CMS 2019 Final Call Letter

Announcement of Calendar Year (CY) 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter    April 2, 2018

For payment year 2019, CMS will implement the updated CMS-HCC model without count variables that was provided in Part I of the Advance Notice for comparison.

"This model incorporates the proposed additional Chronic Kidney Disease, mental health, and substance use disorder conditions, updates the data years used to calibrate the model from 2013 diagnoses predicting 2014 cost to 2014 diagnoses predicting 2015 cost, and selects 2014 diagnoses for calibration with the CPT/HCPCS-based methodology that is used to select risk adjustment eligible diagnoses submitted to the encounter data system. "

See New Coefficients Below:

Encounter Data

CMS is also finalizing the proposal to calculate 2019 risk scores by adding 25% of the risk score

calculated using encounter data and FFS diagnoses (with inpatient RAPS data to supplement encounter data) and 75% of the risk score calculated using RAPS and FFS diagnoses.

 Download the entire Call Letter here

Smoky Mountain Center introduces mental health literacy program

Press release

From Smoky Mountain Center:

Smoky Mountain Center, in collaboration with the Mountain Area Health Education Center (MAHEC*) and Western North Carolina Health Network, is pleased to add up to thirty new instructors to the Mental Health First Aid team in a training session March 3-7, 2014 at the MAHEC Mary C. Nesbit Biltmore Campus.

The MHFA training course is designed to give members of the public key skills to help someone who is developing a mental health problem or experiencing a mental health crisis. Through this program, conducted by the National Council for Behavioral Health, new instructors will be certified to teach the 8-hour course to a variety of audiences. MHFA is one of several evidence-based programs Smoky Mountain Center provides to the community. The program is intended to identify opportunities for early intervention for individuals experiencing mental health concerns.

“We are thrilled to bring Mental Health First Aid to our Western North Carolina communities,” said Elizabeth Flemming, MA, LPC, Continuing Education Planner at MAHEC. “Most people know how to recognize and appropriately react to medical emergencies, but there is little knowledge in the general public about what to do in a mental health crisis.”

“I’d like to see people as familiar with MHFA as they are with CPR,” states Carolyn Dorner, Quality Coordinator at WNC Health Network. “We need to know how to respond when our friends, family, coworkers and neighbors need help.”

Genny Pugh, Senior Director for Community Collaboration at Smoky, said, “Mental Health First Aid is one of several evidence based programs we provide in our communities. Offering Mental Health First Aid classes to citizens across our 23 county catchment supports wellness for individuals and families through early identification and intervention for mental health concerns.

“We’re enthused to welcome MAHEC as a partner in extending mental health first aid across the country” says Linda Rosenberg, MSW, president and CEO of the National Council. “We anticipate the new instructors will have a great impact on the mental health communities throughout Western North Carolina and will be key players in improving mental health literacy nationwide.”

More than 3,700 U.S. instructors are already certified by Mental Health First Aid USA (MHFA-USA)** as instructors in all 50 states, the District of Columbia, and Puerto Rico. Instructors come from a variety of backgrounds, including behavioral healthcare, law enforcement and public safety, universities, faith communities and primary care. Included on SAMHSA’s National Registry of Evidence Based Programs and Practices, studies show that training in Mental Health First Aid builds confidence in helping an individual experiencing a mental health challenge, reduces negative or distancing attitudes towards individuals with mental illnesses, and increases mental health literacy – being able to identify, understand and respond to signs of mental illnesses and substance use disorders.

Smoky Mountain Center manages mental health, substance abuse, and intellectual/developmental disability services in Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey Counties in North Carolina. Access to services is available 24 hours a day, 7 days a week by calling 1-800-849-6127.
*MAHEC was established in 1974 and is a leader in healthcare, education and innovation. Located in Asheville, MAHEC serves a 16-county region in Western North Carolina. It is the largest Area Health Education Center in North Carolina, which evolved to address national and state concerns with the supply, retention and quality of health professionals. MAHEC’s mission is to train the next generation of healthcare professionals for Western North Carolina through quality healthcare, innovative education, and best practice models that can be replicated nationally.

