Unlisted Preventive Service Initial Preventive Physical Exam G0402 Annual Wellness Visit G0438, G0439 90460, 90461, Immunization Administration Vaccine Flu Vaccine Administration G0008 Administration Pneumonia Vaccine G0009 Administration Care Transitional Care Management 99495, 99496 Management 99487, 99489, CCM Codes Chronic Care Management G0506 59400, 59510, 59610, Routine Obstetric Care 59618 OB/GYN Evaluation & Management 99460 99465 – Services Nursing 99304 99310, 99315 – – Nursing Facility Care Facility 99316, 99318 Home Services New/Established Patient Care 99341 99350 – Domiciliary/ 99324 99328, 99334 – – Rest Home/ New/Established Patient Care 99337 Custodial Care Denominator: Total ACO expenditures by payer. Section 2. Non-Claims-Based Spending Numerator: payments to primary care providers and practices within the ACO, by payer, including: Capitation payments Payments for PCMH recognition (ex. percent of extended Blueprint funding to PCMH practices) Payments to reward achievement of quality or cost-savings goals (ex. percent of VBIF allocated to primary care) Payments aimed at developing capacity to improve care for a defined population of patients, such as patients with chronic conditions (ex: pilot program for comprehensive payment to primary care practices) Payments to help providers adopt HIT Payments or expenses for supplemental or activities, such as practice coaches, patient educators, patient navigators or nurse care managers (ex. percent of Care Coordination Model) Complex Care Coordination Program Payments for CHT Process improvement/other quality management activities
Unlisted Preventive Service Initial Preventive Physical Exam G0402 Annual Wellness Visit G0438, G0439 Vaccine Administration Immunization Administration 90460, 90461, Flu Vaccine Administration G0008 Pneumonia Vaccine Administration G0009 Care Management Transitional Care Management 99495, 99496 CCM Codes Chronic Care Management 99487, 99489, G0506 OB/GYN Routine Obstetric Care 59400, 59510, 59610, 59618 Evaluation & Management Services 99460 – 99465 Nursing Facility Nursing Facility Care 99304 – 99310, 99315 – 99316, 99318 Home Services New/Established Patient Care 99341 – 99350 Domiciliary/ Rest Home/ Custodial Care New/Established Patient Care 99324 – 99328, 99334 – 99337 Denominator: Total ACO expenditures by payer. Section 2. Non-Claims-Based Spending Numerator: payments to primary care providers and practices within the ACO, by payer, including: Capitation payments Payments for PCMH recognition (ex. percent of extended Blueprint funding to PCMH practices) Payments to reward achievement of quality or cost-savings goals (ex. percent of VBIF allocated to primary care) Payments aimed at developing capacity to improve care for a defined population of patients, such as patients with chronic conditions (ex: pilot program for comprehensive payment to primary care practices) Payments to help providers adopt HIT Payments or expenses for supplemental or activities, such as practice coaches, patient educators, patient navigators or nurse care managers (ex. percent of Care Coordination Model) Complex Care Coordination Program Payments for CHT Process improvement/other quality management activities
CY19%20FINAL_GMCB%20ACO%20Budget%20Guidance_OneCareLLC_7-24-2018.docx