The final regulations to implement the accountable care organization provisions of the 2010 healthcare reform law have entered one of their last steps, according to an online notice.

The Office of Management and Budget began its review of the final rule for the ACO program, also known as the Medicare Shared Savings Program, on Oct. 5. Such OMB reviews are usually the last or one of the last steps that regulations take before they are publicly issued. Officials at the CMS would not comment on whether the highly anticipated rule to implement the ACO section of the Patient Protection and Affordable Care Act would come within days or weeks.

The final rules have been delayed by their complexity and by the number of federal entities involved in their creation: the CMS, HHS, HHS' inspector general's office, the Federal Trade Commission and the Internal Revenue Service. Several representatives from those entities have emphasized since the draft rules were issued that they were closely reviewing feedback on the ACO proposals and that the final rules will include significant changes from the initial proposal.

More than 1,200 comments were submitted to the proposed rule, according to a CMS official.

Healthcare industry observers told Modern Healthcare in recent weeks that they were closely watching the final form that the proposal will take after an earlier draft drew widespread criticism. Healthcare providers have criticized the proposed ACO rules as overly proscriptive, while carrying too much financial risk and too little potential reward.

Additionally, Republicans have alleged that ACOs will allow participating providers to command higher private insurance rates regardless of their success at improving quality and lowering costs for Medicare.