CMS Finalizes Rate Cuts in 2023 Medicare Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) recently released the 2023 Medicare Physician Fee Schedule (PFS) final rule, effective Jan. 1, 2023. The rule reduces the PFS conversion factor by $1.55 (4.7%) to $33.06 in a calendar year (CY) 2023 from $34.61 in CY 2022, which reflects a required statutory update of 0% and the expiration of the one-year Congress-approved 3% increase in PFS payments for CY 2022. The finalized rule also includes changes in policies for telehealth, opioid use disorder, dental services, and the Medicare Shared Savings Program (MSSP).

The CMS finalized:

  • Expanding the telehealth category 3 codes list and extend coverage through Dec. 31, 2023
  • Modifying opioid treatment program payment rates that will increase overall payments for medication-assisted treatment and other treatments for opioid use disorder
  • Clarified that Medicare Fee-For-Service (FFS) payment for dental services when it is an integral part of treatment, such as dental exams and necessary treatment before organ transplants, cardiac valve replacements and valvuloplasty procedures
  • Making several changes to increase participation in the MSSP, including updates to benchmarks to sustain long-term participation and reduce costs. The CMS also updated quality measurement policies, including a new healthy equity adjustment that will award bonus points to accountable care organizations serving high proportions of underserved beneficiaries

Members with questions and feedback should contact Renée Smiddy at the MHA.

Provider Enrollment Requirements Reinstated Effective Dec. 1, 2022

The Michigan Department of Health and Human Services (MDHHS) issued MMP 22-38 COVID-19 Response: Termination of Bulletin MSA 20-28, which reinstates provider enrollment requirements. The following processes with be reinstated effective Dec. 1, 2022:

  • Community Health Automated Medicaid Processing System (CHAMPS) enrollment revalidations. The MDHHS will begin provider revalidation date notifications starting Nov. 2022.
  • Resume site visits for prospective and current providers.
  • Fingerprint-based criminal background checks.
  • Enrollment application fees. Providers may still request a hardship waiver.

Members with questions should contact Renée Smiddy at the MHA.

MDHHS Releases Proposed Policy to Resume Required Enrollment Activities

The Michigan Department of Health and Human Services (MDHHS) released a proposed policy to rescind remaining waived provider enrollment (PE) requirements implemented by MSA 20-28 and resume required enrollment activities that were waived during the federal COVID-19 Public Health Emergency (PHE).  The MDHHS proposes to reinstate the following processes beginning Dec. 1, 2022:

  • Community Health Automated Medicaid Processing System (CHAMPS) enrollment revalidations with MDHHS notifying providers beginning November 2022 of their rescheduled validation date, which will be assigned on a rolling basis starting with providers who have had the longest revalidation pause. Providers may view their rescheduled revalidation date in CHAMPS.
  • Site visits for prospective and current providers which will be performed following all state and federal public health guidelines, such as masking and social distancing.
  • Fingerprint-based criminal background checks associated with providers in the high-risk category.
  • Enrollment application fees for providers who had their fees waived under MSA 20-28. Providers may still request a hardship waiver per the Centers for Medicare and Medicaid Services (CMS) guidelines which will only be granted after the MDHHS receives approval from the CMS.

Members are encouraged to review the proposed policy and submit comments to the MDHHS by Oct. 28. Members with questions should contact Renée Smiddy at the MHA.

Member Feedback Requested on Proposed Telemedicine Policy

The Michigan Department of Health and Human Services (MDHHS) recently released a proposed policy to update Medicaid coverage of telemedicine services after the conclusion of the federal COVID-19 public health emergency (PHE). The policy outlines several updates, including:

  • Making permanent policies established during the PHE through bulletins MSA 20-09 (General Telemedicine Policy Changes) and MSA 21-24 (Asynchronous telemedicine services). MSA 20-09 requires either direct or indirect patient consent for all telemedicine services and defines originating and distant sites. MSA 21-24 clarifies Medicaid coverage for asynchronous telemedicine services, including store and forward services, remote patient monitoring and interprofessional consultations.
  • Not requiring prior authorization unless the equivalent in-person service requires prior authorization. Authorization requirements for Medicaid health plans may vary.
  • Establishing payment rates for allowable telemedicine services at the same level as in-person services. To effectuate this policy, the provider must report the place of service as they would if they were providing the service in-person, along with modifier 95 – Synchronous Telemedicine Service. *MDHHS varies from Medicare telehealth billing by not using place of service 02 or 10 but aligns in the use of modifier 95.
  • Allowing audio-only telemedicine services only for select situations where the beneficiary does not have access to audio/visual capabilities. These codes are currently represented as CPT codes 99441-99443 and 98966-98968.

