The Long-Awaited Massachusetts Health Policy Commission Accountable Care Organization Certification Standards Are Here

December 15, 2015 Alerts and Newsletters

Under Chapter 224 of the Acts of 2012 ("Chapter 224"), the Massachusetts Health Policy Commission ("HPC"), which was created under that Act, is required to establish a process for the voluntary certification of accountable care organizations ("ACOs"). On December 9, 2015, the HPC released the long-awaited "Proposed Accountable Care Organization (ACO) Certification Standards" ("Proposed Standards") for public comment. These proposed certification standards address core competencies for ACOs in care delivery and are designed to ensure that certification is attainable for systems of differing sizes, infrastructure and technical capabilities, populations served, and locations.

Chapter 224 lists a number of mandatory minimum standards for the certification of ACOs and authorizes the HPC to develop additional standards that are consistent with the goals for ACO certification set forth in Chapter 224. Acting on this authority the HPC has proposed thirty one criteria for ACO certification (some of which have various documentation requirements), which are grouped in the following three categories:

  • General mandatory criteria, which address the legal and governance structure of the ACO, risk stratification and population specific interventions, the provision of care across the continuum, participation in MassHealth alternative payment methodologies, patient centered medical home adoption rates, cost, utilization, and quality analytics, patient and family experience, and community health;
  • Market and patient protection criteria, which address risk-bearing provider organization status, HPC material change notice compliance, compliance with federal and state antitrust laws, compliance with HPC's Office of Patient Protection guidance concerning patient grievances, quality and financial performance reporting, and consumer price transparency; and
  • Reporting only criteria, which require reporting in the areas of palliative care, care coordination, peer support, adherence to evidence-based guidelines, alternative payment methodology adoption for primary care, flow of payments to providers, ACO population demographics and preferences, and commitment to electronic health record interoperability.

Unlike the "general mandatory criteria" and the "market and patient protection criteria," the HPC will review the ACO's responses to the "reporting only criteria" but will not qualitatively assess these responses. Rather, the HPC will reference and rely on this reported information when making future changes or adjustments to the ACO certification program. Note that the Proposed Standards make no mention of the concept introduced in Chapter 224 under which certain ACOs designated as "model ACOs" could receive preferential contracting under state health programs.

The HPC is seeking stakeholders' comments and perspectives on the proposed ACO certification framework, criteria, and documentation requirements. In particular, the HPC asks specific questions concerning certain criteria and also poses eight general questions regarding the ACO certification framework. Comments on the Proposed Standards are due to the HPC by 5:00 pm on January 29, 2016. The HPC will also hold a public hearing on January 6, 2016 to discuss the Proposed Standards.

The Health Care Group at Verrill Dana is analyzing the criteria set forth in the Proposed Standards and considering the submission of comments. For more information, to suggest comments, or to request assistance in submitting your own comments, please contact any member of the Health Care Group at Verrill Dana.

This communication is intended for general information purposes and as a service to clients and friends of Verrill Dana, LLP. This publication, which may be considered advertising under the ethical rules of certain jurisdictions, should not be construed as legal advice or a legal opinion on any specific facts or circumstances, nor does it create attorney-client privilege.

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