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
- ACO Participant List and Participant Agreement Guidance
- SNF 3-Day Rule Waiver Guidance
- Beneficiary Incentive Program Guidance
- ACO Banking Form Instructions
- Repayment Mechanism Arrangements Guidance
- ACO Compliance Plan Guidance
- Data and Report Sharing
- Financial and Beneficiary Assignment Specifications
- Quality Resources and Information
- Primary Service Area Calculation
- Requesting Technical Assistance and Reconsideration Review Guidance
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.
- ACO Participant List and Participant Agreement Guidance (Updated 6/01/2022) (PDF)
- Frequently asked questions about affiliating with an ACO as an “Other Entity (PDF),” instead of as an ACO participant
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.
- Repayment Mechanism Arrangements Guidance (Updated 6/01/2022) (PDF)
- Appendix A: Escrow Agreement Template (Updated 6/01/2022) (PDF)
- Appendix B: Escrow Agreement Amendment Sample (Updated 5/10/2021 (DOCX)
- Appendix C: Letter of Credit Sample (Updated 5/10/2021) (DOCX)
- Appendix D: Surety Bond Sample (Updated 5/10/2021) (DOCX)
- Appendix E: Repayment Mechanism Documentation Cover Sheet (Updated 5/10/2021) (DOCX)
- Appendix F: ACO-Initiated Request to Edit Repayment Mechanism Task in ACO-MS (Updated 06/01/2022) (DOCX)
- Appendix G: Repayment Mechanism Checklist (Updated 06/01/2022) (PDF)
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/PY 2022 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.
- Claim and Claim Line Feed Information Packet v36 (PDF): The purpose of this Information Packet (IP) is to describe the content and basic operations of the Claim and Claim Line Feed (CCLF) files sent to ACOs participating in the Shared Savings Program. Additionally, this document provides file layouts, variable definitions, and instructions for CCLF files.
- Medicare Shared Savings Program Uses and Limitations of The Claim and Claim Line Feed User Guide v4 (PDF): The purpose of this document is to provide ways that ACOs can use the CCLF data files to help better coordinate patient care and describes limitations in comparability of CCLFs to other reports and data sources.
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.
Current Years Shared Savings and Losses and Assignment Methodology Specifications
ACOs participating under agreement periods beginning prior to July 1, 2019, that will be reconciled for Performance Year (PY) 2021 should refer to the benchmarking methodology described in Version 7 (PDF) and assignment sections described in Version 9 (PDF). ACOs participating under agreement periods beginning on or after July 1, 2019 that will be reconciled for PY 2021 should refer to the benchmarking methodology and assignment sections described in Version 9 (PDF). All ACOs participating in PY 2022 should refer to Version 10 (PDF). For prior years information please reference the “Prior Years Shared Savings and Losses and Assignment Methodology Specifications” section further below.
- Shared Savings and Losses and Assignment Methodology, Specifications of Policies to Address the Public Health Emergency for COVID-19 (PDF): describes the changes and clarifications to Shared Savings Program policies, addressing the impact of the coronavirus disease 2019 (COVID-19) pandemic and the resulting PHE, that were finalized in the Calendar Year (CY) 2021 Physician Fee Schedule Final Rule (85 FR 84472).
- Shared Savings and Losses and Assignment Methodology Specifications Version 10 (PDF): incorporates changes to Shared Savings Program assignment policies outlined in the CY 2022 Physician Fee Schedule Final Rule (86 FR 65524) that are applicable for PY 2022.
- Shared Savings and Losses and Assignment Methodology Specifications Version 9 (PDF): incorporates changes to Shared Savings Program policies outlined in the CY 2021 Physician Fee Schedule Final Rule (85 FR 84472), including the beneficiary assignment methodology and the quality performance standard applicable for PYs beginning on January 1, 2021. Note: Version 9 of the Specifications is relevant to ACOs with agreement periods starting on or after July 1, 2019, except as otherwise noted.
- Shared Savings and Losses and Assignment Methodology Specifications Version 7 (PDF): incorporates the changes outlined in the CY 2019 Physician Fee Schedule Final Rule (83 FR 59452) that are applicable for PY 2019 for ACOs participating as of January 1, 2019.
Prior Years Shared Savings and Losses and Assignment Methodology Specifications
- Shared Savings and Losses and Assignment Methodology Specifications Version 8 (PDF)
- Shared Savings and Losses and Assignment Methodology Specifications Version 6 (PDF)
- Shared Savings and Losses and Assignment Methodology Specifications Version 5 (PDF)
- Shared Savings and Losses and Assignment Methodology Specifications Version 4 (PDF)
- Shared Savings and Losses and Assignment Methodology Specifications Version 3 (PDF)
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.
Beginning PY 2021, ACOs participating in the Shared Savings Program are required to report through the Alternative Payment Model (APM) Performance Pathway (APP) for purposes of assessing their Shared Savings Program quality performance.
The APP is designed to:
- Reduce reporting burden
- Create new scoring opportunities for participants in Merit-based Incentive Payment System (MIPS) APMs
- Encourage participation in APMs
To learn more about the APP, refer to the resources below:
The PY 2022 APP Toolkit (ZIP) contains resources designed to help ACOs participating in the Shared Savings Program to successfully report quality data through the APP for PY 2022.
