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Health Care Homes (aka Medical Homes) - Medicare Demonstration/Payment

Medicare Payment for Health Care Home Services Set to Begin in October
Through Minnesota's participation in the Medicare Multi-payer Advanced Primary Care Practice (MAPCP) demonstration, certified health care homes will be reimbursed for care coordination services provided to fee-for-service Medicare beneficiaries beginning 10/1/11. Health care home payment rates for Medicare have been approved by the federal Office of Management and Budget (OMB) [PDF: 284KB/2 pages], clearing the final hurdle before the demonstration can be launched. Implementation planning is well underway to equip Minnesota's contracted Medicare Part B carrier to process health care home claims. Detailed Medicare billing instructions for providers will be made available soon. Please visit the Minnesota Department of Health's health care home web site for the most up-to-date information. Certified Health Care Homes who wish to participate in the MAPCP demonstration and have not already notified MDH should contact MDH at health.healthcarehomes@state.mn.us or call 651-201-5421.

On this page:

Background

Minnesota has been selected by the Centers for Medicare and Medicaid Services (CMS) to be one of eight states participating in the Medicare Multi-payer Advanced Primary Care Practice (MAPCP) demonstration project. This demonstration will add Medicare to Minnesota's existing multi-payer health care home initiative as a payer for certified health care homes.

The Minnesota Departments of Health and Human Services jointly applied for the demonstration project, with guidance from a wide array of stakeholders. The demonstration is slated to begin in 2011 and last for three years.

Quick facts

  • Providers must be certified health care homes in order to participate in the demonstration.
  • All certified health care homes may participate in the demonstration; there is not a separate application process to participate.
  • The demonstration is not a grant to the state; funds from Medicare will go directly to health care homes through the services they provide and bill for.
  • CMS will be using Minnesota's payment methodology for care coordination reimbursements for qualifying Medicare beneficiaries.
  • The billing mechanism will be the same one that certified health care homes currently use to bill for services provided to Minnesota Health Care Program enrollees.
  • The demonstration covers fee-for-service Medicare beneficiaries.
  • The state anticipates that more than 225,000 Medicare beneficiaries will be served by a certified health care home during the demonstration period.
  • This demonstration is particularly important to clinics and clinicians in rural Minnesota with large proportions of Medicare patients.
  • The demonstration is a big step toward achieving critical mass in the state's goal of transforming primary care through health care homes.

CMS fact sheet on the demonstration (PDF)

CMS Q & A on the demonstration (PDF)

State of Minnesota's application for the demonstration (PDF: 4.1MB/70 pages)

FAQ's - Medicare Reimbursement for Minnesota Health Care Homes: The Multi-payer Advanced Primary Care Practice (MAPCP) Demonstrations (PDF: 243KB/7 pages)

MAPCP Demonstration State: Minnesota

Medicare Billing Instructions

For detailed billing instructions please see these documents:

Medicare's MAPCP Demonstration Project Billing Webinars

Who should attend?
If you have been certified as a Health Care Home you can start billing Medicare Fee For Service for Monthly Care Coordination Claims covered under the demonstration project.

This webinar is for newly certified clinics or certified clinics already billing who need a refresher or who have new staff

What is this about?
This is a voluntary webinar that is offered about every two months. It covers the same material each time however, there is time at the end for questions and collaborative troubleshooting. Please feel free to attend as often as needed so you can completely understanding the billing process.

Agenda

  • Who is eligible for payment under the demonstration?
  • How to update provider information including Medicare numbers
  • The claims submission process
  • The MDH Provider File
  • Common claim denial reasons
  • Sharing your Experience and Suggestions

To register for an upcoming Webinar please select the date of the session you would like to attend.

2013 Webinars

February 12, 2013 12-1:00 p.m.
April 9, 2013 - Canceled 12-1:00 p.m.
June 11, 2013 12-1:00 p.m.
August 13, 2013 12-1:00 p.m.
October 8, 2013 12-1:00 p.m.
December 10, 2013 12-1:00 p.m.

MAPCP Webinar Materials

A link to the recorded version of the webinar is available by request.

If you have questions please contact us at health.healthcarehomes@state.mn.us or 651-201-5421.

MAPCP Steering Committee

The workgroup is advisory to the Medicare Advanced Primary Care Demonstration project. The workgroup provides:

  • Direction and advice in development of the RFP.
  • Ongoing support, participation and advice in the ongoing implementation of the demonstration project.
  • Participates and leads other workgroup initiatives to implement new strategies identified by the workgroup.
  • Reviews and advises on policy, evaluation materials, results and does problem solving as needed.

MAPCP Steering Committee Participants (PDF: 28KB/1 page)

Group members will participate for three years of the demonstration and meetings will be held quarterly.

2013 meetings

Time: 1:00 p.m. - 3:00 p.m.

Dates: Location:
January 18, 2013 SOP Minnesota Room
March 8, 2013 - CANCELLED SOP Minnesota Room
June 14, 2013 Location TBD
September 20, 2013 Location TBD
December 13, 2013 Location TBD

Minnesota Department of Health's Snelling Office Park (SOP) location:

Minnesota Department of Health
Snelling Office Park
1645 Energy Park Drive
Saint Paul, MN 55108
Google map

2012 meetings

  • April 6, 2012 - NEW DATE*
  • June 15, 2012
  • September 21, 2012
  • December 14, 2012
 1:00-2:30 p.m.
1:00-3:00 p.m.
1:00-3:00 p.m.
CANCELED
 Red River Room
Bigfork Room
Red River Room

* new date - rescheduled from March 16, 2012

2011 meetings

Updated Monday, 08-Apr-2013 09:05:38 CDT