May 29, 2018
The Centers for Medicare & Medicaid Services (CMS) announced that it is opening the advanced alternative payment model (APM) module for Medicare Advantage (MA) plans. The module will allow Medicare plans to request that their payment arrangements receive what is referred to as an Other Payer Advanced APM determination as part of the Quality Payment Program (QPP). Through the submission process, plans submit information to CMS regarding plan contracts with providers. The module is currently available in the Health Plan Management System (login required).
Under the Medicare Access and CHIP Reauthorization Act (MACRA), beginning in the 2019 performance year, eligible clinicians may use their other payer risk contracts in combination with participation in an advanced APM in traditional Medicare to qualify for the five percent bonus under the advanced APM track. Additional information on the QPP is available here.
CMS also released a guide to assist plans in the submission process. The guide details the process for plans to submit information to CMS demonstrating that the payment arrangement meets the criteria to qualify as an advanced APM: (1) requiring at least 50 percent of eligible clinicians in each participating APM entity group to use certified electronic health records technology (CEHRT) to document and communicate clinical care information; (2) basing payments for covered professional services on quality measures comparable to those used in the merit-based incentive payment system (MIPS); and (3) requiring participants to bear more than nominal financial risk.