The Centers for Medicare and Medicaid Services (CMS) issued guidelines and application instructions on December 21 for the Independence at Home (IAH) demonstration program under section 3024 of the Affordable Care Act (ACA). This three-year Medicare initiative will offer a comprehensive range of primary care services in the homes of beneficiaries with multiple chronic conditions and functional limitations.   It is designed to test whether home-based primary care models can help reduce hospitalizations, improve patient and caregiver satisfaction, improve quality of care, and reduce expenditures for persons who need help in their own homes to manage multiple health issues. Many frail elderly persons with complex conditions are at risk of costly and life-threatening medical emergencies because they can’t readily access a primary care site when they should do so. CMS is trying to ameliorate this by defining relevant performance measures and realigning Medicare payment incentives for qualified organizations based on those measures. Providers electing to participate in the new demonstration will earn incentive payments if they achieve specified cost containment and quality of care objectives using a home-based primary care delivery model appropriate for high-risk individuals. Provider participation initially will be limited to 50 medical practices or consortia of medical practices led by physicians or nurse practitioners with prior experience delivering home-based primary care, and each such practice must serve at least 200 Medicare fee-for-service beneficiaries with multiple chronic conditions and functional limitations in order to participate in the three year demonstration. This cautious, closely monitored beginning could become a new paradigm for serving many of the frail elderly and disabled under Medicare and Medicaid if the three year demonstration achieves its intended results. Applications to participate are due February 6.