CMS Eligibility Requirements Checklist for MSSP ACO Participation

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1 ATTACHMENT 1 CMS Eligibility Requirements Checklist fr MSSP ACO Participatin 1. General Eligibility Requirements ACO participants wrk tgether t manage and crdinate care fr Medicare fee-fr-service beneficiaries. The ACO must becme accuntable fr the quality, cst, and verall care f the Medicare fee-fr-service beneficiaries assigned t the ACO. ACOs must meet r exceed a minimum savings rate established by CMS, meet minimum quality perfrmance standards, and therwise maintain their eligibility t participate in the MSSP in rder t receive shared savings payments. ACOs perating under the tw-sided mdel that meet r exceed a minimum lss rate must share lsses with the Medicare prgram. 2. Eligible Prviders and Suppliers ACO participants r cmbinatins f ACO participants must qualify as ne, r mre, f the fllwing prviders r suppliers r participate thrugh an ACO frmed by ne r mre f the fllwing: Prfessinals in grup practice arrangements. Netwrks f individual prfessinal practices. Partnerships r jint venture arrangements between hspitals and ACO prfessinals. Hspitals emplying ACO prfessinals. CAHs that bill under Methd II. RHCs. FQHCs. 3. Organizatinal and Management Requirements An ACO must be a legal entity, frmed under applicable State, Federal, r Tribal law, and authrized t cnduct business in each State in which it perates fr the fllwing purpses : Receiving and distributing shared savings. Repaying shared lsses r ther mnies determined t be wed t CMS. Establishing, reprting, and ensuring prvider cmpliance with health care quality criteria, including quality perfrmance standards. Fulfilling ther ACO functins identified in this part. An ACO must maintain an identifiable gverning bdy with authrity t execute the functins f an ACO, including but nt limited t, prmting evidence-based medicine and patient engagement, reprting n quality and cst measures, and crdinatin f care. These materials are prvided fr infrmatinal purpses nly and d nt cnstitute legal advice. These materials are intended, but nt prmised r guaranteed t be current, cmplete, r up-t-date and shuld in n way be taken as an indicatin f future results. Transmissin f the infrmatin is nt intended t create, and the receipt des nt cnstitute, an attrney-client relatinship. These are nt ffered as and d nt cnstitute legal advice r legal pinins. Yu shuld nt act r rely n any infrmatin cntained herein withut first seeking the advice f an attrney.

2 The gverning bdy must have respnsibility fr the versight and strategic directin f the ACO and hlding ACO management accuntable fr the ACO's activities. The gverning bdy must have a transparent gverning prcess. The gverning bdy members must have a fiduciary duty t the ACO and must act cnsistent with that fiduciary duty. The gverning bdy f the ACO must be separate and unique t the ACO in cases where the ACO cmprises multiple independent ACO participants. If the ACO is an existing entity, the ACO gverning bdy may be the same as the gverning bdy f that existing entity, prvided it satisfies all ther ACO gverning bdy requirements. The ACO must prvide fr meaningful participatin in the cmpsitin and cntrl f the ACO's gverning bdy fr ACO participants r their designated representatives. The ACO gverning bdy must include a Medicare beneficiary representative(s) served by the ACO wh des nt have a cnflict f interest with the ACO, and wh has n immediate family member with a cnflict f interest with the ACO. At least 75 percent cntrl f the ACO's gverning bdy must be held by ACO participants. The gverning bdy members may serve in a similar r cmplementary manner fr an ACO participant. In cases in which the cmpsitin f the ACO's gverning bdy des nt meet the requirements abve, the ACO must describe why it seeks t differ frm these requirements and hw the ACO will invlve ACO participants in innvative ways in ACO gvernance r prvide meaningful representatin in ACO gvernance by Medicare beneficiaries. The ACO gverning bdy must have a cnflict f interest plicy that applies t members f the gverning bdy. The cnflict f interest plicy must Require each member f the gverning bdy t disclse relevant financial interests; and Prvide a prcedure t determine whether a cnflict f interest exists and set frth a prcess t address any cnflicts that arise. The cnflict f interest plicy must address remedial actin fr members f the gverning bdy that fail t cmply with the plicy. An ACO must have a leadership and management structure that includes clinical and administrative systems that align with and supprt the gals f the Shared Savings Prgram and the three aims f better care fr individuals, better health fr ppulatins, and lwer grwth in expenditures. The ACO's peratins must be managed by an executive, fficer, manager, general partner, r similar party whse appintment and remval are under the cntrl f the ACO's gverning bdy and whse leadership team has demnstrated the ability t influence r direct clinical practice t imprve efficiency prcesses and utcmes.

