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Michael J. Astrue, Commissioner of Social Security, today announced that the agency’s first Extended Service Team (EST) is open for business in Little Rock, Arkansas. The Little Rock EST will make disability decisions for state Disability Determinations Services (DDSs) that are most adversely affected by the flood of new initial disability claims resulting from the economic downturn and from counterproductive furloughs of employees at the state level. Later this year, Social Security will open additional ESTs in Madison, Mississippi; Roanoke, Virginia; and Oklahoma City, Oklahoma. The ESTs are in states that have a history of high quality and productivity, as well as the capacity to hire and train significant numbers of additional employees.

“The strategy behind ESTs builds on our success with National Hearing Centers, where cases are handled electronically from all over the country,” Commissioner Astrue said. “These centralized units have reduced the hearings backlog and improved processing times at some of the hardest-hit hearing offices. This approach clearly works and extending it in this way can help us meet the challenge of unprecedented growth in our disability workloads.”

Social Security expects to receive more than 3.3 million applications for disability benefits this fiscal year (FY), about 700,000 more than in FY 2008. In addition, more than a dozen states are furloughing federally-funded state workers who make disability decisions for Social Security. The combination of increased workloads and state furloughs has resulted in a growing backlog of initial disability applications in state DDSs.

“More Americans than ever are turning to us for help,” said Commissioner Astrue. “I am grateful that Governor Beebe bucked the trend and recognized the value of more of our federally-funded jobs in his state. The opening of the Arkansas EST and our other planned expansions in Mississippi, Virginia, and Oklahoma will significantly benefit disabled workers and their families as well as create new job opportunities to these states during difficult economic times.”

For more information about Social Security’s strategy to address the unprecedented increase in disability benefit applications, go to www.socialsecurity.gov/legislation/testimony_111909.htm.

Medicare covers many of your health care needs. Today’s Medicare is working with private companies approved by Medicare that provide different ways to get your health care and prescription drug coverage in the Medicare Program. The Medicare plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality. Your Medicare plan choices include:

• The Original Medicare Plan – This is a fee-for-service plan that covers many health care services and certain drugs. You can go to any doctor or hospital that accepts Medicare. When you get your health care, you use your red, white, and blue Medicare card.

  The Original Medicare Plan pays for many health care services and supplies, but it doesn’t pay all of your health care costs. There are costs that you must pay, like coinsurance, copayments, and deductibles. These costs are called “gaps” in Medicare coverage. You might want to consider buying a Medigap policy to cover these gaps in Medicare coverage. You can also add prescription drug coverage by joining a Medicare Prescription Drug Plan.

  For more information on the Original Medicare Plan, visit the Original Medicare Plan section of this website.

• Medicare Advantage Plans – Available in many areas. If you have one of these plans, you don’t need a Medigap policy. These plans include:
  • Health Maintenance Organizations (HMO),
  • Preferred Provider Organizations (PPO)
  • Private Fee-for-Service Plans
  • Medicare Special Needs Plans
  • Medicare Medical Savings Account Plans (MSA)

  These plans may cover more services and have lower out-of-pocket costs than the Original Medicare Plan. Some plans cover prescription drugs. In some plans, like HMOs, you may only be able to see certain doctors or go to certain hospitals to get covered services.

  Click here for more information on Medicare Advantage Plans.

• Medicare Prescription Drug Plans – These stand-alone plans add prescription drug coverage to the Original Medicare Plan, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans and Medicare Medical Savings Account Plans. Click here for more information on Medicare Prescription Drug Plans.

The Medicare plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality. To compare your Medicare Health Plan choices, go to the Medicare Options Compare. To compare Medicare Prescription Drug Plans, go to the Medicare Prescription Drug Plan Finder.

Help Paying for Health Care Costs

There are wide ranges of health care coverage choices that may help pay for some of your health care costs. These health care choices work with the benefits you have from Medicare. What you choose will affect how much you pay, what benefits you have, which doctors you can see, and other things that may be important to you. For more information about programs that may help pay for some of your health care costs, please read Section 7 and Section 8 of the Medicare & You 2010 handbook.

