Payment rate reduced by 1.25% in CMS proposed physician payment rule
CMS is also proposing increases in payment for many visit services, such as primary care, and changes impacting cancer treatment.
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The Centers for Medicare and Medicaid Services issued the calendar year 2024 Medicare Physician Fee Schedule (PFS) proposed rule, with overall proposed payment amounts being reduced by 1.25% compared to CY 2023.
CMS is also proposing increases in payment for many visit services, such as primary care, and these proposed increases require offsetting and budget-neutrality adjustments to all other services paid under the PFS, by law, the agency said.
The proposed CY 2024 PFS conversion factor is $32.75, a decrease of $1.14, or 3.34%, from CY 2023.
WHAT'S THE IMPACT? HEALTH EQUITY
In the realm of health equity, CMS is proposing coding and payment for several new services to help underserved populations, including addressing unmet health-related social needs that can potentially interfere with the diagnosis and treatment of medical problems.
First, CMS is proposing to pay for certain caregiver training services in specified circumstances, so that practitioners are appropriately paid for engaging with caregivers to support people with Medicare in carrying out their treatment plans.
CMS is also proposing separate coding and payment for community health integration services, which would include person-centered planning, health system coordination, promoting patient self-advocacy and facilitating access to community-based resources to address unmet social needs that interfere with the practitioner's diagnosis and treatment of the patient.
According to CMS, these are the first Physician Fee Schedule services designed to include care involving community health workers.
And in accordance with President Biden's cancer moonshot – the goal of giving everyone with cancer access to covered patient navigation services – CMS is proposing payment for Principal Illness Navigation services to help patients navigate cancer treatment and treatment for other serious illnesses. These services are also designed to include care involving other peer support specialists, such as peer recovery coaches for individuals with substance use disorder.
The rule also proposes coding and payment for social determinants of health risk assessments, which could be furnished as an add-on to an annual wellness visit or in conjunction with an evaluation and management visit.
CMS is also proposing that payment can be made for certain dental services prior to and during several different cancer treatments, including, but not limited to, chemotherapy.
BEHAVIORAL HEALTH
According to CMS, the rule also contains important changes to improve access to behavioral health in Medicare. It proposes to allow marriage and family therapists and mental health counselors, including addiction counselors, to enroll in Medicare and bill for their services for the first time. The rule also proposes increased payment for crisis care, substance use disorder treatment and psychotherapy.
As for the Medicare Shared Savings Program – the largest Accountable Care Organization program in the country – CMS is proposing changes to the assignment methodology that it said would better promote access to accountable care for people who see nurse practitioners, physician assistants and clinical nurse specialists for their primary care services.
CMS is also proposing changes to the financial benchmarking methodology to better encourage participation by ACOs serving complex populations. In total, these proposals are expected to increase participation in the Shared Savings Program by roughly 10% to 20%.
In addition, the agency is proposing to increase the performance threshold in the Quality Payment Program from 75 to 82 points for the CY 2024 Merit-Based Incentive Payment System (MIPS) performance period/2026 MIPS payment year.
There are also proposed changes to promote care for individuals with diabetes, by enhancing the Medicare Diabetes Prevention Program (MDPP) Expanded Model to further increase participation and access in underserved communities. This rule proposes to extend the MDPP Expanded Model's Public Health Emergency Flexibilities for four years, which would allow all MDPP suppliers to continue to offer MDPP services virtually using distance learning delivery through December 31, 2027, as long as they maintain an in-person Centers for Disease Control and Prevention organization code.
ON THE RECORD
"At CMS, our mission is to expand access to health care and ensure that health coverage is meaningful to the people we serve," said CMS Administrator Chiquita Brooks-LaSure. "CMS' proposals in the proposed physician payment rule would help people with Medicare navigate cancer treatment and have access to more types of behavioral health providers, strengthen primary care, and for the first time, allow Medicare payment for services performed by community health workers."
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
