(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 19
program or demonstration project that involves such shared savings, or the Independence
at Home Demonstration under section 1866E of the Act.
Section 1899(c) of the Act provides the Secretary with discretion to determine an
appropriate method to assign Medicare FFS beneficiaries to an ACO participating in the
Shared Savings Program. This discretion is limited, however, by the fact that under the
Act, assignment must be based on beneficiaries' utilization of primary care services
provided under Medicare by an ACO professional who is a physician as defined in
section 1861(r)(1) of the Act.
Section 1899(d) of the Act establishes the principles and requirements for
payments and treatment of savings under the Shared Savings Program. Specifically,
section 1899(d)(1)(A) of the Act provides that, subject to the requirements concerning
monitoring avoidance of at-risk patients, payments shall continue to be made to providers
of services and suppliers participating in an ACO under the original Medicare FFS
program under Parts A and B in the same manner as they would otherwise be made,
except that a participating ACO is eligible to receive payment for shared savings if the
following occur:
• The ACO meets quality performance standards established by the Secretary;
and
• The ACO meets the requirements for realizing savings.
Section 1899(d)(1)(B) of the Act establishes the savings requirements and the
method for establishing and updating the benchmark against which any savings would be
determined. Specifically, section 1899(d)(1)(B)(i) of the Act establishes that, in each
year of the agreement period, an ACO shall be eligible to receive payment for shared