CMS Proposes New 'Principal Illness Navigation' Service

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CMS Proposes New 'Principal Illness Navigation' Service
by Daniel Tashnek

In its 2024 physician fee schedule (PFS) proposed rule, the Centers for Medicare & Medicaid Services is proposing the development and reimbursement of a new service it's calling "principal illness navigation," or PIN.

CMS defines the term as follows: "Principal illness navigation services are to help people with Medicare who are diagnosed with high-risk conditions — e.g., cancer, mental health conditions, substance use disorder (SUD) — identify and connect with appropriate clinical and support resources."

While we do not know many details about PIN services just yet, CMS has provided some additional information that helps us gain a better understanding of what the agency is envisioning for principal illness navigation. CMS notes that principal illness navigation services, along with another new service called "community health integration," involves a person-centered assessment. The assessment's objectives include the following:

  • Better understanding a patient's life story
  • Improving care coordination
  • Improving targeted health education
  • Building patient self-advocacy skills
  • Helping with health system navigation
  • Facilitating access to community-based social services to address unmet social determinations of health (SDOH) needs

CMS further notes that principal illness navigation services are designed to include care involving other peer support specialists. As an example, CMS sites peer recovery coaches for individuals with SUD.

We are excited to see how the PIN service might work as an initiating service or be used concurrently with principal and chronic care management for patients with the most difficult to navigate or high-acuity conditions. To learn more about PIN and some of the other key changes included in the 2024 PFS proposed rule, watch the on-demand recording of the Prevounce special webinar, "Understanding Medicare's 2024 Proposed Additions & Changes to Remote Care Management."

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