%%EOF Lastly, section 130 of the CAA subjects all newly enrolled RHCs (as of January 1, 2021, and after), both independent and provider-based, to a national payment limit per-visit. Fri., 12/31/2021 : 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. 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. 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. This regulatory advisor will summarize some of the key changes, but does not include all provisions. 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. The practitioner who provides the substantive portion of the visit (more than half of the total time spent) would bill for the visit. CMS also finalized the proposal to continue the additional payment for at-home COVID-19 vaccinations for CY 2023. Similar to the approach we finalized in the CY 2021 PFS final rule for office/outpatient E/M visit coding and documentation, we finalized and adopted most of these AMA CPT changes in coding and documentation for Other E/M visits (which include hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessment) effective January 1, 2023. 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. To review the entire final rule, visit the Federal Register. Section 130 of the CAA as amended by section 2 of P.L. CMS is also proposing to require use of a new modifier for services furnished using audio-only communications, which would serve to certify that the practitioner had the capability to provide two-way, audio/video technology, but instead, used audio-only technology due to beneficiary choice or limitations. 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. Based on comments received. 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Individuals who intend to view and/or listen to the meeting do not need to register. 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. Exempting certain types of independent diagnostic testing facilities (IDTF) from several of our IDTF supplier standards in 42 CFR 410.33. Specifically, in accordance with section 1833(h)(3)(B) of the Act, we are finalizing to include in our regulations the following requirements for the travel allowance methodology: (1) a general requirement, (2) travel allowance basis requirements, and (3) travel allowance amount requirements. We finalized conforming regulatory text changes in accordance with section 304 of the CAA, 2022 to amend paragraph (b)(3) of 42 CFR 405.2463, What constitutes a visit, and paragraph (d) of 42 CFR 2469, FQHC supplemental payments, to include the delay of the in-person requirements for mental health visits furnished by RHCs and FQHCs through telecommunication technology under Medicare until the 152. 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. 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. The pandemic has highlighted the importance of access to COVID-19 vaccines, as well as access to other preventive vaccines. 616 0 obj <>/Filter/FlateDecode/ID[<93B9AE44C85DD84DBD2BDB2B6969AAC0>]/Index[596 30]/Info 595 0 R/Length 103/Prev 230955/Root 597 0 R/Size 626/Type/XRef/W[1 3 1]>>stream CMS is proposing to require that OTPs use a service-level modifier for audio-only services billed using the counseling and therapy add-on code and document in the medical record the rationale for a service being furnished using audio-only services, in order to facilitate program integrity activities. 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. This approach would be applied to section 505(b)(2) drug products where a billing code descriptor for an existing multiple source code describes the product and other factors, such as the products labeling and uses, are similar to products already assigned to the code. Sign up to get the latest information about your choice of CMS topics. Payment is also made to several types of suppliers for technical services, most often in settings for which no institutional payment is made. CMS has received a request from the American Indian and Alaska Native community to amend its Medicare regulations to make all IHS- and tribally-operated outpatient facilities/clinics eligible for payment at the Medicare outpatient per visit/AIR, regardless of whether they were owned, operated, or leased by IHS. In addition, we are finalizing a policy to update this fee amount annually by the percent change in the CPI-U. ( 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. 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. Finally, CMS indicated in the final rule that we intend to address payment for new codes that describe caregiver behavioral management training in CY 2024 rulemaking. Communication Center: 800-884-1684 (voice), 800-700-2320 (TTY) or California's Relay Service at 711 | contact.center@dfeh.ca.gov .gov clinical laboratories, and beneficiaries homes. The calendar year (CY) 2022 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation. 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. Secure .gov websites use HTTPSA You may be eligible for Medicaid if your income is low and you match one of the following descriptions: You think you are pregnant. For CY 2023, we finalized a year-long delay of the split (or shared) visits policy we established in rulemaking for 2022. 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. There is just one federal holiday in October: Columbus Day. 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. 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. The CY 2023 Medicare Physician Payment Schedule Final Rule updates payment policies and rates as well as other provisions for services offered on or after Jan. 1, 2023, under the Medicare Physician Payment Schedule. 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. . Electronic Prescribing of Controlled Substances-- Section 2003 of the SUPPORT Act. The finalized codes include a bundle of services furnished during a month that we believe to be the starting point for holistic chronic pain care, aligned with similar bundled services in Medicare, such as those furnished to people with suspected dementia or substance use disorders. However, this process is not available for companies that do not have any records to report. 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. Split (or shared) visits could be reported for new as well as established patients, and initial and subsequent visits, as well as prolonged services. CMS is proposing to allow RHCs and FQHCs to bill for TCM and other care management services furnished for the same beneficiary during the same service period, provided all requirements for billing each code are met. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, 2022 NFRM OPPS Statewide CCRs and Upper Limits (ZIP) (ZIP), 2022 NFRM Alternative Statewide CCRs and Upper Limits (ZIP), 2022 NPRM OPPS Statewide CCRs and Upper Limits (ZIP), Alternative 2022 NPRM OPPS Statewide CCRs and Upper Limits (ZIP), CY 2022 Special Wage Index Assignments for Cap on Wage Index Decreases (ZIP), 2022 Procedure Price Lookup Comparison File. The individual providing the substantive portion must sign and date the medical record. Sign up to get the latest information about your choice of CMS topics in your inbox. Christian. 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. or D.O.) 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. and also establishes the professional qualifications for these practitioners. Federal government websites often end in .gov or .mil. 625 0 obj <>stream . CMS also solicited comments on whether there are other drugs with unique circumstances that may warrant an increase in the applicable percentage. New Year's Day Monday, January 3 ; Martin Luther King, Jr. Day Monday, January 17 Origin and Destination Requirements Under the Ambulance Fee Schedule. Section 90004 of the Infrastructure Investment and Jobs Act (Pub. Effective Nov. 3, 2022, NC Medicaid Dental Fee Schedules are located in the Fee Schedule and Covered Code site.
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