ACO MSSP SOW FY27_Draft for SSN.pdf

Department of Health and Human Services

Centers for Medicare & Medicaid Services

Statement of Work

Accountable Care Organization Medicare Shared Savings Program®

(ACO MSSP) Financial Services (draft November 2026) DRAFT

A. Purpose The financial services contractor (Contractor) shall be responsible for making payments and providing related financial services in support of the Accountable Care Organization (ACO) Medicare Shared Savings Program (MSSP) for the Centers for Medicare & Medicaid Services (CMS).

B. Background

The Medicare Shared Savings Program (MSSP) offers providers and suppliers (e.g., physicians, hospitals, and others involved in patient care) an opportunity to create an Accountable Care Organization (ACO).

An ACO agrees to be held accountable for the quality, cost, and experience of care of an assigned Medicare Fee-for-Service (FFS) beneficiary population. The goal is for the ACO to focus on delivering the right care at the right time, while avoiding unnecessary services and medical errors. When the ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, the ACO may be eligible to share in the savings it achieves for Medicare. The MSSP has different participation options (tracks) that allow ACOs to select an arrangement that makes the most sense for their organization.

The MSSP is an important innovation for moving the CMS' payment system away from volume and toward value and outcomes and is an alternative payment model that:

• Promotes accountability for a patient population.

• Coordinates items and services for Medicare FFS beneficiaries.

• Encourages investment in high quality and efficient services.

Under the MSSP, providers of services and suppliers that participate in an ACO continue to receive traditional Medicare FFS payments under Parts A and B. ACOs that successfully meet quality and savings requirements share a percentage of the savings with Medicare. ACOs under a performance-based risk track may also be required to repay Medicare for shared losses.

As of January 1, 2026, there are 511 ACOs participating in the MSSP, serving a total of 12.6 million beneficiaries. Within the MSSP, CMS enters into agreements with ACOs. ACOs facilitate coordination and cooperation among health care providers to improve the quality of care for Medicare FFS beneficiaries and reduce the rate of growth in expenditures under Medicare Parts A and B. For each performance year of the agreement period, ACOs share in a percentage of the savings they generate if the expenditures of the ACO’s assigned beneficiaries are below their benchmark (i.e., their unique targets) by an amount that meets or exceeds a minimum savings rate threshold, and if they meet the quality performance standard and otherwise maintain their eligibility to participate in the MSSP. ACOs participating in a two-sided model must also pay CMS a percentage of shared losses if expenditures for the ACO’s assigned beneficiaries for the performance year exceeds their benchmark by an amount that meets or exceeds a minimum loss rate threshold.

The MSSP also offers an Advance Investment Payment (AIP) option where eligible ACOs receive an upfront payment of $250,000 and two years of quarterly payments.

The Center for Medicare (program office) is always evaluating the program and updating payment options, impacting the volume and frequency of payments to be disbursed to the ACOs.

DRAFT

STATUTORY BACKGROUND

Section 3022 of the Affordable Care Act amended Title XVIII of the Social Security Act (the Act) (42 U.S.C. 1395 et seq.) by adding new section 1899 to the Act to establish the Shared Savings Program.

The requirements for assignment under the program were amended by the 21st Century Cures Act (December 2016, Pub. L. 114–255). The 21st Century Cures Act amended section 1899 of the Act to require the Secretary to assign beneficiaries to ACOs participating in the MSSP based not only on their utilization of primary care services furnished by physicians, but also on their utilization of services furnished by Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), effective for performance years beginning on or after January 1, 2019. The Bipartisan Budget Act of 2018 (February 2018, Pub. L. 115–123) amended section 1899 of the Act to provide for greater flexibility in the assignment of Medicare FFS beneficiaries to ACOs by allowing ACOs in tracks under retrospective beneficiary assignment a choice of prospective assignment for the agreement period, permitting Medicare FFS beneficiaries to voluntarily identify an ACO professional as their primary care provider for purposes of assigning such beneficiaries to an ACO and requiring that such beneficiaries be notified of their ability to make and change such identification, and mandating that any such voluntary identification will supersede claims-based assignment, among other changes.

For the MSSP regulations, refer to 42 CFR part 425. Details on these regulations, and changes to the regulations, are specified in Federal Register publications that can be accessed through the Program Statutes & Regulations webpage of the Shared Savings Program website.

