(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 74 ACO during the performance year. However, since the MSR adjusts with the number of assigned beneficiaries, there is a built-in incentive for ACOs to increase their beneficiary population. We believe a reasonable compromise would balance the statutory requirements, program incentives, and recognition of expected variation in an ACO's assigned population. Thus, we are proposing that if an ACO's assigned population falls below 5,000 during the course of the agreement period, we would issue a warning and place the ACO on a corrective action plan. The ACO would remain eligible for shared savings for the performance year for which the warning was issued. We further propose that if the ACO fails to meet the eligibility criterion of having more than 5,000 beneficiaries by the completion of the next performance year, the ACO's participation agreement will be terminated and the ACO will not be eligible to share in savings for that year. Thus, for example, if during the first performance year, an ACO's assigned population fell below 5,000, we would issue a warning, notifying the ACO of the variation in their assigned population. The ACO would be placed on a corrective action plan which could include, for example, a plan to add more primary care providers to the ACO. The ACO would remain eligible to share in savings for the first performance year. However, if the ACO's assigned population had not returned to at least 5,000 by the end of the second performance year, then that ACO's agreement will be terminated and the ACO would not be eligible to share in savings for the second performance year. We also propose to reserve the right to review the status of the ACO while on the corrective action plan and terminate the agreement on the basis that the ACO no longer meets eligibility requirements. We request comment on this proposal and on other potential options for
CMS-1345-P 75 addressing situations where the assigned beneficiary population falls below 5,000 during the course of an agreement period. 8. Required Reporting on Participating ACO Professionals Section 1899(b)(2)(E) of the Act requires ACOs to "provide the Secretary with such information regarding ACO professionals participating in the ACO as the Secretary determines necessary to support the assignment of Medicare FFS beneficiaries to an ACO, the implementation of quality and other reporting requirements…, and the determination of payments for shared savings…." As discussed in sections II. B and II. D. of this proposed rule, we are proposing to define an ACO operationally as a legal entity that is comprised of a group of ACO participants which are in turn defined to mean Medicare-enrolled providers or suppliers, as identified by their TINs. However, TIN level data alone may not be entirely sufficient for a number of purposes in the Shared Savings Program such as implementing our methodology for beneficiary assignment and calculating the quality performance score. Accordingly, to satisfy the requirements under section 1899(b)(2)(E) of the Act, we are proposing that entities applying to participate in the Shared Savings Program must provide not only the TINs of the ACO and the ACO participants, but also a list of national provider identifiers (NPIs) associated with the ACO providers/suppliers, which would separately identifies the physicians that provide primary care. We are also proposing to require an ACO to maintain, update, and annually report to us the TINs of its ACO participants and the NPIs associated with the ACO providers/suppliers. We believe that requiring this information offers the level of transparency needed to implement the Shared Savings Program.
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DEPARTMENT OF HEALTH AND HUMAN SERV
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CMS-1345-P 3 Centers for Medicare &
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CMS-1345-P 5 C. Overview and Intent
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CMS-1345-P 7 7. Aligning ACO Qualit
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CMS-1345-P 9 CCNC Community Care of
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CMS-1345-P 11 SSN TIN Social Securi
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CMS-1345-P 13 better coordinate car
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CMS-1345-P 15 and efficient service
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CMS-1345-P 17 ACO shall have at lea
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CMS-1345-P 19 program or demonstrat
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CMS-1345-P 21 Section 1899(d)(3) of
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Page 33 and 34: CMS-1345-P 33 personal physicians;
Page 35 and 36: CMS-1345-P 35 • Experience with n
Page 37 and 38: CMS-1345-P 37 when looking at the e
Page 39 and 40: CMS-1345-P 39 Medicare FFS benefici
Page 41 and 42: CMS-1345-P 41 by only those ACO par
Page 43 and 44: CMS-1345-P 43 Since the statute req
Page 45 and 46: CMS-1345-P 45 For FQHCs and RHCs, t
Page 47 and 48: CMS-1345-P 47 individual practition
Page 49 and 50: CMS-1345-P 49 additional Medicare e
Page 51 and 52: CMS-1345-P 51 The ACO's legal entit
Page 53 and 54: CMS-1345-P 53 We note that by propo
Page 55 and 56: CMS-1345-P 55 and administrative sy
Page 57 and 58: CMS-1345-P 57 governance would crea
Page 59 and 60: CMS-1345-P 59 demonstration, partic
Page 61 and 62: CMS-1345-P 61 We believe that these
Page 63 and 64: CMS-1345-P 63 • Clinical manageme
Page 65 and 66: CMS-1345-P 65 participants and ACO
Page 67 and 68: CMS-1345-P 67 Section 1899(b)(2)(A)
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Page 71 and 72: CMS-1345-P 71 program while still f
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Page 79 and 80: CMS-1345-P 79 b. Processes to Promo
Page 81 and 82: CMS-1345-P 81 • Telehealth. • T
Page 83 and 84: CMS-1345-P 83 centeredness that is
Page 85 and 86: CMS-1345-P 85 mechanism for coordin
Page 87 and 88: CMS-1345-P 87 We are soliciting com
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Page 91 and 92: CMS-1345-P 91 panel. Such a proposa
Page 93 and 94: CMS-1345-P 93 addressing disparitie
Page 95 and 96: CMS-1345-P 95 Individualized plans
Page 97 and 98: CMS-1345-P 97 beneficiaries by mini
Page 99 and 100: CMS-1345-P 99 a. Compliance Plans W
Page 101 and 102: CMS-1345-P 101 generated by ACO par
Page 103 and 104: CMS-1345-P 103 C. Establishing the
Page 105 and 106: CMS-1345-P 105 After evaluating the
Page 107 and 108: CMS-1345-P 107 when the final payme
Page 109 and 110: CMS-1345-P 109 performance of ACO p
