The Centers for Medicare & Medicaid Services (CMS) has recently finalized the Calendar Year (CY) 2024 Medicare Physician Fee Schedule (PFS) rule, marking a significant step forward in healthcare policy. This rule introduces crucial updates aimed at bolstering primary care, advancing health equity, supporting family caregivers, and expanding access to vital services, including behavioral and oral health care. Notably, the CY 2024 PFS final rule incorporates provisions for principal illness navigation services, directly supporting the Biden-Harris Administration’s Cancer Moonshot initiative to accelerate the fight against cancer by aiding patients and their families in navigating the complexities of cancer treatment and other serious illnesses.
“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,” stated U.S. Department of Health and Human Services Secretary Xavier Becerra. This commitment extends to key priorities of the Biden-Harris Administration, such as enhancing behavioral health care, providing robust support for family caregivers, promoting value-based care models, and aggressively advancing the President’s Cancer Moonshot initiative.
While the CY 2024 PFS final rule includes mandatory updates to clinician payments under the PFS, resulting in an overall reduction of 1.25% in finalized payment amounts compared to CY 2023, CMS is strategically increasing payments for essential services like primary and longitudinal care visits. The finalized CY 2024 PFS conversion factor is set at $32.74, reflecting a decrease of $1.15, or 3.4%, from CY 2023.
CMS Administrator Chiquita Brooks-LaSure emphasized the agency’s dedication: “CMS remains steadfast in our commitment to supporting physicians and ensuring that people with Medicare have access to the care they need to stay healthy as well as navigate health conditions they are facing.” The new rule underscores this commitment by improving payment structures for primary care and mental health services, introducing payments for novel navigation services for individuals facing cancer and other serious illnesses, supporting family caregivers, and enhancing access to dental care for patients undergoing cancer treatment.
Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare, highlighted the comprehensive impact of these changes. “The impact of these changes means that people with Medicare will be able to access Marriage and Family Therapists and Mental Health Counselors for behavioral health treatment, access culturally-sensitive care from community health workers, care navigators, and peer support workers, access primary care where the provider is invested in a long-term, trusting relationship, and that caregivers for persons with Medicare will have access to appropriate training,” she explained. These changes represent a holistic approach, acknowledging individuals with Medicare as whole persons with unique needs and life circumstances.
Advancing Health Equity and Bolstering Caregiver Support through Enhanced Coding
Building upon CMS’s ongoing commitment to health equity and the Biden-Harris Administration’s Executive Order to support caregivers, the CY 2024 PFS final rule introduces distinct coding and payment mechanisms for several new services. These are specifically designed to support underserved populations and address unmet health-related social needs that can significantly impact the diagnosis and treatment of medical conditions.
Firstly, CMS will now provide payment for specialized caregiver training services under specific conditions. This ensures that healthcare practitioners are appropriately compensated for their crucial engagement with caregivers, empowering them to effectively support individuals with Medicare in adhering to their prescribed treatment plans. This recognition of caregiver contributions is pivotal in enhancing patient outcomes and overall well-being.
Furthermore, the rule finalizes separate coding and payment for community health integration services. These services encompass person-centered planning, seamless health system coordination, active promotion of patient self-advocacy, and facilitated access to essential community-based resources. These resources are vital in addressing social needs that may impede a practitioner’s ability to accurately diagnose and effectively treat a patient. These are groundbreaking Physician Fee Schedule services, explicitly designed to incorporate the invaluable contributions of community health workers. These workers play a critical role in bridging the gap between underserved communities and vital healthcare and social services, thereby expanding equitable access to care and improving health outcomes for the Medicare population.
Principal Illness Navigation Services: A Key Advancement in Cancer Care Coding
The CY 2024 PFS final rule introduces and finalizes coding and payment for principal illness navigation services. These services are tailored to provide crucial care navigation for individuals facing high-risk conditions, most notably cancer. A cancer diagnosis can be overwhelming, confusing, and emotionally taxing. This policy action represents a significant stride towards realizing the Cancer Moonshot initiative’s ambitious goal of ensuring that comprehensive navigation services are accessible to every American affected by cancer. Moreover, CMS is finalizing a subset of principal illness navigation services specifically designed to support individuals grappling with behavioral health conditions, utilizing auxiliary personnel such as peer support specialists to deliver these critical services.
