A: Medicare defines an ACO “Participant” by its Tax Identification Number (“TIN”), therefore a person with authority to do so on behalf of a potential participant TIN will need to sign a OneCare Vermont “Participant Agreement” as well as submit additional information required by Medicare. The participating network is a clinically integrated network across the State of Vermont.
A: Given the detailed rules of the MSSP, a TIN that includes multiple physician providers and services must belong to only one ACO. Medicare requires all providers billing through a network participant TIN to be part of the ACO. For a provider or provider organization to belong to more than one ACO, the provider would need to bill using different TINs, one for each ACO.
A: It is generally contemplated that ACO networks may wish to explore expansion given the investment in clinical integration required under the Medicare program. At this time, however, the OneCare Vermont participant network and participation agreement is limited in scope to the Medicare Shared Savings Program (MSSP).
A: We are working directly with the Vermont Health Care Reform team which envisions provider payment incentives changing across all payers. The MSSP, which includes population-based targets, shared savings incentives and quality measurement with financial implications, is consistent with the goals of payment reform. How Medicare and the OneCare Vermont MSSP participation may fit into a coordinated multi-payer approach or single payer model will develop over time.
A: The ACO is permitted to add or remove network participants during the three year period; however this is a challenging proposition for the ACO given the change this may represent in attributed Medicare beneficiary populations and performance opportunities. OneCare Vermont envisions at least one additional formal opportunity for new network participants to join the network on January 1, 2014. The ability and circumstances for network participants to resign from the network and the MSSP are defined in the participation agreement.