Centers for Medicare & Medicaid Services
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Washington, DC 20201
Office of Media Affairs
New Affordable Care Act Support to Improve Care Coordination for nearly 200,000 People with Medicare
Federally Qualified Health Center Advanced Primary Care Practice (FQHC APCP) Demonstration Fact Sheet
The Federally Qualified Health Center Advanced Primary Care Practice (FQHC APCP) demonstration project is a new Affordable Care Act initiative that will pay an estimated $42 million over three years to up to 500 FQHCs to coordinate care for Medicare patients. This demonstration project, operated by the Centers for Medicare and Medicaid Services (CMS) in partnership with the Health Resources Services Administration (HRSA), will test the effectiveness of doctors and other health professionals working in teams to improve care for up to 195,000 Medicare patients. This initiative is part of a broader effort by the Obama Administration, made possible by the Affordable Care Act, to improve care and lower costs.
The FQHC Advanced Primary Care Practice demonstration will show how the patient-centered medical home model can improve quality of care, promote better health, and lower costs. Participating FQHCs must implement electronic health records, help patients manage chronic conditions, as well as actively coordinate care for patients. To help participating FQHCs make these investments in patient care and infrastructure, they will be paid a monthly care management fee for each eligible Medicare beneficiary receiving primary care services. In return, FQHCs agree to adopt care coordination practices that are recognized by the National Committee for Quality Assurance (NCQA). CMS and HRSA will provide technical assistance to help FQHCs achieve these goals.
Eligibility Requirements
FQHCs:
· FQHCs must have provided primary care medical services to at least 200 eligible Medicare beneficiaries in the most recent 12-month period (“look-back” period). This can include those with both Medicare and Medicaid coverage (Medicare-Medicaid enrollees or dual eligibles).
· All participating FQHCs must be listed in the Provider Enrollment Chain and Ownership System (PECOS) file and be able to receive electronic funds transfer (EFT). FQHCs that have not recently submitted an 855A form are not listed in PECOS and therefore will not be eligible to participate in the demonstration.
· FQHCs that currently do not receive claims payment through EFT must submit the necessary form to receive EFT or they will not be eligible to participate in the demonstration.
· FQHCs must submit claims for payment to National Government Services or to Noridian Administrative Services, the jurisdiction 3 Medicare Administrative Contractor (MAC).
Medicare Beneficiaries:
· Beneficiaries, including dually eligible Medicare/Medicaid beneficiaries, must have been enrolled in the Medicare Part A and Part B fee-for-service program during the look-back period, and may not be currently in hospice care or under treatment for end-stage renal disease (ESRD).
· Beneficiaries enrolled in Medicare Advantage are not eligible to participate in this demonstration.
· Attribution of beneficiaries to an FQHC will be based on Medicare administrative data for beneficiaries for whom CMS has a claim in the look-back period.
· Beneficiary eligibility is verified each quarter prior to CMS making payments. Participating FQHCs will receive an updated roster of attributed beneficiaries along with the quarterly fee payment.
Payment:
· Participating FQHCs will receive a monthly care management fee of $6.00 for each eligible Medicare beneficiary attributed to their practice. This fee is intended to help defray the cost of transformation into a person-centered, coordinated, seamless primary care practice. The fee, which will be made quarterly, is in addition to the usual all-inclusive payment FQHCs receive for providing Medicare covered services.
· FQHCs will automatically receive payments, without the need to submit a claim.
· Payment can only be made via Electronic Funds Transfer (EFT).
Application and Review Process
A. Application Website
CMS is using a web-based application process for this demonstration. Eligible FQHCs will find an application form and instructions on the demonstration web site located at www.fqhcmedicalhome.com. Applications should be completed and submitted electronically. Each individual FQHC must submit an application form to be considered for participation in the demonstration. Applications for multiple sites will not be accepted.
The application form has several sections to collect baseline data on practice characteristics and agreements, including general background questions, agreement and acceptance with terms and conditions, a supplemental survey questionnaire, as well as a PCMH readiness assessment. All sections and questions must be completed to be considered for participation in this demonstration.
B. Application Timetable/Milestones
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