Summary of Medicare Shared Savings Program Final Rule on Accountable Care Organizations


On November 2, 2011, the Centers for Medicare and Medicaid Services (“CMS”) published a Final Rule implementing the Medicare Shared Savings Program (“MSSP”) established under Section 3022 of the Patient Protection and Affordable Care Act (the “Final Rule”). The Final Rule signals CMS’s strong desire to encourage widespread formation of accountable care organizations (“ACOs”).

By addressing many of the most significant objections raised by industry stakeholders in response to the proposed rule that was released last spring (the “Proposed Rule”), the Final Rule is likely to stimulate the formation of ACOs during 2012 and 2013. The regulatory analysis supporting the release of the Final Rule indicates that CMS assumes 1 to 5 million Medicare beneficiaries will align with between 50 and 270 ACOs during the first four years of the program. Broadening the list of entities eligible to form an ACO to include FQHCs increases the likelihood that dual eligibles and less affluent Medicare beneficiaries will participate in Medicare ACOs. A summary of the Final Rule is provided below.

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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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