10/21/11

Health Care Alert: CMS Releases ACO Final Rule

Related Practices

Attorneys & Professionals

On October 20, 2011, the Centers for Medicare and Medicaid Services (“CMS”)  released its final rule implementing provisions of the Medicare Shared Savings Program for Accountable Care Organizations (“Final Rule”), created in last year’s Health Reform legislation.1  The Final Rule will be published in the Federal Register on November 2, 2011. 

CMS implemented the Shared Savings program as part of its broader efforts targeted at improving coordination of care, encouraging investment in infrastructure and redesigned care processes, and incenting higher value care.  Accountable Care Organizations (“ACOs”) that meet quality standards and generate savings will share in these savings with the Medicare Program.  In a previous publication, we discussed the provisions of CMS’s proposed rule.2  In response to more than 1300 public comments, CMS has made significant modifications aimed at reducing the burden and cost for participating ACOs.  Major changes to the Medicare Shared Savings Program proposed rule include the following:

In conjunction with CMS’s Final Rule, other federal agencies issued documents addressing a number of other issues regarding ACOs.  CMS and the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) jointly issued an interim final rule establishing five waivers of the Stark Physician Self-Referral Law, the Anti-Kickback Statute, and certain provisions of the Civil Monetary Penalty Law.  The Federal Trade Commission and the Department of Justice jointly issued a “Statement of Antitrust Enforcement Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program.”  Finally, the Internal Revenue Service has created a Fact Sheet with Questions and Answers entitled “Tax-Exempt Organizations Participating in the Medicare Shared Savings Program Through Accountable Care Organizations.”  Further analysis of this guidance will be forthcoming. 

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Patient Protection and Affordable Care Act (“ACA”), Pub. L. 111-148, 124 Stat. 119, as amended by Health Care and Education Reconciliation Act of 2010, Pub. L. 111-152, 124 Stat. 1029.

Medicare Shared Savings Program:  Accountable Care Organizations 76 Fed. Reg. 19528 (April 7, 2011).