Medicare Shared Savings Program Toolkit
What is the Medicare Shared Savings Program?
Application Key Dates
How to Start the Application Process
How to Complete the Application
Forms, Templates & Supporting Documentation
How to Complete the ACO Participant List Template
How to Complete the Governing Body Template
How to Complete the ACO Participant Agreement Template
Requests for Additional Information
Request to Withdraw a Pending Application
Application Determination Reconsideration Review Process
Who to Contact for Assistance
Helpful Links and Additional Information
The Medicare Shared Savings Program (Shared Savings Program) facilitates coordination and cooperation among healthcare providers to improve the quality of care for Medicare fee-for-service (FFS) beneficiaries. Eligible providers and suppliers may participate in the Shared Savings Program by creating or participating in an accountable care organization (ACO.) The Shared Savings Program rewards ACOs that lower their rate of growth in health care costs while meeting quality performance standards.
Complete this application to be considered for participation in the Shared Savings Program. Throughout this document, we refer to applicant as “Applicant,” “you,” or “ACO”. We refer to the Centers for Medicare & Medicaid Services as “CMS,” “us” or “we.”
At any time before or after the start of the agreement period, we may verify that you are eligible and in compliance with Medicare requirements by conducting onsite visits to your ACO facilities or through other program monitoring techniques. If you do not meet the requirements in this application or if you do not operate the ACO consistent with the applicable statute, regulations or terms of the ACO agreement, you could be denied entry or removed from the Shared Savings Program.
It’s important that you review the regulations at 42 CFR Part 425 and the guidance available on our Web site. These offer more information about the nature of the ACO requirements. They will help you in giving appropriate responses.
Nothing in this application is intended to supersede either the statute or the regulations. You are required to comply with all applicable requirements of the statute and regulations, even if we have not referenced a statutory or regulatory requirement in this application. Your responses to the questions in this application serve as an attestation as to whether or not you will comply with the rules and regulations of the Shared Savings Program as of the date of the agreement or an earlier where indicated.
You must submit your application by Wednesday, July 31 by 8:00 pm EST for the January 1, 2014 start date. We will not review applications we get after this date and time.
Below is the current timeline for the Shared Savings Program application review process. Dates are subject to change, so check the Shared Savings Program Web site frequently for updates.
|Applications posted on CMS Web site||June 2013|
|NOIs accepted||CLOSED for Program Year 2014|
|CMS User ID forms accepted||May 3, 2013-June 10, 2013 (CLOSED for Program Year 2014)|
|Applications accepted||July 1, 2013 – July 31, 2013 (CLOSED for Program Year 2014)|
|Application approval or denial decision||Fall 2013|
|Reconsideration review deadline*||Late Fall 2013|
* Date an organization must receive a favorable reconsideration review determination in order to qualify for the start date indicated on the application.
Step 1: Submit a Notice of Intent to Apply – Closed for Program Year 2014
Step 2: Get a CMS User ID to Submit Your Application - CLOSED for Program Year 2014
To submit your application, you need a CMS User ID to access the Health Plan Management System (HPMS.)
Submit Form CMS-20037 Application for Access to CMS Computer Systems for acceptance no later than June 10, 2013. Processing times vary due to volume.
Step 3: Complete Your Application - CLOSED for Program Year 2014
Follow the link you got in your CMS User ID notice to fill out the application on the Health Plan Management System (HPMS), our on-line application system.
Your application is pre-populated with the information you gave us on your Notice of Intent to apply (NOI). If you find an error in any pre-populated information, send an email with the change request and correct information to SSPACO_Applications@cms.hhs.gov. In the subject line, include your ACO ID and the words “Request to Change Pre-populated Information.”
Use the MSSP Reference Table [PDF, 464KB] as a guide as you complete your application in HPMS. See 2014 Medicare Shared Savings Program Application Form for a copy of the application questions. Be sure to use the required templates, correct file format(s), and follow required naming conventions specified in the reference table.
