Kaiser Family Foundation Survey on State Medicaid Managed Care ...

APPENDIX 10: PCP Requirements and Payment Methodologies in PCCM Programs, by StatePCP RequirementsPayment MethodologyState24 Hour/7Day-a-WeekCoverageMeet StateReportingRequirementsParticipationin StateQualityInitiativesMinimumPanel SizeMaximumPanel SizeMust providePrimary Care OtherFee-for-Service withCaseManagement Case Management FeeFee-for-Servicewith SharedSavingsProvisionAL X X X X X $2.60 PMPM XAR X X X X X X $3.00 PMPMFee-for-Service withEnhancedVisit RateCapitated for ServicesDelivered by PCP withGatekeeperResponsibility for OtherServices Other Other DescriptionCO X X X X $2.00-$1.50 PMPM X The PCPP is strictly Fee-for-ServiceCT X X X X X $7.50 PMPMFL X X X X X X X $2.00 PMPMGA X X X X $1.75 PMPMIA X X X X X X $2.00 PMPMID X X X X $3.50 PMPMIL X X X X X X X$2.00 PMPM for children, $3.00PMPM for parents and $4.00 PMPMfor seniors and adults with disabilities.XIN X X $6.00 PMPMKS X X X X X X $2.00 PMPMKY X $4.00 PMPMLA X X X X$1.50 PMPM effective 1/1/11(previously $3)MA X XME X X X X X$3.50 PMPM for PCCM + $3.50 PMPMfor PCMHMT X X X X X $3.00 PMPM PCCM X $3.75 PMPM EPCCMNC X X X X X X X $1.00 to $5.00 PMPM X X Additional PMPM for CCNC NetworksND X X X $2.00 PMPMNY X X X X X XOK X X X X X X X XOR XVaries by type of medical home; avg is$4.50 PMPMPA X X X X X X XRI X X $4.00 or $8.00 PMPMFee-for-service for providers. PMPMfor the administrative servicecontractor. Pay for performanceopportunities for both providers andvendor.SC X X X X X X $10.00 PMPM X MCCW : Fee-for-service paid $230.96SD X X X X $3.00 PMPMTX X X X X X X$4.90 PMPM effective September 1,2010 and $4.85 PMPM as of February1, 2011. RHCs & FQHCs are at $5.00PMPM for except for title V, X and XXfamily planning services.UT XVA X X X X $3.00 PMPMVT X X X $5.00 PMPMWA X X $3.00 PMPMWV X X X X $3.00 PMPMTotal 27 14 13 3 15 24 13 25 1 2 2 5Note: 31 states have PCCM programs.70 00