CMS Introduces Latest Principal Illness

CMS Introduces Latest Principal Illness Navigation Service

In the 2024 proposed rule for physician fee schedule, the CMS is suggesting the introduction and reimbursement of a fresh service known as “principal illness navigation” (PIN).

According to CMS, PIN aims to aid Medicare beneficiaries diagnosed with high-risk conditions such as mental health issues, cancer, and substance use disorder by assisting them in finding and connecting with appropriate clinical and support resources.

CMS’s Vision for Principal Illness Navigation & Community Health Integration

While detailed information about PIN services remains limited, CMS has offered additional insights into their vision for principal illness navigation. CMS emphasizes that PIN services, along with another new offering called “community health integration,” will involve a patient-centered assessment with the following objectives:

  • Enhancing comprehension of a patient’s life story.
  • Improving care coordination.
  • Enhancing targeted health education.
  • Cultivating patient self-advocacy skills.
  • Assisting with health system navigation.
  • Facilitating access to community-based social services to address unmet social determinants of health (SDOH) needs.

Furthermore, CMS states that principal illness navigation services will involve care collaboration with peer support specialists. For instance, CMS mentions the inclusion of peer recovery coaches for individuals with SUD.

360 HealthTek & Medicare 2024 Proposed Changes

We eagerly anticipate observing how the PIN service could function as an initiating service or be used concurrently with principal and chronic care management for patients facing the most complex or high-acuity conditions. To delve deeper into PIN and other significant changes featured in the 2024 PFS proposed rule, visit and Understanding Medicare’s 2024 Proposed Additions & Changes to Remote Care Management in detail.

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