No mandatory antitrust review for ACOs

To the relief of interested parties, certain accountable care organizations (ACO) will not be subject to mandatory antitrust review as a condition to participate. Along with yesterday's release of the Centers for Medicare & Medicaid Services (CMS) final rule, the Federal Trade Commission (FTC) and the Department of Justice (DoJ) issued a final antitrust enforcement policy.

The agencies will not challenge as per se illegal a Shared Savings Program ACO that jointly negotiates with private insurers to serve patients in commercial markets if the ACO satisfies certain conditions.

However, the FTC and DoJ still plan to enforce antitrust laws, protecting market competition.

"The Department of Justice and the FTC will continue to enforce vigorously the antitrust laws, consistent with the policy statement and with the goals of this innovative program to protect health care consumers from higher prices and lower quality care," states the joint press release.

ACOs, therefore, still must comply with CMS rules for eligibility and use the same governance and leadership structures in Medicare and commercial markets. The regulatory agencies will continue to monitor complaints against ACO formations.

For more information:
- read the press release
- check out the final policy (.pdf)
- here's the FAQ sheet (.pdf) on voluntary review

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