Save the Date!

Fifth Annual Virtual Statewide Quality Forum

October 8, 2025 | noon - 1 p.m.

The North Carolina Department of Health and Human Services Division of Health Benefits and North Carolina AHEC, in conjunction with the five Medicaid managed care standard plans, will host the Fifth Annual Virtual Statewide Quality Forum on October 8 from noon-1 p.m. Topics will include:

• Simplification Updates
• Key Developments on NC Division of Health Benefits
• Key Developments on 2026 Advanced Medical Home Measures and Benchmarking Approach
• Key Developments on NC HealthConnex Updates
• Screen Early, Optimize Health: Proven Strategies for Success

The forum is designed to help providers, practice managers, and quality managers succeed with Medicaid Managed Care quality initiatives. Look for additional details, including how to register, soon.

We hope you can join us!

Today we bring you updates from the latest CMS QPP Newsletter for Small Practices:

CMS Proposes Policy Changes for Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) has issued its Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule, which includes proposed policies for the Quality Payment Program (QPP).

The Notice of Proposed Rulemaking (NPRM) includes proposals for the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs), as well as several Requests for Information (RFIs).

Specifically, we’re proposing policies that:

• Continue the transformation of MIPS through MIPS Value Pathways (MVPs).
• Are responsive to feedback and concerns raised by interested parties.
• Maintain stability within the MIPS program through the established performance threshold.

2026 Policy Proposal Highlights

Key QPP policies that we are proposing in the CY 2026 PFS Proposed Rule include:

• Introducing 6 new MVPs for the 2026 performance year that are related to diagnostic radiology, interventional radiology, neuropsychology, pathology, podiatry, and vascular surgery.
• Introducing a 2-year informational-only feedback period for new cost measures, allowing clinicians to receive feedback on their score(s) and find opportunities to improve performance before a new cost measure affects their MIPS final score.
• Maintaining the current performance threshold policies, leaving the performance threshold set at 75 points through the 2028 performance year.
• Introducing Qualifying APM Participant (QP) determinations at the individual level, in addition to existing determinations at the APM entity level.

Overview of RFIs

We are also seeking feedback on RFIs about the following topics:

• Establishing Core Elements for MVPs, to require reporting on key quality measures within each MVP.
• Establishing a process to assign clinicians to an MVP, to facilitate the most relevant reporting for their scope of care.
• Transitioning to FHIR-based electronic clinical quality measure (eCQM) reporting in quality reporting programs.
• Understanding the current environment, including challenges, with collecting and exchanging high-quality healthcare data.
• Changing requirements for the Query of Prescription Drug Monitoring Program (PDMP) Measure and Performance-Based Measures in the Public Health and Clinical Data Exchange Objective.
  

Medicaid Managed Care Back Porch Chat

Key Updates: Children and Families Specialty Plan (CFSP) Launch, HOP

Thursday, July 31 | noon-1p.m.

NC Medicaid published the 2025 NC Medicaid Standard Plan Performance Comparison Tool and accompanying Technical Guide. The new tool allows Medicaid beneficiaries to compare the performance of the five NC Medicaid Standard Plans.  

The tool enables beneficiaries to make informed decisions about which Standard Plan works best for them. It provides easy-to-read comparisons of how the Standard Plans perform across different domains of health care, including: getting care, care experience, experience with providers, reproductive and sexual health, and children’s health. The complementary technical guide provides details on how NC Medicaid conducted the comparison, and where the data came from.  

Here's one excerpt from the tool:

A Full Star means the health plan performed better than the average of all the Standard Plans

A Half-Filled Star means the health plan performed within the average of all the Standard Plans

An Empty Star means the health plan performed worse than the average of all the Standard Plans

Sources:

NC Medicaid Standard Plan Performance Comparison Tool 2025

NC Medicaid 2025 Standard Plan Performance Comparison Tool Technical Guide

NC Medicaid Quality Management and Improvement webpage

The AHEC Standardized Onboarding and Credentialing program aims to improve the process of placing health science students in clinical placements through partnerships as well as onboarding and credentialing tools.

These tools help reduce the time and resources needed to onboard and credential students to clinical rotations. These tools, as well as support and guidance from AHEC and other partners, can make it easier for small practices to host students, helping to increase opportunities for training, and ultimately increasing clinical capacity. To get started or for more information, please contact Aubrey Delaney, Associate Director Onboarding and Credentialing at Audelaney@wakeahec.org. 

Learn more: Standardized Student Onboarding and Credentialing.

From CMS:

CMS is committed to crushing fraud, waste, and abuse. The WISeR Model, which stands for Wasteful and Inappropriate Service Reduction, will help meet this goal, while supporting people with Original Medicare to receive safe and appropriate care and protecting federal taxpayers.

