Accountable Care Organizations (ACOs): Can Post-Acute Providers Participate in ACOs?

ACO is the buzz word we hear today. We learn about ACO’s related to hospitals and physicians, but what about post-acute care providers? Post-acute-care providers such as homecare, hospice and HME need to be included in the ‘big ACO picture’ as well.

Section 1899(a) (1) (A) of the Affordable Care Act defines ACOs as “groups of providers of services and suppliers” that work together to manage and coordinate care for Medicare fee-for-services beneficiaries.

The statute lists the following groups of providers of services and suppliers that are eligible to participate as an ACO:

  • ACO professionals, i.e. physicians in group practice arrangements
  • Networks of individual practices of ACO professionals
  • Partnerships or joints venture arrangements between hospitals and ACO professionals
  • Hospitals employing ACO professionals
  • Such other groups of providers of services and suppliers as the Secretary of the U.S. Department of Health and Human Services (HHS) determines appropriate

The final regulations go on to define ACO providers and suppliers as follows: ACO provider/supplier means an individual or entity that– (1) Is a provider or a supplier; (2) Is enrolled in Medicare; (3) Bills for items and services it furnished to Medicare fee-for-service beneficiaries under a Medicare billing number assigned to the TIN of an ACO participant in accordance with applicable Medicare regulations; and (4) Is included on the list of ACO providers/suppliers that is required under Section 425.204(c)(5).

The commentary to the final regulations governing ACOs makes it even clearer that post-acute providers can participate in ACOs: We do not believe that we should be prescriptive in setting any requirements for the number, types and location of providers/suppliers that are included as ACO participants.

The commentary also states that ACO participants are defined as any Medicare-enrolled provider or supplier, including pharmacists. Consequently, based upon the statute, the final regulations, and commentary to the final regulations, it is clear that post-acute providers may join doctors to form ACOs.

Is being a part of an ACO part of your business plan?