CMS Physician Payment Rule Advances Health Equity

On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) proposed rule. The proposal, aiming to advance health equity, includes an overall 1.25% reduction in PFS payments, with increases in payments for primary care services requiring offsetting budget adjustments.

Key proposals include expanding behavioral health services, supporting President Biden’s Cancer Moonshot, and advancing value-based care. Specific proposals include caregiver training services, community health integration services, and principal illness navigation services to help patients navigate treatment for serious illnesses such as cancer.

For the first time, Medicare is proposed to pay for services performed by community health workers and marriage and family therapists, enhancing mental health coverage. CMS is also proposing payments for certain dental services before cancer treatments and increased payment for crisis care, substance use disorder treatment, and psychotherapy.

Proposed changes in CMS’s largest Accountable Care Organization (ACO) program, the Medicare Shared Savings Program, aim to promote access to accountable care for individuals who see nurse practitioners, physician assistants, and clinical nurse specialists for primary care services. The proposal is expected to increase participation in the Shared Savings Program by roughly 10% to 20%.

CMS proposes to enhance the Medicare Diabetes Prevention Program (MDPP) Expanded Model to increase participation and access in underserved communities and extend its Public Health Emergency Flexibilities through December 31, 2027.

Lastly, CMS proposes to increase the performance threshold in the Quality Payment Program to 82 points and align the program with the Universal Foundation, a set of core quality metrics across CMS programs.

Sourced from CMS.gov