How the COVID-19 PHE may have impacted costs, and whether health care providers envision these costs to continue. We have finalized the CPM codes to include the following elements in the code descriptor: diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and coordination between relevant practitioners furnishing care, such as physical and occupational therapy, complementary and integrative care approaches, and community-based care, as appropriate. CMS is finalizing the proposal that locality adjustments for services furnished via mobile units would be applied as if the service were furnished at the physical location of the OTP registered with DEA and certified by SAMHSA. However, we believe it would be beneficial to create system efficiencies related to the reconciliation and invoicing system of the discarded drug refunds and the new inflation rebate programs under the Inflation Reduction Act, and so we are not finalizing the timing of the initial report to manufacturers or date by which the first refund payments are due. COVID-19 Vaccines Furnished in RHCs and FQHCs (Technical Updates). For additional Customer Contact Center closures due to scheduled training exercises, refer to: Scheduled Contact . Relative value units (RVUs) are applied to each service for work, practice expense, and malpractice expense. Section 90004 of the Infrastructure Investment and Jobs Act (Pub. following federal holidays for calendar year 2022: . Codifying these proposals and revised policies in new regulations at 42 CFR 415.140. Conforming Technical Changes to the In-Person Requirements for Mental Health Visits. Weekends: The customer service department is Closed on Saturday and Sunday. 625 0 obj <>stream Based on comments received. or If we determine changes to our existing policies are needed, we would propose modifications in subsequent rulemaking. The dates listed under Part D also apply to MA and cost-based plans offering a Part D benefit. We finalized the proposed rebasing and revising of the 2017-based MEI with some technical revisions to the proposed method based on public comments. After reviewing comments on the proposals, we understand that it would be beneficial to provide interested parties more opportunity to comment on the specific details of changes in coding and payment mechanisms prior to finalizing a specific date when the transition to more appropriate and consistent payment and coding for these products will be completed. CMS is proposing a longer transition for Accountable Care Organizations (ACOs) reporting electronic clinical quality measure/Merit-based Incentive Payment System clinical quality measure (eCQM/MIPS CQM) all-payer quality measures under the Alternative Payment Model (APM) Performance Pathway (APP), by extending the availability of the CMS Web Interface collection type for two years, through performance year (PY) 2023. The finalized policy will use a new modifier instead of using a new HCPCS G-code as we proposed because we were persuaded by the commenters that a modifier would allow for better accuracy of reporting and reduce burden for audiologist. CMS is also finalizing the proposal to permit the use of audio-only communication technology to initiate treatment with buprenorphine in cases where audio-video technology is not available to the beneficiary, and all other applicable requirements are met. CMS is finalizing that providers will be required to report the JW modifier beginning January 1, 2023 and the JZ modifier no later than July 1, 2023 in all outpatient settings. CMS is proposing a series of changes to the Medicare Ground Ambulance Data Collection System including: For more information, please visit:https://www.federalregister.gov/public-inspection/current, CMS News and Media Group The CAA, 2022 also delays the in-person visit requirements for mental health visits via telecommunications technology, including those furnished by RHCs and FQHCs, until 152 days after the end of the PHE. Sign up to get the latest information about your choice of CMS topics in your inbox. ACTION: Notice. CMS has applied this methodology for these billing codes in the July 2021 ASP Drug Pricing files. However, we are soliciting comment on whether the original date of January 1, 2022, should remain, in light of the proposed exceptions to the mandate. d 3 This applies to Medicare Part A and Part B. This fee schedule takes effect January 1, 2022, so make sure your office staff are aware of the new information. CMS is implementing the final part of section 53107 of the Bipartisan Budget Act of 2018, which requires CMS, through the use of new modifiers (CQ and CO), to identify and make payment at 85% of the otherwise applicable Part B payment amount for physical therapy and occupational therapy services furnished in whole or in part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs), for dates of service on and after January 1, 2022. Sign up to get the latest information about your choice of CMS topics. Payment rates are calculated to include an overall payment update specified by statute. Over the course of the program, CMS has heard from stakeholders that there is often not enough information included in teaching hospital records for verification that the record was correctly reported. However, we are soliciting comment on whether the original date of January 1, 2022, should remain, in light of the proposed exceptions to the mandate. You are legally blind. Also beginning April 1, 2021, section 130 as amended requires that