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

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, CMS Chronic Care Management Payment Update

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 3 CMS Chronic Care Management Payment Revised – Issued July 3, 2014 Highlights

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 4 CMS Chronic Care Management Payment Revised – Issued July 3, 2014 Highlights

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) 5

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. 6

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

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 by August 2, 2014 with the subject line: “Comment on CMS Revised CCM Code 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

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 9

MiPCT Key Messages Sustainability and Continuity Regardless of whether CMS extends the demonstration period is extended to 2015, MiPCT d iscussions 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 10

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 11