Members are encouraged to submit comments to the MDHHS by Sept. 20. Questions should be directed to Renée Smiddy at the MHA.

CMS Proposes Rate Cuts in 2023 Medicare Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule for physician fee schedule (PFS) payments and other Medicare Part B issues, effective Jan. 1, 2023. The rule proposes to reduce the PFS conversion factor by $1.53 (4.6%) to $33.08 in calendar year (CY) 2023, compared to $34.61 in CY 2022. The proposed rule also includes changes in policies for telehealth, opioid use disorder, dental services, and the Medicare Shared Savings Program (MSSP).

The CMS proposes to:

  • Reduce the conversion factor to $33.08, which reflects a required statutory update of 0% and the expiration of the one-year Congress-approved 3% increase in PFS payments for CY 2022.
  • Delay indefinitely the payment penalty period of the Appropriate Use Criteria. The CMS is unable to forecast when the payment penalty phase will begin again.
  • Expand the list of telehealth category 3 codes and extend coverage through Dec. 31, 2023.
  • Delay for one year (until Jan. 1, 2024) implementation of its policy to define the substantive portion of a split (or shared) visit based on the amount of time spent by the billing practitioner.
  • Make several changes to increase participation in the MSSP, including implementing longer glide paths to downside risk for accountable care organizations (ACOs) and modifying benchmarking methodology to ensure ACOs do not have to compete against their own best performance.
  • Expand behavioral health access by permitting licensed professional counselors, marriage and family therapists, and other types of practitioners to provide services, thereby creating an exception to the direct supervision requirement for “incident to” billing.

Members are encouraged to submit comments to the CMS by Sept. 7. Questions and feedback should be directed to Renée Smiddy at the MHA.

LARA Rules Requiring Implicit Bias Training Take Effect June 1

The Department of Licensing and Regulatory Affairs (LARA) revised Public Health Code Rules requiring implicit bias training for all professions licensed or registered under the Public Health Code, except for Veterinary Medicine, effective June 1.

First-time applicants for licensure or registration must have completed a minimum of two hours of implicit bias training within the previous five years.

Beginning June 1, those renewing licenses or registrations must complete one hour of implicit bias training for each year of their license or registration cycle. However, for renewal applications submitted between the rule’s promulgation date of June 1, 2021, and May 31, 2022, only one hour of training is required. This includes licensees whose 90-day renewal window includes June 1, 2022. For example, a license scheduled for renewal in August 2022 can be renewed in May, requiring only one hour of training regardless of the length of the license or registration cycle. Subsequent renewals would require an hour of training for each year of the license or renewal cycle.

Documentation of this training must be retained for six years from the date of applying for licensure, registration or renewal. The department retains the right to audit licensees or registrants and request documentation of completion of training.

The department released a frequently asked questions document for implicit bias training, which includes clarification that trainings with prerecorded videos must also provide opportunities for interaction between participants and the instructor. Therefore, prerecorded videos without instructor interaction would not satisfy the implicit bias training standard.

Members with questions related to implicit bias training requirements may contact the Bureau of Professional Licensing. For more information, contact Renée Smiddy at the MHA.

Federal 100% Cost Share for COVID-19 Expenses Extended

The Federal Emergency Management Agency (FEMA) in February 2021 increased federal funding for COVID-19 pandemic expenses from 75% to 100%, retroactive to the beginning of the pandemic in January 2020. The agency has now extended the COVID-19 federal 100% cost share for an additional three months, from April 1 to July 1, 2022.

This extension allows FEMA to pay 100% federal funding for the costs of eligible COVID-19 expenses, which include COVID-19-related medical care, vaccination and testing efforts. Absent an additional extension from the Biden administration, the federal cost share will reduce to 90% after July 1.

