CMS Posts Medicaid Other Payer Advanced APMs List and Eligible Clinician Initiated Submission Form

The Centers for Medicare & Medicaid Services (CMS) posted two new Advanced Alternative Payment Model (APM) resources related to other payer Advanced APMs.  The first is a list of six Medicaid payment arrangements that CMS determined are other payer Advanced APMs for the 2019 performance period.  These arrangements were selected from submissions by payers made earlier this year.

The second is the clinician initiated submission form, which eligible clinicians can use to request that CMS determine whether their Medicaid payment arrangements qualify as other payer Advanced APMs.  CMS will review payment arrangements to determine whether the arrangements meet the other payer Advanced APM criteria.

Under the Quality Payment Program (QPP), clinicians can use their other payer revenue in combination with traditional Medicare Advanced APM participation to qualify for the Advanced APM bonus.  CMS determines whether payment arrangements that plans or clinicians submit meet the criteria to be an other payer Advanced APM.


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459, or Mara McDermott at 202-204-1462,