1. (a) General. This section applies to ACOs in agreement periods beginning on July 1, 2019, and in subsequent years. Before the start of a performance year, an ACO may make elections related to its participation in the Shared Savings Program, as specified in this section, effective at the start of the applicable performance year and for the remaining years of the agreement period, unless superseded by a later election in accordance with this section.

   1. (1) Selection of beneficiary assignment methodology. An ACO may select the assignment methodology that CMS employs for assignment of beneficiaries under subpart E of this part. An ACO may select either of the following:

      1. (i) Preliminary prospective assignment with retrospective reconciliation, as described in § 425.400(a)(2).
      2. (ii) Prospective assignment, as described in § 425.400(a)(3).

   2. (2) Selection of BASIC track level. An ACO participating under the BASIC track in the glide path may select a higher level of risk and potential reward, as provided in this section.

      1. (i) An ACO participating under the BASIC track's glide path may elect to transition to a higher level of risk and potential reward within the glide path than the level of risk and potential reward that the ACO would be automatically transitioned to in the applicable year as specified in § 425.605(d)(1). The automatic transition to higher levels of risk and potential reward within the BASIC track's glide path continues to apply to all subsequent years of the agreement period in the BASIC track.

      2. (ii) An ACO transitioning to a higher level of risk and potential reward under paragraph (a)(2)(i) of this section must meet all requirements to participate under the selected level of performance-based risk, including both of the following:

         1. (A) Establishing an adequate repayment mechanism as specified under § 425.204(f).
         2. (B) Selecting a MSR/MLR from the options specified under § 425.605(b).

2. (b) Election procedures.

   1. (1) All annual elections must be made in a form and manner and according to the timeframe established by CMS.
   2. (2) ACO executive who has the authority to legally bind the ACO must certify the elections described in this section.

[83 FR 68066, Dec. 31, 2018]