Updates to the Open Payments Financial Transparency Program. In consideration of our ongoing efforts to update the PFS payment rates with more predictability and transparency, and in the interest of ensuring payment stability, we proposed not to use the updated MEI cost share weights to set PFS payment rates for CY 2023. 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. 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. Share sensitive information only on official, secure websites. Start Preamble AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. Individuals who intend to view and/or listen to the meeting do not need to register. The travel allowance is paid only when the nominal specimen collection fee is also payable. .gov 202-690-6145. 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. lock . 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. An official website of the United States government. Specifically, CMS proposed to change the terminology of skin substitutes to wound care management products, and to treat and pay for these products as incident to supplies under the PFS beginning on January 1, 2024. 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. Additionally, CMS is clarifying that OTPs can bill Medicare for medically reasonable and necessary services furnished via mobile units in accordance with SAMHSA and DEA guidance. Orthodox Christmas Day 2022. 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 . Currently, the payment penalty phase of the AUC program is set to begin January 1, 2022. CMS also proposed and sought comment on payment for other dental services that were inextricably linked to, and substantially related and integral to, the clinical success of, an otherwise covered medical service, such as dental exams and necessary treatments prior to organ transplants, cardiac valve replacements, and valvuloplasty procedures. We are, however, finalizing that we will issue a preliminary report on estimated discarded drug amounts based on claims from the first two calendar quarters of 2023 no later than December 31, 2023 and will revisit the timing of the first report in future rulemaking. In addition, we are finalizing a policy to update this fee amount annually by the percent change in the CPI-U. Last Updated Mon, 15 Nov . As future dates for 2022 are announced, we will update the calendar. Epiphany 2022. Share sensitive information only on official, secure websites. Columbus Day is on the second Monday of October which falls between October 8th and October 14th. 7500 Security Boulevard, Baltimore, MD 21244 . 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 . 625 0 obj
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As noted above, the rebased and revised MEI weights were not used in CY 2023 PFS ratesetting. July 29, 2021 announcement of 2022 Part 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 . April 14 July 4 is a holiday for 12-month employees only This calendar reects the 2022-2023 academic calendar approved by the Board of Education on July 13, 2021. 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. We are proposing that the changes would be applicable for determining beneficiary assignment beginning with PY 2022. Under the exception, grandfathered tribal FQHCs bill as if it were provider-based to an Indian Health Service (IHS) hospital and are paid the Medicare outpatient per visit rate, also referred to as the IHS all-inclusive rate (AIR). We are also proposing to modify the threshold for determining whether an ACO is required to increase its repayment mechanism amount during its agreement period. 2501 Mail Service Center Raleigh, NC 27699-2501 NC Medicaid Contact Center . Thus, beginning CY 2022, the coinsurance required of Medicare beneficiaries for planned colorectal cancer screening tests that result in additional procedures furnished in the same clinical encounter will be gradually reduced, and beginning January 1, 2030, will be zero percent. . We are also seeking comment on whether stakeholders believe there are other codes that should be included in this definition to inform future rulemaking. CMS is also clarifying that any service furnished primarily for the diagnosis and treatment of a mental health or substance use disorder can be furnished by auxiliary personnel under the general supervision of a physician or NPP who is authorized to furnish and bill for services provided incident to their own professional services. Closed on State holidays. Definition of split (or shared) E/M visits as evaluation and management (E/M) visits provided in the facility setting by a physician and an NPP in the same group. ( For CY 2023, we are finalizing a number of policies related to Medicare telehealth services, including making several services that are temporarily available as telehealth services for the PHE available at least through CY 2023 in order to allow additional time for the collection of data that may support their inclusion as permanent additions to the Medicare Telehealth Services List. 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. Lastly, in light of questions we have received from interested parties, we are finalizing as proposed to codify in our regulations, and make certain modifications and clarifications to, the Medicare CLFS travel allowance policies. 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. 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. 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. 202-690-6145. 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. We are also proposing to modify the threshold for determining whether an ACO is required to increase its repayment mechanism amount during its agreement period. ) 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). 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. Contact Information. CMS is proposing to require that OTPs use a service-level modifier for audio-only services billed using the counseling and therapy add-on code and document in the medical record the rationale for a service being furnished using audio-only services, in order to facilitate program integrity activities. and also establishes the professional qualifications for these practitioners. Physicians services paid under the PFS are furnished in various settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities. 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. 