Today, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Physician Fee Schedule to transform how Medicare pays for primary care through a new focus on care management and behavioral health designed to recognize the importance of the primary care work physicians perform. The rule also proposes policies to expand the Diabetes Prevention Program within Medicare starting January 1, 2018. This is the first time a preventive service model from the CMS Innovation Center would be expanded into the Medicare program.

The rule’s primary care proposals improve how Medicare pays for services provided by primary care physicians and other practitioners for patients with multiple chronic conditions, mental and behavioral health issues, as well as cognitive impairment or mobility-related impairments.

These changes will improve payment for clinicians who are making investments of time and resources to provide more coordinated and patient-centered care. These proposed coding and payment changes will better reflect the resources involved in furnishing contemporary primary care, care coordination and planning, mental health care, and care for cognitive impairment, such as Alzheimer’s disease. In addition, these proposed changes further reinforce Medicare’s transformation to better align priorities and reward physicians for quality care through the Quality Payment Program.
“Today's proposals are intended to give a significant lift to the practice of primary care and to boost the time a physician can spend with their patients listening, advising and coordinating their care -- both for physical and mental health,” said CMS Acting Administrator Slavitt. “If this rule is finalized, it will put our nation's money where its mouth is by continuing to recognize the importance of prevention, wellness, and mental health and chronic disease management.”

To learn more about these efforts to support and improve access to primary care, please visit the CMS Blog at https://blog.cms.gov/2016/07/07/focusing-on-primary-care-for-better-health/.

In March 2016, CMS announced that the Diabetes Prevention Program met the statutory eligibility criteria for expansion into Medicare. Today, CMS is proposing to expand the Diabetes Prevention Program into Medicare beginning January 1, 2018. Our proposal would allow Medicare Diabetes Prevention Program suppliers, recognized by the Centers for Disease Control and Prevention, to submit claims to Medicare for providing diabetes prevention services. CMS is proposing a process for suppliers to enroll in the program so they can furnish services and bill Medicare as soon as possible after the program becomes effective.

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