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ACO Primary Care Flex (ACO PC Flex) Model: Preliminary ACO PC Flex Rate Book Posted

Centers for Medicare & Medicaid Services

*ACO Primary Care Flex (ACO PC Flex) Model:*

*Preliminary ACO PC Flex Rate Book Posted*

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*Preliminary ACO PC Flex Rate Book Available*

The Preliminary PY 2025 ACO PC Flex Rate Book [ https://www.cms.gov/priorities/innovation/files/aco-pc-flex-py25-prelim-ratebook.xlsx ] has been posted to the ACO PC Flex website. For the ACO PC Flex Model, there will be two rate books for PY 2025 used in payment calculation affecting County Base Rates, federally qualified health centers (FQHC)/rural health clinics (RHC) add-ons, and the County Enhancement: the Preliminary Rate Book and the Updated Rate Book. The Preliminary Rate Book, which is now available, uses base years 2021-2023 and will be used for the prospective primary care payments (PPCP) paid between January and June 2025. The Preliminary PY 2025 ACO PC Flex Rate Book does not yet include the FQHC/RHC add-ons; the FQHC/RHC add-ons will be announced in August 2024. A version including the FQHC/RHC add-ons will be made available on the ACO PC Flex website. The FQHC/RHC add-ons will be populated in the parameters tab of the Preliminary Rate Book but the County Base Rates will not change.

The Updated PY 2025 Rate Book, expected to be published toward the end of the second quarter of 2025, will use base years 2022-2024 and will be used for PPCP paid between July 2025 and December 2025, with payment rates retroactively applied back to January 2025. Because claims reductions and payment of County Base Rate and FQHC/RHC add-ons will not start until July of 2025, this retroactivity will only apply to the County Enhancement. Other methodological changes may be implemented with the Updated Rate Book to improve payment accuracy and will be detailed in the forthcoming ACO PC Flex Rate Book technical document.

For PY 2025 only, once the Updated Rate Book is implemented, CMS will pay the greater of the two rate books by comparing the sum of the County Base Rate, the FQHC/RHC add-on (where eligible), and the County Enhancement (where eligible) at the beneficiary-month level.

 

This determination of payable rates for PY 2025 will be calculated prior to adjustments for clinical risk, Primary Care Outside of ACO (PCOA), and the Primary Care Prospective Administrative Trend (PCPAT).

We expect there will be an additional Updated Rate Book for use in PY 2026 that will reflect the full CMS-HCC model, version 28, consistent with applications of this model version in Medicare Advantage (MA) and the Shared Savings Program if adopted. This rate book for 2026 will use base years 2022-2024 and is expected to be published at the same time as the Updated Rate Book for PY 2025.

More details on financial methodology, including settlement, is forthcoming. If you are interested in receiving additional information, updates, or have questions about the ACO Primary Care Flex Model, please contact the model team at ACOPCFlex@cms.hhs.gov.

 

To stay updated on upcoming model announcements and events, join our ACO PC Flex listserv by registering your email [ https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_13195%3eClick ]. The ACO PC Flex Model webpage [ https://www.cms.gov/priorities/innovation/innovation-models/aco-primary-care-flex-model ] has additional resources, such as the Model Overview Webinar [ https://www.cms.gov/aco-pc-flex-overview-webinar ], Factsheet [ https://www.cms.gov/files/document/aco-pc-flex-fs.pdf ], and FAQs [ https://www.cms.gov/priorities/innovation/innovation-models/aco-primary-care-flex-model/faqs ]

Centers for Medicare & Medicaid Services (CMS) has sent this update. To contact Centers for Medicare & Medicaid Services (CMS) go to our contact us [ https://secure-web.cisco.com/1Wm5LuslbEdfAe7EA7DY2ayJZWgtMfqTSqVGch4C0r2ixdxlR1FMGgzxfqaUX04eP0JGYZAoSXotcflqLJWiVOyaKYkR1yDA68xM1auevfddKdtMVUkTGKylc8ZXI8TPjNkPBpqogxAaQuX0XkdPNiiPMdt7KBGg4MdNDSPTvGtY3Odlxr7szBNTXmtBnOR9N-clkdhiyD00X3IMAMbeTI7k_KHMLZby-PoHeaspq3Y2ZKIahx_IRxw5plCCC_zSRPk5rjdX2Be-wJhadhl4vqviJJ4xlmY-Nn4rBRFVHQi79Gi98-uShELH7ZBYRJLuU9PbAYyhdBLcve9PQJv49CGUvNST7juboq0o8ZwIiuYSimTL-Rf3xlIVJThiwSf-APW8BuAmVy8wtirn0L4j1Wk8qlwwI-J_r4ElM-sZFDW2nlmNTbpfEvW9Ht_PKCMJtg7xFDhcm07x9IT7ytB0srI6MsvlgHKRXPUyEX4CdOOJ5uP_V7K27yrFEARdrnrZvF93gBz-iD8JCukcmUdxFHdl7ULwxZLGt-ZCuiW7OSTc/https%3A%2F%2Flnks.gd%2Fl%2FeyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDcsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHA6Ly93d3cuY21zLmdvdi9BYm91dC1DTVMvQWdlbmN5LUluZm9ybWF0aW9uL0NvbnRhY3RDTVMvaW5kZXguaHRtbCIsImJ1bGxldGluX2lkIjoiMjAyNDAyMjIuOTA2NjYyMjEifQ.i0vH3tedpZo0tEgQau_Rsa5zf4Mza079MM2aCPX1p1Y%2Fs%2F2905793976%2Fbr%2F237579287421-l ] page.    

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