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. Year 2 of the MPIP expanded participation to include the following physician types:
Beginning April 1, 2018, MPIP has expanded participation to include the following physician types:
For additional information on each plan’s access and quality criteria for qualified providers in Year 2, please click the link below.
Below is a list of physicians by name, reported by the plans to the Agency, who meet MPIP Year 2 qualifying criteria prior to the implementation date October 1, 2017. Qualified providers will begin to receive enhanced rates for dates of service beginning on or after the implementation date October 1, 2017.
During each year of MPIP, plans are required to reassesses physician eligibility for the program six months after implementation. For MPIP Year 2, plans will be required to reassess physician eligibility for enhanced rates for dates of service beginning on or after April 1, 2018. This allows providers who become qualified after the October 1, 2017 implementation date a second opportunity to become eligible for MPIP. The Year 2 qualified provider list, available at the link below, will be updated after each reassessment.
MPIP Year 2 Qualified Providers List: October 1, 2017 - March 31, 2018 [Updated 10/2/2017 - 937KB MS Excel]
MPIP Year 2 Qualified Providers List: April 1, 2018 - September 30, 2018 [Updated 4/2/2018 - 1.29MB MS Excel]
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 [Updated 4/5/2018 - 84KB]
For additional information on types of physicians excluded from the MMA Physician Incentive Program, please click the link below.
Pediatric Primary Care Physicians and Obstetricians/Gynecologists
Included services are services for which a qualified provider will receive an enhanced payment. For a complete list of included services for pediatric primary care physicians and OB/GYNs, please click the link below.
MPIP Included Services [Updated 10/17/2016 – 29KB MS Excel]
For Community Care Plan (CCP), the included services are slightly different. A complete list of CCP’s MPIP included services can be found on CCP’s website at:
Board Certified Pediatric Specialists
Included services are all medically necessary pediatric specialist services provided to recipients under the age of 21 by qualified physicians who are adolescent medicine specialists, pediatric allergists, pediatric cardiologists, pediatric cardiovascular surgeons, pediatric critical care specialists, pediatric dermatologists, pediatric endocrinologists, pediatric gastroenterologists, pediatric general surgeons, pediatric hematologists, pediatric hospitalists, pediatric infectious disease specialists, pediatric internal medicine specialists, pediatric nephrologists, pediatric neurologists, pediatric neurology surgeons, pediatric oncologists, pediatric ophthalmologists, pediatric orthopedic surgeons, pediatric otolaryngologists, pediatric physical medicine and rehab specialists, pediatric plastic surgeons, pediatric psychiatrists, pediatric pulmonologists, pediatric rheumatologists, and pediatric thoracic surgeons.
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 October 1, 2017, 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, 2017.
For included service codes for which there is no equivalent Medicare rate, the following attachment provides a formula and guidance for calculating the rate: Attachment 6: Florida Managed Medical Assistance Physician Incentive Program (MPIP) Rate Calculation GuidanceThe enhanced rates for the vaccine administration codes are as follows:
|Vaccine Administration Services Codes – MPIP Rates|
|Code||Description||Maximum Fee *|
|90460||Administration of first vaccine/toxoid through 18 years of age, via any route, with counseling.||$24.01|
|+90461||Administration of vaccine/toxoid component through 18 years of age with counseling.||$12.00|
|90471||Administration of one vaccine, single or combination vaccine/toxoid. (percutaneous, intradermal, subcutaneous or intramuscular).||$24.01|
|+90472||Administration of each additional vaccine, single or combination vaccine/toxoid. (percutaneous, intradermal, subcutaneous or intramuscular).||$12.00|
|90473||Immunization administration by intranasal or oral route of one vaccine, single or combination vaccine/toxoid.||$24.01|
|+90474||Administration of each additional intranasal or oral vaccine (single or combination vaccine/toxoid).||$12.00|