CMS proposes Medicare ACO regulations

April 15, 2011

The Patient Protection and Affordable Care Act directs the Secretary of Health and Human Services to develop a Medicare Shared Savings Program for qualified accountable care organizations. On March 31, the Centers for Medicare and Medicaid Services proposed regulations describing how the program would work and what constitutes an accountable care organization. If adopted, the regulations would:

  • Encourage hospitals, physicians and others to form ACOs to improve individuals' care, enhance population health and slow health care spending.
  • Define ACOs as voluntary coalitions caring for at least 5,000 Medicare fee-for-service beneficiaries.
  • Charge ACOs with assessing, monitoring and reporting on the care they deliver.
  • Charge CMS with setting benchmarks for the savings the ACOs are to achieve in delivering care. ACOs that save more will be rewarded financially, and those that do not reach the benchmark will have to repay the losses.

CMS is taking comments on the regulations through June 6.

 

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