Legal Regulatory Barriers To Effective ACO Implementation

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

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