Specifically, PCPs qualify for one of four reimbursement tiers based on their capabilities – those who qualify for higher tiers receive higher care management fees. Care management fees range from $2.50 to $10 and vary based on the characteristics of the PCP’s practice and the patients attributed to the PCP. In the Healthy Connections program, primary care providers (PCPs) are paid on a fee-for-service basis, plus a per member per month (PMPM) care management fee. How Healthy Connections Value Care Operates The agency submitted a State Plan Amendment (SPA) in October 2019 to secure Centers for Medicare & Medicaid Services (CMS) approval of its new payment model, which awards payment to FQHCs and other providers based on how much they improve costs and quality of care provided to Medicaid enrollees. In 2017, the Medicaid agency began working to incorporate value-based payment into Healthy Connections. In 2016, Idaho Medicaid launched its Healthy Connections program, which blended the two initiatives. Idaho has operated a Medicaid Primary Care Case Management (PCCM) program since 1993 and has worked to advance patient-centered medical homes (PCMHs) since 2008, when the Governor’s Select Committee on Health Care recommended PCMH implementation as a priority. The agency plans to sign contracts to implement the model in January, with implementation beginning July 1, 2020.īoth FQHCs and other types of providers have expressed interest in participating in this value-based model. Starting in early 2020, Idaho will launch a new value-based payment model that will compensate federally qualified health centers (FQHCs) and other providers based on how much they improve the cost and quality of care delivered to Medicaid enrollees. Chronic Disease Prevention and Management.Primary Care/Patient-Centered/Health Home.Integrated for Pregnant/Parenting Women.
Healthy Child Development State Resource Center.Physical and Behavioral Health Integration.The RAISE Family Caregiver Resource and Dissemination Center.Children and Youth with Special Health Care Needs.
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