(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 53
We note that by proposing that the ACO be required to have a TIN, we are not
proposing to require that the ACO itself be enrolled in the Medicare program, in contrast
to this requirement for each ACO participant.
Also, by proposing that each ACO must be constituted as a legal entity
appropriately recognized and authorized under applicable State law, we are not proposing
to require that existing legal entities appropriately recognized under State law must form
a separate new entity for the purpose of participating in the Shared Savings Program. If
the existing legal entity meets the eligibility requirements to be an ACO, as described in
this proposed rule, it may operate as an ACO, as long as it is recognized under applicable
State law and is capable of receiving and distributing shared savings, repaying shared
losses, and performing the other ACO functions identified in the statute and regulations,
including the requirement for shared governance for ACO participants.
For example, a hospital employing ACO professionals, which is one of the
entities identified in section 1899(b)(1) of the Act, may be eligible to participate in the
Shared Savings Program as an ACO with its current legal structure, as recognized under
applicable State law, and would not be required to develop a separate new entity. We
recognize, however, that the absence of a separate legal entity to operate the ACO may
make it more difficult for us to audit and otherwise assess ACO performance. We solicit
comment on whether we should require all ACOs participating in the Shared Savings
Program to be formed as a distinct legal entity appropriately recognized and authorized to
conduct its business under applicable State law or whether an existing legal entity could
be permitted to participate in the Shared Savings Program as an ACO, including entities
that have similar arrangements with other payors. However, we propose that if an