(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 277
of dual eligible beneficiaries and includes several provisions to address their special
needs. For instance, section 2602 of the Affordable Care Act established a Federal
Coordinated Health Care Office within CMS to bring together officers and employees of
the Medicare and Medicaid programs at CMS to: (1) more effectively integrate benefits
under the Medicare and Medicaid programs; and (2) improve the coordination between
the Federal government and States for individuals eligible for benefits under both such
programs in order to ensure that these individuals receive full access to the items and
services to which they are entitled under titles XVIII and XIX of the Act.
Additionally section 1899(j) of the Act provides that "[t]he Secretary may give
preference to ACOs who are participating in similar arrangements with other payers."
The statute prescribes neither the kind of preference that the Secretary should provide to
such ACOs nor what other types of arrangements should be considered "similar" for
purposes of such a preference. We believe that the more patients an ACO sees for which
it is eligible to receive performance-based incentives, such as shared savings, the more
likely it is that the ACO will adopt substantial behavior changes conducive to improved
quality and cost savings.
We are seeking comment on methods to provide preference to ACOs that serve a
large dual-eligible population or that enter and maintain similar arrangements with other
payers. Specifically we seek comment regarding suggestions to encourage accountability
for dual-eligible beneficiaries and participation in similar arrangements with other types
of payers.