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CMS Releases Final ACO Rule

The Centers for Medicare & Medicaid Services (CMS) today issued its final rule for Accountable Care Organizations (ACOs). In today’s announcement, CMS Administrator Don Berwick noted that more than 1,300 comments were received on the proposed rule. The final rule incorporates a number of these suggestions, including:

  • Increasing incentives and streamlining the Shared Savings Program;
  • Extending the benefits of the new program to a broader range of beneficiaries;
  • Making the one-sided model truly one-sided;
  • Expanding participation to Rural Health clinics, Federally Qualified Health Centers, and organizations where specialists provide primary care; and
  • Providing a flexible starting date in 2012

In conjunction with the release of CMS’ final rule on ACOs, the Office of Inspector General released an interim final regulation on waivers of fraud and abuse provisions; the Internal Revenue Service issued a fact sheet on tax exempt organizations participating in the Shared Savings Program; and the Department of Justice (DOJ) and the Federal Trade Commission (FTC) today issued a final version of a joint policy statement on antitrust enforcement. The FTC and DOJ final policy statement:

  • Preserves an antitrust “safety zone” for certain ACOs;
  • Provides examples of conduct that, under certain circumstances, may raise competitive concerns;
  • Provides expanded coverage – the policy statement no longer applies only to collaborations formed after March 23, 2010; and
  • Shifts antitrust review from mandatory to voluntary review.
©2021 von Briesen & Roper, s.cNational Law Review, Volume I, Number 294
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About this Author

von Briesen & Roper’s Health Law Section provides comprehensive legal services to the health care industry nationwide as both general counsel and special project counsel. Our clients include integrated delivery systems, academic medical centers, community hospitals, Catholic-sponsored hospitals, rural and critical access hospitals, imaging centers, physicians and multi-specialty clinics, specialty hospitals, ancillary suppliers, home health agencies, nursing homes, hospices, assisted living facilities, mental health and AODA facilities, DME suppliers, laboratories,...

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