Michael J. Astrue, Commissioner of Social Security, today announced the agency is providing helpful health care information and website links to the more than three million individuals who apply each year for Social Security and Supplemental Security Income (SSI) disability benefits. The website links take disability applicants to two U.S. Department of Health and Human Services (HHS) websites – www.healthfinder.gov where they will find information and tools to help them better understand and cope with their conditions; and www.healthfinder.gov/rxdrug where they may be able to get help paying for prescription drugs.

“This year over three million Americans will apply for disability benefits. Whether they meet the statutory test and qualify for benefits or not, almost all of them are facing difficult economic and medical challenges. One of the advantages of our fully electronic system is that our notices can provide applicants with valuable information provided by HHS that might help them make good choices faster,” Commissioner Astrue said. “Twenty five years ago, I had the experience of filing for disability benefits on behalf of my seriously ill father. It would have been a blessing to have had easy access to this kind of important information.”

The website at www.healthfinder.gov provides detailed information about specific diseases. For example, an applicant with breast cancer, rheumatoid arthritis, Alzheimer’s disease, diabetes, or other diseases can go to the site to gather information about diagnosis, symptoms, treatment, ongoing research, and local resources available to people with those diseases. The website at www.healthfinder.gov/rxdrug links people to the Partnership for Prescription Assistance, which directs people to information on reduced cost or free prescription drugs offered by drug companies, state and local governments, and local organizations.

The helpful health care links also are available on Social Security’s website at www.socialsecurity.gov/applyfordisability.

In another key step to further states’ role in developing a robust U.S. health information technology (HIT) infrastructure, the Centers for Medicare & Medicaid Services (CMS) announced today that Vermont’s Medicaid program will receive federal matching funds for state planning activities necessary to implement the electronic health record (EHR) incentive program established by the American Recovery and Reinvestment Act of 2009 (Recovery Act).  Vermont will receive approximately $294,000 in federal matching funds.

EHRs will improve the quality of health care for the citizens of Vermont and make their care more efficient.   The records make it easier for the many providers who may be treating a Medicaid patient to coordinate care.  Additionally, EHRs make it easier for patients to access the information they need to make decisions about their health care.

The Recovery Act provides a 90 percent federal match for state planning activities to administer the incentive payments to Medicaid providers, to ensure their proper payments through audits and to participate in statewide efforts to promote interoperability and meaningful use of EHR technology statewide and, eventually, across the nation.

“We congratulate Vermont for qualifying for these federal matching funds to assist its plan for implementing the Recovery Act’s EHR incentive program,” said Cindy Mann, director of the Center for Medicaid and State Operations at CMS. “Meaningful and interoperable use of EHRs in Medicaid will increase health care efficiency, reduce medical errors and improve quality-outcomes and patient satisfaction within and across the states.”

Vermont will use its federal matching funds for planning activities that include conducting a comprehensive analysis to determine the current status of HIT activities in the state.  As part of that process, Vermont will gather information on issues such as existing barriers to its use of EHRs, provider eligibility for EHR incentive payments, and the creation of a State Medicaid HIT Plan, which will define the state’s vision for its long-term HIT use.

Additional information on implementation of the Medicaid-related provisions of the Recovery Act’s EHR incentive payment program may be found at: http://www.cms.hhs.gov/Recovery/11_HealthIT.asp#TopOfPage

Patients that have similar clinical characteristics and similar costs are assigned to an MS-DRG. The MS-DRG will be associated with a fixed payment amount based on the average cost of patients in the group. Patients are assigned to a MS-DRG based on diagnosis, surgical procedures, age and other information. Medicare uses this information that is provided by hospitals on their bill to decide how much they should be paid. Hospital Compare shows information for each hospital on selected MS-DRGs from October 2007 through September 2008. If a MS-DRG has “Complications” or “Comorbidities” in its title, it means the hospital may have treated more complicated patients.

