Medicaid Payment Incentives
Additional Medicaid funds for recognized clinics
Recognized primary care homes are eligible for supplemental Medicaid payments to support the care they provide their Medicaid patients with certain chronic conditions. These payments are for the enhanced services that patients receive at primary care homes that help them better manage their health. Please note that participation in these payment incentives is optional. These payments are available through September 2013.
To find out more about the Medicaid incentive payments currently available, please carefully read the Supplemental Payment Options Packet NOTE: This document was updated on 5/1/2013.
Secure Web Portal for Medicaid PCPCH Patient List Submission
On January 1, 2013, the Oregon Health Authority launched a new secure web portal to process Medicaid PCPCH payments
We are pleased to announce that starting January 1, 2013 a new secure web portal is available to allow recognized primary care homes, Coordinated Care Organizations, and managed care plans to easily manage and make changes to their roster of Oregon Health Plan patients assigned to recognized clinics for PCPCH payments. This allows OHA to pay recognized primary care homes prospectively for the care they provide these patients.
Provider Notice- Important Updates 4/5/13
Provider Notice – Revised Patient List Template effective 3/1/13
Medicaid PCPCH Revised Patient List Template effective 3/1/13
Updated Provider Notice 01/24/13
Medicaid PCPCH Web Portal Guide
How to Use the Medicaid PCPCH Web Portal:
January 3, 2013 Web Portal Orientation Webinar:
Reminder About Web Portal Pins Requirements
If you will be utilizing the Medicaid PCPCH web portal, please contact your MMIS administrator to assign specific security roles to staff that will access the portal. If you need assistance in obtaining or resetting PINs, please contact Amy McMahan at (503) 945-6590.
Patient Lists: New Template & Formatting Requirements Effective 3/1/13
To ensure your Medicaid PCPCH payments are processed efficiently and accurately, new formatting and template requirements for patient lists have been established. Beginning immediately, please submit all patient lists according to the following specifications and formatting requirements below. Delays may occur for patient lists submitted in alternate formats.
New Template & Formatting Requirements
Last Updated 2/19/13
- Save the patient list as a “.csv (comma delimited)” file type before sending
- Do not add columns to the template for additional information
- Do not add a header or footer to the file
- All Client IDs must be capitalized, have 8 characters and have no special characters
- All input values that are dates must be formatted as a date and have a 4 digit year
(Ex. 01/01/2013 or 1/1/2013)
- Under "ACA Qualified", enter a capital "Y" or "N". Please do not leave blank
- The file name can only include letters, numbers, underscores and be no more than 50 characters
- Use a space for hyphenated patients names, do not use a dash
- For DMAP/Medicaid IDs that begin with a '0' (Ex. 011223, 009911) format the column "DMAP ID" as text and put an apostrophe in front of the number.
Deadlines for Retrospective Patient List Submissions
To ensure that retrospective patient lists for periods between October 2011 and December 2012 are processed in a timelier manner, new deadlines have been set beginning January 15, 2013. Please note that primary care homes are eligible for payments beginning on their effective date of PCPCH recognition.
These deadlines are designed to improve DMAP’s response time so that we can process lists and issue payments in a timelier manner. We will process the lists on a first come, first served basis and we encourage primary care homes to submit their lists as soon as possible and not wait for the deadlines.
Please note that we will be unable to process payments past the below deadlines. We apologize for any inconvenience.
|Period for patient lists /
core service provision
|10/1/11 to 12/31/11
|1/1/2012 to 3/31/12
||April 15, 2013|
|4/1/12 to 6/30/12
||June 15, 2013|
|7/1/12 to 12/31/12
||September 15, 2013|
Service and Documentation Requirements
Recognized primary care homes are eligible to receive the Medicaid PCPCH payment incentives only if the service and documentation requirements are met. Please see below for an overview of the requirements. Service documentation is subject to auditing by the OHA and CMS. Clinics could perform chart reviews to confirm that an activity took place or produce electronic reports if audited.
Quarterly Core Service - Each eligible “ACA-Qualified” patient for a given quarter must receive at least one of the six core services, documented in the patient’s medical record:
· Care coordination
· Health promotion
· Comprehensive transitional care
· Comprehensive care management
· Individual and family support services
· Referral to community and social support services
Quarterly Panel Management Activities – Recognized primary care homes must have one team member log on to the provider panel management portal at least quarterly. Once logged on, clinics will have the opportunity to track quality measures through the portal and use as a panel management tool if desired.
If a clinic has their own information technology system for panel management purposes, they can submit a request to DMAP.PCPCH@state.or.us to utilize this as an alternative. Clinics must have the ability to retain documentation that they have utilized their own panel management system on at least a quarterly basis. In the request, please include at least one example of a specific quality measure tracked through your system, the process for providers to access this information, and examples of ways the information is used to provide proactive outreach and population management.
Patient education, engagement, and agreement to participate – Recognized primary care homes must perform patient engagement, education, and obtain their agreement to participate in the Patient-Centered Primary Care Home Program. This must be documented in each patients’ medical record within six months of initial participation. The six month timeframe to complete this requirement begins after a clinic has submitted their patient list and DMAP has successfully assigned a patient to your clinic. Patient education can be done over the phone, in-person, or by mailing a letter or brochure. Patient engagement and agreement to participate must be active, no passive opt-outs, and can be completed verbally via phone or in-person. If a patient declines to participate or the clinic is unable to obtain agreement after 6 months of attempts, the clinic should notify DMAP and not include that patient on future patient list submissions.
Person-centered plan – Recognized primary care homes must work with each patient to develop a person-centered plan within six months of initial participation and revise as needed. The six month timeframe to complete this requirement begins after a clinic has submitted their patient list and DMAP has successfully assigned a patient to your clinic. The plan must include self-management, preventive and chronic illness care goals, action plans for exacerbations of chronic illness, and end-of-life plans when appropriate. If a clinic is unable to establish the plan within 6 months, the clinic should note a preliminary plan in the patients’ medical record and a strategy to engage the patient to develop the full plan. For helpful information on developing care plans, please watch the Patient-Centered Primary Care Institute’s webinar, “Care Plans – Best Practices for Development and Implementation.”
Resources for Medicaid payment incentives:
Provider Panel Management Portal
Recognized clinics that choose to participate in the payment program for Medicaid patients must have one team member log on to the provider portal at least quarterly. Clinics will then have the opportunity to track quality measures through the portal and use as a panel management tool if desired. The provider portal is part of Quality Corp's reports available to providers in Oregon.
If you have not used Quality Corp's provider portal before, you will need to complete the registration process.
If your clinic has already registered for Quality Corp's provider portal, please sign in to the portal.
Questions? We can help.
For questions about the Medicaid PCPCH payments, please email DMAP.PCPCH@state.or.us.