Federal Activities

Centers for Medicare and Medicaid Services (CMS): Accountable Care Organizations under the CMS Medicare Shared Savings Program
As part of our nation’s health care reform program authorized by the Accountable Care Act, the Obama administration introduced a series of programs to assist in improving the quality of care provided to patient’s and reducing the overall cost of healthcare. One of those programs is the Medicare Shared Savings Program (MSSP). On November 2, 2011 the Department of Health and Human Services (HHS) issued its set of guidelines for the creation of Accountable Care Organizations (ACO) under the MSSP, which became effective on January 3, 2012.

The Shared Savings Program is a volunteer program that adds onto Medicare parts A and B fee-for-service, created to provide incentives for ACOs and their participants who provide efficient care to individuals and their communities through efficient care coordination resulting in quality care and lower healthcare costs. The incentives are based upon quality and savings requirements.

Rules and Regulations
The Federal government released a series of Notices of Proposed Rule Making draft regulations on the Accountable Care Organizations (ACOs) in April, 2011 and the Final Rule in November, 2011.

  • CMS and HHS Office of Inspector General (OIG)
    • On March 31, 2011, CMS and 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.
      • Click here for a HIMSS summary of the joint CMS and HHS-OIG proposed rule.
      • Click here for the HIMSS response to this proposed rulemaking.
    • On November 2, 2011, the Final Rule was published in the Federal Register.
  • The Internal Revenue Service (IRS)
    • On April 18, 2011, the IRS issued a notice requesting comments regarding the need for guidance on participation by tax-exempt organizations in the Shared Savings Program through ACOs.
    • On October 20, 2011, IRS posted a Fact Sheet with Questions and Answers entitled Tax-Exempt Organizations Participating in the Medicare Shared Savings Program through ACOs.

CMS Innovation Center: Pioneer ACO Model
According to CMS, the Pioneer ACO Model is designed for health care organizations and providers that are already experienced in coordinating care for patients across care settings. It will allow these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Savings Program. And it is designed to work in coordination with private payers by aligning provider incentives, which will improve quality and health outcomes for patients across the ACO, and achieve cost savings for Medicare, employers and patients.

The payment models being tested in the first two years of the Pioneer ACO Model are a shared savings payment policy with generally higher levels of shared savings and risk for Pioneer ACOs than levels currently proposed in the Medicare Shared Savings Program. In year three of the program, participating ACOs that have shown a specified level of savings over the first two years will be eligible to move a substantial portion of their payments to a population-based model. These models of payments will also be flexible to accommodate the specific organizational and market conditions in which Pioneer ACOs work.

  • Detailed information about the 32 Pioneer ACOs (September 2012), click HERE
  • For a General Fact Sheet on the Pioneer Accountable Care Organization Model (September 2012), clickHERE
  • For a Fact Sheet on Pioneer ACO Beneficiary Protections and Quality, clickHERE
  • For Pioneer ACO Frequently Asked Questions, click HERE
  • Questions can be e-mailed to pioneeraco@cms.hhs.gov.