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Coverage and Delivery Reform

Coverage Expansion | Demonstrations and CMMI | Patient Care Quality

The Affordable Care Act (ACA) calls for new programs and initiatives that will transform how healthcare is delivered. Innovative pilot programs specified in the legislation, such as accountable care organizations (ACOs), are currently being implemented. The ACA also created the Centers for Medicare and Medicaid Innovation (CMMI), which is tasked with developing and funding demonstration projects to improve the quality of care for patients. CMMI launched programs such as the Pioneer ACO, Bundled Payments for Care Improvement, and the Health Care Innovation Challenge.

Court Update: What You Should Know About the Recent Circuit Court Rulings on the ACA, the IRS, and Tax Subsidies 

The ACA also establishes new requirements for health insurance coverage. Starting in 2014, consumers and small businesses will be able to purchase coverage through state-level exchanges. These exchanges will offer insurance options, aid consumers in selecting plans, and coordinate eligibility for premium tax credits. Also in 2014, Medicaid will expand to cover those at or below 133 percent of the federal poverty level.

Related: Geographic Variation | Requirements for 501(c)(3) Hospitals

New Coverage and Delivery Reform Resources

What You Should Know About the Recent Circuit Court Rulings on the ACA, the IRS, and Tax Subsidies

July 25, 2014

An update on the Affordable Care Act (ACA) court cases that challenged the Internal Revenue Service (IRS) rules allowing tax credits for individuals in both state-established and federally-established exchanges

News and Updates

HHS OIG Issues Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements Civil Monetary Penalty

August 30, 2018

Department of Health and Human Services (HHS) Office of the Inspector General (OIG) Aug. 27 released a Request for Information (RFI) regarding the anti-kickback statute and beneficiary inducements civil monetary penalty (CMP) seeking input from the public on addressing regulatory provisions in Medicare and state health programs that may act as barriers to coordinated or value-based care.

AAMC Comments on Stark RFI

August 24, 2018

The Association of American Medical Colleges (AAMC or Association) welcomes this opportunity to comment on the Centers for Medicare and Medicaid Services’ (CMS’s or the Agency’s) Request for Information on reducing burdens of the Physician Self-referral regulations, also known as the Stark regulations, 83 Fed. Reg. 29524 (June 25, 2018).

CMS Issues Proposed Rule Making Significant Changes to the Medicare Shared Savings Program

August 17, 2018

The Centers for Medicare and Medicaid Services (CMS) Aug. 9 proposed significant changes to the Medicare Shared Savings Program (SSP) in a proposed rule entitled “Accountable Care Organizations – Pathways to Success.”

On Patient Care

Testimony and Correspondence