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Section 3021. Establishment of Center for Medicare and Medicaid Innovation (“CMI”) within
CMS.
• Purpose: Test innovative payment and service delivery models to reduce Medicare and Medicaid expenditures, while preserving or improving the quality of care.
• Preference in testing models is to be given to models that improve the coordination, efficiency and quality of healthcare services.
• CMI is to be carrying out its duties by not later than January 1, 2011.
• Note: CMI’s activities cover only Medicare Parts A and B, and Medicaid.
Continuing care hospitals offering in-patient rehab, long term care, and home health or skilled nursing care during an in-patient stay and the 30 days immediately following discharge
Home health providers offering chronic care management via interdisciplinary teams
Facilitate in-patient care, including intensive care, at local hospitals, through the use of electronic monitoring by specialists based at integrated health systems.
• Group practices• Networks of individual practices• Partnerships or Joint Ventures• Hospitals employing physicians• Other groups as determined by the Secretary of HHS
• Secretary of HHS will set benchmark for each ACO based on the most recent three years of per beneficiary expenditures for those beneficiaries assigned to the ACO
• Secretary will set target percentage below, and ACO must achieve estimated average per capita Medicare expenditures at or below this target.
• If ACO accomplishes this, it becomes entitled to receive a percentage of the difference (Secretary of HHS sets percentage amount)
• ACO participants will enter into a three year contract with the Medicare program to participate in the shared savings program
Given the nature and purpose of ACOs, a variety of financial relationships will be involved, and, therefore, certain legal issues require consideration. These include:
CMS office of legislation posted “Preliminary Questions & Answers” about ACOs on the CMS website. https://www.cms.gov/OfficeofLegislation/Downloads/AccountableCareOrganization/.pdf
• Private insurance companies are pressing ahead with ACO related activities and not waiting for CMS.
• Several pilots, in various stages of development, are launching soon.
• Engelberg Center for Healthcare Reform at Brookings Institution and the Dartmouth Institute for Health Policy and Clinical Practice (Brookings-Dartmouth Program) are supporting several pilots.