Innovation Models

Innovation Models

The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS. View models and demonstrations currently enrolling. These research and demonstration projects are exempt from the Common Rule under 45 CFR 46.104(d)(5). For additional guidance, refer to the OHRP Revised Common Rule Q&As on Exemptions.

The Innovation Center also plays a critical role in implementing the Quality Payment Program, which Congress created as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In fall 2021, the CMS Innovation Center set a strategic goal for its next ten years: to transform the health system into one that achieves equitable outcomes through high quality, affordable, person-centered care. As part of this, the Center is committed to designing models that are inclusive of a variety of providers who care for underserved populations, ultimately increasing beneficiaries’ access to high-quality care. Learn more.

Our Innovation Models are organized into six categories.

Categories

  • Accountable Care Models:

    Models in which a doctor, group of health care providers or hospital takes financial responsibility for improving quality of care, including advanced primary care services, care coordination and health outcomes for a defined group of patients, thereby reducing care fragmentation and unnecessary costs for patients and the health system.

  • Disease-Specific & Episode-Based Models:

    Models which aim to address deficits in care for a defined population with a specific shared disease or medical condition, procedure, or care episode.

  • Health Plan Models:

    Models comprising Medicare Advantage plans.

  • Prescription Drug Models:

    Models that seek to improve access to and/or the affordability of prescription drugs covered under Medicare (Part B and D) or Medicaid.

  • State & Community-Based Models:

    Models in which a state or community-based organization serves as the main contractual participant, including managed care organizations serving Medicaid beneficiaries.

  • Statutory Models:

    Models and demonstrations requiring testing as determined by Congress and/or the Secretary of Health and Human Services.

Stages

  • Announced:

    Model has been approved but not begun.

  • Announced - Accepting Applications:

    Model has an active Request for Applications (RFA).

  • Announced - Applications Under Review:

    The application period has ended; applicants will be notified directly.

  • Active:

    Model is preparing for implementation, performing currently, or has an ongoing evaluation.

  • Authorized for Expansion:

    Model has been certified for expansion through rule-making.

  • Not Active:

    Model has ended and evaluations are complete.

  • Withdrawn:

    Model will not be implemented.


    Page Last Modified:
    11/08/2023 10:02 AM