CMS Announces Proposed Rule For 2024 Medicare Physician Fee Schedule –

On July 13, 2023, the Centers for Medicare & Medicaid
Services (“CMS”) issued its proposed
rule (the “Proposed Rule”) for the 2024 Medicare
Physician Fee Schedule (“PFS”). The Proposed Rule, which
was issued in the Federal Register on August 7, 2023,
includes updated payment rates, changes to reimbursement for
services related to health equity and social determinants of
health, increases to payment for cancer care support, and changes
to enrollment for mental health providers. CMS projects that the
Proposed Rule will lead to growth in the Medicare Shared Savings
Program (“MSSP”).

Takeaway Reimbursement Numbers

Pursuant to the Proposed Rule, PFS overall payment rates for
2024 will be 1.25% less than the PFS payment rates for 2023. The
proposed PFS conversion factor for 2024 is $32.75, which is $1.14
lower than the 2023 conversion factor of $33.89. Notably, within
this overall decrease, CMS is also proposing increases for certain
forms of direct patient care, including primary care.

Impact to Health Equity Services

CMS is proposing to pay separately for Community Health
Integration and Social Determinants of Health (“SDOH”)
Risk Assessment services. This change is meant to account for the
utilization of resources when clinicians involve community health
workers, care navigators, and peer support specialists in
furnishing medically necessary care to their patients. Previously
care support staff have been able to serve as auxiliary personnel
providing covered services that are incident to services provided
by a billing physician or practitioner. The services described by
the proposed codes in the Proposed Rule would be the first to
describe services involving community health workers, care
navigators, and peer support specialists.

Social Determinants of Health

The Proposed Rule includes coding and payment for SDOH risk
assessments as well, and this is meant to recognize when
practitioners assess SDOH that may impact their ability to treat a
patient. There is a SDOH risk assessment that would be added to the
annual wellness visit as an optional, additional element with an
additional payment. Separately, there are codes and payment for
SDOH risk assessments furnished on the same day as an evaluation
and management visit.

Cancer Support

The Proposed Rule includes payment for certain dental services
that would occur prior to and during certain cancer treatments,
including chemotherapy. CMS is also proposing payment for
“Principal Illness Navigation” services that are meant to
help patients navigate cancer treatment and treatment for other
serious illnesses. Such services can also include care via other
peer support specialists, such as peer recovery coaches for
individuals with substance use disorder.

Mental Health Care

The Proposed Rule would allow, for the first time, marriage and
family therapists and mental health counselors, including addiction
counselors, to enroll in the Medicare program and bill for their
services. Increased payment for crisis care, substance use disorder
treatment, and psychotherapy are also proposed.

Growth of MSSP

CMS projects that the Proposed Rule will increase participation
in MSSP by roughly 10% to 20%. This is projected to occur through
changes to the beneficiary assignment methodology which are meant
to better promote access to accountable care for patients who see
nurse practitioners, physician assistants, and clinical nurse
specialists for their primary care services. The Proposed Rule also
includes changes to the financial benchmarking methodology that is
meant to encourage participation by accountable care organizations
serving complex populations.

Comments and Deadline

CMS is soliciting public comments on the Proposed Rule and the
policy changes included therein. The deadline for submitting
comments is 5 p.m. on September 11, 2023.

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