The Direct Contracting Model Options team hosted a webinar on January 22, 2020 to provide additional information on the Direct Contracting model's payment methodology following the Payment Part 1 Webinar on January 15th. The team presented on additional aspects of the financial model not covered during the Payment Part 1 Webinar, such as its risk adjustment, benchmark methodologies, and quality measures. The forum also provided an opportunity for potential applicants to ask the team questions regarding these topics and other topics related to the model application.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This webinar focuses on the new financial policies featured in the ACO REACH webinar. For more information on the financial methodology for the ACO REACH Model that will be transitioned from the Global and Professional Direct Contracting (GPDC) Model, please refer to prior released financial webinars available on the GPDC Model webpage.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering population based payments and all inclusive population based payments for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 26 from 4:00pm – 5:00pm EDT.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted the third in a series of open door forums on March 31, 2015 focusing on financial methodology and related issues.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted the fifth in a series of open door forums on Tuesday, April 14, 2015. This open door forum focused on letter of intent (LOI) and application.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
As the Kidney Care Choices (KCC) Model application deadline approaches (January 22, 2020), the Center for Medicare and Medicaid Innovation (CMMI) hosted a final office hour on Thursday, January 16, 2020 from 2:00pm – 3:00pm EST. This office hour focused on answering any questions you have about the KCC Model Application.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
During this webinar the Direct Contracting Model Options team hosted a webinar on Wednesday, December 18, 2019 from 1:30 p.m.- 3:00 p.m. EST. During this webinar, presenters provided information about benefit enhancements for the Direct Contracting Model Options.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum providing a application overview for the 2017 Next Generation Accountable Care Organization Model. The open door forum washeld on Tuesday, March 29 from 4:00pm – 5:30pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document summarizes the findings from the first year of the Medicare Advantage Value-Based Insurance Design Model (MA VBID). Nine parent organizations tested innovative benefit designs focused on seven conditions. Most commonly, they offered reduced cost sharing for services conditional on participating in care management. While implementation required new workflows, participants saw potential for improving health and reducing costs. Further evaluation will assess impacts on outcomes.
This webinar focuses on the new financial policies featured in the ACO REACH webinar. For more information on the financial methodology for the ACO REACH Model that will be transitioned from the Global and Professional Direct Contracting (GPDC) Model, please refer to prior released financial webinars available on the GPDC Model webpage.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering population based payments and all inclusive population based payments for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 26 from 4:00pm – 5:00pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted the third in a series of open door forums on March 31, 2015 focusing on financial methodology and related issues.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted the fifth in a series of open door forums on Tuesday, April 14, 2015. This open door forum focused on letter of intent (LOI) and application.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
As the Kidney Care Choices (KCC) Model application deadline approaches (January 22, 2020), the Center for Medicare and Medicaid Innovation (CMMI) hosted a final office hour on Thursday, January 16, 2020 from 2:00pm – 3:00pm EST. This office hour focused on answering any questions you have about the KCC Model Application.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
During this webinar the Direct Contracting Model Options team hosted a webinar on Wednesday, December 18, 2019 from 1:30 p.m.- 3:00 p.m. EST. During this webinar, presenters provided information about benefit enhancements for the Direct Contracting Model Options.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum providing a application overview for the 2017 Next Generation Accountable Care Organization Model. The open door forum washeld on Tuesday, March 29 from 4:00pm – 5:30pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document summarizes the findings from the first year of the Medicare Advantage Value-Based Insurance Design Model (MA VBID). Nine parent organizations tested innovative benefit designs focused on seven conditions. Most commonly, they offered reduced cost sharing for services conditional on participating in care management. While implementation required new workflows, participants saw potential for improving health and reducing costs. Further evaluation will assess impacts on outcomes.
This document summarizes information about the Oncology Care Model (OCM), including that it aims to transform cancer care through multi-payer participation in an episode-based payment model. It outlines that OCM participants are oncology practices that provide chemotherapy and are required to engage in practice transformation. It invites commercial payers, Medicaid, and other governmental payers to participate by signing agreements with CMS and practices. Participating payers can help measure and increase quality, reduce costs, and inform delivery system reform across patient populations.
The document provides an overview of the methodology used to calculate benchmarks and determine savings/losses for ACOs in the Next Generation ACO Model. It discusses how beneficiaries are aligned to ACOs for the baseline and performance years, how the benchmark is calculated by trending the baseline forward using factors like regional and national trends, risk adjustment, and quality performance. It also outlines how payments are reconciled against the benchmark to determine savings or losses. The document contains details on key aspects of the methodology like the geographic adjustment factor trend adjustment and risk arrangement selections.
The Next Generation ACO Model team hosted an open door forum on Tuesday, February 28, 2017. During this open door forum Model team members provided a deep dive presentation examining details of financial aspects relating to the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document provides an overview of the Part D Senior Savings Model proposed by CMS Innovation Center. The model aims to lower out-of-pocket costs for insulin by establishing a stable $35 copay for eligible insulins through the deductible, initial coverage, and coverage gap phases of Part D plans. The model would be voluntary for manufacturers, Part D plans, and beneficiaries. It also outlines the application process and timelines for manufacturers and Part D plans to participate in the 2021 plan year.
