2715676_Condense_DesignASM-PDF_031026.indd
ASM Preparedness
Report and Checklist
F or organizations in mandatory ASM geographic areas
Prepared: January 2026
Purpose: Education and operational readiness planning for Health Systems, Medical Centers, and Ambulatory Groups whose regions have been selected for mandatory participation in the CMS Ambulatory Specialty Model (ASM). This report is educational and does not constitute legal, billing, or regulatory advice.
Sections
- Executive summary (WHO/WHAT/WHEN/WHERE/HOW)
- WHO: Who is affected (clinicians, specialties, thresholds, organizational roles)
- WHERE: Mandatory CBSAs and metropolitan divisions (how to confirm your footprint)
- WHEN: Timeline, performance years vs payment years, and key deadlines
- WHAT: Requirements (measures, scoring, reporting, waivers, data sharing)
- HOW: Implementation playbook (governance, workflows, data/IT, compliance)
- Preparedness checklist (copy/paste-ready)
Appendix A: CMS mandatory geographic areas list (OMB 2023 CBSA/Metro Division codes)
Appendix B: Glossary and references
1 Executive Summary
ASM is a mandatory CMS Innovation Center payment model that holds selected specialists financially accountable for quality and cost performance in outpatient care for two targeted chronic conditions: heart failure and low back pain. Although accountability is scored at the individual clinician level (TIN/NPI), organizations in mandatory regions will need coordinated readiness across clinical operations, quality, finance, compliance, and IT.
| Readiness lens | What to know(high level) |
|---|---|
| WHO | Individual clinicians(TIN/NPI)in selected regions who meet specialty and episode-volume criteria.Organizations support clinician-level readiness(data,workflows,governance). |
| WHAT | Performance is assessed across Quality and Cost(each 50% of final score),with scoring adjustments for Improvement Activities(0/-10/-20 points)和Promoting Interoperability(up to-10points). |
| WHEN | Model starts Jan1,2027.Performance years are2027-2031.Payment adjustments apply two years later in payment years2029-2033. |
WHERE
Mandatory participation applies in a CMS-selected set of CBSAs and metropolitan divisions (roughly one-quarter nationally).
WHY
Improve upstream management, reduce avoidable hospitalizations and unnecessary procedures, and increase transparency and comparability of specialist performance.
HOW
Confirm whether your sites fall in mandatory CBSAs, identify eligible clinicians, map measure workflows (including PROMs), ensure CEHRT and interoperability readiness, stand up governance, and operationalize care coordination requirements (including Collaborative Care Arrangements).
Key regulatory anchors (selected):
• Eligibility and mandatory geographic selection: 42 CFR 512.710. • Data submission requirements and deadlines: 42 CFR 512.720 (including March 31 submission deadline). • Improvement Activities requirements (HRSN + CCAs): 42 CFR 512.735 and 42 CFR 512.771. • Final scoring weights and adjustments: 42 CFR 512.745. • Payment adjustment methodology, risk levels, and redistribution percentage: 42 CFR 512.750. • Data sharing agreement and permitted uses: 42 CFR 512.760. • Telehealth waivers (geographic + originating site): 42 CFR 512.775. • CMS model overview and resources: CMS ASM webpages.
2 [WHO] Who Is Affected
ASM participation is determined at the individual clinician level (a unique TIN/NPI combination). For organizations, this means readiness must be built around provider-level attribution, measure capture, and reporting - even when clinical operations are managed centrally.
2.1 Clinician cohorts and eligibility triggers
A clinician is generally eligible when they
- practice in a mandatory geographic area,
- have a qualifying specialty designation, and
- have at least 20 attributed episodes for the relevant episode-based cost measure in the lookback period (calendar year two years before the ASM performance year).
| ASM cohort | Primary specialty types (examples) | Episode threshold | Lookback logic |
|---|---|---|---|
| Heart failure cohort | General cardiology(as determined by CMS specialty type rules) | ≥20HFEBCM episodes | Calendar year two years before the performance year(attributed per the heart failure episode-based cost measure). |
| Low back pain cohort | Anesthesiology,pain management,interventional pain management,neurosurgery,orthopedic surgery,physical medicine&rehabilitation | ≥20LBPEBCM episodes | Calendar year two years before the performance year(attributed per the low back pain episode-based cost measure). |
2.2 Organizational roles that should be involved
Even though clinicians are scored individually, successful preparation is an organizational effort. The table below highlights typical roles and the artifacts they should produce during 2026.
