(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 106
would only be available in the first year of the program and for all subsequent years all
applications would have to be reviewed and accepted prior to the beginning of the
applicable calendar year and all agreements would be for 3 years.
2. Timing and Process for Evaluating Shared Savings
Section 1899(d)(1) of the Act, as added by section 3022 of the Affordable Care
Act, provides that an ACO shall be eligible to receive shared savings payments for each
year of the agreement period, if the ACO has met the quality performance standards
established under section 1899(b)(3) of the Act and has achieved the required percent of
savings below its benchmark. However, the statute is silent with respect to when the
shared savings determination should be made. Potential ACOs have indicated that they
need timely feedback on their performance in order to develop and implement
improvements in care delivery. In developing our proposals, we have therefore been
attentive to the importance of determining shared savings payments and providing
feedback to ACOs on their performance in a timely manner while at the same time not
sacrificing the accuracy needed to calculate per capita expenditures.
Our determination of an ACO's eligibility to receive a payment for shared savings
will be based upon an analysis of the claims submitted by providers and suppliers for
services and supplies furnished to beneficiaries assigned to the ACO. There is an
inherent lag between when a service is performed and when a claim is submitted to us for
payment. Additionally, there is also a time lag between when the claim is received by us
and when the claim is paid. For this reason, all Medicare service and expenditure data
have what can be defined as a claims run-out period. The claims run-out period is the
time between when a Medicare-covered service has been furnished to a beneficiary and