Special Bulletin: CMS Issues Proposed Rule for Physician Fee Schedule

The proposed rule includes expansions to the Physician Payment Schedule as well as a focus on access to high-quality care.

The Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule, released July 7 by the Centers for Medicare & Medicaid Services (CMS), provides an expansion in access to services, especially in rural areas. The expansion includes behavioral health, cancer screenings, dentistry, and funding for Accountable Care Organizations (ACOs).

These expansions reflect the policies of the current administration’s Unity Agenda, which focuses on cancer screening, mental health and opioid addiction. The CMS stated in its Medicare Learning Network newsletter that it “continues to deliver on its goals of advancing health equity, driving high-quality, whole-person care, and ensuring the sustainability of the Medicare program for future generations.”

 “Integrated coordinated, whole-person care — which addresses physical health, behavioral health, and social determinants of health — is crucial for people with Medicare, especially those with complex needs,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare. “If finalized, the proposals in this rule will advance equity, lead to better care, support healthier populations, and drive smarter spending of the Medicare dollar.”

The CMS aims to improve the availability of mental health care and assistance with substance abuse. Recognizing a national shortage of practitioners in mental health, it set goals in its 2022 CMS Behavioral Health Strategy, proposing to expand the current pool of available practitioners providing mental health services under general rather than direct supervision to include licensed professional counselors, marriage and family therapists, and other types of behavioral health practitioners. CMS also recommends paying for clinical psychologists and licensed clinical social workers “to provide integrated behavioral health services as part of a patient’s primary care team.”

The CMS further recommends that certain types of chronic pain treatments be bundled into monthly payments to improve patient access to those treatments and proposes covering opioidtreatment and recovery services in rural areas as well as services for the homeless, via mobile units.

Further Reading: Federal Register: Public Inspection: Medicare and Medicaid Programs: Calendar Year 2023 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies, Medicare Shared Savings Program Requirements, etc.