At long last, the oft-delayed Proposed Rule for Accountable Care Organizations (the Proposed Rule) has been issued with only nine months remaining before the Medicare Shared Savings Program is implemented on January 1, 2012. The question now is whether there will be a sufficient number of ACO applicants around the country standing in line to manage the health care needs of an expected 5,000,000 Medicare beneficiaries.

The Proposed Rule, along with a new statement on antitrust enforcement and possible waivers of certain federal laws, such as Stark and the Anti-Kickback Statute, reflects considerable thought and unprecedented coordination between CMS, the Federal Trade Commission, the Department of Justice, the Office of the Inspector General and the IRS (the Agencies). However, more questions have been raised than necessarily answered. CMS and the other Agencies are actively seeking comments on many of the key standards that are still in flux and which need to be finalized before a potential ACO participant can make a truly informed decision on whether to submit a certification application to CMS.