| Role | Primary responsibilities / deliverables |
|---|---|
| Executive sponsor(system/group leadership) | Sets governance, resourcing,and accountability;approves prioritized workplan;monitors readiness milestones. |
| Clinical leadership(cardiology,spine/pain,PM&R,orthopedics) | Defines clinical pathways;ensures guideline-concordant care;owns adoption and escalation workflows. |
| Quality/performance improvement | Maps measures to workflows;builds numerator/denominator tracking;runs weekly/monthly performance huddles. |
| Finance/revenue cycle | Models impact of payment adjustments;validates claim flows and attribution;tracks Medicare Part B covered professional services by clinician. |
| Health IT/EHR/analytics | Ensures CEHRT readiness;enables structured data capture;supports PI objectives and reporting;integrates PROM tools. |
| Care management/population health | Implements transition-of-care workflows,patient outreach,HRSN screening coordination,and closed-loop referrals. |
| Compliance/privacy/security | Oversees data sharing agreement requirements;HIPAA and 42 CFR Part 2 considerations;incident response readiness. |
3 [WHERE] Mandatory CBSAs and Metropolitan Divisions
ASM is mandatory only in selected geographic areas defined as Core-Based Statistical Areas (CBSAs) and, for certain large metropolitan statistical areas, metropolitan divisions. CMS selects these areas using a stratified random sampling approach and excludes areas that do not have minimum volumes of eligible clinicians/episodes and areas entirely in U.S. territories.
3.1 How to confirm whether your organization is in a mandatory area
- Inventory all outpatient practice locations where targeted specialists bill Medicare Part B (use the NPI practice address and/or service location on claims).
- Translate each location to its county and then to an OMB 2023 CBSA or metropolitan division code (many GIS tools and public CBSA crosswalks support this).
- Compare the resulting codes to the CMS ASM Mandatory Geographic Areas list (Appendix A).
- If any of your locations fall in a mandatory CBSA/metro division, proceed to clinician eligibility identification (Section 2) and operational readiness (Sections 5-7).
3.2 Common footprint pitfalls (what to watch for)
• Multi-site groups: participation is tied to the clinician’s claims-based specialty and practice location in a mandatory area, not to the organization as a whole.
• TIN/NPI combinations: the same clinician may bill under multiple TINs; payment multipliers can follow the clinician and apply to different TINs depending on post-performance-year affiliation changes.
• Metropolitan divisions vs CBSAs: large metros may be divided into metropolitan divisions; ensure you match to the correct code type in Appendix A.
Appendix A includes the CMS-published list of mandatory geographic areas (OMB 2023 CBSA/Metropolitan Division codes).
4 [WHEN] Timeline and Key Deadlines
ASM begins January 1, 2027. The model has five performance years (2027–2031). Payment adjustments apply in the corresponding payment years two years later (2029–2033), based on the clinician’s performance year final score.
4.1 A practical timeline for organizations in mandatory areas
| Timeframe | What to do / what to expect |
|---|---|
| Early CY 2026 | CMS intends to release an initial list of ASM participants; organizations should begin internal impact assessment and gap analysis. |
| CY 2026 (through year end) | Preparation year: finalize affected clinician roster; build reporting and workflow changes; execute care coordination and interoperability plans. |
| Jan 1, 2027 | Performance Year 1 begins. Start full-year Quality and Cost performance tracking. Begin PI (>=180 days) and Improvement Activities (>=90 days) performance periods as needed. |
| Mar 31, 2028 | Data submission deadline for 2027 performance year (quality, improvement activities, and PI submissions). |
| CY 2029 | Payment Year 1: payment multipliers applied to Medicare Part B covered professional services based on 2027 performance. |
4.2 Measurement periods and submission deadlines (operationally important)
• Quality and Cost performance are assessed over the full calendar-year performance year (Jan1–Dec 31).
• Improvement Activities performance can be a minimum continuous 90-day period in the calendar year (two years prior to the payment year).
• Promoting Interoperability performance can be a minimum continuous 180-day period in the calendar year (two years prior), up to the full year.
• Quality, Improvement Activities, and PI data are submitted after the performance year; cost and claims-based measures are calculated from claims.
• The standard data submission deadline is March 31 of the year following the applicable performance year.
5 [WHAT] What ASM Requires
(Operations, Data, and Compliance)
5.1 Performance framework (how clinicians are scored)
ASM performance is organized into four categories. Quality and Cost are weighted (each 50%) to form the base final score. Improvement Activities and Promoting Interoperability are applied as scoring adjustments (penalties) based on whether required actions and attestations are completed. Additional scoring adjustments can apply for small practices/solo practitioners and for complex patient populations.
