ACO Homebound Waiver for Home Health Proposed by CMS

The Medicare Shared Savings Program Accountable Care Organization Proposed Rule published in the Federal Register on December 8, 2014 proposes to allow certain Accountable Care Organizations (ACOs) to waive the “homebound” requirement that is currently a precursor for Medicare beneficiaries to receive the Medicare home health benefit.

The purpose of the waiver is to allow certain ACOs to offer home health services to patients where they believe it will keep patients out of the hospital, resulting in reduced overall costs to the Medicare program.

CMS has proposed that the waiver would only be available to ACOs participating in the proposed “Track 3” program which is proposed to include two-sided risk and prospective beneficiary assignment.

CMS has also proposed that the services would need to be provided at the direction of an ACO Participant or ACO Provider/Supplier. CMS is considering and seeking comments on whether the home health agency must also be an ACO Participant or ACO Provider/Supplier.

Comments to CMS are due February 6, 2015.

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