In The News

New AHRQ Publications on Insomnia Disorder

New publications from AHRQ can help clinicians and patients effectively manage insomnia disorder, defined as a long-term condition in which a person has trouble sleeping at least three nights each week for at least three months. The clinical guide Management of Insomnia Disorder in Adults Current State of the Evidence found evidence that cognitive behavioral therapy for insomnia can be effective and safe as a treatment. Some short-term studies found that medications were also effective for treating insomnia, but they have potential side effects. Also available is Managing Insomnia Disorder – A Review of the Research for Adults, a companion guide for patients to support treatment options discussions between clinicians, patients and caregivers.

Explanation of Special Status Calculation; New Accredited Online Course Available

Explanation of Special Status Calculation

The Centers for Medicare and Medicaid Services (CMS) has introduced new information on that indicates whether clinicians have “special status” and can therefore be considered exempt from the Quality Payment Program.

To determine if a clinicians’ participation should be considered as special status under the Quality Payment Program, CMS retrieves and analyzes Medicare Part B claims data. A series of calculations are run to indicate a circumstance of the clinician's practice for which special rules under the Quality Payment Program will affect the number of total measures, activities or entire categories that an individual clinician or group must report. These circumstances are applicable for clinicians in: Health Professional Shortage Area (HPSA), Rural, Non-patient facing, Hospital Based, and Small Practices.

For more information, please visit the Quality Payment Program website.

Now Available: Accredited Online Course – Quality Payment Program 2017 Merit-Based Incentive Payment System: Improvement Activities Performance Category

A new, online and self-paced overview course on the Quality Payment is now available through the MLN Learning Management System. Learners will receive information on:

  • The Improvement Activities performance category requirements, and how this category fits into the larger Quality Payment Program
  • The steps you need to take to report Improvement Activities data to CMS
  • The basics about scoring of the Improvement Activities performance category

This course is the third course in an evolving curriculum on the Quality Payment Program, where learners will gain knowledge and insight on the program all while earning valuable continuing education credit. Keep checking back with us for updates on new courses. First time learners will need to register for the MLN Learning Management System. Once registered, learners will be able to access additional courses without having to register. For information on how to login or find training, please visit our MLN Learning Management System FAQ sheet.

CMS Announcement of Proposed Rule for Implementation of the Medicare Diabetes Prevention Program (MDPP) Expanded Model

On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2018 Physician Fee Schedule (PFS) proposed rule that would make additional proposals to implement the Medicare Diabetes Prevention Program (MDPP) expanded model starting in 2018. The MDPP expanded model was announced in early 2016, when it was determined that the Diabetes Prevention Program (DPP) model test through the Center for Medicare and Medicaid Innovation’s Health Care Innovation Awards met the statutory criteria for expansion. Through expansion of this model test, more Medicare beneficiaries will be able to access evidence-based diabetes prevention services, potentially resulting in a lowered rate of progression to type 2 diabetes, improved health, and reduced costs.

The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of pre-diabetes. The clinical intervention, the result of National Institutes of Health-funded research, consists of a minimum of 16 intensive “core” sessions of a Centers for Disease Control and Prevention (CDC) approved curriculum furnished over six months in a group-based, classroom-style setting that provides practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control. After completing the core sessions, less intensive follow-up meetings furnished monthly will help ensure that the participants maintain healthy behaviors. The primary goal of the expanded model is at least 5 percent weight loss by participants.

The CY 2017 Medicare PFS final rule, published in November 2016, established the expansion and aspects of the expanded model policy framework. The CY 2018 PFS proposes additional policies necessary for suppliers to begin providing MDPP services nationally in 2018, including the MDPP payment structure, as well as additional supplier enrollment requirements and supplier compliance standards aimed to ensure program integrity. Services provided under the expanded model would largely be furnished in-person. We present a new proposal on beneficiary engagement incentives. We also include in this proposed rule amendments on previous policies finalized in the CY 2017 PFS regarding MDPP services and beneficiary eligibility.

CMS will accept comments on the proposed rule until September 11, 2017, and will respond to comments in a final rule. The proposed rule will appear in the July 13, 2017 Federal Register and can be downloaded from the Federal Register (PDF).

Final Recommendation Statement: Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors

July 11, 2017 – The U.S. Preventive Services Task Force released today a final recommendation statement on behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors. The Task Force recommends that primary care professionals individualize the decision to offer or refer adults without obesity who do not have hypertension, dyslipidemia, abnormal blood glucose, or diabetes to behavioral counseling to promote a healthful diet and physical activity. To view the recommendation and the evidence on which it is based, please go to The final recommendation statement can also be found in the July 11 online issue of JAMA.

