Context
To implement the Primary Care Sub-Capitation Program, MassHealth will maintain up-to-date lists of the following.
- primary care practice sites, also called PID/SLs (Provider Identification and Service Location), enrolled in each of its Accountable Care Organizations (ACOs)
- the clinical tiers that each enrolled practice site attests to
- the members attributed to enrolled practices
This page outlines the high-level activities that ACOs will complete during the year to maintain this information. While primary care providers are not individually responsible for the tasks, ACOs may need to collaborate with their providers to complete them. Practices can support this process by consistently and proactively informing their ACO of any and all changes.
Timeline
January 1st: ACO contract year begins. Updated list of participating PID/SLs, clinical tier designations, and sub-capitation per-member, per-month (PMPM) rates for the current contract year take effect.
*To learn more about clinical tier attestation see the section Care Delivery Transformation for more details.
**To learn about sub-capitation PMPM rates see the section Rate Methodology for more details.
May: ACOs submit changes to the list of participating PID/SLs and TINs for the following contract year. May is the only time ACOs may add or remove TINs to the program. If ACOs propose PID/SL additions*, they will also submit clinical tier attestations for these sites during this month.
*ACOs can add a new PID/SL to the Primary Care Sub-Capitation Program at any point during the year if the PID/SL's TIN is already enrolled in the ACO. However, May is the only time that ACOs can voluntarily remove PID/SLs from participation (e.g., when removal is not necessitated by site closure)
June: ACOs submit clinical tier attestations for the following contract year for PID/SLs that will continue in the program. Practice administrators should work closely with their ACO partners to complete attestation.
Fall: MassHealth releases sub-capitation PMPM rates for the following contract year.
January 1st of following year: Updated list of participating PID/SLs, clinical tier attestation, and new sub-capitation PMPM rates take effect.
Ongoing:
Monthly: Accountable Care Partnership Plans (ACCPs) provide updated list of members attributed to each participating PID/SL to MassHealth each month. For more details, see the section Member Attribution.
Weekly: MassHealth sends all ACOs (both ACPPs and Primary Care ACOs (PCACOs)) a list of all participating PID/SLs. ACOs are expected to review this list and confirm accuracy.