means youve safely connected to the .gov website. Therefore, for CY 2023, the general specimen collection fee will increase from $3 to $8.574 and as required by PAMA, we will increase this amount by $2 for those specimens collected from a Medicare beneficiary in a SNF or by a laboratory on behalf of an HHA, which will result in a $10.57 specimen collection fee for those beneficiaries . On July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) released an advance copy of the calendar year (CY) 2022 Medicare Physician Fee Schedule (PFS) proposed payment rule.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. Determination of ASP for Certain Self-administered Drug Products. Contact Information. 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. CMS is finalizing our interim final policy (85 FR 19276) that the expanded list of covered destinations for ground ambulance transports was for the duration of the COVID-19 PHE only. 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. Heres how you know. Codifying these proposals and revised policies in new regulations at 42 CFR 415.140. With the proposed budget neutrality adjustment to account for changes in RVUs (required by law), and expiration of the 3.75 percent payment increase provided for 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. 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. CMS is proposing to begin the payment penalty phase of the AUC program on the later of January 1, 2023, or the January 1 that follows the declared end of the PHE for COVID-19. NC Medicaid Division of Health Benefits. Beginning January 1, 2022, PAs would be able to bill Medicare directly for their services and reassign payment for their services. CMS is proposing revisions to the definition of primary care services that are used for purposes of beneficiary assignment. When the PTA/OTA independently furnishes a service, or a 15-minute unit of a service in whole without the PT/OT furnishing any part of the same service. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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. However, this process is not available for companies that do not have any records to report. permanently cover and pay for covered monoclonal antibody products used as pre-exposure prophylaxis for prevention of COVID-19 under the Medicare Part B vaccine benefit. Jan 7 - Fri. Holiday & training closures. 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. 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). 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. Geographic adjusters (geographic practice cost index) are also applied to the total RVUs to account for variation in practice costs by geographic area. 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. 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. 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). Accordingly, CMS is proposing to include a specific definition for PODs, as well as make explicit the requirement for PODs to report and self-identify. CMS has applied this methodology for these billing codes in the July 2021 ASP Drug Pricing files. However, this proposed change would allow RHCs and FQHCs to report and receive payment for mental health visits furnished via real-time telecommunication technology in the same way they currently do when visits take place in-person, including audio-only visits when the beneficiary is not capable of, or does not consent to, the use of video technology. Here's the Social Security holiday schedule for 2023: New Year's Day: Monday, Jan. 2 (observed) Martin Luther King Jr. Day: Monday, Jan. 16. We plan to conduct a Town Hall in early CY 2023 with interested parties to address commenters concerns as well as discuss potential approaches to the methodology for payment of skin substitute products under the PFS. Origin and Destination Requirements Under the Ambulance Fee Schedule. 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. We also seek comments from stakeholders on the Shared Savings Programs calculation of the regional adjustment, and blended national-regional growth rates for trending and updating the benchmark, as well as comments on the risk adjustment methodology. That is, for services furnished on or after January 1, 2022, the coinsurance amount paid for planned colorectal cancer screening tests that require additional related procedures shall be equal to a specified percent (i.e., 20% for CY2022, 15% for CYs 2023 through 2026, 10% for CYs 2027 through 2029, and zero percent beginning CY 2030) of the lesser of the actual charge for the service or the amount determined under the fee schedule that applies to the test. means youve safely connected to the .gov website. We confirmed our intention to implement the telehealth provisions in sections 301 through 305 of the CAA, 2022, via program instruction or other subregulatory guidance to ensure a smooth transition after the end of the PHE. Under Open Payments, there are three kinds of records reported: (1) general (with categories like food and travel), (2) research, and (3) ownership interest. We are also proposing to freeze the quality performance standard for PY 2023, by providing an additional one-year before increasing the quality performance standard ACOs must meet to be eligible to share in savings, and additional revisions to the quality performance standard to encourage ACOs to report all-payer measures. 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. In an effort to be as expansive as possible within the current authorities to have diagnostic testing available to Medicare beneficiaries who need it during the COVID-19 PHE, we changed the Medicare payment rules to provide payment to independent laboratories for specimen collection from beneficiaries who are homebound or inpatients not in a hospital for COVID-19 testing under certain circumstances and increased payments from $3-5 to $23-25. CY 2022 PFS Ratesetting and Conversion Factor. 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. Second, we are finalizing our proposed changes and additional clarifications to the Medicare Ground Ambulance Data Collection Instrument. CMS is 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%. https:// Catherine Howden, DirectorMedia Inquiries Form CMS is proposing to implement section 132 of the CAA, 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. We finalized the clarification that a 12-consecutive month cost report should be used to establish a specified provider-based RHCs payment limit per visit. .gov 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. 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 . Opioid Treatment Program (OTP) Payment Policy. Rural HealthClinics (RHCs) and Federally Qualified Health Centers(FQHCs), Chronic Pain Management and Behavioral Health Services. CMS is proposing to make conforming technical changes to the regulatory text related to COVID-19 vaccines for RHCs and FQHCs. website belongs to an official government organization in the United States. 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. 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. Customer Support will be closed from 9:30 am - 12 pm CT on the second and fourth . Ambulatory Surgical Center (ASC) fee schedule - 2022. CMS is also soliciting comment on: (1) whether additional documentation should be required in the patients medical record to support the clinical appropriateness of audio-only telehealth; (2) whether or not we should preclude audio-only telehealth for some high-level services, such as level 4 or 5 E/M visit codes or psychotherapy with crisis; and (3) any additional guardrails we should consider putting in place in order to minimize program integrity and patient safety concerns. 