Payment & Delivery Models

Payment model proposal process for MACRA begins

The Medicare Access and CHIP Reauthorization Act (MACRA) established the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to make recommendations to the Secretary of the Department of Health and Human Services (HHS) on physician-focused payment models (PFPM)—and the PTAC is now preparing to accept proposal submissions.

HHS is required by MACRA to establish criteria for PFPMs and to respond to the recommendations of the PTAC. Individual physicians and stakeholder entities can now profess intent to submit their proposed models to the PTAC for consideration. The PTAC will evaluate whether or not each proposal meets HHS’ criteria and make recommendations for refinement, further study, testing and implementation of the proposed PFPMs.

Submitting your proposal

There are two steps to submitting a proposed PFPM. The first step is to submit a non-binding letter of intent at least 30 days in advance of your full payment model proposal submission—this began Oct. 1.

The second step will be to submit a full proposal for consideration, and the PTAC will begin accepting full proposals on Dec. 1.

The letter of intent template will guide you to make sure the PTAC has all of the information it needs ahead of your proposal submission. A letter of intent should be two pages or less, single spaced, and include:

  • Expected participants
  • Goals of the payment model
  • A model overview
  • Implementation strategy
  • Timeline

For more detailed information on each of these points, check out the instructions for letter of intent submissions.

All letters of intent must be sent as an attachment to [email protected] as either a PDF or Word document with 12-point Times New Roman font. The email subject line should include LOI (letter of intent) followed by the organization name and a key word or phrase describing the model.

Read more about the PTAC, letters of intent, proposal requirements and the characteristics of payment models likely to be recommended by the PTAC.

To learn more about alternative payment models (APM) and their place in the new Medicare payment system, visit the AMA's Medicare payment reform Web page.

For more on physician efforts to develop and implement APMs: