(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 20
savings only if the estimated average per capita Medicare expenditures under the ACO
for Medicare FFS beneficiaries for Parts A and B services, adjusted for beneficiary
characteristics, is at least the percent specified by the Secretary below the applicable
benchmark. The Secretary shall determine the appropriate percent of shared savings to
account for normal variation in Medicare expenditures, based upon the number of
Medicare FFS beneficiaries assigned to an ACO. Section 1899(d)(1)(B)(ii) of the Act, in
turn, requires the Secretary to estimate a benchmark for each agreement period for each
ACO using the most recent available 3 years of per beneficiary expenditures for Parts A
and B services for Medicare FFS beneficiaries assigned to the ACO. This benchmark
must be adjusted for beneficiary characteristics and such other factors as the Secretary
determines appropriate and updated by the projected absolute amount of growth in
national per capita expenditures for Parts A and B services under the original Medicare
FFS program, as estimated by the Secretary. Furthermore, the benchmark must be reset
at the start of each new agreement period.
Section 1899(d)(2) of the Act provides for the actual payments for shared savings
under the Shared Savings Program. Specifically, if an ACO meets the quality
performance standards established by the Secretary, and meets the savings requirements,
a percent (as determined appropriate by the Secretary) of the difference between the
estimated average per capita Medicare expenditures in the year, adjusted for beneficiary
characteristics, and the benchmark for the ACO may be paid to the ACO as shared
savings and the remainder of the difference shall be retained by the Medicare program.
The Secretary is required to establish limits on the total amount of shared savings paid to
an ACO.