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted the fourth in a series of open door forums on Tuesday, April 7, 2015. This open door forum focused on benefit enhancements and beneficiary care coordination reward.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare-Medicaid Accountable Care Organization Model team hosted a webinar for states that are participating in the Medicare-Medicaid ACO Model on Thursday, June 15, 2017. Participating states have the opportunity to share in Medicare savings generated by Medicare-Medicaid ACOs in their state. This webinar covered the methodology for calculating those shared savings.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The ET3 Model team hosted a tutorial webinar on Thursday, August 8th, 2019 from 12:00 p.m.-1:30 p.m. EDT, to provide an overview of the Application Portal. During the session, the ET3 Model team reviewed key functionality of the Portal as well as provided guidance and tips for ambulance suppliers and providers to submit a complete application to participate in the Model. The webinar also provided an opportunity for Q & A with the ET3 Model team.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
During this webinar the Direct Contracting Model Options team hosted a webinar on Tuesday, January 7, 2020 from 1:00 p.m.- 2:30 p.m. EST. During this webinar, presenters provided an overview and demonstration of the Direct Contracting application portal and answered questions about the portal from the audience.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This open door forum will provide follow up information to 2015 and 2016 Shared Savings Program ACOs applying to AIM, including suggestions and resources to consider when submitting their application. Attendees had the opportunity to ask subject matter experts questions about the AIM application process.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare and Medicaid Innovation hosted a series of two webinars on Wednesday, July 15 and Thursday, July 16, 2015. These webinars focused on providing an overview of the model and provided an opportunity for attendees to ask questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
During this office hours the Direct Contracting Model Options team offered participants an opportunity to ask follow-up questions and receive additional information about the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Million Hearts: Cardiovascular Disease Risk Reduction Model team hosted an open door forum on Thursday, September 3, 2015. Attendees received an overview of the application as well an opportunity for question and answers about the Model. Joining the team was Paul Meissner, Director of Research Program Development at Montefiore Medical Center, who talked about why the Model is important to his organization.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Thursday, June 12, 2014 from 4:00pm - 5:00pm EDT that focused on the application process, specifically how to apply through Grants.gov.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Integrated Care for Kids (InCK) Model team presented a webinar covering the notice of funding opportunity application on Thursday, April 18 from 2:30 p.m. to 4:00 p.m. EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Kidney Care Choices (KCC) Model team hosted a Comprehensive Kidney Care Contracting (CKCC) Model Options finance webinar on Friday, November 22, 2019 from 12:00 p.m. - 1:00 p.m. EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Next Generation ACO Model team hosted an open door forum on Tuesday, March 14, 2017. During this open door forum Model team members provided an overview of the application and discussed participating provider lists.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
During this webinar, the Primary Care First Model Options team reviewed information necessary to submit an application for Primary Care First. The team discussed details on various parts of the application and answered frequently asked questions. Attendees also could submit questions live.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Next Generation ACO Model team hosted an open door forum on Tuesday, January 31, 2017. During this open door forum Model team members provided an overview of the Model, along with information pertaining to the Letter of Intent (LOI).
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Direct Contracting Model Options team hosted office hours on February 4, 2020. During the session, the Direct Contracting Model Options team provided a brief review of key aspects of the Direct Contracting financial model that were covered during the Payment Part One Webinar, such as its risk-sharing options and risk mitigation strategies, as well as its capitation and other advanced payment alternatives. This session offered participants an opportunity to ask follow-up questions about these topics.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering the application process for the 2017 Next Generation Accountable Care Organization Model on Tuesday, March 8, 2016 from 4:00 - 5:00pm EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted a repeat of the first open door forum in a series focusing on various aspects of the Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document summarizes information about the Oncology Care Model (OCM), including that it aims to transform cancer care through multi-payer participation in an episode-based payment model. It outlines that OCM participants are oncology practices that provide chemotherapy and are required to engage in practice transformation. It invites commercial payers, Medicaid, and other governmental payers to participate by signing agreements with CMS and practices. Participating payers can help measure and increase quality, reduce costs, and inform delivery system reform across patient populations.
The document provides an overview of the methodology used to calculate benchmarks and determine savings/losses for ACOs in the Next Generation ACO Model. It discusses how beneficiaries are aligned to ACOs for the baseline and performance years, how the benchmark is calculated by trending the baseline forward using factors like regional and national trends, risk adjustment, and quality performance. It also outlines how payments are reconciled against the benchmark to determine savings or losses. The document contains details on key aspects of the methodology like the geographic adjustment factor trend adjustment and risk arrangement selections.
The Next Generation ACO Model team hosted an open door forum on Tuesday, February 28, 2017. During this open door forum Model team members provided a deep dive presentation examining details of financial aspects relating to the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document provides an overview of the Part D Senior Savings Model proposed by CMS Innovation Center. The model aims to lower out-of-pocket costs for insulin by establishing a stable $35 copay for eligible insulins through the deductible, initial coverage, and coverage gap phases of Part D plans. The model would be voluntary for manufacturers, Part D plans, and beneficiaries. It also outlines the application process and timelines for manufacturers and Part D plans to participate in the 2021 plan year.
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted the fourth in a series of open door forums on Tuesday, April 7, 2015. This open door forum focused on benefit enhancements and beneficiary care coordination reward.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare-Medicaid Accountable Care Organization Model team hosted a webinar for states that are participating in the Medicare-Medicaid ACO Model on Thursday, June 15, 2017. Participating states have the opportunity to share in Medicare savings generated by Medicare-Medicaid ACOs in their state. This webinar covered the methodology for calculating those shared savings.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The ET3 Model team hosted a tutorial webinar on Thursday, August 8th, 2019 from 12:00 p.m.-1:30 p.m. EDT, to provide an overview of the Application Portal. During the session, the ET3 Model team reviewed key functionality of the Portal as well as provided guidance and tips for ambulance suppliers and providers to submit a complete application to participate in the Model. The webinar also provided an opportunity for Q & A with the ET3 Model team.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
During this webinar the Direct Contracting Model Options team hosted a webinar on Tuesday, January 7, 2020 from 1:00 p.m.- 2:30 p.m. EST. During this webinar, presenters provided an overview and demonstration of the Direct Contracting application portal and answered questions about the portal from the audience.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This open door forum will provide follow up information to 2015 and 2016 Shared Savings Program ACOs applying to AIM, including suggestions and resources to consider when submitting their application. Attendees had the opportunity to ask subject matter experts questions about the AIM application process.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare and Medicaid Innovation hosted a series of two webinars on Wednesday, July 15 and Thursday, July 16, 2015. These webinars focused on providing an overview of the model and provided an opportunity for attendees to ask questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
During this office hours the Direct Contracting Model Options team offered participants an opportunity to ask follow-up questions and receive additional information about the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Million Hearts: Cardiovascular Disease Risk Reduction Model team hosted an open door forum on Thursday, September 3, 2015. Attendees received an overview of the application as well an opportunity for question and answers about the Model. Joining the team was Paul Meissner, Director of Research Program Development at Montefiore Medical Center, who talked about why the Model is important to his organization.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Thursday, June 12, 2014 from 4:00pm - 5:00pm EDT that focused on the application process, specifically how to apply through Grants.gov.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Integrated Care for Kids (InCK) Model team presented a webinar covering the notice of funding opportunity application on Thursday, April 18 from 2:30 p.m. to 4:00 p.m. EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Kidney Care Choices (KCC) Model team hosted a Comprehensive Kidney Care Contracting (CKCC) Model Options finance webinar on Friday, November 22, 2019 from 12:00 p.m. - 1:00 p.m. EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Next Generation ACO Model team hosted an open door forum on Tuesday, March 14, 2017. During this open door forum Model team members provided an overview of the application and discussed participating provider lists.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
During this webinar, the Primary Care First Model Options team reviewed information necessary to submit an application for Primary Care First. The team discussed details on various parts of the application and answered frequently asked questions. Attendees also could submit questions live.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Next Generation ACO Model team hosted an open door forum on Tuesday, January 31, 2017. During this open door forum Model team members provided an overview of the Model, along with information pertaining to the Letter of Intent (LOI).
