DoJ, FTC firm up Shared Savings Program policy
Because the Medicare Shared Savings Program final rule will no longer require a mandatory antitrust review for certain collaborations as a condition of entry into the program, the final policy statement no longer contains provisions relating to mandatory antitrust review, according to a final policy statement from the Federal Trade Commission and Department of Justice.
Published in conjunction with the Centers for Medicare & Medicaid Services’ (CMS) final rule on accountable care organization (ACO) requirements, the statement noted that the agencies will continue to protect competition in markets served by ACOs that participate in the Shared Savings Program, aided by data and information from CMS that will assist the agencies in monitoring the competitive effects of ACOs.
“Specifically, CMS will provide the agencies with aggregate claims data regarding allowed charges and fee-for-service payments for all ACOs accepted into the Shared Savings Program and also with copies of all of the applications to the Shared Savings Program of ACOs formed after March 23, 2010,” the notice stated. “The agencies will monitor complaints about an ACO’s formation or conduct and take whatever enforcement action may be appropriate. Additionally, upon request, the agencies will provide an expedited 90 day review for newly formed ACOs that wish to obtain additional antitrust guidance.”
The other significant change from the proposed policy statement is that--with the exception of the voluntary expedited antitrust review--the entire policy statement applies to all collaborations among otherwise independent providers and provider groups that are eligible and intend, or have been approved, to participate in the Shared Savings Program.
“Its applicability is no longer limited to those collaborations formed after March 23, 2010, the date on which the Patient Protection and Affordable Care Act was enacted,” the notice clarified.
Read the final policy statement here.
Published in conjunction with the Centers for Medicare & Medicaid Services’ (CMS) final rule on accountable care organization (ACO) requirements, the statement noted that the agencies will continue to protect competition in markets served by ACOs that participate in the Shared Savings Program, aided by data and information from CMS that will assist the agencies in monitoring the competitive effects of ACOs.
“Specifically, CMS will provide the agencies with aggregate claims data regarding allowed charges and fee-for-service payments for all ACOs accepted into the Shared Savings Program and also with copies of all of the applications to the Shared Savings Program of ACOs formed after March 23, 2010,” the notice stated. “The agencies will monitor complaints about an ACO’s formation or conduct and take whatever enforcement action may be appropriate. Additionally, upon request, the agencies will provide an expedited 90 day review for newly formed ACOs that wish to obtain additional antitrust guidance.”
The other significant change from the proposed policy statement is that--with the exception of the voluntary expedited antitrust review--the entire policy statement applies to all collaborations among otherwise independent providers and provider groups that are eligible and intend, or have been approved, to participate in the Shared Savings Program.
“Its applicability is no longer limited to those collaborations formed after March 23, 2010, the date on which the Patient Protection and Affordable Care Act was enacted,” the notice clarified.
Read the final policy statement here.