Group or virtual group can attest to an improvement activity when at least 50% of the clinicians (in the group or virtual group) perform the same activity during any continuous 90-day period within the same performance period. We are finalizing our proposal with modification, such that instead of requiring that a group must perform the same activity for the same continuous 90 days in the performance period as proposed, we are requiring that a group must perform the same activity during any continuous 90-day period within the same performance year.

• Addition of 2 new Improvement Activities.

• Modification of 7 existing Improvement Activities.

• Removal of 15 existing Improvement Activities.

• IA_PM_1: Participation in Systematic Anticoagulation Program

• IA_CC_3: Implementation of additional activity as a result of TA for improving care coordination

• IA_PSPA_14: Participation in Quality Improvement Initiatives

• IA_PSPA_5: Annual Registration in the Prescription Drug Monitoring Program

• IA_PSPA_24: Initiate CDC Training on Antibiotic Stewardship

• IA_BMH_3: Unhealthy alcohol use

• IA_BE_11: Participation in a QCDR, that promotes use of processes and tools that engage patients for adherence to treatment plan

• IA_BE_2: Use of QCDR to support clinical decision making

• IA_BE_9: Use of QCDR patient experience data to inform and advance improvements in beneficiary

• IA_BE_10: Participation in a QCDR, that promotes implementation of patient self-action plans.

• IA_CC_6: Use of QCDR to promote standard practices, tools and processes in practice for improvement in care coordination

• IA_AHE_4: Leveraging a QCDR for use of standard questionnaires

• IA_AHE_2: Leveraging a QCDR to standardize processes for screening

• IA_PM_10: Use of QCDR data for quality improvement such as comparative analysis reports across patient populations

• IA_CC_4: Participation in CMS Transforming Clinical Practice Initiative

CMS is updating § 414.1380(b)(3)(ii)(A) and (C) removing the reference to the four listed accreditation organizations to be recognized as patient-centered medical homes and removing the reference to the specific accrediting organization for comparable specialty practices: To be eligible for Patient-Centered Medical Home designation, the practice must meet one of the following criteria:

• The practice has received accreditation from an accreditation organization that is nationally recognized (such as the four organizations specified for PY 2019);

• The practice is participating in a Medicaid Medical Home Model or Medical Home Model;

• The practice is a comparable specialty practice that has received recognition through a specialty recognition program offered through a nationally recognized accreditation organization; OR

• The practice has received accreditation from other certifying bodies that have certified a large number of medical organizations and meet national guidelines, as determined by the Secretary. The Secretary bus determine that these certifying bodies must have 500 or more certified member practices, and require practices to include the following:

(1) Have a personal physician/clinician in a team-based practice

(2) Have a whole-person orientation

(3) Provide coordination or integrated care

(4) Focus on quality and safety

(5) Provide enhanced access