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Application Toolkit

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

Note that this is the 2017 Application Toolkit for the 2018 application cycle. We will update this page in the spring of 2018 for the 2019 application cycle.

Application Reference Manual

The Application Reference Manual is the primary resource for ACOs applying to the Shared Savings Program, to the Medicare ACO Track 1+ Model (Track 1+ Model), and/or for a Skilled Nursing Facility (SNF) 3-Day Rule Waiver. This document guides ACOs through the application process for the January 1, 2018 program start date and includes detailed instructions for responding to each application question, managing ACO-specific information in CMS systems, and responding to requests for information (RFIs). The Application Reference Manual provides access to all guidance and templates referenced below.

 

Application Guidance and Templates

In addition to completing the application questions, applicants must also provide supporting documentation as part of the application process. The guidance and template 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 should include a beneficiary representative. Initial and renewal applicants must submit a completed Governing Body Template, 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, and upload an executed ACO Participant Agreement for each submitted ACO participant. Additionally, initial and renewal applicants must also complete and submit the ACO Participant Agreement Crosswalk to demonstrate that their sample ACO Participant Agreement(s) complies with Shared Savings Program requirements.

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 business name, address, TIN, financial institution information, authorized/delegated official, or Form contact.

Repayment Mechanism

Required for ACOs applying to Track 2, Track 3, or the Track 1+ Model

ACOs applying to a two-sided risk arrangement (Track 2, Track 3, or the Track 1+ 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 with their application by the application deadline. Applicants will receive separate Repayment Mechanism Requests for Information (RM RFIs) during the application process.

SNF Affiliate List and SNF Affiliate Agreement

Required for ACOs applying to the SNF 3-Day Rule Waiver (for Track 3 and Track 1+ Model ACOs)

SNF 3-Day Rule Waiver applicants must submit a list of SNF affiliates, upload a sample SNF Affiliate Agreement, and upload an executed SNF Affiliate Agreement for each submitted SNF affiliate. SNF 3-Day Rule Waiver applicants must also complete and submit the SNF Affiliate Agreement Crosswalk to demonstrate that their sample SNF Affiliate Agreement(s) complies with Shared Savings Program requirements.

 

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