By: Julius W. Hobson, Jr.
On July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) posted the proposed rule for the 2022 Physician Fee Schedule (PFS) and other Medicare Part B issues. The proposed rule was published in the Federal Register on July 23, 2021. Comments are due by 5:00 p.m. on September 13, 2021.
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 202 PFS conversion factor is $33.58, a decrease of $1.31 from the CY 2021 PFS conversion factor of $34.89. The PFS conversion factor reflects the statutory update of 0.00 percent and the adjustment necessary to account for changes in relative value units and expenditures that would result from CMS proposed policies.
Diabetes Prevention Program (MDPP)
The proposed PFS rule proposes changes to the Medicare Diabetes Prevention Program expanded model intended to increase supplier enrollment, with a goal of increasing beneficiary participation and access to services that can help them develop and maintain healthy behaviors to prevent onset of type 2 diabetes. CMS anticipates that the proposed changes would make it easier for local suppliers to participate and reach their communities, and may allow CMS to perform a more robust evaluation of the expanded model.
CMS is proposing to utilize the CMS Innovation Center’s waiver authority to waive the provider enrollment Medicare application fee for all organizations that submit an application to enroll in Medicare as an MDPP supplier on or after January 1, 2022. CMS is proposing to shorten the MDPP services period to one year by removing the Ongoing Maintenance sessions (months 13-24) of the MDPP set of services for beneficiaries starting MDPP on or after January 1, 2022. MDPP beneficiaries who were participating in the MDPP set of services on or before December 31, 2021, may continue with the ongoing maintenance phase if they maintain 5 percent weight loss and attendance requirements. CMS is proposing to increase performance payments for MDPP beneficiary achievement of the 5 percent weight loss goal, as well as continued attendance during each core maintenance interval.
First, CMS does not use the Physician Practice Expense Information Survey data for reproductive endocrinology and spine surgery since these specialties currently are not separately recognized by Medicare, nor does CMS have a method to blend the PPIS data with Medicare-recognized specialty data.
There are proposed changes in RVUs for some specialties, including endocrinology which reflect increases relative to other physician specialties. These increases can be attributed largely to the proposed update to clinical labor pricing as the services furnish rely primarily on clinical labor for their Practice Expense (PE) costs.
The CY 2022 PFS estimated impact on total allowed charges by specialty is (allowed charges: $506), (impact of PE RVU changes: 2%), and (combined impact: 2%).
The CY 2022 PFS estimated impact on total allowed charges by specialty using the first year of a four-year clinical labor pricing transition for endocrinology is (allowed charges: $506), (impact of PE RVU changes: 1%), and (combined impact: 1%).
The endocrinology set takes additional criteria into consideration, which includes, but is not limited to: whether the measure reflects current clinical guidelines and the coding of the measure includes relevant clinician types. CMS may reassess the appropriateness of individual measures, on a case-by-case basis, to ensure appropriate inclusion in the specialty set. Measure tables in this set include previously finalized measures that CMS is maintaining within the set, measures that are proposed to be added, and measures that are proposed for removal, as applicable. CMS requests comment on the measures available in the proposed Endocrinology specialty set. (See Federal Register, page 39637 in the link below).
CMS continues to evaluate the temporary expansion of telehealth services that were added to the telehealth list during the COVID-19 Public Health Emergency (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. CMS is also proposing furnishing mental health telehealth services under the proposed rule.
Physician Assistant Services
CMS is proposing to implement Section 403 of Division CC of the CAA that authorizes Medicare to make direct payment to PAs for professional services they furnish under Part B beginning January 1, 2022. PAs would be able to bill Medicare directly for their services and reassign payment for their services.
Requiring Certain Manufacturers to Report Drug Pricing Information for Part B
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. Manufacturers without such agreements have the option to voluntarily submit ASP data. For calendar quarters beginning January 1, 2022, the CAA requires manufacturers of drugs or biologicals payable under Part B without a Medicaid Drug Rebate Agreement to report ASP data. CMS is proposing to make regulatory changes to implement the new reporting requirements.
Medicare Provider Enrollment
CMS is proposing several provider enrollment regulatory revisions that will strengthen program integrity while assisting Medicare beneficiaries. These include:
- Exempting certain types of independent diagnostic testing facilities (IDTF) from several of CMS IDTF supplier standards.
- Expanding CMS authority to deny or revoke a provider’s or supplier’s Medicare enrollment in order to protect the Medicare program and its beneficiaries.
- Establishing specific rebuttal procedures in regulation for providers and suppliers whose Medicare billing privileges have been deactivated.
For those interested, here is the link to the proposed CY 2022 Physician Fee Schedule as published in the Federal Register: 2021-14973.pdf (govinfo.gov)