CMS Direct Contracting Model Options

Categories: Policy.

On November 25, 2019, the Center for Medicare & Medicaid Innovation announced the release of the Direct Contracting Model Application. The payment model options available under Direct Contracting create opportunities for a broad range of organizations to participate with CMS in testing the next evolution of risk-sharing arrangements.

Direct Contracting is a set of three voluntary payment model options aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS). Information for the first two options (Professional & Global) is below and the third model option will be released by CMS later this year.

  1. Professional offers the lower risk-sharing arrangement—50% savings/losses—and provides Primary Care Capitation, a capitated, risk-adjusted monthly payment for enhanced primary care services.
  2. Global offers the highest risk sharing arrangement—100% savings/losses—and provides two payment options: Primary Care Capitation (described above) or Total Care Capitation, capitated, risk-adjusted monthly payment for all services provided by DC Participants and preferred providers with whom the DCE has an agreement.

The Professional and Global options aim to attract a range of health care providers operating under a common governance structure, with attention given to advancing primary care as a means to better managing health care overall. CMS expects that the use of voluntary alignment will attract organizations that previously were ineligible because of their low volume of Medicare FFS beneficiaries, such as organizations that currently operate in the MA program. Each payment model option includes features aimed at encouraging organizations focused on care for patients with complex, chronic conditions, and seriously ill populations to participate.

The CMS Innovation Center is requesting a Letter of Intent (LOI) from organizations interested in either the Professional or Global options. The LOI is open for those applicants that did not submit one previously from November 25 through December 10.

There are two application submission periods: one for applicants interested in participating in the Implementation Period and a second one for applicants wanting to start the model in the first performance year. The application for organizations interested in the Implementation Period will be open from Monday, November 25, 2019 to Tuesday, February 25, 2020. The application for organizations interested in starting in the first performance year will open in Spring 2020.

Hospice and palliative care programs will want to contract as a preferred partner with Direct Contracting entities in their geography. A hospice and palliative care organization may also want to consider applying as a Direct Contracting Entity for the High Needs Population.

Download additional information from CMS.


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