On Oct. 20, 2011, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) released the final regulations (Final Rule) pertaining to Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program (SSP). In conjunction with the release of the Final Rule, other Federal agencies also released guidance or regulations related to the SSP. In addition, HHS also announced a new program called the Advance Payment Program, which is designed to provide financial incentives for physician groups and other types of providers to participate in the SSP.

In general, the Final Rule provides greater flexibility and increased financial incentives for entities wishing to participate as ACOs in the SSP. In particular, CMS has provided more flexibility, not only in terms of the types of entities eligible to participate as ACOs, but also in terms of ACO operations and governance.

An outline of the three most significant aspects of the Final Rule is provided below, followed by a summation of the Final Rule’s key provisions on ACO structure and operations, a summary of Federal agency guidance and supplemental regulations, and an overview of the agency announcement on the Advance Payment Program.

Source: Client Alert
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