Alerts

Changes to Patient-Centered Medical Home (PCMH) Attestation Process

1/19/2021


Alabama Medicaid Primary Care Physician (PCP) Groups actively participating with an Alabama Coordinated Health Network (ACHN) may be eligible to receive a share of the quarterly Patient-Centered Medical Home (PCMH) Bonus Payment. The total PCMH Bonus is 5% of the entire annual ACHN bonus pool of $15 million dollars. The PCMH Bonus will be based on actual achievement of or progress towards achievement of PCMH Certification through a nationally recognized entity such as the National Committee for Quality Assurance (NCQA), the Joint Commission, or the Compliance Team, among others. Attestation for this certification must be received annually by the Agency no later than October 1st to ensure eligibility for the PCMH Bonus for the upcoming fiscal year. 

 

Note: The PCMH Bonus is optional. PCP Groups may still be eligible to receive the quality and cost effectiveness bonus payments if they chose not to participate in the PCMH attestation process.

 

The Alabama Medicaid Agency made the following changes to the PCMH Bonus attestation process:

 

1.    Beginning Fiscal Year 2021, PCMH Bonus Payments will be paid to PCP Groups who have achieved or are working towards achieving PCMH Certification from a nationally recognized certifying entity (e.g. NCQA, the Joint Commission, the Compliance Team, etc.).

 

2.    ALL PCP Groups interested in receiving the PCMH Bonus Payment must attest to the Agency. This includes PCP Groups who have achieved or made progress towards PCMH Certification through NCQA.

 

3.    Attestation must be received annually by the Agency no later than October 1st. The attestation will be valid for one year.

 

4.    PCP Groups can begin submitting their attestation for FY 2022 now. 

 

PCP Groups that have not received PCMH Recognition but have made adequate progress towards PCMH Recognition may be eligible to receive the PCMH Bonus. PCP Groups that have made adequate progress must complete and submit the PCMH Attestation Form and supporting documentation showing adequate progress with their certifying entity. Refer to Chapter 40, Section 40.20 of the most current version of the Alabama Medicaid Provider Billing Manual for definitions of adequate progress for each certifying entity.

 

You may access the Provider Manual with the following link: https://medicaid.alabama.gov/content/Gated/7.6.1G_Provider_Manuals.aspx

 

To be eligible for the PCMH Bonus, PCP Groups should adhere to the following protocol:

 

1.    Obtain PCMH Recognition or make adequate progress. PCMH Recognition is a separate process from attestation. PCP Groups must contact the national certifying entity from which they wish to receive recognition and make progress or complete the PCMH Certification process. The Agency cannot assist with the PCMH Certification process nor recommend a certifying entity to PCP Groups.


Note: It is imperative that PCP Groups begin the PCMH Certification process with their certifying entity as soon as possible to avoid tardy attestation to the Medicaid Agency. The Agency will not accept attestations after the October 1st deadline.

 

2.    Attest to the Medicaid Agency. After receiving PCMH Certification or making adequate progress from the national certifying entity, the PCP Group must attest (via PCMH Attestation Form) to the Agency no later than October 1st to receive PCMH Bonus eligibility for the upcoming fiscal year (e.g. to receive PCMH Bonus eligibility for FY 2022, the attestation form and supporting documentation must be received by October 1, 2021). The Agency will not accept attestations after the October 1st deadline.

 

3.    Receive notification. PCP Groups who attest to the Agency will be notified of their PCMH Bonus eligibility status via mail and/or e-mail.

 

4.    Remember to attest every year. PCP Groups that wish to continue to receive the PCMH Bonus must attest annually no later than October 1st. 

 


For questions related to the PCMH attestation process, e-mail ACHN@medicaid.alabama.gov.