The Centers for Medicare and Medicaid Services (CMS) released the Request for Applications (RFA) for the Long-term Enhanced ACO Design (LEAD) model, a 10-year voluntary model that will run from January 1, 2027, through December 31, 2036, following the sunset of ACO REACH. The model builds on the CMS Innovation Center’s (CMMI) commitment to improving care for complex and high needs and to make it easier for both providers and patients to engage in preventive care.
Model components beneficial to long term and post-acute care (LTPAC) providers include:
- Monthly voluntary alignment;
- Treatment of High Needs as a beneficiary category rather than a track;
- Concurrent risk adjustment for High Needs beneficiaries;
- Improved benchmarking with no rebasing;
- Administrative add-on payments without recoupment; and
- Lowered minimum thresholds for ACOs serving a significant proportion of High Needs beneficiaries.
CMS will evaluate applicants based on five domains alongside program integrity and market-impact assessments: organizational readiness; revenue sources and payment arrangements; beneficiary and caregiver experience; data and health information capabilities; and preventive care infrastructure.
Performance Year (PY) 2026 ACO REACH participants may submit abbreviated applications. CMS anticipates offering additional application cycles in future years; however, interested organizations are encouraged to apply for the initial cohort. Organizations that do not apply in this cycle but remain interested in the model may submit a nonbinding Letter of Interest to receive updates and future application timelines.
AHCA/NCAL continues to engage with CMS to strengthen the LEAD model’s applicability for high needs focused ACOs, especially long term care providers. AHCA/NCAL has also developed a brief summary of the LEAD model as it pertains to long term and post-acute care. (Please note that a member log-in is required to view the summary).
The model RFA and FAQs are also available. Please contact AHCA’s Population Health Policy Analyst Rohini Achal or Nisha Hammel, Vice President, Reimbursement Policy & Population Health with any questions.