Because MS-DRGs are highly technical, patients and other consumers may need to work with a doctor or other healthcare provider to understand these terms as well as the payment and volume information. ‘CC’ refers to complications or comorbidities. MCC refers to major complications or comorbidities. When Medicare pays a hospital based on the MS-DRG, it takes into account the following (case mix):

• How bad the illness is or if the patient dies (severity of illness)
• How likely it is that the patient will get better or get worse (prognosis)
• What would happen if the patient does not receive immediate or continuing care (need for intervention)
• How much and what type of service the hospital needed to provide, such as lab work, X-rays or physical therapy (resource intensity)

The payment and volume information is for acute care hospitals. “Critical access hospitals (CAH)”, “Acute Care – VA Medical Centers” and “Children’s Hospitals” are not included because they are paid using another method.

Median Medicare Payments

Median Medicare payments for the same MS-DRG can vary. The median payment refers to the midpoint of all payments to the hospital for a particular MS-DRG, that is, half the payments were lower and half the payments were higher than the median payment. A hospital can get a higher payment for any or all of the following reasons:

• It is classified as a teaching hospital
• It treats a high percentage of low-income patients (disproportionate share)
• It may treat unusually expensive cases (outlier payments)
• It pays its employees more compared to the national average because the hospital is in a high-cost area (wage index). Note: The hospital’s wage index is calculated using the hospital’s payroll records, contracts and other wage related documentation

Range of Payments 25th – 75th Percentile

Hospital Compare lets you compare the hospitals you select with other hospitals in your state and in the nation. The state and national amounts are shown as a range of payments (between the 25th percentile and the 75th percentile). This is the range of payments for the most typical cases treated for the MS-DRG. The information doesn’t include unusually low payments for cases, such as when a patient was transferred to another facility before being fully treated. It also doesn’t include unusually high payments for cases that are more complex and costly to treat. Only one number appears in this field when the 25th and 75th percentiles are the same.

Source : http://www.hospitalcompare.hhs.gov/Hospital/Static/ConsumerInformation_tabset.asp?activeTab=6&language=English&version=default

OHIO: Governor Ted Strickland has signed into law a bill providing temporary extensions of Ohio continuation (mini-COBRA) coverage from 12 months to 15 months, permitting Ohio residents who lose their jobs to take full advantage of the federal subsidies available to help pay for the cost of mini-COBRA, or state continuation coverage. This law brings Ohio into compliance with national standards established by the National Association of Insurance Commissioners (NAIC) to provide uniformity in agent licensure and oversight. Forty-six other states have already adopted these standards.

Results of a clinical trial conducted in a largely self-contained religious community during the 2008-09 influenza season show that immunizing children against seasonal influenza can significantly protect unvaccinated community members against influenza as well. The study was conducted to determine if immunized children could act as a barrier to limit the spread of influenza to the wider, unvaccinated community, a concept known as herd immunity.

Researchers recruited volunteers from 46 Canadian Hutterite religious colonies that have limited contact with surrounding, non-Hutterite populations. A total of 947 children between 36 months to 15 years of age participated in the trial; 502 children in 22 colonies received 2008-09 seasonal influenza vaccine, while 445 youth in the other colonies received hepatitis A vaccine. The hepatitis A vaccine served as a control vaccine for comparison.

In the six months after the children were vaccinated, 119 of 2,326 unvaccinated community members (who were of all ages) developed laboratory confirmed cases of influenza. Of these, 80 of 1,055 were from colonies where children received hepatitis vaccine, while 39 of 1,271 were from colonies where children received the influenza vaccine.

The researchers found that influenza vaccination was 61 percent effective at indirectly preventing illness — that is, protecting via herd immunity — in unvaccinated individuals if they lived in a colony where approximately 80 percent of the children had received flu vaccine. The findings, they write, “…offer experimental proof to support selective influenza immunization of school aged children…to interrupt influenza transmission. Particularly, if there are constraints in quantity and delivery of vaccine, it may be advantageous to selectively immunize children in order to reduce community transmission of influenza.”

Mark Loeb, M.D., of McMaster University, Hamilton, Ontario, led the trial. The research was funded in part by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and by the Canadian Institutes for Health Research.

