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Program Statutes & Regulations

Find statutes and regulatory documents describing the establishment and further modifications to the Shared Savings Program through stand-alone rules and sections within the annual Physician Fee Schedule (PFS) rules. For the complete and up-to-date Shared Savings Program regulations, see the eCFR.

Statutory Basis

Congress enacted the Patient Protection and Affordable Care Act (Pub.L. 111-148) on March 23, 2010. Section 3022 of the Affordable Care Act amended Section 1899 of the Social Security Act and established the Shared Savings Program. To learn more, see the Affordable Care Act and Social Security Act.

 

Shared Savings Program Interim Final Rule for Extreme and Uncontrollable Circumstances December 21, 2017

CMS displayed an interim final rule with comment period (IFC) that established policies for assessing the quality and financial performance of Shared Savings Program Accountable Care Organizations (ACOs) affected by extreme and uncontrollable circumstances, such as Hurricanes Harvey, Irma, Maria, and the California wildfires, during Performance Year (PY) 2017. The IFC includes the following:

  • CMS will use the same determination of an extreme and uncontrollable circumstance as determined under the Quality Payment Program, including the identification of affected geographic areas.
  • ACOs with 20 percent or more of their assigned beneficiaries who reside in impacted counties, or an ACO legal entity located in impacted counties, will receive the higher of their ACO reported quality score or the mean Shared Savings Program ACO quality score.
  • Performance-based risk ACOs will have any owed losses adjusted for the percent of the ACO’s assigned beneficiaries residing in impacted counties and the length of the emergency declaration.

To learn more, see Federal Register December 2017 IFC.

Please note, the comment period closed on February 20, 2018 at 5:00 p.m. Eastern Time (ET).

Physician Fee Schedule Final Rule November 2, 2017

The PFS final rule published in November 2017 includes the following:

  • Modifications to the Shared Savings Program beneficiary assignment methodology for performance year 2019 and subsequent years.
  • Revisions to ACO quality reporting.
  • Skilled Nursing Facility (SNF) 3-Day Rule Waiver Application requirement that ACOs report their financial relationships and modifications to the Shared Savings Program Initial Application.
  • Addressing compliance with ACO participant taxpayer identification number (TIN) exclusivity requirement.
  • Treatment of individually beneficiary-identifiable payments made under a demonstration, pilot, or time limited program.

To learn more, see Details for Calendar Year (CY) 2018 Physician Fee Schedule Final Rule.

Proposed Rule July 13, 2017

To learn more, see Details for Proposed CY 2018 Revisions to Payment Policies Under PFS.

Physician Fee Schedule Final Rule November 2, 2016

The PFS final rule published in November 2016 included the following:

  • Revisions permitting eligible professionals in ACOs to report quality apart from the ACO including during the 2016 Physician Quality Reporting System (PQRS) special reporting period for eligible professionals.
  • Modifications to the assignment algorithm to align beneficiaries to an ACO when a beneficiary has designated an ACO professional as responsible for their overall care.

To learn more, see Details for CY 2017 Revisions to Payment Policies Under PFS.

Proposed Rule July 7, 2016

To learn more, see Details for Proposed CY 2017 Revisions to Payment Policies Under PFS.

Shared Savings Program Final Rule June 6, 2016

The new final rule published in June 2016 included the following:

  • Revisions to the approach for resetting (or rebasing) an ACO's benchmark for a second or subsequent agreement period beginning on or after January 1, 2017 to take into account regional fee-for-service (FFS) expenditures.
  • Revisions to the methodology for national FFS calculations to use assignable Medicare FFS beneficiaries (a subset of the broader FFS population) instead of all FFS beneficiaries.
  • Addition of an option for ACOs participating under Track 1 to apply to renew for a second agreement period under a two-sided model (Track 2 or Track 3). If the ACO’s renewal request is approved, the ACO may request that its initial participation agreement under Track 1 be extended for an additional year (that is, the ACO would enter a fourth performance year under Track 1).

To learn more, see:

Proposed Rule January 28, 2016

To learn more, see Federal Register January 2016 Proposed Rule.

Physician Fee Schedule Final Rule October 30, 2015

The PFS final rule published in October 2015 included the following:

  • Clarifying how PQRS-eligible professionals participating within an ACO meet their PQRS reporting requirements when their ACO satisfactorily reports quality.
  • Amending the definition of primary care services to include claims submitted by Electing Teaching Amendment (ETA) hospitals and exclude claims submitted by SNFs when the claim contains the place-of-service 31 modifier.

To learn more, see Details for CY 2016 Revisions to Payment Policies Under PFS.

Proposed Rule July 8, 2015

To learn more, see Details for Proposed CY 2016 Revisions to Payment Policies Under PFS.

Shared Savings Program Final Rule June 9, 2015

The final rule improves several program areas including:

  • Creates a new performance-based risk option (Track 3) that includes prospective beneficiary assignment, a higher sharing rate, and the opportunity to use new care coordination tools.
  • Permits ACOs to participate in one additional 3-year agreement period under Track 1 and maintain the same maximum sharing rate applicable in their first agreement period.
  • Establishes a waiver of the 3-day stay SNF rule for beneficiaries that are prospectively assigned to ACOs under Track 3.
  • Streamlines the process for ACOs to access Medicare beneficiary claims data necessary for health care operations, while retaining the opportunity for beneficiaries to decline to have their claims data shared with the ACO.
  • Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings, and announces CMS’ intent to propose further improvements to the benchmarking methodology later this year.
  • Revises the assignment methodology to remove certain specialty types whose services are not likely to indicate the provision of primary care services. Includes primary care services furnished by nurse practitioners, physician assistants, and clinical nurse specialists.

To learn more, see:

Proposed Rule December 8, 2014

To learn more, see Federal Register December 2014 Proposed Rule.

Shared Savings Program Final Rule November 2, 2011

To learn more, see Federal Register November 2011 Final Rule.

Proposed Rule April 7, 2011

To learn more, see Federal Register April 2011 Proposed Rule.

 

Other Regulations

To learn more about other applicable regulations, refer to the resources below:

 

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