a payment limit per-visit be established for smaller provider-based RHCs enrolled before January 1, 2021. Federal government websites often end in .gov or .mil. The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, ACTION: Notice. There is just one federal holiday in October: Columbus Day. For more details on Shared Savings Program quality proposals, please refer to the Quality Payment Program PFS proposed rule fact sheet:https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1517/2022%20QPP%20Proposed%20Rule%20Overview%20Fact%20Sheet.pdf. increased applicable percentage of 35 percent for this drug. endstream endobj startxref Effective July 1, 2022 - For dates of service on/after July 1, 2022, processed on or after July 5, 2022 (CMS Change Request 12773) Note . These proposals, in addition to existing policies, provide three years for ACOs to transition to reporting the three eCQM/MIPS CQM all-payer measures under the APP. Rural HealthClinics (RHCs) and Federally Qualified Health Centers(FQHCs), Chronic Pain Management and Behavioral Health Services. We are also finalizing revisions to 414.504(a)(1) to indicate that initially, data reporting begins January 1, 2017 and is required every 3 years beginning January 2023. Columbus Day is on the second Monday of October which falls between October 8th and October 14th. In the CY 2023 HH PPS proposed rule (87 FR 37605), CMS provided data analysis on Medicare home health benefit utilization, including overall total 30-day periods of care and average periods of care per HHA user; distribution of the type of visits in a 30-day period of care for all Medicare fee-for-service (FFS) claims; the percentage of periods that receive the LUPA; estimated costs for 30-day . Mental Health Services furnished via Telecommunications Technologies for RHCs and FQHCs. For a fact sheet on the CY 2023 Quality Payment Program changes, please visit (clicking link downloads zip file): https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2136/2023%20Quality%20Payment%20Program%20Final%20Rule%20Resources.zip, For a fact sheet on the Medicare Shared Savings Program changes, please visit:https://www.cms.gov/files/document/mssp-fact-sheet-cy-2023-pfs-final-rule.pdf, CMS News and Media Group The calendar is available in the Downloads section in both a color and plain text format and identifies the following dates: CMS Holidays. The field would only be visible to the teaching hospital disputing the information. We are also proposing to clarify and refine policies that were reflected in certain manual provisions that were recently withdrawn. Before sharing sensitive information, make sure youre on a federal government site. 100-04, chapter 16, 60.1., did not have corresponding regulations text and some of the manual guidance is no longer applicable. These RVUs become payment rates through the application of a conversion factor. Only payments that are associated with research should be delayed for publication. Proposed changes to the data collection period and data reporting period for selected ground ambulance organizations in year three; Proposed revisions to the timeline for when the payment reduction for failure to report will begin and when the data will be publicly available; and. We grouped these changes and clarifications into four broad categories: editorial changes for clarity and consistency; updates to reflect the web-based system; clarifications responding to feedback from questions from interested parties and testing; and typos and technical corrections. %PDF-1.6 % As noted above, the rebased and revised MEI weights were not used in CY 2023 PFS ratesetting. This budget reflects the Administration's commitment to serve families across the country, with investments in priority areas, such as maternal health, data and research, tribal health, and early child care and learning. CMS is proposing the lesser of methodology for drug and biological products that may be identified by future OIG reports. Physician-owned distributorships (PODs) are a subset of group purchasing organizations, but are not specifically defined in the Open Payments regulation. We are also proposing to update the payment regulation for MNT services at 414.64 to clarify that MNT services are, and have been, paid at 100% (instead of 80%) of 85% of the PFS amount, without any cost-sharing, since CY 2011. Section 405 of the CAA also requires that beginning July 1, 2021, the ASP-based payment limit for billing codes representing Cimzia (certolizumab pegol) and Orencia (abatacept) as identified in a July 2020 OIG report adhere to the lesser of methodology. Washington's Birthday: Monday, Feb. 20. More specifically CMS is seeking information on: CMS is also seeking stakeholder input on two other issues. We are proposing to expand coverage of outpatient pulmonary rehabilitation services, paid under Medicare Part B, to beneficiaries who were hospitalized with COVID-19 and experience persistent symptoms, including respiratory dysfunction, for at least four weeks after hospitalization. Opioid Treatment Program (OTP) Payment Policy. Given the ongoing stakeholder interest in this issue, the proposed rule includes a comment solicitation to obtain information on the costs involved in furnishing preventive vaccines, with the goal to inform the development of more accurate rates for these services. Origin and Destination Requirements Under the Ambulance Fee Schedule. We also finalized creation of Medicare-specific coding for payment of Other E/M prolonged services, similar to what CMS adopted in CY 2021 for payment of Office/Outpatient prolonged services. Dec 21 5. CMS is proposing to require an in-person, non-telehealth service be provided by the physician or practitioner furnishing mental health telehealth services within six months prior to the initial telehealth service, and at least once every six months thereafter. FQHCs are paid under the FQHC Prospective Payment System (PPS) under Medicare Part B based on the lesser of the FQHC PPS rate or their actual charges. Medicare annual statistics - Modified Monash Model locations (2009-10 to 2021-22) 20 February 2023. Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 10872 Date: July 2, 2021 . Therefore, CMS is finalizing the proposal to add an exception to the direct supervision requirement under our incident to regulation at 42 CFR 410.26 to allow behavioral health services to be provided under the general supervision of a physician or non-physician practitioner (NPP), rather than under direct supervision, when these services or supplies are furnished by auxiliary personnel, such as LPCs and LMFTs, incident to the services of a physician (or NPP). As CMS continues to evaluate the temporary expansion of telehealth services that were added to the telehealth list during the COVID-19 PHE, CMS is proposing to allow certain services added to the Medicare telehealth list to remain on the list to the end of December 31, 2023, so that there is a glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE. hbbd```b``+@$Ln`,r~"YwEO0&y$ v;5H[x lN0 = The refund amount is the amount of discarded drug that exceeds an applicable percentage, which is required to be at least 10%, of total allowed charges for the drug in a given calendar quarter. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). For a fact sheet on the CY 2023 Quality Payment Program changes, please visit (clicking link downloads zip file): https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2136/2023%20Quality%20Payment%20Program%20Final%20Rule%20Resources.zip. People with Medicare, family members, and caregivers should visitMedicare.gov, the Official U.S. Government Site for People with Medicare, for the latest information on Medicare enrollment, benefits, and other helpful tools. CMS proposed to clarify and codify certain aspects of the current Medicare fee-for-services payment policies for dental services. We are proposing to remove the requirement that the medical nutrition therapy referral be made by the treating physician and update the glomerular filtration rate (GFR) to reflect current medical practice. Clinical Laboratory Fee Schedule: Laboratory Specimen Collection and Travel Allowance. Start Preamble AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. You are a child or teenager. This calendar schedule will assist in determining the 60th day from the start of care (SOC) date. Recertification is part of the annual process that reporting entities undertake when they submit records, primarily allowing for the companies to update their system information. Christian. We are seeking comment on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology. We are also proposing to allow a one-time opportunity for certain ACOs that established a repayment mechanism to support their participation in a two-sided model beginning on July 1, 2019; January 1, 2020; or January 1, 2021; to elect to decrease the amount of their existing repayment mechanisms. ACOs accepting performance-based risk must establish a repayment mechanism (i.e, escrow, line of credit, surety bond) to assure CMS that they can repay losses for which they may be liable upon reconciliation. RHCs and FQHCs are not authorized to serve as distant site practitioners for Medicare telehealth services after the end of the COVID-19 public health emergency. This flexible effective date is intended to take into account the impact that the PHE for COVID-19 has had and may continue to have on practitioners, providers and beneficiaries. Medicare Manuals. The proposed method for determining the 2017-based MEI relies on estimating base year expenses from publicly available data from the U.S. Census Bureau NAICS 6211 Offices of Physicians. Similar to the approach we finalized in the CY 2021 PFS final rule for office/outpatient E/M visit coding and documentation, we finalized and adopted most of these AMA CPT changes in coding and documentation for Other E/M visits (which include hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessment) effective January 1, 2023. In addition to cases where one remaining unit of a multi-unit therapy service to be billed, this revision to the policy would apply in a limited number of cases where more than one unit of therapy, with a total time of 24-28 minutes is being furnished. Under the primary care exception specifically, only MDM would be used to select the visit level to guard against the possibility of inappropriate coding that reflects residents inefficiencies rather than a measure of the time required to furnish the services. Exempting certain types of independent diagnostic testing facilities (IDTF) from several of our IDTF supplier standards in 42 CFR 410.33. On November 01, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. and also establishes the professional qualifications for these practitioners. Catherine Howden, DirectorMedia Inquiries Form We are also proposing to extend the compliance deadline for Part D prescriptions written for beneficiaries in long-term care facilities to January 1, 2025. For CY 2022, in response to numerous stakeholder questions and to promote proper therapy care, CMS is proposing to revise the de minimis standard established to determine whether services are provided in whole or in part by PTAs or OTAs. The business center is open daily from 8:30 am to 4:30 pm, local time. Finally, CMS indicated in the final rule that we intend to address payment for new codes that describe caregiver behavioral management training in CY 2024 rulemaking. