Share Your Experiences to Advocate for Medicare to Support and Train Family Caregivers
Your story and experiences matter!
Last month, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments from us on proposed policy changes for Medicare payments.
These proposed policy changes include training for family caregivers and navigation system support.
We have an opportunity to turn a proposal into a reality by sharing our support and our stories.
Training and Support for Medicare Beneficiaries and Their Family Caregivers
Specifically, the suggested changes that could help family caregivers are:
Caregiver Training Services
For CY 2024, CMS is proposing to make payment when practitioners train and involve caregivers to support patients with certain diseases or illnesses (e.g., dementia) in carrying out a treatment plan. We are proposing to pay for these services when furnished by a physician or a non-physician practitioner (nurse practitioners, clinical nurse specialists, certified nurse-midwives, physician assistants, and clinical psychologists) or therapist (physical therapist, occupational therapist, or speech language pathologist) under an individualized treatment plan or therapy plan of care. This proposed action is consistent with the recent Biden-Harris Administration Executive Order on Increasing Access to High Quality Care and Supporting Caregivers, and if finalized, would help support care for persons with Medicare, by better training caregivers.
Services Addressing Health-Related Social Needs (Community Health Integration Services, Social Determinants of Health Risk Assessment, and Principal Illness Navigation Services)
For CY 2024, CMS is proposing coding and payment changes to better account for resources involved in furnishing patient-centered care involving a multidisciplinary team of clinical staff and other auxiliary personnel. These proposed services are aligned with the HHS Social Determinants of Health Action Plan and also help implement the Biden-Harris Cancer Moonshot goal of every American with cancer having access to covered patient navigation services. Specifically, we are proposing to pay separately for Community Health Integration, Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation services to account for resources when clinicians involve community health workers, care navigators, and peer support specialists in furnishing medically necessary care. While these care support staff have been able to serve as auxiliary personnel to perform covered services incident to the services of a Medicare-enrolled billing physician or practitioner, the services described by the proposed codes are the first that are specifically designed to describe services involving community health workers, care navigators, and peer support specialists.
Community Health Integration (CHI) and Principal Illness Navigation (PIN) services involve a person-centered assessment to better understand the patient’s life story, care coordination, contextualizing health education, building patient self-advocacy skills, health system navigation, facilitating behavioral change, providing social and emotional support, and facilitating access to community-based social services to address unmet social determinations of health (SDOH) needs. Community Health Integration services are to address unmet SDOH needs that affect the diagnosis and treatment of the patient’s medical problems. Principal Illness Navigation services are to help people with Medicare who are diagnosed with high-risk conditions (for example, mental health conditions, substance use disorder, and cancer) identify and connect with appropriate clinical and support resources.
CMS is further clarifying that the community health workers, care navigators, peer support specialists, and other such auxiliary personnel may be employed by Community-Based Organizations (CBOs) as long as there is the requisite supervision by the billing practitioner for these services, similar to other care management services. (My note: These community community health workers, care navigators, peer support specialists, and other such auxiliary personnel also could provide these services to the family caregiver on behalf of the patient.)
In addition to better recognizing costs associated with patient-centered care, access to these services could contribute to equity, inclusion, and access to care for the Medicare population and improve the outcomes for the patient (particularly in RHCs, FQHCs, underserved, and low-income populations, where there is a disparity in access to quality care). We are also proposing coding and payment for SDOH risk assessments to recognize when practitioners spend time and resources assessing SDOH that may be impacting their ability to treat the patient. Additionally, we are proposing to add the SDOH risk assessment to the annual wellness visit as an optional, additional element with an additional payment. Separately, we are also proposing codes and payment for SDOH risk assessments furnished on the same day as an evaluation and management visit.
Post a Comment in Support of these Programs and Include Your Experiences
You can post a comment supporting these initiatives until 5 p.m. ET on September 11. When you add a comment, share why you support these programs and how these programs would have been helpful in the past, could help you today and will help in the future.
Training
When you share your support about training, add a story about providing care without the proper training and the impact on you and your caree.
System Navigation
If you've tried to find services, share how difficult searching for resources and services can be. If you have completed our training programs (Certified Caregiving Consultant, Specialist or Facilitator), share your experiences working with and supporting family caregivers. You can share how you helped a client find services and the difference that made or how your support group members constantly share ways to tap into community resources.
Additional Support for Family Caregivers
If you've attended any of our monthly planning sessions, you also can share how helpful it is to attend a facilitated conversation to help you put plans in place for emergencies and for your stress management. We'd love the reimbursement for system navigation and patient support also to include facilitated meetings for family caregivers.
Post Your Comment by 5 p.m. ET on September 11
To share your support and experiences, visit https://www.regulations.gov/document/CMS-2023-0121-1282 and click on the "Comment" button on the left under the name of the proposed rule.
If you'd like, copy your comment before posting and then come back and share what you wrote. You'll inspire us!!
Thank you so much for your support!
Resources
Post your comment here: https://www.regulations.gov/document/CMS-2023-0121-1282
New Medicare Proposal Would Cover Training for Family Caregivers
Calendar Year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule#Advocacy
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