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).

 

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.

 

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.

To learn more about quality measures for the 2018 performance year, refer to:

Prior Years Quality Documentation

 

Quality Measurement Performance Program Interactions Guidance

Supplemental Quality Reporting Documentation

For more information on quality reporting requirements, reference:

 

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.

  

 

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Page Last Modified:
12/11/2019 01:35 PM