ACO Name and Location

Prospect Health Services PA, Inc.
Crozer ACO 
175 East Chester Pike 
Suite 1101 
Ridley Park, PA 19078

About our ACO:

The Centers for Medicare & Medicaid Services (CMS) has announced its commitment to achieve better care for individuals, better health for populations, and reduced expenditures. For those reasons, CMS is partnering with health care providers who agree to accept joint responsibility for the cost and quality of care outcomes for Medicare beneficiaries through Accountable Care Organizations (ACOs).

An ACO is a group of doctors, hospitals, and other healthcare providers who come together voluntarily to coordinate high-quality care for Medicare patients, like you, to better meet their individual needs and preferences. Coordinated care helps patients get the right care at the right time, while avoiding unnecessary duplication of services.

For beneficiaries enrolled in the original Medicare program, relationships with ACO providers will NOT limit available benefits, and beneficiaries will still have the right to use any doctor or hospital that accepts Medicare, at any time. Participants in the Crozer ACO have additional benefits available to them at no additional cost, including:

• Three-day Skilled Nursing Facility (SNF) Rule Waiver: Under current Medicare law, Medicare only covers care in a SNF if a patient has a prior three-day inpatient hospital stay. This new feature may allow you to get Medicare-covered SNF services at a participating SNF without a mandatory three-day inpatient hospital stay. For a list of participating SNFs, please click SNF three-day waiver providers below.

If you have any questions about the Crozer ACO or the government’s Medicare Shared Savings Program please contact us; your local State Health Insurance Assistance Program (SHIP); or Medicare 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048 or 711. You can also get more information online at the websites below:

• Centers for Medicare & Medicaid Services 
• Medicare Shared Savings Program
• State Health Insurance Assistance Program (SHIP) 

For previous years' financial and quality performance results, please visit data.cms.gov.

Payment Rule Waivers

• Skilled Nursing Facility (SNF) 3-day Rule Waiver:
  • Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR § 425.61C2.
• Waiver for Payment for Telehealth Services:
  • Our ACO clinicians provide telehealth services using the flexibilities under 42 CFR § 425.612(f) and 42 CFR § 425.613.

Fraud and Abuse Waivers

ACO Pre-Participation Waiver

The following information describes each arrangement for which our ACO seeks protection under the ACO Pre-Participation Waiver, including any material amendment or modification to a disclosed arrangement.

• Parties to the arrangement: N/A
• Date of arrangement: N/A
• Items, services, goods, or facility provided: N/A
• Date and nature of any amendments to the arrangement, if applicable: N/A

ACO Participation Waiver

The following information describes each arrangement for which our ACO seeks protection under the ACO Participation Waiver, including any material amendment or modification to a disclosed arrangement. 

• Parties to the arrangement: N/A 
• Date of arrangement: N/A
• Items, services, goods, or facility provided: N/A 
• Date and nature of any amendments to the arrangement, if applicable: N/A