TO: ACHN
Participating Providers
Alabama
Medicaid providers enrolled with Medicaid and actively participating with an
ACHN as Primary Care Physician (PCP) Groups will be eligible to receive a quarterly
PCMH bonus payment. The PCMH Recognition bonus is 5% of the entire annual pool
of $15 million dollars. For the first bonus payment in FY 2021, the PCMH bonus
will be based on actual achievement of or progress toward achievement of PCMH
Recognition through a nationally recognized entity such as the National
Committee for Quality Assurance (NCQA) or the Joint Commission of Healthcare
Organization (JCAHO). Certification or attestation for this achievement must be
received annually by the
Agency no later than August 1st to ensure credit for a bonus
payment for the upcoming fiscal year.
What are the benefits of PCMH Recognition?
- Improved efficiency and lower practice costs
- Access to PCMH guidelines to help streamline care
coordination and care management
- Enhanced reimbursement support
- Additional recognition
- Streamlined participation in other value-based care
models
Which providers qualify for the PCMH Bonus Payment?
PCP Groups enrolled with Medicaid and actively participating
with an ACHN are eligible to receive bonus payments for PCMH Recognition.
What do providers need to know about the PCMH Recognition Process?
PCP Groups that have received or are
in the process of achieving PCMH Recognition through NCQA will be verified by
the Medicaid Agency. NCQA will send a list of all providers that have received
or are in the process of achieving PCMH Recognition from their organization.
The Medicaid Agency will review the list annually to determine the providers
that have received or have made progress toward PCMH Recognition through NCQA.
Providers that are identified on the list will be eligible to receive the 5%
PCMH Recognition bonus payment.
PCP Groups that received or making
progress towards PCMH Recognition through JCAHO or another certifying entity
must submit an Attestation Form and proof of their PCMH Recognition
certification to the Medicaid Agency.
Definition of ‘progress toward achievement’ of PCMH Recognition?
For those
PCP Groups achieving PCMH Recognition through NCQA, the PCP Group must have had
at least one check in towards PCMH Recognition. The Agency will receive a list
of PCP Groups who have met criteria and will approve if the group had at least
one check in during the previous year.
For those PCP
Groups who are working with a nationally recognized entity other than NCQA,
these groups must show progress toward completion of PCMH Recognition. The
Agency will determine the appropriate level of progress to receive the 5% bonus
payment. Documentation from the nationally recognized entity must be attached
to the Attestation Form. A printout of the screen showing progress is
considered sufficient documentation. The Agency will review the Attestation
Form with the required attachments and will process the request based on
established guidelines. If the Agency disapproves the submitted Attestation
Form and attachments, a formal letter will be mailed to the PCP Group
explaining the reason(s) for the disapproval.
ACHN enrolled PCP
Groups must send the completed PCMH Attestation Form and attachments by mail,
fax, or email.
Mail to:
Alabama Medicaid Agency
Network Provider Assistance Unit
Attention: Travis Houser
501 Dexter Avenue
Montgomery, Alabama 36103-5624
Fax to 334-353-3856
E-mail to Travis.Houser@medicaid.alabama.gov AND Patricia.Toston@medicaid.alabama.gov
Where can a provider go for details regarding the ACHN program?
https://medicaid.alabama.gov/content/5.0_Managed_Care/5.1_ACHN/5.1.3_ACHN_Providers.aspx
For questions related to
the PCMH Attestation process for PCPs enrolled with the ACHN, contact Patricia
Toston via email at Patricia.Toston@medicaid.alabama.gov or Travis Houser at Travis.Houser@medicaid.alabama.gov.
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