Qis Implementation Plan And Progress Report Form Page 3
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28QIS Implementation Plan and Progress Report Form
OMB 0938-1286
Expiration Date: 10/31/2018
15. Current Payment Model(s) Description
4
Select the category(ies)
of payment models that are used by the issuer across its Marketplace
product line. If “Fee for Service – Linked to Quality or Value” AND/OR “Alternative Payment Models
Built upon Fee for Service Architecture” is checked, provide the percentage of payments tied to
quality or value.
Payment Model Type
Payment Model Description
Payments are based on volume of services
Fee for Service – No Link to
Quality and Value
and not linked to quality or efficiency.
At least a portion of payments vary based on
Fee for Service – Linked to Quality
the quality or efficiency of health care delivery.
and Value
Some payment is linked to the effective
Alternative Payment Models Built
management of a segment of the population
on Fee for Service Architecture
or an episode of care. Payments still triggered
by delivery of services, but opportunities for
shared savings or two-sided risk.
Payment is not directly triggered by service
Population-based Payment
delivery so payment is not linked to volume.
Clinicians and organizations are paid and
responsible for the care of a beneficiary for a
long period (e.g., more than one year).
5
Provide percentage of payments:
Percentage of Fee for Service payments linked to quality and value:
%
Percentage of payments tied to quality and value through alternative payment models:
%
4
Categories of payment models are defined in Alternative Payment Model Framework and Progress Tracking (APM
FPT) Work Group – Alternative Payment Model (APM) Framework Final White Paper.
See the QIS Technical Guidance and User Guide for the 2018
Plan Year for examples of payment models within each category.
To calculate the percentage of payments for Fee for Service payments linked to quality and value, and/or Alternative
5
Payment Models tied to quality and value, issuers should use the calculation methodologies defined in the Measuring
Progress: Adoption of Alternative Payment Models in Commercial, Medicare Advantage, and State Medicaid Programs
(APM Measurement Effort) Final Paper. See Table 1 (p. 710) for
instructions to calculate the percentage of payments for these two payment model categories.
pg. 3
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid
Office of Management and Budget (OMB) control number. The valid OMB control number for this information collection is 0938-1286. The time
required to complete this information collection is estimated to average 48 hours. If you have comments concerning the accuracy of the time
estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop
C4-26-05, Baltimore, Maryland 21244-1850.
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Parent category: Medical