Alert
AHEAD Model: Six States to Participate in Hospital Global Payments Model
The Centers for Medicare & Medicaid Services (CMS) announced two additional states have been selected to participate in the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, bringing the total to six states. Under cooperative agreements with CMS, each state will receive up to $12 million during the first six years of the 11-year model to support implementation.
The AHEAD Model introduces hospital global budgets for Medicare fee-for-service (FFS), Medicaid, and commercial payor spending and offers a voluntary payment enhancement program for primary care practices. Notably, participating hospitals will receive prospective, biweekly payments in place of traditional Medicare FFS claims payments—providing stable and predictable funding.
The selected states are as follows:
- Maryland
- Vermont
- Connecticut
- Hawaii
- New York counties including the Bronx, Kings, Queens, Richmond, and Westchester
- Rhode Island
Selected states will begin a pre-implementation period in July 2024. Maryland and Vermont will participate in Cohort 1, which begins the first program year in January 2026; Connecticut and Hawaii will participate in Cohort 2, and New York and Rhode Island will participate in Cohort 3, which will both begin the first program year in January 2027.
Our previous article provides additional details about the AHEAD Model’s goals, eligibility, model overlap issues, funding mechanisms, data collection and performance metrics, and the program timeline.
Next Steps
The Cohorts 1 and 2 states entered a model pre-implementation period in July 2024, and the Cohort 3 states will begin pre-implementation in January 2025.
Hospitals and primary care providers located in selected states should familiarize themselves with the payment mechanisms, requirements, and potential risks and benefits of the model.
Early preparation may include financial modeling, quality benchmarking and performance improvement, and development of care management infrastructure and health equity plans.
We’re Here to Help
Contact your Moss Adams professional for help navigating the program, including planning for receiving AHEAD Model payments, operational planning, quality reporting, and assistance with other compliance requirements.