Program Participation

Find information on program methodologies and participation requirements to prepare for each performance year, comply with requirements during the performance year, and report on performance after the close of the year. For all guidance related to program participation, refer to Program Guidance & Specifications.

Preparing for the Performance Year

ACO Participant List and Participant Agreement Management

ACOs participating in the Shared Savings Program may modify their ACO Participant List and associated agreements for the upcoming performance year during established timeframes.

SNF Affiliate List and Agreement Management

Participating ACOs approved for a Skilled Nursing Facility (SNF) 3-Day Rule Waiver may modify their SNF Affiliate List and associated agreements for the upcoming performance year during established timeframes.

Annual Certification

On an annual basis, the Shared Savings Program requires ACOs to review, certify, and electronically sign official program documents. Prior to the start of the upcoming performance year, ACOs must complete the Annual Certification process.

What to Expect During the Performance Year

Beneficiary Notification and Marketing

Beginning July 1, 2019, an ACO or ACO participant provides each beneficiary with a standardized written notice before or at the first primary care visit of the performance year in the form and manner specified by CMS. In addition, an ACO participant posts signs in its facilities and in settings where beneficiaries receive primary care services, making standardized written notices available upon request. The notification must include information about the following:

  1. That the ACO's providers/suppliers are participating in the Shared Savings Program;
  2. The beneficiary’s option to decline claims data sharing; and
  3. The beneficiary’s ability to, and the process by which, he or she may identify or change the person he or she chose for the purposes of voluntary alignment.

In addition, if an ACO operates a Beneficiary Incentive Program (BIP), the ACO or its ACO participants must also notify Medicare fee-for-service (FFS) beneficiaries that it is operating a BIP.

CMS provides ACOs in the program with guidelines for marketing the Shared Savings Program to beneficiaries.

Beneficiary Assignment

Beneficiary assignment contributes to key program operations, such as calculating the ACO’s financial benchmark, assessing the ACO’s financial performance after the close of each performance year, and determining the ACO’s sample of beneficiaries for quality reporting.

For more information on assignment, refer to Program Guidance & Specifications.

Data and Report Sharing

CMS provides ACOs with information on their assigned population and financial performance at the start of the agreement period and routinely during the performance year. ACOs must request to receive monthly Claim and Claim Line Feed (CCLF) files on Medicare FFS beneficiaries who have not declined to share their data.

For more information on data and report sharing, refer to Program Guidance & Specifications.

Electronic Funds Transfer Authorization Agreement

Participating ACOs must maintain a current Electronic Funds Transfer Authorization Agreement (Form CMS-588) to receive shared savings.

Public Reporting

The Shared Savings Program requires ACOs to create and maintain a dedicated webpage to publicly report required organizational and programmatic information, such as organizational contact information and performance results. CMS provides instructions to ACOs ahead of each public reporting cycle.

Compliance Monitoring

Throughout the year, the Shared Savings Program expects ACOs to comply with program requirements. Each ACO must have a designated compliance official and a detailed compliance plan.

Ongoing Communication with CMS

CMS regularly hosts webinars, shares program updates, and makes written materials available so that participating ACOs are up-to-date with program activities.

Post-Performance Year Activities

Quality Reporting and Measurement

Shared Savings Program ACOs must demonstrate that they meet the quality performance standards for each performance year before they can share in any earned savings.

For more information on quality, refer to Program Guidance & Specifications.

Financial Reconciliation

ACOs are rewarded when they lower growth in Medicare Parts A and B expenditures (relative to their benchmark) while meeting quality performance standards at the same time. Performance year financial reconciliation occurs annually after CMS assesses quality performance.

CMS adjudicates any earned shared savings payments or incurred losses in the fall following each performance year.

For more information on financial reconciliation, refer to Program Guidance & Specifications.

 

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Page Last Modified:
05/08/2019 11:30 AM