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
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).
- October 20, 2011: The Centers for Medicare & Medicaid Services (CMS) issued a final rule that establishes accountable care organizations (ACO) under the Shared Savings Program. The CMS final rule is available online at https://www.gpo.gov/fdsys/pkg/FR-2011-11-02/pdf/2011-27461.pdf
- U.S. Department of Health and Human Services/Centers for Medicare and Medicaid Services News Release: HHS Announces New Incentives For Providers To Work Together Through Accountable Care Organizations When Caring For People With Medicare
- June 9, 2015: CMS issued a final rule addressing changes to the Medicare Shared Savings Program including provisions relating to the payment of Accountable Care Organizations participating in the Shared Savings Program. The CMS final rule is available online at https://www.gpo.gov/fdsys/pkg/FR-2015-06-09/pdf/2015-14005.pdf
- October 28, 2015: CMS and OIG jointly issued a final rule finalizing waivers of the application of the physician self-referral law, the Federal anti-kickback statute, and the civil monetary penalties law provision relating to beneficiary inducements to specified arrangements involving accountable care organizations under section 1899 of the Social Security Act. The rule is Medicare Program: Final Waivers in Connection with the Shared Savings Program
- CMS and HHS Office of Inspector General (OIG) jointly issued an interim final rule with comment period establishing 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. The interim final rule with comment period is available online at https://www.gpo.gov/fdsys/pkg/FR-2011-11-02/pdf/2011-27460.pdf
- Interim Final Rule: Medicare Program; Final Waivers in Connection With the Shared Savings Program; Continuation of Effectiveness and Extension of Timeline for Publication of Final Rule
- Medicare Shared Savings Program Waivers: Additional Guidance - This document contains additional guidance for Medicare Shared Savings Program participants with respect to the waivers of the physician self-referral law, the anti-kickback statute, and the civil monetary penalties (CMP) law in a document jointly prepared by CMS and the OIG.
- The Federal Trade Commission and the Department of Justice jointly issued a "Statement of Antitrust Enforcement Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program" (Antitrust Policy Statement). The Antitrust Policy Statement is available online at https://www.ftc.gov/os/fedreg/2011/10/111020aco.pdf
- U.S. Department of Justice/Federal Trade Commission News Release:
Department of Justice/Federal Trade Commission Issue Final Statement of Antitrust Policy Enforcement Regarding Accountable Care Organizations
- U.S. Department of Justice/Federal Trade Commission News Release:
- And the Internal Revenue Service (IRS) has posted a Fact Sheet with Questions and Answers entitled Tax-Exempt Organizations Participating in the Medicare Shared Savings Program through Accountable Care Organizations at https://www.irs.gov/newsroom/article/0,,id=248490,00.html
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 https://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 https://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: https://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 https://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
- Morning Session
- Afternoon Session