2017 Medicare Shared Savings Program Toolkit

Use the 2017 Application Reference Manual (Updated 07/14/2016) PDF, 1MB as a guide as you complete your Initial Application or Renewal Application and/or Skilled Nursing Facility (SNF) 3-Day Rule?Waiver Application (only available to Track 3 applicants) in the Health Plan Management System (HPMS). Be sure to use the required templates, correct file format(s), and naming conventions outlined in the Application Reference Manual appendices. Please do not upload the hard copy application forms in HPMS. Paper applications are not accepted.
Access HPMS , our online application system, to complete and submit your application.
How to Complete Form CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement
Use the Form CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement to tell us about the relationship with your banking partner.
Include the Form CMS 588 ACO Cover Sheet PDF, 98KB and supporting documentation in your package. Your Form CMS-588 package must be sent by tracked mail to the address included in the instructions. Do not upload this document with your application materials in HPMS.
Use the Governing Body Template to tell us about your Governing Body. All fields relate to the members on the Governing Body.
For instructions on how to complete the form, see How to complete the Governing Body Template PDF, 211KB
See the "HPMS SSP ACO Participant List Management Module User Guide? to assist you with submitting your ACO Participant List in HPMS. This User Guide is located in the User Manual? section of the SSP ACO Participant List Management" module in HPMS.
Use the ACO Participant Agreement Template to tell us about the agreements you have with your ACO participants.
Use the User Guide in HPMS to assist you with submitting your SNF Affiliate List in HPMS (Coming Soon).
Use the SNF Affiliate Agreement Template to tell us about the agreements you have with your SNF affiliates.
While we review your application(s) or anytime during your agreement period, we may ask you to submit additional information to support the statements you made on this application. affiliate marketing average income You will get a formal request for information (RFI) with instructions on how to submit information. We must get the requested information by the date specified on the CMS notice.
To withdraw a pending application(s), you must submit a written request to that effect on your organization's letterhead, signed by the authorized official, before CMS issues final approval or denial dispositions. Your letter must include:
Send the request as a PDF to SSPACO_Applications@ Put your ACO ID and the words ?Withdrawal Request' in the subject line of the e-mail.
You may have the right to request a reconsideration review if we deny your Medicare Shared Savings Program and/or SNF 3-Day Rule Waiver application(s). Please see the Reconsideration Review Request and Process Guidance for further instructions.
For help with Form CMS-20037 and CMS User ID: HPMS_Access@ or (800) 220-2028
For password resets and if your account is locked: CMS_IT_SERVICE_DESK@ or (800) 562-1963
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