Legislation aims to improve Medicare ACO services in rural, medically underserved areas

(FOX 2)

New legislation aims to expand access to coordinated health care in rural areas.

U.S. Representative Derek Kilmer (WA-06) introduced the ‘ACO Assignment Improvement Act of 2021,’ designed to bolster Medicare Accountable Care Organizations, or ACOs, to include nurse practitioners, physician assistants and clinical nurse specialists.

ACOs are groups of hospitals, doctors and health care providers that join together to coordinate care for a certain region. According to the Centers for Medicare & Medicaid Services, ACOs deliver high-quality care at lower costs than traditional health services, and have been ‘highly effective’ in responding to the COVID-19 pandemic.

Currently, Medicare beneficiaries meet with a primary care physician, who will assign them to an ACO—for example, a beneficiary in the Seattle area may be assigned to Health Connect Partners, Polyclinic Medicare ACO or Rainier Health Network. But, this often cannot happen in rural or medically underserved areas.

The new bill would allow for ACO assignment based on primary care visits with nurse practitioners, physician assistants and clinical nurse specialists.

"No matter where you live, you ought to be able to go to a health care provider," said Rep. Kilmer. "Folks who live in rural communities shouldn’t be disadvantaged because they see a nurse practitioner or a physician assistant or clinical nurse specialist. Every American should be able to get medical care close to home and stay healthy without breaking the bank. This legislation will help with that. And it rewards primary care providers who are focused on improving the quality of care and putting their patients first."

The bill is co-sponsored by Reps. Kathleen Rice (NY-04), Mike Gallagher (WI-08) and Adrian Smith (NE-03), and endorsed by MultiCare, the Washington State Hospital Association, the National Association of ACOs (NAACOS) and several other health care organizations.

"This legislation will both improve patients’ access to care, especially in rural America and reduce inequities by removing the statutory requirement that patients have at least one primary care visit with a physician during the year in order to be assigned to an ACO," said NAACOS Presdent and CEO Clif Gaus. "Removing this requirement will allow nurse practitioners, physician assistants, and other nonphysician providers (NPPs) to contribute toward ACO assignment even if their patients never see a physician for a qualifying visit during the year."

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