CMS Proposes Revisions to ACO Regulations

The Centers for Medicare and Medicaid Services (CMS) published proposed revisions to the Accountable Care Organization (ACO) regulations on Dec. 8. The proposed changes are intended to incorporate guidance that CMS issued since the Shared Savings Program was established and to add provisions to support program compliance and growth. This proposed rule would modify the regulations that were promulgated in November 2011 to implement the Shared Savings Program.

The proposed revisions include provisions that would, among other things:

expand Medicare beneficiary-identifiable data shared with ACOs regarding their assigned beneficiaries;
improve transparency and clarity regarding the identification and reporting of professionals, providers and suppliers participating in ACOs;
expand the CPT codes that are used to assign beneficiaries to an ACO and include nurse practitioner and physician assistant claims in the assignment methodology;
expand flexibility to address situations in which an ACO’s assigned beneficiary population falls below 5,000;
strengthen ACO governing bodies and reduce the potential for conflicts of interest; and
create new ACO eligibility requirements to:
- promote the use of enabling technologies for improving care coordination for beneficiaries, including electronic health records and other health IT tools; telehealth services (including remote patient monitoring); health information exchange services; or electronic tools to engage patients in their care.
- require ACO applicants to describe how they will partner with long term and post-acute care providers to improve care coordination for assigned beneficiaries.

In addition, the proposed regulations include provisions to encourage greater ACO participation in risk-based payment models by:

allowing ACOs to continue participating under a one-sided participation agreement after their first three-year agreement;
reducing risk under the two-sided risk model (Track 2); and
adopting an alternative risk-based model, referred to as Track 3, which includes proposals for a higher sharing rate and prospective assignment of beneficiaries.

Comments on the proposed regulations are due by 5 p.m. on Feb. 6, 2015.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124.