ACO Final Rule Provides for Waiver of SNF Three-Day Rule

​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) that provides for a programmatic waiver of the three-day rule for skilled nursing facility (SNF) care. 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 5, 2014, Issues in Continuing Care Risk Management). 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.