CMS assigns beneficiaries to ACOs based on services furnished in FQHCs or RHCs or both consistent with the general assignment methodology in Sec. 425.402, with two special conditions:
(a) Such ACOs are required to identify, through an attestation, physicians who directly provide primary care services in each FQHC or RHC that is an ACO participant and/or ACO provider/supplier in the ACO.
(b) Under the assignment methodology in Sec. 425.402, CMS treats a service reported on an FQHC/RHC claim as a primary care service --
(1) If the claim includes a HCPCS or revenue center code that meets the definition of primary care services under Sec. 425.20;
(2) Performed by a primary care physician if the NPI of a physician identified in the attestation provided under paragraph (a) of this section is reported on the claim for a primary care service (as described in paragraph (b)(1) of this section) as the attending provider; and
(3) Performed by a non-physician ACO professional if the NPI reported on the claim for a primary care service (as described in paragraph (b)(1) of this section) as the attending provider is an ACO professional but is not identified in the attestation provided under paragraph (a) of this section. [76 FR 67973, Nov. 2, 2011, as amended at 80 FR 32841, June 9, 2015]