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. For CY 2022, in response to stakeholder concerns about parity with other types of NPPs, we are proposing to establish regulations at 410.72 for their services since they are the only NPP type listed at section 1842(b)(18)(C) of the Act without a regulatory provision in this section of 42 CFR subpart B. Outpatient clinics operated by a tribal organization under the Indian Self-Determination Education and Assistance Act or by an Urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act are eligible to become FQHCs. CMS is finalizing requirements for the use of the JW modifier, for reporting discarded amounts of drugs, and the JZ modifier, for attesting that there were no discarded amounts. Since the requirements for the chronic pain management and behavioral health integration services are similar to the requirements for the general care management services furnished by RHCs and FQHCs (which are the current services for which RHCs and FQHCs can use HCPCS code G0511) the payment rate for HCPCS code G0511 will continue to be the average of the national non-facility PFS payment rates for the RHC and FQHC care management and general behavioral health codes (CPT codes 99484, 99487, 99490, and 99491) and PCM codes (CPT codes 99424 and 99425) Payment will be updated annually based on the PFS amounts for these codes, which is how these updates are made currently. In accordance with section 4(b) of the Protecting Medicare and American Farmers from Sequester Cuts Act, we are finalizing certain conforming changes to the data reporting and payment requirements at 42 CFR part 414, subpart G. Specifically, we are finalizing revisions to 414.502 to update the definitions of both the data collection period and data reporting period, specifying that for the data reporting period of January 1, 2023 through March 31, 2023, the data collection period is January 1, 2019 through June 30, 2019. Start Preamble AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). In instances where the service is not defined in 15-minute increments including: supervised modalities, evaluations/reevaluations, and group therapy. CMS is also finalizing the proposal to allow a psychiatric diagnostic evaluation to serve as the initiating visit for the new general BHI service. Chronic Pain Management and Treatment Services. 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. CMS is proposing to reduce burden and streamline the Shared Savings Program application process by modifying the prior participation disclosure requirement, so that the disclosure is required only at the request of CMS during the application process, and by reducing the frequency and circumstances under which ACOs submit sample ACO participant agreements and executed ACO participant agreements to CMS. CMSs proposal would eliminate the confusion that the two types of ownership records may create and facilitate easier understanding and analysis of the data by having only one type of ownership record. 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. That is, the Medicare payment limit for the drug or biological billing code would be the lesser of: (1) the payment limit determined using the current methodology (where the calculation includes the ASPs of the self-administered versions), or (2) the payment limit calculated after excluding the non-covered, self-administered versions. ( Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). We finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. SUMMARY: This notice announces a $688.00 calendar year (CY) 2023 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 . .gov CMS is proposing to make conforming technical changes to the regulatory text related to COVID-19 vaccines for RHCs and FQHCs. 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 For prescribers who are in the geographic area of a natural disaster, or who are granted a waiver based on extraordinary circumstances, such as an influx of patients due to a pandemic. CMS is proposing to allow OTPs to furnish counseling and therapy services via audio-only interaction (such as telephone calls) after the conclusion of the COVID-19 PHE in cases where audio/video communication is not available to the beneficiary, including circumstances in which the beneficiary is not capable of or does not consent to the use of devices that permit a two-way audio/video interaction, provided all other applicable requirements are met. You are a child or teenager. lock or D.O.). The practitioner who provides the substantive portion of the visit (more than half of the total time spent) would bill for the visit. Updated Medicare Economic Index (MEI) for CY 2023. On 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, on or after January 1, 2022. This schedule lists holiday closures for the First Coast offices and provider contact centers responsible for serving providers in Florida, Puerto Rico, and the U.S. Virgin Islands. The calendar year (CY) 2022 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation. With the budget neutrality adjustments, which are required by law to ensure payment rates for individual services dont result in changes to estimated Medicare spending, the required statutory update to the conversion factor for CY 2023 of 0%, and the expiration of the 3% supplemental increase to PFS payments for CY 2022, the final CY 2023 PFS conversion factor is $33.06, a decrease of $1.55 to the CY 2022 PFS conversion factor of $34.61. 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%. In the proposed rule, CMS proposed that an initial invoice for the refund to be sent to manufacturers in October 2023. 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. Specifically, in accordance with section 1833(h)(3)(B) of the Act, we are finalizing to include in our regulations the following requirements for the travel allowance methodology: (1) a general requirement, (2) travel allowance basis requirements, and (3) travel allowance amount requirements. These proposals would result in lower required initial repayment mechanism amounts, and less frequent repayment mechanism amount increases during an ACOs agreement period, thereby lowering potential barriers for ACOs participation in two-sided models and increasing available resources for investment in care coordination and quality improve activities. The CY 2023 Medicare Physician Payment Schedule Final Rule updates payment policies and rates as well as other provisions for services offered on or after Jan. 1, 2023, under the Medicare Physician Payment Schedule. 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. 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. 