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Window to Washington

An inside-the-beltway look at the legislative and regulatory process.
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By Jessica Zigmond and Rich Daly

For pediatric ACOs, providers need not apply

By Rich Daly

Among the myriad federal healthcare initiatives stemming from the Patient Protection and Affordable Care Act, at least one highly anticipated program has fallen through the cracks. The 2010 law authorized the creation of pediatric accountable care organizations within Medicaid. Such pilot projects were supposed to start on Jan. 1.

The planned program would link Medicaid provider pay to patient outcomes and supposedly track the higher-profile version of adult ACOs in Medicare. After a rocky initial start, the adult version of ACOs has gotten under way, but the Medicaid children's version appears to have stalled.

Cindy Mann, director of the Center for Medicaid and State Operations at the CMS, said in an interview that the Medicaid children's program has not launched because it remained unfunded. The 2010 healthcare law simply authorized it to run from 2012 through 2016, while leaving it up to Congress to subsequently provide the money.

However, CMS officials I contacted did not respond to questions of whether the Obama administration had yet to even request funding for the program or if it planned to do so.

The lack of movement has left some Medicaid advocates confused, since the program was the only ACO specifically authorized for Medicaid.

The American Academy of Pediatrics hailed the inclusion of the provision after enactment of the law and issued detailed guidance to regulators developing the new care delivery and financing model.

“There is risk in bundling the care of children and adults into one organizational structure,” the AAP guidance stated. “The ACO may overwhelmingly focus on the adult population with marginal attention to the needs of children.”

For now, it does not appear that such guidance is needed.

Follow Rich Daly on Twitter @MHRDaly.

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