For those of you anxiously awaiting clarification from applicable government agencies regarding Accountable Care Organizations, good news!!! Clarification has arrived by way of proposed regulations and guidance from none other than CMS (Medicare), the Federal Trade Commission and the Department of Justice.
The documents released today are the beginning of the finalization process – now begins a period of public comment, promulgation and thereafter, adoption of final rules, regulations and guidance. If you would like to read the applicable documents, see below. If you have no interest in reading the approximate 500 pages of text, don’t worry, I have to read them and I will be providing the listserv with updates and synopses on an ongoing basis – starting next week. After brief review, I am pleased to report that it appears carve-outs to the Stark Law and Anti-kickback statute will be implemented in order for shared savings to become effectuated legally, however, be advised that any such exception will be extremely limited in scope, which we will outline in greater detail shortly.
FEDERAL TRADE COMMISSION/DEPARTMENT OF JUSTICE
(The FTC and DOJ are responsible for monitoring anti-competitive behavior. Because of the proposed structure of ACOs, the FTC and DOJ have issued guidelines specifying those parameters in their view should be met so that an ACO does not acquire too large of a market share and potentially infringe on competition.)
FTC Accountable Care Organization information Page
CMS (MEDICARE)
(CMS has had a lot of explaining to do after Medicare’s Shared Savings Program was introduced in Obama Care – Accountable Care Act, otherwise known as ACA. The proposed rule attached below provides detailed information on formation and operating requirements for ACOs. CMS will be accepting comments from the public, which will be considered and addressed in the formulation of a final rule.)
Federal Register – Accountable Care Organizations CMS Proposed Rule
***For those of you out there who have no idea what I am talking about and have never heard of an Accountable Care Organization, click here. And, please feel free to ask me specific questions that you would like me to address on this topic. If you are looking to take charge of ACO development in your geographic area, contact me to discuss.
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