Breaking Down Barriers to Creating Safety-Net Accountable Care Organizations (ACO): Federal Statutory and Regulatory Issues

Abstract

This report surveys some of the largest challenges to Accountable Care Organization (ACO) formation and outlines how the federal government can do more to clear the path for coordinated care. Safety-net health providers will be affected by a host of unique issues as ACOs emerge, from lack of administrative capacity to limited access to specialists and potential threats to their non-profit status. While federal agencies have worked together to partially address some of these challenges, the paper argues that future regulations and policies will need to give special attention to the safety net in the legal and regulatory framework for ACOs to guarantee that health reform’s potential is realized for all Americans. The most efficient way to do this would be to develop comprehensive program guidelines on safety-net ACO formation that cut across substantive regulatory areas. Supplementing this report are Comments submitted to the Centers for Medicare and Medicaid Services and other federal agencies. The comments argue for full inclusion of federally qualified health centers, and other measures that will support ACO formation in the safety net.

Keywords: Patient Protection and Affordable Care Act of 2010, PPACA, Accountable Care Organizations, ACO, Health care delivery, Health care safety-net, Safety-net providers

JEL Classification: H51, I11, I18, K23, K32