Beginning June 11 through June 28. CMS announced Notice of Intent to Apply (NOIA) and application cycle dates for a January 1, 2020 start date for the Medicare Shared Savings Program (MSSP). Beginning June 11, 2019, CMS will start accepting NOIAs via the Accountable Care Organization (ACO) Management System (ACO-MS). You must submit a NOIA if you intend to apply to the BASIC or ENHANCED track of the Shared Savings Program, apply for a Skilled Nursing Facility 3-Day Rule Waiver, and/or establish and operate a Beneficiary Incentive Program. MSSP fast facts from January 2018 highlight that 1,210 rural health clinics and 421 critical access hospitals were included on ACO participant lists.