Medicare pays health plans 95 percent of the AAPCC, adjusted for the characteristics of the enrollees in each plan.The leading national association of preferred provider organizations (PPOs) and affiliate organizations, and was established in 1983 to advance awareness of the benefits — greater access, choice and flexibility — that PPOs bring to American health care.The basis for Health Maintenance Organization (HMO) or Competitive Medical Plan (CMP) reimbursement under Medicare-risk contracts.The average monthly amount received per enrollee is currently calculated as 95 percent of the average costs to deliver medical care in the fee-for-service sector.This installment of the SAMHSA Disaster Behavioral Health Information Series (DBHIS) focuses on the behavioral health aspects of Zika virus disease.It contains resources to help with possible behavioral health reactions related to the increase in cases of the Zika virus beginning in 2015, and the association of these cases with microcephaly and other birth defects in babies whose mothers were sick with Zika during pregnancy.
The process by which an organization recognizes a program of study or an institution as meeting predetermined standards.
Three organizations that accredit managed care plans are the National Committee for Quality Assurance (NCQA), URAC and the Joint Commission.
Its mission is to be the most valued and effective advocate for the PPO Industry by: educating and informing the federal and state legislative and regulatory bodies, promoting PPO Industry best practices, advancing the business needs of Preferred Provider Networks and Payers, and promoting Preferred Provider Networks and PPO benefit products to purchasers, consumers, employers and the healthcare industry at large.
For additional information, go to A patient’s ability to obtain medical care determined by the availability of medical services, their acceptability to the patient, the location of health care facilities, transportation, hours of operation, and cost of care.
Separate AAPCCs are calculated - usually at the county level - for Part A services and Part B services for the aged, disabled, and people with end stage renal disease (ESRD).
Adjustments are made so that the AAPCC represents the level of spending that would occur if each county contained the same mix of beneficiaries.