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TO:  All Medicaid Enrolled Providers

Alabama Coordinated Health Networks (ACHNs) will begin operation on October 1, 2019. Shortly thereafter, recipients will be attributed to Primary Care Physician (PCP) Groups that are enrolled with Medicaid AND the ACHN. Below are several key items regarding the attribution process that PCPs need to be aware of during this transition to the ACHN:

•    Attribution will be performed in accordance with Alabama Medicaid Administrative Code Rule 560-X-37-.09.

•    Attribution is the process that will be used to associate a Medicaid recipient to the PCP Group that provides primary care to that recipient. Attribution will be determined on a quarterly basis.

•    Attribution is a critical factor in determining distribution of bonus payments among eligible providers.

•    Medicaid will only review the previous two-year history of face-to-face provider visit utilization for each Medicaid recipient. PCPs are encouraged to continue seeing patients, as medically necessary, on a consistent basis to increase the likelihood of attribution.

•    Point values for face-to-face visits will be assigned to the individual provider that performed the service. More points will be awarded for preventive office visits (CPT 99381-99387, 99391-99397) than regular office visits (CPT 99201-99205, 99211-99215).

•    The first bonus payments will be made on the first checkwrite in November 2019. Subsequent payments will be made on a quarterly basis beginning in January 2020.

On September 12, 2019, Medicaid recorded a webinar with more details related to attribution that is available at the following link: 

https://www.youtube.com/watch?v=HcOch_kpY58&feature=youtu.be.

Based on feedback received in relation to the webinar, Medicaid issued an emergency rule on September 19, 2019, amending the attribution process. Namely, in 560-X-37-.09(1)(e), Medicaid clarified that PCP Groups will receive points based on the number of prescriptions filled for chronic care conditions. Further, the rule now defines prescriptions for chronic care conditions as more than one prescription filled for a chronic condition (e.g., asthma) and must correspond to an office visit from the prescribing provider within the previous two (2) years. The rule can be found in its entirety at

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