Accountable Care Organization Checklist

Transcription

1 Accountable Care Organization Checklist It is important that a provider, supplier, or other individual or entity that is considering participating in, or performing functions or services related to, an Accountable Care Organization (ACO), conduct due diligence on the ACO. This due diligence request list is intended to provide a sampling of the documents and information that a party might request when deciding whether to invest in a public sector ACO. This due diligence request list does not include all of the documents and information that a potential ACO participant might need to review. Providers, suppliers, and other individuals or entities that are considering participating in an ACO should independently evaluate whether additional due diligence, documents, and information are needed. This decision might take into account various factors, including, but not limited to, the ACO s composition, structure, and beneficiary population. 1

2 Please provide the following information about your Accountable Care Organization (ACO). ACO s Legal Entity Overview of the ACO s history, mission, and organization, including the ACO s composition and affiliations; Certificate or Articles of Incorporation, Organization, or Formation (including all amendments); Certificate of Authority (to do business in foreign states); Fictitious Name Registrations; Corporate bylaws, limited liability company operating agreement, partnership agreement, or similar operative document (including all amendments); Governing Body board meeting minutes for the last [two years]; and Other ACO corporate governance documentation. ACO s Governance Governing Body charter; List of Governing Body members (including each member s role, whether the member is an ACO participant or ACO provider/supplier, Medicare beneficiary, community member, or other type of representative); ACO committees and key leadership personnel (including a description of each committee s and committee member s responsibilities); Organizational chart showing the flow of responsibility; and Conflict-of-Interest Policy. 2

3 ACO Participants and Markets Provide a list of ACO participants, providers/suppliers, and other individuals and entities performing functions or services related to ACO activities; and Provide a list of markets in which the ACO provides services to beneficiaries. Compliance Compliance plan; Compliance policies and procedures; Compliance audit and monitoring reports since the ACO s date of organization; Identify the ACO s compliance officer and the officer s responsibilities [and the reporting structure of the compliance department]; and Identify the health professional responsible for the ACO s Quality Assurance and Improvement Program (QAIP) (including a description of the individual s responsibilities). Shared Savings/Losses Provide a description of the ACO s flow of funds (including how shared savings and shared losses are allocated to ACO participants); Provide the amount of shared savings earned or losses incurred (i.e., payments made to the Centers for Medicare & Medicaid Services (CMS)) for each of the ACO s performance years since its start date; and 3

4 Describe how the ACO used shared savings payments during each of the ACO s performance years since its start date (including the proportion of shared savings reinvested in infrastructure and the proportion distributed among ACO participants). ACO Agreements All agreements between the ACO and CMS, the Center for Medicare & Medicaid Innovation (CMMI), the U.S. Department of Health and Human Services (HHS), and any other governmental body, agency, or department; Sample ACO participation agreements (including between the ACO and ACO participants, ACO providers/suppliers, and other individuals and entities performing functions or services related to ACO activities); Management and administrative services agreements; Employee agreements; Data use agreements; and Business associate agreements. ACO Operations QAIP; o Provide a copy of the QAIP; and o Describe how the ACO requires ACO participants and ACO provider/suppliers to comply with and implement its QAIP. Describe the ACO s protocols for the following (including how the ACO defines, implements, evaluates, and updates its processes for each): o Evidence-based medicine; 4

5 o Beneficiary engagement; o Internally reporting on quality and cost metrics; and o Coordination of beneficiary care. Quality Performance Results. o Copies of the ACO s performance results for each of the ACO s quality measures (covering each performance year since the ACO s start date); and o Describe how the ACO monitors, gives feedback, and evaluates ACO participant and ACO provider/supplier performance (e.g., provide sample reports that the ACO provides). Financial Information and Reports Financial statements (current year and last full year); Fixed asset list (including: manufacturer, model, year, date of last update, accumulated depreciation, and depreciation schedule); Tax returns (including sales, use, and personal property for the most recent 12 months); Loan documents (including outstanding loan documents and copies of all Uniform Commercial Code financing statements); and List of insurance coverages, including name of insured party, carrier, policy limits, and whether the policy is on a claims-made basis. Legal Matters List of any outstanding litigation and summary of each suit; List of any other government process or investigation and summary of each; 5

6 Legal claims (made, or anticipated to be made, against the ACO); and Correspondence with CMS, CMMI, the HHS Office of Inspector General, the U.S. Department of Justice, state Medicaid carriers, and any other federal, state, local government, or regulatory agency. 6