Michigan Selected as a Market for CMS Primary Care Payment Initiative

The Centers for Medicare & Medicaid Services (CMS) recently announced the 10 states chosen for its Comprehensive Primary Care Plus (CPC+) initiative.  Michigan has been chosen for statewide participation.  In addition to Michigan, the following states were selected on either a state-wide or regional basis:  Arkansas, Colorado, Hawaii, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee.

CMS will enter into a Memorandum of Understanding with selected third party payors in these states.

Payment for services to primary care doctors providing services through this program will be based on three elements:

  • Care management fee (CMF) – a non-visit based fee that is risk adjusted and paid on a quarterly basis;
  • Performance based incentive payment – an incentive based payment evaluating quality, utilization, patient experience and cost which will be paid prospectively and reconciled retrospectively; and
  • Medicare fee schedule or Comprehensive Primary Care Payments (CPCP) – providers participating in Track One of the program will continue to receive fee for service payments based on the physician fee schedule. However, providers who wish to participate in Track Two of the program will receive a lump sum CPCP which CMS states are expected to be larger than fee for service payments.

Practices interested in the program can apply to participate between August 1 – September 15, 2016.

More information can be found on the CMS Innovation Center website:   https://innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Plus

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