The Affordable Care Act, the healthcare reform legislation enacted by Congress in March 2010, required the Department of Health and Human Services to develop the Medicare Shared Savings Program (the “Shared Savings Program”) by January 1, 2012. Through accountable care organizations, healthcare providers may contract with Medicare as part of the Shared Savings Program. Anticipating the federal Shared Savings Program, the State of New York has enacted a law to help develop ACOs within the state. The law authorizes the New York State Department of Health to approve up to seven ACOs between now and December 2015.
Unlike the federal Shared Savings Program, which establishes ACOs on a permanent basis, the New York ACO program is a demonstration program where the state will evaluate viability of ACOs over a time. Although this is a demonstration program, the New York State Department of Health will most likely increase the number of ACOs allowed to participate and establish ACOs on a permanent basis, if the demonstration proves successful.
The New York law, however, does hint at the aspects of ACOs that the regulations will seek to govern. The regulations may address issues, such as:
- governance structure of ACOs;
- patient population served by ACOs;
- adequacy of an ACO’s network of participating healthcare providers; and
- mechanisms by which an ACO will receive and distribute payments to participating healthcare providers; and
- mechanisms that promote evidence-based healthcare, patient engagement, coordination of care and electronic health records.
Furthermore, the new law suggests that New York State may set forth safe harbors that would give ACOs protection from the state’s antitrust, fee-splitting and self-referral laws.
Access information about states seeking a State Innovation waiver under the Affordable Care Act here.
Learn about one of the New York participants in the Pioneer Care Organizations.
Finally, here is an excellent background and analysis piece on the topic from Health Affairs.