Accountable Care Organizations

News & Analysis as of

IRS Denies Tax Exemption to Commercial ACO

On April 8, 2016, the IRS released a final adverse exemption determination with respect to an accountable care organization (ACO) formed by an unnamed nonprofit health care system. The adverse determination confirms and...more

Reforming Medicaid Could Become Toughest Job Ever for Baker Administration

Anyone who follows politics or government in Massachusetts has seen these numbers. They bear repeating: - ..Over the past seven years, spending on Medicaid (MassHealth) has increased 65%. ..Next year, total...more

Massachusetts Establishes Road-Map for New ACO Program

Massachusetts Secretary of Health and Human Services, Marylou Sudders, held a public meeting earlier this week to receive feedback on the proposal of the Executive Office of Health and Human Services (EOHHS) to overhaul the...more

CMS Announces New Alternative Payment Model for Primary Care

Earlier this week, CMS announced the launch of an initiative aimed at transforming the way primary care is delivered. The Comprehensive Primary Care Plus (CPC+) model will be a voluntary 5 year program accommodating some...more

SAMHSA Seeks Comment on Proposed Changes to Address Barriers to Information Sharing

The Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), is seeking comments by April 11, 2016 on a proposed rule to make significant changes to 42 CFR Part 2, the...more

Washington Healthcare Update

This Week: The House of Representatives and the Senate were on recess…but it was not quiet on the health care front! 1. Congress - House of Representatives - House, Senate Democrats Want NIH to Bring Down...more

Washington Healthcare Update

This Week: The Affordable Care Act turned 6 years old on March 23... Four in ten voters say health care is extremely important when picking a President, according to a Kaiser Family Foundation’s new tracking poll......more

CMS Ahead of Schedule in Push for Medicare Alternative Payment Models

CMS has announced that has reached its goal of tying 30% of Medicare payments to alternative payment models that reward quality of care rather than volume of service — 11 months ahead of the target CMS set last year....more

CMS Issues a New Medicare Shared Savings Program Proposed Rule and Aims to Encourage Existing Accountable Care Organizations to...

On February 3, 2016, the Centers for Medicare and Medicaid Services (“CMS”) issued a new proposed rule that makes a number of revisions to the Medicare Shared Savings Program (“MSSP”). Several of the proposed changes create...more

CMS Schedules Calls on Medicare ACO Application Process (April 5 and 19)

CMS is holding two calls in April on the Medicare Shared Savings Program/Accountable Care Organization application process. The first call, scheduled for April 5, will focus on preparing for the Shared Savings Program...more

Telehealth and Medicare: MedPAC Presents Updated Research to the Commission

The status of expanded federal telehealth reimbursement remains uncertain. Continuing an ongoing national policy conversation, the Medicare Payment Advisory Commission (MedPAC) held its second meeting on March 3, 2016, under...more

Health Update - February 2016

Better Late Than Never: CMS Provides Much-Needed Clarity on the 60-Day Overpayment Refund Requirements - On February 12, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the long-awaited final rule (Final...more

Proposed Changes to Methodology to Update ACO Benchmarks

The Medicare Shared Savings Program provides financial rewards to Accountable Care Organizations (ACO’s) that successfully manage overall health care costs for a defined population of beneficiaries while meeting quality of...more

CMS Proposes Additional Changes to MSSP Regulations

The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule modifying the Medicare Shared Savings Program (MSSP) regulations (the “Rule”). Among other changes, the Rule proposes (a) to modify the...more

Health Care Update - February 2016

Are Lawmakers and Stakeholders Ready for the Silver Tsunami? - Last week, the Congressional Budget Office (CBO) released a projection that shows Medicare enrollment will grow by more than 30 percent in the next decade...more

New Year, New Telehealth Opportunities

As we reflect upon how the health care industry has changed in 2015 and what we expect to see in 2016, there is one area that stands out as having great promise for continued growth—telehealth....more

CMS Proposes Changes to Medicare Shared Savings Program/ACO Benchmark Rebasing Rules

On February 3, 2016, CMS published a proposed rule that would revise the methodology CMS uses to measure the performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program (Shared Savings Program)...more

Washington Healthcare Update

This Week: Because of the Blizzard of 2016—also known as “Snowzilla”—in Washington, D.C., and other parts of the East Coast, this is a combined issue... The House of Representatives opted not to come back to town until next...more

CBO’s Budget Forecast and the Silver Tsunami

This week, the Congressional Budget Office (CBO) released a projection that shows Medicare enrollment will grow by more than 30 percent in the next decade alone, and the number of seniors will steadily grow from 55 million...more

AITN - January 2016

CMS Releases Information on Providers Signed Up For New ACO Models – On January 11, 2016, HHS announced that several providers and hospitals have signed up to join new types of Medicare accountable care organizations (ACOs). ...more

Thirteen Ways to Contain Health Care Costs in Massachusetts: The Health Policy Commission Issues Its 2015 Report and...

In 2012 Massachusetts adopted the most recent in a series of comprehensive legislative approaches to health care reform, Chapter 224 of the Acts of 2012 (Chapter 224), which focused especially on addressing the drivers of...more

Health Care E-Note - January 2016

The 2016 Medicare Physician Fee Schedule Final Rule ("Final Rule") contains recent changes to the Federal Stark Law, the majority of which took effect on January 1, 2016. The issuance of the Final Rule on November 16, 2015...more

Senate Working Group Considers Telehealth Policy Changes to Medicare

In keeping with the boom of telehealth legislation introduced last year at both the state and federal level, the Senate Finance Committee is considering several policy changes that, if ultimately enacted, could make...more

Washington Healthcare Update

This Week: The House is not in session this week... The Senate returns today... Committees in the Senate will hold hearings on co-ops and mental health... Vice President Biden will attend the World Economic Forum in...more

Senate Workgroup’s Proposals Address Chronic Illness Through Medicare

The Senate Finance Committee chronic care working group recently released a Policy Options Document continuing an effort that started with a hearing titled, “Chronic Illness: Addressing Patients’ Unmet Needs” in the summer of...more

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