ACO Proposed Rule’s Program Integrity Includes Mandatory Compliance Plans

In its proposed rule for accountable care organizations (“ACOs”), the Centers for Medicare and Medicaid Services (“CMS”) includes mandatory compliance plans as an element of its ACO-program integrity efforts. The compliance plan must include at least the following elements:

• A designated compliance officer who is not legal counsel to the ACO and who reports directly to the ACO’s governing body
• Mechanisms for identifying and addressing compliance problems related to the ACO’s operations and performance
• A method for employees or contractors of the ACO or ACO providers/suppliers to report suspected problems related to the ACO
• Compliance training of the ACO’s employees and contractors
• Requirement to report suspected violations of the law to an appropriate law enforcement agency.

Since the Patient Protection and Affordable Care Act’s enactment, adoption of compliance plans–both for ACOs and generally–has become mandatory for participation in Medicare, Medicaid and the Children’s Health Insurance Program.

For more information, please contact Adrienne Dresevic, Esq., Carey F. Kalmowitz, Esq. or Esq. at (248) 996-8510 or (212) 734-0128 or visit the ACO specialty page on the HLP website.

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