[Provider] Follow-up to Announcement of Communithy Based Care Management Demonstration Project

[Provider Notification]

ATTENTION:            MaineCare Physician Hospital Organizations (PHO),
Federally Qualified Health Centers (FQHC), Physician Practices and other
Clinical Enterprises not associated with a PHO or FQHC caring for
MaineCare members

The following questions have been received from potential applicants for
the Community Based Care Management Demonstration Project.  If
additional questions are received prior to June 6th an updated Q&A will
be released.  

1.         What is the financial reimbursement for the high-risk care
management program from Schaller Anderson?

Financial reimbursement will be negotiated with each of the three
selected demonstration sites relative to methodology of payment. For
example, one group could choose to be paid a PMPM (per member per month)
rate, another a flat monthly fee, or a demonstration site could choose
to subcontract with Schaller Anderson for their staffing needs which
would impact the amount of dollars paid. Using Schaller Anderson's work
drivers and staffing models for a community based care management
program, consideration for reimbursement will be based on the number of
members assigned to the demonstration site as well as their risk
stratification. Payment discussion will occur with each selected
demonstration site during the contracting phase. 

2.         Will the sites reimbursed similar to the North Carolina
Model?

No. The powerpoint slides provided to potential applicants contained
information on the North Carolina model. This was for the purposes of
understanding how North Carolina implemented their model of community
based care management. Providers will continue to be reimbursed
according to MaineCare payment methodology, and in addition, they will
receive a payment from Schaller Anderson for the high risk care
management (as described in the answer to question 1).

 

This is a one-way communication.  Please do not respond to this message.

 

 

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