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Nina Marshall

, National Council for Behavioral Health

Chronic Care Management Services Through Medicare: CMS Drops Direct Supervision Requirement

January 8, 2015 | Medicare | Comments
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Medicare Chronic Care Management (CCM) services allow physician practices to receive a fee for engaging in care management services for beneficiaries who have long-term chronic conditions. Effective this month, CMS has dropped a requirement that non-physician clinical professionals be directly supervised by a physician. Instead, non-face-to-face services may occur “incident to” and under the general supervision of a physician or other qualified health professional, regardless of whether it is inside or outside of the practice’s normal operating business hours.

In Original Medicare, the fee paid to providers will be per-member-per-month – just over $40 – as outlined in the 2015 Medicare Physician Fee Schedule. Under Medicare Advantage, plans will have latitude in how they structure their payment for the service, but it is clear that they will have to offer CCM services to enrollees since it is now a part of traditional Medicare benefits.

More details about the CCM program, who is eligible for the service, and beneficiary acceptance of the service and co-pays can be found through the 2015 Medicare Physician Fee Schedule or through this white paper.