Describe the types of ACOs recognized by the Centers for Medicare and Medicaid Services.
ACO Programs for Medicare and Medicaid Services
Urban and rural health care organizations throughout the industry are working together to coordinate care for Medicare patients. Accountable Care Organization (ACO) programs were established by the Centers for Medicare and Medicaid Services to help facilitate this cooperation.ACO Programs for Medicare and Medicaid Services
Select a type of health care organization that would accept Medicare patients (e.g., family practice, hospital, urgent care, or nursing home).
Write a 700- to 1,050-word executive summary that discusses the purpose of joining an ACO and the funding available through one. Include the following:
Describe the organization you selected and the general services that would be offered to Medicare patients.
Describe the types of ACOs recognized by the Centers for Medicare and Medicaid Services.ACO Programs for Medicare and Medicaid Services
Evaluate industry dynamics that would influence your organization’s decision to participate in an ACO.
Identify the steps needed to participate in an ACO.
Justify participation in an ACO for your organization.
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The Medicare-Medicaid ACO (MMACO) Model is focused on improving quality of care and reducing costs for Medicare-Medicaid enrollees. The MMACO Model builds on the Medicare Shared Savings Program (Shared Savings Program), in which groups of providers take on accountability for the Medicare costs and quality of care for Medicare patients. Through the Model, CMS will partner with interested states to offer new and existing Shared Savings Program ACOs the opportunity to take on accountability for the Medicaid costs for their assigned Medicare-Medicaid enrollees.
Some of the highest-need, highest risk Medicare beneficiaries are those enrolled in both Medicare and Medicaid. In current Medicare ACO initiatives, beneficiaries who are Medicare-Medicaid enrollees may be attributed to ACOs. The Medicare ACO, however, does not have financial accountability for the Medicaid expenditures for those beneficiaries.ACO Programs for Medicare and Medicaid Services
The Medicare-Medicaid ACO Model is an initiative designed by the CMS Innovation Center for new and existing Shared Savings Program ACOs wishing to take on accountability for the full spectrum of Medicare Part A, Part B, Medicaid costs, and quality for their patients. Certain aspects of the Model may vary by state but the over-arching principles and parameters will be consistent across the Model. If Medicare-Medicaid ACOs in the state generate Medicare savings for their Medicare-Medicaid enrollees, states (as well as the Medicare-Medicaid ACO) may be eligible to share in those savings with CMS.
Through the Medicare-Medicaid ACO Model, CMS seeks to encourage participation from safety-net providers in Alternative Payment Models. Medicare-Medicaid ACOs that qualify as “Safety-Net ACOs” will be eligible to receive pre-payment of Medicare shared savings to support the ACO’s investment in care coordination infrastructure.
CMS has released a Request for Letters of Intent from states that wish to work with CMS to design certain state-specific elements of the Model, such as the details of the Medicaid financial methodology and shared savings/shared losses arrangements, selection of additional quality measures, and additional ACO eligibility requirements. States will also have the option to include additional Medicare-Medicaid enrollees not assigned under the Shared Savings Program and/or Medicaid beneficiaries in the target population for the Model, subject to CMS approval.ACO Programs for Medicare and Medicaid Services
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The Medicare-Medicaid ACO Model is open to all states and the District of Columbia that have a sufficient number of Medicare-Medicaid enrollees in fee-for-service Medicaid. CMS will enter into participation agreements with up to six states, with preference given to states with low Medicare ACO saturation. Additional eligibility requirements and details about the application process are provided in the Request for Letters of Intent.
States must follow all rules, including those related to Medicaid coverage, payment and fiscal administration that apply under the approach they are approved to offer. CMS will work with states to determine the appropriate Medicaid authority for their desired approach. State participation in the Model is contingent upon obtaining any necessary approvals and/or waivers from CMS.ACO Programs for Medicare and Medicaid Services