ACO Final Rule Released

The Department of Health and Human Services has released its final rule for accountable care organizations, according to an HHS release.

CMS Administrator Donald Berwick, MD, said the more than 1,300 comments received after the proposed rule were taken into serious consideration and the final rule "includes a number of improvements suggested by those comments."

For instance, the final rule increases the incentives and streamlines the Medicare Shared Savings Program, extending the benefits to a broader range of beneficiaries. Other changes include expanding participation to rural health clinics, federally qualified health centers and organizations where specialists provide primary care, and providing a flexible starting date in 2012.

"This model of delivering care may not be right for everyone, but it provides new incentives for doctors, hospitals, and other healthcare providers to work together in new ways," HHS Secretary Kathleen Sebelius said in the release.

The final rule rounds out to 700 pages and can be read in full here.

Meanwhile, several government agencies have responded to the ACO final rule with relevant notices.

CMS and the Office of Inspector General released an interim final rule that establishes waivers for application of the physician self-referral law; the federal anti-kickback statute and certain civil monetary penalties law provisions to specified arrangements involving ACOs. The federal agencies propose the waivers so as not to unduly slow the development of ACOs under the Shared Savings Program. The interim final rule is subject to a 60-day comment period.

In addition, the Federal Trade Commission and the Department of Justice published a final antitrust enforcement policy statement in the wake of the ACO final rule that differs in two ways from the interim policy statement. Firstly, the final policy statement applies to all collaborations that are eligible or have been approved to participate in the Shared Savings Program (the interim policy statement was limited to collaborations formed after March 23, 2010).

The FTC/DOJ final policy statement also no longer contains provisions relating to mandatory antitrust review, as the Shared Savings Program final rule will no longer require a mandatory antitrust review for certain collaborations as a condition of entry into the program.

Lastly, the Internal Revenue Service has published a fact sheet relating to tax-exempt organizations participating in the Shared Savings Program through an ACO.

Related Articles on the ACO Final Rule:

Final ACO Rule Expected Soon
Rep. Michael Burgess Hopes CMS "Scraps" Initial Approach to ACOs in Final Rule
50 Things to Know About the Proposed ACO Regulations

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