Alternative Payment Models (APMs) Overview - QPP

Alternative Payment Models (APMs) Overview - QPP

Available Now: Medicaid Other Payer Advanced APMs List and the Eligible Clinician Initiated Submission Form

View New Other Payer Advanced APM Resources

The Centers for Medicare & Medicaid Services (CMS) CMS has posted two new resources related to Other Payer Advanced Alternative Payment Models (APMs) on the Quality Payment Program Website. These resources are also available on the Quality Payment Program resource library.

• Medicaid Other Payer Advanced APMs in the Quality Payment Program for Performance Year 2019 –  Provides a list of Medicaid payment arrangements that CMS has determined to be Other Payer Advanced APMs for the calendar year 2019 QP performance period based on submissions from payers made earlier this year through the Payer Initiated Process.
  
  Under Quality Payment Program’s All-Payer Combination Option, State Medicaid Agencies, Medicare Advantage and other Medicare Health Plans, as well as commercial and private payers participating in CMS-sponsored Multi-Payer payment arrangements (CMS Multi-Payer Models), may submit information to CMS about their payment arrangements with eligible clinicians. CMS will determine whether each submitted payment arrangement constitutes as an Other Payer Advanced APM for a given performance year.
   
• The Eligible Clinician Initiated Submission Form – Eligible clinicians can use this form to request that CMS determine whether their payment arrangements qualify as Other Payer Advanced APMs under the Quality Payment Program. CMS will review the payment arrangement information in this form to determine whether the payment arrangement meets the Other Payer APM criteria.

Note: Eligible clinicians should review the list of determined Medicaid Other Payer Advanced APMs before opting to complete the Eligible Clinician Initiated Submission Form.

For More Information

• Visit the Quality Payment Program Website
• Contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292/TTY: 1-877-715-6222.