Increased Medicare Domiciliary Care Rates for 2006
An effective partnership and skillful lobbying have brought
about an important change in payment rates under Medicare
for care provided by physicians and other providers in domiciliary
care facilities such as assisted living facilities. As outlined
in the 2006 Final Medicare Rule released November 1, payment
rates for domiciliary care will be comparable to those paid
for house calls made to patients' homes. Effective January
1, the new rates will apply to nine instead of the previous
six codes equivalent to codes used for home visits.
AAGP joined the American Academy of Home Care Physicians in
putting forth this proposal. Also involved in this effort
were the American Geriatrics Society, the American Podiatric
Medical Association, and the American Medical Directors Association.
This important step ends payment disparities between domiciliary
care facilities and patient homes. Under the previous payment
schedule, payments for domiciliary care were an average 48%
lower than for private home care, and there were no codes
to use to receive higher payments for more complex patients
who now often live in such facilities.
AAGP worked closely with officials at the Centers for Medicare
and Medicaid Services (CMS) to point out the discrepancies
in the payment schedule. In addition, during AAGP's Annual
Meeting in San Diego earlier this year, a number of members
of the Clinical Practice Committee participated in an American
Medical Association (AMA)/Specialty Society Relative Value
Scale Update Committee (RUC) survey for new CPT codes with
domiciliary/assisted living facility services. AAGP had worked
with other professional organizations interested in this issue
to develop a proposal for the AMA's CPT Editorial Panel, which
was approved. The survey was then undertaken for the development
of physician work relative value units (RVUs) to be assigned
to the new codes.
A number of AAGP members played a very important role in helping
to bring about this much-needed and important change in the
assisted living codes. This demonstrates the impact that a
small organization can have on the federal legislative and
regulatory processes with persistence and hard work.
The Medicare Non-facility Payment Rates for 2006 are online
at https://www.aagponline.org/Uploads/Web/RateChg2006.xls.
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