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
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The Direct Contracting Model Options team hosted office hours on February 4, 2020. During the session, the Direct Contracting Model Options team provided a brief review of key aspects of the Direct Contracting financial model that were covered during the Payment Part One Webinar, such as its risk-sharing options and risk mitigation strategies, as well as its capitation and other advanced payment alternatives. This session offered participants an opportunity to ask follow-up questions about these topics.
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The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering the application process for the 2017 Next Generation Accountable Care Organization Model on Tuesday, March 8, 2016 from 4:00 - 5:00pm EST.
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In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted a repeat of the first open door forum in a series focusing on various aspects of the Model.
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In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted the first in a series of open door forums focusing on various aspects of the Model.
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The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum providing letter of intent overview for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, March 22 from 4:00pm – 5:30pm EDT.
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The Direct Contracting Model Options team hosted a webinar on January 15, 2020 to provide an overview of the Direct Contracting Model's payment methodology. During the session, the Direct Contracting model team presented key aspects of the Direct Contracting financial model, such as its risk-sharing options and risk mitigation strategies, as well as its capitation and other advanced payment alternatives. The forum also provided an opportunity for potential applicants to ask the team questions regarding these topics and other topics related to the model application.
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The Value-Based Insurance Design (VBID) Model team hosted a webinar on January 28, 2021 from 4:00-5:00 PM EST. During this webinar, presenters provided a brief review of the recently released Calendar Year (CY) 2022 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component. This session also offered attendees an opportunity to ask follow-up questions.
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The CMS Innovation Center held a Medicare Advantage Value-Based Insurance Design Model webinar on August 24, 2016 from 2:00 – 3:00p.m. EDT. This webinar provided an overview of the changes to the model scheduled to take effect in 2018.
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The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Wednesday, March 17, 2021 from 4:00 - 5:00 PM EDT. During this webinar, presenters provided a preview of the Calendar Year 2022 payment design related to the Hospice Benefit Component of the VBID Model. The session also offered attendees an opportunity to ask follow-up questions.
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The document provides an overview of bundled payments and the Comprehensive Care for Joint Replacement (CJR) model. The CJR model holds hospitals accountable for the quality and costs of lower extremity joint replacements from admission through 90 days post-discharge. It aims to reduce costs while preserving or enhancing quality through care coordination among hospitals, physicians, and post-acute providers. Hospitals must meet quality standards to earn reconciliation payments if costs are below the target price. The model tests bundled payments and quality measurement across different geographic areas.
The GPDC model will transition to the ACO REACH model on January 1, 2023. Current GPDC participants must meet ACO REACH requirements by that date to participate. The application portal for the ACO REACH model will open on March 7, 2022 and close on April 22, 2022. Selections will be made in June 2022 and the first performance year will begin on January 1, 2023, running through 2026. Key differences from traditional ACO models include options for those with fewer than 5,000 beneficiaries, two risk sharing options including capitation, and claims-based quality reporting.
During this webinar, a high-level overview of the ACO REACH Model was provided including information on the participation and eligibility requirements, Accountable Care Organization (ACO) types, payment mechanisms, and beneficiary alignment methodology.
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The document summarizes the Quality Payment Program (QPP) established by the Medicare Access and CHIP Reauthorization Act (MACRA). It outlines two tracks for physician payment under MACRA - the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). MIPS consolidates existing quality programs and adds a cost component, with payment adjustments starting at -4% to +12% in 2019. Advanced APMs offer higher payment updates and bonuses for bearing more than nominal risk. The document provides details on participation requirements, payment adjustments, and strategic considerations for physicians to succeed under the new program.
Deployment of the Medicare Access and CHIP Reauthorization ActPYA, P.C.
PYA Principal Martie Ross and Senior Manager Graham Fox presented, “Mastering MIPS" at the American College of Healthcare Executives’ Congress on Healthcare Leadership.
Learning objectives included:
Gaining an understanding of MIPS—why it was implemented and how it will impact reimbursement, governance, and strategic planning for healthcare organizations.
Identifying questions organizations must consider during MIPS implementation that will lead to financial and operational success.
This Medicare-Medicaid ACO Model webinar included information on the structure of the Model, Model details including beneficiary attribution, financial methodology and quality measurement options within the Model, and an explanation of data, learning and evaluation. The state-specific development and application process, including instructions for submitting letters of intent were also discussed. This webinar was open to the general public and targeted towards interested states.
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USS Value Based—Navigating Old Obstacles in the New WorldPYA, P.C.
A proud supporter of the American Health Lawyers Association (AHLA), PYA joined legal counselors, compliance officers, government representatives, and other attendees October 4-6, at the 2017 Fraud and Compliance Institute, held at the Renaissance Harborplace Hotel, Baltimore, MD. PYA Principal Carol Carden co-presented “USS Value Based—Navigating Old Obstacles in the New World,” with Robert G. Homchick, a partner with Davis Wright Tremaine. The presentation explored: alternative payment models, value-based payments under program waivers, fraud and abuse laws, and IRS rules, as well as valuation and commercial reasonableness of value-based payments.
Quality Payment Program (MACRA) Proposed RuleMick Brown
The Quality Payment Program, established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), began in 2017, known as the transition year. The Program’s main goals are to:
Improve health outcomes.
Spend wisely.
Minimize burden of participation.
Be fair and transparent.
The Quality Payment Program has 2 tracks: (1) The Merit-based Incentive Payment System (MIPS) and (2) Advanced Alternative Payment Models (Advanced APMs).
Because the Quality Payment Program brings significant changes to how clinicians are paid within Medicare, the Centers for Medicare & Medicaid Services (CMS) is continuing to go slow and use stakeholder feedback to find ways to streamline and reduce clinician burden. CMS has engaged more than 100 stakeholder organizations and over 47,000 people since January 1, 2017 to raise awareness, solicit feedback, and help clinicians prepare to participate. Based on stakeholder feedback, CMS established transition year policies from the clinician perspective, such as:
Giving clinicians the option to choose how they’ll participate (also known as Pick Your Pace).
Having a low-volume threshold that exempts many clinicians with a low volume of Medicare
Part B payments or patients.
Allowing flexibilities for clinicians who are considered hospital-based or have limited face-to-
face encounters with patients (referred to as non-patient facing clinicians).
As the Quality Payment Program moves into the second year, CMS wants to ensure that there is meaningful measurement and the opportunity for improved patient outcomes while minimizing burden, improving coordination of care for patients, and supporting a pathway to participation in Advanced APMs.
