The Center for Medicare and Medicaid Innovation (CMMI) announced that the currently on hold Global and Professional Direct Contracting Model (GPDC) will be replaced with a more equity-focused and provider-led Accountable Care Organization Model in 2023. This change ends the previous Geographic Direct Contracting model, which was halted last March.
Encouragingly, the Request for Funding (RFA) for the REACH model, applications due by April 22nd, specifically asks applicants to “describe their approach to engaging patients regarding advanced medical directives, hospice care, palliative care, and generally end-of-life care… and the processes employed by the applicant to ensure that such end- of-life care is respectful of patients’ wishes, and that the use of hospice and palliative care are timely and appropriate”. Also included is a waiver to allow nurse practitioners in participating ACOs to certify terminal illness for hospice admission.
The redesigned model has been renamed the ACO Realizing Equity, Access, and Community Health Model—or ACO REACH. It includes new health equity requirements, changes to risk adjustment and additional application scoring criteria. It also addresses lawmakers concerns over the role of private equity in the model.
CMMI Director Liz Fowler said that “under the ACO REACH Model, health care providers can receive more predictable revenue and use those dollars more flexibly to meet their patients’ needs — and to be more resilient in the face of health challenges like the current public health pandemic.”
C-TAC was supportive of the previous GPDC as it allowed for more coordinated care of participating patients within a geographical area. This is a great need among those living with serious illness. We believe this revised model will allow people in traditional Medicare who get their care through an ACO REACH to have greater access to enhanced benefits, such as telehealth visits, home care after leaving the hospital and help with co-pays and to expect the support of the ACO REACH to help them navigate our complex health system.
The administration said it would also change the makeup of the boards of participating health organizations so that providers will now need to make up 75% of participating organizations’ governing boards, up from 25% in the old model, a CMS senior official told reporters. Going forward, governing boards must include a beneficiary representative who must hold governing board voting rights. All participating entities will also have to develop health equity plans, among other changes.
Click here for CMMI’s webpage on the ACO REACH model and links to the application and directions about applying. We encourage C-TAC members to consider participating in this model.
Written by: Marian Grant, C-TAC Senior Regulatory Advisor
