CMS tests new payment model

Home health and hospice agencies need to let CMS know by Dec. 21 if they want to participate

Medicare wants to know whether a geographic-based approach could improve care quality and lower costs for beneficiaries, and plans to test a new integrated payment and care model in some regions to find out.

Testing of the Geographic Direct Contracting Model is still a couple of years away, but home health and hospice agencies interested in participating should take action by Dec. 21, according to J’non Griffin, President of Home Health Solutions, a Simione Coding Company.

That’s the deadline set by the Centers for Medicaid and Medicare Services (CMS) for agencies to submit a non-binding Letter of Intent to participate in testing, and rank in order of interest 15 potential markets which have been targeted by CMS.

“If agencies want to play in the sandbox, they’re going to need to go ahead and submit this non-binding form now – even though official applications for the first three-year performance period won’t be taken until 2021,” Griffin said.

The GEO Model

The new integrated Geographic Direct Contracting Model is being called the GEO model for short. According to the CMS announcement, it will include two back-to-back performance periods, each running for three years.

The first performance period is scheduled to begin on Jan. 1, 2022, and the second performance period will start on Jan. 1, 2025.

In its Dec. 3 announcement about the new GEO model, CMS said participants within defined geographical areas will work with Direct Contract Entities (DCEs) to coordinate care and social needs for Medicare beneficiaries. Preferred provider networks are expected to be created, and DCE coordination may include care management services, telemedicine, and care delivery systems which are unique to the needs of the region.

Although large health systems and care groups are expected to take the lead in regional care integration efforts, Griffin said there may be many new opportunities for home health and hospice agencies to partner with DCEs and become preferred providers.

“Agencies may want to work with hospitals to become a preferred provider,” she said. “Or they may want to work with telehealth companies to provide services. There are many different ways the model could offer opportunities -- and it is important to signify interest now.”

Letters of Interest

“The Letter of Interest which is due by Dec. 21 is a non-binding letter, just to let CMS determine the interest in participation” Griffin said. “Submitting a response right now will not create any legal obligation to participate in the model.”

Letters of Intent must be submitted to the CMS Innovation Center no later than 11:59 p.m. Dec. 21.