During this webinar the Primary Care First Model Options team provided an introduction to the Primary Care First Model that is geared towards payers, presented and answered questions live on topics related to payer partnership, including the Primary Care First payer alignment framework, benefits of multi-payer partnership, and the payer solicitation elements and selection process.
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This document provides an overview of various Accountable Care Organization (ACO) models in the US healthcare system, including their evolution and performance over the last 5-6 years. It highlights the key growth drivers and success factors for ACOs, such as gaining experience in the program, having larger networks, and utilizing data analytics technologies. The document also analyzes different ACO models based on factors like their benchmark methodology and risk/reward arrangements. Its intended audience includes health systems and payers interested in forming their own ACO networks.
The CMS Innovation Center held the fourth in a series of webinar events for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Wednesday, June 29, 2016 from 4:00p.m. – 5:00p.m. EDT. This webinar explored the LDO and non-LDO financial methodologies and the quality measures that are part of this model.
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The Part D Payment Modernization Model team presented an overview webinar on Wednesday, February 6, 2019 from 1:00 p.m. to 2:00 p.m. EST. This is a repeat of the webinar held on Thursday, January 31 from 1:00 p.m. to 2:00 p.m. EST.
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Similar to Webinar: Direct Contracting Model Options - Payment Part Two (20)
The Medicare Advantage Value-Based Insurance Design (VBID) Model team at the Center for Medicare and Medicaid Innovation (CMMI) and national leaders participated in a discussion around pathways for addressing food and nutritional insecurity at webinar event of our Health Equity Incubation Program on Thursday, March 31, 2022, from 3:00-4:30 PM ET.
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This document provides information about the Calendar Year 2023 Medicare Advantage Value-Based Insurance Design Model application process. It outlines the application timeline and materials available to support MA organizations in submitting their proposals. Key dates include an April 15th deadline to submit applications and a June 6th deadline for MA bids. The presentation reviews the application components and financial reporting requirements. It emphasizes reaching out to CMS with any questions and provides contact information for the VBID model team to support MA organizations throughout the application process.
This document summarizes a webinar presented by CMS/CMMI on health equity updates to the ACO REACH Model. The webinar covered new policies being introduced in PY2023 to promote health equity, including a requirement for ACOs to develop a Health Equity Plan, a benchmark adjustment for ACOs serving underserved populations, data collection on beneficiary demographics and social determinants of health, a benefit enhancement for nurse practitioner services, and consideration of health equity in the application scoring process. The webinar also reviewed the model goals, timeline and upcoming opportunities for questions.
The CMS Innovation Center will host a webinar on Thursday, March 10, 2022 from 3:00-4:00 PM ET. During this webinar, presenters will provide a brief review of the recently released Calendar Year (CY) 2023 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component as well as the payment design related to the Hospice Benefit Component of the VBID Model. This session will also offer attendees an opportunity to ask follow-up questions.
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This webinar provided an overview of the Model and the Part D Sponsor application process, as well as included a Q&A session for interested Part D sponsors.
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The CMS Innovation Center hosted a webinar on Wednesday, March 2, 2022 at 3pm – 4pm ET, during which presenters shared updates on the Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model, the Kidney Care Choices (KCC) Model, and the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. This event was available to the first 1,000 registrants. Presentation materials will be available on the respective model webpages following the session.
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The Medicare Advantage Value-Based Insurance Design (VBID) Model Team hosted an office hours session on Thursday February 3rd, 2022 on the Hospice Benefit Component to provide technical and operational support to interested stakeholders. During this office hours session, presenters answered questions submitted in advance to the VBID Mailbox and offered attendees an opportunity to ask additional questions.
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Has your organization prioritized addressing health inequities? How can a Center for Medicare and Medicaid Innovation (CMMI) Model factor into your organization’s health equity strategy? How can you structure your plan’s benefits to have the greatest impact on underserved communities? What partnership opportunities are available with CMMI?
These are important questions CMMI plans to answer in a new webinar series focused on health equity! CMMI is sponsoring a series of webinars for current and potential Medicare Advantage Organization (MAO) participants in the Value-Based Insurance Design (VBID) Model.
The first webinar in the series provided an overview of the Model’s Health Equity Incubation Sessions effort, articulated a business case for MAOs to leverage VBID Model Components to address health inequities in their member populations, and provided specific guidance and clarification on the full extent of health equity focused flexibilities that fall under the Model’s waiver authority.
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CMMI, in partnership with Million Hearts® at the Centers for Disease Control and Prevention (CDC), will sponsor a webinar entitled Value-Based Insurance Design, Opportunities to Improve Medication Adherence for Cardiovascular Disease Prevention on October 21, 2021 from 3:00-4:00 PM ET. The webinar will present evidence-based high impact strategies for MAOs to improve care and outcomes for beneficiaries with cardiovascular disease (CVD), including underserved populations.
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As part of a broader partnership, CMMI, the Office of the Assistant Secretary for Health (OASH) and the Administration for Community Living (ACL) are jointly sponsoring a webinar titled, Unleashing the Capabilities of MAOs to Deliver Health Innovation for Older Adults in Underserved Settings on October 7 from 2:30-4:00 PM ET to highlight the emerging, numerous opportunities for MAOs to support beneficiaries in more fully meeting their care needs and goals through novel approaches and services enabled by technology.
The webinar will provide an overview of the data supporting these opportunities and will include a panel of three speakers from payer organizations, each of whom will provide an overview of their experience and results in innovating in the use of technology to address unmet enrollee health needs. Panelists include Mona Siddiqui MD, MPH, Senior Vice President for Enterprise Clinical Strategy and Quality at Humana, who will discuss Humana’s approach to the use of data and predictive modeling to proactively engage and provide care for the highest risk and most vulnerable populations; John Wiecha, Medical Director, Senior Products Division at Point32Health, representing the newly combined organizations of Harvard Pilgrim Health Care and Tufts Health Plan will provide an overview of a recent pilot project to improve dementia care through a digital caregiver support program; and Caesar A. DeLeo, MD, MHSA Vice President & Executive Medical Director Strategic Initiatives, Highmark Health Enterprise Clinical Organization, Highmark BCBS who will discuss Highmark’s experience with telemedicine to approach substance use disorders during the pandemic and results from a five-year data driven program addressing appropriate opiate prescribing through profiling and academic detailing.
The webinar offers attendees the opportunity to gain a better understanding of the evidence and potential of several technology-enabled services in improving access, quality and outcomes of care, including, importantly, for underserved populations and will provide MAOs with insights more broadly on the challenges and solutions in design, implementation and evaluation of innovative and technology-enabled service. MAOs that are considering such innovations who may wish to target the use of technology-enabled and/or other services based on chronic illness and/or Low-Income Subsidy (LIS) status through the VBID Model are encouraged to attend.
