The GMCB's oversight of Accountable Care Organizations (ACOs) consists of 1) certification and 2) annual budget review. These regulatory processes include a review of: programs and investments to facilitate the shift to value-based care; investments in health improvement activities; tools and analytics to support providers and improve health care quality and reduce unnecessary costs; ACO administrative costs; and the alignment of ACO strategies with Vermont’s All-Payer Model goals.
There are two types of ACOs that the GMCB will oversee in FY25:
Materials for Certified ACOs
ACOs in Vermont that accept payments from Medicaid or Commercial insurance must be certified in addition to undergoing budget review. Currently, there is only one ACO in Vermont that meets this criteria (OneCare Vermont).
Certification Eligibility Verification Form
- Forms will be posted here when finalized
Certified ACO Budget Guidance
- Guidance will be posted here when finalized
Materials for Medicare-Only ACOs
ACOs that plan to only accept payments from Medicare do not need to undergo certification. The budget review process depends on the ACO's size. Currently, the only Medicare-Only ACO in Vermont has fewer than 10,000 lives.
Medicare-Only ACO Guidance
- Guidance will be posted here when finalized