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Accountable Care Organizations

The Affordable Care Act contains several provisions that support the development of Accountable Care Organizations (ACOs) to manage and coordinate care for beneficiaries. OIG guidance related to ACOs under the Affordable Care Act is below, along with related resources.

Federal Agencies Address Legal Issues Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program

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On October 20, 2011, as part of a cross-agency, coordinated effort, several Federal agencies issued documents addressing legal issues regarding Accountable Care Organizations participating in the Medicare Shared Savings Program (Shared Savings Program).

On March 31, 2011 as part of a cross-agency, coordinated effort, several Federal agencies issued documents addressing legal issues regarding Accountable Care Organizations participating in the Medicare Shared Savings Program (Shared Savings Program).

  • The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would establish accountable care organizations (ACO) under the Shared Savings Program. The CMS proposed rule is available online at http://www.cms.gov/sharedsavingsprogram
  • CMS and HHS Office of Inspector General (OIG) jointly issued a notice with comment period outlining proposals for waivers of certain Federal laws—the physician self-referral law, the anti-kickback statute, and certain provisions of the civil monetary penalty law—in connection with the Shared Savings Program. CMS and OIG also sought comments on further waiver design considerations for the Shared Savings Program and for the separate waiver authority for the Center for Medicare and Medicaid Innovation under section 1115A of the Social Security Act. The joint notice with comment period is available online at http://www.gpo.gov/fdsys/pkg/FR-2011-04-07/pdf/2011-7884.pdf
  • The Federal Trade Commission and the Department of Justice jointly issued a "Proposed Statement of Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program" (Proposed Antitrust Policy Statement). The Proposed Antitrust Policy Statement is available online at: http://www.ftc.gov/opp/aco/
  • And the Internal Revenue Service (IRS) issued a notice requesting comments regarding the need for guidance on participation by tax-exempt organizations in the Shared Savings Program through ACOs. The IRS notice is available online at http://www.irs.gov/pub/irs-drop/n-11-20.pdf

October 2010 Workshop

On Oct. 5, 2010, the OIG, Federal Trade Commission, and the Centers for Medicare & Medicaid Services held a workshop entitled Workshop Regarding Accountable Care Organizations and Implications Regarding Antitrust, Physician-Self-Referral, Anti-Kickback, and Civil Monetary Penalty Laws.

Recordings and Transcripts

For the October 5, 2010 Workshop Regarding Accountable Care Organizations, and Implications Regarding Antitrust, Physician Self-Referral, Anti-Kickback, and Civil Monetary Penalty (CMP) Laws

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