| 42:3.0.1.1.12.1 | SUBPART A
| Subpart A - General Provisions | |
| 42:3.0.1.1.12.1.11.1 | SECTION 425.10
| 425.10 Basis and scope. | |
| 42:3.0.1.1.12.1.11.2 | SECTION 425.20
| 425.20 Definitions. | |
| 42:3.0.1.1.12.2 | SUBPART B
| Subpart B - Shared Savings Program Eligibility Requirements | |
| 42:3.0.1.1.12.2.11.1 | SECTION 425.100
| 425.100 General. | |
| 42:3.0.1.1.12.2.11.2 | SECTION 425.102
| 425.102 Eligible providers and suppliers. | |
| 42:3.0.1.1.12.2.11.3 | SECTION 425.104
| 425.104 Legal entity. | |
| 42:3.0.1.1.12.2.11.4 | SECTION 425.106
| 425.106 Shared governance. | |
| 42:3.0.1.1.12.2.11.5 | SECTION 425.108
| 425.108 Leadership and management. | |
| 42:3.0.1.1.12.2.11.6 | SECTION 425.110
| 425.110 Number of ACO professionals and beneficiaries. | |
| 42:3.0.1.1.12.2.11.7 | SECTION 425.112
| 425.112 Required processes and patient-centeredness criteria. | |
| 42:3.0.1.1.12.2.11.8 | SECTION 425.114
| 425.114 Participation in other shared savings initiatives. | |
| 42:3.0.1.1.12.2.11.9 | SECTION 425.116
| 425.116 Agreements with ACO participants and ACO providers/suppliers. | |
| 42:3.0.1.1.12.2.11.10 | SECTION 425.118
| 425.118 Required reporting of ACO participants and ACO providers/suppliers. | |
| 42:3.0.1.1.12.3 | SUBPART C
| Subpart C - Application Procedures and Participation Agreement | |
| 42:3.0.1.1.12.3.11.1 | SECTION 425.200
| 425.200 Participation agreement with CMS. | |
| 42:3.0.1.1.12.3.11.2 | SECTION 425.202
| 425.202 Application procedures. | |
| 42:3.0.1.1.12.3.11.3 | SECTION 425.204
| 425.204 Content of the application. | |
| 42:3.0.1.1.12.3.11.4 | SECTION 425.206
| 425.206 Evaluation procedures for applications. | |
| 42:3.0.1.1.12.3.11.5 | SECTION 425.208
| 425.208 Provisions of participation agreement. | |
| 42:3.0.1.1.12.3.11.6 | SECTION 425.210
| 425.210 Application of agreement to ACO participants, ACO providers/suppliers, and others. | |
| 42:3.0.1.1.12.3.11.7 | SECTION 425.212
| 425.212 Changes to program requirements during the agreement period. | |
| 42:3.0.1.1.12.3.11.8 | SECTION 425.214
| 425.214 Managing changes to the ACO during the agreement period. | |
| 42:3.0.1.1.12.3.11.9 | SECTION 425.216
| 425.216 Actions prior to termination. | |
| 42:3.0.1.1.12.3.11.10 | SECTION 425.218
| 425.218 Termination of the participation agreement by CMS. | |
| 42:3.0.1.1.12.3.11.11 | SECTION 425.220
| 425.220 Termination of the participation agreement by the ACO. | |
| 42:3.0.1.1.12.3.11.12 | SECTION 425.221
| 425.221 Close-out procedures and payment consequences of early termination. | |
| 42:3.0.1.1.12.3.11.13 | SECTION 425.222
| 425.222 Eligibility to re-enter the program for agreement periods beginning before July 1, 2019. | |
| 42:3.0.1.1.12.3.11.14 | SECTION 425.224
| 425.224 Application procedures for renewing ACOs and re-entering ACOs. | |
| 42:3.0.1.1.12.3.11.15 | SECTION 425.226
| 425.226 Annual participation elections. | |
| 42:3.0.1.1.12.4 | SUBPART D
| Subpart D - Program Requirements and Beneficiary Protections | |
| 42:3.0.1.1.12.4.11.1 | SECTION 425.300
| 425.300 Compliance plan. | |
| 42:3.0.1.1.12.4.11.2 | SECTION 425.302
| 425.302 Program requirements for data submission and certifications. | |
| 42:3.0.1.1.12.4.11.3 | SECTION 425.304
| 425.304 Beneficiary incentives. | |
| 42:3.0.1.1.12.4.11.4 | SECTION 425.305
| 425.305 Other program safeguards. | |
| 42:3.0.1.1.12.4.11.5 | SECTION 425.306
| 425.306 Participant agreement and exclusivity of ACO participants. | |
| 42:3.0.1.1.12.4.11.6 | SECTION 425.308
| 425.308 Public reporting and transparency. | |
| 42:3.0.1.1.12.4.11.7 | SECTION 425.310
| 425.310 Marketing requirements. | |
| 42:3.0.1.1.12.4.11.8 | SECTION 425.312
| 425.312 Beneficiary notifications. | |
| 42:3.0.1.1.12.4.11.9 | SECTION 425.314
| 425.314 Audits and record retention. | |
| 42:3.0.1.1.12.4.11.10 | SECTION 425.315
| 425.315 Reopening determinations of ACO shared savings or shared losses to correct financial reconciliation calculations. | |
| 42:3.0.1.1.12.4.11.11 | SECTION 425.316
| 425.316 Monitoring of ACOs. | |
| 42:3.0.1.1.12.5 | SUBPART E
| Subpart E - Assignment of Beneficiaries | |
| 42:3.0.1.1.12.5.11.1 | SECTION 425.400
| 425.400 General. | |
| 42:3.0.1.1.12.5.11.2 | SECTION 425.401
| 425.401 Criteria for a beneficiary to be assigned to an ACO. | |
| 42:3.0.1.1.12.5.11.3 | SECTION 425.402
| 425.402 Basic assignment methodology. | |
