Application Toolkit

The application submission period for a January 1, 2020 start date is now closed. The Application Toolkit, including the Application Reference Manual and the various guidance documents, will be updated for the January 1, 2021 application submission. The Application Toolkit for the January 1, 2020 application submission is for informational purposes only.

The Application Toolkit provides quick access to guidance relevant to all application types.

Application Reference Manual for a January 1, 2020 Start Date

The Application Reference Manual is the primary resource for ACOs applying to the Shared Savings Program and guides ACOs through the application process.

In addition to the Application Reference Manual, applicants are encouraged to reference the below resources when applying to the Shared Savings Program. The resources will assist ACOs with submitting their application(s) and responding to requests for information (RFIs) in the ACO Management System (ACO-MS).  

(PDF) ACO Management System Resources for ACOs Completing the Initial Application (PDF): Intended to assist initial and re-entering applicants with navigating ACO-MS, from setting up access to completing the application. 
(PDF) Initial Application Checklist (Updated 4/10/2019) (PDF): Intended to guide ACOs through the process of submitting their Initial Application. 
(PDF) Renewal/Early Renewal Application Checklist (Updated 4/10/2019) (PDF): Intended to guide ACOs through the process of submitting their Renewal/Early Renewal Application.
(PDF) SNF 3-Day Rule Waiver Application Checklist (Updated 4/10/2019) (PDF): Intended to guide ACOs through the process of submitting their SNF 3-Day Rule Waiver Application.
(PDF) Application RFI Tip Sheet (Updated 8/15/2019) (PDF): Intended to assist applicants with responding to RFIs in ACO-MS.

Application Guidance for a January 1, 2020 Start Date

In addition to completing the application questions, applicants must also provide supporting documentation as part of the application process. The guidance documents referenced below can be used to help prepare the required supporting documentation.

 ACO Governing Body

Required for initial and renewal applicants

An ACO must have a governing body with authority to execute the functions of the ACO. The governing body must include a beneficiary representative or the ACO must describe how it will provide for meaningful representation of beneficiaries in ACO governance. Initial and renewal applicants must complete the Governing Body Table in ACO-MS as part of the application, which identifies members of the governing body and their roles. 

ACO Participant List and Participant Agreement

Required for initial and renewal applicants

Initial and renewal applicants must submit a list of ACO participant taxpayer identification numbers (TINs), upload a sample ACO Participant Agreement(s), and upload an executed ACO Participant Agreement for each submitted ACO participant. Additionally, initial and renewal applicants must also complete the ACO Participant Agreement Table in ACO-MS as part of the application to demonstrate that their sample ACO Participant Agreement(s) complies with Shared Savings Program requirements. CMS strongly encourages applicants to submit sample ACO Participant Agreements for early feedback with their Notice of Intent to Apply (NOIA).

Electronic Funds Transfer Authorization Agreement

Required for initial and renewal applicants

Initial applicants must submit Form CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement to CMS that accurately reflects organizational information. Renewal applicants only need to submit an updated EFT Authorization Agreement if any of the following ACO information has changed: legal entity name, address, TIN, financial institution information, authorized/delegated official, or Form contact.

 Repayment Mechanism

Required for ACOs participating in a two-sided risk model

ACOs participating in or applying to a two-sided risk model must have the ability to repay all shared losses for which they may be liable. CMS strongly encourages applicants to submit preliminary repayment mechanism documentation for early feedback with their NOIA. 

SNF Affiliate List and SNF Affiliate Agreement

Required for ACOs applying for a SNF 3-Day Rule Waiver 

SNF 3-Day Rule Waiver applicants must submit a list of SNF affiliates, upload a sample SNF Affiliate Agreement(s), and upload an executed SNF Affiliate Agreement for each submitted SNF affiliate. SNF 3-Day Rule Waiver applicants must also complete the SNF Affiliate Agreement Table in ACO-MS as part of the application to demonstrate that their sample SNF Affiliate Agreement(s) complies with Shared Savings Program requirements. CMS strongly encourages applicants to submit sample SNF Affiliate Agreements for early feedback with their NOIA.

Beneficiary Incentive Program

Required for ACOs applying to establish and operate a Beneficiary Incentive Program (BIP)

BIP applicants must certify that the ACO will operate its BIP in accordance with all applicable laws and public reporting requirements. BIP applicants must also describe in writing the nature of the ACO’s proposed BIP and how, if approved, the ACO will implement it.

Annual Certification

Required for all ACOs prior to the start of the upcoming performance year and at the end of each performance year (as applicable)

The Shared Savings Program requires ACOs to review, certify, and electronically sign official program documents.

 

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Page Last Modified:
11/22/2019 08:09 PM