Application Instructions 

We are pleased that you are taking this opportunity to apply to join an Accountable Care Organization (ACO) supported by Caravan Health or CPSI operated in accordance with the Medicare Shared Savings Program (MSSP) established by the Centers for Medicare & Medicaid Services (CMS). Below are resources you will need in order to apply for the program. 

For application assistance, please contact Georgia Green, Application Lead, at ggreen@caravanhealth.com, or call 530-366-5111.

View a Sample Presentation: 
Application Support Webinar Recording

Deadline to Apply

MOST IMPORTANT: Each, individual TIN must complete, hand sign, and submit the 2018 Shared Savings Participation Agreement and complete the 2018 Client Application Worksheet. These must be submitted as soon as possible but no later than June 30, 2017 

Application and Onboarding Process Timeline

Introduction to the SSPA

The Shared Savings Participation Agreement (SSPA) is the standard legal agreement between your organization and the newly formed ACO. The majority of the SSPA language is required by CMS as a condition of participation in an ACO. The SSPA and the Application Worksheet, which provides critical information we need to create your application and support the on-boarding process, together form the basis for your application for the ACO.

We have made best efforts to design these documents to be fair to both sides. If you find something that we have missed, that you find egregious or one-sided, please bring it to our attention so that we can consider it for modification. We cannot accommodate extensive markups (“red-lining”) of the documents. Please advise your attorneys accordingly. 

Please review the following template documents.These documents have been previously sent to you via email:

Additional Agreements Referenced in SSPA

NOTE: These documents are the same for Principal Participants and Non-Principal Participants. A typical community arrangement may involve a hospital that is the Principal Participant (responsible for fees, holding Steering Committee meetings, member of the board and owner of the ACO) with independent practitioners/specialists/clinics (billing Medicare under separate tax payer identification numbers (TINs)) participating in the ACO as Non-Principal Participants.

IMPORTANTYou must use the Legal Business Name associated with your TIN, as written in PECOS, for your “company name”. This is a CMS requirement!! Punctuation matters.  

1.  SSPA Master Signature Page - Signed by the authorized representative (CEO/President) of each unique Principal Participant and Non-Principal Participant TIN, plus the ACO’s Executive Director.  The 4th page of this agreement must be HAND signed and scanned back to Georgia Green at ggreen@caravanhealth.com on or before June 30, 2017.

2. Application Worksheet - Please complete the attached Application Worksheet (.xlsx spreadsheet) per TIN. This document provides the data that we need to successfully submit the MSSP application on your behalf.

Supplemental Information

2018 Program Training Overview: This document provides a thorough overview of Caravan Health ACO training resources available and includes local quality improvement workshops. 

Please review the following template documents prior to your first ACO Board Meeting in 1Q2018. You will be receiving your ACO specific documents in your board packets in advance: 

Job Descriptions

Frequently Asked Questions

PECOS Support 

Independent Clinic/Physician Recruitment

Disclaimer: This Application Packet and the documents contained herein are proprietary in nature and constitute trade secrets.  These documents are confidential and should not be photocopied, reproduced, electronically transmitted, or otherwise used or distributed without express permission of Caravan Health except as necessary to execute the documents and complete the Application Packet.