C. Scope of Work The Contractor shall provide financial services necessary to support the ACO MSSP. The Contractor must be able to open and maintain a CMS approved bank account. The Contractor must be able to retrieve payee information, build a payment file and disburse Electronic Funds Transfer (EFT) payments to the ACOs from this account. The Contractor will perform various pre-validation checks before issuing payments, apply Federal Payment Levy Program (FPLP) withholding in accordance with U.S. Department of Treasury requirements, and send IRS 1099- MISC forms annually for payments made to payees in accordance with IRS threshold and reporting requirements.

The Contractor shall be responsible for collecting overpayments attributable to administrative errors.

The Contractor shall be responsible for project funds control in compliance with all applicable laws, regulations, Federal Accounting Standards, Generally Accepted Accounting Principles, and also comply with CMS’ Office of Financial Management (OFM) guidelines and reporting requirements, and CMS Internet Only Manual (IOM)/Medicare Financial Management Manual, Chapters 3-7 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs- Items/CMS019018.

D. Requirements The Contractor shall:

1. Establish and manage a CMS approved bank account for the MSSP The Contractor shall establish and manage an approved bank account in a designated CMS Medicare bank. The CMS approved bank account shall be non-interest bearing and be restricted to receiving the U.S. Department of Treasury deposits and processing of Accounts Payable (AP), Accounts Receivable (AR) and related ACO MSSP financial transactions. The Treasury shall deposit funds into this account

DRAFT

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019018 for each ACO Shared Savings Program participant as scheduled by CMS. These funds shall be disbursed by the Contractor into the ACO Shared Savings Program participant bank account as indicated on each of their Electronic Funds Transfer Authorization Agreement (CMS-588) form. The Contractor is required to process all payments within 48-hours from the time Treasury funds are deposited into the ACO MSSP bank account unless otherwise directed by CMS. The Contractor shall be responsible for managing the funding in the bank account and for all required reports and reconciliations in accordance with CMS Financial Management Policy.

2. Receive and verify ACO MSSP ACOs banking information CMS shall provide the Contractor with the necessary banking and contact information for each participating ACO via the CMS-588 form, collected from each ACO by CMS. The CMS-588 form includes critical banking information: routing and transit number (RTN), depositor account number (DAN), legal business name, tax identification number (TIN) and participant contact person. In addition to the CMS-588 form, each ACO Shared Savings participant must also submit either a bank printed check or a signed letter from the bank verifying the RTN and DAN.

CMS will share a copy of each CMS-588 form, or updated form with the Contractor either directly via secure email or a secure email invitation link to the file.

Contractor shall retrieve both the CMS-588 form and the supporting bank documentation provided for each ACO. Contractor shall verify the CMS-588 form is filled out entirely and in accordance with the form instructions. Contractor also shall validate the banking information provided on the CMS-588 matches with the supporting documentation.

CMS-588 forms are updated by ACOs mostly on an ad-hoc basis, but also as requested by the program manager and annually as part of a new enrollment year. Many ACOs also update their forms prior to the annual issuance of 1099 forms. The Contractor will need to verify they are utilizing most up-to-date version of the CMS-588 form for each ACO prior to issuing any payment or 1099 form. As of January 2026, there are 511 ACOs enrolled in the Shared Savings Program, with more potentially to be added annually.

3. Coordinate with the COR to develop the timeline and format for the Payment Information File

(PIF)

The Contractor shall work with the COR and other CMS designated project staff to develop the PIF format that the Contractor will use for payment distribution. This file shall be sent by the CMS COR or other CMS designated project staff to the Contractor prior to each payment cycle; at a minimum, this file shall include the legal name, ACO ID, TIN, and payment amount to be disbursed under the Medicare Part A and B Trust funds for each ACO Shared Savings participant. The payment cycles are governed by the Demonstration Payment System (DPS). The DPS schedule dictates documentation due dates, fund approval dates and dates for funds to be disbursed to the Contractor bank account. The COR will provide the Contractor with the DPS schedule as it is updated (annually). The DPS runs two payment cycles per month for a total of 24 per calendar year. An ACO MSSP request could be made for any of these payment cycles.

4. Conduct pre-payment File Validation The Contractor shall conduct pre-payment file validation on the PIF and against the CMS-588 form for each ACO prior to payment to ensure all payee information is accurate. In addition, the Contractor shall validate payment files against the Office of Inspector General (OIG) Exclusion list to ensure ACO MSSP payments are made to sanctioned payees. The Contractor shall notify CMS COR when payees on the payment file are identified on the OIG Exclusion list.

