CMS is proposing revisions to the definition of primary care services that are used for purposes of beneficiary assignment. 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. We finalized our proposal to extend the duration of time that services are temporarily included on the telehealth services list during the PHE for at least a period of 151 days following the end of the PHE, in alignment with the Consolidated Appropriations Act, 2022 (CAA, 2022). Over the last several years, Medicare payment rates for physicians and mass immunizers for administering certain preventive vaccines (flu, pneumonia and hepatitis B vaccines) have decreased by roughly 30%. Official websites use .govA Read More JK and J6 Medicare Part B Ask-the-Contractor Teleconference 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. or When implementing this provision, the Centers for Medicare & Medicaid Services (CMS) finalized in the FY 2011 Hospice Wage Index final rule (75 FR 70435) that the 180th day recertification and subsequent recertifications would correspond to the beneficiary's third or subsequent benefit periods. Sign up to get the latest information about your choice of CMS topics. Medicare Cost Plans. Holidays 11 Last day of Quarter Early Release Days Makeup Days: 1. Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). 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. 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). Also, you can decide how often you want to get updates. 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. 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. 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. 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. . These services will be reported with three separate Medicare-specific G codes. How the costs of furnishing flu, pneumococcal, and hepatitis B vaccines compare to the costs of furnishing COVID-19 vaccines, and how costs may vary for different types of health care providers. 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. This general record for ownership is separate from ownership and investment interest, which is its own type of record. 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. Secure .gov websites use HTTPSA 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. Please refer to the chart below for important answers to common questions. Requiring Manufacturers of Certain Single-Dose Container or Single-Use Package Drugs to Provide Refunds with Respect to Discarded Amounts. New Year's Day (January 2) MLK Jr. Day (January 16) . Payment is also made to several types of suppliers for technical services, most often in settings for which no institutional payment is made. Finally, we are working to address commenters thoughtful feedback and questions regarding the operational aspects of billing and claims processing for these services. 625 0 obj <>stream 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. 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. means youve safely connected to the .gov website. Individuals who intend to view and/or listen to the meeting do not need to register. proposing revisions to the definition of primary care services that are used for purposes of beneficiary assignment. The practitioner who provides the substantive portion of the visit (more than half of the total time spent) would bill for the visit. Expanding our authority to deny or revoke a providers or suppliers Medicare enrollment in order to protect the Medicare program and its beneficiaries. or Medicare Advantage Rates & Statistics. Last Updated Mon, 15 Nov . New Year's Day 2022. Rural Health Clinic (RHC) Payment Limit Per-Visit. hbbd```b``+@$Ln`,r~"YwEO0&y$ v;5H[x lN0 = 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 RVUs become payment rates through the application of a conversion factor. Christmas Eve (December 25) Christmas Day (December 26) Training Closure Schedule. Federal Holiday. 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. 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. Additionally, after consideration of public comments and further analysis, we are finalizing an increase to the nominal fee for specimen collection based on the Consumer Price Index for all Urban Consumers (CPI-U). 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. Holidays: Closed all day, unless otherwise noted. 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. Requiring Certain Manufacturers to Report Drug Pricing Information for Part B. 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. ) 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. However, Medicare currently pays for dental services in a limited number of circumstances, specifically when that service is an integral part of specific treatment of a beneficiary's primary medical condition. 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. From 1 January 2022, patient access to telehealth services will be supported by continued MBS arrangements. 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. 100-04, chapter 16, 60.1., did not have corresponding regulations text and some of the manual guidance is no longer applicable. 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. Updates to the Open Payments Financial Transparency Program. 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. The Division of Ambulatory Services in the CMS Center for Medicare is coordinating the CLFS Annual Public Meeting registration. Faults & service support : Medicare's faults and customer . Additionally, after consideration of public comments and further analysis, we are finalizing an increase to the nominal fee for specimen collection based on the Consumer Price Index for all Urban Consumers (CPI-U). The following provisions demonstrate CMSs commitment to addressing health equities in rural and vulnerable populations. 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. We are proposing that the changes would be applicable for determining beneficiary assignment beginning with PY 2022. For most services furnished in a physicians office, Medicare makes payment to physicians and other professionals at a single rate based on the full range of resources involved in furnishing the service. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Second, as the market for COVID-19 monoclonal antibody products matures, CMS is also seeking comments on whether we should treat these products the same way we treat other physician-administered drugs and biologicals under Medicare Part B. CMS is proposing to make conforming technical changes to the regulatory text related to COVID-19 vaccines for RHCs and FQHCs. Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 10872 Date: July 2, 2021 . 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. 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 . 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. CMS is finalizing a series of changes to the Medicare Ground Ambulance Data Collection System. Holidays. The changes and clarifications aim to reduce burden on respondents, improve data quality, or both. CMS is also proposing to extend the start date for compliance actions to January 1, 2023, in response to stakeholder feedback. Manufacturers without such agreements have the option to voluntarily submit ASP data. This refund applies to refundable single-dose container or single-use package drugs beginning January 1, 2023. hb```e@( Lb! There is an exception for payment under the FQHC PPS for certain tribal FQHCs in operation on or before April 7, 2000. 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. 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. These include: Medicare Ground Ambulance Data Collection System. School makeup days will be used in the order listed. The calendar year (CY) 2022 PFS proposed rule is one of . However, Medicare currently pays for dental services in a limited number of circumstances, specifically when that service is an integral part of specific treatment of a beneficiary's primary medical condition. -425. means youve safely connected to the .gov website. Tribal FQHC Payments Comment Solicitation. Revised interpretive guidelines for levels of medical decision making. The proposed methodology allows for the use of data that are more reflective of current market conditions of physician ownership practices, rather than only reflecting costs for self-employed physicians, and also would allow for the MEI to be updated on a more regular basis since the proposed data sources are updated and published on a regular basis. We announced that we are implementing the telehealth provisions in the Consolidated Appropriations Act, 2022 (CAA, 2022) via program instruction or other subregulatory guidance to ensure a smooth transition after the end of the PHE. The research payment format allows CMS to verify that the payment is being delayed correctly. Spending time (more than half of the total time spent by the practitioner who bills the visit). We are exploring how these policies interact with the Shared Savings Programs other benchmarking policies. 