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On March 31, 2011, the Department of Health and Human Services, Centers for Medicare & Medicaid Services ("CMS"), issued a Notice of Proposed Rulemaking1 implementing section 3022 of the Affordable Care Act.2 These comprehensive proposed rules have been eagerly anticipated by healthcare organizations and advisors. The new "Medicare Shared Savings Program" ("MSSP") is designed to promote accountability for a patient population by establishing criteria for groups of professionals and health practices to enable them to set up accountable care organizations ("ACO"). These organizations are to promote accountability and provide an infrastructure to coordinate patient care with a goal of increasing overall quality performance. Any savings from streamlined care will be shared among the members of the ACO. While it is anticipated that each ACO will be a unique legal entity, included among the members of many ACOs will necessarily be healthcare organizations exempt from tax under section 501(c)(3) of the Internal Revenue Code.

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