Skip to Content

Coastal One Health Partners

  • ACO Pre-Participation Waiver

ACO Pre-Participation Waiver

     WHEREAS, the Secretary of U.S. Department of Health and Human Services has made available waivers of certain federal laws to Accountable Care Organizations (“ACOs”), such as [Coastal One Health Partners ACO], participating in the Medicare Shared Savings Program (“MSSP”). 

     WHEREAS, to avail itself of the Pre-participation Waiver of the federal Physician Self-Referral Law (42 U.S.C. § 1395nn), federal Anti-Kickback Statute (42 U.S.C. § 1320a–7b(b)), and federal Gainsharing Civil Monetary Penalty (42 U.S.C. § 1320a–7a(b)) (the “Pre-participation Waiver”), the ACO’s governing body must verify that: 1) the arrangement is undertaken by parties with the good faith intention to develop an ACO that will participate in the MSSP in a particular year, and the good faith intention to submit a completed application to participate in the MSSP for that year; 2) at least one participant is the ACO or an entity eligible to form an ACO must undertake the arrangement; and 3) the ACO’s participants must not include any drug and device manufacturers, distributors, DME suppliers, or home health suppliers, which verification is set forth herein.

     WHEREAS, to avail itself of the Pre-participation Waiver, the ACO must be taking diligent steps to develop an organization eligible for a MSSP Participation Agreement that would become effective during the target year and to satisfy MSSP governance, leadership, and management requirements, which steps are being undertaken by the Coastal One Health Partners ACO.

     WHEREAS, to avail itself of the Pre-participation Waiver, the ACO's governing body must make and duly authorize a bona fide determination, consistent with the governing body members’ fiduciary duty to the ACO, that the arrangement is reasonably related to the purposes of the MSSP, which determination is set forth herein.

     WHEREAS, to avail itself of the Pre-participation Waiver, the ACO must contemporaneously document—with documents retained for at least 10 years following completion of the arrangement—the start-up arrangement, its authorization by the governing body, and the diligent steps taken to develop the ACO, which retention is directed by Coastal One Health Partners ACO as set forth below.

     WHEREAS, to avail itself of the Pre-participation Waiver, the ACO must publicly disclose arrangements entered into in reliance on the Pre-participation Waiver, which disclosure is authorized by Coastal One Health Partners ACO below.

     WHEREAS, to avail itself of the Pre-participation Waiver, the ACO must file an application for participation in the MSSP on or before the last applicable due date for the target year—or, if the ACO does not submit an application for a participation agreement on or before the last applicable due date for the target year, the ACO must submit a statement describing the reasons it was unable to submit an application—which application Coastal One Health Partners ACO intends to submit on or before July 31, 2017.

     WHEREAS, the Board understands that Cottage Health, a participant of the ACO that has been responsible for the organization and formation of the ACO, has incurred various costs in the development of the ACO, including use of Cottage Health internal staff and other resources, consulting services, recruitment and contracting of ACO participants and providers, and legal services (collectively, the “Start Up Costs”), which costs will not be fully recovered from other ACO participants.

NOW, THEREFORE, THE BOARD OF DIRECTORS OF THE COMPANY DOES HEREBY RESOLVE as follows:

1. Bona Fide Determination.

RESOLVED, that upon review of the Start Up Costs, the Board has made and duly authorized a bona fide determination, consistent with the Board members’ duty, that the arrangement is reasonably related to the purposes of the MSSP as, among other MSSP goals, it will facilitate improvements in care for individuals, better health for populations, and reduced expenditures for Medicare, consistent with the goals of the MSSP.

2. Verification of Good Faith and Participant Eligibility.

RESOLVED, that the Board has verified the following:

a) The arrangement is undertaken with the good faith intention to develop an ACO that will participate in the MSSP in 2018 and with the good faith intention to submit a completed application by July 31, 2017 to participate in the MSSP for 2018;

b) At least one participant is the ACO or an entity eligible to form an ACO; and

c) The ACO’s participants do not include any drug and device manufacturers, distributors, DME suppliers, or home health suppliers.

3. Public Disclosure and Documentation.

RESOLVED, that the Board directs the appropriate officers of Coastal One Health Partners ACO:

a) To publicly disclose the Start Up Costs in the manner required for reliance on the Pre-participation Waiver; and

b) To retain documentation of these Resolutions related to the Board’s approval of reliance on the Pre-participation Waiver for at least 10 years following termination of the Participation Agreement.