Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program, FTC Matter No: V100017 #00018 

Submission Number:
00018 
Commenter:
Tim Wolters
Organization:
Lake Regional Health System
State:
Missouri
Initiative Name:
Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program, FTC Matter No: V100017

We appreciate the efforts made to put forth these proposed policies. We believe one revision is appropriate with regard to the proposed Safety Zones. In the proposed Rural Exception, a Rural Hospital is defined in Footnote 31 to be either a Sole Community Hospital (SCH) or Critical Access Hospital. We request this definition be broadened to, at a minimum, include Medicare-dependent, Small Rural Hospitals (MDH) as defined at 42 C.F.R. 412.108. Our facility is an MDH, but also meets the criteria to be classified as an SCH. However, current regulations do not allow a hospital to be classified as both an SCH and an MDH, and we have elected the MDH classification as it provides more appropriate Medicare reimbursement to our hospital. Just as SCHs are vital safety net hospitals in regions with less access to hospital services, MDHs fill a similar role in regions with heavy concentrations of Medicare beneficiaries. We also believe rural referral centers (RRCs) meeting the criteria under 42 C.F.R. 412.96 should be included in the Rural Hospital definition, as these facilities serve as regional providers caring for more acutely-ill patients in a geographic region. The SCH, MDH and RRC designations are the three widely-accepted definitions for rural prospectively-paid hospitals under the Medicare program, and to single out only SCHs for this definition of Rural Hospitals overlooks the critical contribution made by MDHs and RRCs. Thank you for your consideration of this comment.