(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 40
• Such other groups of providers of services and suppliers as the Secretary
determines appropriate.
Section 1899(h)(1) of the Act defines an "ACO professional" as a physician (as
defined in section 1861(r)(1) of the Act, which refers to a doctor of medicine or
osteopathy), or a practitioner (as defined in section 1842(b)(18)(C)(i) of the Act, which
includes physician assistants, nurse practitioners, and clinical nurse specialists). Section
1899(h)(2) of the Act also provides that, for purposes of the Shared Savings Program,
the term "hospital" means a subsection (d) hospital as defined in section 1886(d)(1)(B) of
the Act, thus limiting the definition to include only acute care hospitals paid under the
hospital inpatient prospective payment system (IPPS). Other providers of services and
suppliers that play a critical role in the nation's health care delivery system, such as
Federally qualified health centers (FQHCs), rural health centers (RHCs), skilled nursing
facilities (SNFs), nursing homes, long-term care hospitals (LTCHs) and critical access
hospitals (CAHs), among others, are not specifically designated as eligible participants in
the Shared Savings Program under section 1899(b)(1) of the Act. We note, however, that
the statutorily defined groups of providers and suppliers that are eligible to participate in
the Shared Savings Program as ACOs, would also have to meet the eligibility criteria
discussed in detail later in this proposed rule in order to qualify for participation in the
program. While the statute enumerates certain kinds of provider and supplier groups that
are eligible to participate in this program, it also provides the Secretary with discretion to
tailor eligibility in a way that narrows or expands the statutory list of eligible ACO
participants. Therefore, we have considered whether it would be advisable, at least in the
initial stage of the Shared Savings Program, to-- (1) permit participation in the program