(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 138 example, if the ACO's assigned population falls below 5,000 during an agreement year as discussed in section II. B. of this proposed rule. • CMS and the ACO may mutually decide to terminate the agreement. We propose that when an ACO reorganizes its structure by excluding ACO participants or by adding or excluding ACO providers/suppliers, deviates from its approved application, changes information contained in its approved application, or experiences other changes which may make it unable to complete its 3-year agreement, it must notify us within 30 days of the event for reevaluation of its eligibility to continue to participate in the Shared Savings Program. We would respond in one of the five ways specified previously. We request comment on this proposal. 9. Future Participation of Previously Terminated Program Participants As described in section II.H. of the proposed rule, there are a number of circumstances under which we may terminate our agreement with an ACO, including avoidance of at-risk beneficiaries and failure to meet the quality performance standards. In contrast, there are also many reasons why an ACO participant TIN, used for assignment, or individual ACO providers/suppliers may drop out of an ACO; such as government exclusion, relocation, retirement, a voluntary decision to terminate participation, or bankruptcy. Permanently barring former program participants from subsequent participation in the Shared Savings Program due to a voluntary or forced termination from an ACO appears unduly harsh given the dynamic nature of organizational membership. Alternatively, we do want to ensure our policy on subsequent participation in the Shared Savings Program does not provide a second chance for under-performing organizations
CMS-1345-P 139 or to providers or suppliers who have been terminated for failing to meet program integrity requirements. We propose the ACO disclose to CMS whether the ACO, its ACO participants, or its ACO providers/suppliers have participated in the program under the same or a different name, and specify whether it was terminated or withdrew voluntarily from the program. If the ACO, its ACO participants or ACO providers/suppliers were previously terminated from the program, the applicant must identify the cause of termination and what safeguards are now in place to enable the prospective ACO to participate in the program for the full period of the 3-year agreement period. We propose that such ACOs may not begin another 3-year agreement period until the original agreement period has lapsed. Additionally, because we believe that subsequent participation in the Shared Savings Program should not provide a second chance for under-performing organizations, we propose that an ACO may not reapply to participate in the Shared Savings Program if it previously experienced a net loss during its first 3-year agreement period. We seek comment on these proposals and whether requirements for denying participation to ACOs that previously under-perform would create disincentives for the formation of ACOs. We are specifically interested in whether this requirement will create disincentives for participation among smaller entities. D. Assignment of Medicare Fee-for-Service Beneficiaries Section 1899(c) of the Act, as added by section 3022 of the Affordable Care Act, requires the Secretary to "determine an appropriate method to assign Medicare FFS beneficiaries to an ACO based on their utilization of primary care services provided under this title by an ACO professional described in subsection (h)(1)(A)." Subsection
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DEPARTMENT OF HEALTH AND HUMAN SERV
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CMS-1345-P 3 Centers for Medicare &
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CMS-1345-P 5 C. Overview and Intent
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CMS-1345-P 7 7. Aligning ACO Qualit
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CMS-1345-P 9 CCNC Community Care of
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CMS-1345-P 11 SSN TIN Social Securi
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CMS-1345-P 13 better coordinate car
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CMS-1345-P 15 and efficient service
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CMS-1345-P 17 ACO shall have at lea
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CMS-1345-P 19 program or demonstrat
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CMS-1345-P 21 Section 1899(d)(3) of
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CMS-1345-P 23 Section 1899 (i) of t
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CMS-1345-P 25 • An ACO will manag
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CMS-1345-P 27 providers participati
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CMS-1345-P 29 The Affordable Care A
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CMS-1345-P 31 establish an estimate
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CMS-1345-P 33 personal physicians;
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CMS-1345-P 35 • Experience with n
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CMS-1345-P 37 when looking at the e
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CMS-1345-P 39 Medicare FFS benefici
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CMS-1345-P 41 by only those ACO par
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CMS-1345-P 43 Since the statute req
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CMS-1345-P 45 For FQHCs and RHCs, t
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CMS-1345-P 47 individual practition
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CMS-1345-P 49 additional Medicare e
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CMS-1345-P 51 The ACO's legal entit
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CMS-1345-P 53 We note that by propo
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CMS-1345-P 55 and administrative sy
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CMS-1345-P 57 governance would crea
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CMS-1345-P 59 demonstration, partic
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CMS-1345-P 61 We believe that these
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CMS-1345-P 63 • Clinical manageme
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CMS-1345-P 65 participants and ACO
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CMS-1345-P 67 Section 1899(b)(2)(A)
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CMS-1345-P 69 be subject to the req
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CMS-1345-P 71 program while still f
