Program Guidance & Specifications
Find guidance and specifications pertaining to Accountable Care Organizations (ACOs) applying to and/or participating in the Shared Savings Program.
The Application Toolkit provides quick access to guidance and templates relevant to all application types. For more information about applying to the Shared Savings Program, refer to the Application Toolkit.
ACOs may request an appeal of an initial determination by CMS in limited circumstances.
Participating ACOs may modify their ACO Participant List and associated agreements for the upcoming performance year during established timeframes.
- ACO Participant List and Participant Agreement Guidance (Updated 7/3/2018)
- Frequently asked questions about affiliating with an ACO as an “Other Entity,” instead of as an ACO participant.
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.
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 2018 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.
Participating ACOs must maintain a current Electronic Funds Transfer Authorization Agreement (Form CMS-588) to receive shared savings.
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.
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 6: incorporates the changes outlined in the Shared Savings Program that are applicable for Performance Year (PY) 2018 and onward.
- Shared Savings and Losses and Assignment Methodology Specifications Version 5: incorporates the changes outlined in the Shared Savings Program 2016 Final Rule that are applicable for PY 2017.
- Shared Savings and Losses and Assignment Methodology Specifications Version 4: incorporates the changes outlined in the 2015 Final Rule applicable to PY 2016.
- Shared Savings and Losses and Assignment Methodology Specifications Version 3: Documentation supporting prior years in the Shared Savings Program, applicable through PY 2015.
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.
- 2018 Measure Information Forms: which describe in detail each administrative and claim based measure
- Quality Measure Benchmarks for the 2018 and 2019 Reporting Years
- 2018 Quality Measure Narrative Specifications: which describes the 31 quality measures for PY 2018
- CAHPS for ACOs Survey website
Prior Years Quality Documentation
- 2017 ACO Quality Reporting Documentation
- 2016 ACO Quality Reporting Documentation
- 2015 ACO Quality Reporting Documentation
- 2014 ACO Quality Reporting Documentation
- 2013 ACO Quality Reporting Documentation
- 2012 ACO Quality Reporting Documentation
Supplemental Quality Reporting Documentation
For more information on quality reporting requirements, reference:
- 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.
- 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.
- Performance Year 2017 Medicare Shared Savings Program & MIPS Interactions: provides an overview of the interaction between MIPS and the Shared Savings Program for Performance Year 2017.
- 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.
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.
- Page last Modified: 08/29/2018 12:27 PM
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