Legislation Aims for More ACO Flexibility

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Proposed legislation introduced in the U.S. House calls for Medicare to pilot a reimbursement mechanism for accountable care organizations based on outcomes and encourages ACO use of telehealth and remote patient monitoring services.

Rep. Diane Black (R-TN), a registered nurse for 40 years, sponsors The ACO Improvement Act (H.R. 5558) along with Rep. Peter Welch (D-VT). Both serve on powerful committees--Black on Ways & Means and Welch on Energy & Commerce.

The legislation would lift certain limitations on use of telehealth services including store-and-forward technology as well as home-based remote monitoring and video conferencing services, reimbursed “in a manner that is financially equivalent to the furnishing of a home health visit,” according to the bill. ACOs also would be permitted to reduce or eliminate cost-sharing that otherwise would be applicable under Medicare Part B and to develop other incentive programs to enhance patient engagement, with the costs of incentives borne by the ACO.

(See also: IT Interoperability, Cost Huge Burdens for ACOs)

Another provision would require a demonstration program “to test the use of payment benchmarks that take into account geographic area differences, such as differences in spending trends within and across regions, and variations in delivery and utilization based on the socioeconomic status of beneficiaries served.”

Medicare beneficiaries in an ACO would be able to select a primary care provider rather than being assigned to a provider, under the legislation. A section of the bill also would authorize waiver of the 3-day prior hospitalization requirement for coverage of skilled nursing facility services. Text of the bill is available at congress.gov.

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