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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 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.


Requesting Technical Assistance and 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 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.


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.

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.


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