Industry News

HHS Issues Proposed ACO Regulations.

The Department of Health and Human Services (HHS) recently released proposed regulations on the implementation of Accountable Care Organizations (ACOs). The ACO program is a voluntary Medicare Shared Savings Program established under the Patient Protection Affordable Care Act. This program is intended to reduce health care costs by improving the coordination of care for Medicare patients.

According to the proposed rule there are a number of requirements that an ACO must meet in order to receive a portion of the Medicare savings, including quality standards and compliance plan requirements. Under the proposed rule, an ACO must meet five standards related to the quality of care. The standards include patient/caregiver experience, care coordination, patient safety, prevention health and at-risk population/frail elderly health. In addition, ACOs will have to establish a compliance plan.

The compliance plan must address the following elements: (1) have a designated compliance officer or individual who is not part of legal counsel. This individual will need to report directly to the ACO’s governing body; (2) develop mechanisms to identify and address compliance issues related to the ACO’s operations and performance; (3) establish a reporting method for employees, providers, suppliers, and contractors to report suspected compliance violations; (4) conduct compliance training to ACO’s employees and contractors; and (5) establish a policy that requires the ACO to report suspected violations to the appropriate law enforcement agency. During the proposed rule comment period, HHS will facilitate a series of open-door forums and listening sessions to help the public understand the ACO program. HHS is accepting comments on the proposed rule until June 6.

Centers for Medicare & Medicaid Services 42 CFR Part 425 Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations. 76 Fed. 67, 19528, 19576 (Apr. 7, 2011). Department of Health and Human Services (HHS). “Affordable Care Act to improve quality of care for people with Medicare.” News Release. 31 Mar. 2011.