Or. Admin. Code § 410-149-0120

Current through Register Vol. 63, No. 11, November 1, 2024

Section 410-149-0120 - CPC+ Practice Reimbursement and Program Integrity

(1) All funds received through the CPC+ demonstration shall be used to support the participating practice site.

(2) As a condition of payment, a participating CPC+ practice shall require and ensure that its participating providers and staff implement the care delivery requirements set forth in their Comprehensive Primary Care Agreement.

(3) Practices shall be entitled to care management fees for all attributed members that had a primary care visit in the prior 18 months from January 1, 2017, and any new attributed members with a primary care visit after January 1, 2017. Under the care management fees, no changes to FFS rates shall be made as additional compensation for services provided.

(4) No part of the care management fee, APM, or PBIPs may be used as an inducement for practices to promote or otherwise affect the provision of any health care item or service owned or distributed by the Authority.

(5) PBIP may be issued prospectively and reconciled to the practice's actual performance score once quality and utilization measurement data becomes available.

(6) Care management fees are provided for care management services and not healthcare service delivery and not subject to Oregon insurance laws and regulations on provider contracting and payment. Any healthcare services rendered by the provider shall be governed by the participating provider agreement between the provider and the Authority.

(7) The enrolled CPC+ practice must use aggregate payments received solely to support infrastructure and provide salary support in meeting the terms, conditions, and milestones of CPC+ as directed by CMS.

(8) If the practice fails to comply with the terms and conditions of the CPC+ demonstration, the Authority may seek reimbursement for any fees paid to the practice.

(9) The Authority shall give the practice prior notice that it has determined the practice was not making a good faith effort to comply with the terms and conditions of the CPC+ demonstration and allow the practice an opportunity to take corrective action, within 90 days of the notice send date, to avoid having to reimburse fees to the Authority.

Or. Admin. Code § 410-149-0120

DMAP 31-2017(Temp), f. 7-28-17, cert. ef. 8-1-17 thru 1-27-18; DMAP 5-2018, adopt filed 01/24/2018, effective 1/24/2018

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 413.042, 413.259 & 414.065