CMS names first 79 ACOs in new 10-year LEAD Model

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CMS names first 79 ACOs in new 10-year LEAD Model

Plus: Elevance's Star Ratings summary judgment brief due tomorrow. The day's rules, money, and enforcement, sourced and tiered below.

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CMS named the first 79 accountable care organizations (ACOs), groups of doctors and hospitals paid to keep Medicare patients healthy for less, in its new 10-year Medicare payment model.

65 of the 79 chose full financial risk. Once a renewing ACO signs onto that track, it can't switch back for the model's remaining decade. CMS says 100+ more ACOs are preparing to join by a mid-December deadline.

Record

Elevance Health, one of the nation's largest health insurers, has its opening legal brief due tomorrow in a fight over how Medicare grades its Medicare Advantage plans, worth real bonus dollars.

Both Elevance and the government asked the court to rule by Dec 14, in time to affect 2027 quality bonus payments. Two related insurer suits over the same ratings dispute are moving in parallel in Washington, D.C.

Also today

OIG finds CMS can't verify Medicaid managed care spending reports Read
Massachusetts SNF operator pays $1M over altered rehab records Read
Florida doctor sentenced for signing fraudulent telemedicine orders Read
CMS sends $54.6M to rural Arkansas health programs Read

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