September 27, 2022

Volume XII, Number 270


September 26, 2022

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Accountable Care Organizations and Shared Savings Program Final Rule

The Centers for Medicare and Medicaid Services (CMS) released the Final Rule to establish Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program (Shared Savings Program) on Oct. 20, 2011. The Final Rule takes into account more than 1,300 stakeholder comments that CMS received after the release of the proposed rule on March 31, 2011.

CMS made the following noteworthy modifications to the proposed rule, intending to make the Shared Savings Program more flexible for and attractive to potential providers:

  • Changed the beneficiary assignment process from retrospective to prospective;
  • Reduced the requisite number of quality measures providers must report (from 65 to 33);
  • Established a rolling admissions process, allowing providers to seek ACO status through 2012;
  • Eliminated mandatory antitrust review for the program’s largest organizations;
  • Modified the one-sided model (shared savings for years 1 and 2, but both shared savings and losses in year 3), eliminating provider risk entirely under this option, while, at the same time, maintaining the two-sided model option, which provides higher sharing rates for ACOs willing to share in performance-based risk;
  • Eliminated requirement that 50 percent of primary care physicians be defined as meaningful electronic health record (EHR) users, while nonetheless establishing EHR as the most significant quality measure for quality-scoring purposes; and
  • Extended benefits of the Shared Savings Program to a broader range of beneficiaries, now including Rural Health Clinics and Federally Qualified Health Centers.

ACOs under the Medicare Shared Savings Program (Shared Savings Program), provided for in the Patient Protection and Affordable Care Act (PPACA), are required to be established by January 1, 2012. 

© 2022 BARNES & THORNBURG LLPNational Law Review, Volume I, Number 306

About this Author

Mark E. Rust Barnes Thornburg Law firm Chicago Corporate Finance and Healthcare Law Attorney

Mark Rust is Managing Partner of the Chicago office of Barnes & Thornburg, LLP, and Chair of the firm’s national Healthcare Department. Mr. Rust concentrates his practice in transactional, regulatory and medical-legal issues affecting healthcare entities and provider organizations. For nearly 30 years he has written about or practiced in healthcare law, writing in a wide variety of publications from theJournal of the American Bar Association to USA Today. He is listed as a notable healthcare lawyer in Chambers USA, Top Healthcare Lawyers of Illinois,Superlawyers...