In a significant stride towards improved healthcare, the Centers for Medicare & Medicaid Services has unveiled its calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) proposed rule. The comprehensive update outlines a vision for improved coverage, increased access, and more equitable healthcare.
- New Codes and Payments for Underserved Populations: To bridge healthcare disparities and extend crucial medical assistance to those in need, CMS proposes coding and payment for new services tailored to underserved populations.
- Caregiver Training Coverage: Recognizing the critical role of caregivers, CMS proposes covering the cost of caregiver training services under specified circumstances. This aims to ensure practitioners are appropriately compensated for guiding caregivers in assisting Medicare beneficiaries with their treatment plans.
- Community Health Integration: A significant proposal redefines how healthcare services are coded and compensated. CMS envisions introducing codes and payments for services focusing on holistic well-being, including patient-centered planning, coordination with healthcare systems, and access to local support networks.
- Principal Illness Navigation: CMS suggests a payment network for Principal Illness Navigation services. Patients with serious illnesses, including cancer, will receive support and guidance to navigate their treatment journey.
- Assessment of Social Factors Affecting Health: Coding and payment for social determinants of health risk assessments are being proposed. These assessments serve as an add-on to wellness or evaluation and management visits, contributing to comprehensive care.
- Expanded Access to Mental Health Services: CMS aims to broaden practitioner enrollment by allowing marriage and family therapists, mental health counselors, and addiction counselors to enroll in Medicare and bill for their services. The proposed changes also elevate payment rates for crucial services such as crisis care, substance abuse disorder treatment, and psychotherapy.
- Medicare Shared Savings Program Enhancements: Changes to the Medicare Shared Savings Program will enable nurse practitioners, physician assistants, and clinical nurse specialists to play more pivotal roles. With refined measures to gauge financial performance, CMS seeks to drive more patients to coordinated care models and foster access to accountable care.
Meena Seshamani, MD, CMS Deputy Administrator and Director of the Center for Medicare, summarizes the proposed changes, “If finalized, the proposals in this rule ensure the people we serve experience coordinated care focused on treating the whole person, considering each person’s unique story and individualized needs — physical health, behavioral health, oral health, social determinants of health, and are inclusive of caregivers, which are all so important to providing the care that people with Medicare deserve.”
With these changes, CMS aims to reshape the healthcare landscape, prioritizing personalized and holistic care for Medicare beneficiaries.