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 pursuant to which care management services shall be provided to patients with chronic diseases (the “Arrangement”).
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: (a) promoting evidence based medicine and engagement with Medicare feefor-service beneficiaries (“MSSP Enrollees”) enrolled in the Scripps ACO; (b) coordinating care of MSSP Enrollees who participate in the Scripps ACO; (c) evaluating the health needs of MSSP Enrollees who participate in the Scripps ACO; (d) communicating clinical knowledge and evidence based medicine to ACO physicians and clinical care participants and to MSSP Enrollees who participate in the Scripps ACO; and (e) communicating the health needs of MSSP Enrollees who participate in the Scripps ACO.
Furthermore, the Management Board of the Scripps ACO has made a bona fide determination that there is a reasonable connection between the Arrangement and the medical care of MSSP Enrollees assigned to the Scripps ACO and that the Arrangement will advance the goals of: (a) adherence by an MSSP Enrollee assigned to the Scripps ACO to a treatment regime and (b) the successful management of a chronic disease or condition of an MSSP Enrollee assigned to the Scripps ACO.
The Management Board of the Scripps ACO approved the Arrangement on May 30, 2018, and Scripps ACO is now in the process of effectuating the Arrangement.