Please specify which provider types (e.g. specialists, primary care physicians, Multi, Checkboxes. 1: PCPs, etc.) assume financial risk (if any) in the program. 2: Specialists (detail), 3: Provider group, 4: Hospitals, 5: Joint physician/hospital ACO, 6: N/A If provider types list above are not applicable, explain financial risk. 200 words. 9.4.12.9.8 Indicate if the following alternative payment model is included in the program specified above: Bundled Payment/ Episode-Based Payment Response Program includes bundled payment. Single, Pull-down list. 1: Yes, 2: No Please list for which clinical conditions or episodes of care the program Unlimited. makes bundled payments to providers and then respond to the questions below for each of the clinical conditions or episodes of care listed. What health care services related to the condition or episode of care are Unlimited. not covered by the bundled payment? Identify the characteristics of the bundled payment program. Multi, Checkboxes. 1: Cost for complications, readmissions, or other such related services included, 2: Bundled payment amount is set below the estimated FFS cost for the same services., 3: Payment amount risk-adjusted, 4: None of the above, 5: Other (explain) Is there an expressed warranty period (e.g. 90 day period within which all 100 words. complications are addressed)? If yes, indicate pre- and post-period; if no N/A OK. indicate N/A If the program pay providers prospectively, please describe the trigger 100 words. event. N/A OK. If the program reconciles the bundled payment retrospectively, please 100 words. describe how the program pays providers during the course of care (e.g. N/A OK. FFS, capitation) and the reconciliation process.
Please specify which provider types (e.g. specialists, primary care physicians, etc.) assume financial risk (if any) in the program. Multi, Checkboxes. 1: PCPs, 2: Specialists (detail), 3: Provider group, 4: Hospitals, 5: Joint physician/hospital ACO, 6: N/A If provider types list above are not applicable, explain financial risk. 200 words. 9.4.12.9.8 Indicate if the following alternative payment model is included in the program specified above: Bundled Payment/ Episode-Based Payment Response Program includes bundled payment. Single, Pull-down list. 1: Yes, 2: No Please list for which clinical conditions or episodes of care the program makes bundled payments to providers and then respond to the questions below for each of the clinical conditions or episodes of care listed. Unlimited. What health care services related to the condition or episode of care are not covered by the bundled payment? Unlimited. Identify the characteristics of the bundled payment program. Multi, Checkboxes. 1: Cost for complications, readmissions, or other such related services included, 2: Bundled payment amount is set below the estimated FFS cost for the same services., 3: Payment amount risk-adjusted, 4: None of the above, 5: Other (explain) Is there an expressed warranty period (e.g. 90 day period within which all complications are addressed)? If yes, indicate pre- and post-period; if no indicate N/A 100 words. N/A OK. If the program pay providers prospectively, please describe the trigger event. 100 words. N/A OK. If the program reconciles the bundled payment retrospectively, please describe how the program pays providers during the course of care (e.g. FFS, capitation) and the reconciliation process. 100 words. N/A OK.
Qualified%20Health%20Plan%20Certification%20Application%20Fourth%20Quarter%202017%20Smal....docx