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Implementation of the Award for the National Provider Enrollment (Medicare and Medicaid) Eastern Region (NPEAST) and Western Region (NPWEST) Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Enrollment Contractors

The purpose of this Change Request (CR) is to adjust claims processing Flat Visit Fee (FVF) payments made for certain primary care services rendered by practices participating in Track 3 of the Maryland Primary Care Program (MDPCP), a component of the Maryland Total Cost of Care Model.

The new Track 3, which the MDPCP will add in 2023, is open to nonhospital-based primary care practices and their partner Care Transformation Organizations (CTOs), if any. Federally Qualifying Health Centers (FQHCs) cannot participate in Track 3. These Track 3 participants will receive a combination of claims and non-claims-based payments based on their attributed Medicare fee-for-service (FFS) beneficiaries. With fewer reporting requirements, Track 3 practices will have the flexibility to implement their own strategies that best target outcomes.

Participants in the MDPCP are primary care practices within the state of Maryland. A primary care practice may include one or more physicians, as well as non-physician providers such as nurse practitioners. Every participating practice will be given a unique practice ID by the CMS implementation support contractor. Providers in a practice will be uniquely defined by the combination of each provider’s tax ID number (TIN) and national provider identifier (NPI).

Track 3 will begin operation on January 1, 2023. Current and new MDPCP participants will have the option to participate in Track 3 from that date through December 31, 2026. CMS will create a provider file that lists all participating providers and the effective and termination dates of their participation in MDPCP Track 3. A given provider (as defined by the combination of TIN and NPI) may only be active in one MDPCP practice at a time. Providers within a practice may have different effective and termination dates (e.g., as they are hired or leave the practice), but the practice itself will have its own effective and termination date for participation in the model. CMS will also create a beneficiary file detailing all attributed (which is also referred to as aligned) Medicare FFS beneficiaries to participants in MDPCP Track 3.

Participants in Track 3 receive a prospective, population-based payment (PBP), paid quarterly; a Flat Visit Fee (FVF) paid at the time of service for certain primary care services; and a Performance-Based Adjustment (PBA) applied to the PBP and FVF that is based on performance on certain quality, utilization, and efficiency measures. The PBP and PBA shall be processed outside the fee for service claims processing system and are not addressed in this CR.

This CR implements the claims process adjustments for the FVF payments made for certain primary care services rendered by practices participating in MDPCP Track 3 to attributed beneficiaries and addresses prohibited HCPCS codes.

Download the Guidance Document


Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: December 09, 2022

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.

This is archived HHS content.