Enhanced Primary Care Program and Clarification about ACC patients and Denver Health

“Enhanced Primary Care Program Details Released by Medicaid: Effective July 1, 2014, Medicaid and the Regional Care Collaborative Organizations (RCCOs), will recognize and reimburse Primary Care Medical Providers (PCMPs) who offer services beyond the traditional fee-for-service primary care model of care. This initiative has been developed to help achieve the overall goals of the Accountable Care Collaborative and is designed to provide incentives for quality improvement. Providers who meet five of the nine following factors will be eligible for an additional payment of $0.50 per member per month (PMPM). This will be a lump sum payment made annually. Click here for additional incentive payment details. Click here for a checklist and examples of each of these 9 factors and how to document completion. Click here for detailed descriptions of how the nine factors will be measured by the RCCOs.

Important Clarification about ACC patients and Denver Health: There is a misunderstanding among the provider community in regards to Accountable Care Collaborative (ACC) patients and Denver Health. Please note: ACC members attributed to Denver Health can be seen by any Medicaid provider and the claim will be paid. Only patients who are enrolled in Denver Health HMO (Managed Choice) must be seen by Denver Health providers unless referral authorization has been received from Denver Health. See these mock eligibility screens for an example of each scenario: Denver Health ACC patient & Denver Health HMO patient. Any questions, please contact Marty.Janssen@state.co.us.” [Source: CCHAP Practice Manager Newsletter]