An illustration showing how vaccination generates herd immunity is available at http://www3.niaid.nih.gov/topics/communityImmunity.htm. Article: M Loeb et al. Effect of influenza vaccination of children on infection rates in Hutterite communities. JAMA 303:943-50 DOI: 10.1001/jama.303.10.943 (2010). Who: NIAID Director Anthony S. Fauci, M.D., and Linda Lambert, Ph.D., chief, Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, NIAID, are available to comment on the study. Contact: To schedule interviews, please contact Anne A. Oplinger, 301-402-1663, aoplinger@niaid.nih.gov.

NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at www.niaid.nih.gov.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2010:

Medicare Premiums for 2010:

Part A: (Hospital Insurance) Premium

• Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
• The Part A premium is $254.00 per month for people having 30-39 quarters of Medicare-covered employment.
• The Part A premium is $461.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B: (Medical Insurance) Premium

Most beneficiaries will continue to pay the same $96.40 premium amount in 2010.  Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium in 2010.  For additional details, see our FAQ titled: “Will my Medicare Part B premium increase in 2010?“

For all others, the standard Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase over the 2009 premium.  The Medicare Part B premium is increasing in 2010 due to possible increases in Part B costs.  If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $110.50 per month.  For additional details, see our FAQ titled: “2010 Part B Premium Amounts for Persons with Higher Income Levels“.

Medicare Deductible and Coinsurance Amounts for 2010:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2010 = $1,100) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period you pay:

• A total of $1,100 for a hospital stay of 1-60 days.
• $275 per day for days 61-90 of a hospital stay.
• $550 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
• All costs for each day beyond 150 days

Skilled Nursing Facility Coinsurance

• $137.50 per day for days 21 through 100 each benefit period.

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

• $155.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $155.00 deductible.)

Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2010 is available in the October 16, 2009 Fact Sheet titled, “CMS Announces Medicare Premiums, Deductibles for 2010” on the www.cms.gov website.

CONNECTICUT: The Human Services Committee is giving strong consideration to two measures that would go a long way toward lowering health care costs and improving health care quality. One bill would use federal funds to create incentives for hospitals to institute a system of electronic medical records in their facilities. By moving away from paper and toward a more technologically advanced system, quality would be improved, with doctors gaining instantaneous access to patients’ medical records. It would also reduce the frequency of adverse drug interactions and unnecessary tests and services, and it would also reduce costs by creating significant new efficiencies.  The Human Services Committee also is considering a bill that would help reduce the current cost shift from public sector health programs to private employers. The bill would release funds previously earmarked for SAGA rate increases. Reducing the current cost shift would allow private-sector employers to better afford health insurance for their employees and decrease the number of uninsured in the state.

The Centers for Medicare & Medicaid Services (CMS) today terminated its contract with Fox Insurance Company.   After an onsite review of the plan and its services, CMS determined that the plan’s significant deficiencies – not meeting Medicare’s requirements to provide enrollees with prescription drugs according to recognized standards of care – jeopardized the health and safety of Fox enrollees.  CMS found that Fox committed a series of violations, including improperly denying its enrollees coverage of critical HIV, cancer, and seizure medications. The termination of the contract is effective immediately.

The immediate termination will not impact or delay access to drugs for the more than 123,000 Medicare beneficiaries currently enrolled in Fox plans. Beginning tomorrow, all enrollees will obtain their drugs through LI-NET, a program run by Medicare and administered by Humana, to ensure that beneficiaries receive their Medicare prescription drugs.    Fox enrollees will be able to choose a new Medicare prescription drug plan through May 1, 2010. Current enrollees who do not choose a plan will be enrolled into a new plan by Medicare.

“The immediate termination of Fox as a Medicare prescription drug plan demonstrates our commitment to protecting the health of some of their most vulnerable enrollees from getting necessary drugs, in some cases life-sustaining medicines. CMS’s immediate action was essential to protect members’ health and safety – an integral part of our contract with all Medicare beneficiaries,” said Jonathan Blum, acting director of CMS’ Center for Drug and Health Plan Choices.   “Fox enrollees also need to know that they are not losing their drug coverage and will continue to have access to needed medicines. We will be sending letters explaining the steps we are taking to ensure they continue to get their medicines.  They can also call 1-800-MEDICARE or their local state health insurance assistance programs if they have questions.”

