On October 20, 2011, the Centers for Medicare and Medicaid Services (“CMS”) released the nearly 700-page, final rule for payments to health care providers and suppliers participating in accountable care organizations (“ACOs”) under the Medicare Shared Savings Program (“MSSP”).  In response to approximately 1,320 public comments to the proposed rule, the final rule makes a number of significant changes, including:

  • Expanding eligibility for participating in the MSSP
  • Eliminating down-side risk and permitting first-dollar sharing in Track 1 (i.e., the payment option under the MSSP for new or less experienced ACOs)
  • Removal of the 25 percent withhold of shared savings
  • Preliminary (prospective) assignment of beneficiaries to ACOs rather than retrospective assignment
  • Modification of the antitrust review policies
  • Providing for federally qualified health centers and rural health clinics to participate in the MSSP by becoming their own ACOs, or by joining an ACO as an ACO participant along with other organizations

CMS has prepared a chart summarizing these changes and others under the final rule.
As analysis and implications of these new rules become available, we will continue to serve as a free resource. Please join the discussion by offering your view, or if you’re interested in submitting an analysis, write me at david.kopans@squiresanders.com.  Also, journalists seeking expert sources on the implications of ACO and other health care reform rules should contact dsheon@WHITECOATstrategies.com.