AKS Value-Based Arrangement Safe Harbors (42 CFR 1001.952(ee)-(gg))
Three safe harbors added in the 2020 Sprint to Coordinated Care final rule covering value-based arrangements at varying risk levels: care coordination, substantial downside risk, and full financial risk.
Primary source
42 CFR 1001.952(ee)-(gg) — eCFR →https://www.ecfr.gov/current/title-42/chapter-V/subchapter-B/part-1001/subpart-C/section-1001.952
Verified May 23, 2026 · This is the authoritative regulator URL. The summary below is a research aid; the linked source controls.
Additional sources
The 2020 Sprint to Coordinated Care final rule added three AKS safe harbors at 42 CFR 1001.952(ee)-(gg) for value-based arrangements (VBAs). The safe harbors are tiered by financial-risk level; the higher the risk borne by VBA participants, the lower the safe-harbor documentation burden.
- Care Coordination Arrangements (ee): in-kind remuneration exchanged among VBE participants for care coordination, with no minimum risk requirement but the most prescriptive conditions (substantially connect to coordination/management of care for the target patient population).
- Substantial Downside Financial Risk (ff): protects monetary and in-kind remuneration when VBE participants assume substantial downside financial risk (defined thresholds — 30% shared losses, prospective per-patient payment, or partial capitation).
- Full Financial Risk (gg): protects monetary and in-kind remuneration when the VBE assumes full financial risk for cost of patient care for at least one year.
Common conditions across all three: written documentation; legitimate value-based purpose; remuneration not based on referrals to a non-participant; coordination of care for a target patient population.
ACOs, bundled-payment arrangements, and risk-bearing primary-care networks are the typical fit. The safe harbors recognize that coordination-driven remuneration is structurally different from traditional referral inducements.
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Last reviewed May 23, 2026 · Citation verified May 23, 2026
Research aid, not legal advice. This summary is an administrative research aid prepared by D3rx. It does not certify compliance, provide legal advice, replace counsel, or guarantee an audit outcome. For authoritative regulatory text follow the primary source link at the top of this page. The practice remains responsible for reviewing, adopting, and maintaining its compliance program.