Work together to provide, manage, and coordinate health care (including primary care) for a defined population;
Have a mechanism for shared governance;
Have the ability to negotiate, receive, and distribute payments; and
Are accountable for the quality, cost, and delivery of health care to the ACO’s patients
Scope of Services: The statute does not specifically define the “array of services” that accountable care organizations (ACOs) will deliver. However, the statute is clear that primary care will be a critical component of the services offered by ACOs.
Patient Population: A definition of the population proposed to be served by an ACO, which may includes references to geographic area and patient characteristics, will be promulgated by the New York Department of Health in forthcoming regulations.
New York’s ACO law, NYS Public Health Code Article 29-E, calls for the convening of a workgroup by the Department of Health that will develop a proposal whereby an ACO—instead of a managed care plan—may serve Medicaid or Family Health plus enrollees who are required to participate in managed care.
The certification of accountable care organizations (ACOs) by the New York Department of Health was authorized in March 2011 with the enactment of Chapter 59 of the Chapter Laws of 2011, which created NYS Public Health Code Article 29-E. This law was revised by Chapter 461 of the Chapter Laws of 2012 in October 2012 to better align the state program with the federal Medicare Shared Savings Program and to expand the ACO initiative from a demonstration to a full program.
The law also authorizes the New York Department of Health to seek federal approvals and waivers to implement ACOs, including waivers needed to obtain federal financial participation.
New York’s ACO law, NYS Public Health Code Article 29-E, requires that accountable care organizations (ACOs) provide for meaningful participation in the composition and control of the ACO’s governing body for ACO participants or designated representatives. ACO governing bodies must have at least one representative from each of the following groups:
ACO participants must hold at least 75 percent control of the ACO’s governing body. Further detail on ACO governance requirements will be issued in forthcoming regulations from the Department of Health.
|Criteria for Participation||
Accountable care organizations (ACOs) must be issued a certificate of authority by the Commissioner of the Department of Health. The Commissioner is authorized to issue certificates through December 31, 2016. New York’s ACO law NYS Public Health Code Article 29-E specifies a number of areas that will be addressed by the ACO regulations, including:
The law also allows the Department of Health to create an expedited review process for certification of organizations approved by the Centers for Medicare & Medicaid Services to participate in the Medicare Shared Savings Program. These ACOs would be certified as “Medicare-only ACOs.”
The Department of Health will discuss accountable care organization (ACO) payments in forthcoming regulations.
However, NYS Public Health Code Article 29-E provides that ACOs may enter into payment arrangements with one or more third-party payers to establish novel payment methodologies, including full or partial capitation. Payment arrangements must include provisions for the ACO to receive and distribute payments to participating providers, including incentive payments (which can include medical home payments). ACOs can have mechanisms in place to pool payments received by participating providers from third-party payers.
|Support for Infrastructure||
New York’s ACO law, NYS Public Health Code Article 29-E, establishes that the Department may directly, or through contracts with not-for-profit organizations, provide:
|Measurement and Evaluation||
In forthcoming regulations, the Department of Health will specify:
NYS Public Health Code Article 29-E directs the Commissioner of Health to ensure that New York’s ACO regulations, including reporting and evaluation requirements, are as consistent as possible with regulations released by the Centers for Medicare & Medicaid Services pertaining to ACOs under the Medicare program.