| 42:3.0.1.1.12.5.11.4 | SECTION 425.404
| 425.404 Special assignment conditions for ACOs including FQHCs and RHCs. | |
| 42:3.0.1.1.12.6 | SUBPART F
| Subpart F - Quality Performance Standards and Reporting | |
| 42:3.0.1.1.12.6.11.1 | SECTION 425.500
| 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. | |
| 42:3.0.1.1.12.6.11.2 | SECTION 425.502
| 425.502 Calculating the ACO quality performance score for performance years (or a performance period) beginning on or before January 1, 2020. | |
| 42:3.0.1.1.12.6.11.3 | SECTION 425.504
| 425.504 Incorporating reporting requirements related to the Physician Quality Reporting System Incentive and Payment Adjustment. | |
| 42:3.0.1.1.12.6.11.4 | SECTION 425.506
| 425.506 Incorporating reporting requirements related to adoption of certified electronic health record technology. | |
| 42:3.0.1.1.12.6.11.5 | SECTION 425.508
| 425.508 Incorporating quality reporting requirements related to the Quality Payment Program. | |
| 42:3.0.1.1.12.6.11.6 | SECTION 425.510
| 425.510 Application of the Alternative Payment Model Performance Pathway (APP) to Shared Savings Program ACOs for performance years beginning on or after January 1, 2021. | |
| 42:3.0.1.1.12.6.11.7 | SECTION 425.512
| 425.512 Determining the ACO quality performance standard for performance years beginning on or after January 1, 2021. | |
| 42:3.0.1.1.12.7 | SUBPART G
| Subpart G - Shared Savings and Losses | |
| 42:3.0.1.1.12.7.11.1 | SECTION 425.600
| 425.600 Selection of risk model. | |
| 42:3.0.1.1.12.7.11.2 | SECTION 425.601
| 425.601 Establishing, adjusting, and updating the benchmark for agreement periods beginning on July 1, 2019, and in subsequent years. | |
| 42:3.0.1.1.12.7.11.3 | SECTION 425.602
| 425.602 Establishing, adjusting, and updating the benchmark for an ACO's first agreement period beginning on or before January 1, 2018. | |
| 42:3.0.1.1.12.7.11.4 | SECTION 425.603
| 425.603 Resetting, adjusting, and updating the benchmark for a subsequent agreement period beginning on or before January 1, 2019. | |
| 42:3.0.1.1.12.7.11.5 | SECTION 425.604
| 425.604 Calculation of savings under the one-sided model. | |
| 42:3.0.1.1.12.7.11.6 | SECTION 425.605
| 425.605 Calculation of shared savings and losses under the BASIC track. | |
| 42:3.0.1.1.12.7.11.7 | SECTION 425.606
| 425.606 Calculation of shared savings and losses under Track 2. | |
| 42:3.0.1.1.12.7.11.8 | SECTION 425.608
| 425.608 Determining first year performance for ACOs beginning April 1 or July 1, 2012. | |
| 42:3.0.1.1.12.7.11.9 | SECTION 425.609
| 425.609 Determining performance for 6-month performance years during CY 2019. | |
| 42:3.0.1.1.12.7.11.10 | SECTION 425.610
| 425.610 Calculation of shared savings and losses under the ENHANCED track. | |
| 42:3.0.1.1.12.7.11.11 | SECTION 425.611
| 425.611 Adjustments to Shared Savings Program calculations to address the COVID-19 pandemic. | |
| 42:3.0.1.1.12.7.11.12 | SECTION 425.612
| 425.612 Waivers of payment rules or other Medicare requirements. | |
| 42:3.0.1.1.12.7.11.13 | SECTION 425.613
| 425.613 Telehealth services. | |
| 42:3.0.1.1.12.8 | SUBPART H
| Subpart H - Data Sharing With ACOs | |
| 42:3.0.1.1.12.8.11.1 | SECTION 425.700
| 425.700 General rules. | |
| 42:3.0.1.1.12.8.11.2 | SECTION 425.702
| 425.702 Aggregate reports. | |
| 42:3.0.1.1.12.8.11.3 | SECTION 425.704
| 425.704 Beneficiary-identifiable claims data. | |
| 42:3.0.1.1.12.8.11.4 | SECTION 425.706
| 425.706 Minimum necessary data. | |
| 42:3.0.1.1.12.8.11.5 | SECTION 425.708
| 425.708 Beneficiaries may decline claims data sharing. | |
| 42:3.0.1.1.12.8.11.6 | SECTION 425.710
| 425.710 Data use agreement. | |
| 42:3.0.1.1.12.9 | SUBPART I
| Subpart I - Reconsideration Review Process | |
| 42:3.0.1.1.12.9.11.1 | SECTION 425.800
| 425.800 Preclusion of administrative and judicial review. | |
| 42:3.0.1.1.12.9.11.2 | SECTION 425.802
| 425.802 Request for review. | |
| 42:3.0.1.1.12.9.11.3 | SECTION 425.804
| 425.804 Reconsideration review process. | |
| 42:3.0.1.1.12.9.11.4 | SECTION 425.806
| 425.806 On-the-record review of reconsideration official's recommendation by independent CMS official. | |
| 42:3.0.1.1.12.9.11.5 | SECTION 425.808
| 425.808 Effect of independent CMS official's decision. | |
| 42:3.0.1.1.12.9.11.6 | SECTION 425.810
| 425.810 Effective date of decision. | |