(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 62
the same organizational structure and clinical care practices to serve both Medicare
beneficiaries and consumers covered by commercial insurance, the certainty created by
harmonizing our eligibility criteria with antitrust requirements will help to ensure that an
ACO organization participating in the Shared Savings Program will not subsequently
face an antitrust challenge that its conduct is per se illegal, which could prevent the ACO
from fulfilling the 3-year term of its agreement under the Shared Savings Program.
Accordingly, we believe an ACO, the ACO participants, and ACO
providers/suppliers should demonstrate an organizational commitment to the Shared
Savings Program and the terms of the 3-year agreement, both as a group and individually,
as well as the leadership and management capabilities necessary to achieve the three-part
aim by managing and coordinating the care of assigned Medicare beneficiaries. We note
that the statute permits ACO participants that form an ACO to use a variety of
collaborative organizational structures, including collaborations short of merger, to
evidence the required organizational commitment and leadership and management
capabilities.
Thus, consistent with the requirement in section 1899(b)(2)(F) of the Act that an
ACO have a leadership and management structure that includes clinical and
administrative systems, we are proposing that ACOs meet the following criteria:
• The ACO's operations would be managed by an executive, officer, manager, or
general partner, whose appointment and removal are under control of the organization's
governing body and whose leadership team has demonstrated the ability to influence or
direct clinical practice to improve efficiency processes and outcomes.