(a) General rules. An ACO may request renewal of its participation agreement for a second or subsequent agreement period.
(1) In order to obtain a determination regarding whether it meets the requirements for renewal of its participation agreement, the ACO must submit a complete renewal request in the form and manner and by the deadline specified by CMS.
(2) An ACO executive who has the authority to legally bind the ACO must certify to the best of his or her knowledge, information, and belief that the information contained in the renewal request is accurate, complete, and truthful.
(3) An ACO that seeks renewal of its participation agreement and was newly formed after March 23, 2010, as defined in the Antitrust Policy Statement, must agree that CMS can share a copy of its renewal request with the Antitrust Agencies.
(b) Review of renewal request. (1) CMS determines whether to renew a participation agreement based on an evaluation of all of the following factors:
(1) CMS determines whether to renew a participation agreement based on an evaluation of all of the following factors:
(i) Whether the ACO satisfies the criteria for operating under the selected risk track.
(ii) The ACO's history of compliance with the requirements of the Shared Savings Program.
(iii) Whether the ACO has established that it is in compliance with the eligibility and other requirements of the Shared Savings Program, including the ability to repay losses, if applicable.
(iv) Whether the ACO met the quality performance standard during at least 1of the first 2 years of the previous agreement period.
(v) For ACOs under a two-sided model, whether the ACO has repaid losses owed to the program that it generated during the first 2 years of the previous agreement period.
(vi) The results of a program integrity screening of the ACO, its ACO participants, and its ACO providers/suppliers (conducted in accordance with Sec. 425.304(b)).
(2) Renewal requests are approved or denied on the basis of the following information:
(i) Information contained in and submitted with the renewal request by a deadline specified by CMS.
(ii) Supplemental information that was submitted by a deadline specified by CMS in response to a CMS request for information.
(iii) Other information available to CMS.
(3) CMS notifies the ACO when supplemental information is required for CMS to make such a determination and provides an opportunity for the ACO to submit the information.
(c) Notice of determination. (1) CMS notifies the ACO in writing of its determination to approve or deny the ACO's renewal request.
(1) CMS notifies the ACO in writing of its determination to approve or deny the ACO's renewal request.
(2) If CMS denies the renewal request, the notice of determination--
(i) Specifies the reasons for the denial; and
(ii) Informs the ACO of its right to request reconsideration review in accordance with the procedures specified in subpart I of this part. [80 FR 32839, June 9, 2015]