Through WISeR, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited process for reviewing the medical necessity of select items and services shown to have little to no clinical benefit and that are particularly vulnerable to fraud, waste, and abuse.

With this announcement, CMS has issued a Request for Applications (RFA) for companies interested in participating in the model.

Find more information on the WISeR Model webpage, as well as the model press release and factsheet.

Send questions about the model to WISeR@cms.hhs.gov.

WEBINAR OPPORTUNITY

Remote Patient Monitoring Optimization for FQHCs

June 25, 2025 | noon-1 p.m.

Join us for an exclusive training webinar hosted by NC AHEC Practice Support in collaboration with the NC Community Health Center Association. The training is designed specifically for federally qualified health center staff interested in optimizing or starting remote patient monitoring (RPM) as a solution for improved patient care. RPM is a new healthcare practice that uses digital devices to collect and transmit patient health data to healthcare providers. It allows for continuous monitoring and management of patient’s conditions from a distance. This healthcare practice can work successfully if implemented correctly. 

This session will provide an overview of the latest trends, how to implement in your workflows, and appropriate Medicare/Medicaid billing codes to ensure financial sustainability and accuracy. Register now and take the first step in learning more.  

Register for the RPM Webinar

Excerpt from CMS QPP Small Practices Newsletter:

2025 Consumer Assessment of Healthcare Providers Survey (CAHPS) for MIPS Survey Registration Now Open

Registration is open through June 30, 2025, at 8 p.m. ET for the CAHPS for MIPS Survey for the 2025 performance year. 

Who can register? 

• Groups, virtual groups, and APM Entities that intend to administer the CAHPS for MIPS Survey as 1 of their 6 quality measures for reporting traditional MIPS
• Groups, subgroups, and APM Entities that are registered to report the following MVPs and that intend to administer the CAHPS for MIPS Survey as 1 of their 4 quality measures:
• Adopting Best Practices and Promoting Patient Safety within Emergency Medicine MVP
• Advancing Cancer Care MVP
• Value in Primary Care MVP

 How to Register 

Groups, virtual groups, and APM Entities will register on the QPP website. You’ll need to have the Security Official role to register your organization. Please refer to the QPP Access User Guide (ZIP, 4MB) for information about obtaining a Security Official role for your organization. To register: 

• Sign in to QPP.
• Click Start Registration from the landing page.
• Click Register or Edit CAHPS Registration.

Subgroups interested in administering the CAHPS for MIPS Survey as 1 of their 4 required quality measures will need to complete their MVP registration prior to registering for the CAHPS for MIPS Survey. After completing the subgroup’s MVP registration, they will need to contact the QPP Service Center by email at QPP@cms.hhs.gov, by creating a QPP Service Center ticket, or by phone at 1‑866‑288‑8292 (Monday through Friday, 8 a.m. – 8 p.m. ET) to register for the CAHPS for MIPS Survey.

You must register by 8 p.m. ET on June 30, 2025. 

 Additional Resource

• 2025 CAHPS for MIPS Survey Registration Guide (PDF, 946KB)

Complete one or both of the interactive, self-paced eLearning modules on your computer or mobile device. Earn free contact hours!

PART 1 - About 1 in 10 Americans have diabetes, with 90-95% of those having Type 2 Diabetes. (CDC) The majority of these people receive health care in the primary care setting (Pilla et. al). Physiologically, diabetes affects multiple organ systems, as well as the emotional well-being of the affected person. Medicine regimens can be complex, especially for an older person with other chronic conditions. To enable the practice staff to support the person with Type 2 Diabetes, this course uses case studies of familiar patients seen in primary care. Practical office-based clinical assessment and patient education concepts are presented. Basic pharmacology of diabetes drugs, laboratory tests used to assess and monitor the disease and common physical exam findings are covered. Register online at www.nwahec.org/75805

PART 2 - Managing diabetes requires much more than taking medicines and visiting the primary care provider’s office---lifestyle changes at the heart of a person’s very self are needed. People with diabetes are 2-3 times more likely to have depression than those without diabetes (CDC). Typically considered a lifelong chronic condition, Type 2 diabetes requires the affected person to incorporate it into their self-image and work every day on difficult behavior changes. Mood disturbances may also be the result of physiologic changes caused by the illness, or from medication side effects. Building on the foundation of Part 1 of this series, this module focuses on the impact a diagnosis of Type 2 Diabetes can have on the mental health of patients they see in primary care. Register online at www.nwahec.org/75808

Part 2 builds on the case study presented in Part 1, so you are encouraged (but not required) to take both modules.

There is no charge for either online course. Course registration is generously supported by the Division of Health Benefits.