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CMS-1345-P 73 Thus, we considered w
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CMS-1345-P 75 addressing situations
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CMS-1345-P 77 include provisions fo
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CMS-1345-P 79 b. Processes to Promo
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CMS-1345-P 81 • Telehealth. • T
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CMS-1345-P 83 centeredness that is
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CMS-1345-P 85 mechanism for coordin
Page 87 and 88: CMS-1345-P 87 We are soliciting com
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Page 91 and 92: CMS-1345-P 91 panel. Such a proposa
Page 93 and 94: CMS-1345-P 93 addressing disparitie
Page 95 and 96: CMS-1345-P 95 Individualized plans
Page 97 and 98: CMS-1345-P 97 beneficiaries by mini
Page 99 and 100: CMS-1345-P 99 a. Compliance Plans W
Page 101 and 102: CMS-1345-P 101 generated by ACO par
Page 103 and 104: CMS-1345-P 103 C. Establishing the
Page 105 and 106: CMS-1345-P 105 After evaluating the
Page 107 and 108: CMS-1345-P 107 when the final payme
Page 109 and 110: CMS-1345-P 109 performance of ACO p
Page 111 and 112: CMS-1345-P 111 cost-effectiveness o
Page 113 and 114: CMS-1345-P 113 they identify priori
Page 115 and 116: CMS-1345-P 115 generally bars the d
Page 117 and 118: CMS-1345-P 117 acting on behalf of
Page 119 and 120: CMS-1345-P 119 previous year's hist
Page 121 and 122: CMS-1345-P 121 providers/suppliers.
Page 123 and 124: CMS-1345-P 123 permitted under the
Page 125 and 126: CMS-1345-P 125 and the claim paymen
Page 127 and 128: CMS-1345-P 127 measurement activiti
Page 129 and 130: CMS-1345-P 129 beneficiary choice:
Page 131 and 132: CMS-1345-P 131 promote trust and pe
Page 133 and 134: CMS-1345-P 133 beneficiaries. We an
Page 135 and 136: CMS-1345-P 135 ensure that ACOs und
Page 137: CMS-1345-P 137 eligibility since th
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Page 143 and 144: CMS-1345-P 143 From a technical, op
Page 145 and 146: CMS-1345-P 145 beneficiaries would
Page 147 and 148: CMS-1345-P 147 associated with thos
Page 149 and 150: CMS-1345-P 149 pediatric medicine,"
Page 151 and 152: CMS-1345-P 151 care services" on th
Page 153 and 154: CMS-1345-P 153 better address the d
Page 155 and 156: CMS-1345-P 155 assignment from year
Page 157 and 158: CMS-1345-P 157 appropriate safeguar
Page 159 and 160: CMS-1345-P 159 ACO only when he or
Page 161 and 162: CMS-1345-P 161 We propose to implem
Page 163 and 164: CMS-1345-P 163 quality and shared s
Page 165 and 166: CMS-1345-P 165 chosen. We seek comm
Page 167 and 168: CMS-1345-P 167 measures to assess t
Page 169 and 170: CMS-1345-P 169 • To the extent pr
Page 171 and 172: CMS-1345-P 171 data collection and
Page 173 and 174: CMS-1345-P 173 improving ACO qualit
Page 175 and 176: CMS-1345-P 175 Domain Measure Title
Page 187 and 188: CMS-1345-P 187 43. At Risk Populati
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CMS-1345-P 189 50. At Risk Populati
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CMS-1345-P 191 Domain Measure Title
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CMS-1345-P 193 Domain Measure Title
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CMS-1345-P 195 Information on Physi
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CMS-1345-P 197 associated with clai
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CMS-1345-P 199 be required to popul
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CMS-1345-P 201 as that term is defi
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CMS-1345-P 203 Table 2: Five Measur
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CMS-1345-P 205 sided shared savings
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CMS-1345-P 207 Table 4: Total Point
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CMS-1345-P 209 Medicare program. Fu
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CMS-1345-P 211 for the first perfor
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CMS-1345-P 213 of quality acknowled
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CMS-1345-P 215 (Option 1) but using
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CMS-1345-P 217 ACO would qualify fo
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CMS-1345-P 219 future rulemaking. W
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CMS-1345-P 221 proposing greater al
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CMS-1345-P 223 6. Public Reporting
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CMS-1345-P 225 efficiency, effectiv
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CMS-1345-P 227 this information ava
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CMS-1345-P 229 Specifically, we see
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CMS-1345-P 231 We considered severa
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CMS-1345-P 233 Track 2: More experi
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CMS-1345-P 235 determinations about
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CMS-1345-P 237 beneficiaries during
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CMS-1345-P 239 truncate an assigned
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CMS-1345-P 241 the demonstration wh
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CMS-1345-P 243 We seek comments abo
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CMS-1345-P 245 Of these two methods
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CMS-1345-P 247 other factor could b
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CMS-1345-P 249 Capitation Rates, Pa
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CMS-1345-P 251 A model that uses be
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CMS-1345-P 253 option to audit ACOs
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CMS-1345-P 255 Thus, we are not pro
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CMS-1345-P 257 subsequently receive
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CMS-1345-P 259 This benchmark is su
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CMS-1345-P 261 nationwide under the
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CMS-1345-P 263 benchmark based on t
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CMS-1345-P 265 upon the number of M
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CMS-1345-P 267 beneficiaries. In re
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CMS-1345-P 269 and share in savings
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CMS-1345-P 271 a result of normal y
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CMS-1345-P 273 • 50 percent or mo
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CMS-1345-P 275 • Among older adul
