Medicare Demonstration/Payment

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)


More information on:

Requirements Overview
Denials
MAPCP Quarterly Reports
MAPCP Billing Instructions and Webinars
MAPCP Steering Committee

Updated Tuesday, April 08, 2014 at 04:23PM