One week after HHS announced the CMS Primary Cares Initiative, a new set of value-based payment models for primary care, CMS Administrator Seema Verma affirmed some Medicare payment models would be mandatory. The American Health Care Association stated it opposed mandatory demonstration projects but supported the development of the rehospitalization value-based purchasing program. Skilled care advocates are wary of mandatory models. Nicole Fallon, VP of health policy and integrated services for LeadingAge, stated a mandatory model could be financially devastating for smaller, rural nursing homes or home health agencies.