---
kind: "section"
citation: "42 U.S.C. § 1395jjj"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1395jjj"
heading: "Shared savings program"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1395jjj"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XVIII — Health Insurance for Aged and Disabled"
  - "Part E — Miscellaneous Provisions"
---

# §1395jjj. Shared savings program

- (a) **Establishment—**
  - (1) **1 In general—** Not later than January 1, 2012, the [Secretary](/usc/42/1301.md?p=a-6) shall establish a shared savings program (in this section referred to as the “program”) that promotes accountability for a patient population and coordinates items and services under parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery. Under such program—
    - (A) groups of providers of services and [suppliers](/usc/42/1395x.md?p=d) meeting criteria specified by the [Secretary](/usc/42/1301.md?p=a-6) may work together to manage and coordinate care for Medicare fee-for-service beneficiaries through an accountable care organization (referred to in this section as an “ACO”); and
    - (B) ACOs that meet quality performance [standards](/usc/42/1320d.md?p=7) established by the [Secretary](/usc/42/1301.md?p=a-6) are eligible to receive payments for shared savings under [subsection (d)(2)](#d-2).
- (b) **Eligible ACOs—**
  - (1) **In general—** Subject to the succeeding provisions of this subsection, as determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6), the following groups of providers of services and [suppliers](/usc/42/1395x.md?p=d) which have established a mechanism for shared governance are eligible to participate as ACOs under the program under this section:
    - (A) ACO professionals in group practice [arrangements](/usc/42/1395x.md?p=w-1).
    - (B) Networks of individual [practices](/usc/42/17061.md?p=19) of ACO professionals.
    - (C) Partnerships or joint venture [arrangements](/usc/42/1395x.md?p=w-1) between [hospitals](/usc/42/1395x.md?p=e) and ACO professionals.
    - (D) [Hospitals](/usc/42/1395x.md?p=e) employing ACO professionals.
    - (E) Such other groups of providers of services and [suppliers](/usc/42/1395x.md?p=d) as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate.
  - (2) **Requirements—** An ACO shall meet the following requirements:
    - (A) The ACO shall be willing to become accountable for the quality, cost, and overall care of the Medicare fee-for-service beneficiaries assigned to it.
    - (B) The ACO shall enter into an agreement with the [Secretary](/usc/42/1301.md?p=a-6) to participate in the program for not less than a 3-year period (referred to in this section as the “agreement period”).
    - (C) The ACO shall have a formal legal structure that would allow the organization to receive and distribute payments for shared savings under [subsection (d)(2)](#d-2) to participating providers of services and [suppliers](/usc/42/1395x.md?p=d).
    - (D) The ACO shall include primary care ACO professionals that are sufficient for the number of Medicare fee-for-service beneficiaries assigned to the ACO under [subsection (c)](#c). At a minimum, the ACO shall have at least 5,000 such beneficiaries assigned to it under [subsection (c)](#c) in order to be eligible to participate in the ACO program.
    - (E) The ACO shall provide the [Secretary](/usc/42/1301.md?p=a-6) with such information regarding ACO professionals participating in the ACO as the [Secretary](/usc/42/1301.md?p=a-6) determines necessary to support the assignment of Medicare fee-for-service beneficiaries to an ACO, the implementation of quality and other reporting requirements under [paragraph (3)](#b-3), and the determination of payments for shared savings under [subsection (d)(2)](#d-2).
    - (F) The ACO shall have in place a leadership and management structure that [includes](/usc/42/1301.md?p=b) clinical and administrative systems.
    - (G) The ACO shall define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies.
    - (H) The ACO shall demonstrate to the [Secretary](/usc/42/1301.md?p=a-6) that it meets patient-centeredness criteria specified by the [Secretary](/usc/42/1301.md?p=a-6), such as the use of patient and [caregiver](/usc/42/1397j.md?p=3) assessments or the use of individualized care plans.
    - (I) An ACO that seeks to operate an ACO Beneficiary Incentive Program pursuant to [subsection (m)](#m) shall apply to the [Secretary](/usc/42/1301.md?p=a-6) at such time, in such manner, and with such information as the [Secretary](/usc/42/1301.md?p=a-6) may require.
  - (3) **Quality and other reporting requirements—**
    - (A) **In general—** The [Secretary](/usc/42/1301.md?p=a-6) shall determine appropriate measures to assess the quality of care furnished by the ACO, such as measures of—
      - (i) clinical processes and outcomes;
