The Centers for Medicare & Medicaid Services (CMS) has released proposed regulations establishing Accountable Care Organizations (ACOs) and creating the Medicare Shared Savings Program (the Program). The Program will permit health care providers and suppliers to form ACOs and to reward those that lower health care costs for Medicare fee-for-service beneficiaries, while meeting quality of care performance standards. The Program will also hold accountable ACOs that fail to generate savings. CMS will assign beneficiaries to ACOs based on their utilization of primary care services.
To facilitate beneficiary assignment and to ensure that ACOs have the baseline data necessary to evaluate and improve care, Medicare is proposing various uses and disclosures of beneficiary data constituting protected health information (PHI). This PHI ranges from demographic information to claims history, and all of it is protected by the privacy regulations issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This advisory discusses CMS’s proposed uses and disclosures of PHI in connection with the Program, its rationale under HIPAA for using PHI, and additional protections proposed by CMS that exceed HIPAA requirements.
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