In another step toward implementation of Accountable Care Organizations (ACOs), on April 10, 2012, the Centers for Medicare & Medicaid Services (CMS) selected 27 ACOs in 18 states to participate in the Medicare Shared Savings Program (Shared Savings Program). These ACOs will serve an estimated 375,000 beneficiaries and, according to CMS, are comprised of 10,000… Continue Reading
Category Archives: Accountable Care Organizations
Subscribe to Accountable Care Organizations RSS FeedCMS Clarifies Key ACO Eligibility Requirements
Posted in Accountable Care Organizations, Health Care Reform, UncategorizedWritten by: Christi Braun and Stephanie Willis Responding to questions from Medicare Shared Savings Program (MSSP) applicants and their counsel, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum on March 16. CMS’ memo focuses on three specific areas: (1) clarification regarding Accountable Care Organization (ACO) participants, ACO providers and suppliers, and their participation… Continue Reading
ML Strategies Posts Weekly Health Care Reform Update on March 12, 2012
Posted in Accountable Care Organizations, Health Care Reform, Pharma & Medical Devices, UncategorizedML Strategies has posted its weekly Health Care Reform Update. This publication provides timely and concise information on implementation of the Affordable Care Act, and other state and federal administrative and legislative activities related to health care reform.
HHS, DOL, and IRS Issue FAQs Addressing Automatic Enrollment, Employer Shared Responsibility and Waiting Periods under the ACA
Posted in Accountable Care Organizations, Health Care Reform, Payors & PBMsThe Affordable Care Act will require major changes to the design, maintenance, and operation of employer-sponsored (and other) group health plans. A recently issued set of frequently asked questions (FAQs) from the Departments of Health and Human Services, Labor, and Treasury/IRS provide interim relief in certain instances, and signal the Departments’ thinking as to others. … Continue Reading
ML Strategies Posts Weekly Health Care Reform Update on February 13, 2012
Posted in Accountable Care Organizations, Health Care Reform, UncategorizedML Strategies has posted its weekly Health Care Reform Update. This publication provides timely and concise information on the Obama Administration’s FY 2013 federal budget totaling $3.8 trillion, implementation of the Affordable Care Act, and other state and federal administrative and legislative activities related to health care reform.
CMS Posts MLR Guidance: Payments to Entities such as IPAs, PHOs, and ACOs
Posted in Accountable Care Organizations, Health Care Reform, Reimbursement, UncategorizedWritten by Gary Bacher CMS posted additional sub-regulatory guidance regarding the Medicare Loss Ratio (MLR) under Section 2718 of the Public Health Service Act, as added by the Affordable Care Act (ACA). The MLR requires health insurance issuers to submit a MLR report to the Secretary of Health and Human Services and issue a rebate… Continue Reading
A Delicate Balance for ACOs: Waiver of Fraud and Abuse Laws and New Program Integrity Requirements
Posted in Accountable Care Organizations, Fraud & Abuse, Health Care ReformHow will the waiver of certain health care fraud and abuse laws and the implementation of program integrity requirements under the new Medicare Shared Savings Program affect the formation and operation of accountable care organizations? In an article published in BNA’s Health Care Fraud Report, Tom Crane, Karen Lovitch, and I explore the delicate balance between… Continue Reading
Berwick Leaves CMS; Tavenner Nominated
Posted in Accountable Care Organizations, Health Care Reform, UncategorizedWritten by Kevin Kappel and Jared Alves The Centers for Medicare & Medicaid Services will be due for new leadership as Don Berwick, its current chief executive, steps down today. If all goes according to the Obama Administration’s plan, Berwick will be replaced by Marilyn Tavenner, the agency’s current principal deputy administrator. Already Tavenner’s nomination appears… Continue Reading
Spending to Save: Innovation Challenge Grants Seek Better Outcomes at a Lower Cost
Posted in Accountable Care Organizations, Health Care Reform, Home Health & Hospice, Hospitals & Health Systems, Long-term Care/Skilled Nursing Facilities, UncategorizedWritten by Jared Alves and Kevin Kappel Stakeholders across the health care spectrum will soon compete for $1 billion in grants offered by the Health Care Innovation Challenge. The initiative, funded as part of the Patient Protection and Affordable Care Act, was announced by the Centers for Medicare and Medicaid Services (CMS) on November 14th… Continue Reading
ML Strategies Posts Weekly Health Care Reform Update
Posted in Accountable Care Organizations, Health Care ReformML Strategies has posted its weekly Health Care Reform Update . This publication provides timely and concise information on implementation of the Affordable Care Act and other state and federal administrative and legislative activities related to health care reform.
CMS, OIG, DOJ, FTC Release New Interim and Final Rules on ACOs
Posted in Accountable Care Organizations, Fraud & Abuse, Hospitals & Health Systems, Reimbursement, UncategorizedWritten by Stephanie D. Willis Today, CMS released the final rule that will implement the Medicare Shared Savings Program (MSSP) mandated by section 3022 of the Affordable Care Act. Simultaneously, the Department of Justice’s Antitrust Division and the Federal Trade Commission released their joint “Statement of Antitrust Enforcement Regarding Accountable Care Organizations Participating in the… Continue Reading
Innovation Center Extends Bundled Payments Initiative Application Deadlines
Posted in Accountable Care Organizations, Health Care Reform, Hospitals & Health Systems, Payors & PBMs, Reimbursement, UncategorizedWritten by Stephanie Willis The Center for Medicare and Medicaid Innovation has extended the deadlines for submitting letters of intent and final applications for participation in the Bundled Payments for Care Improvement Initiative. On August 23rd, Innovation Center Director Dr. Rick Gilfillan, together with Valinda Rutledge, Director of the Patient Care Models Group, and Senior… Continue Reading
