(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 51
The ACO's legal entity may be structured in a variety of ways, including as a
corporation, partnership, limited liability company, foundation, or other entity permitted
by State law. As discussed previously in section II. B. of this proposed rule, and
consistent with section 1899(b)(1)(A)-(D) of the Act, certain specified groups of
providers of services and suppliers who have a mechanism of shared governance may be
eligible to participate as ACOs in the Shared Savings Program. In addition to the groups
specifically identified in the statute, we are proposing to use the Secretary's discretion
under section 1899(b)(1)(E) of the Act to expand the list of eligible groups of providers
and suppliers that may participate in the Shared Savings rogram. Specifically, we are
proposing that ACOs may incorporate other groups of Medicare enrolled providers and
suppliers, many of whom would not be able to form ACOs and participate in the program
independently. As described previously, each of the Medicare-enrolled providers and
suppliers that join together to form an ACO is identified by their Medicare-enrolled TIN
and is referred to herein as an ACO participant. Regardless of whether an ACO
participant is able to meet the eligibility criteria for participation in the Shared Savings
Program independently or must join with others in order to meet criteria, we propose that
the ACO must demonstrate a mechanism of shared governance that provides all ACO
participants with an appropriate proportionate control over the ACO's decision making
process.
In response to the request for information (RFI) that appeared in the
November 17, 2010 Federal Register (75 FR 70165), we received comments regarding
the need for us to remain flexible when defining the required legal structure to allow for a
variety of structural options. For example, commenters noted that we should permit