Accountable Care Organizations and Other Alignment Strategies
The Center for Medicare and Medicaid Services (CMS) was authorized by the Patient Protection and Affordable Care Act (ACA) to create the Medicare Shared Savings Program (MSSP). This program allowed for the establishment of ACO contracts with Medicare. ACOs are accountable for both quality and per capital costs for their patients. Providers such as physicians, hospitals, clinics and home care services can participate in ACOs. And as participants, they are eligible to share a percentage of the savings they realize from their coordination.
ACOs Aren’t New to Us
While ACOs are relatively new entities, our team has been ahead of the curve on them from the beginning. We understand this complex area of law and can work with you on all ACO matters.
What makes us especially unique is that we help entities on both sides of an ACO. We have helped providers set up an ACO, and we have also helped third party payer insurance entities set up their product. Because of our bi-directional experience, we can anticipate issues that either side might raise.
Our healthcare attorneys also draw on the experience of professionals from across the firm, including our government relations practice, where we have relationships with CMS and other relevant agencies. These relationships allow us to offer you our unique insight. In addition, our experience in long-term care positions us well to help long-term care entities participate in ACOs.
Recently, we have:
- Assisted a major health system in establishing an ACO that has applied for participation in the Medicare Shared Savings Program. This assistance included helping with issues related to structure and governance, drafting organizational documents and participation agreements, assisting with the application that was submitted to Medicare and providing advice regarding issues related to the Stark and Anti-Kickback laws as those laws related to or impacted the ACO and its participants.
- Helped a large health care provider structure its non-Medicare commercial insurance accountable care alignment strategy.
How We Can Assist You with ACOs
We can provide you with the following services related to ACOs:
- General advice and business counsel regarding ACOs, including the advantages and disadvantages of participating in ACOs, the various forms of ACOs and other alignment strategies.
- Assistance with the structuring of ACOs, including corporate structure and governance, with an understanding that ACOs are often joint ventures.
- Advice on tax considerations for forming, structuring and operating an ACO, including tax-exempt status and IRS concerns, with the understanding that ACOs are often a mix of for-profit and non-profit entities.
- Assistance with fraud and abuse/regulatory concerns, including considerations regarding the OIG’s notice on proposed waivers regarding Stark and anti-kickback laws.
- Drafting/negotiating/evaluating participation and other agreements among participants and third-party payers, including troubleshooting to spot issues and providing advice.
- Assistance with submission of application to CMS to participate in MSSP.
- Counsel regarding ongoing legal/regulatory operation of an ACO.
- Counsel regarding state regulatory concerns that may arise in relation to operation of an ACO.
- Advice regarding managed care contracting issues.
- Advice and counsel regarding antitrust implications and assistance with antitrust approval processes.