Your Letter of Intent to join Mana ACO.
Fill in the form, sign on screen, and download the finished letter. It takes about three minutes. Then email it to us and we file it with Medicare for you.
What you are confirming
Medicare sets the contents of this letter. Here is every commitment in it, in plain terms, so nothing is a surprise when you read the letter itself.
You intend to join for 2027
Your practice intends to take part in the LEAD Model during 2027, as part of Mana ACO.
You can sign for the practice
You are an executive with authority to enter this agreement on behalf of the practice, its ownership, and its governing board.
You understand how LEAD pays
Mana ACO receives a set monthly amount for the Medicare care of your aligned patients, and the fee-for-service amounts on your claims for those patients are reduced to match, starting January 1, 2027. You are paid for that care through the ACO, and you keep your share of the savings you generate.
You will tell your providers
By October 15, 2026 you will notify the clinicians who bill through your TIN about the payment change. We send you a ready-made notice for this.
You understand the effect on other programs
Joining LEAD under your TIN may prevent clinicians billing under that same TIN from taking part in the Shared Savings Program, another LEAD ACO, Kidney Care Choices, other Medicare shared-savings models, MDPCP, and in some cases the AHEAD models.
Your letter
Your practice details come from the form above. Add who is signing, then sign.
Date: [date]
To: Mana ACO (Mohala Health Incorporated), ACO ID A6032, ACO entity TIN [ACO entity TIN], [ACO address].
Re: Letter of Intent to participate in the CMS LEAD Model for Performance Year 2027
On behalf of [Practice legal business name] (the “Practice”), Taxpayer Identification Number [TIN], located at [practice address], I confirm the following:
- Intent to participate. The Practice intends to participate in the CMS Long-term Enhanced ACO Design (LEAD) Model during Performance Year 2027, and to do so as part of Mana ACO.
- Authority. I am an executive of the Practice, and I affirm that I have the authority to enter into this agreement with Mana ACO on behalf of the Practice, its ownership, and its governing board.
- How LEAD pays. I understand that, under the LEAD Model’s Total Care Capitation, Mana ACO will receive monthly prospective capitation as compensation for the Medicare Part A and B services that the providers billing under our TIN furnish to ACO-aligned beneficiaries, and that our fee-for-service claims for those beneficiaries will be reduced accordingly, beginning January 1, 2027.
- Notice to our providers. By October 15, 2026, the Practice will give written notice of our LEAD participation to the providers who bill Medicare through our TIN and take part in LEAD’s payment mechanisms. That notice will explain the payment mechanism that applies to them, the prospective capitation, and the reduction of claims-based Medicare fee-for-service payments beginning January 1, 2027.
- Effect on other Medicare programs. I acknowledge that participating in the LEAD Model under our TIN may preclude the individuals and entities that bill Medicare through our TIN from participating, under that same TIN, in the Medicare Shared Savings Program, another ACO in the LEAD Model, the Kidney Care Choices Model, any other Medicare initiative that involves shared savings (except as CMS specifies), the Maryland Primary Care Program, and, in certain instances, the Primary Care AHEAD and Hospital Global Budget AHEAD models. The Practice will include this point in the notice it gives to its providers by October 15, 2026.
Sincerely,
Questions practices ask
What am I agreeing to by saying yes?
That your practice intends to take part in Mana ACO for 2027, so we can add you to our Medicare list before the August 5 cutoff. It is not a contract. Nothing binds your practice until you sign the Letter of Intent, and you can tell us to remove you any time before September 8.
Why is August 5 the date?
Medicare lets us add practices to our list until August 5 and not one day later. After that we can only remove practices. So saying yes now costs you nothing and keeps 2027 available while you decide. Waiting closes the door.
Is the Letter of Intent binding?
It is a real commitment of intent, and Medicare treats it that way. What it does not do is set your payment terms or lock in the operating detail. That is the participation agreement, a separate document you review and sign later in the year, before December 31, 2026.
Does my signature have to be handwritten?
Medicare requires the letter to be executed by an executive, with a printed name accompanying a dated signature. Signing on screen here produces exactly that. If you would rather sign by hand, print a blank copy, sign it, scan it, and email it back.
What happens to my fee-for-service billing?
You keep submitting claims the way you do today. For patients aligned to the ACO, the fee-for-service amount on those claims is reduced, and your practice is paid for that care through the ACO instead, starting January 1, 2027. Your patients and your clinical decisions do not change.
Does this cost anything?
No. There is no fee to join Mana ACO, and your practice is not asked to post any financial guarantee. The ACO, not your practice, carries the Model’s financial accountability with Medicare.