| Category | How it is assessed | Impact on final score |
|---|---|---|
| Quality | Condition-specific and cross-cutting quality measures(mix of reported measures and claims-based measures) | 50% weight. |
| Cost | Episode-based cost measures for heart failure or low back pain(claims-calculated) | 50% weight. |
| Improvement Activities (IA) | Two required activities:(1)Primary care connection+HRSN screening coordination;(2)Collaborative Care Arrangement with a primary care practice including specific elements. | Scoring adjustment:0,-10,or-20 points depending on completion. |
| Promoting Interoperability (PI) | Meaningful EHR user requirements using CEHRT, objective-based scoring,and required security attestations over a 180-day(minimum) period. | Scoring adjustment up to-10 points(penalty) based on PI score. |
5.2 Reporting and submission requirements
(what must be submitted vs calculated)
Operationally, ASM combines two data flows: (1) organization/clinician-submitted data for certain Quality measures, Improvement Activities, and Promoting Interoperability; and (2) CMS-calculated measures using administrative claims (Cost measures and certain claims-based Quality measures).
• Quality: submit numerator/denominator data for at least one applicable non-claims quality measure, meeting data completeness, generally at the TIN/NPI level (small practices may submit at the TIN level).
• Improvement Activities: attest to meeting the specifications for each required improvement activity (submitted at the TIN level).
• Promoting Interoperability: submit PI performance data and required attestations at the TIN level, including CEHRT certification ID and performance period dates.
• Cost and claims-based quality measures: no submission; CMS calculates from claims processed after the performance period.
• Deadline: submission is generally due March 31 of the year after the performance year.
5.3 Payment adjustments (how performance becomes dollars)
Payment adjustments are applied to Medicare Part B covered professional services in the ASM payment year, based on the clinician’s final score from the corresponding performance year two years prior. CMS uses a logistic exchange function to transform final scores and applies an ASM risk level (maximum upside/downside) and a redistribution percentage to establish the incentive pool.
| ASM payment year | Risk level(max upside/downside)-per regulation |
|---|---|
| 2029 | 9% |
| 2030 | 9% |
| 2031 | 10% |
| 2032 | 11% |
| 2033 | 12% |
Note: The redistribution percentage is set at 85% in the payment adjustment methodology.
5.4 Medicare payment and telehealth waivers (what changes)
• MIPS waiver: CMS waives the requirements of section 1848(q) (MIPS) for an ASM participant for each ASM performance year the participant meets ASM eligibility criteria.
• Telehealth: CMS waives the geographic site requirement and originating site requirement to permit telehealth visits to originate in the beneficiary’s home or place of residence for medically appropriate services to treat an ASM targeted chronic condition (with specified exceptions, such as certain home health certification requirements).
5.5 CMS data sharing (what you can request and how to govern it)
ASM participants may request beneficiary-identifiable claims data from CMS under a data sharing agreement. Organizations should plan for a formal privacy and security governance process, including a designated data custodian, minimum necessary requests, and controls for downstream recipients (e.g., collaborative care partners and vendors).
• Permitted uses are limited to care coordination, quality/efficiency improvement, and population-based activities applied uniformly to ASM beneficiaries; data may not be used to reduce, limit, or restrict care for specific beneficiaries.
• Substance use disorder record data subject to 42 CFR Part 2 is omitted from shared beneficiary-identifiable data.
• CMS requires annual submission of a signed data sharing agreement with specified privacy/security/breach notification requirements.
5.6 Collaborative Care Arrangements (CCAs)
- what ‘good’ looks like on paper
One required Improvement Activity involves establishing at least one executed Collaborative Care Arrangement (CCA) with a primary care practice that shares ASM beneficiaries. The CCA must be in writing, signed by both parties, and designed to further ASM goals and/or Improvement Activities performance.
• CCA must include collaborative efforts related to at least three of five elements: data sharing; comanagement; transitions in care planning; closed-loop communication; care coordination integration.
• Any payments under a CCA must comply with fraud and abuse laws and cannot be conditioned on volume or value of referrals.
• Both parties must retain clinical decision-making independence and the arrangement may not induce reduction of medically necessary services.
• Maintain contemporaneous documentation (agreement, payment amounts/dates, methodology) and ensure downstream recipients comply with CMS data sharing terms.
6 [HOW] Implementation Playbook for 2026 Readiness
Use 2026 as a structured readiness year. The goal is to enter January 1, 2027 with:
- an accurate roster of eligible clinicians in mandatory areas,
- workflows that reliably capture required measures and PROMs,
- executed care coordination agreements and HRSN screening pathways,
- CEHRT-based interoperability capability, and
- finance and compliance governance for data sharing and payment adjustments.
