Under this demonstration, CMS is participating in multi-payer reform initiatives that are currently being conducted by states to make advanced primary care practices more broadly available. The demonstration will evaluate whether advanced primary care practice will reduce unjustified utilization and expenditures, improve the safety, effectiveness, timeliness, and efficiency of health care, increase patient decision-making and increase the availability and delivery of care in underserved areas.
The Participating MAPCP
This demonstration began in 2011 with eight states participating: Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont. Each project is conducted and coordinated by the participating State and includes Medicaid and substantial participation by private health insurers. The demonstration was initially planned to last for three years in each state.
The demonstration program pays a monthly care management fee for beneficiaries receiving primary care from advanced primary care (APC) practices. The care management fee is intended to cover care coordination, improved access, patient education and other services to support chronically ill patients. Additionally, each participating State will have mechanisms to offer APC practices community support and linkages to State health promotion and disease prevention initiatives.
Medicare participation in three of the state’s programs (Vermont, New York, and Rhode Island) started July 1, 2011. Two additional states (North Carolina and Michigan) were effective October 1, 2011 and the three remaining states became operational January 1, 2012. Each state’s program was planned to be operational for 3 years. By the end of the three year demonstration approximately 1200 medical homes serving over 900,000 Medicare beneficiaries are expected to be participating.
In early 2014 a decision was made to extend the demonstration in all states through the end of 2014, and in September 2014 CMS announced that it would offer six of the eight states participating in the MAPCP demonstration the opportunity to extend the demonstration through 2016. The offer to extend the demonstration was made to those states for which some of the MAPCP Demonstration payment goes to community based organizations that could not bill independently under the Chronic Care Management (CCM) codes proposed to take effect in January, 2015. Five states (Maine, Michigan, New York, Rhode Island, Vermont) accepted the offer and will continue participation in this demonstration through 2016.
- Multi-Payer Advanced Primary Care Demonstration: First Evaluation Report (PDF)
- Solicitation (PDF)
- Demonstration Fact Sheet (revised 4/5/2012) (PDF)
- Demonstration Q & As (revised 04/12/2011) (PDF)
- Press Release Announcing Selected Sites (11/16/2010)
- Demonstration Press Release - Invitation to Participate (06/02/2010)
- Medicare Medical Home (TRHCA/MIPPA) Demonstration