Shared Savings Program Application

Steps to the Shared Savings Program Application Process

Step 1:  Submit a Notice of Intent to Apply - CLOSED for Program Year 2013

Step 2:  Get a CMS User ID to Submit Your Application Online - Form CMS-20037 - DUE July 9, 2012

Step 3:  Complete Your Application

Physician Group Practice Applicants to the Shared Savings Application

Who to Contact for Assistance

Application Cycle: Key Dates for Program Year 2013

*  Date an organization must receive a favorable reconsideration review determination in order to qualify for the start date indicated on the application.

We will issue dates for the January 2014 application cycle in Spring 2013.

Step 1: Submit a Notice of Intent to Apply - CLOSED for Program Year 2013

Step 2: Get a CMS User ID to Submit Your Application - DUE July 9, 2012

To submit your application, you need a CMS User ID to access the Health Plan Management System (HPMS.)  

Submit Form CMS-20037 Application for Access to CMS Computer Systems by

• using the link and instructions provided in your NOI acknowledgement Email,
• via tracked mail (Federal Express, United Parcel Service, etc.) and

• no later than July 9, 2012.  Do not wait until the deadline.

Step 3: Complete Your Application

You must submit your application online through HPMS.  The information posted below is for reference only.

We will accept applications from August 1 through September 6, 2012.

Application

• Use the Toolkit to complete your Application (updated: 7/25/2012) [PDF, 260KB].

Forms

• Form CMS-588  Electronic Funds Transfer (EFT) Authorization Agreement See here for FAQs.
  Formerly “Appendix A”

Templates

• ACO Participant List Template (updated 7/30/12) [ZIP, 4KB] . See here for FAQs.
• Governing Body Template [ZIP, 10KB] . See here for FAQs.
• ACO Participation Agreement Template [ZIP, 282KB] .
• Executed Agreement Template [ZIP, 11KB] .

Physician Group Practice Applicants to the Shared Savings Application

If you are currently a Physician Group Practice Demonstration participant and you would like to submit a Shared Savings Program application, please send an e-mail to the application mailbox.

Who to Contact for Assistance

For NOI or application questions:   SSPACO_Applications@cms.hhs.gov or (410) 786-8084

For problems getting into HPMS, Form CMS-20037, or CMS User ID:  HPMS_Access@cms.hhs.gov or (800) 220-2028

For problems using HPMS and technical assistance:  HPMS@cms.hhs.gov or (800) 220-2028

Visit this page frequently for updated information and materials.