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CMS Releases Final Rule for Accountable Care Organizations

Today, the Centers for Medicare and Medicaid Services (CMS) released its final rule for Medicare’s Accountable Care Organizations (ACO). The program is designed to encourage health care providers to coordinate care in order to achieve cost-savings and improve the quality of care for Medicare patients. Due to substantial criticism from the health care industry, CMS made a number of significant modifications to the proposed rules that were released in March. According to CMS, these modifications include:

  • Greater flexibility in eligibility to participate in the Shared Savings Program
  • Multiple start dates in 2012
  • Establishment of a longer agreement period for those starting in 2012
  • Greater flexibility in the governance and legal structure of an ACO
  • Simpler and more streamlined quality performance standards
  • Adjustments to the financial model to increase financial incentives to participate
  • Increased sharing caps
  • No down-side risk and first-dollar sharing in Track 1
  • Removal of 25 percent withhold of shared savings
  • Greater flexibility in timing for the evaluation of sharing savings (claim run-out reduced to 3 months)
  • Greater flexibility in antitrust review
  • Greater flexibility in timing for repayment of losses
  • Additional options for participation of FQHCs and RHCs

If you have any questions about ACO participation, or any other health law questions, please contact a Wachler & Associates attorney at 248-544-0888.