State-By-State Analysis Of Medicaid MCO Requirements For Provider Alternative Payment Reimbursement

Alternative payment methodologies (APMs) is an umbrella term used to describe payment models that focus on quality, cost of care, or both rather than utilizing pay-for-volume or fee-for-service payment models. APM are used across all payers—Medicare, Medicaid, and commercial—in different ways and at different levels. This report looks at the use of APMs in state Medicaid programs, specifically which states require managed care organizations (MCO) to use APMs for reimbursement to provider organizations. The report outlines whether the state has capitated, at-risk MCOs; whether APMs are included in the MCO’s contract; the . . .