The American Hospital Association says CMS' proposed approach to granting fraud and abuse waivers for organizations participating in the Medicare Shared Savings Program "falls short of what is needed" and could "chill the formation of ACOs," according to AHA comments to CMS and its OIG detailed in an AHA News Now report.
The proposed waivers would waive the application of physician self-referral laws and the Antikickback Statute on shared savings among various providers for services offered through accountable care organizations as part of the MSSP.
The AHA comments state that while the waivers do provide some protection, they only cover the three-year agreement and only to the extent that any savings are realized. "All other arrangements from formation to start-up and through ongoing operation, are either unaddressed or are effectively left with no protection," said the AHA in its comments.
The AHA then urged the HHS Secretary to "use the full scope of the combined authority granted by Congress under the Patient Protection and Affordable Care Act to issue waivers to enable Medicare providers and suppliers to offer the benefits of clinically integrated care to Medicare patients as participants in an ACO or through other clinically integrated organizations providing accountable care," according to the comments.
Read the proposed waiver design for ACOs (pdf).
Related Articles on ACOs:
ACO Fraud And Abuse Waivers Outlined in HHS Notice
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The proposed waivers would waive the application of physician self-referral laws and the Antikickback Statute on shared savings among various providers for services offered through accountable care organizations as part of the MSSP.
The AHA comments state that while the waivers do provide some protection, they only cover the three-year agreement and only to the extent that any savings are realized. "All other arrangements from formation to start-up and through ongoing operation, are either unaddressed or are effectively left with no protection," said the AHA in its comments.
The AHA then urged the HHS Secretary to "use the full scope of the combined authority granted by Congress under the Patient Protection and Affordable Care Act to issue waivers to enable Medicare providers and suppliers to offer the benefits of clinically integrated care to Medicare patients as participants in an ACO or through other clinically integrated organizations providing accountable care," according to the comments.
Read the proposed waiver design for ACOs (pdf).
Related Articles on ACOs:
ACO Fraud And Abuse Waivers Outlined in HHS Notice
4 Points on Exclusivity, Market Power and Transparency in ACOs