The Michigan Primary Care Transformation (MiPCT) Project

1. The Michigan Primary Care Transformation (MiPCT) Project PO Webinar July 9, 2014 Part Two – New CMS Chronic Care Code Update

2. CMS Chronic Care Management Payment Update • 2015 Physician Fee Schedule released on July 3, 2014 (to be published in the Federal Register on July 11 but available now on the CMS website) • Contains updated language regarding the monthly Medicare chronic care code (which is posted on the mipctdemo.org website along with reference material) • Comment period will extend until September 2, 2014

3. CMS Chronic Care Management Payment Revised – Issued July 3, 2014Highlights • Effective Date of Payment and Rate • January 1, 2015 • $41.92 monthly (expectation of at least 20 minutes of clinical services per month) • Which Medicare patients are eligible? • Beneficiaries with 2+ chronic conditions that: • Place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; and • For whom care coordination services would be expected to last at least 12 months or until the death of the patient

4. CMS Chronic Care Management Payment Revised – Issued July 3, 2014Highlights • Chronic care management definition • 24/7 access to health care provider in the practice • Continuity of care with a designated provider • Systematic assessment of health needs, preventive services, medication reconciliation • Creation of a patient-centered care plan document • Management of care transitions • Coordination with home/community services • Secure messaging, internet or other non-face to face communication available • Written agreement from beneficiary for CCM services, documented in chart • Informing beneficiary that only one practitioner can be paid for these services during the month as well as process for revoking agreement to participate

5. Key Themes • Focus on “scope of service”,not standards • PCMH certification standard removed • NP/PA requirement removed • EHR 2014 requirement retained (now classified as a scope of service instead of a standard). • The person providing CCM services does not need to be a direct employee of the practice • CCM services provided do not need to be under the direct supervision of a physician (general supervision suffices). • “Clinical staff” (including nurses and clinical social workers) who meet relevant state requirements (licensing) may deliver care management services (consistent with MiPCT model)

6. Demonstration Extension Update • Language prohibits “double dipping” from both MAPCP demonstration and new CMS chronic care code payment for an eligible beneficiary. • However, practices could bill the new code for Medicare patients who are not attributed to the practice. • Could be interpreted as a constructive sign of increased consideration by CMS of demonstration extension, though CMS has not formally advised the states of their intent to extend.

7. Michigan’s 2013 Submitted Comments • The new language acknowledges several of Michigan’s comments to CMS in 2013 and are no longer open issues • NP/PA Requirement was removed • Practices do not need NCQA or URAC recognition required • Patient consent for care management remains in effect until revoked (annual consent no long applies) • Requirement that practice employ care management staff has been broadened • The following are still items of concern: • Level of payment is less than ideal • Payment references non face-to-face care management services only (vs. also including face to face care management services) • Patients may bear financial responsibility for care management services (e.g., deductible, cost sharing, etc.) • EHR certification level (2014) may be a high bar for some practices

8. Preparing for 2014 Comment Submission • Language posted on MiPCT website and distributed to stakeholder groups upon receipt (ROI subgroup, Operations Group, etc.) • Comments should be forwarded to dbechel@umich.eduby August 2, 2014 with the subject line: “Comment on CMS Revised CCM Code Language” • Discussion opportunities on the new language include: • The ROI Subgroup meeting (July 14) • PO Stakeholder Visioning Meeting (July 29) • Comments will be compiled and reviewed at the August 6 Operations Group meeting and by the Steering Committee to allow for submission by August 29th

9. Coordination with Other States • Discussion has begun with other states • Opportunity to share consolidated comments to promote common themes and alternative language in comments to CMS

10. MiPCT Key Messages Sustainability and Continuity • Regardless of whether CMS extends the demonstration period is extended to 2015, MiPCT discussions with payers have been constructive and promising overall for continued: • Care management funding • Central operations funding for support and accountability • Final agreements will be announced as soon as possible

11. MiPCT Key Messages Sustainability and Continuity, cont. • The MiPCT is a core component of Michigan’s State Innovation Model (SIM); Further, several POs have already expressed commitment to ongoing care management support post demonstration • We cannot lose focus on using the time left in the demonstration period to produce continued and improved results for each payer on: • Increased volume of MiPCT eligible patients receiving Care Management • Reduced Avoidable ED and Inpatient Visits • Improved Clinical Metrics (especially diabetes) • Your continued and focused efforts now on the key metrics above are key to success