CMS issued an enrollment and marketing sanction to Fox on Feb. 26, 2010, because the organization was not following Medicare’s rules for providing prescription drug coverage to its enrollees.   After an onsite audit, which ran between March 2 and March 4, CMS found Fox’s problems persisted and it continued to subject its enrollees to obstacles in getting needed and, in many cases, life–sustaining medicines.  CMS also found that many of the obstacles were in place  to limit access to high-cost drugs, which could have led to enrollees’ clinical needs not being met.   In many cases, Fox enrollees were required to have unnecessary and invasive medical procedures before they were able to obtain drugs.  Fox was unable to satisfactorily address these compliance concerns and furnish medicines to its Medicare enrollees.

Among the audit findings CMS found include:

·       Failing to provide access to Medicare prescription drugs benefits by imposing unapproved prior authorization and step therapy criteria that made it more difficult for beneficiaries to get drugs that are protected by law.

·       Not meeting the plan’s appeals deadlines,

·       Not complying with Medicare regulations requiring enrollees to be transitioned to new drugs at the beginning of the new plan year.

·       Failing to notify enrollees about prior authorization and step therapy determinations as required by Medicare.

According to CMS auditors, Fox was unable to satisfactorily address compliance concerns cited in the enrollment and marketing sanction and meet contractual obligations to provide medicines to Medicare beneficiaries enrolled in their plans.

“We take our oversight role of Medicare prescription drug plans seriously,” said Blum.   “We review and take action on all complaints received about Medicare health and drug plans and will take appropriate and immediate actions wherever necessary.”

CMS encourages Medicare prescription drug plan enrollees having concerns with access to drug coverage to contact 1-800-MEDICARE (1-800-633-4227) or the state health insurance assistance program (SHIP) to help get them resolved. Medicare enrollees, their families and their caregivers can contact a SHIP near them by visiting: http://www.medicare.gov/Contacts/staticpages/ships.aspx

Source: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3634

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DISTRICT OF COLUMBIA:  The D.C. Council approved an emergency version of the “Reasonable Health Insurance Premium Increase Emergency Act of 2010.”  The Act applies retroactively to rate filings after January 1, 2009. The bill is pending review by Mayor Adrian Fenty and will be effective upon his approval. The bill would require establishment of either a specific schedule of fees, or a methodology for determining fees, in accordance with actuarial principles for various categories of enrollees, provided that the enrollment fees not be individually determined based on the status of an enrollee’s health. Fees would be prohibited from being excessive, inadequate, or unfairly discriminatory.The Mayor shall reject or issue an order that an approved filing is no longer effective on rates made after Jan. 1, 2009 in excess of 10 percent. The bill also would allow the Commissioner to approve an exemption to the 10 percent cap, permitting an increase of up to 15 percent over the prior year’s rates upon receipt of adequate documentation supporting the requested increase.

CALIFORNIA: The Accountability and Administrative Review Committee chaired by Assemblyman Hector De La Torre is holding a hearing this week to examine the activities of the Department of Managed Health Care and the Department of Insurance. The hearing will focus on how each handled issues surrounding the rescission of policies in the individual market, including settlements reached with health plans. No health plans or insurers were asked to testify, since the hearing is intended to focus solely on the actions of the regulators. Assemblyman De La Torre is running for state Insurance Commissioner, and he is expected to criticize the two regulatory agencies for being soft on health plans and insurers that have rescinded policies in the state. While Aetna has had few rescissions in California, we will monitor the hearing and keep interested parties informed of any downstream impact the hearing may have.

ARIZONA: Bills prohibiting pre-existing condition and pregnancy exclusions in individual policies have been referred to two separate committees, increasing the likelihood that they will not move forward. The non-covered dental service prohibition bill is expected to be favorably amended with a definition of a “covered service” that is broad enough to extend the negotiated contract rates for services that may be excluded by the policy, retaining cost protections for members.

This is a reminder to turn your clocks forward one hour on Sunday, March 14. The transition officially happens at 2:00am local standard time, which becomes 3:00am local daylight time.

