(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 96
concerned that beneficiaries may be misled into thinking the ACO is similar to a
managed care organization, and that they may only receive services or only certain
services from the other participating ACO providers/suppliers.
Although section 1899 of the Act is silent with regard to marketing activities and
other forms of beneficiary communications by ACOs, section 1899(b)(2)(H) of the Act
requires an ACO to demonstrate "that it meets patient-centeredness criteria." We believe
that in order to be truly patient-centered, an ACO must not only provide care
coordination that is tailored to the needs of the individual beneficiary, but also avoid
engaging in activities that may prevent its assigned beneficiaries from taking advantage
of the full range of benefits to which they are entitled under the Medicare FFS program,
including the right to choose between healthcare providers and care settings. As a result,
issuing beneficiary communications or engaging in marketing activities that may be
confusing or misleading would not be patient-centered because these activities restrict the
ability of beneficiaries and/or their caregivers to be informed about their health care
choices and thus limit the opportunity for beneficiaries to be properly involved in the
management of their own care.
Accordingly, we think it would be appropriate and consistent with the purpose
and intent of the statute to limit and monitor the use of beneficiary communications
specifically related to the ACO operations or functions as well as ACO marketing
activities and materials by ACOs to ensure that such communications and marketing by
ACOs are used only for appropriate purposes, such as notification that a beneficiary's
healthcare provider is participating in the ACO, issuance of any CMS required notices,
notification of provider or ACO terminations. This policy will protect Medicare