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Payment and Delivery System Reform in Medicare: A Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments

Appendix: Payments Allocated for CMMI Models

Table A1: Innovation Center Model Payments, as of September 2014
(From the Centers for Medicare and Medicaid Services’ Report to Congress, December 2014)a

Initiative

CMS Innovation Center payments made to model participants Payments under Title XVIII or XIX made for services on behalf of beneficiaries Other CMS Innovation Center funds obligated to support model development and testing
Primary Care Transformation
Comprehensive Primary Care $172,740,615 Payments not yet made (expected FY 2015) $57,609,096
Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) $45,967,680 N/A $22,868,754
Accountable Care Organizations
Pioneer Accountable Care Organization Model N/A $80,719,585 $87,048,657
Advance Payment Accountable Care Organization Model $67,801,572b $5,705,754c $5,371,781
Comprehensive End-Stage Renal Disease Care Model N/A Payments not yet made $16,476,376d
Bundled Payments for Care Improvement
Bundled Payments for Care Improvement (Models 1-4) N/A Data not yet available $40,399,579
Initiatives Focused on the Medicaid Population
Strong Start for Mothers and Newborns (Strategies 1 & 2) $23,594,395 N/A $47,649,930
Initiatives Focused on Medicare-Medicaid Enrollees
State Demonstrations to Integrate Care for Medicare-Medicaid Enrollees $70,509,361 N/A $18,928,906
Financial Alignment Initiative $5,207,996 Data not yet available $79,839,514e
Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents $78,900,786 N/A $11,245,590
Initiatives to Speed the Adoption of Best Practices
Partnership for Patients N/A N/A $451,352,024
Million Hearts® N/A N/A N/A
Initiatives to Accelerate New Service Delivery and Payment Model Testing
Health Care Innovation Awards Round 1 $879,640,554f N/A $60,477,074
Health Care Innovation Awards Round 2 $120,033,340 N/A $7,272,376
State Innovation Models (Round One) $181,418,835 N/A $32,335,764
State Innovation Models (Round Two) Payments not yet made N/A $1,985,982g
Medicaid Innovation Accelerator Program N/A N/A Obligations not yet made
Maryland All-Payer Model N/A N/A $5,608,084
Medicare Care Choices Model Payments not yet made N/A $1,857,149
Prior Authorization Model: Non-Emergent Hyperbaric Oxygen Therapy N/A N/A Obligations not yet made
Prior Authorization Model: Repetitive Scheduled Non-Emergent Ambulance Transport N/A N/A $4,338,941
Subtotals $1,645,815,124 $86,425,339 $952,665,577
SOURCES:

a Table taken from: Table 3 of Centers for Medicare and Medicaid Services, Report to Congress, December 2014, available at https://innovation.cms.gov/Files/reports/RTC-12-2014.pdf.

b Payments made to model participants in the Advance Payment ACO Model represent the advance payments given to ACOs as part of the model, which were distributed under the authority of section 1115A of the Social Security Act.

c Payments made to model participants in the Advance Payment ACO Model under Title XVIII or XIX were distributed as shared savings payments under the authority of the Medicare Shared Savings Program.

d Of this amount, $1,321,039 was obligated as application support through the FY2013 pre-implementation budget.

e Of this amount, $1,495,660 was obligated for the Financial Alignment Initiative under the FY2011 budget for the State Demonstrations to Integrate Care for Medicare-Medicaid Enrollees.

f This total reflects the full amount of grant funding provided to HCIA awardees for the 3-year period of performance. Funds are used by awardees to implement models, including payments to providers of services, and to suppliers.

g This funding was used for the Medicaid Innovation Accelerator Program (IAP) Learning Collaborative in FY2014. The IAP program is budgeted separately in FY2015 and thereafter.
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