2017 LRHA Rural Health Care Conference October 23, 2017 Carmen Irwin Rural Health Coordinator CMS –Dallas Regional Office Medicare 101 explains the Medicare Program including what it is, coverage and costs, coverage choices, enrollment, coordination of benefits, and how to fight fraud, waste, and abuse. This training module was developed and approved by the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Federally-facilitated Health Insurance Marketplace. The information in this module was correct as of June 2017. To check for an updated version, visit CMS.gov/outreach-and-education/training/cmsnationaltrainingprogram/index.html. The CMS National Training Program provides this as an informational resource for our partners. It’s not a legal document or intended for press purposes. The press can contact the CMS Press Office at press@cms.hhs.gov. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and rulings.

CMS Programs & Updates New Medicare Card Quality Payment Program (QPP) Rural Health Updates Telehealth Changes Chronic Care Management (CCM) Services Rural Health Council RHCs can receive payment for CCM when CPT code 99490 is billed alone or with other payable services on a RHC claim. RHCs are not authorized to bill for any other CCM or behavioral health integration (BHI) services, and no other CCM or BHI codes should be used.

What You Need to Know For Your Patients NEW Medicare card What You Need to Know For Your Patients

New Medicare Card What You Need to Know For Your Patients As you help people with Medicare, here are some key messages to share about the new Medicare card: Medicare will mail new cards between April 2018 – April 2019. To help prevent identity theft, new cards won’t include Social Security numbers. Instead, each person will get a new unique Medicare Number. You don’t need to do anything to get a new card, but you should make sure your mailing address is up to date. Visit ssa.gov/myaccount or call 1-800-772-1213 (TTY: 1-800-325-0778) to correct your mailing address, if updates are needed. Medicare will never call and ask for personal information before sending new cards, so don’t share your Medicare Number or other personal information if someone calls and asks for it. Medicare will mail more information with the new cards – check Medicare.gov for the latest updates.

New Medicare Card What You Need to Know For Your Patients

Quality Payment Program 2017 UPCOMING DATES Quality Payment Program 2017

Upcoming Dates Quality Payment Program 2017 The program’s first performance year is already underway and runs from January 1, 2017 to December 31, 2017. But it’s not too late to participate so you can avoid a negative payment adjustment or earn a positive adjustment Specifically, in 2017 you can choose to participate in MIPS in one of three ways: By submitting a minimum amount of 2017 data to Medicare, making 2017 a test year for you (resulting in no positive or negative adjustment to your payment rate). By submitting 90 days of 2017 data, making 2017 a partial year for you (and making you eligible for a positive adjustment) If you choose to participate for a partial year, you can choose any consecutive 90 days in 2017 to report on. October 2, 2017 is the start of the last 90-day reporting period in 2017. By submitting a full year of data, making 2017 a full year for you (also making you eligible for a positive adjustment). Or you can choose to participate in an Advanced Alternative Payment Model (Advanced APM)

Pick Your Pace for Participation for the Transition Year Participate in an Advanced Alternative Payment Model MIPS Test Pace Partial Year Full Year Some practices may choose to participate in an Advanced Alternative Payment Model in 2017 Submit some data after January 1, 2017 Neutral or small payment adjustment Report for 90-day period after January 1, 2017 Small positive payment adjustment Fully participate starting January 1, 2017 Modest positive payment adjustment Clinicians: Should assess readiness and decide how and when they’ll participate. Can choose to participate in 2017 as a test year by submitting a minimum amount of 2017 data to Medicare. Can choose to partially participate by submitting 90 days of 2017 data to Medicare. With this option, you may earn a small bonus. Can choose full participation by submitting a full year of data to Medicare. With this option, you may earn a moderate bonus. May choose to participate in an Advanced APM in 2017. **Note: Not participating in the Quality Payment Program: If you don’t send in any 2017 data, then you receive a negative 4% payment adjustment. MIPS Pick Your Pace for Participation Options: Test Pace An effort to help clinicians “experiment” with the program Preparing clinicians for broader reporting in 2018 and 2019 Clinicians must submit some data after January 1, 2017 What does “some” data mean? Eligible for a neutral or small payment adjustment Partial Year Clinicians report for a period of 90-days anytime after January 1, 2017 October 2, 2017 is the last day to begin reporting for the 90-day option Eligible for a small positive payment adjustment Full Year Option is for clinicians/practices that are prepared to fully participate starting on January 1, 2017 Eligible for a modest positive payment adjustment. The MIPS payment adjustment is based on the data submitted. The best way to get the maximum MIPS payment adjustment is to participate full year. By participating the full year, you have the most measures to pick from to submit, more reliable data submissions, and the ability to get bonus points. But if you only report 90 days, you could still earn the maximum adjustment—there is nothing built into the program that automatically gives a reporter a lower score for 90-day reporting. We're encouraging people to pick what's best for their practice. Full-year reporting will prepare you most for future of the program. Not participating in the Quality Payment Program for the Transition Year will result in a negative 4% payment adjustment.

