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March 2015


Accountable Care Organization Update






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For more information about this e-Alert, please contact:


Janice A. Anderson



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Joi-Lee K. Beachler



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Matthew J. Murer

Practice Area Chair


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Jane E. Arnold

Practice Area Vice Chair


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Colleen M. Faddick

Practice Area Vice Chair


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On March 10, 2015, the U.S. Department of Health and Human Services announced a new accountable care organization ("ACO") initiative from the Centers for Medicare & Medicaid Services ("CMS") Innovation Center – the Next Generation ACO Model (the "Next Generation Model").

The Next Generation Model builds on experiences with the Pioneer ACO Model and the Medicare Shared Savings Program ("MSSP"), but is intended to set more predictable financial targets to enable providers and beneficiaries greater opportunities to coordinate and provide high quality care. The stated goal of the Next Generation Model is to "test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service ("FFS") beneficiaries."

The announcement of the Next Generation Model follows a flurry of activity from CMS related to the MSSP, including its release of Notice of Proposed Rulemaking (and comment period) and issuance of additional guidance on certain requirements of the ACO Pre-Participation and Participation Waivers (summarized below). CMS has not indicated what, if any, impact the Next Generation Model will have on the MSSP or any of its other shared savings initiatives.

The following is a general overview of the Next Generation Model and MSSP additional guidance on certain requirements of the ACO Pre-Participation and Participation Waivers:

I. Summary of Next Generation ACO Model.

  1. Application Process.
  2. Eligible Providers/Suppliers, Preferred Providers, and Affiliates.
  3. Organization and Governance.
  4. Financial Benchmark, Payment Mechanisms, and Shared Savings.
  5. Beneficiary Eligibility and Alignment.
  6. Benefit Enhancements.
  7. Quality and Performance.
  8. Monitoring and Oversight.
  9. Data Sharing.

II. Summary of Additional Guidance on ACO Pre-Participation & Participation Waivers.

  1. Public Disclosure of Arrangements under the ACO Pre-Participation and ACO Participation Waivers.
  2. Notification of failure to submit a timely application by parties who used the ACO Pre-Participation Waiver.
  3. Requests for an extension of the ACO Pre-Participation Waiver.

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For questions regarding the content of this alert, please contact the authors, a member of Polsinelli's Health Care practice, or your Polsinelli attorney:














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* Law360, March 2014
** The American Lawyer 2013 and 2014 reports







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