Title 42

SECTION 425.10

425.10 Basis and scope.

§ 425.10 Basis and scope.

(a) Basis. This part implements section 1899 of the Act by establishing a shared savings program that promotes accountability for a patient population, coordinates items and services under Medicare parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient services. The regulations under this part must not be construed to affect the payment, coverage, program integrity, and other requirements that apply to providers and suppliers under FFS Medicare, except as permitted under section 1899(f) of the Act.

(b) Scope. This part sets forth the following:

(1) The eligibility requirements for an ACO to participate in the Medicare Shared Savings Program (Shared Savings Program).

(2) Application procedures and provisions of the participation agreement.

(3) Program requirements and beneficiary protections.

(4) The method for assigning Medicare fee-for-service beneficiaries to ACOs.

(5) Quality performance standards, reporting requirements, and data sharing.

(6) Payment criteria and methodologies (one-sided model and two-sided models).

(7) Compliance monitoring and sanctions for noncompliance.

(8) Reconsideration review process.

[76 FR 67973, Nov. 2, 2011, as amended at 80 FR 32833, June 9, 2015]

---