42 CFR § 425.214 - Managing changes to the ACO during the agreement period.
(1) An ACO must notify CMS within 30 days of any significant change.
(3) A “significant change” occurs when an ACO is no longer able to meet the eligibility or program requirements of this part.
(b) Upon becoming aware of a significant change or receiving an ACO's notice of a significant change described in paragraph (b) of this section, CMS reevaluates the ACO's eligibility to continue to participate in the Shared Savings Program and may request additional documentation. CMS may make a determination that includes one of the following:
(1) The ACO may continue to operate under the new structure.
(2) The ACO structure is so different from the initially approved ACO that it must terminate its participation agreement and submit a new application for participation.