Health systems that have adopted the Shared Savings model ACOs could have an additional three years before being financially penalized for poor performance under a new proposal by CMS, Kaiser Health News reported.

The proposal “is one of dozens of changes” put forth by CMS in attempt to ease rules governing ACOs established under the Affordable Care Act. From Kaiser Health News:

“There are more than 330 such networks around the country caring for about 5 million people through the Medicare Shared Savings Program, which includes most of the ACOs. The revisions to the program are intended to entice providers to form new ACOs and to keep existing ones in the program, which is voluntary.

In the first year of the program, 118 ACOs saved Medicare $705 million with about half earning bonuses, government records show.  Another 102 ACOs spent more than Medicare’s benchmark, but only one had to repay Medicare because most ACOs have a three-year grace period when they can earn bonuses but are excused from penalties.”

The new rule would allow both new and established ACOs three years to get their footing before facing three years of increased scrutiny on how much money is saved. That’s about twice as long as current time lines, where potential penalties can kick in after 18 months. Provider organizations have found that relatively short time frame for financial stability with a new payment structure “pretty intimidating,” Sean Cavanaugh, director for Medicare, told the news agency.

Yet the extended three-year window would come with a more stringent price.

“ACOs that after their first three years decide to avoid penalties for the next three could keep no more than 40 percent of the money they save Medicare, rather than the 50 percent maximum they can keep during their first three years.”

In addition, CMS is proposing the creation a new type of ACO. Currently, there’s been the Pioneer ACO model, which assumed the most financial risk and ends in 2016, and the more widely adopted Shared Savings model. The third type would be known as “Track Three,” and would allow ACOs to keep up to 75 percent of the money they save Medicare.

“If they cost Medicare extra, those ACOs would be held responsible for up to 15 percent of the excess spending. Currently ACOs cannot be held responsible for more than 10 percent,” Kaiser Health News reported.