The Centers for Medicare & Medicaid Services (CMS) has proposed new policies under the calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) to promote health equity, expand access to critical medical services, and support the President's Cancer Moonshot mission. These proposed changes aim to improve patient care, especially in underserved populations, and foster innovation in the healthcare system. This blog will explore the key aspects of the proposed rule and how they align with CMS's commitment to strengthening Medicare and advancing health equity.
Promoting Health Equity
CMS is dedicated to addressing disparities in health outcomes and advancing health equity. To achieve this goal, the proposed rule seeks to collect more comprehensive data on health equity factors, such as LGBTQ+ status, race and ethnicity, disability, and rural populations. By analyzing these data points, CMS can gain insights into the unique needs of different patient populations and develop targeted initiatives to close the equity gap.
Expanding Telehealth for Behavioral and Mental Health Care
The COVID-19 pandemic underscored the importance of telehealth services, especially for behavioral and mental health care. In response, CMS is proposing to remove certain statutory restrictions on telehealth services, allowing patients in any location and in their homes to access mental health diagnosis, evaluation, and treatment. Additionally, for the first time, Medicare payment for mental health visits would be extended to services provided by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) through interactive telecommunications technology. This expansion will increase access to mental health services for rural and vulnerable populations.
Enhancing the Medicare Diabetes Prevention Program (MDPP)
Approximately one in three American adults have prediabetes, and certain underserved communities face a higher risk of developing type 2 diabetes. To address this, CMS is proposing changes to the MDPP expanded model, enabling more organizations to provide structured, coach-led sessions in community and healthcare settings to prevent type 2 diabetes. The proposed changes, including waiving the Medicare enrollment fee for new MDPP suppliers and restructuring payments, will increase patient access to preventive diabetes care.
Advancing the Quality Payment Program (QPP)
To improve quality care for Medicare beneficiaries, CMS is proposing changes to the Quality Payment Program (QPP). This value-based payment program encourages high-value care through financial incentives and disincentives for clinicians. The proposed rule seeks to increase the performance threshold for eligible clinicians, encouraging meaningful participation and improved patient outcomes. Additionally, CMS is introducing the first seven MIPS Value Pathways (MVPs), which measure and compare performance across clinician types, providing more meaningful feedback to clinicians.
Expanding Access to Vaccines
As part of the commitment to improving access to vaccines, CMS is seeking feedback to update payment rates for administering preventive vaccines covered under Part B. The proposed rule also includes a special coinsurance rule to reduce patient costs for additional services required during colorectal cancer screening tests.
The proposed changes in the CY 2024 Medicare Physician Fee Schedule reflect CMS's commitment to advancing health equity, expanding access to care, and promoting innovative solutions in healthcare. By strengthening Medicare and addressing the disparities highlighted during the COVID-19 pandemic, CMS aims to ensure that all patients receive comprehensive, high-quality care, regardless of their background or location.
- Fact Sheet on the CY 2024 Physician Fee Schedule proposed rule: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule
- Fact Sheet on the CY 2024 Quality Payment Program proposed changes: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2483/2024%20QPP%20Proposed%20Rule%20Fact%20Sheet%20and%20Policy%20Comparison%20Table.pdf
- Fact Sheet on the proposed Medicare Shared Savings Program changes: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule-medicare-shared-savings-program
- Fact Sheet on recent changes to improve access to behavioral health services: https://www.federalregister.gov/public-inspection/2023-14624/medicare-and-medicaid-programs-cy-2024-payment-policies-under-the-physician-fee-schedule-and-other