Medicare will Pay for New Services for Serious Illness in 2024

In a groundbreaking announcement, Medicare will now pay for a number of services C-TAC has long championed, which promise to benefit people living with serious illness.  The final CY2024 “Physician Fee Schedule” includes provisions that, under specified circumstances, will pay for services such as:

• Community Health Integration (CHI) Service Referrals– There are now new billing codes for community health integration services, which would include person-centered planning, health system coordination, promoting patient self-advocacy, and facilitating access to community-based resources to address unmet social needs. These new Medicare services also promote care delivered by community health workers, an important role that C-TAC has championed as well.

• Principal Illness Navigation (PIN) Services-These new services will help patients navigate treatment for serious illness by reimbursing practitioners for identifying their navigation needs and then deploying navigators to deliver those services. Navigators must be state certified and can be nurses, community health workers, case managers, social workers, etc.

More importantly, CMS’ language about these services is in line with the holistic, quality of life approach C-TAC has long advocated for. Navigators will:

• Conduct person-centered assessments to understand the patient’s life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors.
• Facilitate patient-driven goal setting and establish an action plan.
• Provide tailored support to accomplish the treatment plan.
• Identify or refer patients (and caregiver or family, if applicable) to appropriate supportive services.
• Facilitate and provide social and emotional support to help the patient cope with their condition, SDOH need(s), and adjust daily routines to better meet their diagnosis and treatment goals.
• Leverage knowledge of serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals.
• Caregiver Training Services– CMS will provide new payment to reimburse practitioners to assess whether caregiver training would help their patients achieve their treatment goals and also for the time any such training takes. The actual training can be done by others on the team, so nurses, social workers and others can help provide this new service. C-TAC supported both the assessment and training of family caregivers in this context.
• Social determinants of health risk assessments (SDOH) billing codes– Previously CMS had required practitioners to do SDOH or social risk assessment but not reimbursed them for doing so. These new codes provide payment for these important activities and can be reimbursed as an add-on to an annual wellness visit or in conjunction with an evaluation and management visit.

View the final rule or CMS’s factsheet.

Next steps for CTAC members

Please work with your operations and billing resources to better understand these new service and payment opportunities so as to take advantage of them on behalf of your patients.