(a) General. CMS establishes quality performance measures to assess the quality of care furnished by the ACO. If the ACO demonstrates to CMS that it has satisfied the quality performance requirements in this subpart, and the ACO meets all other applicable requirements, the ACO is eligible for shared savings.
(b) Selecting measures. (1) CMS selects the measures designated to determine an ACO's success in promoting the aims of better care for individuals, better health for populations, and lower growth in expenditures.
(1) CMS selects the measures designated to determine an ACO's success in promoting the aims of better care for individuals, better health for populations, and lower growth in expenditures.
(2) CMS designates the measures for use in the calculation of the quality performance standard.
(3) CMS seeks to improve the quality of care furnished by ACOs over time by specifying higher standards, new measures, or both.
(c) ACOs must submit data on the measures determined under paragraph (b) of this section according to the method of submission established by CMS.
(d) Patient experience of care survey. For performance years beginning in 2014 and for subsequent performance years, ACOs must select a CMS-certified vendor to administer the survey and report the results accordingly.
(e) Audit and validation of data. CMS retains the right to audit and validate quality data reported by an ACO.
(1) In an audit, the ACO will provide beneficiary medical records data if requested by CMS.
(2) The audit will consist of three phases of medical record review.
(3) If, at the conclusion of the third audit process there is a discrepancy greater than 10 percent between the quality data reported and the medical records provided, the ACO will not be given credit for meeting the quality target for any measures for which this mismatch rate exists.
(f) Failure to report quality measure data accurately, completely, and timely (or to timely correct such data) may subject the ACO to termination or other sanctions, as described in Secs. 425.216 and 425.218.