Carrying forward the special status designated upon it in the landmark SGR-repeal legislation from last year, the patient-centered medical home (PCMH) emerges again as a key model that qualifies for payment and scoring incentives despite relaxed cost-sharing requirements.
For example, "Under the statute, medical home models that have been expanded under the Innovation Center authority qualify as advanced [alternative payment models (APMs)] regardless of whether they meet the financial risk criteria," states
a fact sheet that CMS issued about the proposed rule. Participation in an advanced APM exempts providers from MIPS reporting.
The proposed rule contains what appear to be straightforward guidelines for achieving CMS-designated medical home status: A practice "is certified as a [PCMH]" if it achieves medical home accreditation from one of four accrediting bodies; if it's a Medicaid medical home model; or, for specialty practices, if it achieves specialty-specific accreditation from NCQA.
"No other criteria are required for receiving recognition as a certified patient patient-centered medical home or comparable specialty practice except for being recognized by one of the [accrediting organizations]," states the rule.
PCHM bonus: Qualifies as APM, excused from MIPS
Because the PCMH qualifies as an advanced APM, providers operating within a medical home will be eligible for a 5% payment boost in 2019. All advanced APMs, including the PCMH, also are excused from participating in MIPS -- but if you want to participate in MIPS, the PCMH offers additional incentives.
CMS proposes that medical homes will automatically achieve the "highest performance score" possible for the new addition -- the clinical practice improvement activity (CPIA) category -- of the MIPS quality-reporting program.
CMS statest in the proposed rule that "MIPS eligible clinicians who are in a practice that is certified as a patient-centered medical home or comparable specialty practice ... shall be given the highest potential score for the CPIA performance category."
In fact, the entire CPIA category and related performance score "is based on activities that align with the patient-centered medical home," according to the proposed rule.