The NIMH Annual International Research Conference on the Role of Families in Preventing and Adapting to HIV/AIDS is a three-day conference addressing the importance of family in the fight against HIV/AIDS. Family is defined as a network of mutual commitment. Academic researchers and service providers come together to discuss the most effective approaches to working with families that are infected or affected by HIV/AIDS. This year, the conference will be held in Nashville, TN, and the theme will be HIV Prevention and Support for Families Living in Rural Areas. The first day, Community Day, is focused on working with community providers to respond to the social context of HIV risk and enhancing the role of families in preventing and treating HIV/AIDS. Over the course of the next two days, the latest scientific findings from HIV/AIDS family-based studies will be presented in symposia, workshops, and a poster session.

The goal of this initiative is to describe the health and health care trajectories of individuals with autism spectrum disorders (ASD) and their families, and to evaluate the feasibility of using a large population-based database for research on risk factors for ASD. The most recent prevalence data from the Centers for Disease Control and Prevention (CDC) show that one in 110 children have a diagnosis of Autism Spectrum Disorder (ASD), an increase of 57 percent between 2002 and 2006.

Clearly, ASD is a significant public health challenge.  ASD is characterized by core social and communication deficits.  Additionally, there are numerous reports of co-occurring medical conditions such as gastrointestinal disorders, immune dysfunction, and food sensitivities.  However, there is limited scientific evidence on the physical health correlates of ASD, particularly at a general population level. In particular, we know relatively little about the range of health trajectories of people with ASD, both before and after the initial presentation and diagnosis of ASD. Similarly, we know little about pre- and post-diagnosis patterns of health care use over time among people with ASD.

In this context, there is the need for a large-scale study of the health and health care trajectories of children with ASD and their families. A better understanding of the rate of co-occurring medical conditions in children with ASD and their families, and medical decision-making within these families, will inform health care service policy and planning. Additionally, health conditions may provide clues to the heterogeneity of the disorder by providing phenotypic subtypes that could be the basis for exploring genetic and environmental risk factors for ASD.

Such a Health Outcomes study would employ data on one or more large representative populations in the United States to describe the health and health care trajectories of individuals with ASD and their families. The initial phase of the study would analyze existing data to describe health outcomes and utilization of health care services in this population, both before and after ASD is identified for a given individual or within a given family. The study would also gather data that would determine the feasibility of using the database(s) for further exploration of genetic and environmental ASD risk factors.

NIMH · Development of a Clinically Useful Classification of Mental Disorders for Global Primary Care. This initiative aims to consider whether correspondence can be created between a clinically useful classification of mental disorders for global primary care and the overarching typologies of mental disorders that have already been described and will continue to emerge from NIMH’s Research Domain Criteria (RDoC) project.

Based on clinical utility as an overarching priority, formative field studies will be designed to address three broad goals. Goal 1: How disorder categories should be organized by examining clinicians’ conceptualizations of mental disorders and their clinical management. Goal 2: Which clusters of disorders, conditions, or problems should be included in a diagnostic system to facilitate appropriate identification and treatment of mental and behavioral disorders at each level of care—mental health specialty or primary care.  Studies in primary care settings will focus on obtaining the best coverage of high-incidence and high-resource mental health problems, some of which may be most usefully described at the level of problems or symptom clusters rather than by formal diagnoses. Collaboration with NIMH would focus, in part, on relating this work to the domains emerging from the RDoC project.  Goal 3: How information for each disorder should be presented, especially to primary care health providers and patients, to maximize clinical utility.

Scientific Areas of Interest Include:

• Developing ways to simplify, clarify, and reduce the number of mental disorder diagnoses essential for global primary care;
• Focusing on the extent to which it is possible to develop a clinically useful classification of mental disorders for global primary care that is consistent with current knowledge regarding brain circuits germane to mental disorders, the focus of the RDoC project;
• Examining primary care clinicians’ conceptualizations of mental disorders and their clinical management.

Findings from this initiative may inform the diagnosis of mental disorders and interventions for them in clinical settings across the United States and its territories.