Page 111 and 112: CMS-1345-P 111 cost-effectiveness o
Page 113 and 114: CMS-1345-P 113 they identify priori
Page 115 and 116: CMS-1345-P 115 generally bars the d
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Page 119 and 120: CMS-1345-P 119 previous year's hist
Page 121 and 122: CMS-1345-P 121 providers/suppliers.
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CMS-1345-P 125 and the claim paymen
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CMS-1345-P 127 measurement activiti
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CMS-1345-P 129 beneficiary choice:
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CMS-1345-P 131 promote trust and pe
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CMS-1345-P 133 beneficiaries. We an
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CMS-1345-P 135 ensure that ACOs und
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CMS-1345-P 137 eligibility since th
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CMS-1345-P 139 or to providers or s
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CMS-1345-P 141 ACO and the eligibil
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CMS-1345-P 143 From a technical, op
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CMS-1345-P 145 beneficiaries would
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CMS-1345-P 147 associated with thos
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CMS-1345-P 149 pediatric medicine,"
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CMS-1345-P 151 care services" on th
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CMS-1345-P 153 better address the d
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CMS-1345-P 155 assignment from year
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CMS-1345-P 157 appropriate safeguar
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CMS-1345-P 159 ACO only when he or
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CMS-1345-P 161 We propose to implem
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CMS-1345-P 163 quality and shared s
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CMS-1345-P 165 chosen. We seek comm
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CMS-1345-P 167 measures to assess t
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CMS-1345-P 169 • To the extent pr
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CMS-1345-P 171 data collection and
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CMS-1345-P 173 improving ACO qualit
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CMS-1345-P 175 Domain Measure Title
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CMS-1345-P 187 43. At Risk Populati
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CMS-1345-P 189 50. At Risk Populati
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CMS-1345-P 195 Information on Physi
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CMS-1345-P 197 associated with clai
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CMS-1345-P 199 be required to popul
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CMS-1345-P 201 as that term is defi
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CMS-1345-P 203 Table 2: Five Measur
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CMS-1345-P 205 sided shared savings
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CMS-1345-P 207 Table 4: Total Point
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CMS-1345-P 209 Medicare program. Fu
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CMS-1345-P 211 for the first perfor
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CMS-1345-P 213 of quality acknowled
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CMS-1345-P 215 (Option 1) but using
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CMS-1345-P 217 ACO would qualify fo
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CMS-1345-P 219 future rulemaking. W
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CMS-1345-P 221 proposing greater al
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CMS-1345-P 223 6. Public Reporting
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CMS-1345-P 225 efficiency, effectiv
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CMS-1345-P 227 this information ava
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CMS-1345-P 229 Specifically, we see
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CMS-1345-P 231 We considered severa
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CMS-1345-P 233 Track 2: More experi
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CMS-1345-P 235 determinations about
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CMS-1345-P 237 beneficiaries during
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CMS-1345-P 239 truncate an assigned
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CMS-1345-P 241 the demonstration wh
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CMS-1345-P 243 We seek comments abo
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CMS-1345-P 245 Of these two methods
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CMS-1345-P 247 other factor could b
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CMS-1345-P 249 Capitation Rates, Pa
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CMS-1345-P 251 A model that uses be
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CMS-1345-P 253 option to audit ACOs
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CMS-1345-P 255 Thus, we are not pro
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CMS-1345-P 257 subsequently receive
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CMS-1345-P 259 This benchmark is su
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CMS-1345-P 261 nationwide under the
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CMS-1345-P 263 benchmark based on t
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CMS-1345-P 265 upon the number of M
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CMS-1345-P 267 beneficiaries. In re
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CMS-1345-P 269 and share in savings
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CMS-1345-P 271 a result of normal y
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CMS-1345-P 273 • 50 percent or mo
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CMS-1345-P 275 • Among older adul
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CMS-1345-P 277 of dual eligible ben
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CMS-1345-P 279 they incur shareable
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CMS-1345-P 281 for the Medicare pro
