Capitol Correspondence - 04.29.19

HHS Releases New Changes to Fee-for-Service Model, Focusing in Primary Care

Share this page

The Department of Health and Human Services’ (HHS) followed through on its stated interest in reforming fee-for-service models, releasing a new, two-pronged voluntary Medicare payment model for primary care providers. While most disability supports are funded by Medicaid and not Medicare, this shift away from a fee-for-service model in Medicare is relevant to people with disabilities and the providers who support them because it sets precedent for changes that could eventually come to Medicaid. 

As summarized by Health Care Dive:

  • The two-pronged program has paths for small practices and large organizations and a range of options from partial shared risk to full downside risk.
  • The agency projects as many as a quarter of traditional Medicare fee-for-service beneficiaries will be incorporated into the five-year program, called Primary Cares Initiative. It is slated to roll out in January, with a call for applications expected in about a month. [Emphasis added by ANCOR.]
  • CMS is also asking for input on an additional model in the program that would give one organization responsibility for the total cost of care for an entire Medicare population in a geographic area. That model would begin in January 2021. [ANCOR note: the Request for Information is available here, with a deadline of May 23].

As noted on the webpage dedicated to the new model, CMS will hold webinars for stakeholders on April 30th and May 16th.  The webpage also gives more details on the release timeline and offers a fact sheet.