(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 310
resulting from the operation of this program. However, we note that each State has its
own insurance and risk oversight programs and that some States may regulate risk
bearing entities, such as the ACOs participating in the two-sided model under the Shared
Savings Program. Accordingly, we seek comment on whether any of our proposals for
the two-sided model in particular, or the Shared Savings Program in general, would
trigger the application of any State insurance laws, the adequacy of those provisions that
we have set forth, and the ways that we can work with ACOs and States to minimize the
burden of any additional regulation.
4. Verification of Savings and Losses
We will notify an ACO in writing regarding whether the ACO qualifies for a
shared savings payment, and if so, the amount of the payment due. Similarly, we will
provide written notification to an ACO of the amount of shared losses, if any, that it must
pay to the program. We propose that an ACO must make payment in full to CMS of any
shared losses within 30 days of receipt of notification. Because we will calculate
amounts due to, or owed by, the ACO on the basis of information submitted by the ACO,
we propose that the ACO must certify the accuracy, completeness, and truthfulness of
such information. We propose that, as a condition of receiving a shared savings payment,
the ACO must submit to us a written request for the shared savings payment amount.
The written request must certify the ACO's compliance with program requirements for
the relevant performance period as well as the accuracy, completeness, and truthfulness
of any information submitted to us by the ACO, or its ACO participants, or the ACO
providers/suppliers, or another entity, including the accuracy, completeness, and
truthfulness of TINs used to assign patients, any quality data or other information or data