Federal Agencies Release Companion ACO Opportunities and Guidance - October 25, 2011

In addition to the Centers for Medicare & Medicaid Services’ (CMS’) Medicare accountable care organization (ACO) program final rule, several government agencies also released companion opportunities and guidance on Oct. 20. First, CMS’ Center for Medicare & Medicaid Innovation released its Advance Payment Model final solicitation. This program will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program by providing resources to build needed infrastructure. The advance payments will be recovered from any future shared savings achieved by the ACOs.

Also on Oct. 20, the Federal Trade Commission and the U.S. Department of Justice (DOJ) released a final policy statement on ACOs and antitrust issues. The new policy eliminates a mandatory review for a new ACO. However, CMS encourages providers to voluntarily seek a DOJ opinion. In addition, CMS and the Office of Inspector General of the U.S. Department of Health and Human Services released a second interim final rule that establishes five waivers from the Physician Self-Referral Law (the federal anti-kickback statute) and some civil monetary penalties that could present obstacles to providers wishing to form an ACO. Finally, the Internal Revenue Service issued a fact sheet in connection with the final ACO rule.