In a further move to enhance comprehensive care, the rule also finalizes coding and payment for social determinants of health risk assessments. These assessments can be seamlessly integrated as an add-on to annual wellness visits or conducted in conjunction with evaluation and management or behavioral health visits, providing a more holistic approach to patient care.
Supporting Whole-Person Care through Primary Care and Behavioral Health Integration
The CMS Behavioral Health Strategy is fundamentally aimed at supporting an individual’s complete emotional and mental well-being through integrated behavioral health care. The CY 2024 PFS final rule enacts some of the most transformative changes in the Medicare program’s history to significantly improve access to behavioral health services. Starting January 1, 2024, marriage and family therapists and mental health counselors, including qualified addiction, alcohol, or drug counselors, will be eligible to enroll in Medicare for the first time and bill for their professional services. (Detailed information on enrollment can be found here). Additionally, the rule increases payment rates for critical services such as crisis care, substance use disorder treatment, and psychotherapy. Based on valuable public feedback, CMS is also finalizing increased payments for psychotherapy services delivered in conjunction with office visits and for Health Behavior Assessment and Intervention services.
Recognizing primary care’s foundational role in delivering high-quality, whole-person care, CMS is prioritizing accurate and appropriate payment for these essential services through refined payment and coding structures. This aligns directly with the objectives outlined in the HHS Initiative to Strengthen Primary Care. CMS has also acknowledged stakeholder feedback indicating that the redistributive impact of the originally finalized policy may be less significant than initially anticipated. This is due to the recognition that many office visits involve discrete or time-limited care, which would not qualify for additional payment under the new policies.
CMS is further advancing whole-person care within the Medicare Shared Savings Program, the nation’s largest Accountable Care Organization (ACO) program. The rule finalizes modifications to the assignment methodology to enhance access to accountable care for individuals whose primary care is managed by nurse practitioners, physician assistants, and clinical nurse specialists. Changes to the financial benchmarking methodology are also being finalized to better incentivize participation from ACOs serving complex patient populations. Furthermore, the rule continues to support ACOs in their transition towards digital quality measurement and the utilization of interoperable digital data. Collectively, these changes are projected to increase participation in the Shared Savings Program by an estimated 10% to 20%, significantly expanding opportunities for beneficiaries to receive coordinated care from ACOs.
Payment for Essential Dental Services Related to Cancer Treatments
Recognizing the integral link between oral and dental health and overall wellness, this final rule, in direct support of the Biden-Harris Administration’s Cancer Moonshot initiative, finalizes provisions to enable Medicare payment for specific dental services that are clinically linked to various cancer treatments, including chemotherapy.
Dentists interested in enrolling in Medicare to provide these newly covered services can find comprehensive information at https://www.cms.gov/medicare/coverage/dental. This expansion of coverage is crucial for ensuring comprehensive care for individuals undergoing cancer treatment.
Medicare Diabetes Prevention Program (MDPP) Expanded Model Enhancements
To further enhance care for individuals at risk of diabetes, CMS has finalized enhancements to the Medicare Diabetes Prevention Program (MDPP) Expanded Model. The rule extends the MDPP Expanded Model’s Public Health Emergency Flexibilities for an additional four years, through December 31, 2027. This extension allows all MDPP suppliers to continue offering MDPP services virtually, provided they maintain an in-person Centers for Disease Control and Prevention organization code. This continued flexibility is vital for increasing program participation and improving access within underserved communities.
In conclusion, the CY 2024 Medicare Physician Fee Schedule final rule represents a significant advancement in Medicare policy. By prioritizing primary care, integrating essential navigation services for cancer patients, promoting health equity, and expanding access to behavioral and dental health services, CMS is taking meaningful steps to ensure that individuals with Medicare receive comprehensive, patient-centered care that addresses their diverse needs. These policy changes, particularly the enhanced coding and payment structures, are crucial for improving the quality and accessibility of healthcare for millions of Americans.
