. Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). https:// .gov See the below for the following updates: Updated Pricing for codes G0339, G0340, 0275T, 0598T & 0599T effective January 1, 2022. There is an exception for payment under the FQHC PPS for certain tribal FQHCs in operation on or before April 7, 2000. 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. means youve safely connected to the .gov website. Opioid Treatment Program (OTP) Payment Policy. Intended Audience: Hospice billers, compliance and regulatory staff. The framework approach is consistent with the concept of paying similar amounts for similar services and with efforts to curb drug prices. In light of the current needs among Medicare beneficiaries for improved access to behavioral health services, CMS has considered regulatory revisions that may help to reduce existing barriers and make greater use of the services of behavioral health professionals, such as licensed professional counselors (LPCs) and Licensed Marriage and Family Therapists (LMFTs). CY 2023 PFS Ratesetting and Conversion Factor. To address this, CMS is proposing language that will clarify the impermissibility of delaying general payments, and that research-related payments do not need to have been specifically outlined in the original research agreement to be reported as research payments. CMS is proposing several provider enrollment regulatory revisions that will strengthen program integrity while assisting Medicare beneficiaries. For many diagnostic tests and a limited number of other services under the PFS, separate payment may be made for the professional and technical components of services. Medicare annual statistics - Modified Monash Model locations (2009-10 to 2021-22) 20 February 2023. 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. Medicare Cost Plans. Subsequent to the publication of the CY 2022 PFS final rule, which implemented changes to the RHC payment limit as required by the Consolidated Appropriations Act, 2021, interested parties requested clarification regarding the timing of cost reports used to set the RHC payment limit. In addition, we are finalizing a policy to update this fee amount annually by the percent change in the CPI-U. The travel allowance is paid only when the nominal specimen collection fee is also payable. Through review of questions and feedback that we received, we have identified some instances where changes and clarifications to the instrument could improve clarity and be less burdensome to respondents. CMS believes that this change will facilitate access and extend the reach of behavioral health services. Therefore, for CY 2023, as in CY 2022, the substantive portion of a visit is comprised of any of the following elements: As finalized, clinicians who furnish split (or shared) visits will continue to have a choice of history, or physical exam, or medical decision making, or more than half of the total practitioner time spent to define the substantive portion instead of using total time to determine the substantive portion, until CY 2024. Dataset. For more details on Shared Savings Program quality proposals, please refer to the Quality Payment Program PFS proposed rule fact sheet: proposing to revise the methodology for calculating repayment mechanism amounts for risk-based ACOs to reduce the percentage used in the existing amount by 50%. CMS is proposing to clarify that the time when the teaching physician was present can be included when determining E/M visit level. Our policies also directly support President Bidens Cancer Moonshot Goal to cut the death rate from cancer by at least 50 percent over the next 25 years and addresses his recent proclamation of March 2022 as National Colorectal Cancer Awareness Month. We are also finalizing payment for dental exams and necessary treatments prior to the treatment for head and neck cancers starting in CY 2024, and finalizing a process in CY 2023 to review and consider public recommendations for Medicare payment for dental service in other potentially analogous clinical scenarios. The Division of Ambulatory Services in the CMS Center for Medicare is coordinating the CLFS Annual Public Meeting registration. Expanding our authority to deny or revoke a providers or suppliers Medicare enrollment in order to protect the Medicare program and its beneficiaries. 625 0 obj <>stream First, we are finalizing our proposal to update our regulations at 414.626(d)(1) and (e)(2) to provide the necessary flexibility to specify how ground ambulance organizations should submit the hardship exemption requests and informal review requests, including to our web-based portal once that portal is operational. 7500 Security Boulevard, Baltimore, MD 21244, 2022 Medicare Advantage ratebook and Prescription Drug rate information, An official website of the United States government, July 29, 2021 Parts C & D announcement (PDF), July 29, 2021announcement of 2022Part D National Average Monthly Bid Amount, Medicare Part D Base Beneficiary Premium, Part D Regional Low-Income Premium Subsidy Amounts, Medicare Advantage Regional Benchmarks, and Income Related Monthly Adjustment Amounts, Regional Rates and benchmarks, Part D Low Income Premium Subsidy Amounts, 2022Rate calculation data including statutory benchmark data, USPCC amounts (prospective and retrospective). ; 2023 In contrast, PFS rates paid to physicians and other billing practitioners in facility settings, such as a hospital outpatient department (HOPD) or an ASC, reflect only the portion of the resources typically incurred by the practitioner in the course of furnishing the service. This will increase overall payments for medication-assisted treatment and other treatments for OUD, recognizing the longer therapy sessions that are usually required. We are also finalizing our proposals to codify and clarify various laboratory specimen collection fee policies in 414.523(a)(1). To review the entire final rule, visit the Federal Register. . 