HHS Announces New Affordable Care Act Demonstration Project

June 27, 2011, 01:59 PM

The Department of Health and Human Services announced a new demonstration project on June 6, 2011 that will test the effectiveness of doctors and other health professionals working in teams to improve care for up to 195,000 Medicare beneficiaries. The Federally Qualified Health Center (FQHC) Advanced Primary Care Practice demonstration project will pay an estimated $42 million over three years to up to 500 FQHCs to coordinate care for Medicare patients. According to Administrator Dr. Mary Wakefield, by improving coordination between providers the FQHCs in this project can increase access to important primary care services and thus reduce the need for costly hospitalizations or emergency department visits. The eligibility requirements for FQHCs are:

  • FQHCs must have provided primary care medical services to at least 200 eligible Medicare beneficiaries in the most recent 12-month look-back period. This can include those with both Medicare and Medicaid coverage.
  • All participating FQHCs must be listed in the Provider Enrollment Chain and Ownership System (PECOS) and be able to receive electronic funds transfer (EFT). FQHCs that have not recently submitted a Form 855A are not listed in PECOS and, therefore, will not be eligible to participate in the demonstration.
  • FQHCs that currently do not receive claims payment through EFT must submit the necessary form to receive EFT.
  • FQHCs must submit claims for payment to National Government Services or to Noridian Administrative Servicesthe jurisdiction 3 Medicare Administrative Contractor (MAC).

Participating FQHCs will receive a monthly care management fee of $6.00 for each eligible Medicare beneficiary attributed to their practice. This fee is intended to help defray the cost of transformation into a patient-centered, coordinated, and seamless primary care practice. The fee, which will be paid quarterly, will be in addition to the usual all-inclusive payment FQHCs receive for providing Medicare covered services. Applications for the project will be accepted from June 6, 2011 through August 12, 2011, and the demonstration will be conducted September 1, 2011 through August 31, 2014. —Christopher L. McLean