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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.

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)

Medicare Billing Instructions

For detailed billing instructions please see these documents:

If you have questions please contact Dean Ewald at the Minnesota Department of Human Services (DHS) (dean.ewald@state.mn.us; 651-431-3009).

MAPCP Workgroup

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.

View MAPCP Workgroup Participants (PDF: 17KB/2 pages)

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

All meetings will take place at the Minnesota Department of Health's Snelling Office Park 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.
1:00-3:00 p.m.
 Red River Room
Bigfork Room
Red River Room
Red River Room

* new date - rescheduled from March 16, 2012

2011 meetings

Updated Thursday, 17-May-2012 15:00:25 CDT