AHCA/NCAL Sees Positive Steps by CMS on LEAD ACO

In a blog post on July 28, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said recent updates by the Centers for Medicare and Medicaid Services (CMS) to the alignment and financial methodology for the Long-Term Enhanced Accountable Care Organization Design (LEAD) Model “will better account for the unique characteristics and needs” of LTC beneficiaries.

The updates are outlined in the LEAD Alignment and Financial Methodology Paper. LEAD will succeed the ACO REACH Model starting on Jan. 1, 2027.  

Park Place first reported on the positive development for LTC stakeholders on July 17. In that news article, Keith Persinger, CEO, Provider Partners, a national leader in ACOs for skilled nursing and assisted living facilities, said CMS responded positively to sustained input from the providers and operators in reshaping two of the most consequential pieces of its new LEAD Model.

In the blog post, AHCA/NCAL said it has long advocated for policies that recognize the complexity of LTC residents and evaluate providers using methodologies that accurately reflect the populations they serve. The LEAD alignment and financial methodology updates represent meaningful progress toward this goal, the association said.

Alignment Improvements 

AHCA/NCAL said one of the most significant improvements is CMS's refinement of beneficiary alignment. The revised methodology creates exceptions to the Whole Taxpayer Identification Number (TIN) alignment process by excluding certain primary care services furnished during short SNF stays from beneficiary attribution.

“This change is intended to ensure LTC beneficiaries are attributed to the clinicians and providers responsible for managing their ongoing care rather than being assigned based on temporary or episodic encounters,” the post said.  

CMS also finalized additional alignment policies, AHCA/NCAL said, “including refined exclusions for certain specialty practitioners and settings, as well as new voluntary alignment methodologies for High Needs beneficiaries. Together, these updates support more accurate attribution, quality measurement, and financial accountability that better reflect LTC delivery.”

Refinements to Benchmarks

CMS also finalized several benchmark refinements that better recognize the complexity and cost of caring for LTC residents, including what AHCA/NCAL said are key changes: 

• Increasing shared savings under the Professional Risk Option from 50 percent to 60 percent. 

  
  

• Establishing new voluntary alignment benchmark methodologies for High Needs beneficiaries that use more current spending data to better reflect clinical complexity. 

  
  

• Implementing a 4 percent risk score growth cap for High Needs beneficiaries for Performance Years 2027 and 2028.  

  
  

• Refining the Regional Efficiency Adjustment by excluding certain newly participating high-spending TINs from regional expenditure calculations.   

  
  

• Clarifying methodologies for incomplete benchmark-year data and adjusting historical expenditures. 

   

• Defining a methodology for adjusting benchmarks when beneficiaries become aligned or newly qualify as High Needs during the performance year. 

  
  

AHCA/NCAL’s Rohini Achal, population health policy analyst, and Nisha Hammel, vice president, reimbursement policy and population health, prepared the blog post.

Questions or comments? Contact Patrick Connole at pconnole@parkplacelive.com.