(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 56
required under section 1899(b)(1)(G) of the Act. As discussed in more detail later in the
document, this governing body would be comprised of the ACO participants or their
designated representatives, include Medicare beneficiaries served by the ACO, and
possess broad responsibility for the ACO's administrative, fiduciary, and clinical
operations. While the representatives on the governing body could be serving in a similar
or complementary manner for an ACO participant within the ACO, this body must be
separate and unique to the ACO when the ACO participants are not already represented
by an existing legal entity appropriately recognized and authorized to conduct its business
under applicable State law. In those instances where the ACO is comprised of a selfcontained
financially and clinically integrated entity that has a pre-existing board of
directors or other governing body, such as a hospital that employs ACO professionals, we
are also proposing that the ACO would not need to form a separate governing body, as
long as that governing body is able to meet all other criteria required for ACO governing
bodies. In this case, the integrated entity's governing body would be the governing body
of the ACO, and the ACO would be required to provide in its application evidence that its
pre-existing board of directors or other governing body, meets all other criteria required
for ACO governing bodies. Although we wish to provide potential ACOs with some
flexibility on corporate governance and ACO formation, we are concerned that allowing
existing entities to be ACOs would complicate our monitoring and auditing of the ACO.
We solicit comment on this issue.
Moreover, our intent is to encourage not-for-profit, community-based
organizations to participate in the Shared Savings Program. We request comment on
whether requirements for the creation of a governing body as a mechanism for shared