(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 318 propose that the ACO will be re-evaluated both during and at the end of the CAP. If we determine that the ACO has continued to avoid at-risk beneficiaries, the ACO would be terminated from the Shared Savings Program. We also propose that the ACO would not receive shared savings payments while it is under the CAP regardless of the period of performance in question and that the ACO would not be eligible to earn any shared savings for the period during which it is under the CAP for avoiding at-risk beneficiaries. We solicit comments on whether lesser sanctions may be appropriate when an ACO avoids at-risk beneficiaries, such as the cessation of, or a reduction in, the assignment of new beneficiaries to the ACO, a reduction in the amount of the shared savings payment, or a fine for each instance of at-risk beneficiary avoidance. 2. Monitoring Compliance with Quality Performance Standards Section 1899(d)(4) of the Act further authorizes the Secretary to terminate an agreement with an ACO that does not meet the established quality performance standards. To identify ACOs that are not meeting the quality performance standards, we will review the ACO's submission of quality measurement data. We may request additional documentation from an ACO or its ACO participants or ACO providers/supplier, as appropriate. In those instances where an ACO fails to meet the minimum attainment level for one or more domains, we propose to give the ACO a warning and to re-evaluate the following year. If the ACO continues to underperform on the quality performance standards in the following year, the agreement will be terminated. We also propose that if an ACO fails to report one or more measures, we would send the ACO a written request to submit the required data by a specified date and to provide a reasonable written explanation for its delay in reporting the required
CMS-1345-P 319 information. If the ACO fails to report by the requested deadline and does not provide a reasonable explanation for delayed reporting, we would immediately terminate the ACO for failing to report quality measures. We further propose that ACOs that exhibit a pattern of inaccurate or incomplete reporting or fail to make timely corrections following notice to resubmit may be terminated from the program. We note that since meeting the quality standard is a condition for sharing in savings, the ACO would be disqualified from sharing in savings in each year in which it underperforms. 3. Terminating an ACO Agreement There are a number of important program requirements that ACOs must satisfy in order to be eligible to participate in the Shared Savings Program. As a result, in addition to the statutory provisions at section 1899(d)(3) and (d)(4) of the Act regarding termination for avoidance of at-risk beneficiaries and for failure to meet the quality standards, we believe the agreement with an ACO should be contingent upon that ACO continuing to meet the requirements for eligibility to participate in the Shared Savings Program. Accordingly, we propose that an ACO's failure to continue to meet the eligibility requirements for participation in the Shared Savings Program should also result in an ACO's termination from the Shared Savings Program. As described in section II.F. of this proposed rule, termination of an ACO from the Shared Savings Program by us or at the ACOs request for any reason will result in loss of the mandatory 25 percent withhold of shared savings. Therefore, we are proposing that based upon monitoring and assessing ACO operations (including ACO participants and ACO providers/suppliers), we may terminate
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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
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CMS-1345-P 87 We are soliciting com
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CMS-1345-P 89 to ensure that survey
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CMS-1345-P 91 panel. Such a proposa
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CMS-1345-P 93 addressing disparitie
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CMS-1345-P 95 Individualized plans
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CMS-1345-P 97 beneficiaries by mini
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CMS-1345-P 99 a. Compliance Plans W
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CMS-1345-P 101 generated by ACO par
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CMS-1345-P 103 C. Establishing the
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CMS-1345-P 105 After evaluating the
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CMS-1345-P 107 when the final payme
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CMS-1345-P 109 performance of ACO p
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CMS-1345-P 111 cost-effectiveness o
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CMS-1345-P 113 they identify priori
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CMS-1345-P 115 generally bars the d
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CMS-1345-P 117 acting on behalf of
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CMS-1345-P 119 previous year's hist
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CMS-1345-P 121 providers/suppliers.