**Mental Health First Aid USA (MHFA-USA) is a collaboration between the National Council for Behavioral Health, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health.

The National Council for Behavioral Health (National Council) is the unifying voice of America’s community mental health and addictions treatment organizations. Together with our 2,000 member organizations, we serve our nation’s most vulnerable citizens — the more than eight million adults and children living with mental illnesses and addiction disorders. We are committed to ensuring all Americans have access to comprehensive, high-quality care that affords every opportunity for recovery and full participation in community life. The National Council pioneered Mental Health First Aid in the U.S. and has trained nearly 100,000 individuals to connect youth and adults in need to mental health and addictions care in their communities.

 http://www.mountainx.com/article/56705/Smoky-Mountain-Center-introduces-mental-health-literacy-program

Boston safety-net hospital adapting OneHealth behavioral platform to medical home

By: Neil Versel | Jul 25, 2013 

OneHealth Solutions, a company that largely has focused on employer groups, is for the first time applying its mobile and Web platform for patient behavior change to primary care, courtesy of a partnership with Boston Medical Center.

The safety-net hospital, an affiliate of Boston University School of Medicine, is adopting the OneHealth system, originally to treat substance abuse, depression and other behavioral issues, to its patient-centered medical home initiative. Boston Medical Center will offer low-income patients access to the OneHealth online and mobile platform to promote self-management of chronic diseases, offer peer support and engage them in between office visits.

“It will be an integral part of the medical home,” said psychologist Dr. Robert L. Sokolove, who is championing the rollout at the 496-bed hospital in Boston’s South End.

“BMC partnering with OneHealth was done to mitigate a very longstanding issue in disease management,” Sokolove told MobiHealthNews. Counseling patients on smoking cessation, obesity, stress reduction and depression is about teaching skills that lead to lifestyle changes. “After the skill sessions have stopped, maintaining the skills, especially a year out, becomes very, very difficult,” Sokolove said.

OneHealth, available through Android or Apple iOS apps or through the Web, is meant to provide patients with information and social support that leads to the maintenance of newly acquired skills, Sokolove explained. He said that upper-middle-class patients tend to have the social support they need, especially as they are treated for depression and diabetes, but the lower-income populations, including immigrants, that frequent BMC tend to lack such networks.

“This can be one small way for removing those barriers to access,” Sokolove said.

He called the social aspect of the mobile platform a “sort of Facebook for patients” that helps them self-manage chronic diseases and reduce anxiety that can lead to poor choices such as smoking or eating unhealthy foods. “Anxiety is reduced by two factors: attachment and mastery,” explained Sokolove. “We feel less anxious when things are predictable.”

What BMC patients do have are mobile phones, and many are starting to acquire smartphones as well, which makes a mobile platform a great means of outreach. “Many of our patients can’t use a desktop because they don’t have a desk, but they do have smartphones,” Sokolove reported.

Solana Beach, Calif.-based OneHealth, launched its OnTheGo native mobile apps, optimized for tablets, in February. “Our mobile has overtaken the Web experience,” according to CEO Bruce Springer.

The company, which was known as OneRecovery until a little more than a year ago, has its roots in treating substance abuse, but has since integrated medical resources with behavioral tools. Springer said that those with chronic medical issues such as diabetes are 50 percent more likely than others to have behavioral comorbidities like depression, and that can lead to poor lifestyle choices that exacerbate chronic conditions.

Springer said he is excited about working with an academic safety-net provider because he believes the OneHealth system works well with Medicaid and uninisured populations and because Boston University offers research opportunities to help validate the technology.

“It’s hard to reach them,” Springer said of patients BMC is trying to bring into medical homes. “It’s hard to get them activated in programs to improve their health.” With providers increasingly taking on financial risk, they have to manage patients outside the hospital or clinic, and mobile technology is an ideal way to do so, Springer added.

Sokolove said there will be a research element “eventually,” but for now, he wants to get the program launched by September for smoking cessation. “What I hope to do is build it out slowly,” Sokolove said, tailoring the language to the right health literacy levels and tweaking the interface so the OneHealth platform is easy to use.

Boston safety-net hospital adapting OneHealth behavioral platform to medical home