CMS ACO repayment bonds.
From $100. Enter your amount.

An Accountable Care Organization that takes on downside risk in the Medicare Shared Savings Program must put a repayment mechanism in place with CMS under 42 CFR 425.204(f) — a surety bond from a Treasury-certified company is one of the three CMS-approved forms, alongside an escrow account or a letter of credit. Premium is priced at 0.5% of the bond amount, $100 minimum — enter the repayment-mechanism amount from your CMS filing and your exact price appears at the application.

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Required of any ACO accepting shared-loss risk under a two-sided track — Track 2, BASIC Levels C/D/E, and ENHANCED — before the agreement period that carries risk begins

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Must be issued by a company on the Treasury's List of Certified Companies — the same standard CMS applies to every federal surety obligee

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Priced at 0.5% of the bond amount, $100 minimum — enter the figure your CMS repayment-mechanism calculation produced

From $100your price at applicationSoft pullnever a hard inquiryInstantissued the moment you pay

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How it works

Apply to filed in one sitting.

ACO repayment bonds are ordinary commercial surety once the CMS-required amount is in hand — no committee, no scavenger hunt. Here is the whole thing:

TODAY · ONLINE

Apply online

Your ACO’s entity details and EIN, the repayment-mechanism amount CMS calculated, the effective date of your Participation Agreement, and an effective date for the bond. The form closes with a credit consent that authorizes a soft inquiry only.

INSTANTLY

Issued the moment you pay

Repayment bonds at routine ACO amounts approve on the spot, and the executed bond generates as soon as payment clears. A large penal sum, or an ACO past its first agreement period, can draw a short review before the bond releases.

SAME DAY

File with CMS

Your executed bond and power of attorney arrive by email, on CMS’s required surety bond form, ready to submit through your repayment-mechanism documentation. Wet-ink original mailed on request.

About this bond

What it is and who needs it.

What the repayment mechanism actually guarantees

The Medicare Shared Savings Program lets an Accountable Care Organization share in savings it generates for Medicare — but a two-sided model ACO also shares in losses if spending runs over its benchmark. Before CMS will let an ACO carry that downside risk, the ACO has to show it can actually pay a loss if one is assessed. Under 42 CFR 425.204(f), that proof takes the form of a repayment mechanism: an escrow account, a letter of credit, or a surety bond issued by a company on the U.S. Department of the Treasury’s List of Certified (Surety Bond) Companies.

It is the standard three-party surety arrangement: the ACO (the principal), the surety carrier, and CMS as the obligee. If CMS assesses a shared-loss repayment the ACO cannot pay directly, CMS can call the bond up to its penal sum. It is not insurance for the ACO — if the surety pays a claim, the ACO repays the surety under its indemnity agreement. The mechanism has to stay in place for the ACO’s entire participation under a two-sided model, plus 12 months after the agreement period ends.

CMS sets the minimum amount by formula, not by negotiation. For a BASIC Level C/D/E or ENHANCED track ACO, the rule requires the lesser of 0.5% of the ACO’s total per-capita Medicare Parts A and B fee-for-service expenditures or 1% of the total Medicare Parts A and B fee-for-service revenue of its ACO participants. A Track 2 ACO instead uses at least 1% of total per-capita expenditures. Your CMS repayment-mechanism worksheet will show the figure that applies to your ACO — enter that amount, and we price the bond premium separately, from a $100 minimum at 0.5% of that figure.

42 CFR 425.204(f)Under 42 CFR 425.204(f), an ACO participating in a two-sided model must establish one or more repayment mechanisms — an escrow account, a line of credit, or a surety bond from a company on the Treasury’s List of Certified Companies — before it takes on downside risk. For BASIC Levels C/D/E and ENHANCED track ACOs, the amount is the lesser of 0.5% of total per-capita Medicare Parts A and B fee-for-service expenditures or 1% of total Medicare Parts A and B fee-for-service revenue of the ACO’s participants; a Track 2 ACO uses at least 1% of total per-capita expenditures. The mechanism must remain in effect for the ACO’s participation under the two-sided model plus 12 months following the agreement period. Confirm your exact required amount on your CMS repayment-mechanism documentation before you apply.

You need this bond if you are

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An ACO entering a two-sided track — Track 2, BASIC Levels C/D/E, or ENHANCED — for the first time

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An ACO renewing its agreement period whose CMS-calculated repayment amount has changed with its expenditure or revenue data

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An ACO transitioning up from a BASIC Level A/B glide-path track into shared-loss risk

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An ACO switching mechanisms from an escrow account or letter of credit to a surety bond to free up cash or bank collateral

One application, issued the moment you pay.

These are the actual issuing fields — ACO entity details and EIN, the repayment-mechanism amount CMS calculated, and your Participation Agreement effective date. The form closes with a consent that authorizes a soft credit inquiry only.

Start the application →

FAQ

Common questions.

How much is the CMS ACO repayment bond?The premium is priced at 0.5% of the bond amount, with a $100 minimum. CMS sets the bond amount itself under its repayment-mechanism formula — there is no flat number to look up — so enter the figure from your CMS documentation and your exact price appears at the application.

What amount should I enter?The repayment-mechanism amount from your CMS worksheet or notice. For a BASIC Level C/D/E or ENHANCED ACO, the rule sets it at the lesser of 0.5% of the ACO’s total per-capita Medicare Parts A and B expenditures or 1% of participants’ total Medicare Parts A and B revenue; a Track 2 ACO uses at least 1% of total per-capita expenditures. CMS runs that calculation on your data — use the figure it produces.

What does the bond guarantee?That your ACO can repay shared losses CMS assesses during a two-sided agreement period. If a loss is assessed and the ACO cannot pay directly, CMS can claim against the bond up to the penal sum — and if the surety pays, the ACO repays the surety. That penal sum is the surety’s maximum exposure, not a deposit; you pay the premium only.

Where do I file it?The executed bond goes into your ACO’s repayment-mechanism documentation with CMS, on the surety bond form CMS specifies, ahead of the start of the agreement period that carries downside risk. Mention any CMS-specific formatting requirements in your application and the bond comes back on the right form.

Is there a credit check?The application includes a credit consent, but it authorizes a soft credit pull only — a soft inquiry that never affects your score. No hard inquiry ever runs on this bond.

Related bonds

Other Federal bonds.

Put your repayment mechanism in place.

From $100, priced at 0.5% of the bond amount. Enter the amount your CMS filing requires and file the executed bond the same day. Free until issued.

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CMS ACO repayment bonds.From $100. Enter your amount.