ACO REACH ends in 2026: what the LEAD model means for ACOs

ACO REACH stands for Accountable Care Organization Realizing Equity, Access, and Community Health. CMS describes it as a model providing tools and resources for providers to work together in an ACO for people with Original Medicare.

Status checked October 12, 2026: REACH is in its final performance year, while the Long-term Enhanced ACO Design (LEAD) Model is preparing for its first performance year in 2027. Practices need to separate model participation, patient alignment, payment arrangements and their own care-management work. A successor model does not mean that every prior arrangement carries over unchanged.

How ACO REACH works

An accountable care organization brings providers together around responsibility for care quality and total costs. REACH includes primary and specialty care physicians and other providers. It sits at the organization and population level rather than describing one monthly care-management code.

CMS redesigned REACH from the Global and Professional Direct Contracting Model. Its first performance year began January 1, 2023, and it runs through performance year 2026. The current CMS page says REACH is not accepting new applications for the remaining model duration.

REACH offers Professional and Global risk-sharing options and capitation arrangements. CMS describes participating providers as accepting Medicare claims reductions and receiving at least some compensation from their ACO. That makes the practice’s actual payment arrangement essential to understanding how its services are paid.

For patients, model alignment does not replace Original Medicare with a restricted provider network. CMS states that beneficiaries retain their rights, coverage and benefits, including freedom to see any Medicare provider. Explain the actual arrangement without telling a patient that alignment removes that choice.

ACO REACH vs LEAD: the transition timeline

Question	ACO REACH	LEAD
Performance period	January 2023 through December 2026	January 2027 through December 2036
Relationship	Current model concluding in 2026	CMS-designated successor model
Late-2026 status	Final performance year	Optional implementation September 15 through December 31
New participation information	No new REACH applications for remaining duration	Initial application deadline May 17, 2026; future cohort opportunities anticipated
High-needs design	Separate High Needs Population ACO type	Model-wide high-needs policies across participating ACOs
Practice question	Which current agreement governs the service?	Which confirmed participation and payment terms apply in 2027?

The initial LEAD application window closed May 17, 2026. CMS anticipates future cohort opportunities and will announce their dates through later guidance.

CMS’s September 21 implementation notice identifies ACOs preparing for the upcoming performance year. It says implementation participants have an opportunity, not an obligation, to participate in 2027 if they continue meeting model requirements. Participation in that optional period was not required for 2027 participation.

The implementation list is not an exhaustive 2027 participant roster. Confirm the organization’s status and the practice’s role with the responsible ACO team.

LEAD has its own design. Keep 2026 records tied to REACH and review 2027 instructions against LEAD documents.

What changes in the LEAD model design

CMS describes LEAD as a 10-year voluntary model with no traditional benchmark rebasing. It is designed to include smaller, independent and rural practices and organizations serving patients with complex needs.

A notable distinction concerns high-needs populations. REACH has a separate High Needs Population ACO type; LEAD applies high-needs policies across participating ACOs. Ask which patient criteria and methodology apply rather than assuming the older participant category is unchanged.

LEAD includes Professional and Global risk options and several prospective-payment mechanisms. The CMS LEAD model page links its current payment, alignment, risk-adjustment and quality resources. Use the documents for the relevant performance year when reviewing the arrangement.

Mechanism	CMS description	Practice question
Primary Care Capitation	Monthly primary-care payments; includes Base PCC and Enhanced PCC	Which primary-care services and funds are included?
Total Care Capitation	Option under Global Risk for Medicare Parts A and B services of enrolled providers	How does the agreement treat the practice’s services?
Non-Primary Care Capitation	Optional with PCC; not reconciled against fee-for-service billing	Which non-primary-care services are included?
Advanced Payment Option	Optional with PCC; reconciled against actual fee-for-service billing	How are advances and claim payments reconciled?

The CMS FAQ states that Enhanced PCC must be repaid to CMS in full at performance-year end. It also distinguishes true non-primary-care capitation from an advance reconciled against fee-for-service claims. Do not treat every prospective payment as additional unreconciled money.

CMS also describes CARA as an optional initiative initially tested among LEAD ACOs electing Global Risk and CARA. Its data-sharing phase begins in 2027, with episode accountability at the start of 2028. Those stages should not be presented as universal first-day arrangements for every participant.

Patient alignment and practice participation

CMS’s LEAD FAQ describes both claims-based and voluntary beneficiary alignment. Claims-based alignment uses the Participant TIN list for the performance year. Voluntary alignment can occur through Medicare.gov or a signature-based process when the ACO elects that option.

Patient alignment and a practice’s participation arrangement answer different questions. The first concerns which beneficiaries CMS aligns; the second concerns the provider relationship and applicable responsibilities. Ask the ACO for the records that establish each rather than treating a patient list as the entire agreement.

