Centers For Medicare & Medicaid Services Releases Final ACO Rule and Additional Guidance

On October 20, 2011, the Centers for Medicare & Medicaid Services released the final rule on the Medicare Shared Savings Program, in addition to further related guidance, for Accountable Care Organizations ("ACOs"). The Shared Savings Program is an initiative geared toward more coordinated care among providers. The program enables ACO providers and suppliers to receive traditional fee-for-service payments under Medicare Parts A and B, and to become eligible for additional payments if they meet program quality standards and savings requirements. According to the Department of Health and Human Services ("HHS"), the final rule includes broader incentives and a streamlining of the program in comparison to the earlier proposed rule. The regulations will go into effect 60 days after publication in the Federal Register, which is slated for November 2, 2011. Click here for the final rule.

In addition to the final Shared Savings Program rule, CMS has released (1) a notice announcing testing of the Advance Payment Model for ACOs, and (2) an interim final rule with comment period on waivers of application of the physician self-referral law, anti-kickback statute, and certain civil monetary penalty provision to ACOs. The first notice provides information for interested physician-owned and rural providers participating in the Shared Savings Program, with background about the model and the application process. Click here for the notice. Click here for the interim final rule on waiver provisions, issued jointly with the HHS Office of Inspector General. Comments on the interim final rule are due 60 days after publication in the Federal Register, also slated for November 2, 2011.

Finally, in addition to the CMS guidance on ACOs, the Federal Trade Commission and the Department of Justice released the final version of their joint policy statement addressing enforcement of antitrust law in the ACO and Shared Savings program context. The final policy statement was published in the Federal Register on October 28, 2011, and can be found at http://www.ftc.gov/os/fedreg/2011/10/111020aco.pdf.