On October 20, 1011, the Centers for Medicare & Medicaid Services (CMS) released its final rule establishing the Accountable Care Organization (ACO) program. AHCA/NCAL has long advocated that post-acute care facilities – including nursing homes – would be eligible to participate in new ACOs once quality measures for care are finalized in these settings.
Major changes from the draft proposed rule include:
- CMS reducing by half the number of quality measures from 65 to 33;
- The elimination of the electronic health records requirement;
- The introduction of a payment model that allows ACOs to share on the first dollar once a minimum savings rate has been established;
- Changes to the way CMS would assign Medicare beneficiaries to ACOs, offering a preliminary prospective assignment method where beneficiaries would be identified on a quarterly basis. The draft rule proposed retrospective assignment of beneficiaries based on utilization of primary care services, with prospective identification of a benchmark population; and
- Altered eligibility provisions from the draft. The final rule allows federally qualified health centers and rural health clinics to both form and participate in an ACO. CMS also said it listened to the concerns of rural providers and physician-owned entities by extending additional financial support or “advance payments” to help these organizations receive upfront funding that would be recouped as these ACOs implement savings.
For more information, read our overview of the final rule from Reed Smith.
The Medicare Shared Savings Program (MSSP), or ACO program, is expected to save $940 million over three years. CMS estimates 50 to 270 organizations will take part in the first reporting period of the program.
AHCA is examining the details of the final ACO rule to ensure that SNFs can play an important role moving forward. For more information, contact Elise Smith.