The Centers for Medicare & Medicaid Services on Thursday released the calendar year 2024 Medicare Physician Fee Schedule (PFS) final rule, updating Medicare payments and finalizing policies to support primary care, advance health equity, assist family caregivers, and expand access to behavioral and certain oral health care.
The PFS final rule was one of several final rules issued on Thursday that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better access to care, quality, affordability, and innovation.
“The policies announced today aim to strengthen Medicare and advance health equity by expanding access to care and services for people who are part of underserved communities,” said U.S. Department of Health and Human Services Secretary Xavier Becerra in the announcement. “In addition, we are bolstering our commitment to Biden-Harris Administration priorities including behavioral health care, supporting family caregivers, promoting value-based care, and advancing the President’s Cancer Moonshot.”
The final rule:
- Reduces payment amounts by 1.25 percent overall compared to calendar year 2023. However, CMS said it is also finalizing significant increases in payment for primary care and other kinds of direct patient care.
- Overall, the finalized CY 2024 PFS conversion factor is $32.74, a decrease of $1.15, or 3.4 percent, from CY 2023.
- Creates separate 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. CMS will 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.
- Establishes separate coding and payment for community health integration services, which 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. These are the first Physician Fee Schedule services designed to specifically include care involving community health workers, who link underserved communities with critical health care and social services in the community, and expand equitable access to care, improving outcomes for the Medicare population, CMS said.
- Creates coding and payment for social determinants of health risk assessments, which can be provided as an add-on to an annual wellness visit or in conjunction with an evaluation and management or behavioral health visit.
- Sets up coding and payment for principal illness navigation services, which describe similar care navigation services for individuals with high-risk conditions, including cancer. This action will help fulfil the Cancer Moonshot goal of making navigation services available for every American with cancer.
- Finalizes a subset of principal illness navigation services to support individuals with behavioral health conditions through use of auxiliary personnel such as peer support specialists.
- Allows marriage and family therapists and mental health counselors, including eligible addiction, alcohol, or drug counselors who meet qualification requirements for mental health counselors, to enroll for the first time in Medicare starting November 2 and bill for their services starting January 1, 2024.
- Increases payment for crisis care, substance use disorder treatment, and psychotherapy.
- Increases payment for psychotherapy performed in conjunction with an office visit and for Health Behavior Assessment and Intervention services.
- Changes the assignment methodology in the Medicare Shared Savings Program to better promote access to accountable care for individuals who see nurse practitioners, physician assistants, and clinical nurse specialists for their primary care services.
- It also changes the financial benchmarking methodology in the Medicare Shared Savings Program to better encourage participation by accountable care organizations (ACOs) serving complex populations, as well as changes that continue to support ACOs in their transition to digital quality measurement and use of interoperable digital data.
- CMS expects the changes to the Shared Savings Program will increase participation by 10 percent to 20 percent, which will provide additional opportunities for beneficiaries to receive coordinated care from ACOs.
- Retains the performance threshold for the CY 2024-Merit-Based Incentive Payment Systems (MIPS) performance period/2026 MIPS payment year at 75 points. However, over time, CMS plans to set the MIPS performance threshold to better reflect MIPS eligible clinicians’ performance and continue to encourage participation in advanced alternative payment models.
- Finalizes payment for certain dental services linked to different cancer treatments, including, but not limited to, chemotherapy.
- Enhances the Medicare Diabetes Prevention Program (MDPP) Expanded Model to further increase participation and access in underserved communities. CMS will extend the MDPP Expanded Model’s Public Health Emergency Flexibilities for four years, which will allow all MDPP suppliers to continue to offer MDPP services virtually through December 31, 2027, if suppliers maintain an in-person Centers for Disease Control and Prevention organization code.
For more on the final rule, see the CMS fact sheet.