- APM Performance Pathway webpage
- Quality Payment Program (QPP) Resource Library
- Medicare Shared Savings Program: Reporting MIPS CQMs in the Alternative Payment Model Pathway (guidance document): Describes electronic clinical quality measures (eCQM)/MIPS CQM reporting scenarios specific to APM Entity-level reporters. Specifically, this guidance is for Shared Savings Program ACOs and provides a framework that ACOs can use to determine how best to aggregate and match patient data necessary for quality measure performance reporting and measurement according to the structure and needs of each ACO and in accordance with MIPS data completeness requirements.
- Medicare Shared Savings Program: Performance Scores that Equate to the 30th and 40th Percentile MIPS Quality Performance Category Scores for Performance Years 2018 to 2021: Provides background and detail on the MIPS Quality performance category scores that equate to the 30th and 40th percentile for use in establishing the applicable quality performance standard under the Shared Savings Program.
To learn more about the measure specifications and benchmarks applicable to the APP for PY 2022. refer to:
- PY 2022 APM Performance Pathway: CMS Web Interface Measure Benchmarks for ACOs: This document describes methods for calculating the CMS Web Interface measure benchmarks for ACOs reporting the CMS Web Interface measures for PY 2022. The benchmarks for the 10 CMS Web Interface measures are displayed in Appendix A of this document.
- PY 2022 CMS Web Interface Measure Specifications and Supporting Documents: Provides comprehensive descriptions of the PY 2022 CMS Web Interface measures for the MIPS Quality performance category
- 2022 Hospital-Wide All-Cause Unplanned Readmission Measure: Provides details on the measure development and final specifications for the Hospital-Wide, 30-Day, All-Cause Unplanned Readmission Rate for MIPS Groups for PY 2022.
- PY 2022 Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions: Provides the rate of risk-standardized acute, unplanned hospital admissions among Medicare Fee-for-Service (FFS) beneficiaries 65 years and older with MCCs who are assigned to an ACO.
- PY 2022 MIPS Quality Benchmarks: Lists and explains PY 2022 historical benchmarks used to assess performance in the MIPS Quality performance category.
- PY 2022 eCQM/MIPS CQM Measure Set and Resources: Shared Savings Program ACOs have the option to report quality data using the eCQM/MIPS CQM measure set. Resources can be located in the QPP Resource Library and the Electronic Clinical Quality Improvement (eCQI) Resource Center. The eCQI Resource Center provides a centralized location for news, information, tools, and standards related to eCQI and eCQMs for PY 2022
- PY 2022 Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Resources: The resources linked below provide important information specific to the CAHPS for MIPS Survey for ACOs reporting via the APP. CAHPS resources can also be found on the QPP Resource Library.
To learn more about the measure specifications and benchmarks applicable to the APP for PY 2023, refer to:
- PY 2023 APM Performance Pathway: CMS Web Interface Measure Benchmarks for ACOs: This document describes methods for calculating the CMS Web Interface measure benchmarks for ACOs reporting the CMS Web Interface measures for PY 2023. The benchmarks for the CMS Web Interface measures are displayed in Appendix A of this document.
- PY 2023 CMS Web Interface Measure Specifications and Supporting Documents: Provides comprehensive descriptions of the 2023 CMS Web Interface measures for the MIPS Quality performance category.
- PY 2023 Hospital-Wide All-Cause Unplanned Readmission Measure: Provides details on the measure development and final specifications for the Hospital-Wide, 30-Day, All-Cause Unplanned Readmission Rate for MIPS Groups measure for PY 2023.
- PY 2023 Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions: Provides details on the measure development and final specifications for the Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions measure for PY 2023.
Prior Years Quality Documentation
- 2021 ACO Quality Reporting Documentation (ZIP)
- 2020 ACO Quality Reporting Documentation (ZIP)
- 2019 ACO Quality Reporting Documentation (ZIP)
- 2018 ACO Quality Reporting Documentation (ZIP)
- 2017 ACO Quality Reporting Documentation (ZIP)
- 2016 ACO Quality Reporting Documentation (ZIP)
- 2015 ACO Quality Reporting Documentation (ZIP)
- 2014 ACO Quality Reporting Documentation (ZIP)
- 2013 ACO Quality Reporting Documentation (ZIP)
- 2012 ACO Quality Reporting Documentation (ZIP)
Quality Payment Program
The Quality Payment Program improves Medicare by helping providers focus on care quality and the one thing that matters most—making patients healthier.
The Quality Payment Program has two tracks from which clinicians can choose:
- Advanced Alternative Payment Models (APMs): Includes clinicians who are in ACOs participating in the Shared Savings Program Level E of the BASIC track or the ENHANCED track.
- Merit-Based Incentive Payment System (MIPS): Includes MIPS eligible clinicians who are in ACOs participating in the Shared Savings Program under Levels A, B, C, or D of the BASIC track.
Clinicians can view their QPP participation status by performance year, by visiting the QPP Participation Status Lookup Tool and entering their 10-digit National Provider Identifier number. Questions about the QPP Participation Status Lookup Tool may be directed to the QPP Service Center at 1-866-288-8292, (TTY) 1-877-715-6222 or by email at QPP@cms.hhs.gov.
To learn more about Quality Payment Program and Shared Savings Program interaction, visit the Quality Payment Program Resource Library webpage.
Quality Measurement Performance Program Interactions Resources
For more information on interactions between the Shared Savings Program and other CMS initiatives, please reference:
- Interaction with Other Medicare Initiatives: Provides an overview of how the QPP and other CMS Innovation Center initiatives intersect with the Shared Savings Program quality measurement.
- QPP Resource Library: Presents QPP resources, including fact sheets describing the interaction between the Shared Savings Program and the QPP.
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.