NHPCO NewsLine Summer 2019 - 18

continued

set of clinical quality and patient
and caregiver engagement
measures to assess quality and
innovation in care delivery.

Primary Care First Regions
Building on the Comprehensive
Primary Care Plus (CPC+) model,
PCF will be offered in 18 states
(current CPC+ regions) and eight
new regions*.

Primary Care First Model
Options will be offered in 26
regions for a 2020 start date:
Alaska (statewide)*
Arkansas (statewide)
California (statewide)*
Colorado (statewide)
Delaware (statewide)*
Florida (statewide)*
Greater Buffalo region (NY)
Greater Kansas City region
(KS and MO)
Greater Philadelphia region (PA)
Hawaii (statewide)
Louisiana (statewide)
Maine (statewide)*
Massachusetts (statewide)*
Michigan (statewide)
Montana (statewide)
Nebraska (statewide)
New Hampshire (statewide)*
New Jersey (statewide)
North Dakota (statewide)
North Hudson-Capital region (NY)
Ohio and Northern Kentucky
region (statewide in OH, partial
state in KY)
Oklahoma (statewide)
Oregon (statewide)
Rhode Island (statewide)
Tennessee (statewide)
Virginia (statewide)*

18

Newsline / Summer 2019

The CMS Innovation Center has
created an online map showing
locations where CPC+ is being
tested. Visit the map on the CMS
website to search in your area.

PCF Model Options
There are three options to
accommodate providers that
specialize in care for different
populations:
Option 1: PCF
Payment Model

NP, PA) certified in internal
medicine, general medicine,
geriatric medicine, family medicine,
and hospice and palliative medicine.
Practitioners must be in good
standing with CMS and have a
minimum of 125 attributed
Medicare beneficiaries. The primary
care services (not yet defined)
must account for 70-80% of the
collective billing and demonstrate
prior experience with innovation in

Option 2: PCF High
Needs Populations
Payment Model

* Focused on advanced * Promotes care for
primary care practices
high need, seriously
ready to assume
ill population (SIP)
financial risk in
beneficiaries who
exchange for reduced
lack a primary care
administrative burden
practitioner and/or
and performance
effective care
-based payments.
coordination.

Option 3: Participation
in both options 1 and 2
* Allows practices to
participate in both
PCF Payment Model
and the PCF High
Need Population
Payment Model.

* Introduces new
higher payment for
practices caring for
complex, chronically
ill patients.

Eligibility
Option 1:
The Primary Care First (PCF)
Payment Model is designed for
primary care practices with
advanced primary care capabilities
that are prepared to accept
increased financial risk in exchange
for flexibility and potential rewards
based on practice performance.
The practice must include primary
care practitioners (MD, DO, CNS,

care delivery and value-based
payment arrangements. The
practice must also use the 2015
Certified Electronic Health Record
Technology (CEHRT) and must
meet a minimum a set of advanced
primary care delivery capabilities
including 24/7 access to a
practitioner or nurse call line.
CMS will attribute Seriously Ill
Population (SIP) patients lacking
a primary care practitioner or
https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus/ https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus/
NHPCO NewsLine Summer 2019

Table of Contents for the Digital Edition of NHPCO NewsLine Summer 2019
