Accountable Care Organization (ACO)

Public Health Law (PHL) Article 29-E requires the Department of Health (Department) to establish a program governing the approval of Accountable Care Organizations. PHL § 2999-p defines an Accountable Care Organization (ACO) as "an organization of clinically integrated health care providers that work together to provide, manage, and coordinate health care (including primary care) for a defined population; with a mechanism for shared governance; the ability to negotiate, receive, and distribute payments; and accountability for the quality, cost, and delivery of health care to the ACO's patients" and that has been issued a certificate of authority by the Department.

ACO Regulations

Pursuant to PHL Article 29-E, the Department has issued regulations establishing a process for the issuance of certificates of authority to ACOs that meet certain requirements. The regulations, effective December 31, 2014, can be found here:

ACO Applications

Completed ACO applications should be submitted electronically to acobml@health.ny.gov. Questions about completion of an application may be submitted to the same email address.

ACO Applications Submitted in Conjunction with DSRIP

Frequently Asked Questions (FAQs) have been issued to provide guidance to Performing Provider Systems (PPSs) that intend to submit an application for an ACO certificate of authority pursuant to PHL Article 29-E and the associated regulations in conjunction with a Delivery Reform System Incentive Payment (DSRIP) Program Project Plan application. As noted in the FAQs, a completed ACO application submitted by a PPS in conjunction with DSRIP should be sent to DSRIPapp@health.ny.gov with "ACO Application" in the subject line. Questions regarding DSRIP-related ACOs should be sent to the same email address with "ACO" in the subject line.

Medicare-Only ACO Certificates of Authority

As set forth in the statute and regulations, the Department may issue a certificate of authority through an expedited process to a "Medicare-only ACO" -- an entity that documents that it has been approved by the federal Centers for Medicare and Medicaid Services ("CMS") to operate as an ACO under the Medicare program. To date, the Department has issued certificates of authority to the following Medicare-only ACOs:

  • Accountable Care Coalition of Mt Kisco
  • Accountable Care Coalition of the North Country
  • Accountable Care Coalition of Syracuse
  • Adirondacks ACO
  • Asian American Accountable Care Organization
  • Balance Accountable Care Network, LLC
  • Bassett Accountable Care Partners, LLC
  • Beacon Health Partners, LLP
  • Bronx Accountable HealthCare Network IPA
  • Catholic Medical Partners
  • Chautauqua Region Medical Partners
  • HHC ACO Inc.
  • Mount Sinai Care, LLC
  • Primary PartnerCare ACO Independent Practice Association, Inc.
  • St. Joseph's Health Accountable Care Organization, LLC

As set forth in the regulations, a certificate of authority received through this expedited process shall only apply to the Medicare-only ACO's actions related to Medicare beneficiaries under its authorization from CMS.

ACO Certificates of Authority

As set forth in the statute and regulations, the Department may issue a certificate of authority to an entity that documents it has established and satisfied criteria set forth in Statue to operate as an ACO. To date, the Department has issued such certificates of authority to the following:

  • Accountable Care Organization of the North Country, LLC
  • Adirondacks ACO, LLC
  • Bronx Accountable Health Network IPA, INC.
  • CAIPA Care, LLC
  • Greater Buffalo United Accountable Care Organization
  • Innovative Health Alliance of New York, LLC
  • Mount Sinai Health Partners IPA, LLC

Quality performance data will be made available on the Department's website in mid-2018.