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CMS Releases Details on 2021 Direct Contracting Models

Analysis  |  By Steven Porter  
   November 26, 2019

The agency published an RFA that outlines how the global and professional options will work.

Seven months after announcing a package of new value-based payment models to transform primary care, the Centers for Medicare & Medicaid Services released a request for applications (RFA) on Monday that details how organizations can apply to participate in two of the three Direct Contracting (DC) model options.

There were three types of DC arrangements in the agency's announcement last spring: Professional, Global, and Geographic. But the RFA pertains only to the Professional and Global options.

The DC options, slated to begin in 2021, are voluntary payment models that aim to lower costs and maintain or improve quality for Medicare fee-for-service beneficiaries through risk-based contracts. They build on the lessons learned from Accountable Care Organizations (ACOs) and "also leverage innovative approaches from Medicare Advantage (MA) and other private sector risk-sharing arrangements," CMS said.

Some stakeholders who hailed the initial announcement reprised their praise following Monday's announcement.

Premier Senior Vice President of Public Affairs Blair Childs said his organization is pleased to see a model with features Premier has been pushing CMS to adopt.

"This includes allowing primary care capitation using Medicare Advantage rates in the regional benchmark and global budgets for providers who are ready for greater risk," Childs said. "We're also encouraged that the models will provide a quality bonus, coordinate with PACE and Medicaid and focus on care for complex patients."

"We look forward to working with our members to implement this model, which could offer providers an offramp from the fee-for-service treadmill," Childs added.

Clif Gaus, ScD, president and CEO of the National Association of ACOs (NAACOS), said the DC model "is really an ACO by another name."

"Given the robust attention ACOs and the broader health community have given Direct Contracting, NAACOS looks forward to better understanding important details of the program released today," Gaus said, adding that the association is pleased with some of the details it has seen thus far.

The RFA, which was released by the Center for Medicare & Medicaid Innovation (CMMI), also drew applause also from America's Physician Groups (APG) President and CEO Don Crane, JD.

"This is yet another step by CMMI in affirming its commitment to ensuring that patients have access to the high-quality, accountable, and coordinated care physician groups have been providing for decades," Crane said.

"Risk-sharing arrangements properly incentivize physicians to provide high-value, high-quality healthcare to the patients and communities they serve," Crane added. "We look forward to continuing to work with CMMI to put more tools in the toolbox to help physicians who are moving from volume to value."

The agency reopened the submission window for those that didn't turn in a nonbinding letter of intent last August. The new deadline is December 10.

The application period will be open until February 25 for those that wish to take part in the implementation period, according to the agency. The application for those that wish to start in the first performance period will be available in spring 2020, the agency said.

The announcement comes a month after CMS released a separate RFA for both of the Primary Care First (PCF) model options, which are now also set to begin in 2021.

This experimental payment model and CMMI itself are authorized by Section 1115A of the Social Security Act, as added by section 3021 of the Affordable Care Act—which the Trump administration is currently urging a federal appellate court to invalidate.

If the administration is successful in its efforts to topple the ACA through litigation, it would undercut this and other parts of the administration's own healthcare policymaking agenda. (A spokesperson for CMS told HealthLeaders last spring that the agency would continue to champion value-based transformation efforts "in the context of any health reform effort.")

Related: Medicare Just Invited More Competitors Into Value-Based Primary Care

Related: Providers Applaud CMS Primary Care Initiative

Related: Invalidating ACA Would Undercut Parts of Trump's Own Health Policy Agenda

“We look forward to working with our members to implement this model, which could offer providers an offramp from the fee-for-service treadmill.”

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.


The new details pertain to Professional and Global options, but not to the Georgraphic option.

The entire effort and the Innovation Center that hatched it are authorized by the ACA, which the administration is trying to topple.

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