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The ET3 Model and Medicaid: Opportunities for Alignment webinar provided background on the ET3 Model, discussed the benefits for states of aligning coverage and payment policies with ET3, and explored considerations for states seeking to implement new Medicaid services that align with the ET3 Model. This webinar was intended for state Medicaid agencies, ET3 Model Participants, and other stakeholders interested in learning more about optional Medicaid alignment with the ET3 Model.
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CMS announced an Office Hour event for potential applicants to ask questions ahead of the PCF application deadline.
The PCF Model Team was available to answer questions on key topics including eligibility, payment design and attribution, and more.
You may also refer to the materials from the two PCF webinars held in March: Introduction to PCF and Ready, Set, Apply.
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In order to help ETC Model Participants prepare for the ETC Model, CMS conducted an introductory webinar on Wednesday, December 9, 2020 from 1 p.m. to 2 p.m. The webinar provided an overview of the ETC Model, including:
Participant selection
The Home Dialysis Payment Adjustment
The Performance Payment Adjustment
The ETC Model timeline, including the timing of payment adjustments
Information about how to communicate with CMS about the ETC Model
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The Part D Senior Savings Model and Part D Payment Modernization Model teams hosted a webinar on Tuesday, March 23, 2021 from 1:00 to 2:00 PM EDT. During this webinar, presenters provided an overview of the two Models and the Calendar Year (CY) 2022 application process. The session also offered attendees an opportunity to ask follow-up questions.
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- The document discusses the Medicare Advantage Value-Based Insurance Design (VBID) Model for calendar year 2022 and the hospice benefit component payment methodology.
- It provides an overview of the key assumptions used to develop the CY 2022 hospice capitation rates, including trends in hospice and non-hospice claims, service intensity, geographic adjustments, and aggregate and inpatient caps.
- Materials describing the hospice capitation rate development methodology and rates are available on the CMS website for reference. Organizations interested in participating in the VBID Model should submit applications by April 16, 2021.
The Emergency Triage, Treat, and Transport (ET3) Model Medical Triage Line Notice of Funding Opportunity (NOFO) webinar provided an overview of the application process and NOFO requirements for implementing 911 medical triage lines. This webinar was intended for those interested in learning more about the ET3 Model’s Notice of Funding Opportunity, which was released March 12.
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The Primary Care First Model (PCF) Options team provided an overview of the PCF payer partnership. Participants were able to learn about current PCF Model participants, benefits to payer partnership, the framework against which payer proposal alignment will be evaluated, and the payer solicitation process and timeline.
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The Primary Care First Model Options team provided an overview of the Model, including goals, eligibility to participate in the second cohort, payment design and attribution, and data sharing. Model staff answered your questions about these topics.
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This document provides an overview of the Community Health Access and Rural Transformation (CHART) Model, which tests whether aligned financial incentives, operational flexibility, and technical support can help rural healthcare providers transform care delivery and achieve goals like improved access, quality, and financial sustainability. The webinar agenda includes introductions, discussing rural healthcare challenges, the CHART Model goals and design, timeline and next steps, and a question and answer session. The CHART Model has two participation tracks - the Community Transformation Track provides upfront funding and payments to communities that implement care redesign strategies, while the ACO Transformation Track provides advance shared savings payments to encourage Accountable Care Organizations (ACOs) to participate in risk-bearing models.
The Direct Contracting Model Options team hosted a webinar on June 29, 2020 from 1:00 to 2:00 PM EDT. During this webinar, presenters provided a demonstration of the application portal and the Provider List Submission Tool (PLST). Following this session, attendees had an opportunity to ask follow-up questions.
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More from Centers for Medicare & Medicaid Services (CMS) (20)
FT author
Amanda Chu
US Energy Reporter
PREMIUM
June 20 2024
Good morning and welcome back to Energy Source, coming to you from New York, where the city swelters in its first heatwave of the season.
Nearly 80 million people were under alerts in the US north-east and midwest yesterday as temperatures in some municipalities reached record highs in a test to the country’s rickety power grid.
In other news, the Financial Times has a new Big Read this morning on Russia’s grip on nuclear power. Despite sanctions on its economy, the Kremlin continues to be an unrivalled exporter of nuclear power plants, building more than half of all reactors under construction globally. Read how Moscow is using these projects to wield global influence.
Today’s Energy Source dives into the latest Statistical Review of World Energy, the industry’s annual stocktake of global energy consumption. The report was published for more than 70 years by BP before it was passed over to the Energy Institute last year. The oil major remains a contributor.
Data Drill looks at a new analysis from the World Bank showing gas flaring is at a four-year high.
Thanks for reading,
Amanda
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New report offers sobering view of the energy transition
Every year the Statistical Review of World Energy offers a behemoth of data on the state of the global energy market. This year’s findings highlight the world’s insatiable demand for energy and the need to speed up the pace of decarbonisation.
Here are our four main takeaways from this year’s report:
Fossil fuel consumption — and emissions — are at record highs
Countries burnt record amounts of oil and coal last year, sending global fossil fuel consumption and emissions to all-time highs, the Energy Institute reported. Oil demand grew 2.6 per cent, surpassing 100mn barrels per day for the first time.
Meanwhile, the share of fossil fuels in the energy mix declined slightly by half a percentage point, but still made up more than 81 per cent of consumption.
How To Cultivate Community Affinity Throughout The Generosity JourneyAggregage
This session will dive into how to create rich generosity experiences that foster long-lasting relationships. You’ll walk away with actionable insights to redefine how you engage with your supporters — emphasizing trust, engagement, and community!
Causes Supporting Charity for Elderly PeopleSERUDS INDIA
Around 52% of the elder populations in India are living in poverty and poor health problems. In this technological world, they became very backward without having any knowledge about technology. So they’re dependent on working hard for their daily earnings, they’re physically very weak. Thus charity organizations are made to help and raise them and also to give them hope to live.
Donate Us:
https://serudsindia.org/supporting-charity-for-elderly-people-india/
#oldagehome, #donateforeldersinkurnool, #donateforelders, #donationforelders, #donateforoldpeople, #donationforoldpeople, #sponsorforelders, #sponsorforoldpeople, #donationforcharity, #charity, #seruds, #kurnool, #donateforoldagehome, #oldagehomedonation
Presentation by Julie Topoleski, CBO’s Director of Labor, Income Security, and Long-Term Analysis, at the 16th Annual Meeting of the OECD Working Party of Parliamentary Budget Officials and Independent Fiscal Institutions.
