. "6 Public- and Private-Sector Policy Support." Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, DC: The National Academies Press, 2008.
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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
Medicare law generally proscribes fee-for-service (FFS) reimbursement for “screening,” but screening still occurs in FFS and Medicare Advantage plans in several ways
Medicare FFS also provides full coverage for health and behavior assessment
Coverage and reimbursement vary by state, but generally:
Some screening covered for children under age 21 through the Medicaid Early Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit
Coverage of Health and Behavior Current Procedural Terminology (CPT) codes varies by state
Care Planning; Linking of Patients with Psychosocial Services; Coordination of Psychosocial and Biomedical Care; Follow-up
Some reimbursement is provided as part of FFS payments for medical Evaluation and Management (E/M) services, and payments for some E/M services increased in 2007
Medicare Advantage plans’ more flexible reimbursement also allows for these services
Multiple demonstration projects are ongoing to test models of care coordination
Medicaid payments are generally low, but states’ Primary Care Case Management (PCCM) programs offer some financial support, as do state Medicaid agency contracts with managed care plans; as of 2005, 25 states offered PCCM services with some limits
Most states also offer “targeted case management” to certain beneficiaries to enable access to and coordination of necessary medical, social, and educational care and other service needs (CMS, 2005a)
