Requirements relating to design of arrangement The requirements of this subparagraph for an internal cost savings sharing arrangement of an ACO are as follows: (i) No reduction in medically necessary care ACO participants may not reduce or limit medically necessary items and services furnished to Medicare fee-for-service beneficiaries. (ii) Voluntary participation Participation by providers of services and suppliers in the arrangement is voluntary. (iii) Transparency The arrangement is transparent and subject to audit by the Secretary. (iv) Quality of care ACO participants participating in the arrangement meet quality performance standards established by the Secretary under subsection (b)(3). (v) Payment methodology Distributions of internal cost savings under the arrangement is not based on the volume or value of referrals or business otherwise generated. (C) Reporting requirements The requirements of this subparagraph for an arrangement of an ACO is that the ACO provides the following information to the Secretary for purposes of evaluating the arrangement: (i) Methodology The methodology for distributions of internal cost savings under the arrangement among all ACO participants, including the frequency of and the criteria for such distributions. (ii) Care redesign A detailed explanation of how the arrangement will achieve improved quality and patient experience, as well as the anticipated cost savings. (iii) Eligibility to participate in arrangement The criteria for participation by ACO participants, particularly professionals, in the arrangement. (iv) Distribution plan A comprehensive plan for distributions of internal cost savings under the arrangement. (D) Waivers The Secretary shall waive such provisions of this title and title XI as may be necessary to carry out this paragraph. (E) Definitions In this paragraph: (i) Internal cost savings sharing arrangement The term internal cost savings sharing arrangement means an arrangement among ACO participants of an ACO for the distributions of internal cost