Chronic Care Management (CCM), implemented by Centers for Medicare & Medicaid Services (CMS) in 2015 to reimburse doctors for “non-face-to-face” care coordination services for people suffering from more than one chronic condition. The aim of the program was to encourage physicians and patients to connect outside of office visits to proactively monitor and advise patient conditions and to reduce overall treatment costs.
Since implementation, there have been concerns about the complexity of the program’s requirements on physician practices, and ambiguity about what was billable under the program’s CPT code 99490.
CMS and Congress have been working on adjustments to CCM to make it easier to implement by physicians and to access by patients.
On November 2, 2016, CMS issued new rules that update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) for 2017, specifically related to Chronic Care Management (CCM).
New codes allow payment for assessing and planning care for patients with cognitive impairment, as well as pay for new care collaboration models between primary care physicians and psychiatrists. This includes separate payments for existing CPT codes describing non-face-to-face prolonged evaluation and management services.
“These policies will give significant support to the practice of primary care and boost the time a physician can spend with his or her patients listening, advising, and coordinating their care,” CMS Acting Administrator Andy Slavitt said in a press release.
Under the final rule, the agency will make separate payments for certain existing Current Procedural Terminology (CPT) codes describing non-face-to-face prolonged evaluation and management services. CMS also will revalue existing CPT codes describing prolonged face-to-face services.
Separately, the United States Senate Finance Committee Chronic Care Working Group recently released a draft healthcare payment reform bill targeting chronic disease management programs and services, such as the Independence at Home Model, telehealth consultations, accountable care organization (ACO) initiatives, and Medicare Advantage plans.
In addition to demonstration extensions, the working group proposed to increase the cap on the total number of participating beneficiaries from 10,000 to 12,000. The bill would also give practices at least three years, rather than two, to earn shared savings payments before they are terminated from the model.
The draft bill also contained payment reform proposals for telehealth services targeting chronic disease management. For example, the legislation would establish Medicare reimbursement coverage for telehealth appointments that fulfill monthly clinical assessment requirements for beneficiaries receiving dialysis treatment at home.
Senators also proposed to allow Medicare Advantage plans to offer “additional, clinically appropriate, telehealth benefits in its annual bid amount beyond the services that currently receive payment under Part B.” Medicare Advantage plans can currently provide basic telehealth services as part of the standard benefit, but plans must use their rebate dollars to pay for the services because they are not separately reimbursed by Medicare.
The draft legislation also called on the Government Accountability Office (GAO) to investigate several potential healthcare payment reforms for chronic disease management services. The federal watchdog would be required to report on Medicare reimbursement codes for one-time visits and longitudinal care planning services, the effectiveness of Medicare and other payer medication synchronization programs, and the impact of obesity drugs on patient outcomes and healthcare spending.