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Accountable Care Organizations Rules and Comments

The Affordable Care Act (ACA) establishes a Medicare Shared Savings Program (MSSP) designed to drive efficient, high-quality care for Medicare fee-for-service beneficiaries. Under this program, groups of health care providers can form accountable care organizations (ACOs). These ACOs agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries assigned to them. At the end of March 2011, the Obama Administration released proposed regulations for the MSSP.

ACOs are becoming an increasingly important model of care designed to foster greater care coordination, improve quality and reduce costs. The ACA authorized a Medicare shared savings program to allow groups of providers to form ACOs and share in the responsibility of providing high-quality, cost-efficient care to their patients. Though a Medicaid ACO program was not included in the ACA, the Center for Medicare and Medicaid Innovation offers an opportunity for safety net health systems to innovate in this area and design an ACO care model that specifically targets the unique needs of the Medicaid patient population.

Medicare Shared Savings Program Regulations

Final Rule

Published October 2011.

Association Comments on Proposed Rule

Submitted June 2011.

Proposed Rule

Published April 2011.

Waiver Designs in Connection with Medicare Shared Savings Program


Published April 2011.

Medicare Advanced Payment Initiative


Published November 2011.

Association Comments on Notice

Submitted June 2011.




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