6.1 Workstreams to stand up (recommended)
| Workstream | Primary outputs |
|---|---|
| A. Impact assessment & roster | Confirm mandatory CBSA/metro division footprint; generate preliminary list of potentially eligible clinicians; validate specialty type and episode volume; set clinician-level owners. |
| B. Measure-to-workflow mapping | Map each required measure to discrete EHR fields and operational touchpoints; define numerator/denominator logic; validate data completeness workflows. |
| C. Clinical pathway optimization | Standardize evidence-based management for HF and conservative-care-first pathways for LBP; define escalation pathways; align referral networks. |
| D. Care coordination & CCAs | Implement IA-1 and IA-2 requirements; design closed-loop referral and communication processes; execute and document CCAs with primary care partners. |
| E. PI / CEHRT & interoperability | Confirm CEHRT certification; enable e-prescribing, HIE options, patient access, public health reporting; complete Security Risk Analysis and SAFER Guide attestations. |
| F. Analytics, finance & forecasting | Build clinician-level dashboards for Quality, Cost, IA, and PI; model payment adjustment exposure; track Medicare Part B revenue subject to multipliers. |
| G. Compliance & data governance | Prepare for CMS data sharing agreement; define minimum necessary request process; vendor/downstream recipient controls; incident response procedures. |
6.2 Practical clinician-level dashboards (minimum viable set)
• Eligibility & attribution: confirmed specialty type; episode counts; mandatory CBSA/metro division code; TIN/NPI combinations.
• Quality performance: measure-level denominators, numerators, completion rates, and benchmark position (where available).
• Cost performance: episode cost trends, high-cost service flags (e.g., admissions for HF; imaging/surgery pathways for LBP).
• PROM completion: baseline and follow-up completion rates; missing follow-up list with due dates.
• IA completion: evidence artifacts (HRSN screening coordination logs; CCA documents; referral loop compliance).
• PI completion: objective/measure readiness; CEHRT ID; SRA and SAFER attestation dates; 180-day performance window tracking.
6.3 Clinical workflow examples (illustrative)
Heart failure (HF) examples
• Post-discharge touchpoint: within 7 days of an HF-related hospitalization or ED visit, complete medication reconciliation, symptom check, and escalation plan; schedule follow-up in 7–14 days.
• Guideline-directed medical therapy (GDMT) reliability: structured prompts for evidence-based beta-blocker and ACEi/ARB/ARNI status with contraindication capture; lab guardrails (K+, creatinine/eGFR).
• BP control workflow: ensure at least one valid, recent BP measurement for eligible patients; use home BP recheck logic when clinic BP is elevated.
• Functional status PROM cadence: baseline and follow-up functional status assessment captured in discrete fields with timestamps.
Low back pain (LBP) examples
• Conservative-care-first pathway: standardized criteria for when imaging is appropriate; referral pathway to PT and non-opioid pain strategies where clinically indicated.
• Functional status PROM capture: baseline and follow-up functional status measure completion to support outcome reporting and care planning.
• Medication safety for older adults: medication review workflows to avoid high-risk medications where possible; deprescribing support.
• Depression screening and follow-up: screening integrated into intake or annual workflow; positive screen triggers a documented follow-up plan and referral tracking.
7 ASM Preparedness Checklist (copy/paste-ready)
Use this checklist to drive a 2026 readiness workplan. Each item should have an accountable owner and a tangible evidence artifact.
| Status | Domain | Action item | Owner | Target / evidence |
