Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

CMS Provides Clarity on $840M Quality Care and Cost Initiative

By Stephanie Reardon

CMS clarified the enrollment process for a quality care and cost initiative, and answer questions before the application process ends on February 5, 2015.

- In October, 2014 the Department of Health and Human Services (HHS) introduced a new initiative to fund fruitful applicants who work with medical providers to reevaluate and restructure their practices. The aim of this funding is to help physicians switch from quantity of care structures, to a patient-focused healthcare system that focuses on quality care. This initiative has a goal to lower costs while improving care., previously outlined this initiative when it was first announced; however, it has been updated frequently since this first announcement to clarify the enrollment process and answer questions before the application process ends on February 5, 2015.

The Center for Medicare & Medicaid Services (CMS) has clarified that the submission process for inclusion in HHS’s $840 million support initiative requires an applicant to use Section V for guidance on what to include within their application. If all of the required information is not included or the required topics are not appropriately addressed, then the applicant may not be accepted.

The Funding Opportunity Announcement (FOA) application is limited to 40 pages which should include a one-page Project Abstract Summary, the Project Narrative and the Budget Narratives. In addition to the 40 pages, a provider’s application should also include the four standard forms.

CMS also clarified that the Budget Narrative, , the yearly breakdown of costs and categories, that is to be included within each provider’s FOA application, cannot be presented in one budget narrative for the entire duration of the initiative period. Instead, a provider’s application must include a yearly breakdown of costs for each budget year for the duration of the project. A provider should also include a detailed cost breakdown by year for each line item outlined in the SF 424A.

According to CMS, a clinical practice is not allowed to participate in more than one Transforming Clinical Practice Initiative (TCPI) funding program. CMS will remove a clinician that joins an Accountable Care Organization or a Medicare Shared Savings Program from the TCPI program because it will count as joining another funding program.

Currently, organizations that are allowed to participate as a Practice Transformation Network are:

  • Associations
  • Clinical Management Organizations
  • Clinical Integration Networks
  • Commercial Insurers
  • Community Mental Health Agencies
  • Delivery System Reform Incentive Payment (DSRIP) Program
  • For-Profit Organizations
  • Groups of Health Networks Collaboratively Independent Hospitals
  • Independent Physician’s Associations
  • Home Health Organizations
  • Hospice Organizations
  • HRSA Funded Health Center Controlled Network (HCCN)
  • Integrated Health Systems
  • Medical Schools
  • Medical Research Centers
  • Physician Groups (any type)

CMS anticipates that the TCPI will utilize measurement for results through quality improvements over time. Providers that apply to participate in TCPI are expected to already have a well-established system of recording and utilizing population health data for patient-focused care and improved outcomes. As time passes, CMS expects that each participating Practice Transformation Network will converge on similar methods to improve these data collection measures.

More information on frequently asked questions can be found on the CMS website.



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