Webinar: Direct Contracting Model Options - Payment Part Two
1. Direct Contracting:
Global and Professional Options
Payment Part Two Webinar
January 22, 2020
Center for Medicare and Medicaid Innovation
Centers for Medicare & Medicaid Services (CMS)
1
2. Webinar Agenda
2
• Direct Contracting Overview
• Benchmarking
• Standard DCEs
• New Entrant & High Needs Population DCEs
• Reconciliation Example
Payment Part 2 Webinar Agenda (TODAY)
Payment Part 1 Webinar Agenda (January 15th)
• Payment Mechanisms
• Risk Mitigation
• Reconciliation
The financial methodology described in this webinar is still in development and is subject to change. CMS will
release additional information as it becomes available.
4. Model Goals
4
Transform risk-sharing
arrangements in
Medicare Fee-For-
Service (FFS)
Empower beneficiaries
to personally engage
in their own care
delivery
Reduce provider
burden to meet health
care needs effectively
5. Financial Goals and Opportunities
5
• New performance year benchmark methodologies focused on increasing
benchmark stability, simplicity, and prospectivity;
• Capitation and other advanced payment alternatives for model
participants; and
• Financial model that supports broader participation by entities new to
Medicare FFS and/or focused on delivering care for high needs populations.
The Direct Contracting Model builds on the Next Generation ACO Model,
introducing several new model design elements including:
6. Provider Relationships
6
Direct Contracting Entity (DCE)
• Must have arrangements with Medicare-enrolled providers or suppliers, who agree to participate in the
Model and contribute to the DCE’s goals pursuant to a written agreement with the DCE.
• DCEs form relationships with two types of provider or supplier:
• Used to align beneficiaries to the DCE
• Required to accept payment from the DCE
through their negotiated payment arrangement
with the DCE, continue to submit claims to
Medicare, and accept claims reduction
• Report quality
• Eligible to receive shared savings
• Have option to participate in benefit
enhancements and beneficiary engagement
incentives
DC Participant Providers
• Not used to align beneficiaries to the DCE
• Can elect to accept payment from the DCE
through a negotiated payment arrangement
with the DCE, continue to submit claims to
Medicare, and accept claims reduction
• Eligible to receive shared savings
• Have option to participate in benefit
enhancements and beneficiary engagement
incentives
Preferred Providers
7. Risk Options
7
Professional Global
50% shared savings / shared losses
risk arrangement
• Must select the Primary Care Capitation
(PCC)
• No discount for the Performance Year
Benchmark
100% shared savings / shared
losses risk arrangement
• Must choose either the Total Care
Capitation (TCC) or Primary Care
Capitation (PCC)
• Performance Year Benchmark includes
a discount that begins at 2% in PY1 and
increases to 5% by PY5
8. Summary of DCE Types
8
Standard New Entrant High Needs
DCEs with substantial
historical claims-based
experience serving
Medicare FFS
DCEs with limited
experience delivering
care to Medicare FFS
beneficiaries
DCEs that focus on
beneficiaries with
complex, high needs,
including individuals
dually eligible for
Medicare and Medicaid
Professional and Global are available for each DCE type
Risk
Arrangement
Options
DCE Types
10. What is the Benchmark?
10
• The benchmark is a Per Beneficiary Per Month
(PBPM) dollar amount against which a DCE is held
accountable for performance year (PY) Medicare FFS
expenditures for its aligned beneficiaries
• The benchmark is inclusive of the total cost of care for
Medicare Parts A & B services (Part D is not included)
• Separate benchmarks will be set for the Aged & Disabled
(A&D) and ESRD beneficiary entitlement categories
• CMS compares expenditures incurred in the
performance year for beneficiaries aligned to a DCE
against the benchmark to determine shared savings or
shared losses during reconciliation
The method for calculating
the benchmark varies
depending on the type of
DCE and how beneficiaries
are aligned to the DCE
(claims-based or voluntary
alignment)
11. Benchmarking Approaches
11
1. Beneficiaries who could be aligned to the same DCE via both voluntary and claims-based alignment will be treated as
having claims-based alignment for benchmarking
DCE Type Standard New Entrant High Needs
Alignment
Option1
Claims-Based
Alignment
Voluntary Alignment Both Options Both Options
PY1
PY2
PY3
PY4
PY5
Standard
Benchmarking
Approach using
historical expenditures
for beneficiaries that
would have aligned to
the DCE in the base
years (CY17 – CY19)
Regional Benchmarking Approach that does not use historical expenditures,
instead composed entirely of the adjusted MA Rate Book for the PY
(this approach uses only the final three steps in the following slide)
Modified Standard Benchmarking Approach using recent historical
expenditures (from PY1 – PY3, as applicable) for beneficiaries aligned to the DCE
12. How is the Benchmark Calculated?
12
Calculate
historical
expenditures
based on
beneficiaries
aligned to the
DCE through
Participant
Providers
Apply a trend
based on
projected US Per
Capita Cost
(USPCC) to
account for
changes in
health care
spending by year
Standardize
historical
expenditures for
variations in
beneficiary
health risk and
Geographic
Adjustment
Factors (GAFs)
Blend historical
expenditures
with performance
year regional
expenditures
using adjusted
Medicare
Advantage (MA)
rate book
Adjust for the
health risk and
Geographic
Adjustment
Factors (GAFs)
of aligned
beneficiaries in
performance
year
Apply discount
(Global only) as
well as quality
withhold and
amount of the
quality withhold
earned back
The benchmarking methodology generally includes the following steps, but will be applied
differently depending on the type of DCE and how beneficiaries are aligned to the DCE
Calculate
Historical
Expenditures
Trend
Baseline with
USPCC
Apply Risk-
and
Geographic-
Standardization
Incorporate
Regional
Expenditures
(MA Rate
Book)
Adjust for
Risk and
Geography for
Performance
Year
Apply
Discount /
Quality
Withhold
14. Calculate Historical Expenditures:
Claims-Based Alignment1
14
1. Beneficiaries who could be aligned to the same DCE via both voluntary and claims-based alignment will be treated
as having claims-based alignment for benchmarking.
Baseline Year 2017 2018 2019
% Contribution to
Historical Baseline
10% 30% 60%
Standard DCE
• The historical baseline expenditure is calculated using a
weighted average of historical Medicare expenditures
for beneficiaries that would have been aligned to the
DCE (via its current Participant Providers) in the base
years (CYs 2017, 2018, and 2019)
• The base years will remain 2017-2019 for the entire 5-
year model
• However, the historical baseline expenditure will be
updated each PY as CMS will use a DCE’s most recent
list of DC Participant Providers to identify the
beneficiaries that would have been aligned to the DCE
for each base year and determine their associated
expenditures
Historical Base Year Weighting for
the Baseline Period
Fixed Baseline Years
Regional
Expenditures
Risk / GAF
Adjust
Risk / GAF
Stand.
