The Centers for Medicare & Medicaid Services (“CMS”) has released a proposed rule that would implement the Patient Protection and Affordable Care Act (the “Affordable Care Act”) provisions relating to Medicare payment to providers of services and suppliers participating in Accountable Care Organizations (“ACOs”). Under these provisions (found in Section 3022 of the Affordable Care Act) beginning January 1, 2012 providers of services and supplies may be eligible for additional Medicare payments based on meeting certain specified quality and savings requirements.

CMS states that ACOs are intended to be part of a program “that promotes accountability for a patient population and coordinates items and services under [Medicare] parts A and B, and encourages investment in infrastruture and redesigned care processes for high quality and efficient service delivery.” The aim of the program, referred to by CMS as the “three-part aim,” is (1) better care for individuals, (2) better health for populations, and (3) lower growth in expenditures. The quality standards for ACOs would focus on five key areas:

  • Patient/caregiver care experiences
  • Care coordination  
  • Patient safety  
  • Preventive health  
  • At-risk population/frail elderly health.

Along with publication of the proposed rule, CMS and other federal agencies have issued a number of documents intended to provide providers and suppliers guidance that will help them form ACOs without violating certain fraud and abuse, antitrust, and tax laws. Those documents include a joint CMS and Office of Inspector General notice and solicitation of public comments on potential waivers of certain fraud and abuse laws, a joint Department of Justice and Federal Trade Commission proposed antitrust policy statement, and an IRS notice requesting comments regarding the need for additional tax guidance for tax-exempt organizations participating in the program.

The proposed rule can be found here.