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. In December 2020, CMS implemented the first phase of this mandate by naming the standard that prescribers must use for EPCS transmissions and delaying compliance actions until January 1, 2022. Share sensitive information only on official, secure websites. When both the PTA/OTA and the PT/OT each furnish less than eight minutes for the final 15-minute unit of a billing scenario. Call To Action. The final CY 2023 MEI update is 3.8 percent based on the most recent historical data available. CMS is proposing to give companies the option to recertify and attest to the fact that they do not have any records to submit for a reporting year. Additionally, CMS is allowing periodic assessments to be furnished audio-only when video is not available for the duration of CY 2023, to the extent that it is authorized by SAMSHA and DEA at the time the service is furnished. CMS has received a request from the American Indian and Alaska Native community to amend its Medicare regulations to make all IHS- and tribally-operated outpatient facilities/clinics eligible for payment at the Medicare outpatient per visit/AIR, regardless of whether they were owned, operated, or leased by IHS. Official websites use .govA Spending time (more than half of the total time spent by the practitioner who bills the visit). Also, you can decide how often you want to get updates. 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. Clinical Laboratory Fee Schedule: Laboratory Specimen Collection and Travel Allowance. Drug manufacturers with Medicaid Drug Rebate Agreements are required to submit Average Sales Price (ASP) data for their Part B products in order for their covered outpatient drugs to be payable under Part B. Secure .gov websites use HTTPSA . here are several provisions that CMS is proposing that are aimed at bolstering the abilities of RHCs and FQHCs to furnish care to underserved Medicare beneficiaries. We are proposing to amend the beneficiary notification requirement to set forth different notification obligations for ACOs depending on the assignment methodology selected by the ACO to help avoid unnecessary confusion for beneficiaries. Fri., 12/31/2021 : Catherine Howden, DirectorMedia Inquiries Form Holiday Name Calendar Date Legal Banking Holiday Observed Date BCBSIL Holiday Observed Date* New Year's Day 2022 . Updates to the Open Payments Financial Transparency Program. ) 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). We are exploring how these policies interact with the Shared Savings Programs other benchmarking policies. This approach would be applied to section 505(b)(2) drug products where a billing code descriptor for an existing multiple source code describes the product and other factors, such as the products labeling and uses, are similar to products already assigned to the code. and also establishes the professional qualifications for these practitioners. In order to stabilize the price for methadone for CY 2023 and subsequent years, CMS is finalizing the proposal to revise our methodology for pricing the drug component of the methadone weekly bundle and the add-on code for take-home supplies of methadone. Revised interpretive guidelines for levels of medical decision making. Under our existing regulations, if a resident participates in a service furnished in a teaching setting, a teaching physician can bill for the service only if they are present for the key or critical portion of the service. We will take into account the comments we received in response to CY 2023 rulemaking and feedback received in association with the Town Hall in order to strengthen proposed policies for skin substitutes in future rulemaking. The individual providing the substantive portion must sign and date the medical record. Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. 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. Washington's Birthday: Monday, Feb. 20. For calendar quarters beginning January 1, 2022, the CAA requires manufacturers of drugs or biologicals payable under Part B without a Medicaid Drug Rebate Agreement to report ASP data. Medicare Ground Ambulance Data Collection System. We observe most federal holidays, as well as select additional corporate holidays. Share sensitive information only on official, secure websites. and also establishes the professional qualifications for these practitioners. SUMMARY: This notice announces a $631.00 calendar year (CY) 2022 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new . Basic Eligibility. Only payments that are associated with research should be delayed for publication. The field would only be visible to the teaching hospital disputing the information. We are also seeking comment on whether stakeholders believe there are other codes that should be included in this definition to inform future rulemaking. Relative value units (RVUs) are applied to each service for work, practice expense, and malpractice expense. CMS is also announcing that we are making permanent the option for laboratories to maintain electronic logs of miles traveled for the purposes of covering the transportation and personnel expenses for trained personnel to travel to the location of an individual to collect a specimen sample. Chronic Pain Management and Treatment Services. In the CY 2022 PFS proposed rule, we are proposing the following: Similarly, we are proposing to refine our longstanding policies for critical care services. Jun 07, 2022 1:00PM - 2:00PM EST Care management is a central theme for the Centers for Medicare & Medicaid Services as a key component of the total care . 