Click here for summary of ACO proposed regulations and guidance documents
Five federal agencies issued a series of proposed regulations and guidance documents related to Accountable Care Organizations (ACOs) created by the Patient Protection and Affordable Care Act (PPACA). The Centers for Medicare and Medicaid Services (CMS) released a proposed rule to establish the ACO criteria required by PPACA. CMS and the Department of Health and Human Services Office of Inspector General (OIG) jointly issued a notice with comment period regarding waiver of fraud and abuse laws for qualified ACOs.
The Department of Justice (DOJ) and Federal Trade Commission (FTC) issued joint guidance regarding application of antitrust laws to ACOs. The Internal Revenue Service (IRS) also released a notice and request for comments regarding whether current IRS guidance is adequate for participation of tax-exempt organizations in ACOs involving non-exempt entities.
The Healthcare Department of Barnes & Thornburg has prepared the attached summary of significant provisions of the proposed ACO regulations and guidance documents issued by these agencies. This summary is intended to assist healthcare providers in navigating their way through the proposed rules and guidance documents.
The attached chart provides detail on many provisions of the proposed rules and guidance, including, but not limited to, the following topic areas:
- Shared Savings Program requirements.
- Legal structure, governance, leadership and management of ACOs.
- ACO compliance plans.
- Assignment of beneficiaries.
- Payment and treatment of savings.
- Quality reporting.
- Monitoring reporting and disclosure requirements.
- Fraud and abuse proposed waivers.
- ACO antitrust proposed enforcement policies.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
