CMS Issues Final Rule on Medicare ACO Program

On October 20, 2011, the Centers for Medicare and Medicaid Services (CMS) issued the final rule to implement the Medicare Shared Savings Program (MSSP), making substantial changes to the proposed rule so that health centers may now participate meaningfully in a key Accountable Care Organization (ACO) initiative of health reform.

Key changes to the final rule include:

• Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are now eligible to independently form an ACO.
• Beneficiaries are initially prospectively assigned with a retrospective reconciliation at the end of a performance year.
• The number of quality performance measures has been reduced from 65 across five domains to 33 across four domains.
• ACOs participating in Track 1 (the one-sided risk model) no longer face down-side risk in the third performance year.

At the same time the final rule was released, CMS and the Office of Inspector General (OIG) finalized two proposed waivers to permit shared savings distributions and other aspects of ACO arrangements implicating fraud and abuse laws. In addition, the agencies proposed additional waivers to address start-up and operating activities and incentives offered to beneficiaries to encourage preventative care and patient compliance.

CMS will accept applications from prospective ACOs after January 1, 2012. The final rules can be found in the e-Library at HealthCenterCompliance.com.