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 . Last Updated Mon, 15 Nov . We are also seeking comments related to the calculation of costs for transportation and personnel expenses for trained personnel to collect specimens from such patients. Open Payments is a national transparency program that requires drug and device manufacturers and group purchasing organizations (known as reporting entities) to report payments or transfers of value to physicians, teaching hospitals, and other providers (known as covered recipients) to CMS. Manufacturers without such agreements have the option to voluntarily submit ASP data. The following provisions demonstrate CMSs commitment to addressing health equities in rural and vulnerable populations. The calendar is available in the Downloads section in both a color and plain text format and identifies the following dates: CMS Holidays. This often leads to disputes, a process by which the covered recipient initiates a conversation with the reporting entity to get more information, creating work for both parties. Before sharing sensitive information, make sure youre on a federal government site. website belongs to an official government organization in the United States. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Based on comments received. 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. Under the proposal, physicians would see a decrease of $1.31 in the conversion factor on Jan. 1, 2022, going from $34.89 . Official websites use .govA COVID-19 Vaccines Furnished in RHCs and FQHCs (Technical Updates). This fee schedule takes effect January 1, 2022, so make sure your office staff are aware of the new information. Section 130 of the CAA as amended by section 2 of P.L. Updated Medicare Economic Index (MEI) for CY 2023. CY 2022 PFS Ratesetting and Conversion Factor. The pandemic has highlighted the importance of access to COVID-19 vaccines, as well as access to other preventive vaccines. Then, in subsequent years, the limit is updated by the percentage increase in Medicare Economic Index (MEI). 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. In the 2022 CMS Behavioral Health Strategy (https://www.cms.gov/cms-behavioral-health-strategy), CMS included a goal to improve access to, and quality of, mental health care services and included an objective to increase detection, effective management, and/or recovery of mental health conditions through coordination and integration between primary and specialty care providers. In CY 2017 and 2018 PFS rulemaking, CMS received comments that initiating visit services for behavioral health integration (BHI) should include in-depth psychological evaluations delivered by a clinical psychologist (CP), and that CMS should consider allowing professionals who were not eligible to report the approved initiating visit codes to Medicare to serve as a primary hub for BHI services. Further, section 1814(i)(6) of the Act, as added by section 3132(a)(1)(B) of the PPACA, authorized . CMS is committed to ensuring that ACOs establishing a repayment mechanism to support their participation in a two-sided model beginning with PY 2022 do not overfund their repayment mechanism arrangements according to the existing methodology if we finalize the proposed revisions to reduce repayment mechanism amounts. Rural HealthClinics (RHCs) and Federally Qualified Health Centers(FQHCs), Chronic Pain Management and Behavioral Health Services. Where the prescriber and dispensing pharmacy are the same entity; issue 100 or fewer controlled substance prescriptions for Part D drugs per calendar year. Electronic Prescribing of Controlled Substances-- Section 2003 of the SUPPORT Act. Exempting certain types of independent diagnostic testing facilities (IDTF) from several of our IDTF supplier standards in 42 CFR 410.33. See the 'Urban Area/State Code' and be sure to select the appropriate CBSA to view fees for your facility. ASC Drug Fees are also located on the CMS ambulatory surgical center (ASC) payment page. An official website of the United States government The calendar year (CY) 2022 PFS proposed rule is one of . Some examples include reconstruction of the jaw following fracture or injury, tooth extractions done in preparation for radiation treatment for cancer involving the jaw, or oral exams preceding kidney transplantation. Medical Nutrition Therapy Coverage and Payment Issues. From 1 January 2022, patient access to telehealth services will be supported by continued MBS arrangements. Please refer to the chart below for important answers to common questions. In addition, we have been asked to consider certain flexibilities regarding the cost reporting requirement for these types of facilities. -425. As a health practitioner you must meet certain requirements to bill for Medicare Benefits Schedule (MBS) items under Medicare or prescribe subsidised medicines. 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