SUPPORT Act Medicare Provisions Effective 1/1/2020: AWS and IPPE

Healthcare providers rendering Annual Wellness Visit and Initial Preventive Physical Examination services to Medicare beneficiaries should ensure they have updated their clinical documentation templates and protocols to comply with the SUPPORT Act.

According to the Congressional Research Service Summary of Provision 2002 of the Support Act:

Medicare beneficiaries are entitled to annual “well” visits. The first such visit, furnished in the first year of enrollment, is the Initial Preventive Physical Examination (IPPE), often called the “welcome to Medicare” visit (SSA §1861(ww)). Annually thereafter, beneficiaries are entitled to an annual wellness visit (AWV) and personalized prevention plan services (SSA §1861(hhh)). Regulations at 42 C.F.R. Part 410, Subpart B, specify, for each visit, the provision of a health assessment;a suite of physical measurements (e.g., blood pressure);and education, counseling, and referral for additional preventive services that are covered separately. Consultative services that must be furnished include, among others, end-of-life planning (upon agreement with the patient) and screenings for depression and alcohol misuse.

Section 2002 amends the IPPE authority in SSA Section 1861(ww) to include a review of the beneficiary’s current opioid prescriptions, defined as (1) a review of potential risk factors for OUD; (2) an evaluation of pain severity and the treatment plan; (3) the provision of information on non-opioid treatment options; and (4) referral to a specialist, as appropriate. In addition, it adds to the required elements of the IPPE “screening for potential substance use disorders.” It also amends the AWV authority in SSA Section 1861(hhh) to include the same review of the beneficiary’s current opioid prescriptions as for the IPPE, as well as “screening for potential substance use disorders and referral for treatment as appropriate.” These additional requirements apply to visits furnished on or after January 1, 2020. The provision shall not be construed to prohibit separate payments for additional services for substance abuse that are furnished on the same day as an IPPE or AWV.