{"id":2285,"date":"2017-10-20T07:51:28","date_gmt":"2017-10-20T13:51:28","guid":{"rendered":"https:\/\/dsiohn098w.mpqhf.org\/blog\/?p=2285"},"modified":"2017-10-20T07:51:46","modified_gmt":"2017-10-20T13:51:46","slug":"care-delivery-requirements-program-year-2","status":"publish","type":"post","link":"https:\/\/dsiohn098w.mpqhf.org\/blog\/care-delivery-requirements-program-year-2\/","title":{"rendered":"Care Delivery Requirements for Program Year 2"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/dsiohn098w.mpqhf.org\/blog\/wp-content\/uploads\/2017\/10\/10.20.2017-NEW-REQUIREMENTS.png\" alt=\"\" width=\"1200\" height=\"300\" class=\"alignnone size-full wp-image-2286\" srcset=\"https:\/\/dsiohn098w.mpqhf.org\/blog\/wp-content\/uploads\/2017\/10\/10.20.2017-NEW-REQUIREMENTS.png 1200w, https:\/\/dsiohn098w.mpqhf.org\/blog\/wp-content\/uploads\/2017\/10\/10.20.2017-NEW-REQUIREMENTS-300x75.png 300w, https:\/\/dsiohn098w.mpqhf.org\/blog\/wp-content\/uploads\/2017\/10\/10.20.2017-NEW-REQUIREMENTS-768x192.png 768w, https:\/\/dsiohn098w.mpqhf.org\/blog\/wp-content\/uploads\/2017\/10\/10.20.2017-NEW-REQUIREMENTS-1024x256.png 1024w\" sizes=\"(max-width: 1200px) 100vw, 1200px\" \/><\/p>\n<h1>Care Delivery Requirements for Program Year 2<\/h1>\n<h5>October 20, 2017<\/h5>\n<h6>Written by Kristen Schuster, Practice Facilitator<\/h6>\n<p>CMS had several announcements and changes for 2018 during the week of October 16th.<br \/>\nThe practice point of contact was sent an important email on October 16th.  This email included: <\/p>\n<p>1) The Amended and Restated CPC+ Participation Agreement (PA)<br \/>\n2) Amended and Restated PA Guidance<br \/>\n3) Program Year (PY) 2 Care Delivery Requirement Guidance <\/p>\n<p>If the appropriate person did not receive this email, log in to the CMS portal and identify the main point of contact that was on the PA.  If you are still unable to locate the email with the attachments contact Telligen support.  The signed PA for PY 2 is due <strong>December 1st, 2017.<\/strong><\/p>\n<p>CMS also announced changes to the Care Delivery Requirements for PY 2.  Please note the changes by Track listed below.<\/p>\n<p><strong>Track 1 Changes<\/strong><\/p>\n<p><strong>Access and Continuity (1)<\/strong><\/p>\n<ul>\n<li><strong>1.3<\/strong>&#8211; Measure continuity of care for empaneled patients by practitioners and\/or care teams in the practice.<\/li>\n<\/ul>\n<p><strong>Care Management (2)<\/strong><\/p>\n<ul>\n<li><strong>2.1<\/strong>&#8211; Use a two-step risk stratification process for all empaneled patients, addressing medical need, behavioral diagnoses, and health-related social needs.<\/li>\n<li><strong>2.2<\/strong>&#8211; Based on risk stratification provide longitudinal care management.<\/li>\n<\/ul>\n<p><strong>Comprehensiveness and Coordination (3)<\/strong><\/p>\n<ul>\n<li><strong>3.1<\/strong>&#8211; Enact collaborative care agreements with at least two groups of specialists identified based on the analysis of CMS and other payer reports.<\/li>\n<li><strong>3.3<\/strong>&#8211; Develop a plan for implementation of at least one option from a menu of options for integrating behavioral health into care, based on an assessment of practice capability and population need.<\/li>\n<\/ul>\n<p><strong>Patient and Caregiver Engagement (4)<\/strong><\/p>\n<ul>\n<li><strong>4.1<\/strong>&#8211; Convene a Patient and Family Advisory Council (PFAC) at least <strong>three<\/strong> times in Program Year 2, and integrate recommendations into care and quality improvement activities as appropriate. <\/li>\n<li><strong>4.2<\/strong>&#8211; Implement self-management support for at least three high-risk conditions.