Shared Savings Program Benchmark PUFs

Guidance for CMS' intention to release the Shared Savings Program analytical public use files on an annual basis.

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 15, 2019

The Center for Medicare (CM) has created analytical files that can be used to inform those interested in the Shared Savings Program’s use of factors based on regional fee-for-service (FFS) expenditures in establishing, adjusting, updating and resetting historical benchmarks for Accountable Care Organizations’ (ACOs).

For each calendar year, CMS will release two public use files (PUFs): (1) Aggregate Expenditure and Risk Score Data on Assignable Beneficiaries by County PUF and (2) Number of ACO Assigned Beneficiaries by County.

Regulatory background - The methodologies for calculating regional FFS expenditures for the Shared Savings Program and determining assigned beneficiaries and assignable beneficiaries are specified in the program’s regulations at 42 CFR part 425, and subject to change through rulemaking. As finalized with the June 2016 final rule (81 FR 37950), CMS initially incorporated factors based on regional FFS expenditures into ACOs’ rebased historical benchmarks for second or subsequent agreement periods beginning in 2017 and onward, and annual updates to these rebased benchmarks. In the Shared Savings Program December 2018 final rule (83 FR 67816), for agreement periods beginning on July 1, 2019 and in subsequent years, CMS revised the benchmarking methodology to also incorporate factors based on regional FFS expenditures in establishing the ACO’s historical benchmark beginning with the ACO’s first agreement period. CMS also revised the methodology for using factors based on regional FFS expenditures to establish, adjust and update the ACO’s historical benchmark.

County-level Aggregate Expenditure and Risk Score Data on Assignable Beneficiaries PUF - Aggregate data consisting of per capita Parts A and B FFS expenditures, average CMS-HCC prospective risk scores and total person-years for assignable beneficiaries by Medicare enrollment type (End Stage Renal Disease (ESRD), disabled, aged/dual eligible, aged/non-dual eligible). It is the intent of CM to publish this PUF annually, in the summer following the conclusion of the calendar year to which it relates and when any file updates are available.

Data Alert: The Performance Year 2021 County-level Aggregate Expenditure and Risk Score Data on Assignable Beneficiaries by County PUF has been posted and made available as of 04/09/2021. The data is downloadable below.

Number of ACO Assigned Beneficiaries by County PUF - Aggregate data consisting of total assigned beneficiaries by ACO for each county where at least one of their assigned beneficiaries resides. These data files include: encrypted ACO ID that is used on publicly released files; state ID (SSA state code); county ID (SSA county code); total person-years by Medicare enrollment type (ESRD, disabled, aged/dual eligible, aged/non-dual eligible); total assigned beneficiary person-years; total number of beneficiaries contributing at least one person-month. It is the intent of CM to publish this PUF annually, close in time to the availability of the annual Shared Savings Program ACO PUF containing performance year results.

Data Alert: The Performance Year 2019 and Performance Year 2019A Number of ACO Assigned Beneficiaries by County PUF has been posted and made available as of 10/15/2020.

The data is downloadable below or available in an interactive format on data.cms.gov:

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