CMS Centers for Medicare and Medicade Services

Author: Brianna Plencner, CPC, CPMA  Senior Consultant & Manager, Practice Development, HCCI

The Centers for Medicare & Medicaid Services (CMS) recently announced its decision to redesign and rename the Global and Professional Direct Contracting (GPDC) model to the ACO Realizing Equity, Access, and Community Health (ACO REACH) Model beginning in performance year (PY) 2023.

The participating Direct Contracting Entities part of GPDC will finish the current performance year and then must agree to meet all ACO REACH model requirements by January 1, 2023, to continue model participation. (ACO REACH model transition officially starts January 2023 and continues through PY 2026.)

CMS confirmed the permanent cancellation of the Geographic Direct Contracting (Geo) Model. The Geo Model was unveiled in December 2020 and later paused in March 2021. It is being canceled due to concerns raised by stakeholders.

The ACO REACH Model Request for Applications (RFA) is available. CMS is accepting applications from new eligible provider-led organizations interested in participating in the ACO REACH model until April 22, 2022. Applications can be submitted by using the CMS Web Portal; after reviewing the RFA, initial applications will be non-binding.

The key differences in the ACO REACH model compared to GPDC include the following:

  • It requires the development and implementation of a health equity plan, which ACOs must update annually and report progress to CMS.
  • REACH ACOs serving higher proportions of underserved beneficiaries will receive a beneficiary-level adjustment to increase the benchmark (related to quality bonus). Certain demographic-level information will be required to be collected, and CMS will encourage the collection of SDoH data.
  • There’s a new benefit enhancement related to nurse practitioners’ (NPs) scope of practice, allowing NPs part of ACO REACH to certify patients for hospice and diabetic shoes.
  • Participating providers generally must hold at least 75% of the governing board voting rights (compared to 25% for GPDC).
  • Each ACO REACH governing board must include a beneficiary representative and a consumer advocate who must have voting rights; these roles must be filled by different people.

Table 6.2 below reviews the minimum beneficiary attribution requirements based on the ACO type:

ACO Reach Model

Refer to the ACO REACH Model web page or subscribe to the CMS Innovation Center Listserv for additional information and to stay up to date.