Provider FAQ - OneCare Vermont

Frequently Asked Questions for Providers

Q: How do physicians and hospitals participate in OneCare Vermont?

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.  

Q: Can a provider or organization be a part of multiple Medicare ACOs?

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.

Q: Is the network for the ACO intended or allowed to apply to commercial contracts or other payers?

A: It is generally contemplated that ACO networks may wish to explore expansion given the investment in clinical integration required under the Medicare program. The OneCare Vermont participant network and participation agreement is open to the Medicare Shared Savings Program (MSSP), Vermont Medicaid Next Generation Program (VMNG), and the Commercial Exchange Shared Savings Program (XSSP).

Q: How does this fit in the overall Vermont approach to Health Care Reform?

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.

Q: Can I enter the ACO network later or leave early?

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.