Trend
Baseline
Historical
Expenditures
Discount /
Quality
15. 15
1. Beneficiaries who could be aligned to the same DCE via both voluntary and claims-based alignment will be treated as having
claims-based alignment for benchmarking
Historical Base Year Weighting for the
Baseline Period
Rolling Baseline Years
PY4 (2024) PY5 (2025)
Baseline Year 2021 2022 2021 2022 2023
% Contribution
to Historical
Baseline
33% 67% 10% 30% 60%
• For PY1 – PY3, the benchmark will not
incorporate any of the voluntarily aligned
beneficiaries’ historical expenditures
• Beginning in PY4, the benchmark will
incorporate recent historical expenditures
for aligned beneficiaries to establish the
historical baseline expenditure
• The historical baseline expenditure will be
a weighted average of the recent
beneficiary Medicare expenditures, with
rolling base years
Standard DCE
Calculate Historical Expenditures:
Voluntary Alignment1
Regional
Expenditures
Risk / GAF
Adjust
Risk / GAF
Stand.
Trend
Baseline
Historical
Expenditures
Discount /
Quality
16. 16
Standard DCE
Trend Baseline with USPCC
Regional
Expenditures
Risk / GAF
Adjust
Risk / GAF
Stand.
Trend
Baseline
Historical
Expenditures
Discount /
Quality
As the trend is prospective, DCEs will know the trend rate prior to the start of the
performance year1
Trending the baseline expenditures accounts for the differences in healthcare costs
between the base years and the performance year
The historical baseline expenditures will be prospectively trended forward each
performance year using the projected US Per Capita Cost (USPCC) growth
(developed annually by the CMS Office of the Actuary (OACT))
1. Under limited circumstances, CMS reserves the right to make changes to the trend retrospectively if the trend
is inaccurate to prevent DCEs from being unfairly penalized or rewarded for major payment changes beyond
their control
17. Apply Risk and Geographic Standardization
17
• CMS will risk standardize the historical baseline expenditures to account for
differences in risk for the beneficiaries included in the historical baseline
expenditures calculation
• CMS will apply a modified risk adjustment methodology for the Direct Contracting
Model to achieve two primary goals
1. Improve the accuracy of risk adjustment for complex, high-risk
beneficiaries with serious illness.
2. Mitigate the influence of coding intensity on risk adjustment.
• CMS will also standardize the historical baseline expenditures to account for the
regional Geographic Adjustment Factors (GAFs)1 applied to payments in the base
years
Standard DCE
Regional
Expenditures
Risk / GAF
Adjust
Risk / GAF
Stand.
Trend
Baseline
Historical
Expenditures
Discount /
Quality
1
2
1. GAFs are applied to Medicare FFS payments to account for county pricing differences (e.g., the Medicare area
wage index, and the geographic practice cost index)
18. Incorporate Regional Expenditures
18
The Direct Contracting Model incorporates regional dynamics by using an adjusted version of the
Calendar Year’s (CY) MA Rate Book that CMS’ Office of the Actuary (OACT) updates annually
Each PY, CMS will apply
the corresponding CY’s
Adjusted MA Rate Book
(i.e., in PY1 the 2021
Adjusted MA Rate Book
will be used, in PY2 the
2022 Adjusted MA Rate
Book will be used, etc.)
Adjust the
MA Rate
Book
• Adjust the MA Rate Book to make it appropriate for the Direct Contracting
context
• The adjusted MA Rate Book will be established by county prior to each PY
• Additional details on the adjustments to the MA Rate Book for the Direct
Contracting Model are forthcoming
Blend
Baseline
with Rate
Book
Cap Impact
of the Rate
Book
• The impact of incorporating the Regional Expenditures on the trended
Historical Baseline Expenditures will be constrained
• Maximum upward adjustment is limited to 5% of the FFS USPCC for the PY
• Maximum downward adjustment is limited to 2% of the FFS USPCC for the
PY
Standard DCE
Regional
Expenditures
Risk / GAF
Adjust
Risk / GAF
Stand.
Trend
Baseline
Historical
Expenditures
Discount /
Quality
• Determine the weighted average adjusted MA Rate Book expenditures
(“Regional Expenditures”) for each DCE based on the geographic distribution
of its beneficiaries
• Blend the Regional Expenditures with the DCE’s trended Historical Baseline
Expenditure
• The weight assigned to the Regional Expenditure component of the blend
will increase each PY
19. Incorporate Regional Expenditures (cont.)
19
• The Historical Baseline
Expenditures will be blended
with the Regional Expenditures
from the Adjusted MA Rate
Book
• The weighting of the Regional
Expenditures component in the
PY benchmark will increase
over the model performance
period
PY 1
(2021)
PY2
(2022)
PY3
(2023)
PY4
(2024)
PY5
(2025)
DCE’s Historical
Baseline
Expenditures
65% 65% 60% 55% 50%
Regional
Expenditures (Adj.
MA Rate Book)
35% 35% 40% 45% 50%
Blending the Historical Baseline Expenditures with
the Regional Expenditures
Standard DCE
Regional
Expenditures
Risk / GAF
Adjust
Risk / GAF
Stand.
Trend
Baseline
Historical
Expenditures
Discount /
Quality
20. Risk and GAF Adjust for Performance Year
20
• After incorporating Regional Expenditures, CMS will risk adjust the benchmark to
account for the risk profiles of the beneficiaries aligned to the DCE for the
performance year
• As with risk standardization, CMS will apply the modified risk adjustment
methodology to achieve two primary goals:
1. Improve the accuracy of risk adjustment for complex, high-risk beneficiaries
with serious illness.
2. Mitigate the influence of coding intensity on risk adjustment.
• CMS will also apply an adjustment to the benchmark to account for the regional
Geographic Adjustment Factors (GAFs)1 applied to payments in the performance
year
Standard DCE
Regional
Expenditures
Risk / GAF
Adjust
Risk / GAF
Stand.
