1. The Michigan Primary Care Transformation (MiPCT) Project CMS FINAL Physician Fee Schedule – 2016 Highlights for MiPCT Practices

2. 1) New Advance Care Planning Codes ▫Purpose: To pay for a provider's time discussing patient choices for advance directives and completing necessary forms. ▫Code Detail:  Coverage of first 30 minutes  Additional 30-minute blocks ▫Beginning 1/1/16, CMS will reimburse CPT codes 99497 and 99498. 2 The Final PFS (Issued 10/30/15)- Implications for the MiPCT

3. 1) New Advance Care Planning Codes, cont. ▫Does NOT waive beneficiary copay for discussions (except for discussions at annual wellness visits) ▫Also billable for FQHCs and RHCs ▫Payment estimated at $86 for 99497 (initial 30-minutes) and $75 for 99498 (subsequent 30 minutes). 3 The Final PFS (Issued 10/30/15)- Implications for the MiPCT

4. 2) Transitional Care Management (99495 and 99496) ▫Now allows submission of claim when the face-to- face visit is completed 3) Still Waiting……..New Collaborative Care Model Code for Beneficiaries with Common Behavioral Conditions…Potentially in 2017 4 The Final PFS (Issued 10/30/15)- Implications for the MiPCT

5. 4) The Bigger Issue for Us – Potential Comprehensive Primary Care Expansion Our “sister program” that parallels the Multipayer Advanced Primary Care Demonstration (MAPCP) approach. ▫CPCI focus areas (milestones) largely similar to MiPCT programming  Enhanced patient access and continuity of care,  Planned chronic and preventive care,  Risk-stratified care management,  Patient and caregiver engagement, and  Coordination of care across a “medical neighborhood” CMS staff acknowledge that (if expanded), an announcement early in 2016 is key to continuity of staffing and servicing 5 The Final PFS (Issued 10/30/15)- Implications for the MiPCT, cont.