      - (ii) patient and, where practicable, [caregiver](/usc/42/1397j.md?p=3) experience of care; and
      - (iii) utilization (such as rates of [hospital](/usc/42/1395x.md?p=e) admissions for ambulatory care sensitive conditions).
    - (B) **Reporting requirements—** An ACO shall submit data in a form and manner specified by the [Secretary](/usc/42/1301.md?p=a-6) on measures the [Secretary](/usc/42/1301.md?p=a-6) determines necessary for the ACO to report in order to evaluate the quality of care furnished by the ACO. Such data may include care transitions across health care settings, [including](/usc/42/1301.md?p=b) [hospital](/usc/42/1395x.md?p=e) discharge planning and post-[hospital](/usc/42/1395x.md?p=e) discharge follow-up by ACO professionals, as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate.
    - (C) **Quality performance standards—** The [Secretary](/usc/42/1301.md?p=a-6) shall establish quality performance [standards](/usc/42/1320d.md?p=7) to assess the quality of care furnished by ACOs. The [Secretary](/usc/42/1301.md?p=a-6) shall seek to improve the quality of care furnished by ACOs over time by specifying higher [standards](/usc/42/1320d.md?p=7), new measures, or both for purposes of assessing such quality of care.
    - (D) **Other reporting requirements—** The [Secretary](/usc/42/1301.md?p=a-6) may, as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate, incorporate reporting requirements and incentive payments related to the [physician](/usc/42/1395x.md?p=r) quality reporting initiative (PQRI) under [section 1395w–4 of this title](/usc/42/1395w–4.md), [including](/usc/42/1301.md?p=b) such requirements and such payments related to electronic prescribing, electronic health records, and other similar initiatives under [section 1395w–4 of this title](/usc/42/1395w–4.md), and may use alternative criteria than would otherwise apply under such section for determining whether to make such payments. The incentive payments described in the preceding sentence shall not be taken into consideration when calculating any payments otherwise made under [subsection (d)](#d).
  - (4) **No duplication in participation in shared savings programs—** A [provider of services](/usc/42/1395x.md?p=u) or [supplier](/usc/42/1395x.md?p=d) that participates in any of the following shall not be eligible to participate in an ACO under this section:
    - (A) A model tested or expanded under [section 1315a of this title](/usc/42/1315a.md) that involves shared savings under this subchapter, or any other program or demonstration [project](/usc/42/13641.md?p=2) that involves such shared savings.
    - (B) The [independence](/usc/42/242q–4.md?p=1-B) at [home](/usc/42/1395x.md?p=iii-3-B) medical practice pilot program under [section 1395cc–5 of this title](/usc/42/1395cc–5.md).
- (c) **Assignment of Medicare fee-for-service beneficiaries to ACOs—**
  - (1) **In general—** Subject to [paragraph (2)](#c-2), the [Secretary](/usc/42/1301.md?p=a-6) shall determine an appropriate method to assign Medicare fee-for-service beneficiaries to an ACO based on their utilization of—
    - (A) in the case of performance years beginning on or after April 1, 2012, primary care services provided under this subchapter by an ACO professional described in [subsection (h)(1)(A)](#h-1-A); and
    - (B) in the case of performance years beginning on or after January 1, 2019, services provided under this subchapter by a [Federally qualified health center](/usc/42/1395x.md?p=aa-4) or [rural health clinic](/usc/42/1395x.md?p=aa-2) (as those terms are defined in [section 1395x(aa) of this title](/usc/42/1395x.md?p=aa)), as may be determined by the [Secretary](/usc/42/1301.md?p=a-6).
  - (2) **Providing flexibility—**
    - (A) **Choice of prospective assignment—** For each agreement period (effective for agreements entered into or renewed on or after January 1, 2020), in the case where an ACO established under the program is in a Track that provides for the retrospective assignment of Medicare fee-for-service beneficiaries to the ACO, the [Secretary](/usc/42/1301.md?p=a-6) shall permit the ACO to choose to have Medicare fee-for-service beneficiaries assigned prospectively, rather than retrospectively, to the ACO for an agreement period.
    - (B) **Assignment based on voluntary identification by medicare fee-for-service beneficiaries—**
      - (i) **In general—** For performance year 2018 and each subsequent performance year, if a system is available for electronic designation, the [Secretary](/usc/42/1301.md?p=a-6) shall permit a Medicare fee-for-service beneficiary to voluntarily identify an ACO professional as the primary care provider of the beneficiary for purposes of assigning such beneficiary to an ACO, as determined by the [Secretary](/usc/42/1301.md?p=a-6).
