---
kind: "section"
citation: "42 C.F.R. § 425.214"
title: "42"
number: "425.214"
heading: "Managing changes to the ACO during the agreement period."
url: "https://uscodex.org/cfr/42/425.214"
---

# §425.214. Managing changes to the ACO during the agreement period.

- (a)
  - (1) An ACO must notify CMS within 30 days of any significant change.
  - (2) An ACO's failure to notify CMS of a significant change does not preclude CMS from determining that the ACO has experienced a significant change.
  - (3) A “significant change” occurs when an ACO is no longer able to meet the eligibility or program requirements of this part.
- (b) Upon becoming aware of a significant change or receiving an ACO's notice of a significant change described in [paragraph (b)](#b) of this section, CMS reevaluates the ACO's eligibility to continue to participate in the Shared Savings Program and may request additional documentation. CMS may make a determination that includes one of the following:
  - (1) The ACO may continue to operate under the new structure.
  - (2) The ACO structure is so different from the initially approved ACO that it must terminate its participation agreement and submit a new application for participation.
  - (3) The ACO no longer meets the eligibility criteria for the program and its participation agreement must be terminated.
  - (4) CMS and the ACO may mutually decide to terminate the participation agreement.

## Notes

### Amendments

[76 FR 67973, Nov. 2, 2011, as amended at 80 FR 32838, June 9, 2015]

### Authority

Authority: 42 U.S.C. 1302, 1306, 1395hh, and 1395jjj.

### Source

Source: 76 FR 67973, Nov. 2, 2011, unless otherwise noted.

### Amendments

[76 FR 67973, Nov. 2, 2011, as amended at 80 FR 32838, June 9, 2015]