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 physicians and other healthcare providers who participate in the Scripps ACO may have shared use, at no cost, of clinical and hospital facilities that are co-branded Scripps M.D. Anderson Cancer Center for the provision of coordinated oncology services (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) managing and coordinating the care of Medicare fee-for-service beneficiaries (“MSSP Enrollees”) who participate in the Scripps ACO; (b) meeting the clinical integration requirements of the MSSP; (c) evaluating the health needs of MSSP Enrollees who participate in the Scripps ACO; and (d) communicating clinical knowledge and evidence based medicine to the ACO Participants and to MSSP Enrollees who participate in the Scripps ACO.
The Management Board of the Scripps ACO approved the Arrangement on September 26, 2018, and Scripps ACO is now in the process of effectuating the Arrangement.