CMS expects LEAD participants to include current REACH participants, other ACOs and fee-for-service providers with no prior ACO participation. That expected mix is not confirmation that a particular organization or practice has completed participation requirements. Verify the actual status before describing a practice as participating.

The Medicare Shared Savings Program guide explains a neighboring ACO framework. Use it to identify the program named in a practice’s documents. REACH, LEAD and the Shared Savings Program should not be used interchangeably in patient explanations or operational instructions.

Where CCM and PCM fit beside an ACO model

Chronic care management and principal care management are defined Medicare Part B services with their own patient and service requirements. CCM addresses multiple qualifying chronic conditions; PCM addresses a single qualifying high-risk condition. Model participation alone does not establish eligibility for either service.

Review	ACO model arrangement	CCM or PCM service
Who and what	Participating organization, providers and aligned population	Patient, billing practitioner and defined service
Payment basis	Selected model mechanism and applicable agreement	Code requirements plus the applicable payment arrangement
Records	Participation, alignment and model-specific reporting	Consent, care plan, qualifying work and time
Decision owner	ACO and responsible practice leadership	Billing practitioner and practice billing review

For clinical-staff services, CCM uses 99490 for at least 20 minutes and 99439 for each additional 20 minutes per calendar month. PCM uses 99426 for the first 30 minutes and 99427 for each additional 30 minutes. The code names do not settle how a model’s capitation or claims reduction affects payment.

Review the model payment documents and practice agreement before assuming a separately payable amount sits on top of a prospective payment. Keep that payment question distinct from whether the patient received a qualifying service. The value-based care and fee-for-service comparison explains the broader payment concepts without replacing the arrangement-specific review.

A monthly practice review during the transition

1. Confirm the current model and period

Record whether the work concerns REACH performance in 2026, LEAD implementation or LEAD performance in 2027. Keep the governing documents with that period. This helps staff avoid applying the right instruction to the wrong date.

2. Verify the practice and patient records

Confirm the practice’s role and the source of any patient-alignment list. Identify who can answer a discrepancy in participation or alignment. Do not assume that an earlier list remains current without review.

3. Assign operational responsibilities

Name the person responsible for referrals, follow-up, clinical escalation and documentation. Keep a separate owner for payment and model-reporting questions. A patient task should reach a responsible person rather than remain an item on an organizational report.

4. Reconcile service and payment questions

Review actual monthly services against their requirements and payment treatment against the applicable agreement. Record unresolved issues with the source needed to answer them. Update the instructions when the relevant CMS guidance or confirmed arrangement changes.

Discuss practice-level CCM and PCM responsibilities

The ACO care management page provides context for practice-level CCM and PCM questions. Review the practice’s service needs separately from its model participation and payment arrangement.

Companian does not offer the ACO REACH or LEAD models.

Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.

Which team members’ time counts toward each code is set in your services agreement. Keep responsibility for model-specific contracting and payment questions with the appropriate organization.

Key takeaways

• REACH performance concludes in 2026; LEAD performance starts in 2027.
• Optional LEAD implementation is a separate late-2026 period.
• Confirm the practice’s participation and patient-alignment records.
• Review the actual payment mechanism before assuming separate payment.
• Assess CCM and PCM against their own service requirements.

Frequently asked questions about aco reach

What does ACO REACH stand for?

REACH stands for Realizing Equity, Access, and Community Health. ACO means accountable care organization.

Is LEAD simply a new name for ACO REACH?

CMS identifies LEAD as the successor model with its own design and performance period. Do not assume that every prior practice arrangement carries over unchanged.

Has LEAD begun as of October 2026?

Its optional implementation period runs in late 2026. The performance period begins January 1, 2027.

Is the implementation participant list the complete 2027 roster?

No, CMS says participation in the optional period was not required for 2027 participation. The notice explicitly says the list is not exhaustive for the performance year.

Does REACH alignment restrict a patient’s provider choice?

CMS says Original Medicare beneficiaries retain their rights, coverage and benefits. They retain freedom to see any Medicare provider.

Does an ACO relationship automatically make CCM separately payable?

No, review the actual model payment mechanism and practice agreement. A qualifying service record and its payment treatment are separate questions.

Physician practices furnish Medicare Part B chronic care management and principal care management, including 99490, 99439, 99426 and 99427, under their applicable requirements. Companian: Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.

Read more: Medicare Shared Savings Program · Value-based care and fee-for-service · CCM CPT codes

Disclosures

Companian supplies Care Advocates and documentation to physician practices nationwide. Companian is not a medical practice and does not bill Medicare. The billing practitioner keeps the care plan, every clinical decision and the claim. Patients pay the usual Medicare Part B deductible and coinsurance for these services unless other coverage pays it.

This guide summarizes CMS information for practices nationwide. It is not legal or billing advice.