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The Health Reform Law Section-By-Section
Accountable Care Organizations
Section 3022 of the
Affordable Care Act
Read the statutory language applicable to this section
Federal agency guidance
Bulletins applicable to this section
Not later than January 1, 2012, the
Secretary of HHS is required to establish a shared savings program that promotes accountability
for a patient population and coordinates items and services
under Medicare parts A and B, and encourages investment in infrastructure
and redesigned care processes for high quality and
efficient service delivery.
Under the shared savings program groups of providers of services and suppliers
meeting certain criteria specified by the Secretary of HHS may work
together to manage and coordinate care for Medicare fee-for-
service beneficiaries through an Accountable Care
Organization. Those ACOs that meet quality performance standards
established by the Secretary of HHS will be eligible to receive payments or shared savings.
Eligible Accountable Care Organizations
The following groups of providers of services and suppliers that
have established a mechanism for shared governance are
eligible to participate as ACOs
Requirements of Accountable Care Organizations
An ACO must meet the following
- The ACO must be willing to become accountable
for the quality, cost, and overall care of the Medicare
fee-for-service beneficiaries assigned to it.
- The ACO must enter into an agreement with the
Secretary of HHS to participate in the program for not less than
a 3-year period (the ‘"agreement
- The ACO must have a formal legal structure that
would allow the organization to receive and distribute payments
for shared savings to participating
providers of services and suppliers.
- The ACO must include primary care ACO professionals
that are sufficient for the number of Medicare fee-for-
service beneficiaries assigned to the ACO. At a minimum, the ACO is required to have at least
5,000 such beneficiaries assigned to it in order to be eligible to participate in the ACO program.
- The ACO must provide the Secretary of HHS with such
information regarding ACO professionals participating in
the ACO as the Secretary determines necessary to support
the assignment of Medicare fee-for-service beneficiaries to
an ACO, the implementation of quality and other reporting
requirements, and the determination
of payments for shared savings.
- The ACO must have in place a leadership and
management structure that includes clinical and administrative
- The ACO must define processes to promote evidence-
based medicine and patient engagement, report on
quality and cost measures, and coordinate care, such as
through the use of telehealth, remote patient monitoring,
and other such enabling technologies.
- The ACO must demonstrate to the Secretary of HHS that
it meets patient-centeredness criteria specified by the Secretary,
such as the use of patient and caregiver assessments
or the use of individualized care plans.
The Secretary of HHS is required to determine
appropriate measures to assess the quality of care furnished
by the ACO, such as measures of clinical processes and outcomes;
patient and, where practicable, caregiver
experience of care; and utilization (such as rates of hospital admissions for ambulatory care sensitive conditions).
An ACO will be required to submit
data in a form and manner specified by the Secretary of HHS
on measures the Secretary determines necessary for the
ACO to report in order to evaluate the quality of care
furnished by the ACO. Such data may include care transitions
across health care settings, including hospital discharge
planning and post-hospital discharge follow-up by
ACO professionals, as the Secretary determines appropriate.
Payments and Treatment of Savings
Under the program ACO participating providers and suppliers payments will continue paid by Medicare in the same manner as they would otherwise
be paid except that a participating ACO is eligible to
receive payment for shared savings if the ACO meets the quality performance standards established by the Secretary of HHS and the ACO meets the saving requirement described below.
The "savings requirement" requires that for each year of the
agreement period, the estimated average per capita Medicare expenditures
under the ACO for Medicare fee-for-service beneficiaries
for parts A and B services, adjusted for beneficiary
characteristics, is at least the percent specified
by the Secretary of HHS below an established applicable benchmark.
Final Rule: Accountable Care
Published in the November 2, 2011 Federal Register, final rule implementing section 3022 which
contains provisions relating to Medicare payments to providers of services and suppliers
participating in Accountable Care Organizations under the Medicare Shared Savings
Effective Date: January 3, 2012
Chart Comparing the Proposed Rule with the Changes in the Final Rule
Interim Final Rule: Final Waivers in Connection With the Shared Savings Program
Published in the November 2, 2011 Federal Register, interim final rule with comment period that establishes waivers of the
application of the Stark law, the anti-kickback statute, and
certain civil monetary penalties law provisions to specified arrangements
involving accountable care organizations.
Effective Date: November 2, 2011
Comment Period: Comments must be submitted by January 3, 2012
Federal Agency Guidance
Announcement of a
New Application Deadline for the
Advance Payment Model
From the November 30, 2011 Federal Register CMS notice announcing a new
application deadline for participation in
the Advance Payment Model for certain
accountable care organizations
participating in the Medicare Shared
Savings Program scheduled to begin in
2012. (Starts at the bottom of the page)
Guidance Will Help Health Care Providers Form Procompetitive ACOs and Protect Health Care Consumers from Higher Prices and Lower Quality Care
October 20, 2011 news release and link to statement of antitrust enforcement policy regarding Accountable Care
Organizations from the Department of Justice and FTC.
Making Good on ACOs' Promise — The Final Rule for the Medicare Shared Savings Program
October 20, 2011 article in the New England Journal of Medicine by Donald M. Berwick, M.D. on finalization of the federal regulations for ACOs.
Notice: Advanced Payment Model
CMS notice announcing the testing of the Advance Payment Model for
certain accountable care organizations participating in the Medicare Shared Savings
Program scheduled to begin in 2012, and providing information about the model and
application process. Published in the November 2, 2011 Federal Register.
CMS Notice to Establish a New System
September 19, 2011 CMS notice in the Federal Register establishing a new system of
records to support the
Medicare Shared Savings Program and
Pioneer ACO Model.
Transcript of the Accountable Care Workshop -- Morning Session
Transcript of the morning session of the October 5, 2010 HHS- sponsored Accountable Care Organizations, and Implications Regarding Antitrust, Physician Self-Referral, Anti-Kickback, and Civil Monetary Penalty Laws workshop.
Transcript of the Accountable Care Workshop -- Afternoon Session
Transcript of the afternoon session of the October 5, 2010 HHS- sponsored Accountable Care Organizations, and Implications Regarding Antitrust, Physician Self-Referral, Anti-Kickback, and Civil Monetary Penalty Laws workshop.
Medicare Accountable Care Organizations
Preliminary questions & answers on Accountable Care Organizations as prepared by the Centers for Medicare & Medicaid.
Bricker & Eckler Bulletins
ACOs Take Two: Major Changes in Final Regulations
CMS recently published the Interim Final Rule on Accountable Care Organizations and the Shared Savings Program with substantial changes intended to reduce previously identified challenges to participation.
Multiple Government Agencies and Departments Make Coordinated Release of Final Medicare ACO Rules
Federal agencies issue interim final rules with comment periods and final policy statements regarding the implementation of Medicare Accountable Care Organizations.
On Your Mark, Get Set, ACO – A Quick Run Through of the Proposed ACO And Medicare Shared Savings Program Rule
April 13, 2011
Bulletin on the Centers for Medicare & Medicaid Services proposed rule to implement the Medicare Shared Savings Program for Accountable Care Organizations.
Shared Savings Programs/Accountable Care Organizations
Bulletin on section 3022 of the Patient Protection and Affordable Care Act dealing with accountable care organizations.