The Centers for Medicare and Medicaid Services (CMS) has announced the 14 regions (in 16 states) that will be participating in the Comprehensive Primary Care Plus (CPC+) program for Medicare fee-for-service (FFS) beneficiaries:
- Arkansas: Statewide
- Colorado: Statewide
- Hawaii: Statewide
- Kansas and Missouri: Greater Kansas City Region
- Michigan: Statewide
- Montana: Statewide
- New Jersey: Statewide
- New York: North Hudson-Capital Region
- Ohio: Statewide and Northern Kentucky: Ohio and Northern Kentucky Region
- Oklahoma: Statewide
- Oregon: Statewide
- Pennsylvania: Greater Philadelphia Region
- Rhode Island: Statewide
- Tennessee: Statewide
The program is an multi-payer initiative so each region has identified public and private payers that have tentatively agreed to participate:
To support the delivery of comprehensive primary care, CPC+ includes three payment elements, with two payment “tracks”:
- Care Management Fee (CMF): The program will provide participating primary care practices a non-visit based CMF that will be paid per Medicare beneficiary per month. The amount is risk-adjusted for each practice to account for the intensity of care management services required for the practice’s specific population. These Medicare CMFs will be paid to the practice on a quarterly basis. Practices participating in Track 2 will be eligible for higher CMFs.
- Performance-based incentive payment: CPC+ will prospectively pay and retrospectively reconcile a performance-based incentive based on how well the practice performs on patient experience measures, clinical quality measures, and utilization measures that drive total cost of care. Practices participating in Track 2 will be eligible for higher incentive payments.
- Payment under the Medicare Physician Fee Schedule: Primary care practices participating in Track 1 will continue to bill and receive payment from Medicare FFS as usual. Primary care practices participating in Track 2 practices also will continue to bill as usual, but the FFS payment will be reduced to account for CMS shifting a portion of Medicare FFS payments into Comprehensive Primary Care Payments (CPCP), which will be paid in a lump sum on a quarterly basis. However, given the expectations that Track 2 practices will increase the comprehensiveness of care delivered, the CPCP amounts will be larger than the FFS payment amounts they are intended to replace.
The program and new payments will begin January 2017. In addition, practices that participate in CPC+ may qualify for additional incentive payments available for the Advanced Alternative Payment Models in the proposed Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (performance year proposed to also begin January 2017).
CPC+ has 13 requirements for Track 1 practices and 24 requirements for Track 2 practices:
Here is a Frequently Asked Questions and answers for primary care practices:
CMS also has released a video explaining the program:
Primary care practices in the participating regions have until September 15, 2016 to apply to participate in CPC+. Practices applying to participate in Track 2 must secure support from their health IT vendor to support and participate in the program. CMS will be hosting numerous webinars before September 15 to provide additional information about the program.