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Tuesday, September 26, 2023

CMS Pronounces Proposed Rule for 2024 Medicare Doctor Price Schedule


On July 13, 2023, the Facilities for Medicare & Medicaid Providers (“CMS”) issued its proposed rule (the “Proposed Rule”) for the 2024 Medicare Doctor Price Schedule (“PFS”). The Proposed Rule, which was issued within the Federal Register on August 7, 2023,  consists of up to date cost charges, adjustments to reimbursement for providers associated to well being fairness and social determinants of well being, will increase to cost for most cancers care help, and adjustments to enrollment for psychological well being suppliers. CMS tasks that the Proposed Rule will result in progress within the Medicare Shared Financial savings Program (“MSSP”).

Takeaway Reimbursement Numbers

Pursuant to the Proposed Rule, PFS total cost charges for 2024 will likely be 1.25% lower than the PFS cost charges for 2023. The proposed PFS conversion issue for 2024 is $32.75, which is $1.14 decrease than the 2023 conversion issue of $33.89. Notably, inside this total lower, CMS can also be proposing will increase for sure types of direct affected person care, together with major care.

Influence to Well being Fairness Providers

CMS is proposing to pay individually for Group Well being Integration and Social Determinants of Well being (“SDOH”) Threat Evaluation providers. This modification is supposed to account for the utilization of sources when clinicians contain group well being employees, care navigators, and peer help specialists in furnishing medically essential care to their sufferers. Beforehand care help workers have been capable of function auxiliary personnel offering coated providers which are incident to providers supplied by a billing doctor or practitioner. The providers described by the proposed codes within the Proposed Rule could be the primary to explain providers involving group well being employees, care navigators, and peer help specialists.

Social Determinants of Well being

The Proposed Rule consists of coding and cost for SDOH threat assessments as properly, and that is meant to acknowledge when practitioners assess SDOH that will influence their capacity to deal with a affected person. There’s a SDOH threat evaluation that might be added to the annual wellness go to as an elective, further component with a further cost. Individually, there are codes and cost for SDOH threat assessments furnished on the identical day as an analysis and administration go to.  

Most cancers Help

The Proposed Rule consists of cost for sure dental providers that might happen previous to and through sure most cancers therapies, together with chemotherapy. CMS can also be proposing cost for “Principal Sickness Navigation” providers that are supposed to assist sufferers navigate most cancers remedy and remedy for different critical diseases. Such providers may embody care through different peer help specialists, akin to peer restoration coaches for people with substance use dysfunction.

Psychological Well being Care

The Proposed Rule would enable, for the primary time, marriage and household therapists and psychological well being counselors, together with habit counselors, to enroll within the Medicare program and invoice for his or her providers. Elevated cost for disaster care, substance use dysfunction remedy, and psychotherapy are additionally proposed.

Progress of MSSP

CMS tasks that the Proposed Rule will enhance participation in MSSP by roughly 10% to twenty%. That is projected to happen by way of adjustments to the beneficiary project methodology which are supposed to higher promote entry to accountable take care of sufferers who see nurse practitioners, doctor assistants, and medical nurse specialists for his or her major care providers. The Proposed Rule additionally consists of adjustments to the monetary benchmarking methodology that’s meant to encourage participation by accountable care organizations serving advanced populations.

Feedback and Deadline

CMS is soliciting public feedback on the Proposed Rule and the coverage adjustments included therein. The deadline for submitting feedback is 5 p.m. on September 11, 2023.

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