Medicare Proposal on Accountable Care Organizations Released
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule regarding Accountable Care Organizations (ACOs) (March 31, 2011, Display Copy, CMS-1345-P).
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 lengthy proposed 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, such as the annual wellness visit, from ACO providers.
CMS and the Office of the Inspector General (OIG) have also issued a companion proposed rule on Waivers in Connection with the Medicare Shared Savings Program and the Innovation Center (March 31, 2011, Display Copy, CMS-1345-NC2). This proposal would waive the Physician Self-Referral Law, the federal anti-kickback statute, and certain civil monetary penalties law provisions for specified financial arrangements involving ACOs. It would also waive fraud and abuse laws so that the Center for Medicare & Medicaid Innovation—another part of the Medicare Shared Savings Program—could carry out its mission of testing new payment and service delivery models.
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AOTA is reviewing these documents and offers members an in-depth analysis of the proposed rules and their implications for occupational therapy below; we will also be soliciting your feedback (email@example.com) and drafting comments to submit to CMS in the next few months.
AOTA Analysis: Proposed Rule for Medicare Shared Savings Program and Accountable Care Organizations (ACOs)