On June 25, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would implement key provisions in the Affordable Care Act of 2010 that expand preventive services for Medicare beneficiaries, improve payments for primary care services and promote access to health care services in rural areas. The proposed policies would apply to payments under the Medicare Physician Fee Schedule (MPFS) for services furnished on or after Jan. 1, 2011.

"The rule we are proposing...is just one part of the administration's efforts to improve the health status of Medicare beneficiaries by expanding access to preventive services, and promoting early detection and prompt treatment of medical conditions," said Jonathan Blum, deputy administrator and director of CMS's Center for Medicare. "Beginning in 2011, Medicare will cover an annual wellness visit that will offer an opportunity for the physician and patient to develop a more comprehensive approach to maintaining or improving the patient's health and reducing risks of chronic disease."

The proposed rule would implement provisions in the Affordable Care Act that will eliminate out-of-pocket costs for beneficiaries for most preventive services, including the new annual wellness visit. This visit augments the benefits of the Initial Preventive Physical Examination (also known as the "Welcome to Medicare Visit") with an annual wellness visit that allows the physician and patient to develop a personalized prevention plan that includes not only the preventive services generally available to the Medicare population, but additional services that may be appropriate because of the patient's individual risk factors, CMS stated.

CMS explained that the proposed rule would improve access to primary care services by implementing an incentive payment for primary care services furnished by primary care practitioners that can include physicians, nurse practitioners, clinical nurse specialists and physician assistants. The proposed rule would also implement a payment incentive program for general surgeons performing major surgery in areas designated by the Secretary of Health & Human Services as Health Professional Shortage Areas, would allow physician assistants to order post-hospital extended care services in skilled nursing facilities, and would pay certified nurse midwives for their services under the MPFS at the same rates as physicians.

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