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or 7500 Security Boulevard, Baltimore, MD 21244 . An official website of the United States government 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. 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. 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 . These claims will require the modifier 95 to identify them as services furnished as telehealth services. 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 is proposing several provider enrollment regulatory revisions that will strengthen program integrity while assisting Medicare beneficiaries. 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. The calendar year (CY) 2022 PFS final rule is one of several rules that reflect a broader . CMS is proposing to make conforming technical changes to the regulatory text related to COVID-19 vaccines for RHCs and FQHCs. ( CMS believes that this change will facilitate access and extend the reach of behavioral health services. 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. lock means youve safely connected to the .gov website. Through review of questions and feedback that we received, we have identified some instances where changes and clarifications to the instrument could improve clarity and be less burdensome to respondents. After reviewing comments on the proposals, we understand that it would be beneficial to provide interested parties more opportunity to comment on the specific details of changes in coding and payment mechanisms prior to finalizing a specific date when the transition to more appropriate and consistent payment and coding for these products will be completed. ) 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. 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. As proposed, CMS will base the payment amount for the drug component of HCPCS codes G2067 and G2078 for CY 2023 and subsequent years on the payment amount for methadone in CY 2021 and update this amount annually to account for inflation using the PPI for Pharmaceuticals for Human Use (Prescription). 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CMS is proposing to make regulatory changes to implement the new reporting requirements. ; 2023 CMS has applied this methodology for these billing codes in the July 2021 ASP Drug Pricing files. 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. In addition, we are finalizing a policy to update this fee amount annually by the percent change in the CPI-U. CMS is also proposing changes to address an overlap between general and ownership payments. To address this, CMS is proposing language that will clarify the impermissibility of delaying general payments, and that research-related payments do not need to have been specifically outlined in the original research agreement to be reported as research payments. Concurrent Billing for Chronic Care Management Services (CCM) and Transitional Care Management (TCM) Services for RHCs and FQHCs. Requiring Manufacturers of Certain Single-Dose Container or Single-Use Package Drugs to Provide Refunds with Respect to Discarded Amounts. CMS is proposing to clarify that the time when the teaching physician was present can be included when determining E/M visit level. Federal government websites often end in .gov or .mil. We are also finalizing our proposals to codify and clarify various laboratory specimen collection fee policies in 414.523(a)(1). hbbd```b``+@$Ln`,r~"YwEO0&y$ v;5H[x lN0 = Requiring reporting of a modifier on the claim to help ensure program integrity. Secure .gov websites use HTTPSA You can decide how often to receive updates. . Contents. 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. When both the PTA/OTA and the PT/OT each furnish less than eight minutes for the final 15-minute unit of a billing scenario. 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). Heres how you know. The travel allowance is paid only when the nominal specimen collection fee is also payable. We are proposing to refine our longstanding policies for split (or shared) E/M visits to better reflect the current practice of medicine, the evolving role of non-physician practitioners (NPPs) as members of the medical team, and to clarify conditions of payment that must be met to bill Medicare for these services. RHCs and FQHCs are not authorized to serve as distant site practitioners for Medicare telehealth services after the end of the COVID-19 public health emergency. 117-7, requires that, beginning April 1, 2021, independent RHCs and provider-based RHCs in a hospital with 50 or more beds receive an increase in their payment limit per visit over an 8-year period, with a prescribed amount for each year from 2021 through 2028. or D.O.). The CAA, 2022 also delays the in-person visit requirements for mental health visits via telecommunications technology, including those furnished by RHCs and FQHCs, until 152 days after the end of the PHE. The Division of Ambulatory Services in the CMS Center for Medicare is coordinating the CLFS Annual Public Meeting registration. 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. Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. Medicare Advantage Rates & Statistics. Thus, CMS proposes a slight decrease in PFS payment rates of 0.14% in CY 2022. CMS is proposing to implement Section 122 of the CAA, which amends the statute by providing a special coinsurance rule for procedures that are planned as colorectal cancer screening tests but become diagnostic tests when the practitioner identifies the need for additional services (e.g., removal of polyps). 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. 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. 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. The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, CMS is engaged in an ongoing review of payment for E/M visit code sets. Payments are based on the relative resources typically used to furnish the service. . file delivery for Medicare Advantage or Illinois Medicaid claims. 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. Overall, the de minimis standard would continue to be applicable in the following scenarios: 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. This will increase overall payments for medication-assisted treatment and other treatments for OUD, recognizing the longer therapy sessions that are usually required. We are seeking comment on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology. Home Health 60-day Episode Calendar Schedule SOC Date End of Episode 01/01 thru 03/01 01/02 thru 03/02 01/03 thru 03/03 01/04 thru 03/04 01/05 thru 03/05 01/06 thru 03/06 01/07 thru 03/07 01/08 thru 03/08 Sign up to get the latest information about your choice of CMS topics. Holidays 11 Last day of Quarter Early Release Days Makeup Days: 1. We are also proposing to clarify and refine policies that were reflected in certain manual provisions that were recently withdrawn. n$4ldjz2;$::@Dh@ L+600g QQi7,n1s2s9BeBc`De@9 H10(="*U%` + The changes and clarifications aim to reduce burden on respondents, improve data quality, or both. Medigap (Medicare Supplement Health Insurance) Medical Savings Account (MSA) Private Fee-for-Service Plans. In contrast, PFS rates paid to physicians and other billing practitioners in facility settings, such as a hospital outpatient department (HOPD) or an ASC, reflect only the portion of the resources typically incurred by the practitioner in the course of furnishing the service. To review the entire final rule, visit the Federal Register. We also included a comment solicitation seeking public input as we develop a more consistent, predictable approach to incorporating new data in setting PFS rates. 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. Relative value units (RVUs) are applied to each service for work, practice expense, and malpractice expense. That critical care visits cannot be reported during the same time period as a procedure with a global surgical period. Eliminated use of history and exam to determine code level (instead there would be a requirement for a medically appropriate history and exam). 625 0 obj <>stream allow a one-time opportunity for certain ACOs that established a repayment mechanism to support their participation in a two-sided model beginning on July 1, 2019; January 1, 2020; or January 1, 2021; to elect to decrease the amount of their existing repayment mechanisms.