|---|---|---|---|---|
| [ ] | Governance | Stand up an ASM readiness steering committee and monthly executive review cadence. | System/GPO leader | Q1 2026 - Charter; meeting schedule; decision log |
| [ ] | Footprint | Map all outpatient practice locations for targeted specialties to OMB 2023 CBSA/ metro division codes. | Analytics / Strategy | Q1 2026 - Location-to-CBSA crosswalk |
| [ ] | Footprint | Confirm mandatory area status using CMS Mandatory Geographic Areas list (Appendix A). | Analytics / Strategy | Q1 2026 - Impact memo + list of affected sites |
| [ ] | Clinician roster | Generate preliminary list of potentially eligible clinicians (TIN/NPI) in mandatory areas. | Quality / Analytics | Q1 2026 - Roster with TIN/NPI, specialty, site |
| [ ] | Clinician roster | Validate specialty type and episode volume eligibility criteria for each clinician. | Quality / Analytics | Q2 2026 - Validated eligibility file + assumptions |
| [ ] | Measure mapping | Select reporting method(s) for non-claims quality measures (EHR/eCQM, registry, etc.). | Quality / IT | Q2 2026 - Measure reporting plan |
| [ ] | Measure mapping | Define discrete EHR fields and workflows for all required measures (including PROMs). | IT / Clinical Ops | Q2 2026 - Data dictionary + workflow maps |
| [ ] | Quality ops | Build numerator/denominator and data completeness dashboards; assign measure owners. | Quality | Q2 2026 - Dashboards + owner list |
| [ ] | HF clinical ops | Implement HF escalation and post-discharge transition workflows (e.g., 7-day touch). | Cardiology leadership | Q3 2026 - Protocol + training completion |
| [ ] | HF clinical ops | Operationalize GDMT reliability workflows with contraindication capture. | Cardiology leadership | Q3 2026 - Order sets; med reconciliation steps |
| [ ] | HF clinical ops | Operationalize BP control workflow including home BP rechecks and device validation. | Cardiology + Nursing | Q3 2026 - BP protocol + training |
| [ ] | LBP clinical ops | Implement conservative-care-first pathway and imaging appropriateness governance. | Spine/pain leadership | Q3 2026 - Pathway + utilization monitoring |
| [ ] | PROMs | Deploy PROM collection workflow and reminders; ensure baseline + follow-up capture. | Quality / IT | Q3 2026 - PROM tool + completion dashboards |
| [ ] | Improvement Activities | Implement IA-1: primary care access confirmation and HRSN screening coordination. | Care management | Q3 2026 - Workflow + evidence logs |
| [ ] | Improvement Activities | Implement IA-2: execute at least one CCA with a primary care practice sharing ASM beneficiaries. | Network/Medical affairs | Q3 2026 - Signed CCA + required elements |
| [ ] | Closed-loop comms | Deploy closed-loop referral and communication workflow between specialists and primary care. | Clinical ops / IT | Q4 2026 - Referral loop metrics |
| [ ] | PI/CEHRT | Confirm CEHRT status and obtain CMS EHR Certification ID(s) from CHPL. | IT | Q2 2026 - CEHRT inventory + IDs |
| [ ] | PI/CEHRT | Plan PI reporting window (>=180 days) and required objective selection (HIE options). | IT / Quality | Q3 2026 - PI plan + timeline |
| [ ] | PI/CEHRT | Complete Security Risk Analysis and SAFER Guides annual self-assessment workflow. | Security / IT | Q4 2026 - SRA report; SAFER evidence |
| [ ] | Data sharing | Designate a data custodian and prepare governance for CMS data sharing agreement. | Compliance | Q3 2026 - Named custodian; SOPs |
| [ ] | Data sharing | Define minimum necessary request process and downstream recipient controls (vendors, CCA partners). | Compliance / Privacy | Q4 2026 - Policies; BAAs / DUA templates |
| [ ] | Finance | Model payment adjustment exposure and build clinician-level Part B revenue tracking. | Finance | Q2 2026 - Forecast model; revenue dashboard |
