The Centers for Medicare and Medicaid Services (CMS) has issued a final rule amending provisions of the Medicare Shared Savings Program related to accountable care organizations (ACOs). Originally proposed in December 2014, the revisions affect several program areas, including beneficiary assignment, data sharing, available risk models, eligibility requirements, participation agreement renewals, and compliance and monitoring (see the December 3, 2014, HRC Alerts). According to CMS, the rulemaking was intended to encourage continued and enhanced stakeholder participation, to reduce administrative burden for ACOs while facilitating their efforts to improve care outcomes, and to maintain excellence in program operations while bolstering program integrity. In the December 2014 proposed rule, CMS sought comment on a number of options the agency had been considering in order to encourage ACOs to take on two-sided performance-based risk under the Shared Savings Program. Based on the comments received, the final rule allows for resetting the benchmark in a second or subsequent agreement period by integrating previous financial performance and equally weighting benchmarks for subsequent agreement periods and the use of programmatic waiver authority to improve participation by offering regulatory relief from requirements related to the skilled nursing facility three-day stay rule. CMS intends to address other modifications to program rules in future rulemaking in the near term to improve the willingness of ACOs to take on performance-based risk. The final rule was published in the June 9, 2015, Federal Register. Most of the provisions are effective August 3, 2015; however, some related to claims data sharing will not take effect until November 1, 2015, and January 1, 2016.

HRC Recommends: ACOs can include hospitals, clinical specialists, and post-acute providers, among others. ACOs make providers jointly accountable for the health of their patients, and in return, give financial incentives to providers to coordinate care and lower costs by avoiding unnecessary tests and procedures. ACOs must meet a litany of quality measures; ACOs that are unable to save money risk losing the costs of investments made to improve care. Risk managers should be aware of the revisions to the Medicare Shared Savings Program, as the incentives and new processes may affect the organization's interest in operating as an ACO.