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CENTERS FOR MEDICARE &
MEDICAID SERVICES (CMS)
Special
Edition – Tuesday, July 13, 2021
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CMS Proposes Physician Payment Rule to Improve Health Equity,
Patient Access
CMS is proposing changes to address the
widening gap in health equity highlighted by the COVID-19 Public Health
Emergency (PHE) and to expand patient access to comprehensive care,
especially in underserved populations. In CMS’s annual Physician
Fee Schedule (PFS) proposed rule, the agency is recommending steps that
continue the Biden-Harris Administration’s commitment to strengthen and build
upon Medicare by promoting health equity; expanding access to services
furnished via telehealth and other telecommunications technologies for
behavioral health care; enhancing diabetes prevention programs; and
further improving CMS’s quality programs to ensure quality care for Medicare
beneficiaries and to create equal opportunities for physicians in both small
and large clinical practices. “Over the past year, the public health
emergency has highlighted the disparities in the U.S. health care system,
while at the same time demonstrating the positive impact of innovative
policies to reduce these disparities,” said CMS Administrator Chiquita
Brooks-LaSure. “CMS aims to take the lessons learned during this time and
move forward toward a system where no patient is left out and everyone has
access to comprehensive quality health services.” CMS Seeks Feedback on Health Equity Data
Collection: CMS is committed to addressing the
significant and persistent inequities in health outcomes in the U.S. by
improving data collection to better measure and analyze disparities across
programs and policies. In the proposed PFS rule, CMS is soliciting feedback
on the collection of data, and on how the agency can advance health equity
for people with Medicare (while protecting individual privacy), potentially
through the creation of confidential reports that allow providers to look at
patient impact through a variety of data points - including, but not limited
to, LGBTQ+, race and ethnicity, dual-eligible beneficiaries, disability, and
rural populations. Access to these data may enable a more comprehensive
assessment of health equity and support initiatives to close the equity gap.
In addition, hospitals and health care providers may be able to use the
results from the disparity analyses to identify and develop strategies to
promote health equity. Expanding Telehealth and Other
Telecommunications Technologies for Behavioral and Mental Health Care: In the proposed rule, CMS is reinforcing
its commitment to expanding access to behavioral health care and reducing
barriers to treatment. CMS is proposing to implement recently enacted
legislation that removes certain statutory restrictions to allow patients in
any geographic location and in their homes access to telehealth services for
diagnosis, evaluation, and treatment of mental health disorders. Along with
this change, CMS is proposing to expand access to mental health services for
rural and vulnerable populations by allowing, for the first time, Medicare to
pay for mental health visits when they are provided by Rural Health Clinics
(RHCs) and Federally Qualified Health Centers (FQHCs) to include visits
furnished through interactive telecommunications technology. This proposal
would expand access to Medicare beneficiaries, especially those living in
rural and other underserved areas. To further expand access to care, CMS is
proposing to allow payment to eligible practitioners when they provide
certain mental and behavioral health services to patients via audio-only
telephone calls from their homes when certain conditions are met. This
includes counseling and therapy services provided through Opioid Treatment
Programs. These changes would be particularly helpful for those in areas with
poor broadband infrastructure and among people with Medicare who are not
capable of, or do not consent to the use of, devices that permit a two-way,
audio/video interaction for their health care visits. “The COVID-19 pandemic has put enormous
strain on families and individuals, making access to behavioral health
services more crucial than ever,” said Brooks-LaSure. “The changes we are
proposing will enhance the availability of telehealth and similar
options for behavioral health care to those in need, especially in
traditionally underserved communities.” Boosting Participation in the Medicare
Diabetes Prevention Program: CMS is proposing a change to expand the reach
of the Medicare Diabetes Prevention Program (MDPP) expanded model. MDPP was
developed to help people with Medicare with prediabetes from developing type
2 diabetes. The expanded model is implemented at the local level by MDPP
suppliers: organizations who provide structured, coach-led sessions in
community and health care settings using a Centers for Disease Control and
Prevention approved curriculum to provide training in dietary change,
