Or. Admin. Code § 410-149-0100

Current through Register Vol. 63, No. 10, October 1, 2024

Section 410-149-0100 - Definitions

(1) "Alternative Payment Methodology (APM)" means a payment mechanism that is at least a partial alternative to fee-for-service (FFS) payments for Track 2 practice sites. APMs shall allow Track 2 practice sites the flexibility to provide comprehensive care outside of the constraints of a billable office visit.

(2) "Attributed Members" means those Oregon Health Plan (OHP) clients assigned to the CPC+ practice under the Comprehensive Primary Care Plus (CPC+)demonstration who are not enrolled with a managed care plan or CCO for physical health services.

(3) "Care Management Fees" means per-member per-month (PMPM) incentive payments issued by the Oregon Health Authority (Authority) to CPC+ practice sites for attributed members.

(4) "Participating Providers" means the health care providers practicing within the practice site approved by CMS to participate in CPC+.

(5) "Patient-Centered Primary Care Home" means a primary care practice site that has applied and achieved recognition as a PCPCH at a particular tier level by the Authority.

(6) "Performance Based Incentive Payment (PBIP)" means a PMPM payment made to the CPC+ practices, based on annual performance on quality measures, patient experience of care, and utilization measures.

(7) "Practice" means the practice site that has been selected by CMS to participate in the CPC+ demonstration.

(8) "Track 1 Practice" means a CPC+ practice designation issued by CMS as one of two possible designations that stipulate the advanced care requirements and payment options available to the practice.

(9) "Track 2 Practice" means a CPC+ practice designation issued by CMS as one of two possible designations that stipulate the advanced care requirements and payment options available to the practice.

Or. Admin. Code § 410-149-0100

DMAP 5-2018, adopt filed 01/24/2018, effective 1/24/2018

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 413.042, 413.259 & 414.065