5. Conduct pre-note testing The Contractor shall conduct pre-note testing on the PIF in accordance with National Automated Clearing House Association (Nacha) standards for payment purposes to validate payee bank information. The Contractor shall work with CMS to resolve any errors/rejects from the pre-note testing.

In addition to the pre-note process, the COR may direct the Contractor to run the Account Validation Service (AVS) validation for certain payments.

6. Apply Federal Payment Levy Program (FPLP) withholding to the payment amounts

The Contractor shall ensure that all ACO MSSP payments are subjected to the FPLP withholding to collect payments for Federal tax or non-tax debts in accordance with the U.S. Department of Treasury policy and procedures. The Contractor will ensure the offset funds are returned to Treasury in accordance with Treasury policy and procedures. The Contractor shall produce letter listing the FPLP withholding amount for each ACO, as applicable. The COR will provide a template for the letter and will forward the final copy to the program office who will ensure delivery to the ACO.

Prior to the first payment, the Contractor will need to coordinate with the U.S. Treasury to conduct testing and establish a connection to the U.S. Treasury Offset Program (TOP) database that will be used by the Contractor to perform TIN matching validation of ACO MSSP payee payments.

7. Prepare Electronic Funds Transfer (EFT) payment file The Contractor shall prepare the EFT payment file to upload for disbursement to ACOs through the CMS approved bank account. CMS shall certify the total funding requested and authorize the transfer of funds through Healthcare Integrated General Ledger Accounting System (HIGLAS) from CMS’ account with Treasury to the bank account maintained by the Contractor.

COR will alert the Contractor as to the expected date of deposit of funds from Treasury. Contractor shall confirm receipt of funds for each deposit. The Contractor shall make EFT deposits to the ACOs no later than 48 hours after the bank has received the funds deposit from the Treasury, unless otherwise directed by the COR.

8. Overpayment recovery The Contractor shall work with CMS/Office of Financial Management (OFM)/Financial Services Group (FSG)/Division of Financial Services and Debt Management (DFSDM) to develop and mail demand letters to recover overpayments from Shared Savings participants for administrative errors, as required by CMS. The Contractor shall post the receivables within their accounting system and report on collections to CMS. The Contractor shall also refer uncollected delinquent debts to Treasury if payment in full is not received within 90 days from the date of the demand letter. The Contractor shall be capable of accepting both ACH/wire transfer payments of MSSP receivables into their CMS bank account and paper check payments deposited to a designated CMS lockbox account.

9. Prepare and send an ACH Daily Batch Detail Report to CMS The Contractor shall forward an ACH Daily Batch Detail Report for each payment cycle to CMS. The Report shall include the gross total funding request, the Shared Savings participant ACO ID number, name, TIN and payee amounts to support the total amount of the funding request.

10. Issue IRS 1099-MISC forms to each payee annually The Contractor shall issue IRS 1099-MISC forms to all payees (excluding non-profits) that received payments during the prior calendar year, no later than January 31st of the following calendar year.

Contractor shall ensure the proper program and payment information is printed on each 1099-MISC in accordance with IRS threshold and reporting requirements.

11. Provide financial management and funds control in compliance with CMS requirements The Contractor shall ensure that financial management and funds control processes are in compliance with CMS standards, regulations, and requirements. The Contractor shall reconcile the bank account monthly and provide bank statements to the COR for review after every payment cycle.

12. Provide financial project reports to COR as required The Contractor shall provide CMS with a detailed monthly payment report including payment amount by recipient, payment date, and other detailed payment information after each payment cycle. The Contractor shall provide monthly Daily Balance reports and Summary reports provided by the designated CMS commercial bank as well as bank account reconciliations.

• Government Furnished Property None

• Report Requirements The Contractor shall provide monthly progress reports to the COR as indicated in #12 and other reporting as deemed necessary by the COR.

E. Deliverables

The following table outlines the schedule of deliverables the Contractor shall be required to meet.

Deliverable

Requirement

Description

Due Date

1.

D.1.

Establish CMS Bank Account for MSSP payments

Three weeks after date of award

2.

D.2.

Verify receipt of secure files or link to MSSP ACO CMS-588 forms

Within 48 hours of receiving link/file from CMS

3.

D.3.

Coordinate with CMS to develop the format for the Payment Information File

Two weeks after date of award

4.

D.4.

Validate the EFT payment file using the CMS-588 forms

Within three business days following receipt of file from COR.

