The Michigan Primary Care Transformation (MiPCT) Project

CMS FINAL Physician Fee Schedule – 2016 Highlights for MiPCT Practices

•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.

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The Final PFS (Issued 10/30/15)- Implications for the MiPCT

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).

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The Final PFS (Issued 10/30/15)- Implications for the MiPCT

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

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The Final PFS (Issued 10/30/15)- Implications for the MiPCT

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

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The Final PFS (Issued 10/30/15)- Implications for the MiPCT, cont.