APM Opportunity Coming soon
FQHCs will soon have the chance to submit a letter of interest and apply for a new payment opportunity in California. This historic moment comes after approximately two decades of the Prospective Payment System (PPS) being in place. This new opportunity - an alternative payment methodology (APM) - aims to build on the best parts of PPS, while helping FQHCs stabilize payment and leverage more of their care teams to deliver even better patient-centered quality care.
Three CPCA APM Committees and an all-member Workgroup have been informing the development of an APM for the last two years. In December of 2021, the state and CPCA agreed to extend the launch of the APM to 2024 to spend more time on the details of the model. Over the last six months, a number of state-led workgroups have been formed and have met regularly to inform rate development, quality measures and data capture, and the application. The working state objective is to release the opportunity to submit a letter of interest (LOI) to participate in the APM to FQHCs in August 2022. The LOI will inform the state to the breadth of interest in the APM. Then, in November, the state plans to release the opportunity to officially and formally apply to the APM. Health centers that apply will be notified in March 2023 if they will be accepted to convert their site-based PPS rates to a PPS equivalent Per Member Per Month (PMPM) rate. It is completely voluntary for FQHCs to apply and to change their PPS payment to a PMPM.
FQHCs that participate in the APM are assured that they will receive no less than PPS and will be made whole to PPS should their visits increase in the new model. For many FQHCs, this commitment, plus the flexibility afforded in the new model, will help to stabilize cash flow and position FQHCs for more innovative care delivery models.
In May, CPCA launched “APM Cohort 0” with 14 health centers across the state. These CHCs are committed to preparing for the APM and positioning their organizations to apply. A series of supports and tools are under development to support Cohort 0 and all other CHCs interested in the APM opportunity. The California Health Care Foundation, who is funding CPCA’s APM policy work, is also supporting the development of an APM Implementation Guide that will be ready in the fall for those FQHCs interested in the APM. The guide will provide an assortment of tools to help FQHCs think through the array of elements and impacts of the APM model.
Health centers interested in learning more are encouraged to explore and utilize the APM Initiative page.