Chronic Care Management Services Agreement FAQ

Chronic Care Management Services Agreement FAQ CNY AIM

If my practice contracts with the CIN to provide chronic care management services, what portion of my practice’s collections for CCM Services and AWV Services must be paid to the CIN as a fee for care management services?

Your practice will be required to remit a percentage of the practice’s collections for CCM services and AWV services. The exact percentage is determined through the use of a Fair Market Value (FMV) assessment. Specifically, it was calculated using the ratio of Work RVU’s to Total RVU’s. This methodology was reviewed by the CIN’s Quality Improvement and Population Health Committee and approved by the CIN’s Management Board.

Is the practice required to pay the defined percentage of collections for all CCM Services/AWV Services billed by the practice or only for patients who have received care management services from the CIN Care Management Team?

The practice is only required to remit collection for the CCM or AWM Services performed by CIN Health Coaches on behalf of the practice. The practice is not required to remit a percentage of collections for those CCM and AWM services rendered by the practice’s employed staff.

How will patients be assigned to receive care management services?

Historical claims data and current clinical information for all ACO assigned beneficiaries will be reviewed and stratified using the ACO’s risk stratification tools and applications. Patients will be ranked according to several different criteria and assigned to a RN Health Coach. Health Coaches will build a panel of patients from the practices that they serve.

Since the contract for chronic care management services is exclusive, can my practice still refer eligible patients to Health Homes for Medicaid care coordination?

Yes. The contract for CCM services applies only to those patients that have not already been assigned to an existing Medicaid Health Home. For example, Medicare beneficiaries with both Medicare and Medicaid coverage (dual eligible enrollees) may be assigned to a Medicaid Health Home that is not affiliated with the Trinity Health Integrated Care ACO. Incidentally, your practice may refer patients to any eligible participating Medicare provider regardless of their participation with the Trinity Health Integrated Care ACO.