CMS Releases Medicaid APM Certification Process for the Advanced APM Track of the QPP

CMS recently announced the process for Medicaid Alternative Payment models (APMs) to be certified as Other Payer Advanced APMs under Medicare’s Quality Payment Program (QPP). Under the Advanced APM track of the QPP, eligible clinicians who meet either payment or patient thresholds will be eligible for payment incentives. While currently only participation in Medicare Advanced APMs contribute to meeting the Advanced APM thresholds, beginning in 2019 participation in a combination of Medicare Advanced APMs and Other Payer Advanced will apply.

Managed care organizations (MCOs) that want to submit models for certification as Other Payer Advanced APMs must do so through the state Medicaid agency. CMS created a document to assist states in collecting information from MCOs for this process. Other relevant resources on the QPP website include:

  • Medicare health plans fact sheet is available here.
  • CMS Multi-payer Models fact sheet is available here.
  • Guide to Submitting Medicaid Requests for Other Payer Advanced APM Determinations is available here.

For more information on the Quality Payment Program (QPP) visit the McDermottPlus MACRA Resource Center or contact Sheila Madhani at 202-204-1459, smadhani@mcdermottplus.com.