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. endstream endobj 597 0 obj <. CMS is proposing a series of standard technical proposals involving practice expense, including the implementation of the fourth year of the market-based supply and equipment pricing update, changes to the practice expense for many services associated with the proposed update to clinical labor pricing, and standard rate-setting refinements. Ambulatory Surgical Center Dental, Federally Qualified Health Center Dental, General Dental, and Rural Health Center Dental fee schedules prior to Nov. 3, including archives, are available at the links below.Please follow these steps to look up the plan's maximum allowable for many . Section 405 of the CAA requires the Office of Inspector General (OIG) to conduct periodic studies on non-covered, self-administered versions of drugs or biologicals that are included in the calculation of payment under section 1847A of the Social Security Act. from March quarter 2008-09 to December quarter 2022-23. As a health practitioner you must meet certain requirements to bill for Medicare Benefits Schedule (MBS) items under Medicare or prescribe subsidised medicines. Contact Information. When the PTA/OTA furnishes eight minutes or more of the final unit of a billing scenario in which the PT/OT furnishes less than eight minutes of the same service. Currently, the payment penalty phase of the AUC program is set to begin January 1, 2022. This modification in our finalized policy necessitates multiple changes to our claims processing systems, which will take some time to fully operationalize, but audiologists may use modifier AB, along with the finalized list of 36 CPT codes, for dates of service on and after January 1, 2023. For CY 2022, we are making several proposals that take into account the recent changes to E/M visit codes, as explained in the AMA CPT Codebook, which took effect January 1, 2021. Therefore, we are soliciting comment on these topics that could be used to inform future payment policy decisions. The continued arrangements build on the temporary telehealth items introduced as part of the Government's response to the COVID-19 pandemic, and will continue to enable all Medicare eligible Australians to access telehealth (video and phone) services for a range of (out of hospital . Also, you can decide how often you want to get updates. proposing revisions to the definition of primary care services that are used for purposes of beneficiary assignment. ) Dataset. ( At present, the addition of any procedure beyond the planned colorectal screening (for which there is no coinsurance) results in a beneficiarys having to pay coinsurance. Additionally, in light of the distinction between a PHE declared under section 319 of the Public Health Service Act (PHS Act) and an Emergency Use Authorization (EUA) declaration under section 564 of the Food, Drug, and Cosmetic Act (FD&C Act), and the possibility that they will not terminate at precisely the same time, CMS is clarifying the policies finalized in the CY 2022 PFS final rule regarding the administration of COVID-19 vaccine and monoclonal antibody products, to reflect that those policies will continue through the end of the calendar year in which the EUA declaration for drugs and biological products is terminated. Lastly, section 130 of the CAA subjects all newly enrolled RHCs (as of January 1, 2021, and after), both independent and provider-based, to a national payment limit per-visit. You may be eligible for Medicaid if your income is low and you match one of the following descriptions: You think you are pregnant. We are also proposing to extend the compliance deadline for, Part D prescriptions written for beneficiaries in, Section 405 of the CAA also requires that beginning July 1, 2021, the ASP-based payment limit for billing codes. In instances where the service is not defined in 15-minute increments including: supervised modalities, evaluations/reevaluations, and group therapy. ) In the event a holiday falls on a weekday or weekend, Medicare is closed for business. Effective for CY 2023, CMS 1) finalized our proposal to clarify and codify certain aspects of the current Medicare FFS payment policies for dental services when that service is an integral part of specific treatment of a beneficiary's primary medical condition, and 2) other clinical scenarios under which Medicare Part A and Part B payment can be made for dental services, such as dental exams and necessary treatments prior to, or contemporaneously with, organ transplants, cardiac valve replacements, and valvuloplasty procedures. The proposed exceptions would apply: We are proposing that prescribers be able to request a waiver where circumstances beyond the prescribers control prevent the prescriber from being able to electronically prescribe controlled substances covered by Part D. We are proposing to initially enforce compliance by sending compliance letters to prescribers violating the EPCS mandate.