(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 45
For FQHCs and RHCs, therefore, we currently lack the requisite data elements
(service code, physician, physician specialty, and specific attribution of services to the
rendering health care professionals) in the claims and payment systems to enable us to
determine (1) beneficiary assignment during the performance year under section 1899(c)
of the Act, which requires that assignment to an ACO be based on utilization of primary
care services furnished by a physician; and (2) expenditures during the 3-year
benchmark. In the case of FQHCs, we recently finalized regulations requiring the
collection of HCPCS codes for services beginning in 2011, in preparation for the
development of the FQHC PPS. However, there is no statutory requirement for
collecting from FQHCs the other data elements, such as the direct link between provider
and service, which would be required for beneficiary assignment under the Shared
Savings Program. Moreover, there is neither the statutory requirement for collection of
HCPCS codes from RHCs nor any plan to expand this data collection effort to RHCs. In
both the case of FQHCs and RHCs, reporting the information necessary to participate in
the Shared Savings Program would be a significant change in operations that we are
reluctant to impose through regulation without either a statutory requirement or clear
support for such a regulatory change from the FQHC and RHC community at large that
they would be willing to have all RHC/FQHCs provide this information uniformly, solely
to enable independent formation of an ACO for purposes of participation in the Shared
Savings Program by the subset of those FQHC/RHCs that choose to do so.
Therefore, in the absence of the data elements required for assignment of
beneficiaries, it is not possible for FQHCs and RHCs to participate in the Shared Savings
Program by forming their own ACOs. It is, however, possible for them to join as an