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AOTA Analysis: Final Rule for Medicare Shared Savings Program and Accountable Care Organizations (ACOs)

The Centers for Medicare & Medicaid Services (CMS) has issued its final rule regarding Accountable Care Organizations (ACOs), which was published in the November 2, 2011 Federal Register. This final rule follows the agency's proposed rule, which AOTA analyzed and submitted comment.  Authorized by section 3022 of the Affordable Care Act (the health care reform law), ACOs are designed to create incentives for health care providers to work together to treat an individual patient across care settings. ACOs that lower health care costs while meeting performance standards on care quality will be eligible to receive financial incentives through the Medicare Shared Savings Program.

Under the final rule, the providers participating in an ACO would work together to coordinate care and as patients move among practitioners’ offices, hospitals, laboratories, and other settings in an effort to streamline the process and eliminate duplication and errors. Patient and provider participation in an ACO is voluntary, and Medicare beneficiaries are expected to still be able to obtain their regular Medicare fee-for-service benefits. Some of the barriers to entry found in the proposed rule were eliminated in the final rule, incentivizing provider participation. For example, providers will be able to start sharing in the savings earlier, the number of quality measures that must be met for purposes of performance bonuses was reduced from 65 measures in five domains to 33 measures in four domains, and providers will know earlier which beneficiaries have or are likely to be assigned to their ACO.

CMS and the Office of the Inspector General (OIG) have also issued a companion interim final rule addressing waivers of the Physician Self-Referral Law, the federal anti-kickback statute, and other fraud and abuse laws for ACOs. The Department of Justice (DOJ) and Federal Trade Commission (FTC) released an Antitrust Policy Statement on ACOs and the Internal Revenue Service (IRS) issued a fact sheet for tax-exempt organizations participating in the program.

All rules take effect January 1, 2012.

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AOTA is analyzing these documents and preparing informational materials for occupational therapy practitioners. Please send questions/comments to rrpd@aota.org.

References:

AOTA Comments on Proposed Rule (December 3, 2010)

AOTA Analysis: Proposed Rule for Medicare Shared Savings Program and Accountable Care Organizations (ACOs)

ACOs Final Rule (Display Copy - October 20, 2011)

CMS Fact Sheet on ACOs

CMS & OIG Interim Final Rule on Fraud and Abuse Waivers (Display Copy - October 20, 2011)

DOJ & FTC Antitrust Policy Statement (October 20, 2011)

IRS Fact Sheet, Tax-Exempt Organizations Participating in the Medicare Shared Savings Program through Accountable Care (FS-2001-11)