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The Michigan Primary Care Transformation (MiPCT) Project. PO Open Forum Webinar July 29, 2014. Post-Demonstration MiPCT. Ongoing “MiPCT V.2”. Potential CMS Year Extension. 1/1/15. Original Demonstration Period. 1/1/12. Proposed Components Maintained via Payer Support :
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The Michigan Primary Care Transformation (MiPCT) Project PO Open Forum Webinar July 29, 2014
Post-Demonstration MiPCT Ongoing “MiPCT V.2” Potential CMS Year Extension 1/1/15 Original Demonstration Period 1/1/12 • Proposed Components Maintained via Payer Support: • Care Management Funding • Central Administration, including • Support Services, Policy Analysis, Communication, Multipayer Coordination and Governance • Data and Reporting • Training and Education • Recruitment of Additional Payers • Practice Growth Over Time: Manage practice participation growth over time to reach State goals
Payer UpdatesPriority Health • Continue to pay G and CPT codes for CM • No member liability (even if member has an HSA) • CM billing to be adjudicated and paid real time (no longer batched retrospectively) • For all lines of business, with potential exception of Medicaid Priority which is still in determination • Also for specialty providers (e.g. oncology, cardiology) • Will pay new CMS Chronic Care code for non-face-to-face care coordination (level to be finalized but expected to be about $42PMPM) • Coordination with G and CPT codes in development • Potential for this to be an alternative to CPT code non-face-to-face reimbursement
Payer UpdatesPriority Health, cont. • In addition, related incentives at two levels: • $3.25 PMPM to practices who attest to having a CM in the office • Practice must provide CM to a minimum of 2% of Priority Health patients • CM does not have to be employed by the practice • Practice must submit examples of care plans • $1 PMPM if practice has PCMH (but no onsite Care Manager) • Priority will continue streamlined MiPCT administrative funding for MiPCT support services to practices and POs
Payer UpdatesMedicaid • $7.50 PMPM equivalent to continue for 2015 • Not dependent on demonstration period extension by CMS • Differential rates for forward years in exploration • Aged Blind and Disabled (ABD) population • Temporary Assistance to Needy Families (TANF) and Healthy Michigan populations
Other Updates • In-Person PO Leader Visioning Session in fall • 2015 Care Management revenue modeling in development • Comments on CMS proposed language for monthly chronic care management code due to dbechel@umich.edu by August 2 • CMS decision on demonstration period extension still in process • Applications for practices who want to participate in patient and family advisor training are due Aug 1 (provides four Practice Learning Credits)
