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Deadline Extended: Direct Contracting Geographic PBP Model RFI

The Center for Medicare & Medicaid Innovation (CMMI) has extended to May 30 the deadline for its request for information (RFI) on the new direct contracting geographic population-based payment (PBP) model. The model is expected to begin in January 2021.

Entities participating in the geographic PBP model would assume full risk for the total cost of care for Medicare fee-for-service beneficiaries in a defined target region. In the first performance year, CMS will limit participation to four target regions, proposed by applicants and subject to CMS requirements.

Under the geographic PBP model, a direct contracting entity’s (DCE’s) total cost of care accountability would depend on historical Medicare Parts A and B per capita spending in the target region. CMS will select one or more DCE per target region, with a preference for target regions with at least two DCEs, to encourage competition. The agency would pay DCEs on a capitated basis, with the option to contract directly with health care providers for services used by aligned beneficiaries.

CMS seeks stakeholder feedback on criteria the agency should consider for selecting DCEs, as well as general model design questions, such as:

  • selection criteria for target regions;
  • types of entities interested in participating;
  • how to identify and resolve potential conflicts of interest;
  • beneficiary protection considerations; and
  • payment methodology parameters.

Submit comments electronically to DPC@cms.hhs.gov and include “Geographic PBP RFI” in the subject line.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Emily Schweich is a senior communications associate for America's Essential Hospitals.

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