CMS issued its proposed updates Thursday to the 2017 Medicare Physician Fee Schedule. This year's changes include a number of new policies that reflect a broader agency-wide strategy to enhance quality, spend smarter and improve Americans' health.
Here are the six most important changes to note.
1. One the most sweeping changes CMS proposed was to add the Diabetes Prevention Program — an Innovation Center prediabetes lifestyle intervention — to Medicare beginning in 2018. As part of this proposal, CMS is seeking comment on how it should establish the Medicare Diabetes Prevention Program. The parameters the agency seeks comment on include:
- Immediate national expansion or a phased expansion
- Enrollment of CDC-recognized Diabetes Prevention Program organizations in Medicare on Jan. 1, 2017
- Definition of which beneficiaries are eligible for the program
- Requirements for providers to obtain National Provider Identification numbers
- Payment structure based on the number of sessions beneficiaries attend and their ability to achieve and maintain a minimum weight loss
- Requirements that each program submit claims electronically using standard Medicare forms, and protect patient information in compliance with HIPAA and CMS standards
- Quality metrics and reporting elements required on Medicare claims submissions
- Telehealth qualifications
- Development of audit policies
- Educational resources and technical assistance
2. CMS proposed expanding eligible telehealth services. The additional codes would include those for end-stage renal disease-related dialysis, advanced care planning and critical care consultations. The critical care consultations provided via telehealth would use the new Medicare G-codes.
3. The agency plans to begin gathering data on the activities and resources involved in global surgical procedures. CMS proposed an initiative in 2015 to streamline global payments for surgical procedures, but this proposal was prohibited under another piece of legislation that passed in 2015: the Medicare Access and CHIP Reauthorization Act. As a result, CMS now wants to collect claims-based and practitioner survey data to determine if it needs to revalue the way it pays for pre-operative, operative and post-operative surgical care. Any changes that would be made to the global surgical codes would be made through a separate notice and comment rulemaking, CMS said.
4. CMS proposed changes to provider and supplier requirements for Medicare Part C. The agency proposed requiring providers and suppliers to be screened and enrolled in Medicare to contract with a Medicare Advantage organization to provide items and services to those enrolled in Medicare Advantage health plans. "Medicare beneficiaries, the Medicare Trust Funds, and the program at large are at risk when providers and suppliers have not been adequately screened and enrolled," said CMS. The agency said it is vital that Medicare program integrity efforts are extended to all providers and suppliers that receive Medicare payments, even when payments are received through an intermediary source like a Medicare Advantage plan.
5. CMS wants to improve data transparency. Medicare Advantage organizations use a bidding process to apply to participate in the Medicare Advantage program. The bids reflect the organization's estimated costs to provide benefits to enrollees. CMS proposed releasing data associated with these bids on an annual basis. The agency also proposed releasing Medicare health and drug plan medical loss ratio data on a yearly basis to help beneficiaries make enrollment decisions.
6. The agency proposed revising the methodology used to calculate geographic practice cost indices. CMS adjusts payments under the physician fee schedule to reflect local differences in practice costs using geographic practice cost indices (GPCIs). The agency proposed revising the methodology used to calculate GPCIs to increase overall physician fee schedule payments in Puerto Rico. The proposed updates would be phased in over 2017 and 2018.
CMS will accept comments on the proposed rule until Sept. 6.
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