3 Clinical management and versight must be managed by a senir-level medical directr wh is a physician and ne f its ACO prviders/suppliers, wh is physically present n a regular basis at any clinic, ffice, r ther lcatin participating in the ACO, and wh is a bard-certified physician and licensed in a State in which the ACO perates. Each ACO participant and each ACO prvider/supplier must demnstrate a meaningful cmmitment t the missin f the ACO t ensure the ACO's likely success. Meaningful cmmitment may include, fr example, a sufficient financial r human investment (fr example, time and effrt) in the nging peratins f the ACO such that the ptential lss r recupment f the investment is likely t mtivate the ACO participant and ACO prvider/supplier t achieve the ACO's missin under the Shared Savings Prgram. A meaningful cmmitment can be shwn when an ACO participant r ACO prvider/supplier agrees t cmply with and implement the ACO's prcesses and is held accuntable fr meeting the ACO's perfrmance standards fr each required prcess. The ACO must include primary care ACO prfessinals that are sufficient fr the number f Medicare fee-fr-service beneficiaries assigned t the ACO. The ACO must have at least 5,000 assigned beneficiaries. CMS deems an ACO t have initially satisfied the requirement t have at least 5,000 assigned beneficiaries if the number f beneficiaries histrically assigned t the ACO participants in each f the three years befre the start f the agreement perid, is 5,000 r mre. If at any time during the perfrmance year, an ACO's assigned ppulatin falls belw 5,000, the ACO will be issued a warning and placed n a Crrective Actin Plan. 4. Required ACO Prcesses and Functins An ACO must Prmte evidence-based medicine and beneficiary engagement, internally reprt n quality and cst metrics, and crdinate care; Adpt a fcus n patient centeredness that is prmted by the gverning bdy and integrated int practice by leadership and management wrking with the rganizatin's health care teams; and Have defined prcesses t fulfill these requirements. Have a qualified healthcare prfessinal respnsible fr the ACO's quality assurance and imprvement prgram, which must include the defined prcesses belw. Fr each prcess belw, the ACO must Explain hw it will require ACO participants and ACO prviders/suppliers t cmply with and implement each prcess, including the remedial prcesses and penalties (including the ptential fr expulsin) applicable t ACO participants and ACO prviders/suppliers fr failure t cmply with and implement the required prcess; and Explain hw it will emply its internal assessments f cst and quality f care t imprve cntinuusly the ACO's care practices.

4 The ACO must define, establish, implement, evaluate, and peridically update prcesses t accmplish the fllwing: Prmte evidence-based medicine. These prcesses must cver diagnses with significant ptential fr the ACO t achieve quality imprvements taking int accunt the circumstances f individual beneficiaries. Prmte patient engagement. These prcesses must address the fllwing areas: Cmpliance with patient experience f care survey requirements; Cmpliance with beneficiary representative requirements; and A prcess fr evaluating the health needs f the ACO's ppulatin, including cnsideratin f diversity in its patient ppulatins, and a plan t address the needs f its ppulatin. In its plan t address the needs f its ppulatin, the ACO must describe hw it intends t partner with cmmunity stakehlders t imprve the health f its ppulatin. An ACO that has a stakehlder rganizatin serving n its gverning bdy will be deemed t have satisfied the requirement t partner with cmmunity stakehlders. Cmmunicatin f clinical knwledge/evidence-based medicine t beneficiaries in a way that is understandable t them. Beneficiary engagement and shared decisin-making that takes int accunt the beneficiaries' unique needs, preferences, values, and pririties; Written standards in place fr beneficiary access and cmmunicatin, and a prcess in place fr beneficiaries t access their medical recrd. Develp an infrastructure fr its ACO participants and ACO prviders/suppliers t internally reprt n quality and cst metrics that enables the ACO t mnitr, prvide feedback, and evaluate its ACO participants and ACO prvider(s)/supplier(s) perfrmance and t use these results t imprve care ver time. Crdinate care acrss and amng primary care physicians, specialists, and acute and pst-acute prviders and suppliers. The ACO must Define its methds and prcesses established t crdinate care thrughut an episde f care and during its transitins, such as discharge frm a hspital r transfer f care frm a primary care physician t a specialist (bth inside and utside the ACO); and As part f its applicatin, the ACO must: Submit a descriptin f its individualized care prgram, alng with a sample individual care plan, and explain hw this prgram is used t prmte imprved utcmes fr, at a minimum, its high-risk and multiple chrnic cnditin patients. Describe additinal target ppulatins that wuld benefit frm individualized care plans. Individual care plans must take int accunt the cmmunity resurces available t the individual.

5 5. Prhibitin frm Participatin in Other Shared Savings Initiatives ACOs may nt participate in the Shared Savings Prgram if they include an ACO participant that participates in the independence at hme medical practice pilt prgram, a mdel tested r expanded that invlves shared savings, r any ther Medicare initiative that invlves shared savings. 6. Mandatry Cmpliance Plan The ACO must develp a Cmpliance Plan that cntains at least the fllwing elements A designated cmpliance fficial r individual that is nt legal cunsel t the ACO and reprts directly t the ACO s gverning bdy. Mechanisms fr identifying and addressing cmpliance prblems related t the ACO s peratins and perfrmance. A methd fr emplyees r cntractrs f the ACO, ACO participants, ACO prviders/suppliers, and ther individuals r entities perfrming functins r services related t ACO activities t annymusly reprt suspected prblems related t the ACO t the cmpliance fficer. Cmpliance training fr ACO, ACO participants and the ACO prviders/suppliers. A requirement fr the ACO t reprt prbable vilatins f law t an apprpriate law enfrcement agency.

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