The Medicare Physician Fee Schedule proposed rule for FY27 was released earlier this month and includes several key areas relating to social isolation and loneliness. Below are a few key areas the Action Network plans to comment on, with additional areas to follow.
If you are interested in contributing to our response, please reach out to us at info@endsocialisolation.org.
Shared Medical Appointments (HCPCS Code GSMAS)
CMS recognizes that SMAs can help address social isolation and loneliness for peers with similar health challenges. CMS also highlights that SMAs are aligned with the President’s Executive Order, “Establishing the President’s Make America Healthy Again Commission.” As such, CMS proposed several changes to increase the uptake and use of SMAs, including how clinicians can bill for these appointments and what the appointments must include.
CMS is requesting additional information to better understand the resource costs and requirements for developing intensive lifestyle interventions to reduce the risk of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD). CMS notes that, “intensive lifestyle interventions would be in concert with but would not specifically include risk factor reduction in modifiable behaviors such as controlling contributing conditions (for example, hypertension, diabetes), eliminating tobacco use (in any form), and addressing hearing loss.”
Some of the key questions in this RFI include:
- What are the essential domains to address in a multi-domain intensive lifestyle intervention to reduce the risk of cognitive decline for older adults at risk for developing AD/ADRD that would be appropriate to include under Medicare?
- Should these interventions be made available as a one-time service (that is, to teach older adults how to make changes in their lifestyle to help reduce AD/ADRD risk) or on a recurring (for example, annual) basis?
- Should the eligibility for these services be restricted to beneficiaries with a diagnosis of mild cognitive impairment (MCI), or early-stage dementia? If so, how should this diagnosis be made or confirmed?
- Given Intensive Lifestyle Intervention’s (ILIs) are multi-domain, and likely include physical activity, nutrition, potentially additional domains such as sleep and stress management, who are the essential interdisciplinary team members that CMS should account for in developing appropriate resource costs for future services?
- How should CMS support the development of our Health Technology Ecosystem to support older adults reducing their risk for developing AD/ADRD using intensive lifestyle changes?
CMS is seeking feedback on their proposal to remove the Functional Status Change for Patients with Low Back Impairments (MIPS Q220) from the ASM low back pain quality measure set and replace it with Functional Outcome Assessment (MIPS Q182). CMS notes that the proposed Functional Outcome Assessment could capture information on improvements in patient reported social isolation and physical activity.