How to Complete ACO Management System (ACO-MS) Registration (Updated 4/10/2023) (PDF)

This tip sheet provides information on how applicants must register in ACO-MS in order to begin their application.

ACO-MS: Initial Access Information (Updated 4/10/2023) (PDF)

This tip sheet provides information on how to obtain access to ACO-MS and what to expect the first time you sign into the system.

Shared Savings Program ACO Participation Options (Updated 4/10/2023) (PDF)

This document outlines the different participation options (tracks) that allow Accountable Care Organizations (ACOs) to assume various levels of risk. The table in the document summarizes the characteristics of the participation options under the BASIC track and ENHANCED track.

Application Reference Manual (Updated 4/10/2023) (PDF)

The Application Reference Manual is the primary resource for ACOs applying to the Medicare Shared Savings Program (Shared Savings Program) and guides ACOs through the application process.

In addition to the Application Reference Manual, the resources below will assist ACOs with submitting the different elements of their application(s) and responding to requests for information (RFIs) in ACO-MS.   

Advance Investment Payments Guidance (Updated 4/10/2023) PDF (PDF)

Applies to initial applicants identified as low revenue and inexperienced with performance-based risk Medicare ACO initiatives interested in receiving Advance Investment Payments (AIP)

The Shared Savings Program will offer a new payment option, AIP, to provide an opportunity for entities in rural and underserved areas to join together to form ACOs, build the infrastructure needed to succeed in the Shared Savings Program, and promote equity by holistically addressing beneficiary needs, including social needs.

• How to Complete the AIP Supplemental Information and Spend Plan in ACO-MS (PDF)
  • This tip sheet provides instructions on how to complete the AIP supplemental information spend plan. 
• Advance Investment Payments at a Glance (Updated 04/10/2023) (PDF) 
• Advance Investment Payments Roles for Community Based Organizations at a Glance (Updated 04/10/2023) (PDF)
• ACO-CBO Webinar-Coordinating to Holistically Address Beneficiary Social Needs (Updated 4/24/2023) (PDF) 
  • ACO-CBO webinar with Closed Caption embedded (download link)

ACO Participant List and Participant Agreement Guidance (Updated 4/10/2023) (PDF)

The ACO Participant List and Participant Agreement Guidance document describes 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. Participating ACOs may modify their ACO Participant List and associated agreements for the upcoming performance year during established timeframes.

• 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 (PDF).” 
• Adding ACO Participants & SNF Affiliates in ACO-MS (Updated 4/10/2023) (PDF)
  • This tip sheet provides information on how to add ACO participants and SNF affiliates in ACO-MS.
• Beneficiary Assignment Estimates in ACO-MS (Updated 4/10/2023) (PDF) 
  • This tip sheet provides information on how beneficiary assignment estimates will be displayed for each submitted ACO Participant. 

ACO Banking Form Instructions (Updated 4/10/2023) (PDF)

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

Repayment Mechanism Arrangements Guidance (Updated 4/10/2023) (PDF)

Applies to ACOs electing to participate in two-sided risk

• Appendix A: Escrow Agreement Template (Updated 4/10/2023) (PDF)
• Appendix B: Escrow Agreement Amendment Sample (Updated 4/10/2023) (DOCX)
• Appendix C: Letter of Credit Sample (Updated 4/10/2023) (DOCX)
• Appendix D: Surety Bond Sample (Updated 4/10/2023) (DOCX)
• Appendix E: Repayment Mechanism Documentation Cover Sheet (Updated 4/10/2023) (DOCX)
• Appendix F: Repayment Mechanism Checklist (Updated 4/10/2023) (PDF) 

SNF 3-Day Rule Waiver Guidance (Updated 4/10/2023) (PDF) 

Applies to ACOs applying for a Skilled Nursing Facility (SNF) 3-Day Rule Waiver 

• Adding ACO Participants & SNF Affiliates in ACO-MS (Updated 4/10/2023) (PDF)
  • This tip sheet provides information on how to add ACO participants and SNF affiliates in ACO-MS. 

Requests for Information in ACO-MS (Updated 4/10/2023) (PDF)

The tip sheet provides information on how to correct deficiencies and/or make updates or modifications to the ACO application or change request(s).

Beneficiary Incentive Program Guidance (Updated 5/14/2021) (PDF)

Applies to ACOs interested in establishing and operating a Beneficiary Incentive Program (BIP)

Overview of ACO-MS User Access and ACO Contacts (Updated 11/15/2023) (PDF)

This tip sheet provides an overview of the various ACO contact types and the permissions associated with those types in ACO-MS.

Application Webinars

Shared Savings Program Application: Finalizing Phase 1 & Preparing for Phase 2 (Conducted 8/30/2023)

The Shared Savings Program hosted an office hours webinar to assist applicants in finalizing Phase 1 submissions, which closes September 5th at 12:00 p.m. ET, and preparing for Phase 2, which opens October 19th at 12:00 p.m. (noon) ET.

• Shared Savings Program Application: Finalizing Phase 1 & Preparing for Phase 2 (PDF)

• Shared Savings Program Application: Finalizing Phase 1 & Preparing for Phase 2 Recording with Closed Caption embedded (download link)

Making the Most of Phase 1 RFI-1 Webinar (Conducted 7/14/2023)

The Shared Savings Program hosted an office hours webinar to assist applicants in responding to the Phase 1 RFI-1 which opened July 11th and closed August 1st at 12:00 p.m. (noon) ET.

• Shared Savings Program: Making the Most of Phase 1 RFI-1 (PDF)

• Shared Savings Program: Making the Most of Phase 1 RFI-1 Recording with Closed Caption embedded (download link)

Navigating the Application Webinar (Conducted 5/8/2023)

This webinar shows applicants how to use the application toolkit to prepare your application for the upcoming cycle. The new Advance Investment Payments option to encourage health care providers in rural and underserved areas to join together as ACOs is also discussed.

• Shared Savings Program: Navigating the Application (PDF)

• Shared Savings Program: Navigating the Application Recording with Closed Caption embedded (download link)

ACO Signing Event Resources 

ACO Signing Event Instructions (Updated 10/24/2023) (PDF)

How to Review and Certify the ACO Participant List and ACO Provider/Supplier List in ACO-MS (Updated 10/24/2023) (PDF)

This tip sheet provides general information on how to review and certify your ACO Participant List and ACO Provider/Supplier List in ACO-MS during the ACO Signing Event. 

ACO Provider/Supplier List in ACO-MS and Managing the ACO Provider/Supplier List in ACO-MS (Updated 10/24/2023) (PDF)

This tip sheet provides information on key points for adding and/or deleting ACO providers and suppliers in ACO-MS.

ACO Provider/Supplier Bulk Upload in ACO-MS (Updated 10/24/2023) (PDF)

This tip sheet provides detailed instructions for managing your ACO Provider/Supplier List in ACO-MS; specifically, adding and/or deleting multiple ACO providers and suppliers by uploading a file into ACO-MS.

Program Participation

For more information and resources on the program methodologies and participation requirements, refer to the Program Guidance & Specifications webpage.

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