(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 376 One-sided model means a model under which the ACO may share savings with the Medicare program, if it meets the requirements for doing so, but is not liable for sharing any losses incurred under the provisions of §425.7(c). Physician Quality Reporting System means the system established under section 1848(k) of the Act. Primary care physician means a physician (as defined at §410.20(b)(1)) who has a primary specialty designation of internal medicine, general practice, family practice, or geriatric medicine. Primary care services mean the set of services identified by the following HCPCS codes: 99201 through 99215, 99304 through 99340, and 99341 through 99350, G0402 (the code for the Welcome to Medicare visit); and G0438 and G0439 (codes for the annual wellness visits). Reporting period means January 1 through December 31. TIN means Federal taxpayer identification number. Two-sided model means a model under which the ACO may share savings with the Medicare program, if it meets the requirements for doing so, and is also liable for sharing any losses incurred under the provisions of §425.7(d). Subpart B--Shared Savings Program Requirements §425.5 Eligibility and governance requirements. (a) General requirements. (1) Under the Shared Savings Program, ACO participants may work together to manage and coordinate care for Medicare fee-for-service beneficiaries through an ACO that participates in the Shared Savings Program and meets the criteria specified in this part. (2) ACOs that exceed a minimum savings rate established under §425.7(c)(2) and (d)(2),
CMS-1345-P 377 meet the minimum quality performance standards established under §425.10, and otherwise maintain their eligibility to participate in the Shared Savings Program under this section are eligible to receive payments for shared savings under §425.7 of this subpart. (3) ACOs that operate under the two-sided model established in this section must share losses with the Medicare program under §425.7 of this subpart. (b) Eligible providers and suppliers. The following ACO participants, which must have established a mechanism for shared governance, are eligible, separately or in combination, to form ACOs that may participate in the Shared Savings Program: (1) ACO professionals in group practice arrangements. (2) Networks of individual practices of ACO professionals. (3) Partnerships or joint venture arrangements between hospitals and ACO professionals. (4) Hospitals employing ACO professionals. (5) Providers or suppliers otherwise recognized under the Act that are not ACO professionals or hospitals, as defined in §425.4. (6) CAHs that bill under Method II (as described in §413.70(b)(3)) (c) Reporting of TINs. (1) Each ACO must report to CMS the TINs of the ACO participants comprising the ACO along with a list of associated National Provider Identifiers (NPIs), at the beginning of each performance year and at other such times as specified by CMS. (2) For purposes of the Shared Savings Program, each ACO participant TIN upon which beneficiary assignment is dependent is required to commit to a 3-year agreement with CMS and will be exclusive to one ACO. (3) ACO participant TINs upon which beneficiary assignment is not dependent are required to commit to a 3-year agreement to the ACO, and the ACO participant must not be required to be
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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
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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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Page 327 and 328: CMS-1345-P 327 Shared Savings Progr
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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: CMS-1345-P 375 Act. Hospital means
Page 379 and 380: CMS-1345-P 379 (C) Begin to operate
Page 381 and 382: CMS-1345-P 381 (D) The civil moneta
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Page 387 and 388: CMS-1345-P 387 monitoring and evalu
Page 389 and 390: CMS-1345-P 389 (i) It plans to use
Page 391 and 392: CMS-1345-P 391 (1) Have a beneficia
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Page 401 and 402: CMS-1345-P 401 §425.8 ACO quality
Page 403 and 404: CMS-1345-P 403 (2) CMS scores indiv
Page 405 and 406: CMS-1345-P 405 (a) Monitoring of AC
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Page 409 and 410: CMS-1345-P 409 (5) The procedures e
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Page 417 and 418: CMS-1345-P 417 (c) Notwithstanding
Page 419 and 420: CMS-1345-P 419 (ii) Quality perform
Page 421 and 422: CMS-1345-P 421 (i) The beneficiary
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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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