Guidance

An ACO participant is an entity identified by a Medicare-enrolled Taxpayer Identification Number through which one or more ACO providers/suppliers bill Medicare. These documents describe the requirements that an ACO participating in, or applying to, the Shared Savings Program must follow with respect to its ACO Participant List, ACO Provider/Supplier List, and ACO Participant Agreement. Currently 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 

ACO-MS Resource

• ACO Participant Change Requests in ACO-MS

Other Resource

• Frequently asked questions about affiliating with an ACO as an Other Entity instead of as an ACO Participant can be found in Other Entities Frequently Asked Questions. 

Instructions

ACOs must submit banking information and the required supporting financial documentation as part of the application. These documents describe the requirements for completing these forms.

• Banking Form Instructions 

ACO-MS Resource

• Submitting and Managing Banking Information Documents in ACO-MS

Other Resources

• Form CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement
• Form CMS-588 Cover Sheet

Guidance

The Shared Savings Program offers a payment option, AIP, to provide an opportunity for entities to join together to form ACOs, build the infrastructure needed to succeed in the Shared Savings Program. 

These documents provide an overview of the requirements for an initial applicant ACO to participate in AIP. 

• Advanced Investment Payments Guidance 

Supplemental Information 

An ACO that is interested in receiving advance investment payments will need to complete supplemental informational materials as part of their initial application. 

• AIP Supplemental Information

ACO-MS Tip Sheets

• How to Complete the AIP Supplemental Information and Spend Plan in ACO-MS

Other Resources

• Advance Investment Payments at a Glance

Guidance

An ACO must demonstrate that it has established an adequate repayment mechanism prior to the start of its agreement period to be eligible to participate in a two-sided risk model of the Shared Savings Program (Levels C, D, or E of the BASIC track, or the ENHANCED track). These documents describe the requirements and process for establishing and maintaining a repayment mechanism.

• Repayment Mechanism Arrangement Guidance 

Templates

• Appendix A: Escrow Agreement Template
• Appendix B: Letter of Credit Template
• Appendix C: Surety Bond Template

Cover Sheet

• Appendix D: Repayment Mechanism Documentation Cover Sheet

Checklists

• Appendix E: New Repayment Mechanism Checklist
• Appendix F: Renewing ACO Repayment Mechanism Checklist

Guidance

The SNF 3-Day Rule Waiver waives the requirement for a 3-day inpatient hospital stay prior to a Medicare-covered, post-hospital, extended-care service for eligible beneficiaries if certain conditions are met. Only Shared Savings Program ACOs that are currently participating in or applying to certain Shared Savings Program performance-based risk tracks have the opportunity to apply for a waiver of the SNF 3-Day Rule, and they must apply separately for the waiver during the annual application process. These documents describe the requirements and process for establishing and maintaining a SNF 3-Day Rule Waiver.

• SNF 3-Day Rule Waiver Guidance

Sample Application

• SNF 3-Day Rule Waiver Application

ACO-MS Tip Sheet

• SNF Affiliate Change Requests in ACO-MS 

Guidance

ACOs participating in certain two-sided models may apply to establish and operate a BIP. These documents describe the eligibility requirements and process for ACOs to establish and maintain a BIP.

• Beneficiary Incentive Program Guidance 

Sample Application

• BIP Application

The Shared Savings Program will offer a new payment option, Prepaid Shared Savings (PSS), to eligible ACOs who are experienced with two-sided risk payment models and have an established history of earning shared savings.

These documents provide an overview of the requirements for an eligible ACO to participate in PSS. 

• Prepaid Shared Savings Guidance 

Supplemental Information

An ACO that is interested in receiving prepaid shared savings will need to complete PSS supplemental information.

• PSS Supplemental Information

ACO-MS Resource 

• How to Complete the PSS Supplemental Information and Spend Plan in ACO-MS 

   

To participate in the Shared Savings Program, each ACO must have a compliance plan. Upon request, the ACO must submit the compliance plan to demonstrate that it satisfies the regulation requirements. ACOs must certify that they have completed a compliance plan. This document provides an overview on creating a compliance plan. 

• Creating a Shared Savings Program Compliance Plan

Guidance

Prior to the start of a new performance year and at the end of each performance year (as applicable), the Shared Savings Program requires all ACOs to review, certify, and electronically sign documents related to their participation in the Shared Savings Program. 

• ACO Signing Event Instructions