Guidance

An ACO Participant is an entity identified by a Medicare-enrolled TIN through which one or more ACO providers/suppliers bill Medicare. The 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. 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 Resources

• Adding ACO Participants & SNF Affiliates in ACO-MS 
• Beneficiary Assignment Estimates in ACO-MS 

Other Resources

• 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

In order to receive payments from CMS, ACOs must submit Form CMS-588, the accompanying Form CMS-588 cover sheet, and the required supporting financial documentation as part of the application.

• Banking Form Instructions 

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, and promote equity by holistically addressing beneficiary needs, including social needs.

To be eligible for advance investment payments, ACOs must be initial applicants identified as low revenue and inexperienced with performance-based risk and have selected level A of the BASIC track. 

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
• Advance Investment Payments Roles for Community Based Organizations 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).

• Repayment Mechanism Arrangement Guidance 

Templates & Samples

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

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.. 

• SNF 3-Day Rule Waiver Guidance

Sample Application

• SNF 3-Day Rule Waiver Application

ACO-MS Tip Sheet

• Adding ACO Participants & SNF Affiliates in ACO-MS

The ACO Primary Care Flex Model (ACO PC Flex Model) is a voluntary model that will focus on primary care delivery in the Shared Savings Program. It will test how prospective payments and increased funding for primary care in ACOs impact health outcomes, quality, and costs of care. The flexible payment design will empower participating ACOs and their primary care providers to use more innovative, team-based, person-centered and proactive approaches to care.

ACOs who are interested in the  ACO PC Flex Model must first apply the Shared Savings Program. ACOs who do not have an application to begin a new agreement period will not be able to respond the ACO PC Flex Model Request for Application.  

More Information

Guidance

ACOs participating in certain two-sided models may apply to establish and operate a BIP to provide an incentive payment with a value of up to $20 to each assigned beneficiary for each qualifying primary care service received. 

• Beneficiary Incentive Program Guidance 

Sample Application

• BIP Application

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. 

• 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

ACO-MS Tip Sheets

• How to Review and Certify the ACO Participant List and ACO Provider/Supplier List in ACO-MS
• Managing the ACO Provider/Supplier List in ACO-MS
• ACO Provider/Supplier Bulk Upload in ACO-MS