Model Scope
Products and services that add up to success in the ACA Marketplace.
LEAD will operate for 10 performance years—from January 1, 2027 through December 31, 2036. ACO REACH ran for six years and Medicare Shared Savings Program (MSSP) agreement periods are five years, making this the longest performance period CMS has tested for an accountable care model. The model is available nationally. (RFA §III.A)
Implementation Period: An optional implementation period beginning September 15, 2026 allows accepted applicants to begin voluntary alignment activities, such as collecting signed attestation forms and conducting beneficiary outreach, before PY 2027 begins. (RFA §III.B)
Application deadlines, LOI availability, and other key dates are summarized on the Key Dates and Timeline page. Organizations not ready for the first cohort may submit a non-binding Letter of Interest. Questions can be directed to with the subject “Application Question.” (RFA §IV.A)
Risk Sharing Options
LEAD offers two risk sharing arrangements (RFA §IX.A):
| Feature | Global Risk Option | Professional Risk Option |
| Savings/Losses Sharing | Up to 100% | Up to 50% |
| Discount (CMS Share) | Yes — 1.75%–3.0% (Ramped) | None |
| TCC Eligible | Yes | No |
| NPCC Eligible | Yes | No (non-PC specialists only) |
| CARA Eligible | Yes | No |
| MSR/MLR | None — First Dollar | None — First Dollar |
| Minimum Tenure Before Switch | N/A | 4 years before switching to Global |
Key Insight: No Minimum Savings Rate (MSR) or Minimum Loss Rate (MLR) applies under either option — both generate first-dollar savings or losses. This contrasts with MSSP, which applies an MSR for one-sided models and permits ACOs in two-sided models to select an MSR/MLR. (RFA §IX.A)
Frequently Asked Questions
Yes, but ACOs must remain in the Professional Risk option for at least four performance years before transitioning to Global Risk. (RFA §IX.A)
Standard ACOs must maintain at least 5,000 aligned beneficiaries with at least 3,000 claims-based aligned in at least one base year. Newly entering ACOs start at 1,000 (growing to 5,000 by year 5). ACOs with ≥40% High Needs beneficiaries start at 800 (growing to 1,600 by year 5). (RFA §VII.B.5)
ACOs that fall within 10% below minimums receive a two-time buffer before facing potential termination. (RFA §VII.B.5)
