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Electronic Code of Federal Regulations

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e-CFR Data is current as of August 28, 2014

Title 42Chapter IVSubchapter BPart 425


TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)

SUBCHAPTER B—MEDICARE PROGRAM (CONTINUED)

PART 425—MEDICARE SHARED SAVINGS PROGRAM

rule

Subpart A—GENERAL PROVISIONS

§425.10
Basis and scope.
§425.20
Definitions.
rule

Subpart B—SHARED SAVINGS PROGRAM ELIGIBILITY REQUIREMENTS

§425.100
General.
§425.102
Eligible providers and suppliers.
§425.104
Legal entity.
§425.106
Shared governance.
§425.108
Leadership and management.
§425.110
Number of ACO professionals and beneficiaries.
§425.112
Required processes and patient-centeredness criteria.
§425.114
Participation in other shared savings initiatives.
rule

Subpart C—APPLICATION PROCEDURES AND PARTICIPATION AGREEMENT

§425.200
Agreement with CMS.
§425.202
Application procedures.
§425.204
Content of the application.
§425.206
Evaluation procedures for applications.
§425.208
Provisions of participation agreement.
§425.210
Application of agreement to ACO participants, ACO providers/suppliers, and others.
§425.212
Changes to program requirements during the agreement term.
§425.214
Managing changes to the ACO during the agreement.
§425.216
Actions prior to termination.
§425.218
Termination of the agreement by CMS.
§425.220
Termination of an agreement by the ACO.
§425.222
Re-application after termination.
rule

Subpart D—PROGRAM REQUIREMENTS AND BENEFICIARY PROTECTIONS

§425.300
Compliance plan.
§425.302
Program requirements for data submission and certifications.
§425.304
Other program requirements.
§425.306
Participation agreement and exclusivity of ACO participant TINs.
§425.308
Public reporting and transparency.
§425.310
Marketing requirements.
§425.312
Notification to beneficiaries of participation in shared savings program.
§425.314
Audits and record retention.
§425.316
Monitoring of ACOs.
rule

Subpart E—ASSIGNMENT OF BENEFICIARIES

§425.400
General.
§425.402
Basic assignment methodology.
§425.404
Special assignment conditions for ACOs including FQHCs and RHCs.
rule

Subpart F—QUALITY PERFORMANCE STANDARDS AND REPORTING

§425.500
Measures to assess the quality of care furnished by an ACO.
§425.502
Calculating the ACO quality performance score.
§425.504
Incorporating reporting requirements related to the Physician Quality Reporting System Incentive and Payment Adjustment.
§425.506
Electronic health records technology.
rule

Subpart G—SHARED SAVINGS AND LOSSES

§425.600
Selection of risk model.
§425.602
Establishing the benchmark.
§425.604
Calculation of savings under the one-sided model.
§425.606
Calculation of shared savings and losses under the two-sided model.
§425.608
Determining first year performance for ACOs beginning April 1 or July 1, 2012.
rule

Subpart H—DATA SHARING WITH ACOS

§425.700
General rules.
§425.702
Aggregate reports.
§425.704
Beneficiary-identifiable data.
§425.706
Minimum necessary data.
§425.708
Beneficiaries may decline data sharing.
§425.710
Data use agreement.
rule

Subpart I—RECONSIDERATION REVIEW PROCESS

§425.800
Preclusion of administrative and judicial review.
§425.802
Request for review.
§425.804
Reconsideration review process.
§425.806
On-the-record review of reconsideration official's recommendation by independent CMS official.
§425.808
Effect of independent CMS official's decision.
§425.810
Effective date of decision.


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