Wednesday, May 18, 2011

CMS Today Announces Three New Initiatives Intended to Enable Prospective Accountable Care Organizations to Hit the Ground Running

Legal Bulletin

By David A. Manko, Esq. and George Choriatis, Esq.

The Centers for Medicare and Medicaid Services (CMS) today announced three new initiatives in connection with its efforts to advance accountable care organizations (ACOs) – a new type of healthcare organization being promoted under the Patient Protection and Affordable Care Act (“Affordable Care Act”) enacted last year.  As discussed in our prior alerts, the Affordable Care Act requires CMS to establish a new Shared Savings Program under Medicare, which is intended to encourage physicians, hospitals, and other healthcare providers to form ACOs to assume accountability and coordinate their services for a defined patient population and to be rewarded for improving the effectiveness and efficiency of their care with respect to that patient population.  Today’s announcement follows several important developments regarding ACOs that have taken place over the past two months.  On March 31, 2011, CMS had issued proposed regulations implementing the Shared Savings Program.  On that same day, the HHS Office of Inspector General, the Federal Trade Commission, and the Internal Revenue Services had made various proposals to provide protection to ACOs under the federal healthcare fraud and abuse laws, the anti-trust laws, and the tax laws.  During that same week, the New York State legislature had enacted a law establishing an ACO demonstration project in New York State.  

The new initiatives announced by CMS today are intended to help ACOs hit the ground running when the Shared Savings Program commences, which is planned to commence in 2012.  These new initiatives are as follows:

(1)        The Center for Medicare and Medicaid Innovation (Innovation Center) is establishing a new “Pioneer ACO Model” program, which is intended to support “vanguard” organizations that already have extensive experience in coordinating care for patients and are well-poised to serve as ACOs to test innovative payment models and other innovations that differ from those established in the Shared Savings Program.  Up to 30 organizations will be accepted into the program.   Organizations interested in participating in the Pioneer ACO Model must submit to CMS a letter of intent by June 10, 2011 and a complete application by July 18, 2011. 

            (2)        The Innovation Center also issued a request for comments on a new initiative it is considering, the Advance Payment Initiative.  The Advance Payment Initiative, if implemented, would provide that certain ACOs participating in the Medicare Shared Savings Program would be entitled to receive pre-payments of a portion of their future shared savings for use in investing in the infrastructure necessary to coordinate care and improve value for patients.  Parties interested in submitting comments must do so by June 17, 2011.

(3)        CMS is establishing a new series of free training sessions, the Accelerated Development Learning Sessions.   The sessions will be made available to providers interested in participating in CMS’s ACO initiatives.  They will teach providers interested in becoming ACOs how to develop an action plan for moving toward providing better coordinated care.

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