Today, the Department of Health and Human Services (HHS) released the highly anticipated final rule for the Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs). ACOs are groups of physicians, hospitals, and other health care providers, who will form 1 entity to voluntarily provide coordinated care to Medicare patients. In the final rules, the Centers for Medicare and Medicaid Services (CMS) discusses the extensive comments that it received from stakeholders regarding the proposed rule released in April of this year. As a result of those comments, CMS has made several revisions to the final rule.

Of note, the final rule:

• Significantly minimizes the ACO risk-sharing in losses and increases the amount of minimum savings that can be shared among ACO providers and suppliers.
• Reduces the proposed 65 quality reporting measures around 5 domains to 33 measures around 4 domains.
• Phases in the quality measures from a performance basis over the 3-year period of the ACO agreement.
• Adds Federally Qualified Health Centers and Rural Health Clinics to the list of providers eligible to both form and participate in an ACO.
• Removes requirements that the ACO meet the electronic health record (EHR) meaningful use requirements and instead adds EHR capabilities to the list of quality measures.
• Requires that ACOs be notified in advance of the Medicare patient population assigned to the ACO.

The final rule mandates that MSSP ACO applications will be accepted beginning January 1, 2012. The first ACO agreements will start on or after April 1, 2012, and July 1, 2012. ACOs must report quality measures for calendar year 2013 to qualify for first performance year shared savings.

Second, the Center for Medicare and Medicaid Innovation released its Advance Payment Model, which will advance ACOs a portion of their future shared savings to aid in supporting physician-owned and rural ACOs with up-front costs for infrastructure and investments.

Third, in concert with the MSSP rulemaking, CMS and the HHS Office of the Inspector General released an interim final rule with comment addressing waivers of certain provisions of the Stark, anti-kickback, and civil money penalties laws in consideration of ACOs.

Lastly, the Federal Trade Commission in partnership with the Department of Justice released a final statement on the enforcement of the anti-trust law as it relates to ACOs, and the Internal Revenue Service released a fact sheet to provide guidance to tax-exempt organizations that form ACOs.

APTA will be analyzing all of these proposed rules over the coming weeks and providing summaries and several resources to members on the impact of ACOs on physical therapy. To read APTA's comments on the proposed rule or to find out more about ACOs visit APTA's ACO Resource Center.