LEAD Model

The LEAD Model is the CMS Innovation Center’s next-generation accountable care model, authorized under Section 1115A of the Social Security Act. This section provides a comprehensive overview of every aspect of the model — from eligibility and alignment through financial settlement and quality measurement.

Model Scope & Duration

10-year model, application timeline, implementation period, risk sharing options.

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Participation Requirements

Full-TIN participation, Preferred Providers, eligibility, governance, screening, EHR, model overlaps, Advanced APM status.

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Beneficiary Alignment

Claims-based and voluntary alignment, Hybrid option, lookback periods, PQEM codes, specialty codes, minimum thresholds.

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Benchmarking Methodology

Historical baseline, no rebasing, ACPT savings wedge, benchmark adjustments, regional rate book transition.

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Risk Adjustment

A&D, ESRD, and High Needs models, coding intensity caps, AI-inferred risk scores.

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Financial Settlement

Discount rates, quality withhold, risk corridors, stop-loss, settlement timing, financial guarantee.

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Capitation & Payment

TCC, PCC, Enhanced PCC, NPCC, APO, Administrative Add-On with worked examples.

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Quality Measurement

Claims measures, eCQMs, quality scoring, CI/SEP, Prevention and Quality Plan, High Performers Pool.

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Healthy Living Strategy

8 benefit enhancements, patient incentives, Tech Enabler Initiative.

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CARA Initiative

Episode-based risk arrangements, Default vs. Max Flex, RISE to Age in Place.

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Medicare-Medicaid Integration

State partnerships, data sharing, aligned accountability for dually eligible beneficiaries.

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Key Dates & Timeline

Application deadline, implementation period milestones, decision framework.

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Ready to evaluate LEAD for your organization?