The proposed rule, which makes payment cuts to the physician fee schedule, includes policies to advance health equity as well as expand access to medical services such as behavioral health care and certain oral health services.
The Centers for Medicare & Medicaid Services (CMS) on Thursday issued the calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) proposed rule, which the agency said would expand behavioral health services, support the Biden Administration’s Cancer Moonshot mission, and improve value-based care.
“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 in a statement. “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.”
The CY 2024 Medicare PFS proposed rule includes the following:
Payment rate updates:
- Proposed payment amounts under the PFS would be reduced by 1.25 percent compared to CY 2023
- An increase in payment for many visit services, such as primary care, which will legally require offsetting and budget neutrality adjustments to all other services paid under the PFS
- A proposed CY 2024 PFS conversion factor of $32.75, which is a decrease of $1.14, or 3.34 percent, from CY 2023
Health equity efforts: CMS is seeking to advance health equity through the coding and payment of several new services to support underserved populations. The agency proposes:
- Payment for certain caregiver training services, in particular circumstances, to ensure practitioners are appropriately paid for engaging with caregivers supporting the treatment plans of individuals with Medicare
- Separate coding and payment for services provided by community health workers, including person-centered planning, health system coordination, promoting patient self-advocacy, and facilitating access to community-based resources to address unmet social needs
- Payment for Principal Illness Navigation services to help patients navigate cancer treatment as well as treatment for other serious illnesses, such as substance use disorder
- Coding and payment for social determinants of health risk assessments, whether as an add-on to an annual wellness visit or during an evaluation and management visit
Oral health services payments: CMS is proposing that payment be made for certain dental services prior to and during certain cancer treatments, such as chemotherapy.
A focus on behavioral health and primary care: CMS said this proposed rule includes some of the most important changes to improve access to behavioral health in Medicare in the program’s history. The agency is seeking:
- To allow marriage and family therapists as well as mental health counselors, including addiction counselors, to enroll in Medicare and bill for their services
- Increased payment for crisis care, substance use disorder treatment, and psychotherapy
- New payment and coding to accurately and appropriately pay for primary care
Other proposals outlined by CMS in the proposed rule include:
- Changes in the assignment methodology of the Medicare Shared Savings Program to improve access for individuals who see nurse practitioners, physician assistants, and clinical nurse specialists for their primary care
- Changes to the financial benchmarking methodology to further encourage ACO participation in vulnerable communities
- An increase in 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
- Changes to align the Quality Payment Program with the Universal Foundation
- Changes to enhance the Medicare Diabetes Prevention Program Expanded Model to increase participation and access in vulnerable communities
For more information, see the CMS fact sheets for the CY 2024 Physician Fee Schedule proposed rule, the CY 2024 Quality Payment Program proposed changes, the proposed Medicare Shared Savings Program changes, and a pdf of the unpublished rule.