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CMS Proposal: Proposed Definition for Eligibility of Navigation Services

  • Clara Lambert
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CMS Proposal: Proposed Definition for Eligibility of Navigation Services was created by Clara Lambert

Posted 8 months 3 weeks ago #100
CMS has proposed the following definition for patients who would be eligible for reimbursable Principal Illness Navigation (PIN) services starting January 2024:
The following characteristics would have to be present:
(a) one serious, high-risk condition expected to last at least 3 months and that places the patient at significant risk of hospitalization, nursing home placement, acute exacerbation/decompensation, functional decline, or death; and
(b) The condition requires development, monitoring, or revision of a disease-specific care plan, and may require frequent adjustment in the medication or treatment regimen, or substantial assistance from a caregiver.

Would this definition exclude any patients from your current caseload?

CMS is seeking feedback from navigators about this definition. You may discuss more than one topic in your comments to CMS. When submitting comments on this topic, please reference:
88 FR 52262 (proposed August 7, 2023) – Medicare and Medicaid Programs; CY 2024 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies, section II.E.(27)(e)(ii) 
When commenting, please also reference file code CMS-1784-P
Last Edit:8 months 3 weeks ago by Clara Lambert
Last edit: 8 months 3 weeks ago by Clara Lambert. Reason: addition of statement for reference to file

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