In addition to a slew of changes to Medicare's physician payment policies, the CMS on Thursday proposed expanding a program aimed at helping people avoid diabetes.
The CMS suggests starting the program in 2018 and is seeking comment whether to launch the effort nationally or in additional select markets.
The program began in 2013 and enrolled beneficiaries in eight states: Arizona, Delaware, Florida, Indiana, Minnesota, New York, Ohio, and Texas. It is the first from the CMS Innovation Center, which was created by the Affordable Care Act, to be proven successful enough to be elevated from a demonstration and rolled out to the full Medicare program. The ACA allows the CMS to expand programs that prove effective without the approval of Congress.
As part of the effort, beneficiaries receive coaching, lifestyle intervention, and moderate physical activity, all with the goal of preventing the onset of diabetes in individuals who are prediabetic.
People with higher than normal blood sugar levels were enrolled and attended weekly training sessions on nutrition, exercise and overall healthy living.
Those who attended at least four sessions reduced their body weight by about 5%. Weight loss has been proven to reduce the risk of developing diabetes. Medicare estimated a savings of $2,650 per participant, which is beyond the cost of the program.
Participating programs, which need to be recognized by the Centers for Disease Control and Prevention, would have to enroll in Medicare beginning Jan. 1, 2017.
In March, the CMS estimated expansion of the diabetes model would reduce net Medicare spending.
Providers would be paid for the number of sessions attended by patients and their ability to achieve and maintain a minimum weight loss.
The agency is seeking comment on how exactly it should expand access to the program and how it should define an eligible prediabetic patient.
Another key proposal in the physician fee schedule rule would update the quality measures used in the the Medicare Shared Savings Program to protect beneficiaries when accountable care organizations waive the rule requiring patients to be hospitalized for at least three days before Medicare will reimburse care at a skilled nursing facility.
Beginning in 2017, providers can ask to waive the three-day rule if they send patients to nursing homes that carry at least three stars on Medicare's five-star quality ratings.
The CMS also wants to require healthcare providers and suppliers to be screened and enrolled in Medicare in order to contract with a Medicare Advantage organization.
This proposal creates consistency with CMS' current healthcare provider and supplier enrollment requirements for all other programs. It is also consistent with a recently published policy for Medicaid managed care plans.
“CMS believes this proposed rule is necessary to help ensure that Medicare enrollees receive appropriate or medically necessary items or services from health care providers and suppliers that fully comply with Medicare enrollment requirements,” the agency said.
The rule also contains proposals to increase payments for routine office visits for treating patients with mobility-related disabilities. Currently, Medicare pays approximately $73 for these visits, even though the patient might need to spend more time with the physician or require more physical and staff support during the visit, according to CMS. Now it's proposed that Medicare would pay approximately $119 for the visit.
The various provisions in the new rule will result in $500 million in additional Medicare reimbursement to physicians over what they received in 2016.
Comments on the 2017 physician fee schedule will be accepted through Sept. 6, 2016.
