- Practice with 5,000+ Medicaid members and national primary care or patient centered medical home accreditation including National Committee for Quality Assurance (NCQA) standards (established in 2017), NCQA II/III, URAC, Joint Commission, AAAHC
- Practice with 500+ Medicaid members and NCQA standards (established in 2017) or NCQA III
- Practice with 500+ Medicaid members and CPC Plus participation.
Eligibility for Ohio CPC practice participation is determined using a physician’s Medicaid billing identification number. Beginning Monday, January 1, 2018, Ohio CPC practices may be eligible for two payment streams: (1) a prospective per-member-per-month (PMPM) payment to support activities required by the Ohio CPC program with an average per member, per month of $4, and (2) a retrospective shared savings payment to reward practices for achieving total cost of care savings.
Ohio Medicaid will be submitting changes to the Ohio Administrative Code Patient-Centered Medical Home Rule to continue with Ohio CPC Program. More details regarding enrollment of new practices will be released soon. For additional information, reference the ODM’s Ohio CPC Program website.