By Lindsay Mehalik and Susan Sumrell
On June 22, 2011, CMS hosted a conference call for those centers invited to participate in the FQHC Advanced Primary Care Practice Demonstration to go over the details and answer any questions. The demo is scheduled to begin in early September 2011. Applications are due to CMS no later than midnight on August 12, 2011.
Approximately 1,340 invitations were sent last week to FQHCs that meet CMS’ eligibility requirements for demo participation. CMS spent some time during the call outlining these demo eligibility requirements, emphasizing that to be eligible the site must have provided primary care services to at least 200 Medicare beneficiaries in the most recent 12 month look back period. These beneficiaries must be enrolled in Medicare Part A and B; Medicare Advantage plan participants are not eligible beneficiaries. Each “brick and mortar” site that wishes to participate must submit an individual application, and each site must meet the Medicare beneficiary requirement, regardless of how many beneficiaries are served in the health center’s overall collaborative system. Additionally, sites must be able to receive electronic fund transfers, and must be submitting claims to NGS or Nordian. Please note, that your health center must be invited to apply for this demo. A full listing of eligibility requirements can be found in the presentation slides.
The FQHC APCP Demonstration is scheduled to last 3 years, during which time CMS expects at least 90% of the 500 FQHC’s selected to participate will achieve Level 3 Primary Care Medical Home Recognition in accordance with the recently revised 2011 NCQA PCMH standards. This will require submission of updates to the Readiness Assessment Survey, participation in random audits and review of feedback from CMS. Health centers that currently hold Medical Home Recognition, either through NCQA or another organization, will be eligible to participate in the demo; however these sites will still be expected to work to achieve Medical Home recognition under the 2011 NCQA standards.
CMS also explained that participating health centers will receive financial support during the demo in the form of a care management fee. This will be an $18 quarterly, prospective, per beneficiary payment based on a roster of attributed beneficiaries. The payment will be automatic and will not require a claim submission. Health centers will be provided with a roster of beneficiaries at the start of the demo, which will be revised quarterly based on a review of the previous 12 months. Beneficiaries will be attributed to the participating health center that they have visited most frequently in the previous 12 months, thereby avoiding paying for a beneficiary more than once.
In order to apply, each eligible FQHC site will complete an application form as well as an initial NCQA Readiness Assessment Survey. The application will create an account on the NCQA PCMH system and will provide CMS with the information necessary to qualify the health center for participation. The Readiness Assessment Survey will provide CMS with a baseline as to the readiness of a health center to become a PCMH. Sites will gain access to this survey once CMS has received and processed their application form. Both the application and the form must be completed by August 12, 2011 to receive consideration. Applicants will be informed of final decisions by August 26, 2011. Selections will be made to ensure representation of a number of FQHC characteristics, including size and geography.
CMS emphasized that there is no cost to health centers to participate. Survey costs are expected to be offset by the care management fee, and there are no costs to apply or be accepted. Widespread participation in this demo is crucial to its findings, and will pave the way for other FQHC’s towards becoming a PCMH in the future.
This is an exciting opportunity for health centers to demonstrate the high quality care that they provide to their Medicare patients. We encourage all eligible health centers to seriously consider the benefits of participating in this demo. Please don’t hesitate to let us know if you have any questions.