Proposed Rules for Accountable Care Organizations Participating in the Medicare Shared Savings Program PDF Download
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Author: Mark A. Zezza Publisher: ISBN: Category : Languages : en Pages : 29
Book Description
The Affordable Care Act authorizes the Centers for Medicare and Medicaid Services (CMS) to establish a Medicare Shared Savings Program that will allow a new form of health care provider, the accountable care organization, to participate in the Medicare program. On March 31, 2011, CMS released a much anticipated Notice for Proposed Rule-Making, which contains proposed rules for implementing the new program. CMS is soliciting public comment on the proposal, which will be incorporated into the final rule to be published later this year.
Author: Mark A. Zezza Publisher: ISBN: Category : Languages : en Pages : 29
Book Description
The Affordable Care Act authorizes the Centers for Medicare and Medicaid Services (CMS) to establish a Medicare Shared Savings Program that will allow a new form of health care provider, the accountable care organization, to participate in the Medicare program. On March 31, 2011, CMS released a much anticipated Notice for Proposed Rule-Making, which contains proposed rules for implementing the new program. CMS is soliciting public comment on the proposal, which will be incorporated into the final rule to be published later this year.
Author: The Law The Law Library Publisher: Createspace Independent Publishing Platform ISBN: 9781721545278 Category : Languages : en Pages : 130
Book Description
Medicare Program - Medicare Shared Savings Program - Accountable Care Organizations - Revised Benchmark Rebasing Methodology (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) The Law Library presents the complete text of the Medicare Program - Medicare Shared Savings Program - Accountable Care Organizations - Revised Benchmark Rebasing Methodology (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition). Updated as of May 29, 2018 Under the Medicare Shared Savings Program (Shared Savings Program), providers of services and suppliers that participate in an Accountable Care Organization (ACO) continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. This final rule addresses changes to the Shared Savings Program, including: Modifications to the program's benchmarking methodology, when resetting (rebasing) the ACO's benchmark for a second or subsequent agreement period, to encourage ACOs' continued investment in care coordination and quality improvement; an alternative participation option to encourage ACOs to enter performance-based risk arrangements earlier in their participation under the program; and policies for reopening of payment determinations to make corrections after financial calculations have been performed and ACO shared savings and shared losses for a performance year have been determined. This book contains: - The complete text of the Medicare Program - Medicare Shared Savings Program - Accountable Care Organizations - Revised Benchmark Rebasing Methodology (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) - A table of contents with the page number of each section
Author: The Law The Law Library Publisher: Createspace Independent Publishing Platform ISBN: 9781722393588 Category : Languages : en Pages : 360
Book Description
Medicare Program - Medicare Shared Savings Program - Accountable Care Organizations (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) The Law Library presents the complete text of the Medicare Program - Medicare Shared Savings Program - Accountable Care Organizations (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition). Updated as of May 29, 2018 This final rule implements section 3022 of the Affordable Care Act which contains provisions relating to Medicare payments to providers of services and suppliers participating in Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program. Under these provisions, providers of services and suppliers can continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, and be eligible for additional payments if they meet specified quality and savings requirements. This book contains: - The complete text of the Medicare Program - Medicare Shared Savings Program - Accountable Care Organizations (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) - A table of contents with the page number of each section
Author: The Law The Law Library Publisher: Createspace Independent Publishing Platform ISBN: 9781721545339 Category : Languages : en Pages : 26
Book Description
Medicare Program - Medicare Shared Savings Program - Extreme and Uncontrollable Circumstances Policies for Performance Year 2017 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) The Law Library presents the complete text of the Medicare Program - Medicare Shared Savings Program - Extreme and Uncontrollable Circumstances Policies for Performance Year 2017 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition). Updated as of May 29, 2018 This interim final rule with comment period establishes policies for assessing the financial and quality performance of Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organizations (ACOs) affected by extreme and uncontrollable circumstances during performance year 2017, including the applicable quality reporting period for the performance year. Under the Shared Savings Program, providers of services and suppliers that participate in ACOs continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. ACOs in performance-based risk agreements may also share in losses. This interim final rule with comment period establishes extreme and uncontrollable circumstances policies for the Shared Savings Program that will apply to ACOs subject to extreme and uncontrollable events, such as Hurricanes Harvey, Irma, and Maria, and the California wildfires, effective for performance year 2017, including the applicable quality data reporting period for the performance year. This book contains: - The complete text of the Medicare Program - Medicare Shared Savings Program - Extreme and Uncontrollable Circumstances Policies for Performance Year 2017 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) - A table of contents with the page number of each section
Author: Jerry Johnson Publisher: ISBN: Category : Languages : en Pages : 0
Book Description
