Legal Regulatory Barriers To Effective ACO Implementation
Source: Greenway Health
Due to the relatively unique composition of ACOs and partnerships they create to achieve more highly integrated care, questions arise about their legal viability. The Accountable Care Act (ACA) and subsequent regulations seek to ensure that ACOs are able to accomplish their mission by shielding them from undue interference with legal and regulatory barriers.
Antitrust and ACOs
The Federal Trade Commission (FTC) and the Department of Justice (DOJ) issued a joint Policy Statement on ACOs and antitrust concerns
What ACOs will be affected
When the FTC and DOJ will apply particular antitrust analyses to those ACOs
An antitrust safety zone for certain ACOs
The CMS-‐mandated antitrust review process for certain other ACOs
Options for ACOs to gain additional antitrust clarity if they fall outside the safety zone but below the CMS-‐mandated antitrust threshold
CMS issued a rule that includes waivers for ACOs and the Medicare Shared Savings Program (MSSP) under the federal physician self-‐referral, anti-‐kickback and civil monetary penalty laws
Download this fact sheet from Greenway to read more.