(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 423
terminated from the shared savings program as well as subject to additional sanctions and
penalties available under the law.
(g) Beneficiary opportunity to opt-out of claims data sharing. (1) Prior to requesting
claims data about a particular beneficiary, the ACO must inform the beneficiary that it may
request personal health information about the beneficiary for purposes of its care coordination
and quality improvement work, and give the beneficiary meaningful opportunity to opt-out of
having his/her claims information shared with the ACO .
(2) The ACO must supply beneficiaries with a form allowing them to opt-out of data
sharing. The form must be provided to each beneficiary as part of an office visit with a primary
care physician as defined under §425.4, whose services are used to assign beneficiaries to the
ACO.
(3) This requirement will not apply to the initial four data points that CMS will provide
to ACOs for individuals in the 3-year base data set (Beneficiary Name, Beneficiary DOB,
Beneficiary Sex, and Beneficiary HICN) under paragraph (c) of this section.
§425.20 New program standards established during the 3 year agreement period.
(a)(1) ACOs will be subject to all statutory changes.
(2) ACOs will be subject to all regulatory changes with the exception of the following
program areas:
(i) Eligibility requirements concerning the structure and governance of ACOs.
(ii) Calculation of sharing rate.
(iii) Beneficiary assignment.
(b) In those instances where changes in law or regulations require, or otherwise cause an
ACO to change its processes in a manner that affects the design of its care processes and delivery