicare and Medicaid, Private Insurers, Reimbursement Matters, State Matters

On December 1, the Centers for Medicare and Medicaid Services (CMS) announced the issuance of a proposed rule to update and improve the Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs) by emphasizing the provision of primary care services to patients and promoting performance-based risk arrangements. Pursuant to the proposed rule, ACO providers and suppliers will continue to receive traditional Medicare fee-for-service payments and ACOs may be eligible to receive shared savings payments if they satisfy certain quality and cost-savings requirements.

The proposed rule seeks to, among other things:  

  • Modify some of the eligibility requirements for ACO participation in the MSSP; 
  • Provide flexibility to ACOs seeking to renew their participation in the MSSP; 
  • Create new risk-based models to encourage more ACOs to assume performance-based risk, with the possibility of a greater share of the savings; 
  • Refine the manner in which Medicare beneficiaries are assigned to ACOs by placing more emphasis on primary care services that may be provided by non-physician practitioners; 
  • Establish ACO benchmarks that are focused on ACO success and cost efficiency; and 
  • Streamline the process for ACOs to access Medicare beneficiary claims data while permitting beneficiaries the option to decline to have their claims shared with ACOs.

The proposed rule makes changes to a rule promulgated by CMS in November 2011 that implemented the MSSP, which was established under the Affordable Care Act. The MSSP encourages the creation of ACOs by healthcare providers and suppliers, promotes accountability and improved care coordination, and encourages investment in the provision of high-quality healthcare.
CMS is seeking public comments on the proposed rule by February 6, 2015. The provisions of the proposed rule, if adopted, will become effective 60 days after publication of a final rule by CMS.

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