<\/li>\n<\/ul>\n<p><strong>Track 2 Changes<\/strong><br \/>\n<strong>Access and Continuity (1)<\/strong><\/p>\n<ul>\n<li><strong>1.3<\/strong>&#8211; Measure continuity of care for empaneled patients by practitioners and\/or care teams in the practice.<\/li>\n<li><strong>1.4<\/strong>&#8211; Regularly deliver care in at least one way that is an alternative to traditional office visit-based care.<\/li>\n<\/ul>\n<p><strong>Care Management (2)<\/strong><\/p>\n<ul>\n<li><strong>2.1<\/strong>&#8211; Maintain a <strong>two-step<\/strong> risk stratification that takes in to account medical needs, behavioral health, a social needs:<\/li>\n<ul>\n<li>Step 1. Use an algorithm based on defined diagnoses, claims, or other electronic data allowing population-level stratification; and<\/li>\n<li>Step 2. Add the care team\u2019s perception of risk to adjust the risk stratification of patients, as needed.<\/li>\n<\/ul>\n<li><strong>2.2<\/strong>&#8211; Based on risk stratification provide longitudinal care management.<\/li>\n<li><strong>2.3<\/strong>&#8211; For patients receiving longitudinal care management, use a plan of care containing <strong>at least<\/strong> patients\u2019 goals, needs and self-management activities that can be routinely accessed and updated by the care team.<\/li>\n<\/ul>\n<p><strong>Comprehensiveness and Coordination (3)<\/strong><\/p>\n<ul>\n<li><strong>3.3<\/strong>&#8211; Develop a plan to provide comprehensive medication management to patients discharged from the hospital and those receiving longitudinal care management.<\/li>\n<li><strong>3.5<\/strong>&#8211;  Address psychosocial needs for high risk patients.<\/li>\n<li><strong>3.6<\/strong>&#8211; Develop practice capabilities to address the needs of a subpopulation of patients with complex needs that improves the quality of care and utilization.<\/li>\n<\/ul>\n<p><strong>Patient and Caregiver Engagement (4)<\/strong><\/p>\n<ul>\n<li><strong>4.1<\/strong>&#8211; Convene a PFAC at least <strong>quarterly<\/strong> in Program Year 2, and integrate recommendations into care and quality improvement activities, as appropriate.<\/li>\n<li><strong>4.2<\/strong>&#8211; Identify and engage a subpopulation of patients and caregivers in advance care planning.<\/li>\n<\/ul>\n<p><strong>Reminder:<\/strong> Join Mountain-Pacific on October 31st from 12-1PM MST to discuss these changes for 2018.<br \/>\n<strong>Join Here:<\/strong> <a href=\"https:\/\/mpqhf.zoom.us\/j\/645861704\" rel=\"noopener\" target=\"_blank\">https:\/\/mpqhf.zoom.us\/j\/645861704 <\/a><br \/>\n<strong>Call in:<\/strong> 1 646 558 8656<br \/>\n<strong>Meeting ID:<\/strong> 645 861 704<\/p>\n<p>Also, please refer to CPC+ Connect to network with other CPC+ practices utilizing the same EHR for ideas and best practices.  On the Plus Side is a weekly newsletter, emailed to all subscribers that lists upcoming educational events, CPC+ tasks and links to CMS resources.  As always, complete CPC+ information from CMS can be found on the CPC+ Connect Portal.  We encourage you to access the portal and check out all available CMS CPC+ resources. <\/p>\n<p>If you have any questions, or run into issues with any of the CPC+ objectives and would like help please use the \u201cLeave a Reply\u201d section below, or email <a href=\"mailto:kschuster@mpqhf.org?subject=CPC+%20Assistance\" target=\"_blank\">Kristen Schuster<\/a> directly with your questions or comments.