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. Requiring reporting of a modifier on the claim to help ensure program integrity. Medigap (Medicare Supplement Health Insurance) Medical Savings Account (MSA) Private Fee-for-Service Plans. Faults & service support : Medicare's faults and customer . Further, section 1814(i)(6) of the Act, as added by section 3132(a)(1)(B) of the PPACA, authorized . Under this proposal, any minutes that the PTA/OTA furnishes in the scenarios described above would not matter for purposes of billing Medicare. It also gives the Secretary authority to enforce non-compliance with the requirement and to specify appropriate penalties for non-compliance through rulemaking. Per CMS CR#12409, CMS has released the Medicare Physician Fee Schedule. Payment is also made to several types of suppliers for technical services, most often in settings for which no institutional payment is, 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. In addition, we are finalizing conforming changes to our requirements for the phase-in of payment reductions to reflect the amendments in section 4(b) of this law. 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. Individuals who intend to view and/or listen to the meeting do not need to register. 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. Program of All-Inclusive Care for the Elderly (PACE) Regional Preferred Provider Organizations (RPPO) Special Needs Plans. 7500 Security Boulevard, Baltimore, MD 21244, Calendar Year (CY) 2022 Medicare Physician Fee Schedule Proposed Rule. Part B Drug Payment for Section 505(b)(2) Drugs. The final CY 2023 MEI update is 3.8 percent based on the most recent historical data available. Updated Pricing for codes 0100T, 0102T, 0650T . The Telehealth Originating Site Facility Fee has been updated for CY 2023, which can be found with the list of Medicare Telehealth List of Services at the following website: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes. The business center is open daily from 8:30 am to 4:30 pm, local time. means youve safely connected to the .gov website. March 3: Social Security payments for those who receive both SSI . We proposed to rebase and revise the MEI for CY 2023 and solicited comments regarding the future use of the 2017-based MEI weights in PFS ratesetting and the GPCIs. 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. The service(s) can be billed using the codes audiologists already use with the new modifier, and include only those personally furnished by the audiologist. On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2022. View below dates indicate when Noridian operations, including the Contact Center phone lines, will be unavailable for customer service. ( Rural Health Clinic (RHC) Payment Limit Per-Visit. For CY 2022, we are proposing to establish regulations at 410.72 for registered dietitians and nutrition professionals, similar to established regulations for other non-physician practitioners. The statute provides coverage of MNT services by registered dietitians and nutrition professionals, when referred by a physician (an M.D. 2022 NFRM Alternative Statewide CCRs and Upper Limits (ZIP) 2022 NPRM OPPS Statewide CCRs and Upper Limits (ZIP) . CMS finalized a policy to allow beneficiaries direct access to an audiologist without an order from a physician or NPP for non-acute hearing conditions. Payment rates are calculated to include an overall payment update specified by statute. 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. The statute provides coverage of MNT services that may only be provided by registered dietitians and nutrition professionals when referred by a physician (an M.D. d 3 2022 Medicare Advantage ratebook and Prescription Drug rate information. The individual providing the substantive portion must sign and date the medical record. You can decide how often to receive updates. 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. These destinations include, but are not limited to, any location that is an alternative site determined to be part of a hospital, critical access hospital(CAH)or skilled nursing facility (SNF), community mental health centers, Federally qualified health centers, rural health clinics, physician offices, urgent care facilities, ambulatory surgical centers, any location furnishing dialysis services outside of an end-stage renal disease (ESRD) facility when an ESRD facility is not available, and the beneficiarys home. CMS is proposing to clarify that the time when the teaching physician was present can be included when determining E/M visit level. The holiday schedules of public colleges and universities, including technical colleges, may be observed on different dates than shown below in accordance with S.C. Code Section 53-5-10. 100-04, chapter 16, 60.1., did not have corresponding regulations text and some of the manual guidance is no longer applicable. 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. 7500 Security Boulevard, Baltimore, MD 21244, Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule, clinical laboratories, and beneficiaries homes. 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. 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. website belongs to an official government organization in the United States. 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. The federal . For drugs with unique circumstances, CMS solicited comment on whether an increased applicable percentage would be appropriate for drug that is reconstituted with a hydrogel and administered via ureteral catheter or nephrostomy tube into the kidneys; in this circumstance, there is substantial amount of reconstituted hydrogel that adheres to the vial wall during preparation and not able to be extracted from the vial for administration. 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. Section 130 of the CAA as amended by section 2 of P.L. Sign up to get the latest information about your choice of CMS topics in your inbox. The changes proposed for Open Payments in the proposed rule are intended to support the usability and integrity of the data for the public, researchers and CMS. Description: The Hospice Component for the Value-Based Insurance Design (VBID) Model went live on January 1, 2021, and will continue in the future. 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. ) The CAA, 2022, also delays the in-person visit requirements for mental health services furnished via telehealth until 152 days after the end of the PHE. This revised coding and documentation framework includes CPT code definition changes (revisions to the Other E/M code descriptors), including: We finalized the proposal to maintain the current billing policies that apply to the E/Ms while we consider potential revisions that might be necessary in future rulemaking. 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. 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. 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. For additional Customer Contact Center closures due to scheduled training exercises, refer to: Scheduled Contact . L. 117-9, November 15, 2021) amended section 1847A of the Act adding provisions that require manufacturers to provide a refund to CMS for certain discarded amounts from a refundable single-dose container or single-use package drug. PDF 770.49 KB - December 17, 2021 Division/Office. Concurrent Billing for Chronic Care Management Services (CCM) and Transitional Care Management (TCM) Services for RHCs and FQHCs. 7500 Security Boulevard, Baltimore, MD 21244 . endstream endobj startxref 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.
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