Patient 1st and Patient Care Networks of Alabama (PCNA)

Program Location: 
Montgomery, AL
Payer Type: 

Patient 1st is a primary care case management (PCCM) program operated by the Alabama Medicaid Agency. The present program was approved by the Centers for Medicare and Medicaid Services (CMS) in August 2004 and includes expanded technology and tools to help doctors and other health professionals better manage the increasing cost of health care while promoting better care for Medicaid patients. In May 2011, with a 1915(b) Managed Care Waiver, Alabama began to enhance the Patient 1st program through the creation of three community networks that support primary care medical providers to become patient-centered medical homes. These Patient Care Networks of Alabama (PCNA) help primary care providers with coordinating care and teaching patients self-management skills.

Legislation passed by the 2013 Alabama Legislature will build on the three existing PCNAs to create Regional Care Organizations (RCO) - calling for the state to be divided into regions and that a community-led network will coordinate the health care of Medicaid patients in each region, with networks ultimately bearing the risks of contracting with the state of Alabama to provide that care. The Alabama Medicaid Agency met their first milestone by establishing districts effective October 1, 2013. In order to implement RCOs in Alabama, the federal government must approve an exception, or 1115 Demonstration Waiver, to the existing program.

Visit the National Academy for State Health Policy (NASHP) to learn more about Alabama's programs.

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Payment Model: 

According to NASHP, Alabama began a staggered launch of four PCNAs beginning in August 2011, offering up to $50,000 in reimbursement for start-up costs and $3.00 PMPM for enrollees and $5.00 for enrollees who are aged, blind or disabled (ABD). 

Following the implementation of the state’s health homes program in July 2012, the PCNA payment methodology moved to align with the health homes program. Separate per-member per-month payments made to the participating providers and Patient Care Networks of Alabama on behalf of health home-eligible Medicaid enrollees.

Health home providers receive $8.50 per PMPM: $8.00 through the health homes program in addition to an existing $0.50 PMPM to provide care management services under the state’s 1915(b) wavier. PCNAs receive $9.50 PMPM for each health home patient.

Last updated April 2019
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