Part B Drug Payment for Section 505(b)(2) Drugs. The proposals to implement section 90004 of the Infrastructure Act included: how discarded amounts of drugs are determined; a definition of which drugs are subject to refunds (and exclusions); when and how often CMS will notify manufacturers of refunds; when and how often payment of refunds from manufacturers to CMS is required; refund calculation methodology (including applicable percentages); a dispute resolution process; and enforcement provisions. ) CMS is proposing to make regulatory changes to implement the new reporting requirements. PDF 770.49 KB - December 17, 2021 Division/Office. 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. You can decide how often to receive updates. These include: Medicare Ground Ambulance Data Collection System. 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. We are also seeking comment on whether stakeholders believe there are other codes that should be included in this definition to inform future rulemaking. 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. 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. CMS's testing guidance, originally issued in 2020 and also revised on September 23, 2022, reiterates that residents who leave the facility for 24 hours or longer should be treated like new admissions. 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. Article Detail - JF Part A - Noridian 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. Section 123 of the CAA removed the geographic restrictions and added the home of the beneficiary as a permissible originating site for telehealth services when used for the purposes of diagnosis, evaluation, or treatment of a mental health disorder, and requires that there be an in-person, non-telehealth service with the physician or practitioner within six months prior to the initial telehealth service, and thereafter, at intervals as specified by the Secretary. Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule | CMS 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). 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. Further, section 1814(i)(6) of the Act, as added by section 3132(a)(1)(B) of the PPACA, authorized . CMS is proposing the lesser of methodology for drug and biological products that may be identified by future OIG reports. Second, we are finalizing our proposed changes and additional clarifications to the Medicare Ground Ambulance Data Collection Instrument. 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. Eliminated use of history and exam to determine code level (instead there would be a requirement for a medically appropriate history and exam). means youve safely connected to the .gov website. 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 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. The research payment format allows CMS to verify that the payment is being delayed correctly. 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. Jan 7 - Fri. You can decide how often to receive updates. The AMA provides final rule summary (PDF) of the 2023 Medicare Physician Payment Schedule and Quality Payment Program (QPP). CMS is engaged in an ongoing review of payment for E/M visit code sets. 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. Holiday Leave | Department of Administration - South Carolina CMS has applied this methodology for these billing codes in the July 2021 ASP Drug Pricing files. More specifically CMS is seeking information on: The different types of health care providers who furnish vaccines and how have those providers changed since the start of the pandemic. This applies to Medicare Part A and Part B. or D.O.). Please refer to the chart below for important answers to common questions. Laboratory Fee Schedule - Jan. 1, 2022 - PDF. 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. file delivery for Medicare Advantage or Illinois Medicaid claims. 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). Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter as a Colorectal Cancer Screening. Under the proposal, physicians would see a decrease of $1.31 in the conversion factor on Jan. 1, 2022, going from $34.89 . website belongs to an official government organization in the United States. As a health practitioner you must meet certain requirements to bill for Medicare Benefits Schedule (MBS) items under Medicare or prescribe subsidised medicines. CMS is interested in stakeholder input on what qualifies as the home and how we can balance ensuring program integrity with beneficiary access. 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. In the PFS proposed rule, we are proposing to implement the second phase of this mandate by proposing certain exceptions to the EPCS requirement. 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. 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. 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. from March quarter 2008-09 to December quarter 2022-23. Split (or shared) visits could be reported for new as well as established patients, and initial and subsequent visits, as well as prolonged services. The statute provides coverage of MNT services by registered dietitians and nutrition professionals when referred by a physician (an M.D. It also gives the Secretary authority to enforce non-compliance with the requirement and to specify appropriate penalties for non-compliance through rulemaking. When the COVID-19 PHE ends, our regulations will reflect the long-standing ambulance services coverage for the following destinations only: hospital; CAH; SNF; beneficiarys home; and dialysis facility for an ESRD patient who requires dialysis. We finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. Calendar Year (CY) 2022 Medicare Physician Fee Schedule Proposed Rule | CMS An official website of the United States government 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. 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. Holidays: Closed all day, unless otherwise noted. 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. PDF 2022 Holiday Schedule (837 and 835 Transactions) - BCBSIL Holiday & Training Closures - Novitas Solutions .gov CMS proposed several changes to the policies for skin substitute products to streamline the coding, billing, and payment rules and to establish consistency with these products across the various settings. 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. Although we expect the increased specimen collection fees for COVID-19 clinical diagnostic laboratory tests will end at the termination of the COVID-19 PHE, we are seeking comments on our policies for specimen collection fees and the travel allowance as we consider updating these policies in the future through notice and comment rulemaking. CMS Releases CY 2022 Proposed Rule for Physician Fee Schedule - AHA Medigap (Medicare Supplement Health Insurance) Medical Savings Account (MSA) Private Fee-for-Service Plans. Plan Submission Cut-Off. 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. To review the entire final rule, visit the Federal Register. 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. https:// 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. CMS is finalizing that providers will be required to report the JW modifier beginning January 1, 2023 and the JZ modifier no later than July 1, 2023 in all outpatient settings. CMS finalized a policy to allow beneficiaries direct access to an audiologist without an order from a physician or NPP for non-acute hearing conditions. As part of the ongoing updates to E/M visit codes and related coding guidelines that are intended to reduce administrative burden, the AMA CPT Editorial Panel approved revised coding and updated guidelines for Other E/M visits, effective January 1, 2023. The calendar year (CY) 2022 PFS proposed rule is one of . 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. 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. means youve safely connected to the .gov website. Please feel welcome to reach out to our team if you have any questions. 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. COVID-19 Vaccines Furnished in RHCs and FQHCs (Technical Updates). In the proposed rule, CMS proposed that an initial invoice for the refund to be sent to manufacturers in October 2023. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS).