Pursuant to Section 1899(f) of the Social Security Act (42 U.S.C. § 1395jjj) the Secretary of the Department of Health and Human Services (“HHS”) has made available certain waivers of federal fraud and abuse laws in connection with the operation of accountable care organizations (“ACOs”) that have entered into a participation agreement, as defined under 42 C.F.R. § 425.20, under the Medicare Shared Savings Program (“MSSP”) with the Centers for Medicare & Medicaid Services (“CMS”).
Scripps Accountable Care Organization, LLC (“Scripps ACO”) has entered into such a participation agreement with CMS and is in good standing thereunder, pursuant to which Scripps ACO is participating in the MSSP.
Scripps ACO desires to establish an arrangement (the “Arrangement”) pursuant to which it provides the Scripps Health EpicCare EHR, and the end-user hardware and connectivity necessary to implement the EpicCare EHR, to those physicians and other healthcare providers who participate in the Scripps ACO MSSP (collectively, “ACO Participants”), on the terms and conditions set forth in a written Software Access Agreement between Scripps ACO and such ACO Participants (the “Agreement”).
The Management Board of the Scripps ACO has made a bona fide determination that the Arrangement is reasonably related to the purposes of the MSSP, as required by applicable waivers, including, specifically, meeting MSSP requirements for reporting on quality and cost measures; coordinating care of MSSP enrollees assigned to the Scripps ACO (“MSSP Enrollees”); meeting the clinical integration requirements of the MSSP; evaluating the health needs of MSSP Enrollees; communicating clinical knowledge and evidence based medicine to ACO Participants and to MSSP Enrollees; developing standards for MSSP Enrollee access and communication, including MSSP Enrollee access to medical records; and, improving the quality and efficiency of health care delivery to MSSP Enrollees.
The Management Board of the Scripps ACO approved the Arrangement on December 8, 2017, and Scripps ACO is now in the process of effectuating the Arrangement, subject to the terms and conditions of the Agreement.