General Assembly Clears Regulatory Hurdles for Medicare ACOs

This week the General Assembly completed its work on House Bill 287 – Amend Insurance Laws. This bill includes an important provision that exempts Medicare Accountable Care Organizations (ACO) from state insurance laws since they are already overseen by the Centers for Medicare and Medicaid Services (CMS). The exemption is available for participants in the Medicare Shared Savings Program (MSSP), the Next Generation ACO Model and other current and future Medicare ACO programs administered through CMS’s Center for Medicare & Medicaid Innovation. The change comes at a welcome time, too, as more physicians consider forming or joining ACOs in anticipation of Medicare payment reforms under MACRA.

The North Carolina Medical Society (NCMS) spearheaded the legislative effort and worked diligently to ensure the provision was finalized this year. You can review the two-sentence provision on page 20 of HB 287.

State insurance laws have not kept pace with recent innovations in health care delivery and financing, and therefore do not squarely address the latest emergence of risk-sharing providers. This led to uncertainty in how the NC Department of Insurance would view Medicare ACOs from a regulatory perspective. CMS’s Next Gen ACO application raised the stakes even higher by requiring applicant ACOs to demonstrate compliance with state insurance requirements for risk-sharing providers.

This statutory change not only resolves the uncertainty, but also removes a regulatory barrier to our local pursuits of the triple aim and value-based health care. Several members of our ACO Collaborative and MSSP Council helped NCMS tackle this problem, so we thank them for their engagement and assistance in crafting a solution.

 
 

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