New Demo Pays FQHCs to Coordinate Medicare Patients’ Care

A new demonstration being offered by the Centers for Medicare & Medicaid Services (CMS), in partnership with the Health Resources Services Administration (HRSA), gives federally qualified health centers (FQHCs) an opportunity to improve care and earn a little extra money at the same time.

The FQHC Advanced Primary Care Practice (APCP) three-year demonstration is an Affordable Care Act initiative that will test FQHCs’ ability to coordinate care for Medicare patients using a patient-centered medical home model. Beginning Sept. 1, CMS expects to test the effectiveness of doctors and other health care professionals working in teams to improve care for up to 195,000 Medicare patients in up to 500 FQHCs.

This demonstration is no cake walk, though. Participating FQHCs must agree to implement electronic health records (EHRs), help manage chronic conditions, and actively coordinate patient care using National Committee for Quality Assurance (NCQA) standards.

In return, participating FQHCs will be paid a monthly care management fee of $6 for each eligible Medicare beneficiary receiving primary care services (in addition to the usual all-inclusive payment FQHS receive for providing Medicare-covered services). CMS and HRSA also will provide technical assistance.

To qualify for the demo, FQHCs must:

  • have provided primary care to at least 200 Medicare beneficiaries in the past 12 months;
  • be listed in the Provider Enrollment Chain and Ownership System (PECOS) file;
  • be able to receive electronic funds transfers (EFT); and
  • submit claims for payment to National Government Services or Noridian Administrative Services.

Getting into the demonstration is only half the battle. FQHCs should consider several important factors before applying. For example, participating FQHCs also must submit an updated readiness statement every six months for the duration of the demonstration.

There are requirements for beneficiaries, too. Beneficiaries must have been enrolled in the Medicare Part A and/or Part B fee-for-service program for the past 12 months, and may not be in hospice care or under treatment for end-stage renal disease (ESRD). Medicare Advantage folks are ineligible.

FQHCs can apply for the demo via a web-based application process, which began June 6 and ends Aug. 12.

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