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CMS-1345-P 283 and efficiency of ca
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CMS-1345-P 285 have also suggested
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CMS-1345-P 287 providers' willingne
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CMS-1345-P 289 expect to consider i
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CMS-1345-P 291 two years under the
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CMS-1345-P 293 Design Element Minim
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CMS-1345-P 295 performance) under t
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CMS-1345-P 297 For purposes of the
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CMS-1345-P 299 proposed that for th
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CMS-1345-P 301 For example, a two-s
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CMS-1345-P 303 depends on the ACO's
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CMS-1345-P 305 have solicited comme
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CMS-1345-P 307 the ACO's repayment
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CMS-1345-P 309 the growth in Medica
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CMS-1345-P 311 relied upon by us in
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CMS-1345-P 313 requirements not set
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CMS-1345-P 315 entity is in an arra
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CMS-1345-P 317 disease) or benefici
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CMS-1345-P 319 information. If the
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CMS-1345-P 321 ● Failure to compl
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CMS-1345-P 323 harm to beneficiarie
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CMS-1345-P 325 determinations would
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CMS-1345-P 327 Shared Savings Progr
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CMS-1345-P 329 CMS and OIG have joi
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CMS-1345-P 331 The Antitrust Policy
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CMS-1345-P 333 previously. Such an
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CMS-1345-P 335 protects beneficiary
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CMS-1345-P 337 both Medicare benefi
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CMS-1345-P 339 J. Overlap with Othe
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CMS-1345-P 341 CMS shared savings p
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CMS-1345-P 343 Shared Savings Progr
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CMS-1345-P 345 improve the Shared S
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CMS-1345-P 347 V. Regulatory Impact
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CMS-1345-P 349 The Shared Savings P
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CMS-1345-P 351 ACOs work to improve
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CMS-1345-P 353 presumably provide a
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CMS-1345-P 355 • Number of partic
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CMS-1345-P 357 distribution. With t
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CMS-1345-P 359 c. Further Considera
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CMS-1345-P 361 More specifically, w
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CMS-1345-P 363 program and uncertai
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CMS-1345-P 365 Savings Program at 7
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CMS-1345-P 367 ACO-attributed claim
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CMS-1345-P 369 Category Costs COSTS
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CMS-1345-P 371 For the reasons set
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CMS-1345-P 373 (2) Program requirem
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CMS-1345-P 375 Act. Hospital means
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CMS-1345-P 377 meet the minimum qua
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CMS-1345-P 379 (C) Begin to operate
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CMS-1345-P 381 (D) The civil moneta
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CMS-1345-P 383 prior to the start o
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CMS-1345-P 385 for populations, and
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CMS-1345-P 387 monitoring and evalu
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CMS-1345-P 389 (i) It plans to use
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CMS-1345-P 391 (1) Have a beneficia
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CMS-1345-P 393 who were an ACO part
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CMS-1345-P 395 amount for the patie
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CMS-1345-P 397 under §425.7(b). An
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CMS-1345-P 399 (ii) To be responsib
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CMS-1345-P 401 §425.8 ACO quality
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CMS-1345-P 403 (2) CMS scores indiv
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CMS-1345-P 405 (a) Monitoring of AC
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CMS-1345-P 407 required measure dat
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CMS-1345-P 409 (5) The procedures e
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CMS-1345-P 411 demonstrate in its a
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CMS-1345-P 413 days of the notice o
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CMS-1345-P 415 original notice of d
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CMS-1345-P 417 (c) Notwithstanding
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CMS-1345-P 419 (ii) Quality perform
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CMS-1345-P 421 (i) The beneficiary
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CMS-1345-P 423 terminated from the
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CMS-1345-P 425 inclusion of additio
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CMS-1345-P 427 individuals, better
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CMS-1345-P 04/07/2011] [FR Doc. 201
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(ACO) regulations - American Society of Anesthesiologists

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