Program Basics
This AHEAD primary care program launched August 2025
what is the Medicaid Path?
Minimum number of assigned HealthChoice members required at the TIN level to participate.
What is 250 members?
This requirement ensures every Medicaid member is assigned to a primary care provider
What is empanelment using MCO assignment (CTR 1.1)?
Per-member, per-month (PMPM) Care Management Fee for Medicaid Path in 2026
what is $2?
Maryland’s Health Information Exchange used by the Medicaid Path.
What is CRISP? All practices must be connected to CRISP
AHEAD stands for this federal model Maryland joined from 2026–2035.
What is Achieving Healthcare Efficiency through Accountable Design?
Practices must sign this to receive Care Management Fees from an MCO.
What is a contract addendum?
Practice organizations must offer at least one of these to improve access, such as telehealth or same-day visits.
What is an alternative care strategy (CTR 1.4)?
When are CMF payments processed for the Medicaid Path
What is each quarter or Late January, April, July, and October?
The CRISP tool that sends real-time hospital and ED alerts.
What is CEND (CRISP Event Notification Delivery)?
The state office that supports practices with Practice Transformation Coaches.
What is the Office of Advanced Primary Care (OAPC)?
Medicaid members are assigned to practices through this entity.
What is the Managed Care Organization (MCO)?
For practice organizations, this population is a priority for outreach
What is lost to care population?
The two main types of quality incentive payment arrangements in the Medicaid Path
What is Pay-for-Performance (P4P) and Pay-for-Reporting (P4R)
The CRISP platform is used to monitor quality and utilization across payers.
What is the Multi-Payer Reports Platform?
This federal agency partnered with Maryland to implement the AHEAD Model.
What is the Centers for Medicare & Medicaid Services (CMS)?
Name two provider types eligible for Medicaid Path participation.
what is General Practice, Family Medicine (also Internal Medicine, Pediatric Medicine, Nurse Practitioner, Physician Assistant)?
Name one of the child claims-based (P4P) quality measures under the Medicaid Path program.
what is Child and Adolescent Well-Care Visits (WCV) or Developmental Screening in the First Three Years of Life (DEV-CH)?
The first Medicaid Path quality measurement period begins on this date.
What is January 1, 2026?
These CRISP reports must be reviewed at least every 30 days.
What are the Prediction Tools reports?
A goal of the AHEAD Medicaid Path
What is to build a sustainable advanced primary care system that provides high-quality, whole-person care and supports strong healthcare linkages?
A practice organization can choice to participate with how many MCOs.
What is any or all eligible Medicaid MCOs? (up to 9)
For IP hospital and ED discharges, practices must meet at least this follow-up rate to satisfy CTR 2.5.
What is a 50% follow-up threshold?
claims-based (P4P) measures in 2026
what is Emergency Department Utilization (EDU), Acute Hospital Utilization (AHU), Child and Adolescent Well-Care Visits (WCV),Developmental Screening in the First Three Years of Life (DEV-CH)
This must be updated every 90 days
what is CEND panel?