LEAD (Long-term Enhanced ACO Design) Model is sponsored by Centers for Medicare & Medicaid Services (CMS). A 10-year voluntary model starting January 1, 2027, aiming to expand ACO participation, especially for small, independent, and rural providers, with enhanced support for high-needs patients.

LEAD (Long-term Enhanced ACO Design) Model | CMS LEAD (Long-term Enhanced ACO Design) Model The LEAD Model Request for Applications is now available. Accountable care organizations interested in participating in LEAD have until May 17, 2026, to submit an application at https://app. innovation.

cms. gov/LEAD/IDMLogin . Now Available: LEAD Model Letter of Interest (LOI) The Long-term Enhanced ACO Design (LEAD) Model is the Innovation Center’s newest Accountable Care Organization (ACO) focused model, set to launch following the conclusion of ACO REACH at the end of 2026.

LEAD builds upon the CMS Innovation Center’s earlier accountable care work and utilizes improved benchmarking to appeal to a broader mix of health care providers, including those with specialized patient populations and those new to ACOs, such as smaller, independent or rural-based practices.

With a 10-year performance period — the longest CMS has ever tested — LEAD offers a predictable window without rebasing and a pathway toward sustainable long-term benchmarks and savings. LEAD also will focus on better serving coordinated care for high-needs patients, such as those dually eligible for Medicare and Medicaid, and those who are homebound or home limited.

LEAD is a 10-year voluntary model that runs from January 1, 2027, through December 31, 2036. ACOs can apply to participate in the model by responding to a Request for Applications . Problem: Many health care providers have not historically participated in or dropped out of ACOs because of financial and administrative obstacles to success.

Solution: LEAD is designed to address such barriers to support both established and newly created ACOs by providing them enhanced, flexible cash flow payments; and greater freedom and tools to support spending time with and meeting patient needs, including those with specialized care needs.

Outcomes: Through ACOs, health care providers will be empowered to deliver coordinated, accountable care and preventive services — keeping patients healthier and helping to reduce health care costs and unnecessary emergency room visits and hospitalizations.

Strategy: LEAD advances the Innovation Center’s commitment to 1) building opportunities for independent health care providers and practices to be rewarded for delivering better care, 2) promoting and empowering patient choice in both coverage and sites of care, and 3) making it easier for health care providers and patients to engage in preventive care that supports healthier living.

CMS ACO models have shown potential to enhance aspects of care and reduce costs. ACO Models have resulted in lower hospitalizations and reduced emergency department visits and reduced other avoidable high-cost care for their patients. However, earlier models were not constructed for smaller, more rural, and independent practices or those that serve high-needs patients.

LEAD is designed to be more inclusive of these types of provider practices, with improved benchmarks, prospective payments, and other innovative policies that even the playing field and by extension allow for more people, including those with complex health needs, to benefit from better coordinated, accountable care.

LEAD also includes design features that put more focus on preventive care to support healthier aging and gives health care providers expanded flexibility to check in with patients regularly, reach out before problems escalate, and coordinate care that happens between visits — not just during them.

LEAD incorporates key features aligned with the Innovation Center strategy to promote evidence-based prevention, support patient empowerment, and drive choice and competition. Increase the scope of ACOs — to include more small, more rural, and more independent health care providers and Community Health Centers. Enhance evidence-based prevention and care coordination for more patients, including those with high-needs.

Empower patients to be more actively involved in their care. LEAD will better support health care providers and expand participation in ACOs through: A 10-year pathway toward sustainable benchmarks. Flexible, capitated population-based payments to support team-based care and downstream value-based care arrangements.

Integration of care for special populations, including patients with complex needs and dually eligible beneficiaries. Additional innovations include new Benefit Enhancements and Beneficiary Engagement Incentives that create incentives for beneficiaries to seek care from providers in ACOs, including Part B cost sharing support and by 2029, a Part D premium buy down.

LEAD includes key design features: Integration of high-needs patients: Support for high-needs patients, including more accurate risk adjustment and benchmarking, will be integrated across all ACOs, creating an incentive for more providers to develop the capabilities to care for patients with complex needs.

At the same time, organizations that specialize in care for complex, chronic populations will be able to care for more of their patient population under an accountable care framework. Two voluntary risk-sharing options: Global Risk: Eligible to receive up to 100% of their savings and liable for up to 100% of total losses relative to their established performance benchmark.

Professional Risk: Eligible to receive up to 50% of total savings and liable for up to 50% of total losses relative to their established performance year benchmark. Healthy living flexibilities: Will offer participants the option of Benefit Enhancements and Beneficiary Engagement Incentives that support the delivery of coordinated, proactive, and preventive care.

This includes tools for ACOs to encourage beneficiaries to seek care from high-value providers, including Part B cost sharing support and, by 2029, a Part D premium buy down. Medicaid integration: LEAD aims to support the integration of Medicare and Medicaid services for patients receiving Medicare benefits through Original Medicare.

The goal is to create incentives (where none currently exist) for Medicare and Medicaid health care providers to coordinate care and improve outcomes for dually eligible beneficiaries in Original Medicare. During an initial planning phase from March 2026 through December 2027, CMS will identify two states that are interested in partnering to develop a framework for ACO-Medicaid partnership arrangements.

This framework will help define how ACOs and Medicaid organizations can work together to share data and coordinate care to improve outcomes, including preventing avoidable hospitalizations and help patients remain engaged in their communities. Pending successful completion of the planning period, ACOs in the selected states would have the opportunity to enter partnership arrangements with Medicaid organizations.

CMS Administered Risk Arrangements (CARA): The CARA initiative will provide robust CMS support to ACOs to enable episode-based risk arrangements between ACOs and their specialists and provider organizations to facilitate greater and stronger Preferred Provider relationships with these downstream health care providers. In addition, CARA will feature an episode-based falls prevention program.

CMS anticipates that LEAD Participant Providers will include: Current ACO REACH Model participants and other ACOs. Current Medicare fee-for-service health care providers that have historically not participated in ACOs. Health care providers serving underserved populations, such as those with a high proportion of dually eligible individuals, Federally Qualified Health Centers, and Rural Health Clinics.

Request for Applications (RFA) (PDF) LEAD Model Letter of Interest (LOI) ACO Model Comparison (PDF) Application Checklist (PDF) CMS-Administered Risk Arrangements Factsheet (PDF) LEAD Model Application Office Hours - April 21, 2026 Slides (PDF) | Transcript (PDF) LEAD Model RFA Webinar - April 9, 2026 Slides | Transcript | Recording LEAD Model Overview Webinar - March 17, 2026 Slides (PDF) | Transcript (PDF) Frequently Asked Questions Contact the LEAD Model team at LEAD@cms.

hhs. gov . Visit our Innovation Models webpage for a list of all CMS Innovation Center model tests.

LEAD Frequently Asked Questions ACO Model Comparison (PDF) Application Checklist (PDF) Number of Participants: N/A Category: Accountable Care Models Authority : Section 1115A of the Social Security Act CMS Innovation Center Highlights Learn about topics that play a critical role in our work on our Key Concepts webpage . Read stories about our work in action in the Value-Based Care Spotlight . Help with File Formats and Plug-Ins