PHC Florida

Robert Heglar
AHF Provider

Physician Incentive Plan

PHC Florida is pleased to announce its MMA Physician Incentive Plan (MPIP) for Pediatric Primary Care and OB/GYN physicians.  The goal of the MPIP is to provide an incentive to Pediatric Primary Care Physicians and OB/GYNs that provide the highest quality care to PHC Florida enrollees.  Pediatric Primary Care Physicians and OB/GYNs who meet the MPIP qualifying criteria will receive the equivalent of the Medicare rate, as established by the Agency for Health Care Administration (AHCA) for certain covered services for dates of service during the upcoming MPIP payment period, October 1, 2016 through September 30, 2017.

Prior to October 1, PHC Florida will submit a list of physicians to AHCA that will receive the MPIP payments.  Within six months of the payment period, PHC Florida may update the list with additional qualifying physicians.  For the 2016 MPIP, PHC Florida will use the enrollment and claims data from the January 1, 2015 – December 31, 2015 measurement period to ‘identify’ and ‘qualify’ Pediatric Primary Care and OB/GYN physicians for the MPIP.  Once identified, providers must meet certain criteria to receive the increased payment.

Below are the criteria for the MPIP.  Only qualified providers will receive the increased reimbursements for Medicaid as established by AHCA.

Pediatric Primary Care

Identified Provider – The physician must be a PHC Florida PCP with at least one pediatric enrollee.
Quality Provider – Complete at least one pediatric visit in measurement period.

OB/GYN

Identified Provider – The physician must have at least one claim paid by PHC Florida for OB/GYN services provided within measurement period.
Quality Provider – Complete at least 90% of annual cervical screenings required in measurement period.

Provider Contract Amendments
PHC Florida will amend Pediatric Primary Care and OB/GYN provider contracts to include the MMA MPIP language during the months of August and September 2016.

Payment Schedule
PHC Florida will make payments to qualified providers beginning in October 2016.

Quarterly Updates
PHC Florida will provide identified providers with a quarterly report indicating their current status and what is required to achieve “qualified provider” status.  Qualified providers will also receive a quarterly report indicating their current status and progress towards qualifying for the next incentive payment.

Please contact Provider Relations should you have any questions about MPIP.  You may also download the MPIP Summary for more information.


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AHCA 081216 PHC MMA Form 17.1