The Centers for Medicare and Medicaid Services (CMS) has announced the availability of up to 500 demonstration projects for Federally Qualified Health Centers (FQHC) to implement Advanced Primary Care Practice, or patient-centered medical homes, for their Medicare fee-for-service beneficiaries (including dually eligible Medicare-Medicaid beneficiaries).

A FQHC will need to have a minimum of 200 Medicare fee-for-service beneficiaries to qualify for the demonstration project.  In contrast, under the CMS proposed rule for Medicare fee-for-service accountable care organizations (ACOs), an ACO must have at least 5,000 aligned Medicare fee-for-service beneficiaries. Under the multi-payer Pioneer ACOs announced last month, an ACO must have at least 15,000 aligned Medicare fee-for-service beneficiaries.

Once accepted for the demonstration project, an FQHC will receive technical assistance in implementing patient-centered medical homes for those beneficiaries, with the goal of achieving Level 3 recognition as a patient-centered medical home by the National Committee for Quality Assurance (NCQA) by the end of the three-year demonstration project duration.  The Health Services and Resources Administration (HRSA), which provides direct funding to all FQHCs, is collaborating with CMS on these demonstrations and will pay the fees required for NCQA recognition.  The 2011 revised standards for NCQA patient-centered medical homes have six domains:

  • Enhance Access and Continuity
  • Identify and Manage Patient Populations
  • Plan and Manage Care
  • Provide Self-Care and Community Support
  • Track and Coordinate Care
  • Measure and Improve Performance

Interesting, CMS continues to use the term “Advanced Primary Care Practice” for this demonstration project even though it is using (and HRSA is paying the fees) for using a model called “patient-centered medical homes.”

CMS will make “care management fee” incentive payments to the FQHCs for each of the assigned Medicare fee-for-service beneficiaries to offset some of the additional costs of implementing elements of the medical home model, totaling $72 per beneficiary per year. With a minimum of 200 beneficiaries, the minimum payment an FQHC would receive each year would be $14,400.

The application for the demonstration projects is open from now until August 26, 2011 (deadline extended). CMS will notify which FQHCs have been approved for the demonstration projects by September 16 and the projects will begin on October 1, 2011, lasting for three years until September 30, 2014.

FQHCs participating in the demonstration projects need to complete a medical home readiness assessment using an NCQA survey and repeat the assessment every six months until they are able to achieve NCQA recognition.  Applicants must complete and submit a baseline readiness assessment by September 2, 2011.  HRSA will pay the fees required by NCQA to use its proprietary assessment survey.

Curiously, unlike other medical home demonstration projects, this demonstration will not include any pay-for-performance incentives, or require reporting or improvements in quality measures.  It seems the only goal is to assist hundreds of FQHCs achieve NCQA recognition as patient-centered medical homes.  However, transforming FQHCs into patient-centered medical homes will be a significant achievement towards overall health care delivery re-design and quality improvement.

CMS’ website has published updated documents about the demonstration project: a general Description, Fact Sheet, Frequently Asked Questions, and Terms and Conditions.

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