March 22, 2019 – PA Pain

PRESIDENT’S MESSAGE Thomas J. Madejski, MD MSSNY President MSSNY eNews March 22, 2019 Volume 22  Number 12

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Colleagues:

The complaints we receive of misguided prior authorization hassles continue to grow, with deleterious effects on the health of our patients and reducing our satisfaction with being able to provide good quality care to our patients. I spent substantial time on the phone today trying to get authorization for buprenorphine for treatment of pain for one of my patients. This was denied because I did not indicate they had a substance use disorder which they do not really have but are habituated to narcotics. Buprenorphine may be safer for long-term regimen for patients who require Opioid medication for chronic pain. My staff and I spent over an hour going through the regular approval process and unfortunately, similar to my experience a few weeks ago, I had difficulty reaching one of the medical directors to discuss the patient. I finally did receive a call from a pharmacist. She is not a trained clinician to prescribe medication and really was unable to comprehend the needs of my patient. She was very pleasant and hopefully will arrange for the medical director to contact me so that my patient can get the proper care that she needs.

Rationing by inconvenience needs to stop. We need to fix the system. The time has come to finally enable independently practicing physicians to have the right to collectively negotiate contracts with health insurance companies.

A recently released American Medical Association (AMA) survey reported that 91% of responding physicians said that the prior authorization process delays patient access to necessary care; with more than 25% of the respondents indicating that a PA process led to a serious adverse event. Moreover, 86% said that burdens associated with prior authorization were high or extremely high; and 88% reported that these PA requirements had increased in the last 5 years.

Legislation on the Way

During our advocacy day on March 6, we were pleased by the commitment demonstrated by Assembly Health Committee Chair Richard Gottfried and Senate Health Committee Chair Gustavo Rivera to advancing legislation (A.2393/S.3462) they sponsor to enable physicians to collectively negotiate patient care terms with market dominant health insurance companies.

The bill is based upon the “state action doctrine”, a concept articulated by the US Supreme Court several decades ago, which enables a State to permit conduct within its borders that would otherwise be prohibited by antitrust law to vindicate a legitimate public interest provided the state closely monitors this conduct.  In this case, the public interest is preserving the ability of physicians (and other health care practitioners) to be able to fairly negotiate with insurers who have a dominant market positions to ensure patients can receive the timely care they need and deserve.

The bill would require the Commissioner of Health to oversee such negotiations, including permitting such negotiations to go forward in the first instance and approving whatever is ultimately agreed to by the parties. In previous legislative sessions, the bill would advance from the Health committees of the Assembly and Senate to their respective house fiscal committees, but would advance no further.

Help Us to Help You

This is where we need your help.  Please urge your legislators to sign on as a co-sponsor to this critically important legislation.

You can send a letter to your local Assemblymember and Senator here.

Right now, there are nearly 60 co-sponsors of this legislation in the Assembly (please click here for a full list) but it would stand a better chance of being passed if we can increase that number.

Face to Face Meetings Have Big Impact

Furthermore, while several Senators have indicated their conceptual support for the legislation, none have officially joined as co-sponsors.  We need your help to have Senators add their names to be listed on this bill as a co-sponsor.  MSSNY staff and I had a telephone conference with county and specialty society leaders to coordinate activity within your home district to visit legislators and talk with them about the issues that we have concerns about. Face-to-face meetings with your legislators are the best way to move our agenda forward. Please contact your county society to coordinate activity in the home district.

Once the State Budget is completed by (hopefully) April 1, the Legislature will turn in its attention to other non-fiscal policy items.  Please help to ensure that this item will become a legislative priority for the Assembly and Senate.

Comments? comments@mssny.org; @mssnytweet; @TomMadejski

Thomas J. Madejski, MD
MSSNY President

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Capital Update

Legislative, Governor State Budget Negotiations Enter Homestretch; Please Contact Your Legislators on Key Issues
With a State Budget due by April 1, the Assembly, Senate and Governor are entering into the final days of negotiations trying to finalize the Budget. Here is a quick synopsis of some of the top issues being advocated by your Medical Society.

MEDICAID – Both the Assembly and Senate rejected the proposed estimated $80/patient Medicaid cut for deductibles for patients covered by Medicare and Medicaid.  Moreover, the Assembly and Senate both rejected the 0.8% across the Board Medicaid payment cut.   The Assembly and Senate also rejected the proposed repeal of the “prescriber prevails” protections in Medicaid.

MSSNY President Dr. Thomas Madejski issued a statement praising the Assembly and Senate for taking these actions: Press Release:

Please click here: to send a letter to your legislators and the Governor urging that they continue the fight to prevent these cuts.

LEGALIZING RECREATIONAL MARIJUANA – The Assembly and Senate did not include the Governor’s proposal to legalize “adult use” or recreational marijuana in its Budgets, though leadership in both Houses have publicly stated their desire to continue working with the Governor on legislation to enable such use.  This week MSSNY participated in a press conference with a diverse array of organizations including the PTAs, Substance abuse treatment providers, County Health Officials, and Sheriffs Please click here: urging that this proposal be removed from State Budget negotiations.

Please continue to urge your legislators to remove “adult use” marijuana from Budget consideration here:

PUBLIC HEALTH

• This week the Senate and Assembly passed legislation to create a Maternal Mortality Review Board (A.3276, Joyner/S.1819, Rivera) instead of acting on the Governor’s Budget proposal (see related article).

• The Senate accepted the Governor’s recommendation to raise the age of tobacco/e-cigarette sales from 18-21. The Assembly did not, because they already passed “stand-alone” legislation on this issue (A.558, Rosenthal).

• The Senate accepted the Governor’s behavioral health insurance parity reforms in its one-House Budget including elimination of prior authorization for medication assisted treatment.  The Assembly did not include this proposal, but intends to advance their own legislation. (see related article)

EXCESS INSURANCE – Both the Assembly and Senate supported the continued historical funding for the Excess Medical Malpractice Insurance Program that had been proposed in the Governor’s Budget

PBMs – The Senate accepted the Governor’s recommendation to license PBMs, and including provisions to enhance penalties for non-compliance.  MSSNY supports this proposal.  The Assembly did not include it in their one-house indicating that it will pursue “stand alone” legislation to regulate PBMs in New York State.

WORKERS’ COMP – The Assembly rejected the Governor’s proposal to significantly expand the use of non-physician use in Workers’ Compensation that has been opposed by MSSNY (due to the lack of provisions regarding how such practitioners would coordinate with physicians to manage the patients’ care and complete the necessary paperwork).  However, the Senate accepted the approach. Please urge your legislators to continue to oppose this proposal here: (DIVISION OF GOVERNMENTAL AFFAIRS)

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NYS Legislature Passes Bill To Create A Maternal Mortality Review Board
The New York State Legislature this week passed a measure supported by MSSNY and ACOG, District 2 to establish a Maternal Mortality Review Board for the purposes of reviewing data and information related to maternal mortality and morbidity in New York State.  The board will also assess the cause of death and analyze any possible preventable factors in order to develop strategies for reducing the risks of harm and death.  

New York currently ranks 30^th out of 50 states in maternal death rate which is compounded by significant racial and ethnic disparities.  The bill, S. 1819/A. 3276-A, sponsored by Senator Gustavo Rivera and Assemblywoman Latoya Joyner, will now go to Governor Andrew Cuomo for his signature.  The Governor had also called for the creation of a Maternal Review Board within the context of his budget.  The Governor also released a report last week on the status of maternal mortality in NYS last week.  According to the report, “In NYS, the maternal mortality rate for black women was 51.6 deaths per 100,000 live births, compared to 15.9 deaths per 100,000 live births for white women in 2014-2016. Black women are approximately three times more likely to die than white women”.  MSSNY issued a statement praising the Legislature for passing this legislation, and the Governor for advancing this issue. Click here. MSSNY’s Committee on Health Disparities, in collaboration with the NYS Department of Health, will also conduct a two hour CME program on maternal mortality on April 12 at the MSSNY House of Delegates. (CLANCY)

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Nursing Homes Exemption From E-prescription Requirement Ready For Executive Action
Both the Senate and Assembly have passed legislation that would exempt for two years nursing home oral medication prescriptions from the state requirement that all prescriptions be electronically submitted. Senator Rivera’s S.4183 and Assemblyman Gottfried’s A.1034-A are now ready to be sent to the governor for his signature. MSSNY’s Long-Term Care subcommittee has been a strong supporter of this legislation because nursing homes present unique circumstances that often makes compliance with the current e-prescription mandate impractical. This legislation will allow for time to rectify the situation. In nursing homes, physicians are not physically present 24 hours a day, so RNs are allowed to take orders for medication for physicians safely and without delay for the residents who need them. In these instances, the physician would then sign the oral order within 48 hours. This legislation would extend to March 2021 an already existing exemption established by the NYS Department of Health that is due to expire later this year. (AVELLA)

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Physicians Urged to Contact Legislators to Support Enactment of Behavioral Health Insurance Parity Reforms As Part of 2019-20 Budget
With just a few days left until a State Budget is due to be enacted by the Legislature and Governor, physicians are urged to advocate to their legislators that they include the extensive Behavioral Health Insurance Parity Reforms (BHIPR) that have been proposed in the Governor’s Budget.  A letter can be sent from here.  MSSNY has been working with the New York Psychiatric Association and other patient advocacy groups in support of this legislation.The proposed reforms would expand upon New York’s existing parity laws and help to curtail health insurer practices that restrict New Yorkers suffering from Mental Health Conditions (MHCs), Substance Use Disorders (SUDs) and Autism Spectrum Disorders (ASDs), from accessing their health insurance benefits for care and treatment. Among the important proposed reforms include:

• Prohibiting prior authorization for medication assisted treatment;
• Requiring that clinical review criteria used by health insurers be approved by the Commissioner of the OMH or designated by the Commissioner of OASAS;
• Requiring that medical necessity criteria with respect to benefits for MHCs/SUDs and ASDs be made available to the physician or patient upon request;
• Prohibiting an insurer from taking any adverse action in retaliation for the physician filing a complaint, making a report, or commenting to a government body regarding policies and practice that violate this statute.

While there is a possibility that similar legislation could be taken up outside of the State Budget, there is concern that any delay in the enactment of the BHIPR could delay the effective date by a whole year –
leaving individuals and families vulnerable to utilization review and other practices that may not comply with the federal and state MH/SUD, ASD parity laws. (AUSTER)

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Pre-authorization Prohibition for Medication Assisted Treatment Advances in the Assembly
Assemblyman Dan Quart’s A.2904 has passed through the Insurance and Codes committees and has advanced to third reading, ready for a vote in the Assembly. The bill would require health insurers to provide patient access, without prior authorization requirements, for initial and renewal prescriptions for buprenorphine and long-acting injectable naltrexone for the treatment of substance abuse disorders. In 2016, this policy was implemented for Medicaid, but not for commercial insurers. The purpose of this bill is to establish parity for all patients in New York by ensuring that addicted persons with commercial insurance coverage can access medication assisted treatment as prescribed by their health care providers without unnecessary barriers.  A similar provision was included in the Governor’s budget proposal. It was included in the Senate’s one-house budget proposal but removed from the Assembly’s one-house budget. (CLANCY, AVELLA)

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MSSNY CME Webinar Health Matters For Women Registration Now Open
The Medical Society of the State of New York is proud to announce a live continuing medical education (CME) webinar on a women’s health topic entitled “Health Matters for Women: Endometriosis” on Tuesday, April 23rd, 2019 from 7:30 AM to 8:30 AM for all physicians and other health care providers. Registration for the webinar is now open.

Health Matters for Women: Endometriosis.  Register here.
When:  Tuesday, April 23^rd at 7:30am
Faculty: Lisa Eng, DO

Educational Objectives:

Review potential causes of pelvic pain and discuss how to identify endometriosis

Discuss the benefits and risks as well as the efficacy and limitations of available medical therapies for long-term treatment of endometriosis

Discuss implementation of individualized endometriosis treatment plans and options

The Medical Society for the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credit TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. (ULUKAYA)         

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Register Now for Veterans Matters: PTSD & TBI in Veterans Webinar
There is a direct connection between traumatic brain injury (TBI) and PTSD.  Learn more about signs and symptoms at MSSNY’s April 4^th webinar.

Veterans Matters: PTSD & TBI in Veterans. Register here.
When:  Thursday, April 4^th at 7:30am
Faculty: Thomas Madejski, MD

Educational Objectives:

Identify signs and symptoms of PTSD & TBI

Examine evidence-based treatment modalities for PTSD & TBI

Explore military culture and methods to overcome unique barriers to treatment intrinsic to military culture.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. (HOFFMAN)

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Registration Now Open for Medical Matters: Disaster Medicine: Every Physician’s Second Specialty

The Medical Society of the State of New York will conduct a webinar entitled Disaster Medicine: Every Physician’s Second Specialty on March 27, 2019 at 7:30am.

Medical Matters: Disaster Medicine: Every Physician’s Second Specialty
Register here.

When:  Wednesday, March 27^th @ 7:30am
Faculty: Lorraine Giordano, MD, FACEP, FAADM

Educational Objectives:

Identify core preparedness competencies every physician should know

Explore essential elements of preparedness plans for staff, patients, and family

Describe available courses, resources and organizations to obtain disaster preparedness education and training.  

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. (CLANCY, HOFFMAN)

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CME at MSSNY 2019 House of Delegates
MSSNY is proudly offering the following CME seminars at the 2019 House of Delegates in Tarrytown on Thursday April 11^th and Friday April 12^th: 

Thursday April 11^th 1:00-2:00pm:

Medical Matters: What’s Your Diagnosis? Infectious Diseases -Register here.
Faculty: William Valenti, MD

Educational Objectives:

Identify the modes of transmission of infectious agents

Discuss presumptive treatment of infectious diseases in advance of diagnostic testing results

Describe two scenarios and review questions and answers 

Thursday April 11^th 2:00-3:00pm:

Veterans Matters: The Special Mental Health Needs of Women Veterans
Register here.
Faculty: Malene Ingram, MD, Lt. Col. US Army Reserves

Educational Objectives:

Review how the increased role of women in the military has impacted their mental health

Describe mental health concerns unique to women veterans and how to identify and treat them

Identify the barriers that women veterans face in getting the specific care they need 

Friday April 12^th 1:00-2:00pm

Health Matters for Women: Myalgic Encephalomyelitis and Fibromyalgia
Register here.
Faculty: Florence Shum, DO

Educational Objectives:

Review potential causes of chronic diffused pain and fatigue

Discuss how to accurately diagnose Fibromyalgia and Myalgic Encephalomyelitis

Discuss treatment options for Fibromyalgia and Myalgic Encephalomyelitis

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 creditsä.  Physician should only claim credit commensurate with the extent of their participation in the activity. 

Friday April 12^th 2:00-4:00pm

Improving Maternal Mortality Trends in New York State – Seminar and Panel Discussion- Register here.

Faculty: Linda Clark, MD, Lisa Eng, MD, Kenyani Davis, MD & Lauren Tobias, Director, Division of Family Health, NYS DOH

Educational Objectives:

Review maternal mortality trends in NYS

Examine racial disparities around maternal morbidity and mortality

Identify potential practice models to improve patient outcomes

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The Medical Society of the State of New York designates this live activity for a maximum of 2.0 AMA/PRA Category 1 creditsä.  Physician should only claim credit commensurate with the extent of their participation in the activity.

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For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:

pschuh@mssny.org	mauster@mssny.org	pclancy@mssny.org	mavella@mssny.org
charring@mssny.org

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eNews

New York Hospital Settles With Cerner Over Billing Problems: 5 Things to Know
Glen Falls (N.Y.) Hospital has reached a settlement with Cerner over losses it sustained when Cerner’s billing system did not work, according to The Post-Star (3/18).

Five things to know:

1. Glens Falls Hospital President and CEO Dianne Shugrue announced the settlement in an ad in The Post-Star. However, the ad didn’t include the terms of the settlement or when it was reached.
2. The hospital ran the ad after The Post-Star published a report detailing “collection issues” the hospital experienced after implementing a new Cerner billing system in November 2016.
3. According to an audit report cited by The Post-Star, Glens Falls Hospital was unable to collect on $16.3 million in bills in 2016, and that number rose to $54 million in 2017. The auditors attributed $38 million of the increase to “collection issues” caused by the switch to Cerner.
4. The hospital’s ad said the billing problems lasted for two years. “It was a serious, short-term issue and it’s fixed,” Ms. Shugrue said in the ad. Ms. Shugrue told The Post-Star the terms of the hospital’s settlement with Cerner are confidential. She said both parties were satisfied by the settlement.
5. Regarding the settlement, a Cerner spokesperson issued the following statement to Becker’s: “The hospital remains a valued partner. The matter was previously resolved. We continue to work together to provide care to the community.” (Beckers’ Hospital Review 3/19)
   

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FDA Approves Brexanolone as First Medication for Postpartum Depression
The New York Times (3/19,) reports the Food and Drug Administration approved Zulresso (brexanolone) for postpartum depression. The article points out that Zulresso is the first FDA-approved drug for the condition and “works very quickly, within 48 hours.”

The AP (3/19) reports Zulresso is “an IV drug given over 2 ½ days,” and “will cost $34,000 without insurance, plus costs for staying in a hospital or infusion center.” The article adds that “postpartum depression affects about 400,000 American women a year,” and that while “it often ends on its own within a couple weeks…it can continue for months or even years.”

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Join the Fight for Your Profession!  Physician Dinner Reception in Williamsville, Thursday, March 28th to Benefit MSSNYPAC
Dr. Rose Berkun and Dr. John Gillespie to host a dinner reception in support of MSSNYPAC at the home of Dr. Berkun on Thursday, March 28, 2019 from 6-8pm. View Invitation or visit ww.mssnypac.org/events.  Donation of $99/person to MSSNYPAC is suggested and RSVPs can be made to nadolnyc@wnydocs.org or by calling 716-852-1810.

MSSNYPAC is the non-partisan political arm of the Medical Society of the State of New York which provides New York State physicians with the opportunity to build and strengthen relationships with elected leaders in the New York State Legislature and statewide offices. Joining with your colleagues to express your ideas about to inform and shape the policy decisions being made affecting physicians and the patients to whom they provide care is a critical aspect of the practice of medicine.  We thank you for adding your voice and for investing in the future of medicine. If you are unable to attend but still wish to support, visit www.mssnypac.org/contribute. Thank you.

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New Guidelines Back off Aspirin for Primary Cardiovascular Prevention
New guidelines say that daily, low-dose aspirin should be used infrequently to prevent primary cardiovascular disease. The American College of Cardiology and the American Heart Association conclude that aspirin should be reserved for people with the highest cardiovascular risk and the lowest risk for bleeding.

The guideline categorically recommends against aspirin use in those over age 70 and in those at high risk for bleeding, such as patients with chronic renal disease or thrombocytopenia. The guidelines were published in JACC and Circulation and presented at ACC’s annual meeting.

Among the groups’ other recommendations:

• For patients with type 2 diabetes and other cardiovascular risk factors, metformin is the first-line treatment. GLP-1R agonists and SGLT-2 inhibitors may now be considered to help reduce CVD risk.
• Adults should aim to get at least 150 minutes of moderate or 75 minutes of vigorous physical activity a week, which is consistent with prior guidance.
• Statins are recommended with lifestyle changes for patients with elevated LDL levels (at or above 190 mg/dL), type 2 diabetes, or other cardiovascular risk factors.

Guideline in JACC

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EHRs Not Living Up To Their Promise, Say Some Healthcare Providers
In an over 8,000 word article, Fortune (3/18) and Kaiser Health News report on the growing utilization of electronic health records (EHRs) and some of the associated problems.