In 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama. The ACA has three fundamental goals: (1) Increase access to health care; (2) Reduce the cost of health care; and (3) Improve the quality of health care. To reduce costs and improve quality, section 3022 of the ACA promotes the formation and operation of Accountable Care Organizations (ACOs) to treat Medicare beneficiaries in the new Medicare Shared Savings Program (SSP). ACOs are made up of competing health care providers collaborating to deliver efficient, coordinated care that meets quality performance and cost-saving standards that are determined by the Centers for Medicare and Medicaid Services (CMS). ACOs may take many forms, “including networks of individual practices, partnerships, hospitals, [joint ventures] and other health care professionals.” The ACA hopes to encourage new innovative delivery models and does not place heavy restrictions on the form or type of entity sufficient to gain the status of ACO. “It is expected that most health care providers that form ACOs for Medicare beneficiaries will also seek to use the ACO structure for their commercially-insured patients.” In order to produce cost-saving efficiencies, ACOs will look to negotiate contracts between their participating providers, including price terms. ACOs negotiating with private payers raises antitrust concerns over possible price fixing and exercise of market power to restrain trade. ACO practices that restrain trade would undermine the ACA's attempt to reduce costs and improve quality by further impairing the health care market and harming consumers/patients. In 2011, CMS published the final rule implementing section 3022 of the ACA which creates the Medicare Shared Savings Program and encourages the creation of ACOs. The Department of Justice and the Federal Trade Commission are the two government agencies charged with enforcing antitrust law. The Federal Trade Commission and the Department of Justice have recently published guidance laying out antitrust enforcement as it relates to Accountable Care Organizations. There are three significant developments that flow from the guidance: 1) ACOs engaged in joint price negotiations with commercial health plans will be treated under the “rule of reason” if the ACO meets CMS' eligibility standards for SSP participation; 2) ACOs that control up to 30% of market shares in any of its “common services” will be protected by a “safety zone” which shields the ACO from antitrust challenge absent extraordinary circumstances and 3) the Federal Trade Commission and the Department of Justice scrapped a mandatory review of ACOs that might wield market power and replaced it with a voluntary review process that can help ACOs that fall outside the safety zone to better assess its chances of raising antitrust concerns. As mentioned, collaboration between competing providers in ACOs raises antitrust concerns that providers may engage in horizontal price-fixing or exercise market power by setting supracompetitive prices for their services in the commercial market. Horizontal price-fixing violates section 1 of the Sherman Act. Horizontal price-fixing occurs when competitors agree on prices, allowing the competitors to raise prices to supracompetitive levels and possibly shield themselves from competition. ACOs bring competing providers together to share information and coordinate care in order to lower costs and improve the quality of care. An unintended outcome could be horizontal price-fixing by participant providers who use the ACO structure to negotiate with health insurance plans in the commercial market. The result of ACO participant providers engaging in anticompetitive behavior would be higher prices for consumers and lower quality of care. Thus, horizontal price-fixing threatens not only to undermine the goals of the Shared Savings Program, but to possibly exacerbate the very problems that the ACA attempts to solve. This research article explores the guidance, in light of past policy, with a focus on whether the Federal Trade Commission and the Department of Justice's approach properly balances the need to incentivize provider participation in the SSP and the need to prevent restraint of trade in the health care markets. First, we will look at the dynamics of the health care market and the body of law that make up American antitrust law. Second, we will look at how the antitrust statutory law has been applied to the health care market in the past. Finally, we will address the marked changes in antitrust policy as it relates to ACOs under the ACA and whether or not these perceived changes are for the better or the worse.
Author: The Law The Law Library Publisher: Createspace Independent Publishing Platform ISBN: 9781729716502 Category : Languages : en Pages : 42
Book Description
Medicare Program - Final Waivers in Connection With the Shared Savings Program (US Inspector General Office, Health and Human Services Department Regulation) (HHSIG) (2018 Edition) The Law Library presents the complete text of the Medicare Program - Final Waivers in Connection With the Shared Savings Program (US Inspector General Office, Health and Human Services Department Regulation) (HHSIG) (2018 Edition). Updated as of May 29, 2018 This interim final rule with comment period establishes waivers of the application of the Physician Self-Referral Law, the Federal anti-kickback statute, and certain civil monetary penalties (CMP) law provisions to specified arrangements involving accountable care organizations (ACOs) under section 1899 of the Social Security Act (the Act) (the Shared Savings Program), including ACOs participating in the Advance Payment Initiative. Section 1899(f) of the Act, as added by the Affordable Care Act, authorizes the Secretary to waive certain fraud and abuse laws as necessary to carry out the provisions of section 1899 of the Act. This book contains: - The complete text of the Medicare Program - Final Waivers in Connection With the Shared Savings Program (US Inspector General Office, Health and Human Services Department Regulation) (HHSIG) (2018 Edition) - A table of contents with the page number of each section
Author: Mark A. Zezza
Author: Mark A. Zezza
Author: CCH Incorporated
Author: David Newman
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Author: The Law The Law Library
Author: The Law The Law Library
Author: 
Author: The Law The Law Library
Author: Jerry Johnson
Author: The Law The Law Library