In accordance with New York State’s recently enacted accountable care organization (“ACO”) law (Article 29-E of the New York Public Health Law), the New York State Department of Health (“DOH”) will begin to process applications for Medicare-only ACOs to obtain certification under the new statute. The so-called “fast-track certification” under the statute will grant protection for ACO operations under several New York laws, including those pertaining to fee-splitting; corporate practice of a profession; practitioner self-referrals (New York Stark law); anti-trust and restraint of trade. However, under fast-track certification, such protection will only extend to the ACO’s coordination of care for Medicare beneficiaries. ACO activities related to others (i.e., members of commercial insurance health plans) will not be eligible for the legal immunities that flow from the fast-track certification. This more broadly applied protection will not be available until the DOH has promulgated the ACO regulations.
It is expected that the New York State Department of Health soon will issue a letter instructing potential Medicare-only ACO applicants to submit documentation to the DOH’s Hospital Review and Planning Council. It is expected that the DOH will review the following items as part of the application process:
1) The ACO’s CMS letter of approval 2) The ACO’s signed agreement with CMS 3) The ACO’s application to CMS for ACO status 4) The ACO’s formation documents
If you have any questions regarding the fast-track certification process or other questions regarding ACOs, please contact Claudia Hinrichsen, Esq. or visit The HLP website.