ACCOUNTABLE CARE ORGANIZATION (ACO)
TERMS OF SERVICE AND CONDITIONS FOR PARTICIPATING PROVIDERS

1. DEFINITIONS
For the purposes of this Agreement:

  • “ACO” refers to Association of Doctors, an entity formed to coordinate care and improve health outcomes under value-based contracts.

  • “Provider” or “Physician” refers to the undersigned individual licensed physician or group practice entering into this agreement.

  • “CMS” refers to the Centers for Medicare & Medicaid Services.

  • “Payer” refers to CMS, private health plans, or other contracting entities that enter into value-based agreements with the ACO.

2. PURPOSE AND SCOPE
This Agreement governs the relationship between the ACO and the Physician, and sets forth the terms under which the Physician agrees to provide services within the ACO, including compliance with all applicable laws, regulations, and payer agreements.

3. PHYSICIAN OBLIGATIONS
By joining the ACO, the Physician agrees to:

a. Compliance with ACO Policies

  • Follow all protocols, quality benchmarks, and clinical guidelines adopted by the ACO.

  • Adhere to data sharing and documentation requirements.

b. Participation in ACO Initiatives

  • Engage in care coordination, preventative care, and patient education.

  • Participate in ACO quality improvement initiatives and trainings.

c. Data Sharing and Reporting

  • Grant the ACO permission to access and report clinical and financial data as required under ACO contracts with CMS or other payers.

  • Use designated EHR systems, registries, or data platforms as instructed.

d. Patient Attribution and Assignment

  • Accept patients attributed to the ACO as defined by CMS or payer methodologies.

  • Avoid actions that may result in patient steering or gaming attribution.

4. ACO OBLIGATIONS
The ACO shall:

a. Administrative Support

  • Provide the Physician with access to performance reports, quality metrics, and care coordination tools.

b. Distribution of Shared Savings

  • If applicable, share earned savings with Physicians in accordance with the ACO’s Board-approved distribution policy, contingent on quality performance, cost containment, and regulatory compliance.

c. HIPAA Compliance

  • Ensure that all data-sharing arrangements comply with federal and state privacy laws, including HIPAA.

5. TERM AND TERMINATION

a. Term

  • This Agreement shall commence on the Effective Date and continue until terminated in accordance with this section.

b. Termination by Either Party

  • Either party may terminate this Agreement with 60 days written notice.

c. Termination for Cause

  • The ACO may terminate immediately for material breach, license revocation, exclusion from federal programs, or patient safety concerns.

d. Post-Termination Obligations

  • The Physician agrees to assist in transition of care, records retention, and final performance reporting.

6. COMPENSATION AND SAVINGS DISTRIBUTION

a. No Guarantee of Shared Savings

  • Participation does not guarantee shared savings or incentive payments.

b. Method of Distribution

  • Distributions (if any) will be calculated per the ACO’s Savings Distribution Policy, based on performance, cost efficiency, and patient outcomes.

7. INSURANCE AND LICENSURE
Physician shall:

  • Maintain an active license in good standing.

  • Carry professional liability insurance in amounts not less than [$1 million per occurrence/$3 million aggregate] or as required by law or the ACO.

8. COMPLIANCE WITH LAWS
Physician agrees to comply with:

  • All applicable federal and state healthcare laws.

  • The Medicare Shared Savings Program (if applicable).

  • Anti-kickback statutes and the Stark Law.

9. CONFIDENTIALITY
Both parties shall:

  • Maintain the confidentiality of proprietary and patient information.

  • Use data solely for permitted uses under this Agreement and applicable laws.

10. INDEPENDENT CONTRACTOR STATUS
Nothing in this Agreement shall be construed to create a partnership, joint venture, or employment relationship between the parties.

11. INDEMNIFICATION
Each party shall indemnify and hold harmless the other party from claims arising out of negligence, misconduct, or violation of law attributable to their respective conduct.

12. DISPUTE RESOLUTION
Disputes shall first be subject to good faith negotiation, and if unresolved, shall be submitted to binding arbitration in accordance with the rules of the American Arbitration Association.

13. MISCELLANEOUS

a. Governing Law

  • This Agreement shall be governed by the laws of the State of [Insert State].

b. Amendments

  • Must be in writing and signed by both parties.

c. Entire Agreement

  • This constitutes the entire agreement and supersedes all prior discussions or understandings.