COR will send file at least one week prior to each payment cycle

5.

D.5.

Conduct pre-note testing on each payee account. Notify COR of any pre-note issues prior to issuing payment.

Per payment cycle. COR will notify via email exact date for the Contractor to begin pre-note testing

6.

D.6

Perform FPLP TIN comparison with

Treasury’s TOP database; inform COR of any withholdings required and remit those funds to Treasury

Per payment cycle; One letter for each ACO FPLP withholding within 48 hours completing FPLP process

7.

D.7

Create EFT file and disburse payments

EFT files are created with each payment cycle. Funds must be approved and disbursed from the CMS bank account to the ACOs within 48 hours of funding deposit unless otherwise specified by the COR

8.

D.8

Send demand letters and recoup overpayments for administrative errors

As required by CMS

9.

D.9

Provide ACH Daily Batch Detail

Report

One report required for each disbursement. Email to COR within 24 hours of disbursement approval/or as available by the Bank

10.

D.10

Generate and issue IRS 1099-MISC forms to each payee

Annually, no later than January 31st of the following calendar year

F. Assumptions and Constraints

In performing under this SOW, the Contractor shall take the following assumptions and constraints into consideration:

1. All work under this contract shall be performed under the general guidance and monitoring of the CMS COR and is subject to his or her approval.

2. Only ACOs participating in the MSSP shall receive payments via the ACO MSSP bank account.

The program typically issues one large annual payment to participants who shared in the MSSP program savings. This payment is usually made sometime between September-November. The program also makes quarterly payments to a subset of participants for Advance Investment Payments (AIPs). This schedule is currently set up for payments to be made January 1, April 1, July 1 and October 1.

3. CMS shall provide the Contractor with the CMS-588 form for each payee that includes ACO name, TIN, banking account/routing numbers, type of account, payee address and contact information for paper checks and IRS-1099 forms.

4. The Contractor shall maintain financial records in accordance with government accounting principles and applicable government laws and regulations. In addition, payments made under this contract must be accounted for and reported in accordance with CMS financial reporting requirements.

5. The Contractor shall furnish the necessary personnel, facilities, equipment, materials and supplies to perform the work set forth within this SOW.

6. The Contractor shall comply with any and all releases of information (whether electronic or hard copy) with the Privacy Act, Freedom of Information Act, Health Insurance Portability and Accountability Act (HIPAA), and all other federal laws and regulations, as well as all CMS regulations, directives, instructions, and manuals with regard to privacy and security.

7. Any electronic transactions (involving the transmission or acceptance of information by the Contractor) governed by HIPAA shall be in full compliance with all HIPAA laws, regulations, directives, and instructions.

8. The Contractor shall deliver reports and other written deliverables under this SOW in an electronic format compatible with Microsoft Office software and in compliance with the Financial Management Internet-Only Manual (IOM).

11.

D.11 & 12

Provide monthly bank reconciliations, Daily Summary and Balance reports

By the 10th of each Month

12.

D.12

Project reports

Ad-hoc; As requested by the CMS

COR

G. Applicable Reference

The following is provided as a supporting reference to this SOW:

• Internet-Only Manual (IOM); See Internet-Only Manuals http://www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html (100-06 Medicare Financial Management Manual, Chapter 5 Financial Reporting

DRAFT

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html

Appendix

SECTION 508 - ACCESSIBILITY OF ELECTRONIC AND INFORMATION TECHNOLOGY

(a) This Task Order is subject to Section 508 of the Rehabilitation Act of 1973 (29 U.S.C. 794d) as amended by the workforce Investment Act of 1998 (P.L. 105-220). Specifically, subsection 508(a)(1) requires that when the Federal Government procures Electronic and Information Technology (EIT), the EIT must allow Federal employees and individuals of the public with disabilities comparable access to and use of information and data that is provided to Federal employees and individuals of the public without disabilities.

(b) The EIT accessibility standards at 36 CFR Part 1194 were developed by the Architectural and Transportation Barriers Compliance Board ("Access Board") and apply to contracts and task/delivery orders, awarded under indefinite quantity contracts on or after June 25, 2001.