      - (ii) **Notification process—** The [Secretary](/usc/42/1301.md?p=a-6) shall establish a process under which a Medicare fee-for-service beneficiary is—
        - (I) notified of their ability to make an identification described in [clause (i)](#c-2-B-i); and
        - (II) informed of the process by which they may make and change such identification.
      - (iii) **Superseding claims-based assignment—** A voluntary identification by a Medicare fee-for-service beneficiary under this subparagraph shall supersede any claims-based assignment otherwise determined by the [Secretary](/usc/42/1301.md?p=a-6).
- (d) **Payments and treatment of savings—**
  - (1) **Payments—**
    - (A) **In general—** Under the program, subject to [paragraph (3)](#d-3), payments shall continue to be made to providers of services and [suppliers](/usc/42/1395x.md?p=d) participating in an ACO under the original Medicare fee-for-service program under parts A and B in the same manner as they would otherwise be made except that a participating ACO is eligible to receive payment for shared savings under [paragraph (2)](#d-2) if—
      - (i) the ACO meets quality performance [standards](/usc/42/1320d.md?p=7) established by the [Secretary](/usc/42/1301.md?p=a-6) under [subsection (b)(3)](#b-3); and
      - (ii) the ACO meets the requirement under [subparagraph (B)(i)](#d-1-B-i).
    - (B) **Savings requirement and benchmark—**
      - (i) **Determining savings—** In each year of the agreement period, an ACO shall be eligible to receive payment for shared savings under [paragraph (2)](#d-2) only if the estimated average per capita Medicare expenditures under the ACO for Medicare fee-for-service beneficiaries for parts A and B services, adjusted for beneficiary characteristics, is at least the percent specified by the [Secretary](/usc/42/1301.md?p=a-6) below the applicable benchmark under [clause (ii)](#d-1-B-ii). The [Secretary](/usc/42/1301.md?p=a-6) shall determine the appropriate percent described in the preceding sentence to account for normal variation in expenditures under this subchapter, based upon the number of Medicare fee-for-service beneficiaries assigned to an ACO.
      - (ii) **Establish and update benchmark—** The [Secretary](/usc/42/1301.md?p=a-6) shall estimate a benchmark for each agreement period for each ACO using the most recent available 3 years of per-beneficiary expenditures for parts A and B services for Medicare fee-for-service beneficiaries assigned to the ACO. Such benchmark shall be adjusted for beneficiary characteristics and such other factors as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate and updated by the projected absolute amount of growth in national per capita expenditures for parts A and B services under the original Medicare fee-for-service program, as estimated by the [Secretary](/usc/42/1301.md?p=a-6). Such benchmark shall be reset at the start of each agreement period.
  - (2) **Payments for shared savings—** Subject to performance with respect to the quality performance [standards](/usc/42/1320d.md?p=7) established by the [Secretary](/usc/42/1301.md?p=a-6) under [subsection (b)(3)](#b-3), if an ACO meets the requirements under [paragraph (1)](#d-1), a percent (as determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6)) of the difference between such estimated average per capita Medicare expenditures in a year, adjusted for beneficiary characteristics, under the ACO and such benchmark for the ACO may be paid to the ACO as shared savings and the remainder of such difference shall be retained by the program under this subchapter. The [Secretary](/usc/42/1301.md?p=a-6) shall establish limits on the total amount of shared savings that may be paid to an ACO under this paragraph.
  - (3) **Monitoring avoidance of at-risk patients—** If the [Secretary](/usc/42/1301.md?p=a-6) determines that an ACO has taken steps to avoid patients at risk in order to reduce the likelihood of increasing costs to the ACO the [Secretary](/usc/42/1301.md?p=a-6) may impose an appropriate sanction on the ACO, [including](/usc/42/1301.md?p=b) termination from the program.
  - (4) **Termination—** The [Secretary](/usc/42/1301.md?p=a-6) may terminate an agreement with an ACO if it does not meet the quality performance [standards](/usc/42/1320d.md?p=7) established by the [Secretary](/usc/42/1301.md?p=a-6) under [subsection (b)(3)](#b-3).
- (e) **Administration—** [Chapter 35](/usc/44/chch35.md) of title 44 shall not apply to the program, [including](/usc/42/1301.md?p=b) an ACO Beneficiary Incentive Program under subsections [(b)(2)(I)](#b-2-I) and [(m)](#m).
- (f) **Waiver authority—** The [Secretary](/usc/42/1301.md?p=a-6) may waive such requirements of sections [1320a–7a](/usc/42/1320a–7a.md) and [1320a–7b](/usc/42/1320a–7b.md) of this title and this subchapter as may be necessary to carry out the provisions of this section.
