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Direct Contracting:

Global and Professional Options

Benefit Enhancements and Application Office Hours

January 8, 2020
Center for Medicare and Medicaid Innovation
Centers for Medicare & Medicaid Services (CMS)
1
Office Hours Overview

Session Objectives: Review key information related to the Direct Contracting Model’s
benefit enhancements and application, and answer your questions on these topics.
1. Benefit Enhancements
2. Application for Global and Professional Options
3. Open Q&A
4. Model Timeline
5. Upcoming Webinars and Questions
Please submit questions via the Q&A feature to the right of the Adobe platform
throughout the session. We will address questions at multiple points during the event.
2
Benefit Enhancements
Benefit Enhancement and Patient Engagement
Incentives
CMS is seeking to emphasize high-value services and support the ability of DCEs to
manage the care of beneficiaries through benefit enhancements and patient
engagement incentives.
DCEs may choose which, if any, of these benefit enhancements and patient
engagement incentives to implement.
4
Building on the Next Generation ACO Model
Direct Contracting proposes to offer the same benefit enhancements and patient
engagement incentives available in the Next Generation ACO model as well as three
newly proposed benefit enhancements.
1.	 Telehealth Expansion Benefit Enhancement 1. Home Health Services Certified by Nurse
Practitioners
2.	 Post-Discharge Home Visits Benefit
Enhancement	 2. Homebound Requirement Waiver for Home
Health
3.	 Care Management Home Visits Benefit
Enhancement
 3.	 Concurrent Care for Beneficiaries that Elect
the Medicare Hospice Benefit

4.	 3-Day SNF Rule Waiver Benefit
Enhancement
5.	 Chronic Disease Management Reward
6.	 Cost Sharing Support for Part B Services
5
Currently in Next Generation ACO
Model
Newly Proposed for Performance Year
1 of Direct Contracting
Benefit Enhancements

Benefit Enhancements are conditional waivers of certain Medicare payment rules. CMS
uses the authority under Section 1115A of the Social Security Act (Section 3021 of the
Affordable Care Act) to conditionally waive certain Medicare payment requirements.
Goals of these benefit enhancements are to:
Emphasize high-
value services
Support care
management and
closer care
relationships
Allow DCE flexibility
6
Direct Contracting Benefit Enhancements

Direct Contracting Benefit Enhancements Q&A

7
Please submit questions via the Q&A pod to the right of your screen.
Specific questions about your organization can be submitted to DPC@cms.hhs.gov
Application for Global and 

Professional Options
Direct Contracting Application for Global and
Professional Options
Direct Contracting Application for Global and 

Professional Options Q&A

9
Please submit questions via the Q&A pod to the right of your screen.
Specific questions about your organization can be submitted to DPC@cms.hhs.gov
Open Q&A
Direct Contracting Open Q&A

Open Q&A

11
Please submit questions via the Q&A pod to the right of your screen.
Specific questions about your organization can be submitted to DPC@cms.hhs.gov
Model Timeline
Model Timeline

Timeline
Implementation Period (IP)
DCE Applicants
Performance Period (PY1)
DCE Applicants
November 25, 2019 –
February 25, 2020
(Application tool opened
December 20, 2019)
Application Period March 2020 – May 2020
DCE Selection May 2020 September 2020
Deadline for applicants
to sign and return
Participant Agreement
(PA)
June 2020
(IP PA)
December 2020
(Performance Period PA)
December 2020
Initial Voluntary
Alignment Outreach
and start of IP or PY
June 2020 January 2021
This timeline may be subject to change. Please check the Directing Contracting webpage for webinar and office
hour dates and times.
13
Upcoming Webinars and Office Hours
Upcoming Webinars and Office Hours

Webinar Date
Payment – Part 1
(Risk sharing, Risk Mitigation Cash Flow)
January 15, 2020
Payment – Part 2
(Risk Adjustment, Benchmarking, Quality)
January 22, 2020
January 28, 2020
Office Hour Session for Payment Part 1
February 11, 2020
Office Hour Session for Payment Part 2
(register here)
(register here)
(register here)
(register here)
This timeline may be subject to change. Please check the Direct Contracting webpage for webinar and office hour dates
and times.
15
Audience Poll

How likely are you to apply to participate in the Direct Contracting model?
a) Very likely
b) Likely
c) Unlikely
d) Very unlikely
e) Unsure
16
Contact Information

Direct Contracting Webpage

(includes link to application):
https://innovation.cms.gov/initiatives/direct-contracting-model-options/
Email:

DPC@cms.hhs.gov
Salesforce Support:

CMMIForceSupport@cms.hhs.gov
17

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Office Hours: Direct Contracting Model Options - Benefit Enhancements and Application Overview

  • 1. Direct Contracting: Global and Professional Options Benefit Enhancements and Application Office Hours January 8, 2020 Center for Medicare and Medicaid Innovation Centers for Medicare & Medicaid Services (CMS) 1
  • 2. Office Hours Overview Session Objectives: Review key information related to the Direct Contracting Model’s benefit enhancements and application, and answer your questions on these topics. 1. Benefit Enhancements 2. Application for Global and Professional Options 3. Open Q&A 4. Model Timeline 5. Upcoming Webinars and Questions Please submit questions via the Q&A feature to the right of the Adobe platform throughout the session. We will address questions at multiple points during the event. 2
  • 4. Benefit Enhancement and Patient Engagement Incentives CMS is seeking to emphasize high-value services and support the ability of DCEs to manage the care of beneficiaries through benefit enhancements and patient engagement incentives. DCEs may choose which, if any, of these benefit enhancements and patient engagement incentives to implement. 4
  • 5. Building on the Next Generation ACO Model Direct Contracting proposes to offer the same benefit enhancements and patient engagement incentives available in the Next Generation ACO model as well as three newly proposed benefit enhancements. 1. Telehealth Expansion Benefit Enhancement 1. Home Health Services Certified by Nurse Practitioners 2. Post-Discharge Home Visits Benefit Enhancement 2. Homebound Requirement Waiver for Home Health 3. Care Management Home Visits Benefit Enhancement 3. Concurrent Care for Beneficiaries that Elect the Medicare Hospice Benefit 4. 3-Day SNF Rule Waiver Benefit Enhancement 5. Chronic Disease Management Reward 6. Cost Sharing Support for Part B Services 5 Currently in Next Generation ACO Model Newly Proposed for Performance Year 1 of Direct Contracting
  • 6. Benefit Enhancements Benefit Enhancements are conditional waivers of certain Medicare payment rules. CMS uses the authority under Section 1115A of the Social Security Act (Section 3021 of the Affordable Care Act) to conditionally waive certain Medicare payment requirements. Goals of these benefit enhancements are to: Emphasize high- value services Support care management and closer care relationships Allow DCE flexibility 6
  • 7. Direct Contracting Benefit Enhancements Direct Contracting Benefit Enhancements Q&A 7 Please submit questions via the Q&A pod to the right of your screen. Specific questions about your organization can be submitted to DPC@cms.hhs.gov
  • 8. Application for Global and Professional Options
  • 9. Direct Contracting Application for Global and Professional Options Direct Contracting Application for Global and Professional Options Q&A 9 Please submit questions via the Q&A pod to the right of your screen. Specific questions about your organization can be submitted to DPC@cms.hhs.gov
  • 11. Direct Contracting Open Q&A Open Q&A 11 Please submit questions via the Q&A pod to the right of your screen. Specific questions about your organization can be submitted to DPC@cms.hhs.gov
  • 13. Model Timeline Timeline Implementation Period (IP) DCE Applicants Performance Period (PY1) DCE Applicants November 25, 2019 – February 25, 2020 (Application tool opened December 20, 2019) Application Period March 2020 – May 2020 DCE Selection May 2020 September 2020 Deadline for applicants to sign and return Participant Agreement (PA) June 2020 (IP PA) December 2020 (Performance Period PA) December 2020 Initial Voluntary Alignment Outreach and start of IP or PY June 2020 January 2021 This timeline may be subject to change. Please check the Directing Contracting webpage for webinar and office hour dates and times. 13
  • 14. Upcoming Webinars and Office Hours
  • 15. Upcoming Webinars and Office Hours Webinar Date Payment – Part 1 (Risk sharing, Risk Mitigation Cash Flow) January 15, 2020 Payment – Part 2 (Risk Adjustment, Benchmarking, Quality) January 22, 2020 January 28, 2020 Office Hour Session for Payment Part 1 February 11, 2020 Office Hour Session for Payment Part 2 (register here) (register here) (register here) (register here) This timeline may be subject to change. Please check the Direct Contracting webpage for webinar and office hour dates and times. 15
  • 16. Audience Poll How likely are you to apply to participate in the Direct Contracting model? a) Very likely b) Likely c) Unlikely d) Very unlikely e) Unsure 16
  • 17. Contact Information Direct Contracting Webpage (includes link to application): https://innovation.cms.gov/initiatives/direct-contracting-model-options/ Email: DPC@cms.hhs.gov Salesforce Support: CMMIForceSupport@cms.hhs.gov 17