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As we explained in the CY 2025 PFS proposed rule (89 FR 61871), CMS aims to extend this payment option to the ACOs most likely to earn shared savings, to ensure that the addition of prepaid shared savings meets the standard set by section 1899(i)(3) of the Act, which requires CMS to determine that prepaid shared savings will improve the quality and efficiency of items and services furnished under the Medicare program and, when implemented in combination with existing modifications made to the Shared Savings Program payment model specified in section 1899(d) of the Act, not result in more program expenditures than would have resulted under the statutory payment methodology in section 1899(d) of the Act

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