- (g) **Limitations on review—** There shall be no administrative or judicial review under [section 1395ff of this title](/usc/42/1395ff.md), [section 1395oo](/usc/42/1395oo.md) of this title, or otherwise of—
  - (1) the specification of criteria under [subsection (a)(1)(B)](#a-1-B);
  - (2) the assessment of the quality of care furnished by an ACO and the establishment of performance [standards](/usc/42/1320d.md?p=7) under [subsection (b)(3)](#b-3);
  - (3) the assignment of Medicare fee-for-service beneficiaries to an ACO under [subsection (c)](#c);
  - (4) the determination of whether an ACO is eligible for shared savings under [subsection (d)(2)](#d-2) and the amount of such shared savings, [including](/usc/42/1301.md?p=b) the determination of the estimated average per capita Medicare expenditures under the ACO for Medicare fee-for-service beneficiaries assigned to the ACO and the average benchmark for the ACO under [subsection (d)(1)(B)](#d-1-B);
  - (5) the percent of shared savings specified by the [Secretary](/usc/42/1301.md?p=a-6) under [subsection (d)(2)](#d-2) and any limit on the total amount of shared savings established by the [Secretary](/usc/42/1301.md?p=a-6) under such subsection; and
  - (6) the termination of an ACO under [subsection (d)(4)](#d-4) or of an ACO Beneficiary Incentive Program under subsections [(b)(2)(I)](#b-2-I) and [(m)](#m).
- (h) **Definitions—** In this section:
  - (1) **ACO professional—** The term “ACO professional” means—
    - (A) a [physician](/usc/42/1395x.md?p=r) (as defined in [section 1395x(r)(1) of this title](/usc/42/1395x.md)); and
    - (B) a practitioner described in [section 1395u(b)(18)(C)(i) of this title](/usc/42/1395u.md?p=b-18-C-i).
  - (2) **Hospital—** The term “[hospital](/usc/42/1395x.md?p=e)” means a [subsection (d)](#d) [hospital](/usc/42/1395x.md?p=e) (as defined in [section 1395ww(d)(1)(B) of this title](/usc/42/1395ww.md?p=d-1-B)).
  - (3) **Medicare fee-for-service beneficiary—** The term “Medicare fee-for-service beneficiary” means an individual who is enrolled in the original Medicare fee-for-service program under parts A and B and is not enrolled in an [MA plan](/usc/42/1395w–151.md?p=a-8) under part C, an eligible organization under [section 1395mm of this title](/usc/42/1395mm.md), or a PACE program under [section 1395eee of this title](/usc/42/1395eee.md).
- (i) **Option to use other payment models—**
  - (1) **In general—** If the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate, the [Secretary](/usc/42/1301.md?p=a-6) may use any of the payment models described in paragraph [(2)](#i-2) or [(3)](#i-3) for making payments under the program rather than the payment model described in [subsection (d)](#d).
  - (2) **Partial capitation model—**
    - (A) **In general—** Subject to [subparagraph (B)](#i-2-B), a model described in this paragraph is a partial capitation model in which an ACO is at financial risk for some, but not all, of the items and services covered under parts A and B, such as at risk for some or all [physicians](/usc/42/1395x.md?p=q)’ services or all items and services under part B. The [Secretary](/usc/42/1301.md?p=a-6) may limit a partial capitation model to ACOs that are highly integrated systems of care and to ACOs capable of bearing risk, as determined to be appropriate by the [Secretary](/usc/42/1301.md?p=a-6).
    - (B) **No additional program expenditures—** Payments to an ACO for items and services under this subchapter for beneficiaries for a year under the partial capitation model shall be established in a manner that does not result in spending more for such ACO for such beneficiaries than would otherwise be expended for such ACO for such beneficiaries for such year if the model were not implemented, as estimated by the [Secretary](/usc/42/1301.md?p=a-6).
  - (3) **Other payment models—**
    - (A) **In general—** Subject to [subparagraph (B)](#i-3-B), a model described in this paragraph is any payment model that the [Secretary](/usc/42/1301.md?p=a-6) determines will improve the quality and efficiency of items and services furnished under this subchapter.
    - (B) **No additional program expenditures—** [Subparagraph (B)](#i-2-B) of paragraph (2) shall apply to a payment model under [subparagraph (A)](#i-3-A) in a similar manner as such [subparagraph (B)](#i-3-B) applies to the payment model under [paragraph (2)](#i-2).
- (j) **Involvement in private payer and other third party arrangements—** The [Secretary](/usc/42/1301.md?p=a-6) may give preference to ACOs who are participating in similar [arrangements](/usc/42/1395x.md?p=w-1) with other payers.