Members with questions on the FEMA cost share extension may contact Renée Smiddy at the MHA.

Physician Fee Schedule Final Rule Affects Telehealth, Vaccines, More

The Centers for Medicare & Medicaid Services recently released the Medicare Physician Fee Schedule final rule for calendar year 2022, which includes updates to Medicare payments under the schedule and other Medicare Part B issues effective Jan. 1. Provisions of the rule will:

  • Reduce the conversion factor by $1.31, from $34.89 to $33.58, to accommodate budget neutrality with changes in relative value units and the expiration of the 3.75% payment increase provided in the 2021 Consolidated Appropriations Act.
  • Extend eligible telehealth services that were added to the Medicare telehealth services list during the COVID-19 public health emergency (PHE) through Dec. 31, 2023. This will allow for more time for stakeholders to gather data and submit support for requesting that services be permanently added to the Medicare telehealth services list.
  • Implement an in-person visit requirement at least every 12 months to qualify for telehealth service payment.
  • Include audio-only communications technology when used for telehealth services for the diagnosis, evaluation or treatment of mental health disorders furnished to established patients in their homes under certain circumstances.
  • Delay the start date for compliance actions related to electronic prescribing of controlled substances to Jan. 1, 2023, and delay the compliance start date for Part D prescriptions written for beneficiaries in long-term care facilities to Jan. 1, 2025.
  • Delay the penalty phase of the appropriate use criteria program to Jan. 1, 2023, or the Jan. 1 that follows the declared end of the COVID-19 PHE, whichever comes later.
  • Pay $30 per dose for the administration of the influenza, pneumococcal and hepatitis B virus vaccines, and maintain the current payment rate of $40 per dose for the administration of the COVID-19 vaccines. In addition, make the additional payment of $35.50 for COVID-19 vaccine administration in the home through the end of the calendar year in which the ongoing PHE ends.
  • Define and clarify policies for split (or shared) evaluation and management visits, which can be billed by the physician or practitioner who provides the substantive portion of the visit.
  • Allow physician assistants (PAs) to bill Medicare directly for their professional services, reassign payment for their professional services, and incorporate with other PAs and bill Medicare for PA services.
  • Delay the increase in the quality performance standard Accountable Core Organizations must meet to be eligible to share in savings until program year 2024.

Members with questions should contact Renée Smiddy at the MHA.

MHA Comments on Outpatient, Physician Fee Schedule Proposed Rules

The MHA submitted comments on two proposed rules for Medicare payment systems in calendar year 2022 that the Centers for Medicare & Medicaid Services recently released.

The MHA’s comments on the combined rule for the hospital outpatient and ambulatory surgical center payment systems largely focused on price transparency changes, continuing payment cuts to the 340B drug discount program, reduced payment rates for clinic visits provided at grandfathered off-campus hospital outpatient departments, and restoration of the inpatient only list.

The association’s comments on the Medicare Physician Fee Schedule (MPFS) rule focused on a few key issues, including the MPFS conversion factor, appropriate use criteria, telehealth services, electronic prescribing of controlled substances for Part D drugs and closing the health equity gap.

Members with questions regarding the outpatient and ambulatory surgical center rule should contact Vickie Kunz and questions about the MPFS rule should be directed to Renée Smiddy.

FEMA Updates Interim Policy on Eligible Public Assistance Federal Cost Sharing

The Federal Emergency Management Agency (FEMA) has issued a new interim policy, Coronavirus (COVID-19) Pandemic: Safe Opening and Operation Work Eligible for Public Assistance. This interim policy supersedes version 1 that was published April 5, 2021.

This updated policy retroactively amends the applicable time period of eligibility to the beginning of the incident period of Jan. 20, 2020, and specifies that work conducted from the beginning of the incident period to Dec. 31, 2021, will be reimbursed at a federal cost share of 100 percent. Work conducted after Dec. 31, 2021, will be subject to the cost share established at that time.

This version of the interim policy maintains the same scope of work as Version 1, which includes COVID-19 diagnostic testing, purchase and distribution of face masks, cleaning and disinfection, screening and temperature scanning, and installation of temporary physical barriers and signage to support social distancing.

Member with questions on the interim policy may contact Renee Smiddy at the MHA.