(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 326 denial is not consistent with CMS' regulations or statutory authority. The ACO or ACO applicant may not use the reconsideration process to submit required documentation as evidence for the record that was not previously submitted to CMS by the applicable deadline. Furthermore, the reconsideration official will only consider evidence for the record that is submitted in the required format and in the timeframes indicated in the acknowledgement notification, unless additional information is requested by the official. Following the review, the reconsideration official will issue a recommended decision. We further propose that if the ACO or ACO applicant disagrees with the recommendation of the reconsideration official, it will have an opportunity to request a record review of the initial determination and recommendation of the reconsideration official by an independent CMS official who was not involved in the initial determination or the reconsideration review process. An ACO or ACO applicant that wishes to request an on the record review of the reconsideration official's recommendation must submit an explanation of why it disagrees with the recommendation in the timeframe and in the format indicated in the recommendation letter. The CMS official may also review the recommendation of the reconsideration official on his or her own motion. The on the record review process will be based only on evidence presented for the reconsideration review. The CMS official will review the recommendation of the reconsideration official and the supporting materials and make a final agency determination. If an ACO applicant requests a review of a decision to deny its application, and our initial determination is upheld, the application will be considered to have been denied based on the effective date of the original notice of denial. An ACO that requests a reconsideration review of an initial determination to terminate its participation in the
CMS-1345-P 327 Shared Savings Program will be permitted to continue to participate during the review process. However, if our initial determination to terminate the agreement with the ACO is upheld, the decision to terminate the agreement is effective as of the date indicated in the initial notice of termination. An ACO whose Shared Savings Program application has been denied or whose Shared Savings Program agreement has been terminated due to a determination made by a reviewing antitrust agency may not contest the merits of the antitrust agency's determination through the reconsideration review process proposed in this rule. Furthermore, the reconsideration review process proposed in this rule shall not be construed to negate, diminish, or otherwise alter the applicability of existing laws, rules, and regulations or determinations made by other government agencies. We invite public comment, in general, on the structures and procedure of an appropriate review process for ACOs terminated for avoidance of at-risk beneficiaries or other reasons not exempted from review by statute.
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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
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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
Page 275 and 276: CMS-1345-P 275 • Among older adul
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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
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Page 287 and 288: CMS-1345-P 287 providers' willingne
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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
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Page 307 and 308: CMS-1345-P 307 the ACO's repayment
Page 309 and 310: CMS-1345-P 309 the growth in Medica
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Page 313 and 314: CMS-1345-P 313 requirements not set
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Page 317 and 318: CMS-1345-P 317 disease) or benefici
Page 319 and 320: CMS-1345-P 319 information. If the
Page 321 and 322: CMS-1345-P 321 ● Failure to compl
Page 323 and 324: CMS-1345-P 323 harm to beneficiarie
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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
Page 369 and 370: CMS-1345-P 369 Category Costs COSTS
Page 371 and 372: CMS-1345-P 371 For the reasons set
Page 373 and 374: CMS-1345-P 373 (2) Program requirem
Page 375 and 376: 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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