Providers ask CMS to leave ACO waivers open

Providers are worried over potentially stricter accountable care organization (ACO) waivers the Centers for Medicare & Medicaid Services (CMS) will soon finalize.

CMS and the Office of Inspector General (OIG) in October released an interim final rule that allows the Secretary to relax self-referral and anti-kickback laws via waivers to encourage ACOs to participate in the Medicare Shared Savings Program. In response, the American Hospital Association (AHA) urged that the new waivers be finalized as is in a letter yesterday to Acting CMS Administrator Marilyn Tavenner.

The 5,000-hospital group commented on the interim final rule and the established waivers from fraud and abuse laws. Although AHA applauded efforts by CMS and OIG to create a number of waivers, AHA pushed for the regulatory agencies to open up the waivers to other clinically integrated organizations.

"All patients who are covered under federal health programs should have the same opportunity to benefit from the quality and care coordination improvements that clinically integrated organizations can provide," the AHA letter stated.

AHA discouraged narrowing the newly created waivers, as well as discouraged adding specificity and definition of the waivers, arguing that the ACOs will be under sufficient oversight from CMS.

Although ACO advocates generally hail the waivers as pathways toward ACO formation (and therefore care coordination), there are existing regulations that prevent anti-trust organizations and monopolies. The physician self-referral law, the federal anti-kickback statute and certain civil monetary penalties laws are aimed at fighting against healthcare fraud, improper referral payments and unnecessary under- or overuse of services or tests.

For more information:
- check out the AHA letter (.pdf)

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