CMS Releases Proposed ACO Regulations

By Lauren Simpson

Today CMS released proposed regulations for Accountable Care Organizations. The proposed rules are designed to help facilitate care coordination for Medicare patients through creation of incentives, motivating health care providers to work together to treat an individual across multiple care settings. At a quick glance, here are a few of the highlights:

• Beneficiaries do not have to enroll in a specific ACO. Instead, the rule indicates that Medicare will look at the patient’s use of services retrospectively in order to determine which ACO to credit with the care provided. This is designed to incent all ACOs to work towards improving the quality of care for all patient seen, rather than solely focusing on particular patients that are attributed to their organization.
• Under the proposed rule, ACOs refer to a group of providers and suppliers of services that will work together to coordinate care for Medicare fee-for-service beneficiaries they serve. An ACO will be a patient-centered organization where patients and providers are partners in decision-making.
• As part of the Affordable Care Act (section 3302), the Medicare Shared Savings program will reward ACOs that are able to curb rising health care costs while still providing high-quality, evidence-based care for patients. Medicare will continue to pay individual providers and suppliers in a fee-for-service model, but there will be an established benchmark for savings above which ACOs will receive a shared savings payment and below which ACOs will be held liable for losses.

There will be a 60 day public comment period on this proposed rule. Arcadia will be discussing these proposed regulations and considering the need for a response.

In the interim, check out Kaiser Health News. They’ve aggregated some helpful resources from the Department of Health and Human Services, including fact sheets and a video about the proposed regulations.