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. 

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. 

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.

Electronic Funds Transfer Authorization Agreement Guidance

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

Repayment Mechanism Arrangements Guidance

ACOs electing to participate in two-sided risk must have the ability to pay all shared losses for which they may be liable. CMS strongly encourages applicants to submit preliminary repayment mechanism documentation in Microsoft Word format for feedback. 

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 2020 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.

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.

  • Please reference the interim final rule with comment period that published in the Federal Register (85 FR 27550, 27573-27587) on May 8, 2020, and refer to the Code of Federal Regulations, for program policies addressing the impact of COVID-19 on Shared Savings Program ACOs:  
    • Clarifying the applicability of the program’s extreme and uncontrollable circumstances policy to mitigate shared losses for the period of the COVID-19 public health emergency (PHE), beginning in January 2020 and continuing to the end of the PHE as defined in §400.200 (85 FR 27576 & 27577): §§ 425.605(f), 425.606(i), 425.610(i).
    • Adjusting program calculations to remove all Parts A and B fee-for-service payment amounts for episodes of care for treatment of COVID-19, triggered by an inpatient service (85 FR 27577 - 27582): § 425.611.
    • Expanding the definition of primary care services to include codes for online digital evaluation and management services, telephone evaluation and management services, remote evaluation of patient video/images, and virtual check-in for use in determining beneficiary assignment for the performance year starting on January 1, 2020, and for any subsequent performance year that starts during the COVID-19 PHE defined in §400.200 (85 FR 27582 - 27586): § 425.400.

Quality Resources and Information

Quality Measurement

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.

To learn more about Medicare Shared Savings Program quality measurement for the 2020 performance year, refer to: 

To learn more about Medicare Shared Savings Program quality measurement for the 2019 performance year, refer to: 

Prior Years Quality Documentation

Quality Measurement Performance Program Interactions Resources 

For more information on interactions between the Shared Savings Program and other CMS initiatives, please 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:
09/22/2020 03:01 PM