- CMS proposed changes late Thursday to the Physician Fee Schedule that would add about $900 million in additional funding for primary care, care coordination and mental health services next year.
- The agency also wants to expand the Diabetes Prevention Program either nationally or in selected markets, starting Jan. 1, 2018.
- The proposed rule, which sets physician fee levels for calendar year 2017, is due to be published in the Federal Register on July 15.
The increase in funding for care coordination and patient-centered care could reach $5 billion over time, if practitioners provide the services to all Medicare beneficiaries, CMS acting Administrator Andy Slavitt and Patrick Conway, acting deputy administrator and chief medical officer, said in a blog.
“By better valuing primary care and care coordination, we help beneficiaries access the services they need to stay well,” they wrote. “In addition to keeping people healthy, healthcare costs are lower when people have a primary care provider and team of doctors and clinicians overseeing and coordinating their care.”
CMS is also proposing changes to payment for chronic care management, including that for new codes and for care management provided beyond the initial visit for patients with multiple chronic conditions.
There is also a new code to pay for assessments and care planning for people with cognitive impairments and a plan to pay for certain behavioral health services provided via the Collaborative Care model.
Another revision would increase payments for routine office visits for patients with mobility-related disabilities. According to Slavitt and Conway, physicians would be reimbursed $119 for such visits, up from the current $73.
The Diabetes Prevention Program, the first project of the CMS Innovation Center, rolled out in 2013 in eight states: Arizona, Delaware, Florida, Indiana, Minnesota, New York, Ohio, and Texas. The program has proved cost-effective, with estimated savings to Medicare of about $2,650 per participant, according to Modern Healthcare.
Under the proposed expansion, CDC-recognized Diabetes Prevention Program organizations could enroll in Medicare. Practitioners would have to get a National Provider Identification number to participate in the Medicare program.
CMS is seeking feedback on requiring CDC-recognized Diabetes Prevention Program entities to file Medicare claims using standard claims forms and procedures, submitted electronically in batches. The agency also wants input on approaches to mitigate program integrity risks.
Comments on the proposed rule are due Sept. 6.
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