March 9, 2020

State of Alabama
Press Release: Medicaid

Patient-Centered Medical Home (PCMH) Bonus Payments and Requirements

TO:  ACHN Participating Providers

Alabama Medicaid providers enrolled with Medicaid and actively participating with an ACHN as Primary Care Physician (PCP) Groups will be eligible to receive a quarterly PCMH bonus payment. The PCMH Recognition bonus is 5% of the entire annual pool of $15 million dollars. For the first bonus payment in FY 2021, the PCMH bonus will be based on actual achievement of or progress toward achievement of PCMH Recognition through a nationally recognized entity such as the National Committee for Quality Assurance (NCQA) or the Joint Commission of Healthcare Organization (JCAHO). Certification or attestation for this achievement must be received annually by the Agency no later than August 1st to ensure credit for a bonus payment for the upcoming fiscal year.


What are the benefits of PCMH Recognition?

  • Improved efficiency and lower practice costs
  • Access to PCMH guidelines to help streamline care coordination and care management
  • Enhanced reimbursement support
  • Additional recognition
  • Streamlined participation in other value-based care models

Which providers qualify for the PCMH Bonus Payment?

PCP Groups enrolled with Medicaid and actively participating with an ACHN are eligible to receive bonus payments for PCMH Recognition.

What do providers need to know about the PCMH Recognition Process?

PCP Groups that have received or are in the process of achieving PCMH Recognition through NCQA will be verified by the Medicaid Agency. NCQA will send a list of all providers that have received or are in the process of achieving PCMH Recognition from their organization. The Medicaid Agency will review the list annually to determine the providers that have received or have made progress toward PCMH Recognition through NCQA. Providers that are identified on the list will be eligible to receive the 5% PCMH Recognition bonus payment. 

PCP Groups that received or making progress towards PCMH Recognition through JCAHO or another certifying entity must submit an Attestation Form and proof of their PCMH Recognition certification to the Medicaid Agency. 

Definition of ‘progress toward achievement’ of PCMH Recognition?

For those PCP Groups achieving PCMH Recognition through NCQA, the PCP Group must have had at least one check in towards PCMH Recognition. The Agency will receive a list of PCP Groups who have met criteria and will approve if the group had at least one check in during the previous year.

For those PCP Groups who are working with a nationally recognized entity other than NCQA, these groups must show progress toward completion of PCMH Recognition. The Agency will determine the appropriate level of progress to receive the 5% bonus payment. Documentation from the nationally recognized entity must be attached to the Attestation Form. A printout of the screen showing progress is considered sufficient documentation. The Agency will review the Attestation Form with the required attachments and will process the request based on established guidelines. If the Agency disapproves the submitted Attestation Form and attachments, a formal letter will be mailed to the PCP Group explaining the reason(s) for the disapproval.

ACHN enrolled PCP Groups must send the completed PCMH Attestation Form and attachments by mail, fax, or email.

Mail to:
Alabama Medicaid Agency
Network Provider Assistance Unit

Attention: Travis Houser
501 Dexter Avenue
Montgomery, Alabama 36103-5624
Fax
to 334-353-3856
E-mail
to Travis.Houser@medicaid.alabama.gov AND Patricia.Toston@medicaid.alabama.gov


Where can a provider go for details regarding the ACHN program?
https://medicaid.alabama.gov/content/5.0_Managed_Care/5.1_ACHN/5.1.3_ACHN_Providers.aspx

For questions related to the PCMH Attestation process for PCPs enrolled with the ACHN, contact Patricia Toston via email at Patricia.Toston@medicaid.alabama.gov or Travis Houser at Travis.Houser@medicaid.alabama.gov.




The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 20
20 American Medical Associationand © 2020 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.

 

 

 

 



  • For more information, visit http://medicaid.alabama.gov
  • For more state-wide press releases, click here