Primary Care

Primary Care Plus (PCPlus) 

Primary Care Plus (PCPlus) is MaineCare’s new value-based approach to support primary care. PCPlus replaced Primary Care Case Management, Primary Care Incentive Payment, and primary care Health Homes with a single, integrated initiative and offers primary care practices greater flexibility and incentives to meet MaineCare members’ health care needs.  PCPlus transitions away from a volume-based (fee-for-service) payment system toward an approach that provides population-based payments tied to cost- and quality-related outcomes. Primary Care Plus is included as part of the MaineCare Benefits Manual in Chapter VI, Section 3, Primary Care Plus.

About PCPlus

For general information about PCPlus please see the following:

• List of PCPlus Practices by County (PDF)
• Performance-Based Adjustment (PBA) (PDF)
  • Calculating Performance Based Adjustment (PDF)
  • PCPlus Quality Measures (PDF)
  • Primary Care Service Codes (PDF)
  • PCPlus Peer Groups
• PCPlus Orientation: General Overview Presentation (PDF)
  • PCPlus General Orientation Video
• PCPlus Orientation: Operations Presentation (PDF)
  • PCPlus Operations Video
•  PCPlus Provider Operations and Methodology Guide (PDF)

PCPlus Application and Application Support

The PCPlus application is now closed.

Option 1: PCPlus Recertification Application - This abbreviated application is for existing PCPlus providers to recertify as a PCPlus provider. This application MUST be completed by ALL PCPlus enrolled providers, in order to continue as a PCPlus enrolled provider. A PDF version of this application is available.

Option 2: PCPlus Tier Advancement Application - This abbreviated application is for existing PCPlus providers who believe they now meet qualifications for a higher tier. Practices complete this application IN ADDITION TO the Recertification Application, if you feel your practice now qualifies for a different tier. A PDF version of this application is available.

Option 3: Full PCPlus Application - This application is for providers who are not currently enrolled in PCPlus. A PDF version of this application is available.

PCPlus applications must be submitted at the service location-level. For organizations with multiple locations, a separate application must be submitted for each service location. (This includes the Recertification Application.) 

To inquire about the PCPlus application and/or application schedule, please email PCP-Network-Services.DHHS@maine.gov

The following tools and resources that may be helpful in completing the PCPlus application:

• The Community Health Worker (CHW) Services Environmental Scan Guide and Template (Word) provides guidance for providers in submitting the CHW Environmental Scan, which is a PCPlus requirement for some practices..
• The Behavioral and Physical Health Integration Tool is used to understand the current level of Behavioral and Physical Health Integration within the practice and to identify an area of focus for the following twelve-month period.
• Joint Care Management and Population Health Strategy: If a practice is part of MaineCare’s Accountable Communities (AC) program and it is determined that the practice qualifies for Intermediate or Advanced level of PCPlus, MaineCare will request this Strategy from the AC contracted with the practice. This is a written three-year plan, updated annually, which describes operational and financial coordination across the PCPlus practice, the AC, and any Community Care Team, that is contracted with the AC and/or the PCPlus practice. 
• Shared-Decision Making Aid Examples: Decision-making aids are required for PCPlus participation to support members and their families with making important decisions about their care. 
• From the First Tooth supports practices in implementing the fluoride varnish service into a primary care practice to support MaineCare members under age 21.
• Participation with HealthInfoNet, operator of Maine's statewide Health Information Exchange (HIE): Attestation letters from HealthInfoNet to support PCPlus applications can be requested by emailing HealthInfoNet's Client Engagement team at clientengagement@hinfonet.org. For more information about participating in the statewide HIE, please visit https://hinfonet.org/what-we-do/become-a-participant/.

Enhanced Reimbursement for Primary Care

MaineCare offers enhanced reimbursement rates for select primary care services. To receive this reimbursement, please review and submit the attestation form below to apply. Current fee schedules under this option can be found on Health PAS Online Portal. This provision is included in the MaineCare Benefits Manual, Chapter II, Section 90, Physician Services.

• 2019 August Attestation PCP Increase (PDF)

• Please contact Tia Bolduc, Provider Relations Specialist, with questions at (207) 624-6938.

Questions? 

Email the PCCM Unit for questions.