CMS Releases Physician Fee Schedule Final Rule

CMS says it the goal is to support health equity while focusing on high-quality person-centered care.

Increased leverage of telehealth for behavioral care, diabetes prevention and mitigation, and enhanced payment for vaccine administration were three out of many priorities cited by federal officials who announced the release of the Centers for Medicare & Medicaid Services (CMS) 2022 Physician Fee Schedule (PFS) Final Rule on Tuesday.  

With a primary goal to “drive innovation to support health equity and high-quality, person-centered care,” CMS said it also intends to incentivize clinicians to deliver improved outcomes.

“Promoting health equity, ensuring more people have access to comprehensive care, and providing innovative solutions to address our health system challenges are at the core of what we do at CMS,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “The Physician Fee Schedule Final Rule advances all these strategic priorities, and helps build a better Medicare program for the future.”

Behavioral healthcare traditionally called to mind patients on comfortable couches, working one-on-one with a therapist in person. But CMS made it clear in a press release outlining the new Final Rule that it fully intends to allow patients in their homes to access telehealth services for the diagnosis, evaluation, and treatment of mental health disorders via audio-only telephone calls.

“This means counseling and therapy services, including treatment of substance use disorders and services provided through opioid treatment programs, will be more readily available to individuals, especially in areas with poor broadband infrastructure,” the press release read.

In addition, for the first time outside the context of the COVID-19 public health emergency (PHE), Medicare will pay for mental health visits furnished by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) via telecommunications technology.

“The COVID-19 pandemic has highlighted the gaps in our current healthcare system and the need for new solutions to bring treatments to patients, wherever they are,” Brooks-LaSure said. “This is especially true for people who need behavioral health services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options.”

In light of prediabetes impacting nearly 90 million American adults – more than a third of the nation’s total – it should come as no surprise that the Final Rule also addressed this condition. CMS noted that many traditionally underserved communities – including Blacks, Hispanics, American Indians, Pacific Islanders, and some Asian Americans  ̶̶  face an elevated risk of developing type 2 diabetes.

November marks Diabetes Awareness Month in the U.S., making it a timely move, specifically punctuated by CMS taking steps to bolster its Medicare Diabetes Prevention Program (MDPP) expanded model, which was developed to help people with Medicare with prediabetes avoid developing type 2 diabetes.

“Under the expanded model, local suppliers provide structured, coach-led sessions in community and healthcare settings using a Centers for Disease Control and Prevention (CDC)-approved curriculum to provide training in dietary change, increased physical activity, and weight loss strategies,” CMS’s press release read. “CMS is waiving the Medicare enrollment fee for all organizations that apply to enroll as an MDPP supplier on or after Jan. 1, 2022.”

CMS had been waiving the fee during the COVID-19 PHE for new MDPP suppliers, noting that it “has witnessed increased supplier enrollment.” Officials added that they are also shortening the MDPP services period to one year instead of two years, making “delivery of MDPP services more sustainable, (reducing) the administrative burden and costs to suppliers, and (improving) patient access by making it easier for local suppliers to participate and reach their communities.”

On the vaccine front, CMS announced that it will maintain the current payment rate of $40 per dose for the administration of COVID-19 vaccines through the end of the calendar year in which the PHE ends. Effective Jan. 1 of that year (whenever it is), the payment rate for COVID-19 vaccine administration will be set at a rate “to align with the payment rate for the administration of other Part B preventive vaccines.”

CMS will also continue to facilitate vaccinations for common diseases such as influenza, pneumonia, and hepatitis B.

“This year, Medicare reviewed payments for vaccinations to ensure doctors and other health professionals are paid appropriately for providing vaccinations,” officials said. “This final rule will nearly double Medicare Part B payment rates for influenza, pneumococcal, and hepatitis B vaccine administration from roughly $17 to $30. CMS hopes this change will increase access to these potentially life-saving injections and lead to greater vaccination uptake.”

The impacts of the COVID-19 pandemic, which has sickened nearly 47 million and killed nearly 770,000 in the U.S. over the last 20 months, were clearly evident throughout CMS’s announcement – perhaps no more so than when the agency noted that it has finalized expanded coverage of outpatient pulmonary rehabilitation services, paid under Medicare Part B, to individuals who have had confirmed or suspected COVID-19 and experience “persistent symptoms that include respiratory dysfunction for at least four weeks.”

“This goes beyond CMS’s PFS proposed rule, which would have focused the expanded coverage to those hospitalized with COVID-19,” the agency’s press release read. “CMS also finalized a temporary extension of certain cardiac and intensive cardiac rehabilitation services available via telehealth for people with Medicare until the end of December 2023.”

Lastly, officials said, the Final Rule makes several key changes to the CMS Quality Payment Program (QPP), which promotes the delivery of high-value care by clinicians through a combination of financial incentives and disincentives.

“For example, CMS finalized a higher performance threshold that clinicians will be required to exceed in 2022 to be eligible for positive payment incentives,” the press release read. “This new threshold was determined in accordance with statutory requirements for the QPP’s Merit-based Incentive Payment System (MIPS).”

As part of that, CMS said it is officially introducing the first seven MIPS Value Pathways (MVPs): subsets of connected and complementary measures and activities, established through rulemaking, that clinicians can report on to meet MIPS requirements.

“MVPs are designed to ensure more meaningful participation for clinicians and improved outcomes for patients by more effectively measuring and comparing performance within different clinician specialties and providing clinicians more meaningful feedback,” officials said. “This initial set of MVP clinical areas include rheumatology, stroke care and prevention, heart disease, chronic disease management, lower extremity joint repair (e.g., knee replacement), emergency medicine, and anesthesia.”

To review a fact sheet on the Physician Fee Schedule Final Rule, go online to https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2022-medicare-physician-fee-schedule-final-rule.

To review a fact sheet on changes made to the Medicare Diabetes Prevention Program, go to https://www.cms.gov/newsroom/fact-sheets/final-policies-medicare-diabetes-prevention-program-mdpp-expanded-model-calendar-year-2022-medicare.

To review the 2022 Physician Fee Schedule in its entirety, go to https://www.federalregister.gov/public-inspection/current.