The California HealthCare Foundation—in a report authored by Manatt Health—provides an overview of key policy and regulatory issues likely to arise as California policymakers consider the development of Accountable Care Organizations (ACOs) in the state. The paper discusses the Medicare Shared Savings Program Proposed Rule and the ACO Pioneer Program in the context of the California marketplace. It identifies past and current efforts to launch delivery system reforms with goals similar to the federal ACO initiatives. Additionally, the paper assesses how California's existing statutes and regulations may influence ACO development and the specific policy issues that will need to be addressed by lawmakers.