For the past several years, the Centers for Medicare and Medicaid Services (“CMS”) has incentivized hospitals and eligible professionals to adopt and make “meaningful use” of certified electronic health records (“EHR”) technology through the Medicare and Medicaid Meaningful Use programs. Since the inception of these programs, over $16.6 billion in Medicare incentive payments and $8.6 billion in Medicaid incentive payments have been made to hospitals and eligible professionals. Approximately 90% of hospitals and 75% of eligible professionals now participate in these incentive programs. Continue reading this entry
Health Care Law Today is issuing a series of blog posts about the Centers for Medicare and Medicaid Services’ (CMS) proposed rule to revise the Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) regulations (the Proposed Rule). This is the fifth post in Health Care Law Today’s series on the Proposed Rule. Click here to read the previous posts.
This post addresses the changes that the rule would make to how CMS assigns beneficiaries to an ACO participating in the MSSP. The Proposed Rule places a renewed emphasis on primary care for beneficiary assignment. Section 1899(c) of the Social Security Act, the statutory basis for the MSSP, requires the Secretary to “determine an appropriate method to assign Medicare fee-for-service beneficiaries to an ACO based on their utilization of primary care services provided by [ACO professionals.]” The Proposed Rule aims to clarify both what constitutes a primary care service, by expanding its scope, and who can provide primary care services for purposes of assignment. In addition, the Proposed Rule clarifies the assignment methodology based on services provided by federally qualified health centers (FQHCs), rural health clinics (“RHCs”), and Electing Teaching Amendment (ETA) hospitals. Continue reading this entry
This is the fourth post in Health Care Law Today’s series on the proposed rule revising the Medicare Shared Savings Program. The rule was published in the Federal Register on December 8, 2014 and parties have 60 days to offer comments. Click here to read earlier posts about the rule. This post addresses the changes that CMS proposes concerning sharing of beneficiary identifiable data.
CMS may be ready to ramp up the data it is willing to share with Accountable Care Organizations (“ACOs”) that participate in the Medicare Shared Savings Program (“MSSP”).
CMS explained in the November 2011 final rule that 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, monitor provider/supplier quality of care and patient experiences, and produce efficiencies in utilization of services. In the proposed rule, CMS reiterates its expectation that ACOs should be developing and refining these processes. Continue reading this entry
Additional Program Requirements and Beneficiary Protections
Under the Medicare Shared Savings Program (“MSSP”) ACO proposed rule, CMS has proposed additional program requirements, beneficiary protections and participation agreement procedures to enhance ACO transparency and improve patients’ ability to make informed health care decisions. Specifically, CMS has proposed additional public reporting obligations that ACOs must fulfill to participate in the MSSP. These reporting requirements include the following: Continue reading this entry
This is the second post in Health Care Law Today’s series on the proposed rule. Click here to read the first post.
Solutions and opportunities may be on the horizon for post-acute providers (“PAPs”) and hospitals participating (or thinking of participating) in ACOs that have reservations about taking on additional downside cost risk associated with the current Medicare Shared Savings Program (MSSP) model. Continue reading this entry