Market Intelligence Reports | March 6, 2023
Medicaid Health Plan Requirements For Provider Alternate Payment Methodologies: The 2023 OPEN MINDS Market Intelligence Report
There are 42 state Medicaid programs (including District of Columbia) that have at-risk capitated contracts with health plans to finance and deliver Medicaid covered services as of December 2022. Of those states with at-risk capitated contracts with health plans, 32 (76%), included some kind of requirement for the health plans to reimburse provider organizations using alternative payment methodologies (APMs). APM is an umbrella term for pay-for performance, fee-for-service (FFS), and value-based reimbursement arrangements. Although 32 states include some kind of requirement for health plans to reimburse provider organizations using APM, most do not have . . .