Final Rule Will Give ACOs Participating in MSSP Access to More Data for More Beneficiaries

American Hospital Association Recommends Revisions to Medicare ACO Models

This is the third post in Health Care Law Today’s series on the final rule. This post addresses changes to sharing of beneficiary identifiable data.

In its December 8, 2014 proposed rule revising the Medicare Shared Savings Program (“MSSP”), CMS proposed several changes concerning how it would share beneficiary identifiable data with Accountable Care Organizations (“ACOs”). In particular, CMS explained in the proposed rule that while it expects participating ACOs to identify and produce the data they believe necessary to evaluate the health needs of their patient population, improve health outcomes, and monitor quality of care, it also recognizes that ACOs do not always have access to information for care provided to their assigned beneficiaries by health care providers and suppliers outside of the ACO. Continue reading this entry

How Does the King v. Burwell Decision Affect the Affordable Care Act?

The Supreme Court handed the Obama administration a key victory this morning, upholding the tax credits that allow many low-income Americans to purchase health care insurance in states where the federal government is running the insurance marketplace. These tax credits, available to Americans with household incomes between 100% and 400% of the federal poverty line, operate as a form of premium assistance that subsidizes the purchase of health insurance.

The petitioners in King v. Burwell, No. 14-114 (U.S. June 25, 2015), challenged a ruling from the Internal Revenue Service (IRS) and claimed that a phrase in the Affordable Care Act (ACA) indicating that the subsidies are only available to consumers buying insurance in a state-run exchange prohibited the federal government from providing tax credits where states have not established their own exchanges. Arguing that the text of the law should be read literally, they challenged an IRS regulation that makes these tax credits available regardless of whether the exchange is run by a state or the federal government. Continue reading this entry

Top 3 Cybersecurity Misconceptions - Is Your Company at Risk?

Cybersecurity is an issue that should be top-of-mind for all companies. But there are three misconceptions about cybersecurity that can put companies at significant risk. In this video, Foley Partner Michael Overly discusses these misconceptions and how companies should change their views of and approaches to cybersecurity.

MSSP Final Rule ACO Eligibility Requirements, Application and Renewal Process


This is the second post in Health Care Law Today’s series on the final rule. This post addresses Eligibility Requirements, and the Application and the Renewal Process.

ACO Eligibility Requirements

Under the Medicare Shared Savings Program (“MSSP”) ACO Final Rule, CMS finalized new regulations that will change ACO eligibility requirements. The final rule will include new requirements for participation agreements with ACO participants and ACO providers/suppliers, a new process for reporting changes concerning ACO participants and providers/suppliers, as well as clarifications related to the structure and governance of ACOs. Additionally, the final rule requires an ACO to describe in its application for participation how it will encourage and promote the use of enabling technologies for improving care coordination for beneficiaries and how the ACO intends to partner with long-term care and post-acute care providers to improve care coordination for the ACO’s assigned beneficiaries. Continue reading this entry