MMA Physician Incentive Program (MPIP) - Year 4

October 1, 2019 - September 30, 2020

Physicians qualified to participate in the MMA Physician Incentive Program (MPIP) are the physician types listed below who meet plan-specific access and quality criteria. The managed care plan must maintain the same qualification criteria for MPIP Year 4 as was approved by the Agency for Year 3.

MPIP Covered Physician Types:

• Pediatric Primary Care Physicians (including General Practitioners and Family Practitioners)
• OB/GYNs
• Specialist Physicians for all services provided to enrollees under the age of twenty-one (21) years.
  • Beginning October 1, 2019, plans must reimburse both in and out of network Emergency Room physicians at the MPIP enhanced rates for services rendered to members under 21 years of age.
  • Beginning April 1, 2020, plans must reimburse all out of network Hospital-based Specialty physicians at the MPIP enhanced rates for services rendered to members under 21 years of age.

MPIP Year 4 Plan Program Summary [ 450.2 kB ]

MPIP Year 4: Qualified Providers

Below is a list of Primary Care Physicians and OB/GYNs by name, reported by the plans to the Agency, who meet MPIP Year 4 qualifying criteria prior to the implementation date. All specialist physicians serving members under the age of 21 qualify for the MPIP program and will not be listed on the Qualified Providers list. Specialists are encouraged to work with their respective health plans to submit claims for the MPIP enhanced rates when providing services to members under the age of 21.  Qualified providers will begin to receive enhanced rates for dates of service beginning on or after the implementation date.

During each year of MPIP, plans are required to reassess physician eligibility for the program six months after implementation. For MPIP Year 4, plans will be required to reassess physician eligibility for enhanced rates for dates of service beginning on or after April 1, 2020.  This allows providers who become qualified after the October 1, 2019 implementation date a second opportunity to become eligible for MPIP.  The Year 4 qualified provider list, available at the link below, will be updated after each reassessment.

MPIP Year 4 Qualified Providers List: October 1, 2019- September 30, 2020 [ 452.2 kB ]

If you are a provider contracted with a health plan to provide services and you feel that your name was omitted from the Qualified Providers List in error, please contact the plan directly. Plan contact information for providers can be found at the link below.
Health Plan Contacts for Providers

For additional information on types of physicians excluded from the MMA Physician Incentive Program, please click the link below.
Excluded Providers

MPIP Year 4: Included Services and Enhanced Payments

Pediatric Primary Care Physicians and Obstetricians/Gynecologists

The included services to qualify for enhanced payments for Pediatric Primary Care Physicians and Obstetricians/Gynecologists are the following:

- All services provided to recipients under the age of 21 years by a qualified primary care physician;

- All OB/GYN services rendered to pregnant women

Pediatric Specialists
Included services are all medically necessary pediatric specialist services provided to recipients under the age of 21 years.

Enhanced Payment
Payment to a qualified provider for included services will be equivalent to the Medicare Specific Locality fee-for-service rate that is in effect as of January 1, 2019, when a Medicare rate is available for the code associated with the included service.  Payments to qualified providers may be made either through a capitated arrangement or on a fee-for-service arrangement, as defined by the health plan.

NOTE – The enhanced rates for included services are calculated by health plans, according to Medicare rates, effective October 1, 2019.

For pediatric evaluation and management codes included in the file at the following link, the 2019 Medicare Rates in the Excel file must be used for enhanced payments.

MPIP Rates for Children’s Primary Care Codes [ 37.8 kB ]

For codes without rates published on First Coast’s website but that have Medicare Relative Value Units (RVUs), the rate calculation methodology below (as published by the Centers for Medicare & Medicaid Services at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html) must be used.

2019 Non-Facility Pricing Amount =

                [(Work RVU * Work GPCI) +

(Non-Facility PE RVU * PE GPCI) +

(MP RVU * MP GPCI)] * Conversion Factor (CF)

2019 Facility Pricing Amount =

[(Work RVU * Work GPCI) +

(Facility PE RVU * PE GPCI) +

(MP RVU * MP GPCI)] * Conversion Factor (CF)

For MPIP included service codes that do not have a Medicare equivalent and for which RVUs = 0, the managed care plan must use the following formula:

Florida Medicaid rate x 1.6667 = Medicare equivalent rate*

                *this Medicare equivalent rate must be reduced by the 2% sequestration.

Program Documents

• Attachment 2: Florida Medicaid Cesarean Rate Calculation [ 321.4 kB ]
• Attachment 6: Florida Managed Medical Assistance Physician Incentive Program (MPIP) Rate Calculation Guidance

Program History

MPIP Year 1: 2016 – 2017

MPIP Year 2: 2017 – 2018

MPIP Year 3: 2018 – 2019