- (k) **Treatment of physician group practice demonstration—** During the period beginning on March 23, 2010, and ending on the date the program is established, the [Secretary](/usc/42/1301.md?p=a-6) may enter into an agreement with an ACO under the demonstration under [section 1395cc–1 of this title](/usc/42/1395cc–1.md), subject to rebasing and other modifications deemed appropriate by the [Secretary](/usc/42/1301.md?p=a-6).
- (l) **Providing ACOs the ability to expand the use of telehealth services—**
  - (1) **In general—** In the case of telehealth services for which payment would otherwise be made under this subchapter furnished on or after January 1, 2020, for purposes of this subsection only, the following shall apply with respect to such services furnished by a [physician](/usc/42/1395x.md?p=r) or practitioner participating in an applicable ACO (as defined in [paragraph (2)](#l-2)) to a Medicare fee-for-service beneficiary assigned to the applicable ACO:
    - (A) **Inclusion of home as originating site—** Subject to [paragraph (3)](#l-3), the [home](/usc/42/1395x.md?p=iii-3-B) of a beneficiary shall be treated as an originating site described in [section 1395m(m)(4)(C)(ii) of this title](/usc/42/1395m.md?p=m-4-C-ii).
    - (B) **No application of geographic limitation—** The geographic limitation under [section 1395m(m)(4)(C)(i) of this title](/usc/42/1395m.md?p=m-4-C-i) shall not apply with respect to an originating site described in [section 1395m(m)(4)(C)(ii) of this title](/usc/42/1395m.md?p=m-4-C-ii) ([including](/usc/42/1301.md?p=b) the [home](/usc/42/1395x.md?p=iii-3-B) of a beneficiary under [subparagraph (A)](#l-1-A)), subject to [State](/usc/42/1395x.md?p=x) licensing requirements.
  - (2) **Definitions—** In this subsection:
    - (A) **Applicable ACO—** The term “applicable ACO” means an ACO participating in a model tested or expanded under [section 1315a of this title](/usc/42/1315a.md) or under this section—
      - (i) that operates under a two-sided model—
        - (I) described in section 425.600(a) of title 42, Code of Federal Regulations; or
        - (II) tested or expanded under [section 1315a of this title](/usc/42/1315a.md); and
      - (ii) for which Medicare fee-for-service beneficiaries are assigned to the ACO using a prospective assignment method, as determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6).
    - (B) **Home—** The term “[home](/usc/42/1395x.md?p=iii-3-B)” means, with respect to a Medicare fee-for-service beneficiary, the place of residence used as the [home](/usc/42/1395x.md?p=iii-3-B) of the beneficiary.
  - (3) **Telehealth services received in the home—** In the case of telehealth services described in [paragraph (1)](#l-1) where the [home](/usc/42/1395x.md?p=iii-3-B) of a Medicare fee-for-service beneficiary is the originating site, the following shall apply:
    - (A) **No facility fee—** There shall be no [facility](/usc/42/1320a–3.md?p=c-5-B) fee paid to the originating site under [section 1395m(m)(2)(B) of this title](/usc/42/1395m.md?p=m-2-B).
    - (B) **Exclusion of certain services—** No payment may be made for such services that are inappropriate to furnish in the [home](/usc/42/1395x.md?p=iii-3-B) setting such as services that are typically furnished in inpatient settings such as a [hospital](/usc/42/1395x.md?p=e).
- (m) **Authority to provide incentive payments to beneficiaries with respect to qualifying primary care services—**
  - (1) **Program—**
    - (A) **In general—** In order to encourage Medicare fee-for-service beneficiaries to obtain medically necessary primary care services, an ACO participating under this section under a payment model described in clause [(i)](#m-2-B-i) or [(ii)](#m-2-B-ii) of paragraph (2)(B) may apply to establish an ACO Beneficiary Incentive Program to provide incentive payments to such beneficiaries who are furnished qualifying services in accordance with this subsection. The [Secretary](/usc/42/1301.md?p=a-6) shall permit such an ACO to establish such a program at the [Secretary](/usc/42/1301.md?p=a-6)’s discretion and subject to such requirements, [including](/usc/42/1301.md?p=b) program integrity requirements, as the [Secretary](/usc/42/1301.md?p=a-6) determines necessary.
    - (B) **Implementation—** The [Secretary](/usc/42/1301.md?p=a-6) shall implement this subsection on a date determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6). Such date shall be no earlier than January 1, 2019, and no later than January 1, 2020.
  - (2) **Conduct of program—**
    - (A) **Duration—** Subject to [subparagraph (H)](#m-2-H), an ACO Beneficiary Incentive Program established under this subsection shall be conducted for such period (of not less than 1 year) as the [Secretary](/usc/42/1301.md?p=a-6) may approve.
    - (B) **Scope—** An ACO Beneficiary Incentive Program established under this subsection shall provide incentive payments to all of the following Medicare fee-for-service beneficiaries who are furnished qualifying services by the ACO:
      - (i) With respect to the Track 2 and Track 3 payment models described in section 425.600(a) of title 42, Code of Federal Regulations (or in any successor regulation), Medicare fee-for-service beneficiaries who are preliminarily prospectively or prospectively assigned (or otherwise assigned, as determined by the [Secretary](/usc/42/1301.md?p=a-6)) to the ACO.
      - (ii) With respect to any future payment models involving two-sided risk, Medicare fee-for-service beneficiaries who are assigned to the ACO, as determined by the [Secretary](/usc/42/1301.md?p=a-6).
    - (C) **Qualifying service—** For purposes of this subsection, a qualifying service is a primary care service, as defined in section 425.20 of title 42, Code of Federal Regulations (or in any successor regulation), with respect to which coinsurance applies under part B, furnished through an ACO by—
      - (i) an ACO professional described in [subsection (h)(1)(A)](#h-1-A) who has a primary care specialty designation included in the definition of primary care [physician](/usc/42/1395x.md?p=r) under section 425.20 of title 42, Code of Federal Regulations (or any successor regulation);
      - (ii) an ACO professional described in [subsection (h)(1)(B)](#h-1-B); or
      - (iii) a [Federally qualified health center](/usc/42/1395x.md?p=aa-4) or [rural health clinic](/usc/42/1395x.md?p=aa-2) (as such terms are defined in [section 1395x(aa) of this title](/usc/42/1395x.md?p=aa)).
    - (D) **Incentive payments—** An incentive payment made by an ACO pursuant to an ACO Beneficiary Incentive Program established under this subsection shall be—
      - (i) in an amount up to $20, with such maximum amount updated annually by the percentage increase in the consumer price index for all urban consumers ([United States](/usc/42/1395x.md?p=x) city average) for the 12-month period ending with June of the previous year;
      - (ii) in the same amount for each Medicare fee-for-service beneficiary described in clause [(i)](#m-2-B-i) or [(ii)](#m-2-B-ii) of subparagraph (B) without regard to enrollment of such a beneficiary in a medicare supplemental policy (described in [section 1395ss(g)(1) of this title](/usc/42/1395ss.md?p=g-1)), in a [State](/usc/42/1395x.md?p=x) Medicaid plan under subchapter XIX or a waiver of such a plan, or in any other health insurance policy or health benefit plan;
      - (iii) made for each qualifying service furnished to such a beneficiary described in clause [(i)](#m-2-B-i) or [(ii)](#m-2-B-ii) of subparagraph (B) during a period specified by the [Secretary](/usc/42/1301.md?p=a-6); and
      - (iv) made no later than 30 days after a qualifying service is furnished to such a beneficiary described in clause [(i)](#m-2-B-i) or [(ii)](#m-2-B-ii) of subparagraph (B).
    - (E) **No separate payments from the Secretary—** The [Secretary](/usc/42/1301.md?p=a-6) shall not make any separate payment to an ACO for the costs, [including](/usc/42/1301.md?p=b) incentive payments, of carrying out an ACO Beneficiary Incentive Program established under this subsection. Nothing in this subparagraph shall be construed as prohibiting an ACO from using shared savings received under this section to carry out an ACO Beneficiary Incentive Program.
    - (F) **No application to shared savings calculation—** Incentive payments made by an ACO under this subsection shall be disregarded for purposes of calculating benchmarks, estimated average per capita Medicare expenditures, and shared savings under this section.
    - (G) **Reporting requirements—** An ACO conducting an ACO Beneficiary Incentive Program under this subsection shall, at such times and in such format as the [Secretary](/usc/42/1301.md?p=a-6) may require, report to the [Secretary](/usc/42/1301.md?p=a-6) such information and retain such documentation as the [Secretary](/usc/42/1301.md?p=a-6) may require, [including](/usc/42/1301.md?p=b) the amount and frequency of incentive payments made and the number of Medicare fee-for-service beneficiaries receiving such payments.
    - (H) **Termination—** The [Secretary](/usc/42/1301.md?p=a-6) may terminate an ACO Beneficiary Incentive Program established under this subsection at any time for reasons determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6).
  - (3) **Exclusion of incentive payments—** Any payment made under an ACO Beneficiary Incentive Program established under this subsection shall not be considered income or resources or otherwise taken into account for purposes of—
    - (A) determining eligibility for benefits or assistance (or the amount or extent of benefits or assistance) under any Federal program or under any [State](/usc/42/1395x.md?p=x) or local program financed in whole or in part with Federal funds; or
    - (B) any Federal or [State](/usc/42/1395x.md?p=x) laws relating to taxation.

## Footnotes

[^1]: So in original. No par. (2) has been enacted.

## Source credit

(Aug. 14, 1935, ch. 531, title XVIII, § 1899, as added and amended Pub. L. 111–148, title III, § 3022, title X, § 10307, Mar. 23, 2010, 124 Stat. 395, 940; Pub. L. 114–255, div. C, title XVII, § 17007, Dec. 13, 2016, 130 Stat. 1338; Pub. L. 115–123, div. E, title III, §§ 50324(a), 50331, 50341(a), Feb. 9, 2018, 132 Stat. 203, 205, 206.)

## Notes

### Editorial Notes

### Amendments

2018—Subsec. (b)(2)(I). Pub. L. 115–123, § 50341(a)(1), added subpar. (I).

Subsec. (c). Pub. L. 115–123, § 50331, designated existing provisions as par. (1), inserted heading, substituted “Subject to paragraph (2), the Secretary” for “The Secretary”, redesignated former pars. (1) and (2) as subpars. (A) and (B), respectively, of par. (1), realigned margins, and added par. (2).

Subsec. (e). Pub. L. 115–123, § 50341(a)(3), inserted “, including an ACO Beneficiary Incentive Program under subsections (b)(2)(I) and (m)” after “the program”.

Subsec. (g)(6). Pub. L. 115–123, § 50341(a)(4), inserted “or of an ACO Beneficiary Incentive Program under subsections (b)(2)(I) and (m)” after “under subsection (d)(4)”.

Subsec. (l). Pub. L. 115–123, § 50324(a), added subsec. (l).

Subsec. (m). Pub. L. 115–123, § 50341(a)(2), added subsec. (m).

2016—Subsec. (c). Pub. L. 114–255 substituted “utilization of—” for “utilization of primary”, inserted par. (1) designation and “in the case of performance years beginning on or after April 1, 2012, primary” before “care services”, and added par. (2).

2010—Subsecs. (i) to (k). Pub. L. 111–148, § 10307, added subsecs. (i) to (k).

### Statutory Notes and Related Subsidiaries

### Study and Report

Pub. L. 115–123, div. E, title III, § 50324(b), Feb. 9, 2018, 132 Stat. 204, provided that:Study.— In general.—The Secretary of Health and Human Services (in this subsection referred to as the ‘Secretary’) shall conduct a study on the implementation of section 1899(l) of the Social Security Act [42 U.S.C. 1395jjj(l)], as added by subsection (a). Such study shall include an analysis of the utilization of, and expenditures for, telehealth services under such section. Collection of data.—The Secretary may collect such data as the Secretary determines necessary to carry out the study under this paragraph. Report.—Not later than January 1, 2026, the Secretary shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.”