Program Guidance & Specifications
Find guidance and specifications pertaining to Accountable Care Organizations (ACOs) applying to and/or participating in the Shared Savings Program.
Application Guidance
The Application Toolkit provides quick access to guidance relevant to all application types. For more information about applying to the Shared Savings Program, refer to the Application Toolkit.
ACO Participant List and Participant Agreement Management Guidance
Participating ACOs may modify their ACO Participant List and associated agreements for the upcoming performance year during established timeframes. CMS strongly encourages applicants to submit sample ACO Participant Agreements for early feedback with their Notice of Intent to Apply (NOIA).
- ACO Participant List and Participant Agreement Guidance (Updated 4/10/2019) (PDF)
- Frequently asked questions about affiliating with an ACO as an “Other Entity (PDF),” instead of as an ACO participant
- Tip Sheets:
SNF Affiliate List and Agreement Management Guidance
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. CMS strongly encourages applicants to submit sample SNF Affiliate Agreements for early feedback with their NOIA.
Beneficiary Incentive Program Guidance
Participating ACOs approved to establish and operate a Beneficiary Incentive Program (BIP) may provide an incentive payment with a value of up to $20 to each assigned beneficiary for each qualifying primary care service received.
ACO Compliance Plan Guidance
To participate in the Shared Savings Program, each ACO must have a compliance plan in accordance with 42 CFR § 425.300.
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 fee-for-service (FFS) beneficiaries who have not declined to share their data.
- PY 2019 Shared Savings Program Report Templates (ZIP): CMS revises the format of the reports annually to account for changes in the program's regulations, and to incorporate ACOs' feedback on the reports including requests for additional data elements. Please check this file periodically for updates.
Electronic Funds Transfer Authorization Agreement
Participating ACOs must maintain a current Electronic Funds Transfer Authorization Agreement (Form CMS-588) to receive shared savings.
Repayment Mechanism Arrangements Guidance
ACOs that participate in a two-sided risk arrangement 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.
Annual Certification Guidance
The Shared Savings Program requires ACOs to review, certify, and electronically sign official program documents.
Financial and Beneficiary Assignment Specifications
Participating ACOs are encouraged to reference the program’s financial and beneficiary assignment specifications for detailed information on how the Shared Savings Program assigns beneficiaries to each ACO and calculates a historical financial benchmark from which to assess annual financial performance, and ultimately, eligibility for an earned shared savings payment.
- Shared Savings and Losses and Assignment Methodology Specifications Version 7 (PDF): incorporates the changes outlined in the Calendar Year (CY) 2019 Physician Fee Schedule Final Rule (83 FR 59452) that are applicable for Performance Year (PY) 2019 for ACOs participating as of January 1, 2019. A subsequent version will be released that includes updates based on the Pathways to Success Final Rule (83 FR 67816) for ACOs with agreement periods that begin on July 1, 2019.
- Shared Savings and Losses and Assignment Methodology Specifications Version 6 (PDF): incorporates the changes outlined in the CY 2018 Physician Fee Schedule Final Rule (82 FR 52976) and the Shared Savings Program Interim Final Rule for Extreme and Uncontrollable Circumstances (82 FR 60912) that are applicable for PY 2018.
- Shared Savings and Losses and Assignment Methodology Specifications Version 5 (PDF): incorporates the changes outlined in the Shared Savings Program June 2016 Final Rule (81 FR 37949) that are applicable for PY 2017.
- Shared Savings and Losses and Assignment Methodology Specifications Version 4 (PDF): incorporates the changes outlined in the Shared Savings Program June 2015 Final Rule (80 FR 32691) that are applicable for PY 2016.
- Shared Savings and Losses and Assignment Methodology Specifications Version 3 (PDF): documentation supporting prior years in the Shared Savings Program, applicable through PY 2015, as related to the Shared Savings Program November 2011 Final Rule (76 FR 67991).
Quality Measures & Reporting Specifications
Participating ACOs must report quality data to CMS after the close of every performance year to be eligible to share in any earned shared savings and to avoid sharing losses at the maximum level. CMS measures every ACO’s quality performance using standard methods. Quality measures span four domains: patient/caregiver experience, care coordination/patient safety, preventive health, and at-risk populations.
CMS has developed documents related to quality measures for the 2019 performance year.
- 2019 Measure Information Forms (ZIP): which describe in detail each administrative and claims-based measure
- Quality Measure Benchmarks 2019 performance year update (Updated 12/10/2019) (PDF): quality measure benchmarks updated to include only the 2019 performance year benchmarks
- 2019 Quality Measurement Methodology and Resources (PDF): reviews the quality performance standard and scoring methodology for ACOs participating in the Shared Savings Program and describes the Shared Savings Program’s quality measurement and reporting methodology.
- CMS Web Interface Measure Documentation Reference Guide for Performance Year 2019 (PDF): outlines the documentation requirements for each of the 2019 CMS Web Interface quality measures. It is intended to be used as a supplemental resource in conjunction with the 2019 Web Interface measure specifications posted in the online Quality Payment Program Library.
To learn more about quality measures for the 2018 performance year, refer to:
- 2018 Measure Information Forms (ZIP): which describe in detail each administrative and claims-based measure
- Quality Measure Benchmarks 2018 performance year (PDF) (Updated)
- 2018 Quality Measure Narrative Specifications (PDF): which describes the 31 quality measures for the 2018 performance year
- CAHPS for ACOs Survey website
Prior Years Quality Documentation
- 2017 ACO Quality Reporting Documentation (ZIP)
- 2016 ACO Quality Reporting Documentation (ZIP)
- 2015 ACO Quality Reporting Documentation (ZIP)
- 2014 ACO Quality Reporting Documentation (ZIP)
- 2013 ACO Quality Reporting Documentation (ZIP)
- 2012 ACO Quality Reporting Documentation (ZIP)
Quality Measurement Performance Program Interactions Guidance
Supplemental Quality Reporting Documentation
For more information on quality reporting requirements, reference:
- Medicare Shared Savings Program & Quality Payment Program Interactions for Performance Years during 2019: provides an overview of the interactions between the Quality Payment Program and the Shared Savings Program for performance years during 2019.
- Performance Year 2018 Medicare Shared Savings Program & Merit-based Incentive Payment System (MIPS) Interactions: provides an overview of the interaction between MIPS and the Shared Savings Program for Performance Year 2018.
- Interaction with Other Medicare Initiatives: provides an overview of how the Quality Payment Program and other CMS Innovation Center initiatives intersect with the Shared Savings Program.
- Quality Payment Program Resource Library: presents Quality Payment Program resources, including fact sheets describing the interaction between the Shared Savings Program and the Quality Payment Program.
Primary Service Area Calculation
CMS makes data available to applicants to allow them to calculate their share of services in each applicable primary service area as described by the Antitrust Enforcement Policy.
Requesting Technical Assistance and Reconsideration Review Guidance
ACOs may request an appeal of an initial determination by CMS in limited circumstances.