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. Physicians services paid under the PFS are furnished in a variety of settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries homes. CMS is proposing to make regulatory changes to implement the new reporting requirements. 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. 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. Holiday Name Calendar Date Legal Banking Holiday Observed Date BCBSIL Holiday Observed Date* New Year's Day 2022 . 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. Finally, we are working to address commenters thoughtful feedback and questions regarding the operational aspects of billing and claims processing for these services. ; 2023 2022 Holiday Schedule (for 835 and 837 transactions) . Thus, CMS proposes a slight decrease in PFS payment rates of 0.14% in CY 2022. lock 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. Currently, there is a nature of payment category for ownership. ( 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. 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. website belongs to an official government organization in the United States. In the CY 2022 PFS proposed rule we are proposing: The AMA CPT office/outpatient E/M visit coding framework that CMS finalized for CY 2021, under which practitioners can select the office/outpatient E/M visit level to bill, was based either on use of the total time personally spent by the reporting practitioner or medical decision making (MDM). .gov CMS has applied this methodology for these billing codes in the July 2021 ASP Drug Pricing files. 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. 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. Official websites use .govA Updated Medicare Economic Index (MEI) for CY 2023. 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. The reduction over time of the coinsurance percentage holds true regardless of the code that is billed for establishment of a diagnosis, for removal of tissue or other matter, or for another procedure that is furnished in connection with and in the same clinical encounter as the screening. CMS is also finalizing the proposal to allow a psychiatric diagnostic evaluation to serve as the initiating visit for the new general BHI service. Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. Heres how you know. The potential conflict of interest between providers and reporting entities is the heart of the Open Payments program, so quick and clear identification of physician-owned businesses would be beneficial. Then, in subsequent years, the limit is updated by the percentage increase in Medicare Economic Index (MEI). 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. 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 . 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. Based on comments received. That critical care visits cannot be reported during the same time period as a procedure with a global surgical period. 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. Per CMS CR#12409, CMS has released the Medicare Physician Fee Schedule. This proposal responds to ACOs concerns about the transition to all-payer eCQM/MIPS CQM measures, including with respect to aggregating all-payer data across multiple electronic health record (EHR) systems and multiple health care practices that participate in ACOs. March 3: Social Security payments for those who receive both SSI . 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. Conforming Technical Changes to the In-Person Requirements for Mental Health Visits. As noted above, the rebased and revised MEI weights were not used in CY 2023 PFS ratesetting. Based on comments received, CMS is finalizing an increased applicable percentage of 35 percent for this drug. CY 2023 PFS Ratesetting and Conversion Factor. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Additionally, based on the severity of needs of the patient population diagnosed with opioid use disorder (OUD) and receiving services in the OTP setting, CMS is finalizing the proposal to modify the payment rate for the non-drug component of the bundled payments for episodes of care to base the rate for individual therapy on a crosswalk to a code describing a 45-minute session, rather than the current crosswalk to a code describing a 30-minute session. Plan Submission Cut-Off. 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. 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. The pandemic has highlighted the importance of access to COVID-19 vaccines, as well as access to other preventive vaccines. The statute provides coverage of MNT services by registered dietitians and nutrition professionals when referred by a physician (an M.D. We finalized the proposed rebasing and revising of the 2017-based MEI with some technical revisions to the proposed method based on public comments. Also, you can decide how often you want to get updates. https:// We believe 12-consecutive months of cost report data accurately reflects the costs of providing RHC services and will establish a more accurate base from which the payment limits will be updated going forward. We are also seeking comment on how to address scenarios where a physician or practitioner of the same specialty/subspecialty in the same group may need to furnish a mental health service due to unavailability of the beneficiarys regular practitioner. 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. The calendar is available in the Downloads section in both a color and plain text format and identifies the following dates: Sign up to get the latest information about your choice of CMS topics. 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. More specifically CMS is seeking information on: CMS is also seeking stakeholder input on two other issues. and also establishes the professional qualifications for these practitioners. Ambulatory Surgical Center (ASC) fee schedule - 2022. We are proposing that the changes would be applicable for determining beneficiary assignment beginning with PY 2022. Vaccine Administration Services Comment Solicitation. Heres how you know. 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. The business center is closed on Saturday & Sunday. Chronic Pain Management and Treatment Services. -420. Physician-owned distributorships (PODs) are a subset of group purchasing organizations, but are not specifically defined in the Open Payments regulation. ( 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 . We are also finalizing our proposals to codify and clarify various laboratory specimen collection fee policies in 414.523(a)(1). The statute provides coverage of MNT services by registered dietitians and nutrition professionals, when referred by a physician (an M.D. Section 3713 of the CARES Act established Medicare Part B coverage and payment for a COVID-19 vaccine and its administration. lock 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. 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. Heres how you know. website belongs to an official government organization in the United States. In the event a holiday falls on a weekday or weekend, Medicare is closed for business. 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. CMS also solicited comments on whether there are other drugs with unique circumstances that may warrant an increase in the applicable percentage. Orthodox Christmas Day 2022. 2022 Medicare Advantage ratebook and Prescription Drug rate information. 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. Jan 7 - Fri. 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. 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. Section 90004 of the Infrastructure Investment and Jobs Act (Pub. 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.