Now Available: 2017 CMS QRDA III Implementation Guide for Eligible Clinicians and Eligible Professionals, Schematron, and Sample Files

The Centers for Medicare & Medicaid Services (CMS) has published the 2017 CMS Quality Reporting Document Architecture Category III (QRDA III) Implementation Guide (IG) Version 1.0 (7/07/2017) for Eligible Clinicians and Eligible Professionals (EPs) Programs with Schematron and sample files. This version replaces the 2017 CMS QRDA III IG for Eligible Clinicians Reporting v0.1 (12/29/2016).

The 2017 CMS QRDA III IG for Eligible Clinicians and EPs provides technical instructions for QRDA III reporting for the following programs:

  • Merit-based Incentive Payment System (MIPS)
  • Comprehensive Primary Care Plus (CPC+)

The 2017 CMS QRDA III IG for Eligible Clinicians and EPs contains the following high-level changes compared with the reporting specifications in the 2016 CMS QRDA IG:

  • The 2017 IG is based on the Health Level Seven (HL7) QRDA Category III R1, Standard for Trial Use R2.1
  • For MIPS, Advancing Care Information (ACI) measures and Improvement Activities (IA) can be reported using the two new section templates: ACI Section and IA Section, respectively
  • A performance period must now be specified using the Reporting Parameters Act template that is contained within each section template for Quality (electronic clinical quality measures), ACI, and IA

The 2017 CMS QRDA III Schematron provides rules that enforce the conformance statements of the IG. QRDA III submissions to CMS for the 2017 performance period will be submitted through the new Quality Payment Program submissions API or via file upload on the Quality Payment Program website. CMS will provide immediate, clear, and actionable feedback at the time of submission which will enable submitters to be confident that they successfully submitted their data. If there is a problem with the submission, submitters will get the issue specifics right away – and be able to address them immediately. Exact validation feedback provided by the Quality Payment Program may differ, but this Schematron file will validate that a QRDA III file is properly structured and will help with file submission through the Quality Payment Program submission system.

The new Schematron and sample files for this IG replace the 2017 CMS QRDA III Schematrons and Sample Files for Eligible Clinicians Programs v0.1. For more details regarding the changes, visit the “Change Log” sections of the IG.

Additional QRDA-Related Resources:

You can find additional QRDA related resources, as well as current and past implementation guides, on the eCQI Resource Center and the CMS eCQM Library. For questions related to the QRDA Implementation Guides and/or Schematrons, visit the ONC QRDA JIRA Issue Tracker. For questions related to Quality Payment Program/MIPS submissions, visit the Quality Payment Program website or call 1-866-288-8292.

View Recent Quality Payment Program Webinar Recordings Online

Were you unable to participate in a recent Quality Payment Program webinar?

There’s good news: You can view webinar recordings, presentations, and transcripts on the CMS Quality Payment Program Events webpage.

Recent Quality Payment Program webinars include:

CMS encourages you to stay up to date on the Quality Payment Program by visiting the website regularly and subscribing to the Quality Payment Program listserv. To subscribe, visit the Quality Payment Program website and select “Subscribe to Email Updates” in the footer.

For More Information

If you have questions on other topics related to the Quality Payment Program, please contact the Quality Payment Program Service Center at or 1-866-288-8292.

New Special Publication from the NAM Now Available: Effective Care for High-Need Patients

Today, only 5% of patients account for nearly half of the nation's spending on health care. How do we improve care management for these patients while also balancing quality of care and costs?

To advance insights and perspectives on how to improve the care of these high-need patients, the National Academy of Medicine, with the guidance from an expert planning committee, convened three workshops to explore opportunities for improving care and outcomes for high-need patients.

Summarizing and building upon the workshop discussions, Effective Care for High-Need Patients, identifies key characteristics of the high-needs population and introduces a new patient taxonomy that segments high-need patients based on the care they need and how often they need it to help provide better care management to improve their health. It also includes insights into successful models of care and opportunities for a path forward.

Improving care for high-need patients is not only possible--it also contributes to a more sustainable health system. But progress will take a coordinated effort from policy makers, payers, providers, and researchers, as well as patients and their loved ones.

Read the NAM Special Publication.

What do we know about preventing dementia and cognitive decline?

With the rise of dementia and cognitive impairment as national health concerns, there have been a wide range of programs and products, such as diets, exercise regimens, games, and supplements, which claim to keep these conditions at bay. But, how do we know what actually might prevent or reduce risk of cognitive decline or dementia as we age?

To help sort through the data and to understand the current evidence for possible interventions, NIA commissioned a committee of experts through the National Academies of Sciences, Engineering and Medicine to conduct an extensive scientific review and provide recommendations.

The committee did not find sufficient evidence to recommend specific interventions to prevent cognitive decline or dementia. However, they did note “encouraging” evidence for three types of interventions: cognitive training, blood pressure control for people with hypertension, and increased physical activity.

Visit our website to read more about these findings.