Tag Archives: ACOs

Proposed Overhaul to the Medicare Shared Savings Program Would Mean More Risk for ACOs

hospital staff
On August 9, 2018, CMS introduced a proposed rule that would substantially overhaul the Medicare Shared Savings Program (MSSP), requiring Accountable Care Organizations (ACOs) that participate in the MSSP to accept some downside risk and tightening other requirements to increase program integrity. At the same time, the proposed rule would allow ACOs increased flexibility in … Continue reading this entry

IRS Denies Exempt Status for Non-MSSP Accountable Care Organizations

In April, the IRS released a private letter ruling denying section 501(c)(3) status to an accountable care organization (“ACO”) that contracted with third-party payers outside of the Medicare Shared Savings Program (“MSSP”). I.R.S. Priv. Ltr. Rul. 2016-15-022 (Jan. 15, 2016). The ACO was formed by a non-profit, tax-exempt health system to coordinate a clinically integrated … Continue reading this entry

CMS Issues Final Rule on ACOs Participating in the Medicare Shared Savings Program

The Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (the “Final Rule”) for accountable care organizations (“ACOs”) participating in the Medicare Shared Savings Program (“MSSP”) on June 6, 2016. In the Final Rule, CMS reflects its continuing efforts to modify alternative payment programs to make them more workable while also moving toward … Continue reading this entry

Health Care IT Program Discusses Alternative Payment Model Opportunities

A distinguished panel of providers, consultants and IT firms convened on Tuesday, June 21st  in New York at the Foley and Lardner LLP offices to share a discussion focused on the convergence of IT spend and new value based purchasing models (“VBP”) coming out of CMS in increasing frequency—ACOs, BPCI, CJR and CCM.  Key Takeaways … Continue reading this entry

Expansion of Clinical Services at Assisted Living Sites – The New Paradigm

As payment reforms, such as bundled payments and Accountable Care Organizations (ACOs), drive further provider collaboration to achieve lower costs with enhanced outcomes, post- acute providers, especially assisted living sites, find themselves at the junction of important strategic decisions. Historically, assisted living was viewed as a “nursing home light” model that allowed aging in place and possible … Continue reading this entry

CMS Proposes Additional Changes to MSSP Regulations

Regulatory-Developments
The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule modifying the Medicare Shared Savings Program (MSSP) regulations (the “Rule”). Among other changes, the Rule proposes (a) to modify the method in which cost benchmarks for MSSP-participating Accountable Care Organizations (ACOs) are updated both during a three-year agreement period and upon renewal, and … Continue reading this entry

SAMHSA Proposes Major Changes to Federal Substance Abuse Privacy Rule

Electronic Health Records
Almost thirty years after the last substantive change to the federal regulations governing the confidentiality of alcohol and drug abuse patient records, the Substance Abuse and Mental Health Services Administration (SAMHSA) today published a proposed rule (Proposed Rule) to modernize the regulations at 42 CFR Part 2 (the Part 2 Rule). Public comment period on … Continue reading this entry

Senate Workgroup’s Proposals Address Chronic Illness Through Medicare

The Senate Finance Committee chronic care working group recently released a Policy Options Document continuing an effort that started with a hearing titled, “Chronic Illness: Addressing Patients’ Unmet Needs” in the summer of 2014. The workgroup, which is led by Chairman Orrin Hatch, Ranking Member Ron Wyden, and Senators Johnny Isakson and Mark Warner, compiled … Continue reading this entry

2016 Will Be the Year of Telemedicine and ACOs

If 2015 was the year that brought telemedicine directly to consumers, 2016 will be the year of telemedicine and Accountable Care Organizations (ACOs). ACOs are expected to increase the use of telemedicine technologies as a way to improve patient quality, achieve greater cost savings, and meet Center for Medicare & Medicaid Services’ (CMS) patient threshold.… Continue reading this entry

Five Telemedicine Trends Transforming Health Care in 2016

Telemedicine is a key component in the health care industry shift to value-based care as a way to generate additional revenue, cut costs and enhance patient satisfaction. It is expected that the global telemedicine market will expand at a compound annual growth rate of 14.3 percent through 2020, eventually reaching $36.2 billion, as compared to … Continue reading this entry