(c) Each Electronic and Information Technology (EIT) product or service furnished under this contract shall comply with the Electronic and Information Technology Accessibility Standards (36 CFR 1194), as specified in the contract, as a minimum. If the Contracting Officer determines any furnished product or service does not comply with the contract, the Contracting Officer will promptly inform the Contractor in writing. The Contractor shall, without charge to the Government, repair or replace the non-compliant products or services within the period to be specified by the Government in writing. If such repair or replacement is not completed within the time specified, the Government shall have the following recourses:

1. Cancellation of the contract, delivery or task order, purchase or line item without termination liabilities; or

2. In the case of custom Electronic and Information Technology (EIT) being developed by a Contractor for the Government, the Government shall have the right to have any necessary changes made or repairs performed by itself or by another firm for the noncompliant EIT, with the Contractor liable for reimbursement to the Government for any expenses incurred thereby.

(d) The Contractor must ensure that all EIT products that are less than fully compliant with the accessibility standards are provided pursuant to extensive market research and are the most current compliant products or services available to satisfy the contract requirements.

(e) For every EIT product or service accepted under this contact by the Government that does not comply with 36 CFR 1194, the Contractor shall, at the discretion of the Government, make every effort to replace or upgrade it with a compliant equivalent product or service, if commercially available and cost neutral, on either a contract specified refresh cycle for the product or service, or on a contract effective option/renewal date; whichever shall occur first.

Section 508 Compliance for Communications

Contractor shall comply with the standards, policies, and procedures below. In the event of conflicts between the referenced documents and this Task Order shall take precedence.

Rehabilitation Act, Section 508 Accessibility Standards

1. 29 U.S.C. 794d (Rehabilitation Act as amended)

2. 36 CFR 1194 (508 Standards)

3. www.access-board.gov/sec508/508standards.htm (508 standards)

4. FAR 39.2 (Section 508)

5. CMS/HHS Standards, policies and procedures (Section 508)

In addition, all contract deliverables are subject to these 508 standards as applicable.

Regardless of format, all Web content or communications materials produced, including text, audio or video - must conform to applicable Section 508 standards to allow federal employees and members of the public with disabilities to access information that is comparable to information provided to persons without disabilities. All Contractors (including subcontractors) or consultants responsible for preparing or posting content must comply with applicable Section 508 accessibility standards, and where applicable, those set forth in the referenced policy or standards documents above. Remediation of any materials that do not comply with the applicable provisions of 36 CFR Part 1194 as set forth in the Task Order shall be the responsibility of the Contractor or consultant.

The following Section 508 provisions apply to the content or communications material identified in this Task Order:

36 CFR Part 1194.21 a - l

36 CFR Part 1194.22 a – p

36 CFR Part 1194.31 a – f

36 CFR Part 1194.41 a – c

The Contractor shall provide a completed Section 508 Product Assessment Template, and the Contractor shall state exactly how proposed EIT deliverable(s) meet or does not meet the applicable standards.

The following Section 508 provisions apply for software development material identified in this SOW, PWS, or TO:

For software development, the Contractor/Developer/Vendor shall comply with the standards, policies, and procedures below:

Rehabilitation Act, Section 508, Accessibility Standards

(1) 29 U.S.C. 794d (Rehabilitation Act as amended)

(2) 36 CFR 1194 (508 Standards)

36 CFR Part 1194.21 (a – l) http://www.access-board.gov/sec508/508standards.htm%20(508

36 CFR Part 1194.31 (a – f) 36 CFR Part 1194.41 (a – c)

(3) www.access-board.gov/sec508/508standards.htm (508 Standards)

(4) FAR 39.2 (Section 508)

(5) CMS/HHS Standards, policies and procedures (Section 508)

a. Information Technology – General Information (http://www.cms.hhs.gov/InfoTechGenInfo/)

For web-based applications, the Contractor shall comply with the standards, policies, and procedures below:

Rehabilitation Act, Section 508, Accessibility Standards

(1) 29 U.S.C. 794d (Rehabilitation Act as amended)

(2) 36 CFR 1194 (508 Standards)

36 CFR Part 1194.22 (a – p) 36 CFR Part 1194.41 (a – c)

(3) www.access-board.gov/sec508/508standards.htm (508 Standards)

(4) FAR 39.2 (Section 508)

(5) CMS/HHS Standards, policies and procedures (Section 508)

a. Information Technology – General Information (http://www.cms.hhs.gov/InfoTechGenInfo/ http://www.access-board.gov/sec508/508standards.htm http://www.cms.hhs.gov/InfoTechGenInfo/ http://www.access-board.gov/sec508/508standards.htm http://www.cms.hhs.gov/InfoTechGenInfo/