CMS Proposes New ‘Principal Illness Navigation’ Service

In its 2024 doctor price schedule (PFS) proposed rule, the Facilities for Medicare & Medicaid Providers is proposing the event and reimbursement of a brand new service it is calling “principal sickness navigation,” or PIN.

CMS defines the time period as follows: “Principal sickness navigation companies are to assist folks with Medicare who’re identified with high-risk circumstances — e.g., most cancers, psychological well being circumstances, substance use dysfunction (SUD) — determine and join with applicable medical and help sources.”

Whereas we have no idea many particulars about PIN companies simply but, CMS has supplied some extra info that helps us acquire a greater understanding of what the company is envisioning for principal sickness navigation. CMS notes that principal sickness navigation companies, together with one other new service known as “group well being integration,” includes a person-centered evaluation. The evaluation’s targets embody the next:

• Higher understanding a affected person’s life story
• Bettering care coordination
• Bettering focused well being training
• Constructing affected person self-advocacy expertise
• Serving to with well being system navigation
• Facilitating entry to community-based social companies to handle unmet social determinations of well being (SDOH) wants

CMS additional notes that principal sickness navigation companies are designed to incorporate care involving different peer help specialists. For example, CMS websites peer restoration coaches for people with SUD.

We’re excited to see how the PIN service may work as an initiating service or be used concurrently with principal and power care administration for sufferers with probably the most tough to navigate or high-acuity circumstances. To study extra about PIN and a few of the different key adjustments included within the 2024 PFS proposed rule, watch the on-demand recording of the Prevounce particular webinar, “Understanding Medicare’s 2024 Proposed Additions & Changes to Remote Care Management.”