Top Three Reasons ACOs Should Use Telehealth and Telemedicine

Accountable Care Organizations (ACOs) can share costs of telehealth and remote patient monitoring services among their hospitals, providers/suppliers, and other ACO participants, according to federal regulations under the Medicare Shared Savings Program (MSSP) fraud and abuse waivers. In protecting these arrangements, CMS and OIG recognize how telehealth technologies and innovative care processes can help reduce … Continue reading this entry

OIG and CMS Issue Rule: Finalizing Fraud and Abuse Waivers for MSSP ACOs

The Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) of the Department of Health and Human Services just issued a final rule setting forth waivers of specified fraud and abuse laws applicable to the Medicare Shared Savings Program (MSSP). The final rule replaces the Interim Final Rule (IFC) with comment … Continue reading this entry

2014 Medicare ACO Results Released: CMS Asserts Success but Few ACOs Receive Payments

The Centers for Medicare and Medicaid Services (CMS) released, on August 25, 2015, the quality and financial performance results for Medicare Accountable Care Organizations for 2014. CMS touted that Medicare ACOs continued to improve care while slowing growth in health care costs.… Continue reading this entry

The Telehealth Top 10 for 2015

Telemedicine
Telehealth continues to be an innovative alternative to traditional brick-and-mortar medicine. The number of providers offering telehealth services is rapidly increasing and states are enacting laws requiring health plans to cover telehealth services and telehealth technology at a brisk pace. Listed below are the top ten key issues that providers of telehealth services should keep … Continue reading this entry

MSSP Final Rule Adopts All Proposed Additional Program Requirements and Beneficiary Protections Provisions

This is the sixth post in Health Care Law Today’s series on the final rule. This post addresses additional program requirements and beneficiary protections. The Medicare Shared Savings Program (“MSSP”) final rule published on June 4, 2015 finalized all proposed additional program requirements and beneficiary protections outlined in the December 2014 proposed rule. The specific … Continue reading this entry

MSSP Final Rule Provides Modification to Shared Savings Financial Arrangement

This is the fifth post in Health Care Law Today’s series on the final rule. The final Medicare Shared Savings Program (“MSSP”) rule released on June 4, 2015, contains a number of modifications to the financial arrangement contained in the existing regulations. The modifications are designed to encourage ACOs to participate or continue participating in the … Continue reading this entry

Beneficiary Assignment Under the MSSP Final Rule

This is the fourth post in Health Care Law Today’s series on the final rule. This post addresses how CMS assigns beneficiaries to an ACO participating in the MSSP. In the MSSP ACO Final Rule, CMS finalized new regulations that govern the assignment of Medicare fee-for-service beneficiaries to an ACO participating in the MSSP.… Continue reading this entry

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”). … Continue reading this entry

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 … Continue reading this entry

CMS Releases Final Rule on Medicare Shared Savings Program

This is the first post in Health Care Law Today’s Series on the final rule. The Centers for Medicare and Medicaid Services (“CMS”) released a final rule, on June 4, 2015, addressing changes to its Medicare Shared Savings Program (“MSSP”) Accountable Care Organization (“ACO”) Regulations. The final rule follows a proposed rule released on December … Continue reading this entry

Repositioning of Nursing Homes to Alternative Models of Care

The juncture of the increasing drive to lower health care costs, consumer preferences for at home care or care in more residential environments, and the ability to deliver care as needed in portable and flexible ways, all have combined to produce an acceleration in the closure and repositioning of traditional SNFs to alternative uses. All of … Continue reading this entry

CMS Announces Next Generation ACO Model

CMS announced a new ACO payment initiative on March 10, 2015, the Next Generation ACO Model, designed for entities experienced in coordinating care for populations of patients. The announcement reflects CMS’ commitment to exploring different Medicare payment arrangements that encourage providers to assume higher levels of financial risk and reward while delivering quality care. The Next Generation … Continue reading this entry

Takeaways From the FTC/DOJ Workshop on Health Care Competition

The Federal Trade Commission and Department of Justice Antitrust Division held their second public workshop on health care competition on February 24-25, 2015. The workshop is part of the FTC and DOJ’s commitment to periodically “step back” from the work of day-to-day antitrust enforcement to take in a broader perspective of trends in the health care … Continue reading this entry

CMS Proposes Financial Revisions to MSSP to Encourage Continued and Expanded Participation

Preparing for the Conversion to ICD-10
This is the sixth post in Health Care Law Today’s series on the proposed rule modifying the Medicare Shared Savings Program (“MSSP”). The proposed 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 proposed … Continue reading this entry