[Federal Register Volume 76, Number 98 (Friday, May 20, 2011)]
[Pages 29249-29250]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-12383]



Centers for Medicare & Medicaid Services


Medicare Program; Pioneer Accountable Care Organization Model: 
Request for Applications

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.


[[Page 29250]]

SUMMARY: This notice announces a request for applications for 
organizations to participate in the Pioneer Accountable Care 
Organization Model for a period beginning in 2011 and ending December 

DATES: Letter of Intent Submission Deadline: Interested organizations 
must submit a nonbinding letter of intent by June 10, 2011 as described 
on the Innovation Center Web site http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco.
    Application Submission Deadline: Applications must be received on 
or before July 19, 2011.

ADDRESSES: Applications should be submitted by mail to the following 
address by the date specified in the DATES section of this notice: 
Pioneer ACO Model, Attention: Maria Alexander, Center for Medicare and 
Medicaid Innovation, Centers for Medicare and Medicaid Services, Mail 
Stop S3-13-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

FOR FURTHER INFORMATION CONTACT: [email protected] for questions 
regarding the aspects of the Pioneer Accountable Care Organization 
Model or the application process.


I. Background

    We are committed to achieving the three-part aim of better health, 
better health care, and lower per-capita costs for Medicare, Medicaid, 
and Childrens' Health Insurance Program beneficiaries. One potential 
mechanism for achieving this goal is for CMS to partner with groups of 
health care providers of services and suppliers with a mechanism for 
shared governance that have formed an Accountable Care Organization 
(ACO) through which they work together to manage and coordinate care 
for a specified group of patients. We will pursue such partnerships 
through two complementary efforts--the Medicare Shared Savings Program 
and initiatives undertaken by the Center for Medicare and Medicaid 
Innovation (Innovation Center). The Pioneer ACO Model is an Innovation 
Center initiative targeted at organizations that can demonstrate the 
improvements in financial and clinical performance with respect to the 
care of Medicare beneficiaries that are possible in a mature ACO. To be 
eligible to participate in the Pioneer ACO Model, organizations would 
ideally already be coordinating care for a significant portion of 
patients under financial risk sharing contracts and be positioned to 
transform both their care and financial models from fee-for-service to 
a three-part aim, value based model. This notice provides a general 
overview of the Pioneer ACO Model. For more details see the request for 
application which is available on the Innovation Center Web site at 

II. Provisions of the Notice

    Consistent with its authority under section 1115A of the Social 
Security Act (of the Act), as added by section 3021 of the Affordable 
Care Act, to test innovative payment and service delivery models that 
reduce spending under Medicare, Medicaid, or CHIP, while preserving or 
enhancing the quality of care, the Innovation Center aims to achieve 
the following goals through implementation of the Pioneer ACO Model:
     Test a more rapid transition for providers from volume 
based FFS payments to payment for coordination and outcomes.
     Promote a diversity of successful ACOs, including 
physician-led ACOs and those serving indigent or rural populations.
    This Model will test the effectiveness of a combination of the 
     Payment arrangements that place a group of providers at 
joint risk for quality performance and financial performance for the 
majority of their patients and revenues (including non-Medicare 
patients and revenues). Such payment arrangements will require 
participants to transition from fee-for-service to population-based 
payment by the third performance year. We believe the payment 
arrangements being tested will provide more opportunities for rapid 
escalation of shared savings and risk compared to the Medicare Shared 
Savings Program.
     Technical support in the form of rapid data feedback and 
shared learning activities.
     Size and scope of testing: We expect to partner with 
approximately 30 organizations in the Model, with a minimum of 15,000 
Medicare beneficiaries each (5,000 for rural ACOs). The application 
process and selection criteria are described in Section IV of the 
Request for Applications but in general, applications will be 
prioritized based on the strength of their care improvement plans, 
leadership, and commitment to outcomes-based contracts with non-
Medicare purchasers. Final selection will be based on the strength of 
the application and interviews of finalists, together with other 
factors to promote representation of diverse geographic areas, types of 
organizations, and types of Medicare populations served.
     Population: ACOs will be accountable for all fee-for-
service Medicare beneficiaries that CMS determines are aligned with 
them, and who have continuous enrollment in Parts A and B during 
baseline and performance periods, with emphasis on encouraging care of 
underserved populations and dual eligibles.
     Duration: Between 5 and 6 years (start third or fourth 
quarter of 2011 and end December 2016, which includes two 1-year 
optional periods).

III. Collection of Information Requirements

    Section 1115A(d) of the Act waives the requirements of the 
Paperwork Reduction Act of 1995 for the Innovation Center for purposes 
of testing new payment and service delivery models.

    Authority: Section 1115A of the Social Security Act.

    Dated: March 10, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2011-12383 Filed 5-17-11; 8:45 am]