increased physical activity, and weight loss strategies. Approximately one in three American adults
(over 88 million) have prediabetes, and more than eight in 10 do not even
know they have it. Many are at risk for developing type 2 diabetes within
five years. Several underserved communities ̶̶ including African
Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders,
and some Asian Americans ̶̶ are at particularly high risk for
type 2 diabetes. During the COVID-19 PHE, CMS has been waiving
the Medicare enrollment fee for new MDPP suppliers and has observed increased
supplier enrollment. CMS is proposing to waive this fee for all organizations
that submit an application to enroll in Medicare as an MDPP supplier on or
after January 1, 2022. Additionally, CMS is proposing changes to make
delivery of MDPP services more sustainable and to improve patient access by
making it easier for local suppliers to participate and reach their
communities by proposing to shorten the MDPP services period to one year
instead of two years. This proposal would reduce the administrative burden
and costs to suppliers. CMS is also proposing to restructure payments so MDPP
suppliers receive larger payments for participants who reach milestones for
attendance and weight loss. Advancing the Quality Payment Program: CMS is taking further steps to improve the quality
of care for people with Medicare through changes to the agency’s Quality
Payment Program (QPP), a value-based payment program that promotes the
delivery of high-value care by clinicians through a combination of financial
incentives and disincentives. CMS is proposing to require clinicians to
meet a higher performance threshold to be eligible for incentives. This new
threshold aligns with the requirements established for the QPP’s Merit-based
Incentive Payment System (MIPS) under the Medicare Access and CHIP
Reauthorization Act of 2015. To ensure more meaningful participation for
clinicians and improved outcomes for patients, CMS is moving forward with the
next evolution of QPP and proposing its first seven MIPS Value Pathways
(MVPs) - subsets of connected and complementary measures and activities,
established through rulemaking, used to meet MIPS reporting requirements. The
initial set of proposed 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.
MVPs will more effectively measure and compare performance across clinician
types and provide clinicians more meaningful feedback. CMS is also
proposing to revise the current eligible clinician definition to include
clinical social workers and certified nurse-midwives, as these professionals
are often on the front lines serving communities with acute health care
needs. Additionally, CMS is proposing to implement a
recent statutory change that authorizes Medicare to make direct Medicare
payments to Physician Assistants (PAs) for professional services they furnish
under Part B. Beginning January 1, 2022, for the first time, PAs would be
able to bill Medicare directly, thus expanding access to care and reducing
the administrative burden that currently requires a PA’s employer or
independent contractor to bill Medicare for a PA’s professional services. Updating Vaccine Payment Rates: The COVID-19 pandemic has highlighted the
importance of access to vaccines. The Biden-Harris Administration has taken
steps to increase American’s access to COVID-19 vaccinations and is committed
to meeting people where they are and making it as easy as possible for all
Americans to get vaccinated. That commitment extends to other, more common
vaccinations. Medicare payments to physicians and mass
immunizers for administering flu, pneumonia, and hepatitis B vaccines have
decreased by around 30% over the last seven years. In the PFS proposed rule,
CMS is requesting feedback to help update payment rates for administration of
preventive vaccines covered under Part B. In addition to seeking information
on the types of health care providers who furnish vaccines and their
associated costs, CMS is looking for feedback on its recently adopted payment
add-on of $35 for immunizers who vaccinate certain underserved patients in
the patient’s home. CMS is also seeking comments on the treatment of COVID-19
monoclonal antibody products as vaccines, and whether those products should
be treated like other monoclonal antibody products after the COVID-19 PHE. Proposal to Phase Out Coinsurance for
Colorectal Screening Additional Services: CMS is also proposing to implement a recent
statutory change to provide 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). Currently, the addition of any procedure beyond the
planned colorectal screening (for which there is no coinsurance) results in a
patient having to pay coinsurance. Under the proposed change, beginning January
1, 2022, the amount of coinsurance patients will pay for such additional
services would be reduced over time, so that by January 1, 2030, it would be
down to zero. More Information:
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