Frequently Asked Questions Updated for 2020

7. What is an Other Payer Advanced APM?

• Within the Advanced APM pathway, physicians can participate in Medicare Advanced APMs and, beginning with the 2019 performance year, in Other Payer Advanced APMs. Other Payer Advanced APMs are payment arrangements with any payer other than traditional Medicare. Other Payer Advanced APMs include payment arrangements with states (Medicaid payment arrangements, including Medicaid managed care organization arrangements), Medicare Health Plans, or payers with arrangements that are aligned with a CMS Multi-Payer Model.
  
  For a list of Other Payer Advanced APMs, please see the following resources:
  • 2019 List of Medicare Health Plan Other Payer APMs
  • 2019 QPP Multi-Payer Other Payer Advanced APMs
  • 2019 Medicaid Other Payer Advanced APMs in the Quality Payment Program
  • Physicians who are participating in APM arrangements with other payers (e.g., Medicare Advantage plans), “Other Payer Advanced APMs,” can have that participation count towards the requirements for the QPP Advanced APM pathway. For additional information, see the PAI’s Advanced APM Overview.

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