Trend
Baseline
Historical
Expenditures
Discount /
Quality
1
2
1. GAFs are applied to Medicare FFS payments to account for county pricing differences (e.g., the Medicare area wage
index, and the geographic practice cost index
21. Discount and Quality Withhold
21
Step 1: Apply Discount
Global Only
Reduction to the benchmark, that increases each PY
Step 2:
Assess
Quality
Global &
Professional
Quality
Withhold
Reduction to the benchmark applied prior to the PY
Quality
Performance
Earn Back1
DCEs can earn back some or all of the Quality Withhold
at the end of the PY, based on their performance on
quality measures
Step 3: Apply High
Performers’ Pool (HPP)
Global & Professional
The amount of the Quality Withhold that DCEs fail to
earn back contributes to the High Performers’ Pool; high
performing DCEs have the opportunity to earn a portion
of this pool
Top performing DCEs
may exceed 100% of
their pre-discounted
benchmark after
quality and HPP
adjustments
1. Note, the quality strategy was updated in December 2019.
• Advanced Care Planning quality measure removed. A new Care coordination/planning measure is currently under development.
• A pre-defined performance benchmark will serve as the continuous improvement / sustained exceptional performance (CI/SEP)
criteria for PY2
Standard DCE
Regional
Expenditures
Risk / GAF
Adjust
Risk / GAF
Stand.
Trend
Baseline
Historical
Expenditures
Discount /
Quality
22. Discount and Quality Withhold (cont.)
22
PY11
(2021)
PY2
(2022)
PY3
(2023)
PY4
(2024)
PY5
(2025)
Step 1: Apply
Discount
Global Only
Discount -2% -2% -3% -4% -5%
Step 2:
Assess
Quality
Global &
Professional
Quality
Withhold
-5% -5% -5% -5% -5%
Quality
Performance
Earn Back
Up to +5% Up to +5% Up to +5% Up to +5% Up to +5%
Step 3: Apply
HPP2
Global &
Professional
High
Performers’
Pool (HPP)
N/A
Up to
+TBD%
Up to
+TBD%
Up to
+TBD%
Up to
+TBD%
Patient / Caregiver Experience
Survey3
Risk Standardized All
Condition Readmission3
Risk Standardized Acute
Admission Rates for Patients
with Multiple Chronic
Conditions3
Care Coordination / Planning
Under Development
Days Spent at Home
Under Development
(for High Needs DCE type only)
Quality Measures
Impact on PY Benchmark
1. For PY1, CMS anticipates using pay-for-reporting for the quality measure set that will be used to determine the DCE’s quality
performance
2. The High Performers’ Pool will not be applicable in PY1; the detailed methodology for HPP will be made available prior to PY2
3. Pay for performance in PY2
Standard DCE
Regional
Expenditures
Risk / GAF
Adjust
Risk / GAF
Stand.
Trend
Baseline
Historical
Expenditures
Discount /
Quality
23. Discount and Quality Withhold (cont.)
23
• Payment for quality will be tied to
demonstrable continuous
improvement / sustained
exceptional performance (CI/SEP)
in PY 3 - PY 5.
• Specifically, half of the quality
withhold will be tied to a set of
CI/SEP criteria (PY 3 - PY 5)
requiring either improvement relative
to criteria or, for high performing
DCEs, maintenance of performance
• In PY2, a pre-defined performance
benchmark1 will serve as the
CI/SEP criteria.
Calculation of Quality Performance Earn Back
Quality
Score
Up to 100%
Quality
Withhold
5%
Quality
Score
Up to 100%
Half of
Quality
Withhold
2.5%
Up to 5%
Earn Back
Up to 2.5%
Earn Back
If DCE
fails to
meet
CI/SEP
criteria
If DCE
meets
CI/SEP
criteria
Standard DCE
Regional
Expenditures
Risk / GAF
Adjust
Risk / GAF
Stand.
Trend
Baseline
Historical
Expenditures
Discount /
Quality
1. This is new relative to the RFA and the pre-defined performance benchmark criteria is under development
25. 25
The benchmark
methodology for New
Entrant and High
Needs DCEs is
consistent with the
approach for voluntary
aligned beneficiaries in
a Standard DCE
Other benchmarking
steps (e.g., Risk and
GAF Adjustment) will
continue to apply
PY1 PY2 PY3 PY4 PY5
PY1 – PY3 PY4 & PY5
• Aligned beneficiaries’ historical
expenditures are not incorporated into
the PY benchmark
• Only the regional expenditures, as
measured by the Adjusted MA Rate
described earlier, are used to establish
the PY Benchmark
• Beginning in PY4, the benchmark will
incorporate aligned beneficiaries’ recent
experience to establish the Historical
Baseline Expenditures. The Historical
Baseline Expenditures will be a weighted
average of the recent years’ aligned
beneficiary Medicare FFS claims
‒ PY4 (2024): 2021 (33%) and 2022
(67%)
‒ PY5 (2025): 2021 (10%), 2022
(30%), and 2023 (60%)
• The Historical Baseline will then be
blended with the Regional Expenditures
(i.e. adj. MA Rate Book) to establish the
benchmark, using a weighted average:
‒ PY4 (2024): Historical Baseline
(55%), Regional Expenditure (45%)
‒ PY5 (2025): Historical Baseline
(50%), Regional Expenditure (50%)
New Entrant DCE & High Needs DCE
Overview of New Entrant DCE & High Needs DCE
Benchmark Methodology
27. Example of Final Reconciliation
27
$940
PBPM
Performance Year
Benchmark
$1000 PBPM
vs.
Capitation (and
Advanced
Payments)1
$530 PBPM
FFS Claims
Payments
$410 PBPM
Gross Savings
$60 PBPM
(6% of benchmark)
After the Performance Year is completed, CMS compares all Medicare FFS expenditures for services
delivered to aligned beneficiaries against the DCE’s performance year benchmark to determine shared
savings or shared losses
Professional
Corridor 0-5% 5-10%
DCE
Risk
50% 35%
$50 x 50% = $25 PBPM
$10 x 35% = $3.5 PBPM
$28.5 PBPM
1. The Capitation Payment Mechanisms under the Direct Contracting Model include TCC, PCC, and Advanced Payments, and
recoupment / reconciliation will be applied before calculation of total expenditures
Final PY
Benchmark
Total PY
Expenditures
Gross Savings
Application of
Risk Corridors
Shared Savings
29. Direct Contracting Open Q&A
29
Open Q&A
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
31. Model Timeline
31
This timeline may be subject to change. Please check the Directing Contracting webpage for webinar and office
hour dates and times.
Timeline
Implementation Period (IP)
DCE Applicants
Performance Period (PY1)
DCE Applicants
Application Period
November 25, 2019 –
February 25, 2020
(Application tool opened
December 20, 2019)
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
33. 33
This timeline may be subject to change. Please check the Direct Contracting webpage for webinar and office
hour dates and times.
Upcoming Webinars and Office Hours
Webinar Date
Office Hour Session for Payment: Part 1
February 4, 2020
(register here)
Office Hour Session for Payment: Part 2
February 11, 2020
(register here)
34. Audience Poll
34
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
35. 35
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
Contact Information