(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 8 3. Terminating an ACO Agreement 4. Reconsideration Review Process I. Coordination with Other Agencies 1. Waivers of CMP, Anti Kickback, and Physician Self Referral Laws 2. IRS Guidance Relating to Tax Exempt Organization 3. Antitrust Policy Statement 4. Prohibition Against the Shared Savings Program Participation by ACOs with Market Power a. Coordinating the Shared Savings Program Application with the Antitrust Agencies b. Competition and Quality of Care c. Competition, Price, and Access to Care J. Overlap with Other CMS Shared Savings Initiatives 1. Duplication in Participation in Medicare Shared Savings Programs 2. Transition of the Physician Group Practice (PGP) Demonstration Sites into the Shared Savings Program 3. Overlap with the Center for Medicare & Medicaid Innovation (Innovation Center Shared Savings Models III. Collection of Information Requirements IV. Response to Comments V. Regulatory Impact Analysis A. Introduction B. Statement of Need C. Anticipated Effects 1. Effects on the Medicare Program a. Assumptions and Uncertainties b. Detailed Stochastic Modeling Results c. Further Considerations 2. Impact on Beneficiaries 3. Impact on Providers and Suppliers D. Alternatives Considered E. Accounting Statement and Table F. Conclusion Acronyms ACO AHRQ BCBSMA BIPA BQI CAD CAHPS CAHs CAM CBIC Accountable Care Organizations Agency for Healthcare Research and Quality Blue Cross Blue Shield of Massachusetts Benefits Improvement and Protection Act Better Quality Information Coronary Artery Disease Consumer Assessment of Health Providers and Systems Critical Access Hospitals Complementary and Alternative Services Competitive Bidding Implementation Contractor
CMS-1345-P 9 CCNC Community Care of North Carolina CHCs Community Health Centers CHIP Children's Health Insurance Program CMMI Center for Medicare and Medicaid Innovation CMP Civil Monetary Penalties CMS Centers for Medicare and Medicaid Services CNM Certified Nurse Midwife CMS-HCC CMS Hierarchal Condition Category COPD Chronic Obstructive Pulmonary Disease CP Certified Psychologist CSW Clinical Social Worker CVE Chartered Value Exchange CWF Common Working File DHHS Department of Health and Human Services DM Diabetes Mellitus DOJ Department of Justice DRA Deficit Reduction Act of 2005(Pub. L. 109-171) DSH Disproportionate Share Hospital DUA Data use Agreement E&M Evaluation and Management EDB Enrollment Database EHR Electronic Health Record ESRD End Stage Renal Disease eRx Electronic Prescribing Incentive Program FFS Fee For Service FQHCs Federally Qualified Health Centers FTC Federal Trade Commission GAO Government Accountability Office GPCI Geographic Practice Cost Index GPRO Group Practice Reporting Option HAC Hospital Acquired Conditions HCAHPS Health Care Providers Systems and Surveys HCC Hierarchal Condition Category HCO Health Care Organizations HCPCS Health Care Procedural Coding System HHA Home Health Agencies HICN Health Insurance Claim Number HIPAA Heath Insurance Portability and Accountability Act of 1996 HIE Health Information Exchange HIT Health Information Technology HITECH Health Information Technology for Economic and Clinical Health HMO Health Maintenance Organization HRSA Health Resources Services Administration HVBP Hospital Value Based Purchasing IHIE Indiana Health Information Exchange IME Indirect Medical Education
Page 1 and 2: DEPARTMENT OF HEALTH AND HUMAN SERV
Page 3 and 4: CMS-1345-P 3 Centers for Medicare &
Page 5 and 6: CMS-1345-P 5 C. Overview and Intent
Page 7: CMS-1345-P 7 7. Aligning ACO Qualit
Page 11 and 12: CMS-1345-P 11 SSN TIN Social Securi
Page 13 and 14: CMS-1345-P 13 better coordinate car
Page 15 and 16: CMS-1345-P 15 and efficient service
Page 17 and 18: CMS-1345-P 17 ACO shall have at lea
Page 19 and 20: CMS-1345-P 19 program or demonstrat
Page 21 and 22: CMS-1345-P 21 Section 1899(d)(3) of
Page 23 and 24: CMS-1345-P 23 Section 1899 (i) of t
Page 25 and 26: CMS-1345-P 25 • An ACO will manag
Page 27 and 28: CMS-1345-P 27 providers participati
Page 29 and 30: CMS-1345-P 29 The Affordable Care A
Page 31 and 32: CMS-1345-P 31 establish an estimate
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
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CMS-1345-P 59 demonstration, partic
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CMS-1345-P 61 We believe that these
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CMS-1345-P 63 • Clinical manageme
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CMS-1345-P 65 participants and ACO
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CMS-1345-P 67 Section 1899(b)(2)(A)
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CMS-1345-P 69 be subject to the req
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CMS-1345-P 71 program while still f
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CMS-1345-P 73 Thus, we considered w
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CMS-1345-P 75 addressing situations
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CMS-1345-P 77 include provisions fo
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CMS-1345-P 79 b. Processes to Promo
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CMS-1345-P 81 • Telehealth. • T
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CMS-1345-P 83 centeredness that is
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CMS-1345-P 85 mechanism for coordin
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CMS-1345-P 87 We are soliciting com
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CMS-1345-P 89 to ensure that survey
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CMS-1345-P 91 panel. Such a proposa
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CMS-1345-P 93 addressing disparitie
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CMS-1345-P 95 Individualized plans
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CMS-1345-P 97 beneficiaries by mini
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CMS-1345-P 99 a. Compliance Plans W
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CMS-1345-P 101 generated by ACO par
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CMS-1345-P 103 C. Establishing the
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CMS-1345-P 105 After evaluating the
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CMS-1345-P 107 when the final payme
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CMS-1345-P 109 performance of ACO p
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CMS-1345-P 111 cost-effectiveness o
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CMS-1345-P 113 they identify priori
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CMS-1345-P 115 generally bars the d
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CMS-1345-P 117 acting on behalf of
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CMS-1345-P 119 previous year's hist
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CMS-1345-P 121 providers/suppliers.
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CMS-1345-P 123 permitted under the
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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
Page 301 and 302:
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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