- August 22, 2023
- Alerts
CMS Releases Updated Request for Applications for New Making Care Primary Model
On August 14, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a request for applications for the Making Care Primary (MCP) Model, its newest innovation program aimed at improving patient care by supporting the delivery of advanced primary care services. The MCP model, which will run for 10 ½ years – July 2024 to December 2034 – is open to providers in eight states, including New Jersey and parts of New York. The application period will run from September 4, 2023, to November 30, 2023.
Participation is open to Medicare-enrolled organizations providing primary care services, including, solo primary care practices, group practices, health systems, and Federally Qualified Health Centers (FQHCs). Primary care providers that participated in ACO REACH as of May 31, 2023, are not eligible to apply for MCP.
The MCP model offers three tracks for participation, providing an on-ramp for organizations new to value-based care, while also providing participation options for organizations with more experience. Participants will move through these time-limited tracks, with increasing levels of accountability for cost and quality outcomes. Payments include start-up financial support, per beneficiary per month payments, and performance incentive payments.
As participants progress along each track, reimbursements will shift from (a) pure fee-for-service for non-FQHC providers and Medicare FQHC prospective payment system (PPS) for FQHCs, to (b) a blend of prospective primary care payments and the applicable fee-for-service or FQHC PPS payments, (c) culminating in a fully prospective primary care payment (meaning no separate fee-for-service or PPS payments). Participants in each track will be eligible to earn greater financial rewards for improving patient health outcomes. Please note that continuous improvement is calculated by emergency department utilization, as opposed to total per capita cost, a traditionally more challenging metric for FQHCs to achieve.
Should you have any questions regarding the above, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.
Participation is open to Medicare-enrolled organizations providing primary care services, including, solo primary care practices, group practices, health systems, and Federally Qualified Health Centers (FQHCs). Primary care providers that participated in ACO REACH as of May 31, 2023, are not eligible to apply for MCP.
The MCP model offers three tracks for participation, providing an on-ramp for organizations new to value-based care, while also providing participation options for organizations with more experience. Participants will move through these time-limited tracks, with increasing levels of accountability for cost and quality outcomes. Payments include start-up financial support, per beneficiary per month payments, and performance incentive payments.
As participants progress along each track, reimbursements will shift from (a) pure fee-for-service for non-FQHC providers and Medicare FQHC prospective payment system (PPS) for FQHCs, to (b) a blend of prospective primary care payments and the applicable fee-for-service or FQHC PPS payments, (c) culminating in a fully prospective primary care payment (meaning no separate fee-for-service or PPS payments). Participants in each track will be eligible to earn greater financial rewards for improving patient health outcomes. Please note that continuous improvement is calculated by emergency department utilization, as opposed to total per capita cost, a traditionally more challenging metric for FQHCs to achieve.
Should you have any questions regarding the above, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.