Upcoming Dates Quality Payment Program 2017 If you decide not to participate and don’t send in any 2017 data, then you’ll get a negative 4% payment adjustment. The MIPS payment adjustment is based on the data you submit. Participating for the full year provides you with the best chance of earning the maximum positive adjustment. By participating for the full year, you have the most measures to pick from, the most reliable data to submit, and the ability to get bonus points. If you only report 90 days, you could still earn the maximum adjustment—you don’t automatically get a lower score for 90-day reporting. If you choose to participate for 2017, MIPS reporting of 2017 data will run from January 2, 2018 through March 31, 2018

Merit-based Incentive Payment System PROPOSED RULE FOR YEAR 2 Merit-based Incentive Payment System

Proposed Rule for Year 2 MIPS: Low-Volume Threshold Transition Year 1 Final Year 2 Proposed Exclude individual MIPS eligible clinicians or groups who bill <$30,000 in Part B allowed charges OR provide care for <100 Part B enrolled beneficiaries during the performance period or a prior period. Note: For the 2017 and 2018 MIPS performance periods, individual MIPS eligible clinicians and groups who are excluded may voluntarily participate in MIPS, but would not subject to the MIPS payment adjustments. Exclude MIPS eligible clinicians or groups who bill <$90,000 in Part B allowed charges OR provide care for < 200 Part B enrolled beneficiaries during the performance period or a prior period. Note: Starting with the 2019 performance period, individual MIPS eligible clinicians and groups who are excluded, but exceed one of the low-volume thresholds, would be able to opt-in to MIPS and be subject to the MIPS payment adjustments. The increase in the low-volume threshold reduces burden because it exempts more clinicians from MIPS participation. Note that the increase is proposed and not final under the final rule around November 1, 2017. Starting with 2019 MIPS performance period: allow clinicians to opt-in, based on exceeding one or two of the three low-volume thresholds: Medicare revenue, number of Medicare patients, or number of Part B items and services. Seeking comment on this proposal.

Full-service QPP Service Center Assistance for clinicians with all Quality Payment Program questions, including program basics and getting started Quality Innovation Networks — Quality Improvement Organizations (QIN-QIOs) For clinicians in larger practices (more than 15 eligible clinicians) Quality Payment Program — Small, Underserved, and Rural Support (QPP-SURS) For clinicians in smaller practices (less than 15 eligible clinicians) Transforming Clinical Practice Initiative Practice Transformation Networks (PTNs) Support and Alignment Networks (SANs) For clinicians interested in practice transformation and eventually transitioning to an APM APM Learning Networks Learning and Action Networks (LANs) available to specific CMMI models aimed at sharing best practices for success Self-service QPP Online Portal Starting point for information on and interaction with the Quality Payment Program

Rural Health Updates Proposed Changes for 2018

Rural Health Care expansion CMS is gathering information through Stakeholder Engagement Listening Sessions have taken place to better understand provider burden and limitations with regards to Rural Health Care. Proposing physician fee schedule changes to expand Rural Provider reimbursement. Identifying differences among rural health care providers, with regards to quality measure reporting.

Care Coordination Services Proposed for 2018 Care Coordination Services Chronic Care Management (CCM) Services General Behavioral Health Integration (BHI) Services Psychiatric Collaborative Care Model (Psychiatric CoCM) Services

Proposed for 2018 The CY 2018 PFS Proposed Rule proposes to: Revise the CCM payment for RHCs and FQHCs, and Establish requirements and payment for general BHI and psychiatric CoCM services furnished in RHCs and FQHCs. CY 2018 Physician Fee Schedule Proposed Rule: https://www.gpo.gov/fdsys/pkg/FR-2017-07-21/pdf/2017- 14639.pdf

GCCC1 –CCM/General BHI services Summary Proposal: 2 new G codes for RHCs and FQHCs for care coordination services. GCCC1 –CCM/General BHI services Paid at the average of CPT 99490, CPT 99487, and HCPCS G0507. Using 2017 rates, payment would be $61.37 for 20 minutes or more of CCM/General BHI services. GCCC2 –Psychiatric CoCM services G0502 and G0503. •Paid at the average of HCPCS code •Using 2017 rates, payment would be $134.58 for initial or subsequent psychiatric CoCM services. https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/FQHCPPS/Downloads/FQHC-RHC-Care-Coordination- Services-Payment.pdf

CMS Rural Health Council Established in 2016, the CMS Rural Health Council focuses on embedding a rural lens in all of the agency’s work with an eye toward improving three dimensions in rural communities: Ensuring access to high-quality health care for all Americans in rural settings. Addressing the unique economics of providing health care in rural America. Brining the rural health care focus to CMS’ health care delivery and payment reform initiatives.

Creating a Shared Vision of Rural Health Care Engaging with stakeholders Rural Solutions Summit Regional Listening Sessions Incorporating feedback into CMS programs and policies Collaborating to achieve success

Questions?

Carmen Irwin Health Insurance Specialist Carmen.Irwin@cms.hhs.gov 214-767-3532