TO: Participating Alabama Coordinated Health Network Primary Care Physician Groups
RE: Changes to Patient-Centered Medical Home (PCMH) Attestation Process
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.
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