<\/p>\n<p><strong>Other Resource Links<\/strong><\/p>\n<p><a href=\"https:\/\/innovation.cms.gov\/Files\/x\/cpcplus-practicecaredlvreqs.pdf\" rel=\"noopener\" target=\"_blank\">CPC+ PY2 Care Delivery Requirements Guidance<\/a><br \/>\n<a href=\"https:\/\/dsiohn098w.mpqhf.org\/blog\/comprehensive-primary-care-plus-cpc-blog\/\">See all CPC+ Blog Posts<\/a><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<p><strong>Subscribe to the HTS CPC+ Blog<\/strong><br \/>\n<a href=\"http:\/\/eepurl.com\/cH6b4n\" class=\"su-button su-button-style-flat\" style=\"color:#ffffff;background-color:#385173;border-color:#2d415c;border-radius:5px\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"color:#ffffff;padding:0px 30px;font-size:22px;line-height:44px;border-color:#74869d;border-radius:5px;text-shadow:0px 0px 0px #f4f4f4\"> Subscribe<\/span><\/a>\n<p>&nbsp;<\/p>\n<hr \/>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.mpqhf.org\/corporate\/wp-content\/uploads\/2017\/02\/Untitled-3-300x95.png\" alt=\"\" width=\"300\" height=\"95\" class=\"alignnone size-medium wp-image-3035\" \/><\/p>\n<div id=\"boxzero\">\n<section id=\"boxone\">\n<p id=\"boxparagraph\"><strong>See a list of upcoming webinars<\/strong><\/p>\n<p><a href=\"http:\/\/www.mpqhf.org\/corporate\/health-and-technology-services\/webinars-and-events\/upcoming-webinars\/\"><span class=\"link-spanner\">See a list of upcoming webinars<\/span><\/a><\/p>\n<\/section>\n<section id=\"boxtwo\">\n<p id=\"boxparagraph\"><strong>Check out any webinars you missed<\/strong><\/p>\n<p><a href=\"http:\/\/www.mpqhf.org\/corporate\/health-and-technology-services\/webinars-and-events\/webinar-materials\/\"><span class=\"link-spanner\">Check out any webinars you missed<\/span><\/a><\/p>\n<\/section>\n<aside id=\"boxthree\">\n<p id=\"boxparagraph\"><strong>See our CPC+ resources<\/strong><\/p>\n<p><a href=\"http:\/\/www.mpqhf.org\/corporate\/health-and-technology-services\/resources\/cpc-resources\/\"><span class=\"link-spanner\">See our CPC+ resources<\/span><\/a><\/p>\n<\/aside>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Care Delivery Requirements for Program Year 2 October 20, 2017 Written by Kristen Schuster, Practice Facilitator CMS had several announcements and changes for 2018 during the week of October 16th. The practice point of contact was sent an important email on October 16th. This email included: 1) The Amended and Restated CPC+ Participation Agreement (PA) [&hellip;]<\/p>\n","protected":false},"author":13,"featured_media":1738,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[135],"tags":[],"class_list":{"0":"post-2285","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-cpc","8":"entry"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Care Delivery Requirements for Program Year 2 - Mountain Pacific Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dsiohn098w.mpqhf.org\/blog\/care-delivery-requirements-program-year-2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Care Delivery Requirements for Program Year 2 - Mountain Pacific Blog\" \/>\n<meta property=\"og:description\" content=\"Care Delivery Requirements for Program Year 2 October 20, 2017 Written by Kristen Schuster, Practice Facilitator CMS had several announcements and changes for 2018 during the week of October 16th. 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