July 13, 2021
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, to go into effect on or after January 1, 2022. With the proposed budget neutrality adjustment to account for changes in relative value units (required by law), and expiration of the 3.75 percent payment increase provided for calendar year (CY) 2021 by the Consolidated Appropriations Act, 2021 (CAA), the proposed CY 2022 PFS conversion factor is $33.58, a decrease of $1.31 from the CY 2021 PFS conversion factor of $34.89. The PFS conversion factor reflects the statutory update of 0.00 percent and the adjustment necessary to account for changes in relative value units and expenditures that would result from our proposed policies.
In the PFS proposed rule, CMS is reinforcing its commitment to expanding access to behavioral health care and reducing barriers to treatment. CMS is proposing to implement recently enacted legislation that removes certain statutory restrictions to allow patients in any geographic location and in their homes access to telehealth services for diagnosis, evaluation and treatment of mental health disorders. Along with this change, CMS is proposing to expand access to mental health services for rural and vulnerable populations by allowing, for the first time, Medicare to pay for mental health visits when they are provided by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to include visits furnished through interactive telecommunications technology. To further expand access to care, CMS is proposing to allow payment to eligible practitioners when they provide certain mental and behavioral health services via audio-only telephone calls from their homes when certain conditions are met. This includes counseling and therapy services provided through Opioid Treatment Programs.
In addition, with respect to the Quality Payment Program (QPP), CMS is proposing to require clinicians to meet a higher performance threshold to be eligible for incentives. To ensure more meaningful participation for clinicians and improved outcomes for patients, CMS is moving forward with the next evolution of QPP and proposing its first seven Merit-based Incentive Payment System (MIPS) Value Pathways – subsets of connected and complementary measures and activities, established through rulemaking, used to meet MIPS reporting requirements. CMS is also proposing to revise the current eligible clinician definition to include clinical social workers and certified nurse-midwives, as these professionals are often on the front lines serving communities with acute health care needs.
Additionally, CMS is proposing to implement a recent statutory change that authorizes Medicare to make direct Medicare payments to Physician Assistants (PAs) for professional services they furnish under Part B. Beginning January 1, 2022, for the first time, physician assistants would be able to bill Medicare directly, thus expanding access to care and reducing the administrative burden that currently requires a PA’s employer or independent contractor to bill Medicare for a PA’s professional services. CMS is proposing to implement a recent statutory change to provide a special coinsurance rule for procedures that are planned as colorectal cancer screening tests but become diagnostic tests when the practitioner identifies the need for additional services (e.g., removal of polyps). CMS is proposing to implement the recent law requiring that independent RHCs and provider-based RHCs in a hospital with 50 or more beds receive an increase in their payment limit per visit over an 8-year period, with a prescribed amount for each year from 2021 through 2028. CMS is also proposing to implement recent law, which makes FQHCs and RHCs eligible to receive payment for hospice attending physician services when provided by a FQHC/RHC physician, nurse practitioner, or physician assistant who is employed or working under contract for an FQHC or RHC, but is not employed by a hospice program, starting January 1, 2022.
The proposed rule is also soliciting feedback on the collection of data, and on how the agency can advance health equity for people with Medicare (while protecting individual privacy), potentially through the creation of confidential reports that allow providers to look at patient impact through a variety of data points – including, but not limited to, LGBTQ+, race and ethnicity, dual-eligible beneficiaries, disability, and rural populations.
To view the CY 2022 Physician Fee Schedule and Quality Payment Program proposed rule, please visit: https://www.federalregister.gov/public-inspection/current
A press release is attached and can be viewed here: https://www.cms.gov/newsroom/press-releases/cms-proposes-physician-payment-rule-improve-health-equity-patient-access
A fact sheet on the CY 2022 Physician Fee Schedule policies is attached and can be viewed here: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2022-medicare-physician-fee-schedule-proposed-rule
A fact sheet on the CY 2022 Quality Payment Program policies will be available here: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1517/2022%20QPP%20Proposed%20Rule%20Overview%20Fact%20Sheet.pdf
A fact sheet on policies included in this rule for the Medicare Diabetes Prevention Program Expanded Model is attached and can be viewed here: https://www.cms.gov/newsroom/fact-sheets/proposed-policies-medicare-diabetes-prevention-program-mdpp-expanded-model-calendar-year-2022