Subpart A - General Provisions

§ 425.10 - Basis and scope.

§ 425.20 - Definitions.

Subpart B - Shared Savings Program Eligibility Requirements

§ 425.100 - General.

§ 425.102 - Eligible providers and suppliers.

§ 425.104 - Legal entity.

§ 425.106 - Shared governance.

§ 425.108 - Leadership and management.

§ 425.110 - Number of ACO professionals and beneficiaries.

§ 425.112 - Required processes and patient-centeredness criteria.

§ 425.114 - Participation in other shared savings initiatives.

§ 425.116 - Agreements with ACO participants and ACO providers/suppliers.

§ 425.118 - Required reporting of ACO participants and ACO providers/suppliers.

Subpart C - Application Procedures and Participation Agreement

§ 425.200 - Participation agreement with CMS.

§ 425.202 - Application procedures.

§ 425.204 - Content of the application.

§ 425.206 - Evaluation procedures for applications.

§ 425.208 - Provisions of participation agreement.

§ 425.210 - Application of agreement to ACO participants, ACO providers/suppliers, and others.

§ 425.212 - Changes to program requirements during the agreement period.

§ 425.214 - Managing changes to the ACO during the agreement period.

§ 425.216 - Actions prior to termination.

§ 425.218 - Termination of the participation agreement by CMS.

§ 425.220 - Termination of the participation agreement by the ACO.

§ 425.221 - Close-out procedures and payment consequences of early termination.

§ 425.222 - Eligibility to re-enter the program for agreement periods beginning before July 1, 2019.

§ 425.224 - Application procedures for renewing ACOs and re-entering ACOs.

§ 425.226 - xxx

Subpart D - Program Requirements and Beneficiary Protections

§ 425.300 - Compliance plan.

§ 425.302 - Program requirements for data submission and certifications.

§ 425.304 - Beneficiary incentives.

§ 425.305 - Other program safeguards.

§ 425.306 - Participant agreement and exclusivity of ACO participants.

§ 425.308 - Public reporting and transparency.

§ 425.310 - Marketing requirements.

§ 425.312 - Beneficiary notifications.

§ 425.314 - Audits and record retention.

§ 425.315 - Reopening determinations of ACO shared savings or shared losses to correct financial reconciliation calculations.

§ 425.316 - Monitoring of ACOs.

Subpart E - Assignment of Beneficiaries

§ 425.400 - General.

§ 425.401 - Criteria for a beneficiary to be assigned to an ACO.

§ 425.402 - Basic assignment methodology.

§ 425.404 - Special assignment conditions for ACOs including FQHCs and RHCs.

Subpart F - Quality Performance Standards and Reporting

§ 425.500 - Measures to assess the quality of care furnished by an ACO for performance years (or a performance period) beginning on or before January 1, 2020.

§ 425.502 - Calculating the ACO quality performance score for performance years (or a performance period) beginning on or before January 1, 2020.

§ 425.504 - Incorporating reporting requirements related to the Physician Quality Reporting System Incentive and Payment Adjustment.

§ 425.506 - Incorporating reporting requirements related to adoption of certified electronic health record technology.

§ 425.507 - Incorporating Promoting Interoperability requirements related to the Quality Payment Program for performance years beginning on or after January 1, 2025.

§ 425.508 - Incorporating quality reporting requirements related to the Quality Payment Program.

§ 425.510 - xxx

§ 425.512 - Determining the ACO quality performance standard for performance years beginning on or after January 1, 2021.

Subpart G - Shared Savings and Losses

§ 425.600 - Selection of risk model.

§ 425.601 - Establishing, adjusting, and updating the benchmark for agreement periods beginning on or after July 1, 2019, and before January 1, 2024.

§ 425.602 - Establishing, adjusting, and updating the benchmark for an ACO's first agreement period beginning on or before January 1, 2018.

§ 425.603 - Resetting, adjusting, and updating the benchmark for a subsequent agreement period beginning on or before January 1, 2019.

§ 425.604 - Calculation of savings under the one-sided model.

§ 425.605 - Calculation of shared savings and losses under the BASIC track.

§ 425.606 - Calculation of shared savings and losses under Track 2.

§ 425.608 - Determining first year performance for ACOs beginning April 1 or July 1, 2012.

§ 425.609 - Determining performance for 6-month performance years during CY 2019.

§ 425.610 - Calculation of shared savings and losses under the ENHANCED track.

§ 425.611 - Adjustments to Shared Savings Program calculations to address the COVID–19 pandemic.

§ 425.612 - Waivers of payment rules or other Medicare requirements.

§ 425.613 - xxx

§ 425.630 - Option to receive advance investment payments.

§ 425.650 - Benchmarking methodology.

§ 425.652 - Establishing, adjusting, and updating the benchmark for agreement periods beginning on January 1, 2024, and in subsequent years.

§ 425.654 - Calculating county expenditures and regional expenditures.

§ 425.655 - Calculating the regional risk score growth cap adjustment factor.

§ 425.656 - Calculating the regional adjustment to the historical benchmark.

§ 425.658 - Calculating the prior savings adjustment to the historical benchmark.

§ 425.659 - Calculating risk scores used in Shared Savings Program benchmark calculations.

§ 425.660 - Accountable Care Prospective Trend (ACPT).

§ 425.661 - xxx

§ 425.662 - xxx

§ 425.663 - xxx

§ 425.664 - xxx

§ 425.665 - xxx

§ 425.666 - xxx

§ 425.667 - xxx

§ 425.668 - xxx

§ 425.669 - xxx

§ 425.670 - Adjustments to mitigate the impact of significant, anomalous, and highly suspect billing activity on Shared Savings Program financial calculations involving calendar year 2023.

§§ 425.631--425.649 - [Reserved]

§§ 425.661--425.669 - [Reserved]

§§ 425.614--425.629 - [Reserved]

Subpart H - Data Sharing With ACOs

§ 425.700 - General rules.

§ 425.702 - Aggregate reports.

§ 425.704 - Beneficiary-identifiable claims data.

§ 425.706 - Minimum necessary data.

§ 425.708 - Beneficiaries may decline claims data sharing.

§ 425.710 - Data use agreement.

Subpart I - Reconsideration Review Process

§ 425.800 - Preclusion of administrative and judicial review.

§ 425.802 - Request for review.

§ 425.804 - Reconsideration review process.

§ 425.806 - On-the-record review of reconsideration official's recommendation by independent CMS official.

§ 425.808 - Effect of independent CMS official's decision.

§ 425.810 - Effective date of decision.