All the documents you submit must clearly identify you as the ACO applicant with the identification number (ACO ID) you got with your Notice of Intent to Apply (NOI) acknowledgement e-mail.
Some questions require you to submit supporting documentation to us. Using file compression software such as WinZip, compress each section’s files together. Upload the compressed files in HPMS in their respective file upload locations. Supporting documentation is compressed and uploaded to the ‘Supporting Applications Materials’ location. Narratives can be inputted in the text boxes provided in the application through HPMS. ACO Participant List must be uploaded separate from other supporting documents in HPMS. Use the ACO Module User Guide in HPMS for help uploading supporting documents and the Participant List.
- Form CMS-588 (Electronic Funds Transfer (EFT) Authorization Agreement). See Form CMS 855 Tutorial, ACO Banking Form Guidance, Form CMS 588 ACO Cover Sheet and FAQs.
- ACO Participant List Template (updated 05/31/13) [ZIP, 5K]. For assistance, see How to complete Participant List Template (Revised 07/23/13) [PDF, 67KB] and FAQs.
- Governing Body Template (updated 05/31/13) [ZIP, 10KB]. For assistance, see How to complete Governing Body Template [PDF, 81KB] and FAQs .
- ACO Participation Agreement Template (updated 05/31/13) [ZIP, 9KB]. For assistance, see How to complete Participation Agreement Template [PDF, 84KB] and Helpful Tips for ACOs Developing Participant Agreements [PDF, 420KB] .
Use the ACO Participant List Template (updated 05/31/13) [ZIP, 5KB] to give us your ACO Participant List. See How to complete Participant List Template (Revised 07/23/13) [PDF, 67KB] for instructions on how to complete it. See also ACO Participant List FAQs.
Use the Governing Body Template (updated 05/31/13) [ZIP, 10KB] to tell us about your Governing Body. All fields relate to the members on the Governing Body. Do not leave any fields blank.
See How to complete Governing Body Template [PDF, 81KB] for instructions on how to complete it. See also Governing Body FAQs.
Use the ACO Participant Agreement Template to tell us about your agreements with your ACO participants.
See How to complete your ACO Participant Agreement Template for instructions on how to complete it. For additional guidance, see Helpful Tips for ACOs Developing Participant Agreements [PDF, 420KB] , and Additional Guidance for Medicare Shared Savings Program Accountable Care Organization (ACO) Applications [PDF, 113KB]. See also ACO Participate FAQs.
While we review your application or anytime during your agreement period, we may ask you to submit additional information to support the statements you made on this application. You will get a formal request for information with instructions on how to send us your documents. We must get the requested information by the date specified on the CMS notice. We consider the date of submission as the actual date we get the information, and not the postmarked date on the submission.
To withdraw a pending application, you must submit a written request to that effect on your organization’s letterhead, signed by the authorized official, before the date approved ACO agreements are due back to CMS. Your letter must include:
- Your organization’s legal entity name
- ACO ID
- Complete address
- Point of contact information
- Exact description of the nature of the withdrawal
Send the request as a PDF to SSPACO_Applications@cms.hhs.gov. Put your ACO ID and the words ‘Withdrawal Request’ in the subject line of the e-mail.
If we determine that you don’t meet the requirements to enter into a Shared Savings Program agreement and we deny your application, you have the right to request a reconsideration review. Check your denial letter for details on how to request a reconsideration review. Administrative reconsiderations of the denial of an ACO application are governed by the regulations at 42 CFR Part 425, Subpart I.
To be eligible to begin participation on the requested start date, you must get a favorable determination from the reconsideration review or from the on-the-record review by the date noted in the Application Key Dates table.
For questions about the NOI, application, CMS User IDs, or Form CMS-20037: SSPACO_Applications@cms.hhs.gov or (410) 786-8084.
For problems logging in HPMS or about your CMS User ID: HPMS_Access@cms.hhs.gov or (800) 220-2028
For problems using HPMS and technical assistance: HPMS@cms.hhs.gov or (800) 220-2028
- Page last Modified: 08/02/2013 11:43 AM
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