CMS Proposed Rule Describes ACO Quality Performance Standards, Reporting Obligations, And Determination Of Shared Savings Methodology
Mondaq Business Briefing › United States Law Articles in English (2011)
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CMS Proposed Rule Describes ACO Quality Performance Standards, Reporting Obligations, And Determination Of Shared Savings Methodology
On March 31, 2011, CMS published a Proposed Rule to implement Section 3022 of the Patient Protection and Affordable Care Act (ACA), which requires the Secretary of the Department of Health and Human Services (HHS) to establish a Medicare Shared Savings Program (SSP). Under the Proposed Rule, eligible providers, hospitals, and suppliers that participate in the SSP by creating or joining accountable care organizations (ACOs) can continue to receive traditional Medicare fee-for-service payments under Medicare Parts A and B and be eligible for additional payments based upon specified quality and savings requirements.
On the same day, CMS and the Office of Inspector General (OIG) jointly issued a Proposed Rule describing the waiver of application of various fraud and abuse laws with respect to ACOs; the FTC and the Department of Justice (DOJ) jointly issued a Proposed Policy concerning the application of antitrust laws to ACOs; and the IRS issued a Notice concerning tax-exempt entity participation in the SSP. This Legal News Alert is the second in a series of three alerts developed by Foley's Health Care Industry Team to assist you in understanding the newly published guidance. Please see the other alerts in this series: CMS Proposed Rule Describes ACO Requirements: Eligibility, Governance, Application, Monitoring, and Termination Federal Agencies Propose Waivers and Modifications to Facilitate ACOs This Legal News Alert provides an overview of the Proposed Rule's provisions related to quality performance standards, reporting obligations, and the methodology for determining shared savings. Quality Performance Standards and Reporting Requirements Before an ACO can share in any savings, it must demonstrate that it delivers high-quality care by meeting the quality performance standards set by CMS. In the Proposed Rule, CMS describes: (1) measures to assess the quality of care furnished by an ACO; (2) requirements for ACO data submission; (3) quality performance standards; (4) the incorporation of reporting requirements under the Physician Quality Reporting System (PQRS); and (5) requirements for public reporting by ACOs. CMS proposes that an ACO will be considered to have...See the full content of this document
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