| [ ] | Finance | Educate clinicians and leaders on payment year lag and risk levels through 2033. | Finance / Quality | Q3 2026 - Training decks; attendance |
| [ ] | Submission readiness | Test end-to-end submission process for quality, IA, and PI (including March 31 deadline). | Quality / IT | Q4 2026 - Mock submission results |
| [ ] | Go-live readiness | Finalize 2027 performance-year operating cadence (weekly huddles + monthly review). | Quality / Clinical leadership | Q4 2026 - Cadence calendar + KPIs |
Appendix A. CMS Mandatory Geographic Areas for ASM (OMB 2023 Codes)
| Code | Type | CBSA/Metropolitan Division name | | --- | --- | | 10100 | CBSA | Aberdeen,SD | | 10460 | CBSA | Alamogordo,NM | | 10580 | CBSA | Albany-Schenectady-Troy,NY | | 10900 | CBSA | Allentown-Bethlehem-Easton,PA-NJ | | 11100 | CBSA | Amarillo,TX | | 11180 | CBSA | Ames,IA | | 11200 | CBSA | Amherst Town-Northampton,MA | | 11244 | Metropolitan Division | Anaheim-Santa Ana-Irvine,CA | | 11260 | CBSA | Anchorage,AK | | 11540 | CBSA | Appleton, WI | | 11694 | Metropolitan Division | Arlington-Alexandria-Reston, VA-WV | | 12020 | CBSA | Athens-Clarke County, GA | | 12054 | Metropolitan Division | Atlanta-Sandy Springs-Roswell, GA | | 12420 | CBSA | Austin-Round Rock-San Marcos, TX | | 12940 | CBSA | Baton Rouge, LA | | 13540 | CBSA | Bennington, VT | | 13740 | CBSA | Billings, MT | | 13980 | CBSA | Blacksburg-Christiansburg-Radford, VA | | 10100 | CBSA | Aberdeen, SD | | 10460 | CBSA | Alamogordo, NM | | 10580 | CBSA | Albany-Schenectady-Troy, NY | | 10900 | CBSA | Allentown-Bethlehem-Easton, PA-NJ | | 11100 | CBSA | Amarillo, TX | | 11180 | CBSA | Ames, IA | | 11200 | CBSA | Amherst Town-Northampton, MA | | 11244 | Metropolitan Division | Anaheim-Santa Ana-Irvine, CA | | 11260 | CBSA | Anchorage, AK | | 11540 | CBSA | Appleton, WI | | 11694 | Metropolitan Division | Arlington-Alexandria-Reston, VA-WV | | 12020 | CBSA | Athens-Clarke County, GA | | 12054 | Metropolitan Division | Atlanta-Sandy Springs-Roswell, GA | | 12420 | CBSA | Austin-Round Rock-San Marcos, TX | | 12940 | CBSA | Baton Rouge, LA | | 13540 | CBSA | Bennington, VT | | 13740 | CBSA | Billings, MT | | 13980 | CBSA | Blacksburg-Christiansburg-Radford, VA | | 14010 | CBSA | Bloomington, IL | | 14020 | CBSA | Bloomington, IN | | 14100 | CBSA | Bloomsburg-Berwick, PA | | 14260 | CBSA | Boise City, ID | | 14380 | CBSA | Boone, NC | | 14500 | CBSA | Boulder, CO | | 14580 | CBSA | Bozeman, MT | | 15020 | CBSA | Brookhaven, MS | | 15380 | CBSA | Buffalo-Cheektowaga, NY | | 15460 | CBSA | Burlington, IA-IL | | 15540 | CBSA | Burlington-South Burlington, VT | | 16060 | CBSA | Carbondale, IL | | 16260 | CBSA | Cedar City, UT | | 16460 | CBSA | Centralia, IL | | 16540 | CBSA | Chambersburg, PA | | 16620 | CBSA | Charleston, WV | | 16660 | CBSA | Charleston-Mattoon, IL | | 16860 | CBSA | Chattanooga, TN-GA | | 17140 | CBSA | Cincinnati, OH-KY-IN | | 17420 | CBSA | Cleveland, TN | | 17780 | CBSA | College Station-Bryan, TX | | 17860 | CBSA | Columbia, MO | | 18060 | CBSA | Columbus, MS | | 18180 | CBSA | Concord, NH | | 18300 | CBSA | Coos Bay-North Bend, OR | | 18580 | CBSA | Corpus Christi, TX | | 18700 | CBSA | Corvallis, OR | | 18880 | CBSA | Crestview-Fort Walton Beach-Destin, FL | | 19060 | CBSA | Cumberland, MD-WV | | 19124 | Metropolitan Division | Dallas-Plano-Irving, TX | | 19180 | CBSA | Danville, IL | | 19300 | CBSA | Daphne-Fairhope-Foley, AL | | 19340 | CBSA | Davenport-Moline-Rock Island, IA-IL | | 19460 | CBSA | Decatur, AL | | 19660 | CBSA | Deltona-Daytona Beach-Ormond Beach, FL | | 19980 | CBSA | Dodge City, KS | | 20060 | CBSA | Douglas, GA | | 20100 | CBSA | Dover, DE | | 20420 | CBSA | Durango, CO | | 20660 | CBSA | Easton, MD | | 20700 | CBSA | East Stroudsburg, PA | | 20994 | Metropolitan Division | Elgin, IL | | 21120 | CBSA | Elk City, OK | | 21660 | CBSA | Eugene-Springfield, OR | | 21794 | Metropolitan Division | Everett, WA | | 21820 | CBSA | Fairbanks-College, AK | | 22020 | CBSA | Fargo, ND-MN | | 22100 | CBSA | Farmington, MO | | 22220 | CBSA | Fayetteville-Springdale-Rogers, AR | | 22420 | CBSA | Flint, MI | | 22520 | CBSA | Florence-Muscle Shoals, AL | | 22540 | CBSA | Fond du Lac, WI | | 22580 | CBSA | Forest City, NC | | 22744 | Metropolitan Division | Fort Lauderdale-Pompano Beach-Sunrise, FL | | 23240 | CBSA | Fredericksburg, TX | | 23420 | CBSA | Fresno, CA | | 23580 | CBSA | Gainesville, GA | | 239801 | CBSA | Glasgow, KY | | 24540 | CBSA | Greeseley, CO | | 25200 | CBSA | Hailey, ID | | 25260 | CBSA | Hanford-Corcoran, CA | | 25420 | CBSA | Harrisburg-Carlisle, PA | | 25540 | CBSA | Hartford-West Hartford-East Hartford, CT | | 25580 | CBSA | Hastings, NE | | 25620 | CBSA | Hattiesburg, MS | | 25700 | CBSA | Hays, KS | | 25850 | CBSA | Hermitage, PA | | 25940 | CBSA | Hilton Head Island-Bluffton-Port Royal, SC | | 26140 | CBSA | Homosassa Springs, FL | | 26380 | CBSA | Houma-Bayou Cane-Thibodaux, LA | | 26420 | CBSA | Houston-Pasadena-The Woodlands, TX | | 26620 | CBSA | Huntsville, AL | | 26860 | CBSA | Indiana, PA | | 26980 | CBSA | Iowa City, IA | | 27100 | CBSA | Jackson, MI | | 27340 | CBSA | Jacksonville, NC | | 27460 | CBSA | Jamestown-Dunkirk, NY | | 27540 | CBSA | Jasper, IN | | 27740 | CBSA | Johnson City, TN | | 27900 | CBSA | Joplin, MO-KS | | 27980 | CBSA | Kahului-Walluku, HI | | 28020 | CBSA | Kalamazoo-Portage, MI | | 28100 | CBSA | Kankakee, IL | | 28500 | CBSA | Kerrville, TX | | 28740 | CBSA | Kingston, NY | | 28820 | CBSA | Kinston, NC | | 28880 | CBSA | Kiryas Joel-Poughkeepsie-Newburgh, NY | | 29020 | CBSA | Kokomo, IN | | 29180 | CBSA | Lafayette, LA | | 29414 | Metropolitan Division | Lake County-Porter County-Jasper County, IN | | 29484 | Metropolitan Division | Lakewood-New Brunswick, NJ | | 29940 | CBSA | Lawrence, KS | | 30020 | CBSA | Lawton, OK | | 30460 | CBSA | Lexington-Fayette, KY | | 30500 | CBSA | Lexington Park, MD | | 30620 | CBSA | Lima, OH | | 30780 | CBSA | Little Rock-North Little Rock-Conway, AR | | 31140 | CBSA | Louisville/Jefferson County, KY-IN | | 31260 | CBSA | Lufkin, TX | | 31540 | CBSA | Madison, WI | | 31900 | CBSA | Mansfield, OH | | 31930 | CBSA | Marletta, OH | | 32390 | CBSA | Massena-Ogdensburg, NY | | 32580 | CBSA | McAllen-Edinburg-Mission, TX | | 32820 | CBSA | Memphis, TN-MS-AR | | 33020 | CBSA | Mexico, MO | | 33140 | CBSA | Michigan City-La Porte, IN | | 33220 | CBSA | Midland, MI | | 33340 | CBSA | Milwaukee-Waukesha, WI | | 33540 | CBSA | Missoula, MT | | 33660 | CBSA | Mobile, AL | | 33860 | CBSA | Montgomery, AL | | 33980 | CBSA | Morehead City, NC | | 34100 | CBSA | Morristown, TN | | 34260 | CBSA | Mountain Home, AR | | 34580 | CBSA | Mount Vernon-Anacortes, WA | | 34620 | CBSA | Muncie, IN | | 34780 | CBSA | Muskogee, OK | | 34940 | CBSA | Naples-Marco Island, FL | | 35020 | CBSA | Natchez, MS-LA | | 35060 | CBSA | Natchitoches, LA | | 35100 | CBSA | New Bern, NC | | 35340 | CBSA | New Iberia, LA | | 35840 | CBSA | North Port-Bradenton-Sarasota, FL | | 36260 | CBSA | Ogden, UT | | 36420 | CBSA | Oklahoma City, OK | | 36460 | CBSA | Olean, NY | | 36540 | CBSA | Omaha, NE-IA | | 36780 | CBSA | Oshkosh-Neenah, WI | | 36837 | CBSA | Ottawa, IL | | 37020 | CBSA | Owosso, MI | | 37140 | CBSA | Paducah, KY-IL | | 37340 | CBSA | Palm Bay-Melbourne-Titusville, FL | | 37540 | CBSA | Paris, TN | | 37580 | CBSA | Paris, TX | | 37900 | CBSA | Peoria, IL | | 38210 | CBSA | Pikeville, KY | | 38240 | CBSA | Pinehurst-Southern Pines, NC | | 38460 | CBSA | Plattsburgh, NY | | 38820 | CBSA | Port Angeles, WA | | 39060 | CBSA | Pottsville, PA | | 39300 | CBSA | Providence-Warwick, RI-MA | | 39340 | CBSA | Provo-Orem-Lehi, UT | | 39380 | CBSA | Pueblo, CO | | 39460 | CBSA | Punta Gorda, FL | | 39500 | CBSA | Quincy, IL-MO | | 39660 | CBSA | Rapid City, SD | | 39740 | CBSA | Reading, PA | | 39960 | CBSA | Rice Lake, WI | | 40080 | CBSA | Richmond-Berea, KY | | 40140 | CBSA | Riverside-San Bernardino-Ontario, CA | | 40380 | CBSA | Rochester, NY | | 40740 | CBSA | Roswell, NM | | 40900 | CBSA | Sacramento-Roseville-Folsom, CA | | 40940 | CBSA | Safford, AZ | | 40980 | CBSA | Saginaw, MI | | 41100 | CBSA | St. George, UT | | 41140 | CBSA | St. Joseph, MO-KS | | 41460 | CBSA | Salina, KS | | 41540 | CBSA | Salisbury, MD | | 41660 | CBSA | San Angelo, TX | | 41700 | CBSA | San Antonio-New Braunfels, TX | | 41760 | CBSA | Sandpoint, ID | | 41884 | Metropolitan Division | San Francisco-San Mateo-Redwood City, CA | | 42020 | CBSA | San Luis Obispo-Paso Robles, CA | | 42034 | Metropolitan Division | San Rafael, CA | | 42200 | CBSA | Santa Maria-Santa Barbara, CA | | 42220 | CBSA | Santa Rosa-Petaluma, CA | | 42340 | CBSA | Savannah, GA | | 42580 | CBSA | Seaford, DE | | 42680 | CBSA | Sebastian-Vero Beach-West Vero Corridor, FL | | 42940 | CBSA | Sevierville, TN | | 42980 | CBSA | Seymour, IN | | 43060 | CBSA | Shawnee, OK | | 43180 | CBSA | Shelbyville, TN | | 43300 | CBSA | Sherman-Denison, TX | | 43340 | CBSA | Shreveport-Bossier City, LA | | 43420 | CBSA | Sierra Vista-Douglas, AZ | | 43760 | CBSA | Sonora, CA | | 43900 | CBSA | Spartanburg, SC | | 44100 | CBSA | Springfield, IL | | 44260 | CBSA | Starkville, MS | | 44460 | CBSA | Steamboat Springs, CO | | 44940 | CBSA | Sumter, SC | | 45060 | CBSA | Syracuse, NY | | 45104 | Metropolitan Division | Tacoma-Lakewood, WA | | 45220 | CBSA | Tallahassee, FL | | 45294 | Metropolitan Division | Tampa, FL | | 45500 | CBSA | Texarkana, TX-AR | | 45700 | CBSA | Tifton, GA | | 45780 | CBSA | Toledo, OH | | 45860 | CBSA | Torrington, CT | | 45900 | CBSA | Traverse City, MI | | 45940 | CBSA | Trenton-Princeton, NJ | | 46220 | CBSA | Tuscaloosa, AL | | 46340 | CBSA | Tyler, TX | | 46540 | CBSA | Utica-Rome, NY | | 47220 | CBSA | Vineland, NJ | | 47260 | CBSA | Virginia Beach-Chesapeake-Norfolk, VA-NC | | 47300 | CBSA | Visalia, CA | | 47664 | Metropolitan Division | Warren-Troy-Farmington Hills, MI | | 47940 | CBSA | Waterloo-Cedar Falls, IA | | 48200 | CBSA | Waynesville, NC | | 48300 | CBSA | Wenatchee-East Wenatchee, WA | | 48460 | CBSA | West Plains, MO | | 48540 | CBSA | Wheeling, WV-OH | | 48580 | CBSA | Whitewater-Elkhorn, WI | | 48620 | CBSA | Wichita, KS | | 48660 | CBSA | Wichita Falls, TX | | 48680 | CBSA | Wildwood-The Villages, FL | | 48700 | CBSA | Williamsport, PA | | 48864 | Metropolitan Division | Wilmington, DE-MD-NJ | | 48900 | CBSA | Wilmington, NC | | 49010 | CBSA | Winchester, TN | | 49220 | CBSA | Wisconsin Rapids-Marshfield, WI | | 49420 | CBSA | Yakima, WA | | 49780 | CBSA | Zanesville, OH |
Appendix B. Glossary and References
| Term | Meaning |
|---|---|
| ASM performance year | A 12-month period(Jan 1-Dec 31)during the first five calendar years of the ASM test period. |
| ASM payment year | A calendar year when CMS applies a payment multiplier based on the final score from the performance year two years prior. |
| CBSA | Core-Based Statistical Area,as defined by OMB;used by CMS to define mandatory geographic areas. |
| CEHRT | Certified Electronic Health Record Technology (required for Promoting Interoperability). |
| EBCM | Episode-based cost measure;claims-based measure used for cost accountability and eligibility thresholds. |
| Cohort | In ASM,clinicians are grouped into a heart failure cohort or low back pain cohort for benchmarking and scoring. |
| CCA | Collaborative Care Arrangement:a written agreement between an ASM participant and a primary care practice sharing ASM beneficiaries,meeting regulatory requirements. |