2022 NFRM Alternative Statewide CCRs and Upper Limits (ZIP) 2022 NPRM OPPS Statewide CCRs and Upper Limits (ZIP) . Catherine Howden, DirectorMedia Inquiries Form Finalizing the use of the 2017-based MEI cost weights to set PFS rates would not change overall spending on PFS services, but would result in significant distributional changes to payments among PFS services across specialties and geographies. Since January 1, 2002, registered dietitians and nutrition professionals have been recognized to provide and bill for MNT services, meaning nutritional diagnostic, therapeutic, and counseling services. 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. This policy determines which professional should bill for a shared visit by defining the substantive portion, of the service as more than half of the total time. Official websites use .govA Holidays: Closed all day, unless otherwise noted. These claims will require the modifier 95 to identify them as services furnished as telehealth services. CMS is soliciting comment on a decision framework under which certain section 505(b)(2) drug products could be assigned to existing multiple source drug codes. 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. The Centers for Medicare and Medicaid Services (CMS) on July 13 released the proposed 2022 Medicare Physician Fee Schedule, addressing Medicare payment and quality provisions for physicians in the next fiscal year. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Geographic adjusters (geographic practice cost index) are also applied to the total RVUs to account for variation in practice costs by geographic area. In addition, we are seeking comment on different types of compliance actions, so that we may ensure prescribers electronically prescribe controlled substances covered under Part D without overly burdening them. following federal holidays for calendar year 2022: . 596 0 obj
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You are age 65 or older. file delivery for Medicare Advantage or Illinois Medicaid claims. How the COVID-19 PHE may have impacted costs, and whether health care providers envision these costs to continue. ACTION: Notice. Contents. Specifically, we are requesting comments regarding the nominal specimen collection fees for trained personnel to collect specimens from homebound patients and inpatients (not in a hospital). Payment due to Plan. We finalized the proposed rebasing and revising of the 2017-based MEI with some technical revisions to the proposed method based on public comments. CMS finalized the proposal to permit audiologists to bill for this direct access (without a physician or practitioner order) once every 12 months per beneficiary. CMS also solicited comments on whether there are other drugs with unique circumstances that may warrant an increase in the applicable percentage. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, 2022 NFRM OPPS Statewide CCRs and Upper Limits (ZIP) (ZIP), 2022 NFRM Alternative Statewide CCRs and Upper Limits (ZIP), 2022 NPRM OPPS Statewide CCRs and Upper Limits (ZIP), Alternative 2022 NPRM OPPS Statewide CCRs and Upper Limits (ZIP), CY 2022 Special Wage Index Assignments for Cap on Wage Index Decreases (ZIP), 2022 Procedure Price Lookup Comparison File. If we determine changes to our existing policies are needed, we would propose modifications in subsequent rulemaking. 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. Finally, we are working to address commenters thoughtful feedback and questions regarding the operational aspects of billing and claims processing for these services. 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. 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. Dataset. Both of these policies reflect our desire to expand access to quality care and to improve health outcomes for patients through prevention and early detection services, as well as through effective treatments. 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. These services will be reported with three separate Medicare-specific G codes. Secure .gov websites use HTTPSA That critical care visits cannot be reported during the same time period as a procedure with a global surgical period. .gov %PDF-1.6
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The federal . 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. Secure .gov websites use HTTPSA CMS is proposing to allow RHCs and FQHCs to bill for TCM and other care management services furnished for the same beneficiary during the same service period, provided all requirements for billing each code are met. We are also finalizing our proposals to codify and clarify various laboratory specimen collection fee policies in 414.523(a)(1). We are seeking comment on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology. In this rule, CMS finalized refinements to the payment amount for preventive vaccine administration under the Medicare Part B vaccine benefit, which includes the influenza, pneumococcal, hepatitis B, and COVID-19 vaccine and their administration. 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 . ) Based on comments received. This is because the policies implementing the statutory requirements under section 1833(h)(3)(A) of the Act for the laboratory specimen collection fee, which are currently described in the Medicare Claims Processing Manual Pub. View below dates indicate when Noridian operations, including the Contact Center phone lines, will be unavailable for customer service. Medicare Manuals. 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 Proposes Benefit Expansion for Mobility Devices, Advancing Health Equity for People with Disabilities, CMS Announces Increase in 2023 in Organizations and Beneficiaries Benefiting from Coordinated Care in Accountable Care Relationship, CMS Awards 200 New Medicare-funded Residency Slots to Hospitals Serving Underserved Communities, CMS Responding to Data Breach at Subcontractor, Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule - Medicare Shared Savings Program. Call To Action. Payment for Attending Physician Services Furnished by RHCs or FQHCs to Hospice Patients. Electronic Prescribing of Controlled Substances-- Section 2003 of the SUPPORT Act. Section 90004 of the Infrastructure Investment and Jobs Act (Pub. 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. First, we are seeking input on our preliminary policy to pay $35 add-on for certain vulnerable beneficiaries when they receive a COVID-19 vaccine at home. We finalized conforming regulatory text changes in accordance with section 304 of the CAA, 2022 to amend paragraph (b)(3) of 42 CFR 405.2463, What constitutes a visit, and paragraph (d) of 42 CFR 2469, FQHC supplemental payments, to include the delay of the in-person requirements for mental health visits furnished by RHCs and FQHCs through telecommunication technology under Medicare until the 152. Payment rates are calculated to include an overall payment update specified by statute.