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

Takeaway Reimbursement Numbers

Pursuant to the Proposed Rule, PFS general fee charges for 2024 will probably be 1.25% lower than the PFS fee 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 general lower, CMS can also be proposing will increase for sure types of direct affected person care, together with main care.

Impression to Well being Fairness Providers

CMS is proposing to pay individually for Neighborhood Well being Integration and Social Determinants of Well being (“SDOH”) Danger Evaluation companies. 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 mandatory care to their sufferers. Beforehand care help employees have been capable of function auxiliary personnel offering coated companies which are incident to companies supplied by a billing doctor or practitioner. The companies described by the proposed codes within the Proposed Rule can be the primary to explain companies involving group well being employees, care navigators, and peer help specialists.

Social Determinants of Well being

The Proposed Rule consists of coding and fee for SDOH danger assessments as nicely, and that is meant to acknowledge when practitioners assess SDOH that will impression their potential to deal with a affected person. There’s a SDOH danger evaluation that will be added to the annual wellness go to as an optionally available, further factor with an extra fee. Individually, there are codes and fee for SDOH danger assessments furnished on the identical day as an analysis and administration go to.  

Most cancers Assist

The Proposed Rule consists of fee for sure dental companies that will happen previous to and through sure most cancers therapies, together with chemotherapy. CMS can also be proposing fee for “Principal Sickness Navigation” companies that are supposed to assist sufferers navigate most cancers therapy and therapy for different severe diseases. Such companies can even embrace care by way of different peer help specialists, comparable 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 dependancy counselors, to enroll within the Medicare program and invoice for his or her companies. Elevated fee for disaster care, substance use dysfunction therapy, and psychotherapy are additionally proposed.

Progress of MSSP

CMS tasks that the Proposed Rule will improve participation in MSSP by roughly 10% to twenty%. That is projected to happen by way of modifications 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 scientific nurse specialists for his or her main care companies. The Proposed Rule additionally consists of modifications to the monetary benchmarking methodology that’s meant to encourage participation by accountable care organizations serving complicated populations.

Feedback and Deadline

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