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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 cycle for a January 1, 2018, start date is closed. The next opportunity to submit an application to the Shared Savings Program, the Medicare ACO Track 1+ Model (Track 1+ Model), and/or for a Skilled Nursing Facility (SNF) 3-Day Rule Waiver will be in the summer of 2018 for a January 1, 2019, program start date.

For ACOs interested in applying to the Shared Savings Program, see the Application Toolkit.

 

Requesting a Reconsideration Review Guidance

ACOs may request an appeal of an initial determination by CMS in limited circumstances.

 

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 SNF 3-Day Rule Waiver may modify their SNF Affiliate List and associated agreements for the upcoming performance year during established timeframes.

  

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 Claims and Claims Line Feed Files (CCLFs) on Medicare fee-for-service (FFS) beneficiaries who have not declined to share their data.

  • PY 2017 Shared Savings Program Report Templates: 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 (Track 2, Track 3, or the Track 1+ Model) must have the ability to repay all shared losses for which they may be liable.

 

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. 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 PY 2018.

 

To learn more about quality measures for PY 2017, see:

Prior Years Quality Documentation

 

Quality Measurement Performance Program Interactions Guidance

Supplemental Quality Reporting Documentation

For more information on quality reporting requirements, see:

  • 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 official resources to prepare for the Quality Payment Program, including fact sheets describing the interaction between the Shared Savings Program and the Quality Payment Program.
  • Interaction with the 2017 Value Modifier FAQs: provides an overview of the interaction of the Shared Savings Program and the value modifier (VM), including how the VM will be calculated for ACO participants and how to obtain Quality and Resource Use Reports (QRURs).
  • Interaction with Physician Quality Reporting System (PQRS) FAQs: describes the applicability of the PQRS downward payment adjustment based on CMS web interface quality measures and includes answers to frequently asked questions about the interaction and timing between the Shared Savings Program and the traditional PQRS.

 

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.

 

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