The article suggests that when EHRs were adopted they were promoted as a way to make healthcare more efficient, but many healthcare providers say they have had the opposite effect. The article mentions that federal officials, including CMS Administrator Seema Verma and officials at the Food and Drug Administration, have criticized the implementation of EHRs and called for more oversight.

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Insurers, Hospitals Spar Over Surprise Billing: 8 Things to Know
As federal lawmakers work to reach a consensus on a surprise billing solution, insurers and hospitals are debating the issue.

Eight things to know:

1. Representatives of employees, large and small American businesses, health insurance providers and brokers sent a letterMarch 18 urging congressional leaders to act this year to pass legislation that will protect patients from surprise medical bills and reign in rising healthcare costs.
2. The letter — which was signed by nearly 20 groups, including America’s Health Insurance Plans and BlueCross BlueShield Association — said surprise billing legislation should protect patients by banning physicians from sending such bills to patients in situations of emergency, involuntary care, or situations where the patient was unable to choose their provider.
3. It also advocates for requiring that facilities notify patients of whether their physician is in the insurance company’s network and potential options for receiving care from a different provider, without requiring patients to agree to out-of-network care.
4. Authors of the letter said surprise billing legislation should set reimbursement rates that won’t increase premiums or affect access to care “by basing amounts on market rates determined by reasonable, contracted amounts paid by health insurance providers to similar doctors in a geographic area or a percentage of Medicare.”
5. The authors said legislation should also make sure these protections apply to all health plans, including self-funded plans.
6. The letter opposes using arbitration processes that can keep patients in the middle of disputes between the service provider and insurer and result in higher coverage costs.
7. Commentingon the letter, AHA President and CEO Rick Pollack and Federation of American Hospitals President and CEO Chip Kahn said, “Beyond protecting patients and ensuring adequate health plan provider networks, it is essential that insurers and providers of care retain the ability to negotiate appropriate payment rates. Not only is it a dangerous precedent for the government to start setting rates in the private sector, but it could also create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks.”
8. Six national healthcare groups, including the AHA and the FAH, last month penned their own letter to Congress outlining principlesfor lawmakers to consider amid their efforts to eliminate surprise billing. (Becker’s Hospital CFO report)
   

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You Have 2 Weeks to Submit MIPS Year 2 (2018) Data for the QPP
The data submission deadline for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in Year 2 (2018) of the Quality Payment Program is two weeks away. Data can be submitted and updated any time until 8:00 p.m. ET on Tuesday, April 2, 2019.

CMS Web Interface users need to report their Quality performance category data by 8:00 p.m. EST on March 22, 2019. Clinicians who reported Quality measures via Medicare Part B claims can sign in to qpp.cms.gov to view current performance based on claims that have been processed by your Medicare Administrative Contractor.

If you are working with a third-party intermediary to submit data on your behalf, we encourage you to sign in to the Quality Payment Program website during the submission period and review the submission for accuracy. Data cannot be resubmitted after the submission period closes.

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How to Sign-in to the QPP Data Submission System to View or Submit Data
To sign in to qpp.cms.gov and submit data (or view data submitted on your behalf), you need:

• An account (user ID and password)
• Access to your organization

If you’ve signed in to qpp.cms.gov before or have an account with one of the PV/PQRS roles that lets you submit QPP data, you can use those credentials (user ID and password) to sign in at https://qpp.cms.gov/login.

If you’ve never signed in to qpp.cms.gov before, or don’t have an account with one of the PV/PQRS roles that lets you submit QPP data, you’ll need to create an account before you can sign in. Review the QPP Access User Guide and click Register on the sign in page so you can sign in to submit, or view, data.

Note: Clinicians who are not sure if they are eligible to participate in the Quality Payment Program can check their eligibility status using the QPP Participation Status Tool.

For More Information

To learn more about how to submit data, please review the 2018 MIPS data submission FAQs, User Guide and video series available in the QPP Resource Library.

Questions?

If you have questions about how to submit your 2018 MIPS data, contact:

• • The Quality Payment Program by phone: 1-866-288-8292/TTY: 1-877-715-6222; or email: QPP@cms.hhs.gov
  • Your local technical assistance organization
    

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