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Alternative Payment Models (APM)

Jones Day

CMMI Seeks Lifestyle Interventions That Improve Health Outcomes Under New Model

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The Center for Medicare & Medicaid Services Innovation ("CMMI") announced the Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-Based Approaches Through Evidence ("MAHA ELEVATE") Model, designed to improve...more

Krieg DeVault

Congress Advances Bipartisan Health Bill as Part of FY 2026 Funding Package

Krieg DeVault on

House and Senate appropriations leaders have reached a bipartisan, bicameral agreement to keep the federal government funded through fiscal year 2026 while advancing several long-anticipated health care policy changes....more

Sheppard Mullin Richter & Hampton LLP

Day 2 Notes from the 44th Annual J.P. Morgan Healthcare Conference

J.P. Morgan continues to surprise us at lunch, with the Mayor of San Francisco sharing on Monday an update on recent improvements in the city. Then on Tuesday at the Grand Ballroom lunch, it was the first episode of my...more

Akin Gump Strauss Hauer & Feld LLP

CMS Launches Five New Models at the End of 2025: Looks to Advance ACCESS, BALANCE, MAHA ELEVATE, GLOBE and GUARD in 2026

The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) (Innovation Center) has unveiled a series of new models related to the administration’s focus on improving the health of...more

Sheppard Mullin Richter & Hampton LLP

Application Window Opens Soon for CMS ACCESS Model Expanding Technology-Supported Care Options for Traditional Medicare

The Centers for Medicare & Medicare Services’ (“CMS”) Innovation Center will begin accepting applications on January 12 for the recently announced Advancing Chronic Care with Effective, Scalable Solutions (“ACCESS”) Model—a...more

McDermott+

Looking back to look forward: Recap of the CMS Innovation Center’s 2025 announcements

McDermott+ on

Happy New Year! If 2025 was any indication of what 2026 will be like, we have an extremely busy year ahead in the regulatory world. And no area was busier in 2025 than the Centers for Medicare & Medicaid Services (CMS)...more

Epstein Becker & Green

ACCESS Model: CMMI’s New Technology-Enabled Chronic Care Model

The Center for Medicare and Medicaid Innovation (CMMI) recently announced a voluntary, 10-year Medicare payment and service delivery model: Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model....more

McGuireWoods LLP

Maternal Health: Where Mission Meets Margin in a Transforming Market

McGuireWoods LLP on

The market for maternal healthcare offers providers, payors and investors an opportunity to address pressing social needs while unlocking business growth and expansion. U.S. maternal mortality remains unacceptably high while...more

Tucker Arensberg, P.C.

2026 Medicare Physician Fee Schedule

The final Medicare Physician Fee Schedule for 2026 has now taken effect. Under the new rule, Center for Medicare Services (CMS) finalized two separate Medicare conversion factors depending on participation in a qualifying...more

Mintz - Health Care Viewpoints

The BALANCE Model and a New Wave of CMS Drug Pricing Models

On December 23, 2025, the Centers for Medicare & Medicaid Services (CMS) announced the Better Approaches to Lifestyles and Nutrition for Comprehensive hEalth (BALANCE) Model, a voluntary, alternative payment model (APM),...more

Foley & Lardner LLP

CMS ACCESS Model: Providers Prepare for Technology-Driven, Value-Based Care

Foley & Lardner LLP on

On December 1, 2025, the Centers for Medicare & Medicaid Services (CMS) announced the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions), a voluntary, 10-year initiative aimed at improving care for...more

Foley & Lardner LLP

LEAD-ing the Future of ACOs: New Long-term Enhanced ACO Design Model

Foley & Lardner LLP on

The Centers for Medicare & Medicaid Services (CMS) Innovation Center has announced the Long-term Enhanced ACO Design (LEAD) Model — a 10-year initiative designed to advance value-based care for Medicare beneficiaries,...more

Ropes & Gray LLP

Is International Pricing Coming Onshore for Testing? CMS Proposes Models Tying Medicare Part B and Part D Drug Rebates to...

Ropes & Gray LLP on

On December 19, 2025, the Centers for Medicare & Medicaid Services (“CMS”) proposed two mandatory Center for Medicare and Medicaid Innovation (“CMMI”) drug payment models to test whether alternative methods for calculating...more

King & Spalding

CMS Proposes Updates to the IOTA Model

King & Spalding on

On December 11, 2025, CMS issued a proposed rule to update and revise the Increasing Organ Transplant Access (IOTA) Model for Performance Year (PY) 2 (the Proposed Rule). The IOTA Model is a 6-year mandatory alternative...more

Nelson Mullins Riley & Scarborough LLP

2025 Value Based Care Forum: Q&A

During the Nelson Mullins 2025 Annual Value-Based Care Forum, Navigating Opportunities in a Value-Driven World, virtual attendees submitted questions for the panelists to answer. Below are the panelists’ responses, which...more

Bass, Berry & Sims PLC

Taking the LEAD: CMS Unveils the New LEAD Model, Focused on Long-Term Primary Care Success

Bass, Berry & Sims PLC on

On December 18, 2025, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced the Long-term Enhanced ACO Design (LEAD) Model, a voluntary accountable care organization (ACO) initiative set to launch...more

Ankura

Medicare Finalizes 3.8% Physician Reimbursement Increase

Ankura on

On Oct. 31, the Centers for Medicare and Medicaid Services (CMS) released the 2026 Physician Fee Schedule Final Rule (Final Rule), which outlines the changes to payments under the Medicare Physician Fee Schedule (PFS) for...more

Bass, Berry & Sims PLC

CMS Announces Model for Technology-Assisted Chronic Condition Management

Bass, Berry & Sims PLC on

On December 1, the Centers for Medicare & Medicaid Services (CMS) announced the Advancing Chronic Care with Effective, Scalable Solutions Model (ACCESS), a 10-year voluntary alternative payment model (APM) that will pay...more

McDermott+

ACCESS + TEMPO: The 2-door entryway to faster digital health innovation in traditional Medicare

McDermott+ on

Harnessing new digital technologies to treat chronic conditions and improve health outcomes.” If you think this sounds like a goal that directly aligns with one of the administration’s top priorities, making America healthy...more

Epstein Becker & Green

Ambulatory Specialty Model Final Rule: Bringing Specialists into Value-Based Payment

Epstein Becker & Green on

On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the final rule for the Calendar Year (CY) 2026 Medicare Physician Fee Schedule, which finalized the Ambulatory Specialty Model (ASM), targeting...more

Benesch

CMS Announces New ACCESS Model, Advancing a National Outcomes-Based Framework for Chronic Care, Health Equity and Community...

Benesch on

The Centers for Medicare & Medicaid Services (“CMS”), through the CMS Innovation Center (“CMMI”), has announced the ACCESS Model—Advancing Clinical Care, Equity and System Sustainability, a national demonstration model...more

Sheppard Mullin Richter & Hampton LLP

CMS Finalizes Mandatory Ambulatory Specialty Model for Cardiology and Low-Back Pain

The Centers for Medicare & Medicaid Services (“CMS”) recently finalized a rule establishing the new Ambulatory Specialty Model (“ASM”)— a mandatory value-based payment model that could apply to nearly one-quarter of all...more

McDermott+

The Ambulatory Specialty Model: Officially coming your way in 2027

McDermott+ on

We are still waiting for the Centers for Medicare & Medicaid Services (CMS) to issue the remaining three calendar year (CY) 2026 Medicare payment rules....more

Latham & Watkins LLP

Healthcare & Life Sciences: Drug Pricing Digest - November 2025 #2

Latham & Watkins LLP on

On November 6, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a press release announcing the voluntary “GENErating cost Reductions for U.S. Medicaid (GENEROUS)” payment model, which will implement most...more

BakerHostetler

No Opting-Out: Navigating the Uncharted Waters of Medicare’s Ambulatory Specialty Model (ASM)

BakerHostetler on

On Oct. 31, the Centers for Medicare & Medicaid Services (CMS) released the 2026 Medicare Physician Fee Schedule Final Rule, wherein it established the Ambulatory Specialty Model (ASM) – a mandatory alternative payment model...more

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