The Highly Anticipated ACO Guidance Has Been Issued!

On Thursday, March 31, 2011, the Centers for Medicare & Medicaid Services (“CMS”) provided the health care community with some much needed guidance by publishing its Proposed Rule regarding the Medicare Shared Savings Program (the “Shared Savings Program”) and its Accountable Care Organizations (“ACOs”). There is a sixty (60) day public comment period with respect to the Proposed Rule and CMS has encouraged members of the public, including physicians, to submit comments for consideration while the final regulations are being developed.

Within its almost 500 pages of text, the Proposed Rule sets forth an abundance of specific requirements that the ACOs will likely need to satisfy. In addition, the Proposed Rule provides further information regarding the payments that ACOs will receive from CMS. Notably, the Proposed Rule would not only allow ACOs to receive a share of the cost-savings that it generates based upon a benchmark set by CMS but would also require ACOs, at least eventually, to accept downside risk by requiring the ACOs to repay Medicare expenditures above the CMS benchmarks.

It is also important to note that the Proposed Rule was only one of several helpful publications simultaneously issued by Federal agencies, including the U.S. Department of Health and Human Services Office of Inspector General, the Federal Trade Commission, the Department of Justice and the Internal Revenue Service, in a coordinated effort to address barriers and resolve ambiguities with respect to the operation of the Shared Savings Program under health care fraud and abuse, anti-trust and tax exempt laws.

Additional information regarding each of these developments and the Proposed Rule itself can be found at http://www.cms.gov/sharedsavingsprogram/.

For more information, please contact the Health Law Partners, PC at (248) 996-8510, (212) 734-0128, or (770) 804-6475 or visit the ACO specialty page on the HLP website.