CMS Accepting Applications for New Primary Care Payment Model
October 30, 2023
The Centers for Medicare and Medicaid Services (CMS) is accepting applications through December 14, 2023, for new voluntary payment and delivery model — Making Care Primary (MCP). Eligibility requirements and additional details can be found in the request for applications.
The model, which will run 10.5 years, will be launched on July 1, 2024 and will be tested in eight states: Colorado, Massachusetts, Minnesota, New Mexico, New Jersey, North Carolina and certain counties in New York.
The MCP Model will provide a pathway for primary care clinicians with varying levels of experience in value-based care to gradually adopt prospective, population-based payments while building infrastructure to improve behavioral health and specialty integration and drive equitable access to care.
To be eligible to apply to participate in the MCP Model, an organization must:
- Be a legal entity formed under applicable state, federal, or Tribal law, that is authorized to conduct business in each state in which it operates;
- Be Medicare-enrolled;
- Serve as the regular source of primary care for a minimum of 125 attributed Medicare beneficiaries; and
- Have the majority (at least 51%) of their primary care site(s) (physical locations where care is delivered) located in one of the eight states seated by CMS for the program.
Applicants must also:
- Bill Medicare for services furnished by primary care clinicians (MD, DO, CNS, NP, PA) who provide primary care services, including those in internal medicine.
- Have primary care services account for at least 40 percent of the applicant’s collective Medicare revenue for the list of primary care clinicians employed by the applicant.
The MCP Model has three progressive tracks:
- Track 1 – Building Infrastructure: Participants will begin to develop the foundation for implementing advanced primary care services such as risk-stratifying their population, reviewing data, building out workflows, identifying staff for chronic disease management, and conducting health-related social needs screening and referral. Payment for primary care will remain fee-for-service (FFS). Participants can begin earning financial rewards for improving patient health outcomes in this track. Participants will receive start-up upfront infrastructure payments in two lump sums—an initial $72,500 will be partially distributed as a lump sum at the start of the model, and the remaining $72,500 will be paid as a lump sum one year later.
- Track 2 – Implementing Advanced Primary Care: This track builds upon the Track 1 requirements by partnering with social service providers and specialists, implementing care management services, and systematically screening for behavioral health conditions. Payment for primary care will shift to a 50/50 blend of prospective, population-based payments and FFS payments. CMS will continue to provide additional financial support at a lower level than Track 1, as participants continue to build advanced care delivery capabilities. Participants will be able to earn increased financial rewards for improving patient health outcomes.
- Track 3 – Optimizing Care and Partnerships: In Track 3, participants will use quality improvement frameworks to optimize and improve workflows, address silos to improve care integration, develop social services and specialty care partnerships, and deepen connections to community resources. Payment for primary care will shift to fully prospective, population-based payment while CMS will continue to provide additional financial support. Participants have the opportunity to earn greater financial rewards for improving patient health outcomes.
Want to Learn More?
CMS has made a variety of resources available about the program and how to apply. ACOI members interested in exploring this opportunity to participate in a value-based care delivery arrangement are encouraged to review the resources to determine whether the MCP Model may be a good fit.