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CMS-1345-P 123 permitted under the
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CMS-1345-P 125 and the claim paymen
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CMS-1345-P 127 measurement activiti
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CMS-1345-P 129 beneficiary choice:
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CMS-1345-P 131 promote trust and pe
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CMS-1345-P 133 beneficiaries. We an
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CMS-1345-P 135 ensure that ACOs und
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CMS-1345-P 137 eligibility since th
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CMS-1345-P 139 or to providers or s
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CMS-1345-P 141 ACO and the eligibil
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CMS-1345-P 143 From a technical, op
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CMS-1345-P 145 beneficiaries would
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CMS-1345-P 147 associated with thos
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CMS-1345-P 149 pediatric medicine,"
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CMS-1345-P 151 care services" on th
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CMS-1345-P 153 better address the d
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CMS-1345-P 155 assignment from year
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CMS-1345-P 157 appropriate safeguar
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CMS-1345-P 159 ACO only when he or
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CMS-1345-P 161 We propose to implem
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CMS-1345-P 163 quality and shared s
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CMS-1345-P 165 chosen. We seek comm
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CMS-1345-P 167 measures to assess t
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CMS-1345-P 169 • To the extent pr
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CMS-1345-P 171 data collection and
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CMS-1345-P 173 improving ACO qualit
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CMS-1345-P 175 Domain Measure Title
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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 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
Page 267 and 268: CMS-1345-P 267 beneficiaries. In re
Page 269 and 270: CMS-1345-P 269 and share in savings
Page 271 and 272: CMS-1345-P 271 a result of normal y
Page 273 and 274: CMS-1345-P 273 • 50 percent or mo
Page 275 and 276: CMS-1345-P 275 • Among older adul
Page 277 and 278: CMS-1345-P 277 of dual eligible ben
Page 279 and 280: CMS-1345-P 279 they incur shareable
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Page 283 and 284: CMS-1345-P 283 and efficiency of ca
Page 285 and 286: CMS-1345-P 285 have also suggested
Page 287 and 288: CMS-1345-P 287 providers' willingne
Page 289 and 290: CMS-1345-P 289 expect to consider i
Page 291 and 292: CMS-1345-P 291 two years under the
Page 293 and 294: CMS-1345-P 293 Design Element Minim
Page 295 and 296: CMS-1345-P 295 performance) under t
Page 297 and 298: CMS-1345-P 297 For purposes of the
Page 299 and 300: CMS-1345-P 299 proposed that for th
Page 301 and 302: CMS-1345-P 301 For example, a two-s
Page 303 and 304: CMS-1345-P 303 depends on the ACO's
Page 305 and 306: CMS-1345-P 305 have solicited comme
Page 307 and 308: CMS-1345-P 307 the ACO's repayment
Page 309 and 310: CMS-1345-P 309 the growth in Medica
Page 311 and 312: CMS-1345-P 311 relied upon by us in
Page 313 and 314: CMS-1345-P 313 requirements not set
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Page 321 and 322: CMS-1345-P 321 ● Failure to compl
Page 323 and 324: CMS-1345-P 323 harm to beneficiarie
Page 325 and 326: CMS-1345-P 325 determinations would
Page 327 and 328: CMS-1345-P 327 Shared Savings Progr
Page 329 and 330: CMS-1345-P 329 CMS and OIG have joi
Page 331 and 332: CMS-1345-P 331 The Antitrust Policy
Page 333 and 334: CMS-1345-P 333 previously. Such an
Page 335 and 336: CMS-1345-P 335 protects beneficiary
Page 337 and 338: CMS-1345-P 337 both Medicare benefi
Page 339 and 340: CMS-1345-P 339 J. Overlap with Othe
Page 341 and 342: CMS-1345-P 341 CMS shared savings p
Page 343 and 344: CMS-1345-P 343 Shared Savings Progr
Page 345 and 346: CMS-1345-P 345 improve the Shared S
Page 347 and 348: CMS-1345-P 347 V. Regulatory Impact
Page 349 and 350: CMS-1345-P 349 The Shared Savings P
Page 351 and 352: CMS-1345-P 351 ACOs work to improve
Page 353 and 354: CMS-1345-P 353 presumably provide a
Page 355 and 356: CMS-1345-P 355 • Number of partic
Page 357 and 358: CMS-1345-P 357 distribution. With t
Page 359 and 360: CMS-1345-P 359 c. Further Considera
Page 361 and 362: CMS-1345-P 361 More specifically, w
Page 363 and 364: CMS-1345-P 363 program and uncertai
Page 365 and 366: CMS-1345-P 365 Savings Program at 7
Page 367 and 368: 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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(ACO) regulations - American Society of Anesthesiologists

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