Rivas Goldstein, LLP Call : 512-481-2916

CMS makes changes to ACO program: 5 things to know

The United States Centers for Medicare and Medicaid Services (CMS) recently announced changes to its Next Generation Accountable Care Organization (ACO) program. CMS explains these changes are an attempt to continue sufficient financial incentives to encourage higher quality outcomes for organizations that participate in value based arrangements.

Another goal of these changes: to minimize the reporting burden. The COVID-19 pandemic has resulted in many stressors for hospital officials and care providers. The agency is hopeful these changes will help ease the strain that can result from use of their programs.

What are the changes?

The organization has extended the Next Generation ACO program through 2021. Additional changes include:

  • Lowering shared loss. The federal organization is lowering shared loss during the months that were impacted by the coronavirus pandemic.
  • Cap gross savings. It has also announced it will cap gross savings upside potential at 5%.
  • Removal of guarantee requirement. The agency is also removing the 2020 financial guarantee requirement.
  • Cancellation of audit. The agency is also cancelling its previous planned 2019 quality audit.
  • Monitoring impact throughout 2020. CMS has also stated it will continue to monitor the impact throughout the year — signaling the agency may be open to additional changes as needed.

Navigating these and any future changes to CMS systems can be complex. A failure to abide by their rules could result in allegations of wrongdoing and a potential investigation. Anyone subject to such an investigation is wise to seek legal counsel to advocate for their interests and better ensure a favorable outcome.

No Comments

Leave a comment
Comment Information
Email Us For A Response

Rivas Goldstein LLP: On Your Side, Protecting Your Future

Our experienced Texas-based health care lawyers are here to help you and your business succeed. Please call 512-481-2916 or contact our law firm online.

Schedule A Consultation With An Attorney

Bold labels are required.

Contact Information
disclaimer.

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

close

Privacy Policy

Austin Office
3345 Bee Cave Rd, Suite 104
Austin, TX 78746

Phone: 646-859-3790
Map & Directions

New York Office By Appointment Only
405 Lexington Ave 26th Floor
New York, NY 10174

Phone: 512-481-2916
Map & Directions

Review Us