Multi-Payer Advanced Primary Care Practice

Under this demonstration, CMS will participate 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

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There are 8 states participating in the Multi-Payer Advanced Primary Care Practice Demonstration. (List)
To view an interactive map of this Model, visit the Where Innovation is Happening page.

Background

The following states were selected to participate in this demonstration: Maine, Vermont, Rhode Island, New York, Pennsylvania, North Carolina, Michigan, and Minnesota. Each project will be conducted and coordinated by the participating State, will include Medicaid and substantial participation by private health insurers, will show support by the primary care providers, and will be coordinated with State health promotion and disease prevention efforts.

Initiative Details

The demonstration program will pay 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 1st, and the three remaining states became operational January 1, 2012. Each state’s program will 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.

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.

Additional Information



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