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CMS has released a Request for Applications (RFA) for the Direct Contracting demonstration’s Professional and Global options. Organizations interested in participating must submit a Letter of Intent (LOI) for this model by December 10th, 2019. Letters of Intent can be submitted here.You do not need to resubmit an LOI if you already did so when CMS first opened up the online portal earlier this year.
The RFA, available here, includes details about a new category of eligible DC providers, referred to as “High Needs Population Direct Contracting Entities (DCEs)”. This is a change from the previous information on this model. These DCEs are defined as “organizations focused on complex, high needs dually eligible beneficiaries and Medicare FFS beneficiaries at risk of becoming dually eligible.” CMS will align Medicare FFS beneficiaries to these High Needs Population DCEs based on voluntary and claims-based alignment. Organizations interested in serving as High Needs Population DCEs must indicate their preferred DCE type in their responses to this RFA. C-TAC is encouraged to see the inclusion of this new DCE category, as it may offer the best option under DC for those organizations that have traditionally focused on advanced and seriously-ill populations.
The RFA also includes a proposed benefit enhancement, still under consideration by CMS, which is only applicable for DCEs participating in the Global Option. The benefit enhancement would eliminate the requirement that beneficiaries who elect the Medicare Hospice Benefit give up their right to curative care as a condition of electing the hospice benefit. CMS intends to allow qualifying DC Entities to provide care to beneficiaries that have waived their rights to Medicare payment of services related to treatment of their terminal condition.
C-TAC will continue to analyze the RFA and provide updates to our members and partners. We are planning to hold a webinar on Wednesday, December 11th at 12pm ET that will provide in-depth updates on both the DC RFA, as well as the Primary Care First (PCF) RFA, with a focus on the Seriously-Ill Population (SIP) model track. We will share more details and the registration information soon.