Monday, April 4, 2011

ACO, DOJ, ACA,IRS and WAIVERS

 

Details of the ACO, Accountable Care Organization are beginning to emerge.  This link to CMS is the actual proposed rule from Don Berwick MD, currently the Head of CMS.

42 CFR Part 425
[CMS-1345-P]
RIN 0938-AQ22      

This proposed rule would supplement section 3022 of the Affordable Care
Act
which contains provisions relating to Medicare payments to providers of services and suppliers participating in Accountable Care Organizations (ACOs).

The Notice is both comprehensive and fairly specific about ACOs, and includes a glossary of acronyms that is arcane to most readers.

The Notice of Rule Making stipulates commentary be made by :

Instructions on pages 1 & 2 detail delivery methodology.  Send in your comments.

On another ACO front, the Inspector General has issued a number of Waivers allowing ACOs to bypass restrictive anti-trust law and also prior thrulings in regard to medicare restrictions including:

The application of the Physician Self-Referral Law, the Federal anti-kickback statute, and certain civil monetary penalties (CMP) law provisions to specified financial arrangements involving accountable care organizations
(ACOs) under the Medicare Shared Savings Program.

In addition, section 1115A(d)(1) of the Act, as added by section 3021 the ACA, authorizes the Secretary to waive the same fraud and abuse laws, among others, as necessary solely for the purposes of carrying out
the provisions of section 1115A of the Act with respect to the testing of certain innovative payment and service delivery models by the Center for

Medicare and Medicaid Innovation.

Commentary may also be made in accordance with the instructions on page 2 of the notice

IRS implications: NOTICE 2011-20   Another elephant in the room, the IRS, elaborates on ACOs, tax-exempt organizations qualifying for 501C status, and pretty much repeats the party-lines from HHS in regard to ACOs, all designed to grease the rails in regard to health reform as legislated by the ill-informed congress

Department of Justice, also weighs in on the liklihood of real violation of current  federal anti-trust law, and guidelines for avoiding same.

It becomes obvious to the reader that health reform is well orchestrated, designed to overcome most of the free-market rules that remain.

The law will all but paralyze the ability to  deliver  healthcare via small medical practices.

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