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CMS-1345-P 277 of dual eligible ben
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CMS-1345-P 279 they incur shareable
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CMS-1345-P 281 for the Medicare pro
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CMS-1345-P 283 and efficiency of ca
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CMS-1345-P 285 have also suggested
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CMS-1345-P 287 providers' willingne
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CMS-1345-P 289 expect to consider i
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CMS-1345-P 291 two years under the
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CMS-1345-P 293 Design Element Minim
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CMS-1345-P 295 performance) under t
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CMS-1345-P 297 For purposes of the
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CMS-1345-P 299 proposed that for th
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CMS-1345-P 301 For example, a two-s
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CMS-1345-P 303 depends on the ACO's
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CMS-1345-P 305 have solicited comme
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CMS-1345-P 307 the ACO's repayment
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CMS-1345-P 309 the growth in Medica
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CMS-1345-P 311 relied upon by us in
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CMS-1345-P 313 requirements not set
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CMS-1345-P 315 entity is in an arra
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CMS-1345-P 317 disease) or benefici
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CMS-1345-P 319 information. If the
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CMS-1345-P 321 ● Failure to compl
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CMS-1345-P 323 harm to beneficiarie
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CMS-1345-P 325 determinations would
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CMS-1345-P 327 Shared Savings Progr
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CMS-1345-P 329 CMS and OIG have joi
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CMS-1345-P 331 The Antitrust Policy
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CMS-1345-P 333 previously. Such an
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CMS-1345-P 335 protects beneficiary
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CMS-1345-P 337 both Medicare benefi
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CMS-1345-P 339 J. Overlap with Othe
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CMS-1345-P 341 CMS shared savings p
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CMS-1345-P 343 Shared Savings Progr
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CMS-1345-P 345 improve the Shared S
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CMS-1345-P 347 V. Regulatory Impact
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CMS-1345-P 349 The Shared Savings P
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CMS-1345-P 351 ACOs work to improve
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CMS-1345-P 353 presumably provide a
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CMS-1345-P 355 • Number of partic
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CMS-1345-P 357 distribution. With t
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CMS-1345-P 359 c. Further Considera
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CMS-1345-P 361 More specifically, w
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CMS-1345-P 363 program and uncertai
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CMS-1345-P 365 Savings Program at 7
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CMS-1345-P 367 ACO-attributed claim
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CMS-1345-P 369 Category Costs COSTS
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CMS-1345-P 371 For the reasons set
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CMS-1345-P 373 (2) Program requirem
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CMS-1345-P 375 Act. Hospital means
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CMS-1345-P 377 meet the minimum qua
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CMS-1345-P 379 (C) Begin to operate
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CMS-1345-P 381 (D) The civil moneta
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CMS-1345-P 383 prior to the start o
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CMS-1345-P 385 for populations, and
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CMS-1345-P 387 monitoring and evalu
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CMS-1345-P 389 (i) It plans to use
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CMS-1345-P 391 (1) Have a beneficia
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CMS-1345-P 393 who were an ACO part
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CMS-1345-P 395 amount for the patie
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CMS-1345-P 397 under §425.7(b). An
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CMS-1345-P 399 (ii) To be responsib
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CMS-1345-P 401 §425.8 ACO quality
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CMS-1345-P 403 (2) CMS scores indiv
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CMS-1345-P 405 (a) Monitoring of AC
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CMS-1345-P 407 required measure dat
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CMS-1345-P 409 (5) The procedures e
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CMS-1345-P 411 demonstrate in its a
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CMS-1345-P 413 days of the notice o
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CMS-1345-P 415 original notice of d
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CMS-1345-P 417 (c) Notwithstanding
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CMS-1345-P 419 (ii) Quality perform
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CMS-1345-P 421 (i) The beneficiary
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CMS-1345-P 423 terminated from the
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CMS-1345-P 425 inclusion of additio
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CMS-1345-P 427 individuals, better
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CMS-1345-P 04/07/2011] [FR Doc. 201
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