Medicare Accountable Care Organizations: CMS Announces Final Rule


On November 2, 2011, the Centers for Medicare & Medicaid Services (“CMS”) issued the final rule establishing Accountable Care Organizations (“ACOs”) under the Medicare Shared Savings Program (“Final Rule”).

This alert highlights the differences between the Final Rule and the proposed rule (“Proposed Rule”) released in April 2011, and includes an analysis of complementary rules and statements issued by other federal enforcement agencies.

CMS intends the Final Rule to address the concerns expressed in the more than 1,300 public comments it received in response to the Proposed Rule. Among other things, in the Final Rule, CMS (1) changed the beneficiary assignment methodology; (2) reduced the number of quality measures providers are required to report and satisfy; (3) established a more flexible admissions process; (4) modified the risk and reward calculations to eliminate risk for some participants; (5) adjusted the measures for calculating shared savings; and (6) eliminated mandatory antitrust review.

Please see full alert below for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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