Program Guidance & Specifications

Find guidance and specifications pertaining to Accountable Care Organizations (ACOs) applying to and/or participating in the Medicare Shared Savings Program (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 Guidance

Participating ACOs may modify their ACO Participant List and associated agreements for the upcoming performance year during established timeframes. 

SNF 3-Day Rule Waiver 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.

ACO Banking Form Instructions

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. The Centers for Medicare & Medicaid Services (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 2021 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.

Table: Shared Savings and Losses and Assignment Methodology Specifications, Crosswalk between Methodology & Resources

Policies to Address the Public Health Emergency for COVID-19

Benchmarking Methodology

Assignment Methodology and Financial Reconciliation Calculations for PY 2021 onward

Refer to Specifications of Policies to Address the Public Health Emergency for COVID-19 (PDF)

  • Version 9 (PDF) describes methodology applicable to ACOs with agreement periods beginning on July 1, 2019, and in subsequent years.
  • Version 7 (PDF) describes methodology applicable to ACOs with agreement periods beginning on January 1, 2018 or January 1, 2019.

Refer to Version 9 (PDF)

 

Shared Savings and Losses and Assignment Methodology Specifications Version 6

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

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

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

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 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 the Shared Savings Program quality measurement for PY 2020, refer to: 

To learn more about the Shared Savings Program quality measurement for PY 2019, 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.

  

Back to Top

Page Last Modified:
04/30/2021 10:20 AM